Objective:To explore the risk factors of acute Kemmochi type V anterior talofibular ligament (ATFL) injury in X-ray negative children and their predictive efficacy .Methods:A retrospective cohort study was conducted to analyze the clinical data of 92 children with X-ray negative ATFL injury, who were treated at the outpatient department of Jinan Children′s Hospital from June 2023 to March 2025, including 55 boys and 37 girls, aged 5-14 years [8.8(7.0, 11.0)years]. The cause of injury was low-energy ankle sprain and X-ray examination showed no fracture, ie, X-ray negative. According to the Kemmochi classification for ATFL injury, the injury was classified as type V (Kemmochi type V group) in 42 patients and type I-IV (non-Kemmochi type V group) in 50. Gender, age, side of injury, time from injury to first visit, physical examination at the first visit [positive result of ankle inversion test, weight-bearing ability assessment, visual analogue score (VAS)], X-ray examination at the first visit (presence of os subfibulare), and musculoskeletal ultrasound examination at the first visit (swelling degree of ATFL, ankle joint effusion, enhanced blood flow signal of ATFL) were recorded in both groups. Univariate analysis and binary Logistic regression analysis were used to evaluate and determine the independent risk factors for X-ray negative Kemmochi type V ATFL injury in children. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the predictive efficacy of each independent risk factor for Kemmochi type V ATFL injury. Results:Univariate analysis showed significant differences between the two groups in age, VAS, ATFL swelling degree, and ankle joint effusion ( P<0.05) but no significant differences in gender, side of injury, time from injury to the first visit, positive result of ankle inversion test, weight-bearing ability assessment, presence of os subfibulare or enhanced blood flow of ATFL ( P>0.05). Binary Logistic regression analysis indicated that age ( OR=0.79, 95% CI 0.65, 0.97, P<0.05) and ATFL swelling degree ( OR=6.97, 95% CI 1.38, 35.32, P<0.05) were significantly correlated with Kemmochi type V ATFL injury in X-ray negative children. ROC curve analysis showed that the AUC for age and ATFL swelling degree were 0.65(95% CI 0.54, 0.75) and 0.78(95% CI 0.68, 0.86) and the AUC for age combined with ATFL swelling degree was 0.83(95% CI 0.74, 0.90). The optimal threshold values of age and ATFL swelling degree were 9.3 years and 1.0 mm. Conclusions:Age and ATFL swelling degree are independent risk factors for Kemmochi type V ATFL injury in X-ray negative children. Both age and ATFL swelling degree have relatively high independent predictive efficacy, and the combined predictive efficacy of the two is even higher.

Objective:To investigate the methods and skills required for the safe and swift removal of primary or secondary sacral tumors located between the second (inclusive) and fourth sacral vertebrae.Methods:The clinical images, pathology reports, surgical procedures, operation durations, intraoperative bleeding volumes, and postoperative functional follow-up data of 26 patients undergoing sacral tumor resection at the First Affiliated Hospital of Zhengzhou University and Xinjiang Production and Construction Corps Hospital between May 2020 and February 2025 were retrospectively examined. Additionally, the safety measures for sacral tumor resection and techniques for expedited specimen removal were evaluated.Results:According to magnetic resonance imaging (MRI) findings, all 26 patients presented with sacral tumors located between the second (inclusive) and fourth sacral vertebrae. Specifically, 9 patients were diagnosed with primary sacral tumors, pathologically confirmed as chordomas, while 17 patients had secondary sacral tumors. Among the secondary tumor cases, 12 were attributed to recurrent rectal cancer invading the sacrum, and 5 were due to malignant teratomas invading the sacrum. The 26 patients underwent a treatment strategy that began with managing the relationship between the internal iliac artery, vein branches, and the tumor, followed by the resection of the sacrum. During surgery, the bilateral sciatic foramina were accurately positioned, and the presacral fascia was dissected subsequent to the fracture of the sacrum. Among the 26 patients, 9 underwent sacral tumor resection directly through the posterior sacral approach. The average operation time for these patients was (71.1±4.9) minutes, with average blood loss of (186.7±72.8) milliliters. On the other hand, 17 patients underwent sacral tumor resection by transitioning from the supine position to the prone knife position through a combined abdominal and sacral approach. The average operation time for this group was (213.5±19.3) minutes, with average blood loss of (480.0±93.0) milliliters, significantly longer than that of the posterior sacral approach. The follow-up period ranged from 1 to 48 months, with a median of 20 months, ending on March 31, 2025. During this time, 26 patients achieved autonomous defecation with the aid of medication. None of the patients reported any functional movement disorders or pain in their lower limbs. It was observed that two out of the 26 patients developed distant metastasis, while the remaining 24 patients survived without any tumors.Conclusion:By pretreated the relationship between the internal iliac vessels and sacral tumors prior to resecting sacral tumors, utilizing the approach of initially fracturing the sacrum followed by rupturing the presacral fascia, the tumor can be entirely eliminated, resulting in a brief surgical procedure, reduced intraoperative bleeding, and minimal postoperative complications.

Objective:To explore the therapeutic effect of compound Kuijie Ankang Decoction on ulcerative colitis (UC) model mice by non targeted metabonomics; To explore its mechanism.Compound Kuijie Ankang.Methods:The mice were randomly divided into blank control group, model group, Kuijie Ankang Decoction group and sulfasalazine group, with 12 mice in each group. Except the blank control group, the other groups were given 1.5% DSS solution for free drinking to prepare UC model. After successful modeling, Kuijie Ankang Decoction group was intragastrically administered with compound Kuijie Ankang Decoction of 9.68 g/kg, sulfasalazine group was intragastrically administered with sulfasalazine capsule suspension of 320 mg/kg, model group and blank control group were intragastrically administered with equal volume of purified water, once a day, for 7 consecutive days. The body mass and disease activity index (DAI) score of mice were measured. ELISA was used to measure the levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-10 (IL-10) in the colon tissue of mice; the protein expressions of Claudin-1 and Zo-1 in colon tissue were detected by immunofluorescence method. HE staining was used to observe the pathological changes in the colon, and UHPLC-OE-MS technology was used to analyze the endogenous metabolite structure of mouse colon tissue, differential metabolites and related metabolic pathways were screened.Results:Compared with the model group, the colon length in Kuijie Ankang Decoction group and sulfasalazine group increased ( P<0.01), the DAI score decreased ( P<0.01), the levels of TNF-α, IL-1β and IL-6 in colon tissue decreased ( P<0.01), the level of IL-10 increased ( P<0.01), and the average optical density of Claudin-1 and Zo-1 protein increased ( P<0.01 or P<0.05). Metabolomics analysis identified 26 potential differential metabolites, including nicotinamide adenine dinucleotide, guanine, gamma aminobutyric acid, and thiamine, affecting 26 key metabolic pathways, including lysine biosynthesis, thiamine metabolism, cysteine and methionine metabolism. Conclusion:Kuaijie Ankang Decoction may improve metabolites such as Gamma aminobutyric acid and thiamine through metabolic pathways such as lysine biosynthesis to alleviate inflammatory reactions, thereby exerting therapeutic effects on ulcerative colitis in mice.

Objective To explore the effects of camellia honey on intestinal inflammation and injury induced by a high-fat diet(HFD)in Drosophila.Methods A HFD model group of fruit flies was created by feeding with standard culture medium containing 30％lard.Each camellia honey groups were fed the same high-fat medium containing different concentrations of camellia honey.The body mass,eclosion rate,climbing ability,size of lipid droplets,and levels of intestinal reactive oxygen species in adult flies were measured and analyzed.Results Compared with the model group,each camellia honey groups showed significant improvements.Specifically,camellia honey ameliorated the following HFD-induced alterations:decline in eclosion rate,increase in pupal volume,increase in adult average body mass,decrease in adult climbing ability,enlargement of the lipid droplet area,elevation in intestinal ROS levels,and intestinal damage.Conclusions Camellia honey improved the growth and development,intestinal inflammation,and injury induced by a HFD in Drosophila.

Objective:To investigate the methods and skills required for the safe and swift removal of primary or secondary sacral tumors located between the second (inclusive) and fourth sacral vertebrae.Methods:The clinical images, pathology reports, surgical procedures, operation durations, intraoperative bleeding volumes, and postoperative functional follow-up data of 26 patients undergoing sacral tumor resection at the First Affiliated Hospital of Zhengzhou University and Xinjiang Production and Construction Corps Hospital between May 2020 and February 2025 were retrospectively examined. Additionally, the safety measures for sacral tumor resection and techniques for expedited specimen removal were evaluated.Results:According to magnetic resonance imaging (MRI) findings, all 26 patients presented with sacral tumors located between the second (inclusive) and fourth sacral vertebrae. Specifically, 9 patients were diagnosed with primary sacral tumors, pathologically confirmed as chordomas, while 17 patients had secondary sacral tumors. Among the secondary tumor cases, 12 were attributed to recurrent rectal cancer invading the sacrum, and 5 were due to malignant teratomas invading the sacrum. The 26 patients underwent a treatment strategy that began with managing the relationship between the internal iliac artery, vein branches, and the tumor, followed by the resection of the sacrum. During surgery, the bilateral sciatic foramina were accurately positioned, and the presacral fascia was dissected subsequent to the fracture of the sacrum. Among the 26 patients, 9 underwent sacral tumor resection directly through the posterior sacral approach. The average operation time for these patients was (71.1±4.9) minutes, with average blood loss of (186.7±72.8) milliliters. On the other hand, 17 patients underwent sacral tumor resection by transitioning from the supine position to the prone knife position through a combined abdominal and sacral approach. The average operation time for this group was (213.5±19.3) minutes, with average blood loss of (480.0±93.0) milliliters, significantly longer than that of the posterior sacral approach. The follow-up period ranged from 1 to 48 months, with a median of 20 months, ending on March 31, 2025. During this time, 26 patients achieved autonomous defecation with the aid of medication. None of the patients reported any functional movement disorders or pain in their lower limbs. It was observed that two out of the 26 patients developed distant metastasis, while the remaining 24 patients survived without any tumors.Conclusion:By pretreated the relationship between the internal iliac vessels and sacral tumors prior to resecting sacral tumors, utilizing the approach of initially fracturing the sacrum followed by rupturing the presacral fascia, the tumor can be entirely eliminated, resulting in a brief surgical procedure, reduced intraoperative bleeding, and minimal postoperative complications.

Objective:To evaluate the efficacy and safety of nebulized inhalation of recombinant human interferon (IFN) α1b injection in the treatment of respiratory syncytial virus (RSV) associated lower respiratory tract infections (pneumonia and bronchiolitis) in children.Methods:A randomized, double-blind, parallel, placebo-controlled add-on design was used.Children with pneumonia or bronchiolitis aged 2 months to 5 years who tested positive for RSV antigen within 72 hours of onset from 30 clinical trial sites including Beijing Children′s Hospital, Capital Medical University between February 2021 and December 2022 were included in this study and randomly divided into 2 groups at a ratio of 1∶1 based on a stratified-block method.Both groups received basic treatments such as cough control, asthma relieving, expectorant treatment, fever reduction, oxygen therapy, etc.The experimental group received additional nebulized inhalation of IFN α1b injection at a dose of 2.0 μg/(kg·time), twice a day.The control group received nebulized inhalation of placebo twice a day.Clinical efficacy was evaluated based on indicators such as the duration of clinical symptoms and signs, and the Kaplan-Meier method was used to calculate the median and 95% CI of the duration of clinical symptoms and signs.The Log-rank test was used to compared data between groups.Safety was assessed through the incidence of adverse reactions and laboratory tests, and the Chi-square test was used to analyze the difference between groups. Results:There were 123 children in the experimental group and 122 children in the control group.The median durations of all the 5 clinical symptoms and signs [including shortness of breath, wheezing, dyspnea (visible retractions), decreased transcutaneous oxygen saturation, and abnormal mental state] in the experimental group after treatment were slightly shortened than those in the control group [2.7 d(95% CI: 1.9-3.0 d)] vs.[2.9 d(95% CI: 2.6-3.6 d), P=0.027].The improvement in dyspnea (retractions) was especially pronounced in the experimental group, with a relief rate of 50.0% (0, 100%) on the first day of administration[compared with 0 (0, 50.0%) in the control group ( Z=2.002, P=0.025)].The median duration of dyspnea in the experimental group was nearly 1 day shorter than that in the control group [1.0 d(95% CI: 0.7-1.7 d) vs.1.8 d(95% CI: 1.0-2.5 d), P=0.046].There were no significant difference in hospital stay [6.0(5.0, 8.0) d vs.6.5(5.0, 8.0) d, Z=0.675, P=0.500], oxygen therapy duration [32.0(14.0, 96.3) h vs.39.0 (24.0, 83.2) h, Z=0.094, P=0.925], the recovery rate from clinical symptoms during treatment [(105/106, 99.1%) vs.(96/101, 95.0%)], and recurrence rate [(0/106, 0) vs.(2/101, 2.0%)] between the 2 groups (all P>0.05).However, the above-mentioned four indicators in the experimental group showed a trend of clinical benefits.The quantitative virus detection results showed that the RSV viral load in both groups decreased after treatment compared to before treatment.After 2 days of treatment, the decline rate of RSV viral load from the baseline was 0.90 lg copies/(mL·d) in the experimental group and 0.25 lg copies/(mL·d)in the control group, with a statistically significant difference ( P<0.05).Furthermore, there was no statistically significant difference in the incidence of adverse reactions between the 2 groups ( P>0.05).Importantly, no drug-related serious adverse reactions occurred in both groups. Conclusions:The nebulized inhalation therapy of IFN α1b demonstrates efficacy and safety in treating pediatric RSV associated lower respiratory tract infections.It particularly offers outstanding clinical therapeutic value for severe children.

Objective To re-assess the Meta-analyses/network Meta-analyses on baloxavir marboxil in the treat-ment of influenza,and provide evidence-based reference for clinical use of baloxavir marboxil.Methods Meta-ana-lyses/network Meta-analyses on baloxavir marboxil in the treatment of influenza were retrieved from PubMed,Em-base,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases,with re-trieval time from the inception of each database to December 11,2023.Literatures were screened according to the inclusion and exclusion criteria.Information of included literatures was extracted,and the methodological quality,reporting quality and evidence quality of the included literatures were assessed by assessment of multiple systematic reviews 2(AMSTAR-2)scale,preferred reporting items for systematic reviews and Meta-analyses(PRISMA)statement,as well as grading of recommendations,assessment,development,and evaluation(GRADE)system,respectively.Results A total of 7 Meta-analyses/network Meta-analyses were included.The results showed that in terms of alleviation time of influenza symptoms,the efficacy of baloxavir marboxil was not inferior to oseltamivir,peramivir,and zanamivir.In terms of the decrease in influenza virus titer 48 hours after medication,baloxavir mar-boxil was superior to oseltamivir and zanamivir.In terms of safety,baloxavir marboxil had a lower risk of drug-re-lated adverse events than oseltamivir,and was comparable to peramivir and zanamivir.The overall assessment result of methodological quality of AMSTAR-2 scale was relatively low,with 2 literatures being classified as low-level and 5 as extremely low-level.PRISMA scores ranged 15.5-22.The quality of overall report was moderate.Two lite-ratures were scored＞21,and the reports were relatively complete.There were 5 literatures with scores ranging 15-21,and the reports had certain deficiencies.The GRADE evidence quality grading results showed that among the in-cluded 199 outcome indicators,4 indicators were high-level evidence,49 were moderate-level evidence,118 indica-tors were low-level evidence,and 28 indicators were extremely low-level evidence.Conclusion Baloxavir marboxil is comparable to neuraminidase inhibitors in the alleviation time of influenza symptoms,superior to oseltamivir and zanamisvir in decreasing virus titer,and has a lower risk of adverse drug events(especially nausea)than oseltamivir.

Objective:To investigate the effects of rehabilitation nursing based on knowledge-action framework on compliance behavior and coping styles in patients with chronic respiratory failure (CRF), and provide scientific basis and practical guidance for clinical nursing of patients with CRF.Methods:A historical control study was conducted. A retrospective analysis was performed on the clinical data of patients with CRF in Yiwu Central Hospital between January and April 2024. According to admission time, the patients were divided into the control group (admitted from January to February 2024, received routine rehabilitation nursing) and the study group (admitted from March to April 2024, received rehabilitation nursing based on knowledge-action framework). All patients were intervened for 1 month. The differences in self-care ability, compliance behavior, coping styles, quality of life between the two groups were compared using Exercise of Self-Care Agency Scale (ESCA), Compliance Behavior Questionnaire, Trait Coping Style Questionnaire (TCSQ), St. George′s Respiratory Questionnaire (SGRQ).Results:A total of 60 patients with CRF were included, 30 patients in the study group, with 16 males and 14 females, aged (68.72 ± 4.67) years old; 30 patients in the control group, with 17 males and 13 females, aged (69.21 ± 4.18) years old. Before intervention, there were no significant differences in ESCA score, TCSQ score and SGRQ score between the 2 groups (all P>0.05). After 1 month of intervention, ESCA score in the study group was (134.79 ± 5.62) points, higher than (125.34 ± 5.51) points in the control group, the difference was statistically significant ( t=6.58, P<0.05). The compliance behavior (adherence to medical regimens, reasonable diet, work and rest, regular checking) in the study group were 30, 28, 27, 29 cases, higher than 25, 20, 20, 22 cases in the control group, the differences were statistically significant ( χ2 values were 4.81-6.68, all P<0.05). The positive coping score of TCSQ in the study group was (39.67 ± 4.54) points, higher than (32.19 ± 4.38) points in the control group, and score of negative coping score was (13.55 ± 2.28) points, lower than (18.31 ± 2.43) points in the control group, the differences were statistically significant ( t=6.49, 7.82, both P<0.05). The SGRQ score in the study group was (30.23 ± 3.29) points, lower than (35.87 ± 3.66) points in the control group, the difference was statistically significant ( t=6.28, P<0.05). Conclusions:For patients with CRF, rehabilitation nursing based on knowledge-action framework can effectively improve self-care ability and compliance behavior, form more positive coping styles, improve quality of life.

Objective : To investigate the role of AdipoRon, an adiponectin receptor agonist, in treatment of carbon tetrachloride(CCl4) induced liver fibrosis mice model and the mechanisms. Methods : Forty mice were randomly divided into control group, model group, L-AdipoRon group and H-AdipoRon group, with 10 mice in each group. Hepatic fibrosis was induced by intraperitoneal injection of CCl4solution. The mice in L-and H-AdipoRon groups were given 100 mg/kg and 200 mg/kg AdipoRon by gavage, respectively. The activities of serum aspartate aminotransferase(AST) and alanine aminotransferase(ALT) were detected by biochemical method. Liver histopathological changes and fibrosis were detected by HE staining, Masson staining and Sirius scarlet stain. The protein expression levels of Collagen I, α-smooth muscle actin(α-SMA), matrix metalloproteinase 1(MMP-1) and matrix metalloproteinase inhibitor 1(TIMP-1) in mice liver were detected by Western blot. Lipid deposition in liver were detected by oil red O staining. The percentage(%) of CD68+ iNOS+ positive M1-type macrophages in the liver were detected by immunofluorescence. The expression levels of fatty acid synthetase(Fasn), stearoyl-CoA desaturase 1(Scd1), fatty acid transporter(Cd36), peroxissome proliferator activated receptor-α(Pparα) and carnitine palmitoyl transferase 1α(Cpt1α) in mice liver tissues, as well as M1 macrophage-related genes interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) and M2 macrophage-related genes arginase 1(Arg1), Chil3 chitinase-like 3(Ym-1) were detected by RT-qPCR assay. Results : Compared with model group, in low-dose AdipoRon group and high-dose AdipoRon group, serum ALT and AST activities significantly decreased(P<0.05); liver tissues structure were damaged, liver cells degeneration and inflammatory cells infiltration were improved; collagen fiber deposition was also significantly reduced; the relative expression levels of Collagen I, α-SMA and TIMP-1 proteins were significantly down-regulated(P<0.05), while the relative expression levels of MMP-1 protein were significantly up-regulated(P<0.05); the lipid droplets deposition in livers were significantly reduced. The relative Fasn, Scd1 and Cd36 mRNA expression levels in liver tissues were significantly down-regulated(P<0.05), and the relative Pparα and Cpt1α mRNA expression levels were significantly up-regulated(P<0.05); the percentage(%) of CD68+ iNOS+ positive M1-type macrophages significantly decreased(P<0.05); the relative IL-6 and TNF-α mRNA expression levels significantly decreased(P<0.05), the relative Arg1 and Ym-1 mRNA expression levels were significantly up-regulated(P<0.05). In addition, the improvement effects of high-dose AdipoRon group were better than those of low-dose AdipoRon group(P<0.05). Conclusion AdipoRon can improve the disorder of lipid metabolisms, inhibit the M1 type macrophages polarization, and improve the liver fibrosis in CCl4-induced liver fibrosis mice model.

OBJECTIVES: To evaluate the correlation of mean arterial oxygen tension (PaO₂) during the first 24 h following intensive care unit (ICU) admission with mortality in critically ill patients with acute kidney injury (AKI) and determine the optimal PaO₂ threshold for devising oxygen therapy strategies for these patients. METHODS: We collected the clinical data of ICU patients with AKI from the MIMIC-IV database. Based on the optimal first 24-h PaO₂ threshold determined by receiver operating characteristic (ROC) curve analysis and the Youden index maximization principle, we classified the patients into hyperoxia group (with PaO₂ ≥137.029 mmHg) and hypoxemia group (PaO₂<137.029 mm Hg). Multivariable logistic regression and propensity score matching were used to evaluate the correlation of first 24-h PaO₂ levels with in-hospital mortality of the patients. RESULTS: Among the 18 335 patients, 46.7% were in the hyperoxia group, who had an overall mortality rate of 16.9%. The optimal PaO₂ threshold (137.029 mm Hg) had a sensitivity of 78.3%, a specificity of 63.7%, and an AUC of 0.76 (95% CI: 0.74=0.78). Hyperoxia within the first 24 h after ICU admission was associated with a significantly lower in-hospital mortality (OR=0.78) and 90-day mortality (OR=0.77), particularly in stage 1 AKI patients. A non-linear relationship was identified between PaO₂ and mortality of the patients (P<0.001). Kaplan-Meier survival curves indicated a significantly increased 90-day survival rate in the patients in hyperoxia group (P<0.001), who also had shorter durations of mechanical ventilation, less vasopressor use, and shorter lengths of hospital/ICU stay. CONCLUSIONS Maintenance of a PaO₂ level ≥137.029 mmHg within 24 h after ICU admission may improve clinical outcomes of critically ill AKI patients, which underscores the importance of targeted oxygen delivery in ICU care.
Humans ; Acute Kidney Injury/blood* ; Male ; Female ; Middle Aged ; Intensive Care Units ; Aged ; Oxygen/blood* ; Hospital Mortality ; Partial Pressure ; Adult ; Databases, Factual