OBJECTIVE: To investigate the effectiveness of using 3 hollow compression screws combined with 1 screw off-axis fixation under the guidance of three-dimensional (3D) printed guide plate with mortise-tenon joint structure (mortise-tenon joint plate) for the treatment of Pauwels type Ⅲ femoral neck fractures. METHODS: A clinical data of 78 patients with Pauwels type Ⅲ femoral neck fractures, who were admitted between August 2022 and August 2023 and met the selection criteria, was retrospectively analyzed. The operations were assisted with mortise-tenon joint plates in 26 cases (mortise-tenon joint plate group) and traditional guide plates in 28 cases (traditional plate group), and without guide plates in 24 cases (control group). There was no significant difference in the baseline data of gender, age, body mass index, cause of injury, and fracture side between groups ( P>0.05). The operation time, intraoperative blood loss, frequency of intraoperative fluoroscopy, incision length, incidence of postoperative deep vein thrombosis of lower extremity, pain visual analogue scale (VAS) score at 1 week after operation, and Harris score of hip joint at 3 months after operation were recorded and compared. X-ray re-examination was taken to check the quality of fracture reduction, fracture healing, and the shortening length of the femoral neck at 3 months after operation, and the incidences of internal fixation failure and osteonecrosis of the femoral head during operation. RESULTS: Compared with the control group, the operation time, intraoperative blood loss, and frequency of intraoperative fluoroscopy reduced in the two plate groups, and the quality of fracture reduction was better, but the incision was longer, and the differences were significant ( P<0.05). The operation time and intraoperative blood loss were significantly higher in the traditional plate group than in the mortise-tenon joint plate group ( P<0.05), the incision was significantly longer ( P<0.05); and the difference in fracture reduction quality and the frequency of intraoperative fluoroscopy was not significant between two plate groups ( P>0.05). There was 1 case of deep vein thrombosis of lower extremity in the traditional plate group and 1 case in the control group, while there was no thrombosis in the mortise-tenon joint plate group. There was no significant difference in the incidence between groups ( P>0.05). All patients were followed up 12-15 months (mean, 13 months). There was no significant difference in VAS score at 1 week and Harris score at 3 months between groups ( P>0.05). Compared with the control group, the fracture healing time and the length of femoral neck shortening at 3 months after operation were significantly shorter in the two plate groups ( P<0.05). There was no significant difference between the two plate groups ( P>0.05). There was no significant difference in the incidences of non-union fractures, osteonecrosis of the femoral head, or internal fixation failure between groups ( P>0.05). CONCLUSION For Pauwels type Ⅲ femoral neck fractures, the use of 3D printed guide plate assisted reduction and fixation can shorten the fracture healing time, reduce the incidence of postoperative complications, and be more conducive to the early functional exercise of the affected limb. Compared with the traditional guide plate, the mortise-tenon joint plate can reduce the intraoperative bleeding and shorten the operation time.
Humans ; Femoral Neck Fractures/diagnostic imaging* ; Bone Plates ; Fracture Fixation, Internal/instrumentation* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Bone Screws ; Adult ; Aged ; Treatment Outcome ; Printing, Three-Dimensional ; Operative Time

Objective To investigate the relationship between sleep disorders and coronary heart disease through big data combined with Mendelian randomization analysis.Methods Data from 2005 to 2018 National Health and Nutrition Examination Survey in the United States were utilized.Logistic regression analysis was employed to evaluate the association between sleep disorders and coronary heart disease,while analyzing relevant influencing factors.A two-sample Mendelian randomization approach was implemented using Genome-Wide Association Studies to establish causal relationships.Results Logistic regression analysis demonstrated a significant association between sleep disorders and coronary heart disease(P＜0.001),with the neutrophil-to-lymphocyte ratio serving as a mediating factor in this relationship(P＜0.001).Mendelian randomization analysis revealed a positive correlation between sleep disorders and coronary heart disease(OR=1.030,95％CI:1.01-1.04).Conclusion Sleep disorders can increase the risk of coronary heart disease by activating inflammatory factors.

Objective:To examine the prevalence of malnutrition and evaluate the impact of nutritional support on clinical outcomes in elderly patients diagnosed with gastric and colorectal cancer.Methods:A retrospective cohort study was conducted, analyzing elderly patients with gastrointestinal tumors who underwent surgical treatment in the general surgery department from January 2019 to June 2020.The Global Leadership Initiative on Malnutrition(GLIM)criteria were utilized to diagnose malnutrition, and the effects of malnutrition and nutritional support on clinical prognosis were investigated.Results:A total of 426 elderly hospitalized patients with gastric and colorectal tumors who underwent surgical treatment were included in this study.This cohort comprised 199 cases of gastric cancer and 227 cases of colorectal cancer, with ages ranging from 65 to 91 years(mean age: 72.05±5.99).According to the GLIM criteria, 43.7%(186/426)of the patients were diagnosed with malnutrition, of which 25.6%(109/426)were moderately malnourished and 18.1%(77/426)were severely malnourished.Among the gastric cancer patients, 73.4%(146/199)were identified as having nutritional risk, with 48.7%(97/199)being malnourished and 22.6%(45/199)experiencing severe malnutrition.In the colorectal cancer group, 63.9%(145/227)were at nutritional risk, 39.2%(89/227)were malnourished, and 14.1%(32/227)had severe malnutrition.Additionally, 60.3%(257/426)of the patients received nutritional support therapy: 25.4%(108/426)received parenteral nutrition(PN), 11.3%(48/426)received enteral nutrition(EN), 23.7%(101/426)received a combination of EN and PN, while 39.7%(169/426)did not receive any nutritional support.Regardless of the presence or degree of malnutrition, patients who received nutritional support had significantly shorter total hospital stays compared to those who did not receive nutritional support, and this difference was statistically significant( t=5.58, 3.69, 2.21, 3.03, all P<0.05). Conclusions:Providing nutritional support to malnourished patients can reduce the length of hospital stay and improve clinical outcomes.

Objective:To explore the prognostic factors of patients with AML1::ETO-positive acute myeloid leukemia (AML).Methods:A retrospective cohort study was conducted. The clinical data of 42 AML1::ETO-positive AML patients diagnosed in the General Hospital of Ningxia Medical University from November 2012 to December 2023 were collected. The general clinical characteristics and short-term efficacy of patients were summarized, and the Kaplan-Meier method was used to analyze the overall survival (OS) and recurrence-free survival (RFS) of stratified patients based on factors such as age, gender, blood cell count, immunophenotype, treatment plan, and efficacy, and the log-rank test was used for inter-group comparison. Cox proportional hazards model was used for univariate and multivariate analyses on OS and RFS.Results:Among the 42 patients, there were 22 males (52.4%) and 20 females (47.6%), with a median age of 35 years, ranged from 14 to 66 years. The common initial symptoms included fatigue, fever and bleeding. The proportions of patients with CD19 or CD56 positivity were both 54.8% (23/42). Twenty-two cases (52.4%) received IA (idarubicin+cytarabine) regimen, 8 cases (19.1%) received HAA (homoharringtonine+cytarabine+aclarubicin) regimen, and 12 cases (28.6%) received induction chemotherapy with other regimens. Seven patients (16.7%) received hematopoietic stem cell transplantation (HSCT) during subsequent treatment. After one course of induction therapy, 29 cases (69.1%) achieved complete remission (CR). The proportions of patients in the CR group with initial platelet count > 10×10 9/L [86.2% (25/29) vs. 53.8% (7/13)], CD19 positivity [65.5% (19/29) vs. 30.8% (4/13)], CD56 negativity [58.6% (17/29) vs. 15.4% (2/13)], CD34 positivity [96.7% (28/29) vs. 76.9% (10/13)], and IA regimen treatment [58.6% (17/29) vs. 38.5% (5/13)] were higher than those in the non-CR group, and the differences were statistically significant (all P < 0.05). There were no statistically significant differences in the proportions of patients stratified by gender, age, hemoglobin, chromosomal karyotype, and with or without c-kit mutation (all P > 0.05). The median follow-up time was 19.5 months, ranged from 0.9 to 133.0 months. Kaplan-Meier analysis showed that patients with initial platelet count > 10×10 9/L, CD19 positivity, CD56 negativity, non-c-kit mutation, CR after one course of treatment, and subsequent HSCT had good OS and RFS (all P < 0.05). Multivariate Cox regression analysis showed that platelet count (> 10×10 9/L vs. ≤ 10×10 9/L, HR = 0.046, 95% CI: 0.007-0.314, P = 0.002), CD19 expression (positivity vs. negativity, HR = 0.069, 95% CI: 0.010-0.495, P = 0.008), CD56 expression (positivity vs. negativity, HR = 6.478, 95% CI: 1.178-35.631, P = 0.032), CD34 expression (positivity vs. negativity, HR = 38.300, 95% CI: 2.061-711.647, P = 0.014) and CR after one course of treatment (yes vs. no, HR = 0.076, 95% CI: 0.011-0.518, P = 0.008) were independent influencing factors for OS in AML1::ETO-positive AML patients. Platelet count (> 10×10 9/L vs. ≤ 10×10 9/L, HR = 0.101, 95% CI: 0.019-0.540, P = 0.007), CD19 expression (positivity vs. negativity, HR = 0.056, 95% CI: 0.007-0.462, P = 0.007) and CD56 expression (positivity vs. negativity, HR = 7.287, 95% CI: 1.096-48.457, P = 0.040) were independent influencing factors for RFS in AML1:: ETO-positive AML patients. Conclusions:Platelet count > 10×10 9/L and CD19 positivity may indicate a good prognosis for AML patients with AML1::ETO fusion gene, while CD56 positivity may indicate a poor prognosis.

BACKGROUND:Much of the current research on M2 macrophage-derived exosomes focuses on their effects on wound healing and osteoblast proliferation and differentiation,while few studies have focused on their role in regulating microglia phenotype.OBJECTIVE:To discuss the role and molecular mechanisms of M2 macrophage-derived exosomes in the phenotypic regulation of microglia.MERHODS:(1)Bone marrow primary macrophages were extracted and then stimulated with 50 ng/mL interleukin 4 for 24 hours to promote macrophage M2-type polarization.Flow cytometry and cellular immunofluorescence were used to identify the M2-type macrophage marker CD206.(2)M2 macrophage-derived exosomes were extracted and identified.(3)Microglia BV2 were randomly divided into three groups:control group,lipopolysaccharide group,and treatment group.No treatment was done in the control group.500 ng/mL lipopolysaccharide was added to the intervention for 24 hours in the lipopolysaccharide group.500 ng/mL lipopolysaccharide and 25 μg/mL M2 macrophage-derived exosomes were added simultaneously to the treatment group for 24 hours.ELISA was performed to detect the secretion of tumor necrosis factor α and interleukin 10 in the culture supernatant.qRT-PCR was performed to detect the mRNA expression of inducible nitric oxide synthase,arginase 1,interleukin 1β,and interleukin 10 in the cells.Western blot assay was performed to detect the protein expression of inducible nitric oxide synthase,arginase 1,and nuclear factor-κB signaling pathway related protein expression.RESULTS AND CONCLUSION:(1)ELISA results showed that the secretion of tumor necrosis factor α was significantly increased in the lipopolysaccharide group compared with the control group.The secretion of tumor necrosis factor α was reduced and the secretion of interleukin 10 was increased in the treatment group compared with the lipopolysaccharide group.(2)The qRT-PCR results showed that compared with the control group,the mRNA expression of interleukin 1β and inducible nitric oxide synthase increased in the lipopolysaccharide group.Compared with the lipopolysaccharide group,the mRNA expression of interleukin 1β and inducible nitric oxide synthase decreased,and the mRNA expression of interleukin 10 and arginase 1 increased in the treatment group.(3)Western blot assay results showed that the expression of inducible nitric oxide synthase protein was increased in the lipopolysaccharide group compared with the control group.The expression of inducible nitric oxide synthase protein was decreased and the expression of arginase 1 protein was elevated in the treatment group compared with the lipopolysaccharide group.(4)Compared with the control group,the expression of p65 and p-IκB-α proteins in the nuclear factor-κB signaling pathway was reduced in the lipopolysaccharide group,whereas the expression of p65 and p-IκB-α proteins was elevated in the treatment group compared with the lipopolysaccharide group.The results showed that M2-type macrophage-derived exosomes could significantly inhibit lipopolysaccharide-induced inflammatory responses in microglia,enhance the expression of the anti-inflammatory factor interleukin 10,suppress the expression of the pro-inflammatory factors tumor necrosis factor α and interleukin 1β,and promote microglial cell phenotypes polarized from the M1-type to the M2-type.The mechanism may be related to the inhibition of nuclear factor-κB signaling pathway activation by M2-type macrophage-derived exosomes.

Objective:To investigate the effect of CT-derived fractional flow reserve (CT-FFR) measurement sites on the values and the diagnostic performance, and to determine the optimal measurement site for CT-FFR using invasive FFR as the reference standard.Methods:This study was part of the CT-FFR CHINA clinical trial. Patients with suspected coronary artery disease who were scheduled for invasive coronary angiography (ICA) were prospectively recruited from five clinical centers across the country from November 2018 to March 2020. Each enrolled patient underwent coronary CT angiography (CCTA), CT-FFR, ICA, and invasive pressure wire-based FFR assessments sequentially within one week. Four groups of CT-FFR values were obtained on each enrolled target vessels according to different CT-FFR measurement locations: 1, 2, 3 cm distal to the target lesion, and terminal vessel groups. Spearman and Bland-Altman analyses were used to explore the correlation and consistency of CT-FFR values and FFR values at different measurement sites. The measurement deviation of CT-FFR was also compared. Diagnostic accuracy and performance of CT-FFR, including sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC), in discriminating myocardial ischemia were analyzed across all measurement site groups on a per-vessel level, using FFR as the reference standard.Results:A total of 289 patients with 345 target lesion vessels were included. According to CCTA, there were 51 target vessels (14.8%) with<50% stenosis, 106 vessels (30.7%) with 50%-69% stenosis, and 188 vessels (54.5%) with stenosis≥70%. At per-vessel level, CT-FFR and FFR values at each measurement position group were highly positively correlated: 1 cm distal to target lesion group, r=0.734 ( P<0.001); 2 cm distal to target lesion group, r=0.732 ( P<0.001); 3 cm distal to target lesion group, r=0.737 ( P<0.001); terminal vessel group was 0.719 ( P<0.001). At per-vessel level, CT-FFR and FFR values of all measurement sites were in good agreement (Bland-Altman analysis results): 1 cm distal to target lesion group, 0.014 (95% LoA 0.002-0.026); 2 cm distal to target lesion group, 0.026 (95% LoA 0.015-0.038); 3 cm distal to target lesion group, 0.040 (95% LoA 0.039-0.051); terminal vessel group, 0.075 (95% LoA 0.064-0.087). And at per-vessel level, the accuracy of diagnosing myocardial ischemia with CT-FFR at 1 cm was highest [84.6% (95% CI 80.4%-88.3%)], and the lowest accuracy in the terminal vessel group [67.0% (95% CI 61.7%-72.0%)]. However, there was no significant difference in the diagnostic accuracy of CT-FFR at 1 cm, 2 cm [80.6% (95% CI 76.1%-84.6%)] and 3 cm [77.5% (95% CI 72.6%-81.7%)]. AUC of CT-FFR at 1 cm distal to the lesion were both highest for global level and moderately stenosis (50%-69%) lesions [0.85 (95% CI 0.81-0.89), 0.84 (95% CI 0.77-0.90)]. And the differences were statistically significant among the four measurement location groups (all P<0.05). Conclusions:The deviation of CT-FFR increases with measurement site distance distal to target lesions. One centimeter distal to the target lesion is the optimal measurement site, and the CT-FFR value here shows the highest diagnostic performance for myocardial ischemic lesions, especially for moderate stenosis.

Objective The finite element pelvis model with detailed anatomical structures which meets the Chinese human 95th percentile characteristics is developed,and the influence of cortical bone modeling method on the biomechanical response of the real pelvis is explored.Methods Based on the pelvic medical images of a 95th percentile male volunteer,two finite element pelvis models with real hip bone cortical bone thickness(REA-M)and 2 mm uniform cortical bone thickness(CON-M)dominated by hexahedral elements were constructed.Using the simulation method to reconstruct the loading conditions of cadaver experiments,the validation of models was verified by comparing the cadaver experimental results and simulation results,and biomechanical response differences of two models under different working conditions were discussed.Results The simulation data showed that there was a strong correlation between the overall biomechanical responses of two pelvic models and the cadaver experiment,and the mechanical response difference between two models was mostly within 8％,and the correlation score difference between two models was smaller than 2％.Conclusions The validation of two pelvic models established in this study is verified by rebuilding multiple simulation experiments.Although the biomechanical responses of CON-M and REA-M models were different,the difference was small.From the perspective of model simplification,the CON-M model can be used to study the biomechanical response of the pelvis.

Objective To observe the value of three-dimensional ultrasound combined with microvascular flow imaging for prenatal diagnosis of fetal intracranial anomalies.Methods Totally 118 fetuses with intracranial anomalies diagnosed through cranial MRI/induced labor specimen dissection who underwent prenatal ultrasound examination were retrospectively enrolled.Two-dimensional,three-dimensional ultrasound and microvascular flow imaging manifestations of fetal intracranial anomalies were observed,and the accuracy of three-dimensional ultrasound combined with microvascular flow imaging for prenatal diagnosis of fetal intracranial anomalies was analyzed.Results The accuracy of three-dimensional ultrasound combined with microvascular flow imaging for prenatal diagnosis of fetal intracranial anomalies was 93.22％(110/118),of isolated and non-isolated intracranial anomalies was 97.47％(77/79)and 84.62％(33/39),respectively.Six fetuses were missed diagnosis of malformations of cortical development(1 fetus of tuberous sclerosis,4 of abnormal morphology of the sulci gyrus and 1 of schizencephaly)and 1 fetus of intracranial softening lesion,while posterior fossa arachnoid cyst in 1 fetus was misdiagnosed as mega cisterna magna.Conclusion The accuracy of three-dimensional ultrasound combined with microvascular flow imaging for prenatal diagnosis of fetal intracranial anomalies was relatively high.

Objective To observe the value of prenatal ultrasound for diagnosing fetal intracranial arachnoid cyst(IAC)and predicting outcomes.Methods A total of 240 fetuses with IAC confirmed by fetal brain MR examination or clinical follow-up were retrospectively enrolled,and the prenatal ultrasonic manifestations were observed.The outcomes of pregnancy were recorded,and the neurological development and treatment after birth were regularly followed up,then the fetuses were classified into good outcome or poor outcome groups.Univariate and binary logistic regression were used to analyze clinical data and prenatal ultrasonic findings,and the impact factors of outcomes of fetal IAC were screened.Results Among 240 fetuses,IAC located in the supratentorial area in 192(192/240,80.00％)and in the infratentorial area in 48(48/240,20.00％)fetuses.The size of IAC was 0.3-6.2 cm,with an average of(1.4±0.9)cm.Single lesion was found in 230 fetuses(230/240,95.83％),while multiple lesions were detected in 10 fetuses(10/240,4.17％).IAC presented as thin-walled cystic echoes with clear intracranial boundaries and good intracapsular sound transmission in all 240 fetuses,including 150(150/240,62.50％)with simple IAC and 90(90/240,37.50％)complicated with intracranial or other system malformations.Totally 189 fetuses were delivered successfully,while 51 underwent induction of labor.The newborns were followed up to 6-84 months.Among 240 fetuses with IAC,171(171/240,71.25％)had good outcome and 69(69/240,28.75％)had poor outcome.The size,number of lesion and whether combined with malformations or not on prenatal ultrasound and gender were all independent impact factors of outcomes of fetal IAC(OR=1.558,6.323,0.911,2.662,all P＜0.05).Conclusion Prenatal ultrasound could accurately diagnose and predict the outcomes of fetal IAC.