Objective To evaluate the efficacy of combining surgical treatment with biological agents for perianal fistulizing Crohn's disease(pfCD).Methods Sixty patients with perianal fistulizing Crohn's disease(pfCD)admitted to our hospital from May 2021 to December 2023 were randomly allocated into two groups:Treatment Group A(n=30)and Treatment Group B(n=30).Treatment Group A received pfCD surgery combined with inflix-imab(IFX)and azathioprine(AZA),while Treatment Group B underwent pfCD surgery along with ustekinumab(UST)and AZA.The CDAI score,PDAI score,and Assche score were monitored for both groups,and postoperative MRI examinations were conducted to evaluate the healing of pfCD.Results There were statistically significant differences in CDAI,PDAI,and Assche scores between pre-treatment and post-treatment comparisons within treat-ment groups A and B(P<0.05),as well as in the magnitude of change at each time point.Comparisons of CDAI,PDAI,and Assche scores at 8,16,24,and 32 weeks,and PDAI scores at 40 weeks between groups A and B using independent samples t-tests did not yield statistically significant results(P>0.05).However,significant differences were observed for CDAI and Assche scores at 40 weeks(P<0.05).Significant changes in CDAI,PDAI,and Assche scores were noted at 8,16,24,32,and 40 weeks post-treatment within both groups A and B(P<0.05).Multiple comparisons using the LSD method revealed that the changes in these scores at each time point were statistically significant(P<0.05).The data indicate a temporal trend in the changes of CDAI,PDAI,and Assche scores,with group B showing a more rapid decline compared to group A.In terms of fistula response rates,both groups A and B achieved 100%(30/30).However,the clinical healing rate of fistulas was higher in group B at 86.7%(26/30)compared to 76.7%(23/30)in group A.Conclusion The combination of surgical treatment with IFX/UST plus AZA is safe and effective for treating pfCD.However,the long-term efficacy of combining surgical treatment with UST appears to be superior.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Nipah virus (NiV) and related viruses form a distinct henipavirus genus within the Paramyxoviridae family. NiV continues to spillover into the humans causing deadly outbreaks with increasing human-bat interaction. NiV encodes the large protein (L) and phosphoprotein (P) to form the viral RNA polymerase machinery. Their sequences show limited homologies to those of non-henipavirus paramyxoviruses. We report two cryo-electron microscopy (cryo-EM) structures of the Nipah virus (NiV) polymerase L-P complex, expressed and purified in either its full-length or truncated form. The structures resolve the RNA-dependent RNA polymerase (RdRp) and polyribonucleotidyl transferase (PRNTase) domains of the L protein, as well as a tetrameric P protein bundle bound to the L-RdRp domain. L-protein C-terminal regions are unresolved, indicating flexibility. Two PRNTase domain zinc-binding sites, conserved in most Mononegavirales, are confirmed essential for NiV polymerase activity. The structures further reveal anchoring of the P protein bundle and P protein X domain (XD) linkers on L, via an interaction pattern distinct among Paramyxoviridae. These interactions facilitate binding of a P protein XD linker in the nucleotide entry channel and distinct positioning of other XD linkers. We show that the disruption of the L-P interactions reduces NiV polymerase activity. The reported structures should facilitate rational antiviral-drug discovery and provide a guide for the functional study of NiV polymerase.
Nipah Virus/chemistry* ; Cryoelectron Microscopy ; Viral Proteins/genetics* ; RNA-Dependent RNA Polymerase/genetics* ; Phosphoproteins/genetics* ; Humans ; Models, Molecular ; Protein Binding

Objective:To compare the effectiveness of video laryngoscopy and traditional direct laryngoscopy in neonatal endotracheal intubation teaching.Methods:A total of 52 undergraduate clinical interns in the Department of Neonatology at the First Clinical School of Medicine of Zhengzhou University in June 2024 were selected.The participants were randomly divided into a video laryngoscopy group and a traditional direct laryngoscopy group.After the training，skill assessments were conducted.And a questionnaire was used to evaluate whether there were differences in terms of teaching arrangement, teaching methods, classroom interaction, and teachers' attitudes.Results:The skill assessment score of the video laryngoscope group was (72.85 ± 3.36) points, significantly higher than that of the direct laryngoscope group[(65.81 ± 2.80) points], with a statistically significant difference ( P<0.05). The glottis recognition rate in the video laryngoscope group (88.46%) was higher than that in the direct laryngoscope group (61.54%) ( P<0.05).The intubation success rate in the video laryngoscope group (69.23%) was also higher than that in the direct laryngoscope group (38.7%) ( P<0.05). The results of the teaching satisfaction survey questionnaire showed that the satisfaction ratio for teaching methods in the video laryngoscope group was higher than that in the direct laryngoscope group ( P<0.05), while there were no statistically significant differences between the two groups in terms of teaching arrangements, classroom interaction, assessment and evaluation methods, and teacher attitudes ( P>0.05). Conclusion:Using video laryngoscopy for teaching helps interns better master neonatal tracheal intubation skills and is worth promoting.

Objective To compare the effects of functional end-to-end esophagojejunostomy(FETE method)and side-to-side esophagojejunostomy with cis-peristalsis(overlap method)on post-operative rehabilitation,anastomotic leakage,and inflammatory-oxidative stress factors in patients un-dergoing laparoscopic radical resection for esophageal cancer.Methods A total of 115 patients with esophageal cancer were selected as study subjects,and were randomly divided into overlap group(n=57)and FETE group(n=58)using random number table method,and both groups underwent lapa-roscopic radical resection for esophageal cancer.The overlap group received the overlap method,and the FETE group received the FETE method.The surgical-related indicators,postoperative recovery indicators,incidence of anastomotic leakage,inflammatory factors[interleukin-10(IL-10),interleu-kin-6(IL-6),tumor necrosis factor-α(TNF-α)],oxidative stress factors[malondialdehyde(MDA),superoxide dismutase(SOD)],pulmonary function indicators[forced vital capacity(FVC),forced expiratory volume in one second(FEV1),FEV1/FVC],and the scores of the esophageal cancer-specific quality of life questionnaire(QLQ-OES18)were compared between the two groups.Results There was no statistically significant difference in intraoperative blood loss between the two groups(P＞0.05).The FETE group had shorter operative time and intraoperative anastomosis time,and a lar-ger number of lymph node dissection compared with the overlap group,with statistically significant differences(P＜0.05).The FETE group had earlier postoperative first flatus time,first oral intake time,and drainage tube removal time compared with the overlap group,with statistically significant differences(P＜0.05).The incidence of anastomotic leakage was 1.72％in the FETE group and 7.02％in the overlap group,with no statistically significant difference(P＞0.05).One week after surgery,the serum levels of IL-10,IL-6,TNF-α and MDA in the FETE group were lower than those in the overlap group,while the serum SOD level was higher,with statistically significant differences(P＜0.05).One week after surgery,the FVC,FEV,and FEV1/FVC in the FETE group were higher than those in the overlap group,with statistically significant differences(P＜0.05).Three months after surgery,the QLQ-OES18 functional domain scores in the FETE group were higher than those in the overlap group,while the symptom domain and single symptom domain scores were low-er,with statistically significant differences(P＜0.05).Conclusion Both the FETE method and the overlap method can reduce intraoperative blood loss and the incidence of anastomotic leakage when applied in laparoscopic radical resection for esophageal cancer.However,FETE method has shorter operative time,larger number of intraoperative lymph node dissections,faster postoperative recovery,and patients have less inflammatory-oxidative stress response and pulmonary function im-pairment,as well as higher quality of life after surgery,showing greater advantages compared with the overlap method.

Objective To analyze the effect of Shufeng Tongqiao decoction combined with methylprednisolone tablets in patients with chronic sinusitis and nasal polyp(CRSwNP)after operation.Methods A total of 104 patients with CRSwNP underwent endoscopic nasal surgery were prospectively selected,and patients were randomly divided into the hormone group(n=52,postoperative methylprednone tablets)and the study group(n=52,postoperative combined treatment with Shufeng Tongqin Decoction).After removal and shedding,50 cases were included in the hormone group,and 49 cases were included in the study group.The curative effect,lung wind-heat syndrome score,nasal mucosa recovery(assessed by Lund-Kennedy score system)and nasal mucosa remodeling were compared between the two groups.Serum levels of human β-defensin(HBD)-2 and high mobility group protein B1(HMGB1)were detected by enzyme-linked immunosorbent assay.Results The total control rate was higher in the study group than that of the hormone group(95.92%vs.80.00%,P＜0.05).At 12 weeks after surgery,the lung meridian wind heat syndrome scores,Lund-Kennedy scores and serum HMGB1 level were lower than before surgery in both groups(P＜0.05),and the study group was lower than the hormone group(P＜0.05).At 12 weeks after surgery,the epithelial injury grading was better in the study group than that in the hormone group(P＜0.05),and the basement membrane thickness was thinner than that in the hormone group(P＜0.05).Conclusion The joint of Shufeng Tongqiao decoction and methylprednisolone tablets has a better effect on postoperative CRSwNP patients,and it can greatly improve the levels of serum hBD-2 and HMGB1,effectively inhibit nasal mucosal remodeling,and greatly improve the recovery of nasal mucosa.

Objective:To study the correlation between hair fluorine level and hypertension of permanent residents in high altitude areas of Tibet Autonomous Region (Tibet).Methods:A random cluster sampling method was used to select 5 villages in the high altitude areas of Tibet from June to August 2021 and June to August 2022, respectively, and questionnaire survey, physical examination, and biochemical indicator testing were conducted on permanent Tibetan residents in the above mentioned villages. At the same time, hair samples were collected, the hair fluorine level was determined by ion selective electrode method, and the correlation between various indicators and hair fluorine level and hypertension was analyzed.Results:A total of 227 individuals were included, with hair fluorine level of (15.06 ± 0.16) mg/kg. Correlation analysis showed that there was no correlation between the study subjects' systolic blood pressure, diastolic blood pressure, body mass index, pulse, neck circumference, chest circumference, uric acid level and hair fluorine level ( P > 0.05). Abdominal circumference, hip circumference, and hemoglobin level were positively correlated with hair fluorine level ( r = 0.23, 0.14, 0.29, P < 0.05), while blood glucose level and finger pulse oxygen were negatively correlated with hair fluorine level ( r = - 0.23, - 0.24, P < 0.001). Binary logistic regression analysis showed that age ( OR = 1.04, 95% CI: 1.01 - 1.06), chest circumference ( OR = 1.10, 95% CI: 1.01 - 1.20), and hair fluorine level ( OR = 1.22, 95% CI: 1.02 - 1.46) had an impact on hypertension ( P < 0.05). Conclusion:There is a certain correlation between hair fluoride level and hypertension in the population of high altitude areas in Tibet.

Lots of patients with obstructive sleep apnea(OSA)are first recognized in dental institutions.In consideration of dental characteristics,we summarize advances in the application of screening methods for adult OSA patients based on oral examination,craniofacial structure,imaging examination,medical history,clinical symptoms,manifestation,populations at risk and questionnaires.Dental practitioners can screen and identify potential OSA patients,play a better role in the multidisciplinary of OSA,and help the pre-vention of OSA.

Objective:To investigate the clinical efficacy of minimally invasive double anchoring combined with percutaneous kyphoplasty (PKP) for Kümmell disease.Methods:The clinical data of 24 patients with Kümmell disease who were treated with minimally invasive double anchoring combined with PKP in Cangzhou People's Hospital from October 2022 to March 2024 were retrospectively analyzed. Among them, there were 2 T 10 vertebrae, 5 T 11 vertebrae, 7 T 12 vertebrae, 6 L 1 vertebrae, and 4 L 2 vertebrae. There were 6 males and 18 females. The average age was 72.05±4.52 years (range, 66-80 years). The bone mineral density T value was -3.41±0.77 (range, -2.5-4.5). The stages of Li's Kümmell disease included 13 cases of stage II and 11 cases of stage III. The operation time, intraoperative blood loss, and volume of bone cement injected were recorded. The vertebral index, vertebral angle and Cobb angle of diseased segment were measured before and after operation. The visual analogue scale (VAS) was used to assess the degree of pain, the Oswestry disability index (ODI) and the Japanese Orthopaedic Association (JOA) low back pain scale were used to assess spinal function. The Medical Outcome Study short form 36 item health survey (SF-36) was used to assess the general health status of the patients. The postoperative symptom recovery was evaluated by Odom criteria. Results:The mean operative time of the 24 patients was 35.32±6.86 min, the injected volume of bone cement was 4.39±1.72 ml, and the intraoperative blood loss was 16.56±5.21 ml. All patients were followed up for 10 to 14 months, with an average of 11.7 months. Postoperative CT examination showed that the screw positions were satisfactory, and no loosening or displacement of bone cement mass occurred. On the first day after surgery, the vertebral body index, vertebral body angle and Cobb angle of diseased segment were 77.71%±2.75%, 12.40°±1.53° and 25.77°±4.49°, respectively, which represented significant improvements from the preoperative values of 43.09%±5.66%, 22.12°±2.92° and 46.98°±5.68° before surgery ( P<0.05). At the last follow-up, the values were 76.18%±2.32%, 12.41°±2.53°, 26.14°±4.87°, respectively, which were significantly improved compared with those before surgery ( P<0.05), but there was no statistical significance compared with the first day after surgery ( P>0.05). The VAS, ODI and JOA scores on the first day after surgery were 2.11±0.87 points, 22.46±5.49 points and 27.68±2.45 points, respectively, which were significantly improved compared with those before surgery 7.50±0.98 points, 76.25±8.56 points and 14.96±4.91 points ( P<0.05). At the last follow-up, the values were 2.26±0.88, 23.87±3.25 and 26.58±2.77, respectively, which were significantly improved compared with those before surgery ( P<0.05), and there was no statistical significance compared with the first day after surgery ( P>0.05). All 24 patients completed SF-36 scale assessment, and the results showed that there were statistically significant differences in physiological function, physiological role, physical pain, general health status, social function scores and mental health between the patients before surgery and the last follow-up ( P<0.05), while there were no statistically significant differences in vitality and emotional function ( P>0.05). At the last follow-up, the Odom criteria showed excellent results in 18 cases, good in 4 cases, and fair in 2 cases. Conclusions:The application of minimally invasive double anchoring (single nail fixation) combined with PKP in the treatment of Kümmell disease can effectively prevent the loosening and displacement of bone cement masses, and the fixation effect is satisfactory, which can restore the height of the injured vertebrum, reduce kyphosis and improve spinal function. The clinical symptoms of the patients were significantly improved, and the quality of life was enhanced.