BACKGROUND:The Pilon fracture has a complex fracture line and a comminuted fracture fragment.It is often associated with bone loss and soft tissue damage and is one of the most difficult fractures to treat clinically. OBJECTIVE:To analyze the correlation between tibial and fibular fractures in Pilon fractures. METHODS:A retrospective analysis was conducted on 188 patients with Pilon fracture in the Department of Trauma Orthopedics,The Second People's Hospital of Lianyungang City from January 2014 to January 2022.Imaging data of these patients were collected.Fibular fracture level,fibular fracture type,number of fibular fracture blocks,tibial position status,main fracture blocks of the tibia,size of medial fracture blocks of the tibia,tibial fracture angle,Topliss classification(sagittal plane)and Topliss classification(coronal plane)were summarized into a database.SPSS 25.0 was used to analyze the data of tibia and fibula in Pilon fractures by Spearman correlation analysis.On the basis of the correlation,multiple disordered Logistic regression was used to further analyze the correlation. RESULTS AND CONCLUSION:(1)Spearman correlation analysis showed that tibial fracture angle was positively correlated with fibular fracture type,fibular fracture level and fibular fracture number.Tibial position status was positively correlated with tibial fracture angle and Topliss classification(coronal plane),but negatively correlated with major tibial fracture blocks and Topliss classification(sagittal plane).The level of fibular fracture was positively correlated with the type of fibular fracture and the number of fibular fractures.The main fracture blocks of the tibia were positively correlated with Topliss classification(coronal plane)and negatively correlated with Topliss classification(sagittal plane).(2)Multiple Logistic regression analysis showed that:the level of fibular fracture was correlated with the type of fibular fracture(P<0.05);the number of fibular fractures was correlated with the main fracture block of tibia(P<0.05).(3)It is indicated that the more inclined the ankle joint was to the valgus,the more likely it was to lead to fibular fracture,and the higher the fibular fracture level,the more serious the fibular fracture degree,the more complex the fibular fracture type,the larger the tibial fracture angle,the more the tibia presented Topliss classification(coronal plane)fracture.(4)When the ankle joint was more inclined to be in varus or varus + dorsiflexion,the fibula often did not fracture or simple fracture occurred,and the lower the fracture level,the smaller the tibial fracture angle,the more Topliss classification of the tibia(sagittal plane),the more main fracture blocks of the tibia,the larger the medial fracture block.When the ankle joint is in the dorsiflexion,it often results in a simple fibular fracture with a posterolateral tibial fracture.

Background and objective The pathological types of lung ground glass nodules(GGNs)show great significance to the clinical treatment.This study was aimed to predict pathological types of GGNs based on computed tomog-raphy(CT)quantitative parameters.Methods 389 GGNs confirmed by postoperative pathology were selected,including 138 cases of precursor glandular lesions[atypical adenomatous hyperplasia(AAH)and adenocarcinoma in situ(AIS)],109 cases of microinvasive adenocarcinoma(MIA)and 142 cases of invasive adenocarcinoma(IAC).The morphological characteristics of nodules were evaluated subjectively by radiologist,as well as artificial intelligence(AI).Results In the subjective CT signs,the maximum diameter of nodule and the frequency of spiculation,lobulation and pleural traction increased from AAH+AIS,MIA to IAC.In the AI quantitative parameters,parameters related to size and CT value,proportion of solid component,energy and entropy increased from AAH+AIS,MIA to IAC.There was no significant difference between AI quantitative parameters and the subjective CT signs for distinguishing the pathological types of GGNs.Conclusion AI quantitative parameters were valu-able in distinguishing the pathological types of GGNs.

OBJECTIVES: Bloodstream infections in emergency patients have a high incidence, severe disease progression, and rapid deterioration. Early administration of appropriate antimicrobial agents is crucial for improving patient outcomes. This study aims to investigate the incidence, pathogen distribution, and antimicrobial resistance patterns of bloodstream infections in emergency patients, providing a reference for rational antibiotic use in clinical practice. METHODS: Medical records of patients diagnosed with bloodstream infections in the emergency department of a hospital in Hunan Province between January 2018 and October 2022 were retrospectively collected. Clinical characteristics of bloodstream infection patients were analyzed, and the distribution trends and antimicrobial susceptibility of clinical isolates were examined. RESULTS: During the study period, 2 215 blood culture samples were submitted from the emergency department, with a positivity rate of 13.27%. After excluding eight cases with missing data or suspected contamination, 286 patients with bloodstream infections were included, with community-acquired infections accounting for the majority (85.66%). The most common primary infection site was the urinary tract (24.48%), followed by respiratory tract infections (20.28%) and biliary and intra-abdominal infections (17.13%). The 30-day mortality rate of bloodstream infections was 16.08%. A total of 286 pathogens were isolated, including 181 (63.29%) Gram-negative bacteria, primarily Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa; 101 (35.31%) Gram-positive bacteria, mainly Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae; and only 4 (1.40%) fungal isolates. Antimicrobial susceptibility testing showed that the key Enterobacteriaceae strains exhibited resistance rates of 2.4% to carbapenems, 16.3% to piperacillin sodium and tazobactam sodium, and 15.3% to ceftazidime, with no detected resistance to tigecycline or polymyxins. The main non-fermentative bacteria showed resistance rates of 29.6% to piperacillin sodium and tazobactam sodium, 13.3% to cefoperazone sodium and sulbactam sodium, and 27.1% to quinolones. Among Gram-negative bacteria, multidrug-resistant strains accounted for 40.9% (74/181), with carbapenem-resistant Escherichia coli and Klebsiella pneumoniae detected in 5.4% (5/92) and 13.6% (6/44) of cases, respectively. No carbapenem-resistant Pseudomonas aeruginosa was identified. Among Gram-positive bacteria, resistance rates to penicillin G, rifampicin, and cefoxitin were 74.7%, 4.2%, and 50%, respectively, with only 3 cases of resistant to glycopeptide antibiotics. CONCLUSIONS Bloodstream infections in emergency patients are predominantly community-acquired, with Gram-negative bacteria being the most common pathogens. The isolated pathogens exhibited relatively low resistance rates to commonly used clinical antibiotics.
Retrospective Studies ; Emergency Service, Hospital/statistics & numerical data* ; Drug Resistance, Bacterial ; Anti-Bacterial Agents/therapeutic use* ; Incidence ; Microbial Sensitivity Tests/statistics & numerical data* ; Bacteremia/microbiology* ; Community-Acquired Infections/microbiology* ; Gram-Negative Bacteria/isolation & purification* ; Blood Culture/statistics & numerical data* ; Humans ; Male ; Female ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; China/epidemiology*

The exacerbation of progressive multiple sclerosis (MS) is closely associated with obstruction of the differentiation of oligodendrocyte progenitor cells (OPCs). To discover novel therapeutic compounds for enhancing remyelination by endogenous OPCs, we screened for myelin basic protein expression using cultured rat OPCs and a library of small-molecule compounds. One of the most effective drugs was pinocembrin, which remarkably promoted OPC differentiation and maturation without affecting cell proliferation and survival. Based on these in vitro effects, we further assessed the therapeutic effects of pinocembrin in animal models of demyelinating diseases. We demonstrated that pinocembrin significantly ameliorated the progression of experimental autoimmune encephalomyelitis (EAE) and enhanced the repair of demyelination in lysolectin-induced lesions. Further studies indicated that pinocembrin increased the phosphorylation level of mammalian target of rapamycin (mTOR). Taken together, our results demonstrated that pinocembrin promotes OPC differentiation and remyelination through the phosphorylated mTOR pathway, and suggest a novel therapeutic prospect for this natural flavonoid product in treating demyelinating diseases.
Animals ; Cell Differentiation ; Flavanones ; Mice ; Mice, Inbred C57BL ; Myelin Sheath/metabolism* ; Oligodendroglia/metabolism* ; Rats ; Remyelination ; Signal Transduction ; TOR Serine-Threonine Kinases/metabolism*

The exacerbation of progressive multiple sclerosis (MS) is closely associated with obstruction of the differentiation of oligodendrocyte progenitor cells (OPCs). To discover novel therapeutic compounds for enhancing remyelination by endogenous OPCs, we screened for myelin basic protein expression using cultured rat OPCs and a library of small-molecule compounds. One of the most effective drugs was pinocembrin, which remarkably promoted OPC differentiation and maturation without affecting cell proliferation and survival. Based on these in vitro effects, we further assessed the therapeutic effects of pinocembrin in animal models of demyelinating diseases. We demonstrated that pinocembrin significantly ameliorated the progression of experimental autoimmune encephalomyelitis (EAE) and enhanced the repair of demyelination in lysolectin-induced lesions. Further studies indicated that pinocembrin increased the phosphorylation level of mammalian target of rapamycin (mTOR). Taken together, our results demonstrated that pinocembrin promotes OPC differentiation and remyelination through the phosphorylated mTOR pathway, and suggest a novel therapeutic prospect for this natural flavonoid product in treating demyelinating diseases.

Objective To investigate the relationships of MR indexes such as acromio humeral intervals (AHI),lateral extension of the acromion (LEA) and inclination angle of the acromion with the subacromial impingement syndrome (SIS).Methods 151 patients underwent MRI examination of shoulder joints,they were grouped according to age,gender and location of acromion.The differences in age,gender and MR indexes were compared between SIS group and non SIS group.The distribution statuses of SIS in different groups were compared at the same time,the relationships of various MR indexes with SIS were investigated and analyzed.Results There were no statistical differences in age,location distribution,the average shortest AHI value and the thickness of the subacromial bursal effusion between SIS group and non SIS group (P ＞ 0.05).There showed statistical difference in gender between the two groups (P =0.000),and there were more males than females in both groups.The acromion exactly covered the supraspinatus tendon in 79 patients,the average value of LEA in the SIS group was greater than that in the non SIS group,and there showed statistically significant difference between the two groups (P =0.002),the Youden index of LEA was 0.40,the sensitivity was 61％ and the specificity was 79％.The inclination angle of the acromion in the SIS group was smaller than that in the non SIS group,and there was a statistically significant difference between the two groups (P =0.019),the Youden index of the inclination angle of the acromion was 0.18,the sensitivity was 62％ and the specificity was 56％.47 patients in the SIS group had subacromial bursal effusion,51 patients in the non SIS group had subacromial bursal effusion.The thickness of the subacromial bursal effusion in the SIS group was greater than the non SIS group,and there showed statistically significant difference between the two groups (P =0.002),the Youden index of the thickness of the subacromial bursal effusion was 0.34,the sensitivity was 78 ％ and the specificity was 56 ％.Conclusion LEA,the inclination angle of the acromion and the thickness of the subacromial bursal effusion can be used as quantitative MR diagnostic criteria of SIS.The LEA measured by cardiothoracic ratio is simple and easy to use.

Objective To investigate the value of fused 3D-SPACE and 3D-TOF images in diagnosis of intracranial neurovascular compression syndrome.Methods 26 patients with intracranial neurovascular compression syndrome were examined using 3D-SPACE sequence and 3D-TOF sequence.After 3D-SPACE and 3D-TOF were fused by different times,the quality of image as well as the ability of j udging the relationship between nerves and blood vessels was analyzed and compared between the original images and the fused images.Results In this study,the fused images by adding one 3D-SPACE sequence and one 3D-TOF sequence showed the highest accurate than others(2 1 cases),and the j udgement of the relationship between the responsible blood vessels and nerve accor-ded with the surgical results to the highest extent (P<0.05).Conclusion The fusion image of 3D-SPACE sequence and 3D-TOF se-quence can improve the diagnostic ability of the intracranial neurovascular compression syndrome,and the appropriate proportion of the fusion image can show the relationship between the nerve and blood vessel.

Objective To evaluate the correlation between serum uric acid with cognitive disorder after acute cere?bral infarction by prospective study. Methods Four hundred consecutively enrolled patients of acute cerebral infarction were divided into no cognitive impairment group and cognitive impairment group according to the assess of Montreal Cog?nitive Assessment (MoCA). Univariate analysises were conducted in the potential risk factors of cognitive impairment in?cluding age, sex, smoking, alcohol, hypertension, diabetes, dyslipidemia, level of education, infarction in key parts, atrial fibrillation, serum uric acid, blood homocysteine between two groups. The statistically significant indicators in univariate analysises were used as independent variables and the scores of MoCA were used as the dependent variable to conduct multiple linear regression analysis. The assessment on the risk of cognitive impairment after cerebral infarction were con?ducted according to serum uric acid, sex, age and TOAST classification further. Results Serum uric acid was indepen?dent risk factors of cognitive disorder after acute cerebral infarction. The risk of cognitive disorder after acute cerebral in?farction was significantly increased in patients with high level of serum uric acid than with normal level and the relative risk was 1.35,95%CI(1.098,1.660). Especially for the young, male or patients with cerebral infarction in classification of small artery occlusion, the risk increased further, and the relative risk was 1.513, 95%CI(1.092, 2.096)1.412, 95%CI (1.125, 1.771)and 1.464, 95%CI(1.128, 1.900)respectively. Conclusion Exaltation of Serum uric acid was indepen?dent risk factor of cognitive disorder after acute cerebral infarction. The risk of cognitive disorder after acute cerebral in?farction was significantly increased in patients with high level of serum uric acid than with normal level, and especially for the young, male and patients with cerebral infarction in classification of small artery occlusion, the risk increased fur?ther.

OBJECTIVETo investigate the relationship between the stages of calcification of various teeth and cervical vertebral bone ages among children and adolescents in Chengdu.

METHODSThe study subjects consist of 256 children and adolescents in Chengdu with age ranging from 10 to 16 years. All panoramic radiographs and cephalometric radiographs were obtained. The relationship with the stages of chronological ages, calcification of various teeth and cervical vertebral bone ages were analyzed.

RESULTSThe Spearman rank correlation coefficient revealed highly significant relationships between cervical vertebral bone ages and chronological ages (r = 0.726, P < 0.01). Dental ages and chronological ages had medium relationship (r = 0.629, P < 0.01), also dental ages and cervical vertebral bone ages medium relationship (r = 0.668, P < 0.01).

CONCLUSIONCervical vertebral bone ages, chronological ages and dental calcification stages have correlation among children and adolescents in Chengdu. The cervical vertebral bone ages have high connection with chronological ages. Cervical vertebral bone age might be a better indicator in judging growth and development of children and adolescents during orthodontic treatment.

OBJECTIVE To investigate the antimicrobial resistances of Gram-negative bacilli isolated from patients with lower respiratory infection in intensive care unit(ICU),so as to provide reasonable selections for antibiotic in clinical treatment.METHODS The phlegm specimens from ICU inpatients with lower respiratory tract infection were collected from 2004 to 2007,and drug sensitivity test was performed according to NCCLS standards.RESULTS Gram-negative bacilli were accounted for 75.2% of total strains.The most predominant pathogens were Pseudomonas aeruginosa(42.7%),Acinetobacter baumannii(16.3%),Sternotrophomonas maltophilia(10.4%),Escherichia coli(10.0%),and Klebsiella pneumoniae(6.7%).The prevalence of ESBLs in E.coli and K.pneumoniae increased from 54.5% and 37.5 % in 2004 to 65.6 % and 52.7% in 2007.ESBLs non-producing strains showed lower resistance rates to the aminoglycosides,quinolones and the third and fourth generation cephalosporin than those of ESBLs producing strains.Nonfermentative Gram-negative bacilli were very highly resistant to most antimicrobial agents.CONCLUSIONS The drug resistance rates of Gram-negative bacilli of lower respiratory tract are serious.It is important to investigate the antimicrobial resistances of pathogenic bacteria and rationally use of antibiotics.