BACKGROUND:Titanium elastic intramedullary nailing for the treatment of significantly displaced midshaft clavicle fractures has the characteristics of minimally invasive and elastic fixation.The displacement of the fracture is closely related to the later function.However,there are few studies on the three-dimensional displacement analysis of the fracture ends before surgery and after intramedullary fixation such as titanium elastic intramedullary nailing.OBJECTIVE:To explore the three-dimensional displacement of fracture ends after midshaft clavicle fracture and fixation with titanium elastic intramedullary nails,and to analyze the risk factors.METHODS:A total of 91 patients with midshaft clavicle fracture(fracture end shortening ≥15 mm)admitted to Wendeng Orthopedic Hospital of Shandong Province from April 2019 to April 2024 were selected,including 57 males and 34 females,aged(51.73±10.21)years old.All patients received closed reduction and internal fixation with titanium elastic intramedullary nail.CT scans of the affected clavicle were performed before and on the first day after surgery.The CT data were imported into Mimics software for modeling.The length of the clavicle,lateral displacement of the fracture end,and rotation of the distal end of the fracture along the X,Y,and Z axes were measured and recorded before and after surgery.Pearson correlation coefficient was used for correlation analysis of various parameters,and generalized linear regression was used to evaluate risk factors.RESULTS AND CONCLUSION:(1)Preoperatively,the variable that increased the risk of lateral displacement was the number of comminuted bone fragments,the variable that increased the risk of shortening displacement was male patients,and the variable that increased the risk of Z-axis rotation was the left limb.Shortening displacement was significantly positively correlated with lateral displacement(r=0.715,P＜0.001);shortening displacement was significantly positively correlated with X-axis rotation displacement and Y-axis rotation displacement(r=0.265,P=0.028;r=0.303,P=0.011);lateral displacement was significantly positively correlated with Y-axis rotation and Z-axis rotation(r=0.258,P=0.032;r=0.250,P=0.038);X-axis rotation was significantly positively correlated with Y-axis rotation(r=0.382,P=0.001),and Z-axis rotation was significantly positively correlated with Y-axis rotation(r=0.280,P=0.020).(2)Postoperatively:The number of scapula fractures and comminuted bone fragments were variables that increased the risk of postoperative shortening and lateral displacement:Preoperative X-,Y-,and Z-axis rotation displacements were risk variables that increased postoperative X-,Y-,and Z-axis rotation displacements,respectively.Postoperative lateral displacement was significantly positively correlated with postoperative shortening and displacement(r=0.584,P=0.000),and postoperative lateral displacement was also significantly positively correlated with postoperative Y axis rotation and Z axis rotation(r=0.360,P=0.002;r=0.250,P=0.038).Postoperative Y axis rotation was significantly positively correlated with postoperative Z axis rotation(r=0.248,P=0.040).(3)The results showed that the three-dimensional displacement of the clavicle end before and after surgery was affected by many factors,especially the number of comminuted bone fragments,scapula fractures,gender,and original rotation displacement.At the same time,there were complex correlations between various displacements,especially the correlation between shortening displacement and lateral displacement was the strongest.

BACKGROUND:Titanium elastic intramedullary nailing for the treatment of significantly displaced midshaft clavicle fractures has the characteristics of minimally invasive and elastic fixation.The displacement of the fracture is closely related to the later function.However,there are few studies on the three-dimensional displacement analysis of the fracture ends before surgery and after intramedullary fixation such as titanium elastic intramedullary nailing.OBJECTIVE:To explore the three-dimensional displacement of fracture ends after midshaft clavicle fracture and fixation with titanium elastic intramedullary nails,and to analyze the risk factors.METHODS:A total of 91 patients with midshaft clavicle fracture(fracture end shortening ≥15 mm)admitted to Wendeng Orthopedic Hospital of Shandong Province from April 2019 to April 2024 were selected,including 57 males and 34 females,aged(51.73±10.21)years old.All patients received closed reduction and internal fixation with titanium elastic intramedullary nail.CT scans of the affected clavicle were performed before and on the first day after surgery.The CT data were imported into Mimics software for modeling.The length of the clavicle,lateral displacement of the fracture end,and rotation of the distal end of the fracture along the X,Y,and Z axes were measured and recorded before and after surgery.Pearson correlation coefficient was used for correlation analysis of various parameters,and generalized linear regression was used to evaluate risk factors.RESULTS AND CONCLUSION:(1)Preoperatively,the variable that increased the risk of lateral displacement was the number of comminuted bone fragments,the variable that increased the risk of shortening displacement was male patients,and the variable that increased the risk of Z-axis rotation was the left limb.Shortening displacement was significantly positively correlated with lateral displacement(r=0.715,P＜0.001);shortening displacement was significantly positively correlated with X-axis rotation displacement and Y-axis rotation displacement(r=0.265,P=0.028;r=0.303,P=0.011);lateral displacement was significantly positively correlated with Y-axis rotation and Z-axis rotation(r=0.258,P=0.032;r=0.250,P=0.038);X-axis rotation was significantly positively correlated with Y-axis rotation(r=0.382,P=0.001),and Z-axis rotation was significantly positively correlated with Y-axis rotation(r=0.280,P=0.020).(2)Postoperatively:The number of scapula fractures and comminuted bone fragments were variables that increased the risk of postoperative shortening and lateral displacement:Preoperative X-,Y-,and Z-axis rotation displacements were risk variables that increased postoperative X-,Y-,and Z-axis rotation displacements,respectively.Postoperative lateral displacement was significantly positively correlated with postoperative shortening and displacement(r=0.584,P=0.000),and postoperative lateral displacement was also significantly positively correlated with postoperative Y axis rotation and Z axis rotation(r=0.360,P=0.002;r=0.250,P=0.038).Postoperative Y axis rotation was significantly positively correlated with postoperative Z axis rotation(r=0.248,P=0.040).(3)The results showed that the three-dimensional displacement of the clavicle end before and after surgery was affected by many factors,especially the number of comminuted bone fragments,scapula fractures,gender,and original rotation displacement.At the same time,there were complex correlations between various displacements,especially the correlation between shortening displacement and lateral displacement was the strongest.

Lung cancer constitutes the most prevalent and lethal malignant tumor in China. Approximately 85% of lung cancer diagnoses correspond to the non-small cell histological subtype [non-small cell lung cancer (NSCLC)]. Despite surgery being the mainstay for early-stage disease, postoperative recurrence remains high and adjuvant chemotherapy offers limited benefit. In recent years, targeted therapy has demonstrated substantial advantages in driver mutation-positive NSCLC. To this end, the Lung Cancer Medical Education Committee of the Chinese Medical Education Association developed guidelines based on a systematic review of evidence through November 2025, using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach and a modified Delphi method. Focusing on epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), and addressing ROS proto-oncogene 1 (ROS1), B-Raf proto-oncogene serine/threonine kinase (BRAF) V600E mutation, and mesenchymal-epithelial transition factor (MET) exon 14 (METex14) skipping, the guideline covers molecular testing, neoadjuvant/adjuvant therapy, perioperative strategies, minimal residual disease monitoring, and postoperative surveillance. It defines testing requirements, specifies stage-directed and subtype-specific treatments, and standardizes minimal residual disease monitoring. These recommendations emphasize precision and feasibility to improve survival and quality of life.

Objective:This study aims to investigate the feasibility and safety of implanting leadless pacemakers in the low septum and its impact on cardiac electrical synchronization.Methods:A total of 36 patients who received leadless pacemaker implantation at Fuwai Central China Cardiovascular Hospital from January 2021 to August 2023 were included in this study.According to implantation sites of leadless pacemakers,patients were divided into mid-septal group(n=16)and low-septal group(n=20).The clinical characteristics and cardiac electrical synchronization were compared between the two groups.Results:There were 21 male patients,mean age was(68±13)years old.There was no statistical difference in the type of brady-arrhythmia between the two groups(P=0.73).There were 61 implant attempts in these 36 patients,and there was no significant difference in the number of attempts,procedure time,and pacemaker parameters between the two groups,but the average procedure time tended to be shorter in the low-septal group([84±37]minutes vs.[105±35]minutes,P=0.09).In terms of electrical synchronization,there was no statistical difference in QRS duration between the low-septal group and the mid-septal group([162.0±21.1]ms vs.[174.0±14.8]ms,P=0.20).There were no vascular puncture complications,cardiac perforation,or pericardial tamponade during the procedure.There were no complications and readmissions related to the leadless pacemaker during follow-up period.Conclusions:Our results show that the implantation of a leadless pacemaker in the low ventricular septum is safe and effective,has a similar impact on cardiac electrical synchronization as mid-septal pacing.

Objective:To investigate the effect of IL-37 on oxidized low-density lipoprotein(ox-LDL)-induced calcification in human aortic vascular smooth muscle cells(HA-SMCs)and the influence of toll-like receptor(TLR)/nuclear transcription factor(NF-κB)pathway and osteogenic transcription factors,to demonstrate the mechanism of IL-37 in calcification.Methods:The calcifica-tion model of HA-SMCs was treated with ox-LDL,and the model group was pretreated with 100 ng/ml IL-37 or 100 μmol/L PDTC.CCK8 was used to detect cell proliferation activity;flow cytometry was used to detect apoptosis.Alizarin red staining was used to detect calcified nodules.The mRNA levels of smooth muscle actin(SMA),bone morphogenetic protein(BMP2)and IL-37 were detected by qPCR;mRNA and protein expression levels of TLR,NF-κB,p-NF-κB,RUNX-associated transcription factor(RUNX2),alkaline phosphatase(ALP),SMA and smooth muscle 22α(SM22α)were detected by qPCR and Western blot.Results:Compared with the control group,ox-LDL treatment enhanced cellular proliferation activity and was concentration-dependent(P<0.05),and apoptosis rate was increased,while the model group produced significant orange-red calcified nodules,up-regulated mRNA and protein expres-sion of inflammatory factors such as TLR and NF-κB,up-regulated mRNA expression of IL-37,RUNX2,BMP2,ALP,while SMA and SM22α mRNA expressions were decreased,and the protein expressions of p-NF-κB and RUNX2 were increased significantly;compared with the modeling group,the IL-37 pretreatment group showed lower viability and decreased apoptosis rate(P<0.05),sig-nificantly reduced calcified nodules,and the mRNA and protein expression of inflammatory factors such as TLR and NF-κB,and mRNA of RUNX2,BMP2,ALP expressions were downregulated,mRNA expression of SMA and SM22α were elevated,and protein expressions of p-NF-κB and RUNX2 were significantly decreased,showing the same trend as the inhibitor PDTC group in cytokines.Conclusion:IL-37 inhibits calcification of HA-SMCs,which may be related to the inhibition of NF-κB pathway and osteogenic pheno-type transformation.

Objective To evaluate the productivity,quality,and thematic focus of Chinese-language medical research from various regions and institutions across the Inner Mongolia Autonomous Region between 2018 and 2022,providing guidance for the future development of regional medical science and technology.Methods Data were extracted from the China National Knowledge Infrastructure(CNKI)database,The extracted Chinese-language medical literature affiliated with institutions in Inner Mongolia from 2018 to 2022 was analyzed using bibliometric indicators:publication volume,journal quality,research disciplinary distribution,and regional/institutional contributions.Results A total of 17,098 articles were published over five years,with an average annual output of 3 420 papers.Core journals accounted for 30.96%,including 2.82% in the Chinese Science Citation Database(CSCD),9.14% in Peking University Core Journals,and 31.30% in science and technology core journals.General journals accounted for 68.14% .The predominant research focus was"medicine and health"(90.90% ),with Chinese medicine(22.03% ),internal medicine(16.98%),and oncology(16.46%)being the most represented disciplines.Regionally,Ho-hhot(47.73%),Baotou(24.93%),and Chifeng(8.79%)had the highest output.Most publications originated from tertiary hospitals,general hospitals,and higher education institutions.Among the top 20 contributing institutions,Inner Mongolia Medi-cal University(2 220 articles),its affiliated hospital(1 840 articles),and the Inner Mongolia People's Hospital(1 627 arti-cles)ranked on the top in publication volume.Conclusion The quality of the output research in Inner Mongolia requires further improvement,with notable regional disparities.It is recommended to strengthen research management,optimize resource alloca-tion,and promote technological innovation to address these challenges.

Objective To investigate the effect of KH-type splicing regulatory protein(KHSRP)on the malignant biological behavior of lung adenocarcinoma(LUAD)by targeting the Janus kinase 1(JAK1)/signal transducer and activator of transcription 3(STAT3)signaling axis.Methods Clinical data were collected for 64 patients with LUAD,diagnosed at Huaihe Hospital from January 2017 to December 2018.Expression levels of KHSRP were detected in LUAD tissues and adjacent tissues by immunohistochemical staining.KHSRP gene expression was also detected in LUAD cell lines(SPC-A1,H1975,CL1-5,PC-9,Calu-3,H446)and normal human bronchial epithelial cells using quantitative reverse transcription-polymerase chain reaction.KHSRP expression in SPC-A1,H1975,PC-9,and Calu-3 cells was manipulated by lentivirus transfection.The effects of KHSRP on the proliferation,migration,and invasion of LUAD cells were detected by Cell Counting Kit-8 and Transwell assays.The effects of KHSRP overexpression and knockdown were also investigated in a mouse xenograft tumor model,and JAK/STAT signaling pathway proteins were detected by Western blot.Rescue experiments were conducted to verify if KHSRP promoted the malignant progression of LUAD cells by regulating the JAK1/STAT3 signaling pathway.Results KHSRP expression was significantly higher in LUAD tissues compared with adjacent tissues(P＜0.05).Overexpression of KHSRP significantly promoted the proliferation,migration,and invasion of LUAD cells in vitro(P＜0.05).KHSRP also promoted LUAD cell xenograft tumor growth and lung nodule metastasis in nude mice in vivo(P＜0.01).KHSRP knockdown significantly decreased the levels of JAK1,phospho-JAK1,and STAT3 in the JAK/STAT signaling pathway,while the situation was reversed following KHSRP overexpression(P＜0.05).Rescue experiments showed that KHSRP reversed the inhibitory effect of knockdown(P＜0.05).Conclusions KHSRP targets the JAK1/STAT3 signaling pathway and acts as an oncogene in LUAD.

Objective A Cobb angle prediction model for adolescent idiopathic scoliosis(AIS)based on three-point mechanical data from three-dimensional(3D)-printed orthotics and various machine learning algorithms was developed,so as to provide an innovative,radiation-free method for early clinical screening and monitoring of AIS.Methods Clinical data from AIS patients and mechanical data from 3D-printed orthotics were collected to construct a comprehensive dataset with features such as gender,age,disease type,weight,and Risser score.Six algorithms,namely,random forest,support vector regression,gradient boosting regressor,extreme gradient boosting,lightgbm,and catboost,were used to construct and evaluate the performance of Cobb angle prediction models.Results The gradient boosting regressor model had the best performance on several evaluation metrics,achieving a precision rate of 0.937,recall rate of 0.818,F1-score of 0.949,and an area under curve(AUC)value of 0.843.In the validation set,the model's predictions reached an accuracy rate of 0.942,fitting well with the actual Cobb values.Conclusions The Cobb angle prediction model based on mechanical data and machine learning effectively avoids the radiation risks associated with traditional full-spine X-ray examinations in early clinical screening.It provides a non-invasive assessment for AIS patients,enhancing the safety and efficiency of screening and monitoring,and offering a powerful decision-making tool for clinicians,with a great clinical significance.

Objective To investigate the effect of KH-type splicing regulatory protein(KHSRP)on the malignant biological behavior of lung adenocarcinoma(LUAD)by targeting the Janus kinase 1(JAK1)/signal transducer and activator of transcription 3(STAT3)signaling axis.Methods Clinical data were collected for 64 patients with LUAD,diagnosed at Huaihe Hospital from January 2017 to December 2018.Expression levels of KHSRP were detected in LUAD tissues and adjacent tissues by immunohistochemical staining.KHSRP gene expression was also detected in LUAD cell lines(SPC-A1,H1975,CL1-5,PC-9,Calu-3,H446)and normal human bronchial epithelial cells using quantitative reverse transcription-polymerase chain reaction.KHSRP expression in SPC-A1,H1975,PC-9,and Calu-3 cells was manipulated by lentivirus transfection.The effects of KHSRP on the proliferation,migration,and invasion of LUAD cells were detected by Cell Counting Kit-8 and Transwell assays.The effects of KHSRP overexpression and knockdown were also investigated in a mouse xenograft tumor model,and JAK/STAT signaling pathway proteins were detected by Western blot.Rescue experiments were conducted to verify if KHSRP promoted the malignant progression of LUAD cells by regulating the JAK1/STAT3 signaling pathway.Results KHSRP expression was significantly higher in LUAD tissues compared with adjacent tissues(P＜0.05).Overexpression of KHSRP significantly promoted the proliferation,migration,and invasion of LUAD cells in vitro(P＜0.05).KHSRP also promoted LUAD cell xenograft tumor growth and lung nodule metastasis in nude mice in vivo(P＜0.01).KHSRP knockdown significantly decreased the levels of JAK1,phospho-JAK1,and STAT3 in the JAK/STAT signaling pathway,while the situation was reversed following KHSRP overexpression(P＜0.05).Rescue experiments showed that KHSRP reversed the inhibitory effect of knockdown(P＜0.05).Conclusions KHSRP targets the JAK1/STAT3 signaling pathway and acts as an oncogene in LUAD.

Recent studies have shown that the physiological homeostasis of oral mucosal cells is regulated by the circadian clock.Dis-ruption or dysfunction of the circadian clock is closely associated with the development of oral squamous cell carcinoma(OSCC).Research based on the circadian clock offers a novel perspective on the pathogenesis and therapeutic strategies for OSCC.However,there is current-ly limited research on this topic,and people generally have insufficient understanding and recognition of the circadian clock.Given the complexity and challenges of circadian clock which is the fourth dimension of medical research,we organize relevant experts based on summarizing the current research results of circadian clock in the pathogenesis and precision diagnosis and treatment of OSCC,combining the scientific principles of the circadian clock's role and their long-term research experience,then summarizes and recommends the con-sensus opinions for the research of circadian clock in the pathogenesis mechanism and precision diagnosis and treatment of human OSCC,with the hope of providing guidance for the basic research and clinical application of circadian clock or circadian rhythm in the pathogene-sis mechanism and precision diagnosis and treatment of oral and maxillofacial squamous cell carcinoma.