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 influence of Gegen Qinlian Decoction(GQD)on anti-inflammatory,anti-oxidative stress activities and related pathways in rats with non-alcoholic steatohepatitis(NASH),and to clarify its mechanism.Methods:NASH rat model was established with methionine choline deficiency feed,and blank group,model group,positive group and different doses of GQD administration groups were set.By analyzing rat serum inflammation indicators,liver tissue antioxidant capacity indicators,liver tissue pathological sections,and combined with Western blot and RT-qPCR technology,anti-inflammatory and anti-oxidative stress mechanism of GQD on NASH rats were finally clarified.Results:Each dose of GQD could significantly reduce serum levels of IL-6,IL-8,IL-10,IFN-α and IFN-β in NASH model rats.GQD medium and high doses groups were statistically significant compared with model group and positive group;each dose of GQD could significantly reduce contents of ALT,AST and MDA in liver tissue of NASH rats,and significantly increase SOD,GPX,T-AOC contents at the same time;Western blot and RT-qPCR results showed that GQD could significantly reduce expressions of PI3K,AKT,p-FOXO1 protein and mRNA in liver tissue of NASH model,significantly increase expressions of FOXO1,SIRT1,Catalase protein and mRNA,and compared with positive group at high doses,it was also statistically significant.Conclusion:GQD can treat NASH by regulating PI3K/AKT/FOXO1 signaling pathway and exerting anti-inflammatory and anti-oxidative stress effects.

Objective:To investigate influence of Gegen Qinlian Decoction(GQD)on anti-inflammatory,anti-oxidative stress activities and related pathways in rats with non-alcoholic steatohepatitis(NASH),and to clarify its mechanism.Methods:NASH rat model was established with methionine choline deficiency feed,and blank group,model group,positive group and different doses of GQD administration groups were set.By analyzing rat serum inflammation indicators,liver tissue antioxidant capacity indicators,liver tissue pathological sections,and combined with Western blot and RT-qPCR technology,anti-inflammatory and anti-oxidative stress mechanism of GQD on NASH rats were finally clarified.Results:Each dose of GQD could significantly reduce serum levels of IL-6,IL-8,IL-10,IFN-α and IFN-β in NASH model rats.GQD medium and high doses groups were statistically significant compared with model group and positive group;each dose of GQD could significantly reduce contents of ALT,AST and MDA in liver tissue of NASH rats,and significantly increase SOD,GPX,T-AOC contents at the same time;Western blot and RT-qPCR results showed that GQD could significantly reduce expressions of PI3K,AKT,p-FOXO1 protein and mRNA in liver tissue of NASH model,significantly increase expressions of FOXO1,SIRT1,Catalase protein and mRNA,and compared with positive group at high doses,it was also statistically significant.Conclusion:GQD can treat NASH by regulating PI3K/AKT/FOXO1 signaling pathway and exerting anti-inflammatory and anti-oxidative stress effects.

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.

BACKGROUND: The effect of arteriosclerotic intracranial arterial vessel wall enhancement (IAVWE) on downstream collateral flow found in vessel wall imaging (VWI) is not clear. Regardless of the mechanism underlying IAVWE on VWI, damage to the patient's nervous system caused by IAVWE is likely achieved by affecting downstream cerebral blood flow. The present study aimed to investigate the effect of arteriosclerotic IAVWE on downstream collateral flow. METHODS: The present study recruited 63 consecutive patients at the Second Hospital of Hebei Medical University from January 2021 to November 2021 with underlying atherosclerotic diseases and unilateral middle cerebral artery (MCA) M1-segment stenosis who underwent an magnetic resonance scan within 3 days of symptom onset. The patients were divided into 4 groups according to IAVWE and the stenosis ratio (Group 1, n = 17; Group 2, n = 19; Group 3, n = 13; Group 4, n = 14), and downstream collateral flow was analyzed using three-dimensional pseudocontinuous arterial spin labeling (3D-pCASL) and RAPID software. The National Institutes of Health Stroke Scale (NIHSS) scores of the patients were also recorded. Two-factor multivariate analysis of variance using Pillai's trace was used as the main statistical method. RESULTS: No statistically significant difference was found in baseline demographic characteristics among the groups. IAVWE, but not the stenosis ratio, had a statistically significant significance on the late-arriving retrograde flow proportion (LARFP), hypoperfusion intensity ratio (HIR), and NIHSS scores ( F = 20.941, P <0.001, Pillai's trace statistic = 0.567). The between-subject effects test showed that IAVWE had a significant effect on the three dependent variables: LARFP ( R2 = 0.088, F = 10.899, P = 0.002), HIR ( R2 = 0.234, F = 29.354, P <0.001), and NIHSS ( R2 = 114.339, F = 33.338, P <0.001). CONCLUSIONS: Arteriosclerotic IAVWE significantly reduced downstream collateral flow and affected relevant neurological deficits. It was an independent factor affecting downstream collateral flow and NIHSS scores, which should be a focus of future studies. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR2100053661.
Humans ; Constriction, Pathologic/pathology* ; Magnetic Resonance Imaging/methods* ; Middle Cerebral Artery/pathology* ; Tomography, X-Ray Computed

Objective:To investigate the occurrence of inadequate specimens of thyroid nodule fine needle non-aspiration cytology and its possible influencing factors.Methods:Clinical data of 1571 patients with FNAC of 1638 thyroid nodules were analyzed retrospectively, according to whether the FNAC specimen were adequate or not, all cases were divided into adequate group and inadequate group. The related influencing factors on inadequate specimen were analyzed by univariate analysis and multivariate logistic regression.Results:Inadequate specimens occurred in 301 of 1638 (18.4%) nodules. Logistic regression analysis showed that the influencing factors of overall specimen adequacy included operator experience ( P=0.00) , nodules size≤0.5 cm ( P=0.00) , eggshell calcification ( P=0.00) , and cystic ( P=0.00) . Excluding the impact of operator experience, the influencing factors of specimen adequacy included nodules size≤0.5 cm ( P=0.00) , eggshell calcification ( P=0.00) , and cystic ( P=0.00) . Conclusions:Operator experience, nodules size≤0.5 cm, cystic, together with eggshell calcification are influencing factors of specimen adequacy of fine needle non-aspiration cytology in thyroid nodules. For experienced operators, what restrict specimen adequacy is the limitation of FNAC technique. For inexperienced operators, what restrict specimen adequacy is operator’s experience.

Objective:To analyze the effects of different courses of hyperbaric oxygen combined with sertraline on sleep disorders and serum neurologic injury factors in patients after cerebral hemorrhage.Methods:A total of 120 patients with sleep disorders after cerebral hemorrhage were divided into control group ( n=60) and observation group ( n=60) by random number table method. The control group was treated with sertraline only, while the observation group was treated with hyperbaric oxygen on the basis of the treatment in the control group. The sleep quality, clinical efficacy, the levels of serum neuron-specific enolase (NSE), intercellular adhesion molecule-1 (ICAM-1), and tumor necrosis factor-α (TNF-α) before and 10, 20, and 30 d after treatment were compared between the two groups. Results:The scores of Pittsburgh sleep quality index (PSQI) of the observation group were significantly lower than those of the control group at every time point of treatment ( P<0.05); the total sleep time, total deep sleep time, total light sleep time, and rapid eye movement (REM) sleep time of the observation group were significantly longer than those of the control group ( P<0.05); and the sleep latency of the observation group was significantly shorter than that of the control group ( P<0.05). With the prolongation of the treatment course, the PSQI scores of both groups showed decreasing trends ( P<0.05); the total sleep time, total deep sleep time, total light sleep time, and REM sleep time of both groups tended to prolong ( P<0.05); and the sleep latency tended to be shorter ( P<0.05). The total effective rate of the observation group was significantly higher than that of the control group at 10, 20, and 30 d after treatment ( P<0.05). With the prolongation of the treatment course, the total effective rates of the two groups showed increasing trends ( P<0.05); the levels of serum NSE, ICAM-1, and TNF-α in the observation group were significantly lower than those in the control group at every time point of treatment ( P<0.05); and with the prolongation of the treatment course, the above indicators of the two groups showed decreasing trends ( P<0.05). Conclusion:Hyperbaric oxygen therapy combined with sertraline can improve the sleep quality and clinical efficacy of patients after cerebral hemorrhage with sleep disorders.

Objective:To analyze the effects of different courses of hyperbaric oxygen combined with sertraline on sleep disorders and serum neurologic injury factors in patients after cerebral hemorrhage.Methods:A total of 120 patients with sleep disorders after cerebral hemorrhage were divided into control group ( n=60) and observation group ( n=60) by random number table method. The control group was treated with sertraline only, while the observation group was treated with hyperbaric oxygen on the basis of the treatment in the control group. The sleep quality, clinical efficacy, the levels of serum neuron-specific enolase (NSE), intercellular adhesion molecule-1 (ICAM-1), and tumor necrosis factor-α (TNF-α) before and 10, 20, and 30 d after treatment were compared between the two groups. Results:The scores of Pittsburgh sleep quality index (PSQI) of the observation group were significantly lower than those of the control group at every time point of treatment ( P<0.05); the total sleep time, total deep sleep time, total light sleep time, and rapid eye movement (REM) sleep time of the observation group were significantly longer than those of the control group ( P<0.05); and the sleep latency of the observation group was significantly shorter than that of the control group ( P<0.05). With the prolongation of the treatment course, the PSQI scores of both groups showed decreasing trends ( P<0.05); the total sleep time, total deep sleep time, total light sleep time, and REM sleep time of both groups tended to prolong ( P<0.05); and the sleep latency tended to be shorter ( P<0.05). The total effective rate of the observation group was significantly higher than that of the control group at 10, 20, and 30 d after treatment ( P<0.05). With the prolongation of the treatment course, the total effective rates of the two groups showed increasing trends ( P<0.05); the levels of serum NSE, ICAM-1, and TNF-α in the observation group were significantly lower than those in the control group at every time point of treatment ( P<0.05); and with the prolongation of the treatment course, the above indicators of the two groups showed decreasing trends ( P<0.05). Conclusion:Hyperbaric oxygen therapy combined with sertraline can improve the sleep quality and clinical efficacy of patients after cerebral hemorrhage with sleep disorders.

Objective: To investigate the clinical efficacy of reduced port laparoscopic radical resection on colorectal cancer. Methods: Clinical data of 46 patients with colorectal cancer undergoing reduced port laparoscopic radical resection were retrospectively analyzed. Results: All of 46 patients underwent laparoscopic surgery, with an average operation time of 206 minutes, an average intraoperative bleeding of 56 ml, an average number of lymph nodes removement of 12/case (ranged from 6 to 21). One case had incision infection, 2 cases had anastomotic leakage, and they all recovered and discharged after treatment. Conclusions Reduced port laparoscopic radical resection of colorectal cancer is safe and feasible, reduces labor costs, and has a good clinical efficacy, which is worthy of clinical promotion.

Objective To evaluate enhanced recovery after surgery (ERAS) in the treatment of cholecystolithiasis complicated with extra hepaticbile duct stones by laparoscopy and choledochoscopy.Methods Patients were divided into ERAS and control groups according to the inclusion and exclusion criteria.Patients in ERAS group received perioperative management according to enhanced recovery rehabilitation program.Clinical and laboratory results were compared between the two groups.Results 46 patients were enrolled into ERAS group and 40 patients into control group.The ERAS group had shorter time of first postoperative exhaust,first postoperative oral intake,getting out of bed,removal of abdominal drainage tube,postoperative hospital stay (respectively t =-3.658,-15.552,-8.864,-6.673,-6.036,all P ＜ 0.05),less pain in 6,12,24 and 48 hours after operation (F =8.284,P =0.000),and lower complication rate (x2 =4.172,P =0.043),lower C-reactive protein (CRP) level from pre-operation to postoperative day 1,3 and 5 (F =6.692,P =0.013),higher level of prealbumin (PA) from preoperation to postoperative day 1,3 and 5 (F =21.191,P =0.000),lower hospitalization costs (t =-0.592,P =0.004).Conclusion The application of ERAS in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones by laparoscopy combined with choledochoscopy is conducive to rapid postoperative recovery of patients.