OBJECTIVE: To compare the effectiveness of clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation and distal clavicle fractures. METHODS: A clinical data of 90 patients, who underwent clavicular hook plate fixation between January 2014 and June 2023, was retrospectively analyzed. There were 40 patients with distal clavicle fractures (fracture group) and 50 with acromioclavicular joint dislocations (dislocation group). There was no significant difference in the baseline data of gender, age, cause of injury, side of injury, time from injury to operation, and constituent ratio of osteoporosis patients between the two groups ( P>0.05). The time to remove the internal fixators and the occurrence of complications were recorded. Before removing the internal fixator and at 3 months after removing, the visual analogue scale (VAS) score was used to evaluate the degree of pain, and the mobility of the shoulder joint in forward flexion, elevation, and abduction was measured. Before removing the internal fixators, the Constant-Murley score and the University of California, Los Angeles (UCLA) score were used to evaluate the function of the shoulder joint. X-ray films of the shoulder joint were taken during follow-up to observe the occurrence of subacromial osteolysis, acromioclavicular joint osteoarthritis, and distal clavicle bone atrophy. Subgroup comparison was conducted between patients with and without subacromial osteolysis in the two groups. RESULTS: All incisions healed by first intention in both groups. All patients were followed up 1-9 years, with a median of 5 years; the difference in follow-up time between the two groups was not significant ( P>0.05). During follow-up, subacromial osteolysis occurred in 74 cases, including 41 cases of typeⅠand 33 cases of type Ⅱ, distal clavicle bone atrophy in 15 cases, and acromioclavicular joint osteoarthritis in 8 cases. There were significant differences in the removal time of internal fixators, the incidence of bone atrophy, and the incidence of osteoarthritis between the two groups ( P<0.05). There was no significant difference in the incidence of subacromial osteolysis ( P>0.05). Before removing the internal fixators, there was no significant difference in VAS score, UCLA score, and Constant-Murley score between the two groups ( P>0.05), while there were significant differences in shoulder joint range of motion in all directions ( P<0.05). After removing the internal fixators, only the difference in elevation was significant ( P<0.05). Within the group comparison, the VAS score and mobility of shoulder joint in abduction and elevation after removing the internal fixators were significantly superior to those before removing ( P<0.05). In the fracture and dislocation groups, there was only a significant difference in plate length between the subgroup with and without subacromial osteolysis ( P<0.05), while there was no significant difference in the above other indicators ( P>0.05). CONCLUSION Clavicular hook plate is a good choice for treating acromioclavicular dislocation or distal clavicle fractures, but the incidence of subacromial osteolysis is higher, and the degree of bone resorption is more severe in fracture patients. After removal of the internal fixator, the shoulder functions significantly improve. It is recommended to remove the internal fixator as soon as possible within the allowable range of the condition.
Humans ; Clavicle/surgery* ; Acromioclavicular Joint/surgery* ; Bone Plates ; Fracture Fixation, Internal/instrumentation* ; Fractures, Bone/surgery* ; Male ; Retrospective Studies ; Female ; Adult ; Middle Aged ; Treatment Outcome ; Joint Dislocations/surgery* ; Aged ; Range of Motion, Articular ; Young Adult ; Postoperative Complications

Objective:In view of the incomplete evaluation system of actual combat injury treatment ability of grassroots officers and soldiers at present, this paper aims to construct a multi-dimensional evaluation system for combat injury treatment to provide theoretical guidance and evaluation means for warfighting-oriented training on combat injury treatment.Methods:Through literature review, expert consultation, and hierarchical analysis, we determined the factors to evaluate the comprehensive ability of field first aid for combat injuries of grassroots officers and soldiers from the perspective of actual combat, and then established a system for evaluating the actual combat injury treatment ability of grassroots officers and soldiers, in which the weights of factors in each dimension were determined.Results:An evaluation system of actual combat injury treatment ability of grassroots officers and soldiers was formed, which included 4 first-level indices and 16 second-level indices in tactics, strategies, treatment, and protection dimensions.Conclusions:The established evaluation system can provide a reference for actual combat injury treatment training at the grassroots level.

Objective:In view of the incomplete evaluation system of actual combat injury treatment ability of grassroots officers and soldiers at present, this paper aims to construct a multi-dimensional evaluation system for combat injury treatment to provide theoretical guidance and evaluation means for warfighting-oriented training on combat injury treatment.Methods:Through literature review, expert consultation, and hierarchical analysis, we determined the factors to evaluate the comprehensive ability of field first aid for combat injuries of grassroots officers and soldiers from the perspective of actual combat, and then established a system for evaluating the actual combat injury treatment ability of grassroots officers and soldiers, in which the weights of factors in each dimension were determined.Results:An evaluation system of actual combat injury treatment ability of grassroots officers and soldiers was formed, which included 4 first-level indices and 16 second-level indices in tactics, strategies, treatment, and protection dimensions.Conclusions:The established evaluation system can provide a reference for actual combat injury treatment training at the grassroots level.

Objective:To explore the risk factors for osteoporosis in postmenopausal patients with rheumatoid arthritis and establish a prediction model for early identification.Methods:A retrospective analysis was conducted on the clinical data of 128 postmenopausal patients with rheumatoid arthritis who visited Northwest Women′s and Children′s Hospital from May 2021 to December 2023. According to their bone mineral density, the patients were divided into the osteoporosis group (T-score ≤-2.5, n=16) and the non-osteoporosis group (T-score >-2.5, n=112). Clinical data of the two groups were compared. Pearson correlation analysis was used to analyze the correlation of various indicators. Multivariate logistic regression analysis was applied to screen the influencing factors for osteoporosis in postmenopausal patients with rheumatoid arthritis, and a Nomogram model for predicting the risk of osteoporosis in such patients was established. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of the model. Results:The age, Disease Activity Score 28 based on Erythrocyte Sedimentation Rate (DAS28-ESR), β-cross-linked C-telopeptide of type I collagen (β-CTX), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in the osteoporosis group were higher than those in the non-osteoporosis group, while the bone mineral density of lumbar vertebrae t1-4, left hip, right hip, serum calcium, and estradiol (E 2) levels were lower (all P<0.05). Pearson correlation analysis showed that DAS28-ESR was negatively correlated with bone mineral density of lumbar vertebrae t1-4 ( r=-3.026, P=0.002), left hip ( r=-3.409, P<0.001), and right hip ( r=-4.125, P<0.001). Multivariate logistic regression analysis showed that age ( OR=4.697, 95% CI: 2.509-8.795), DAS28-ESR ( OR=4.889, 95% CI: 2.611-9.154), β-CTX ( OR=4.816, 95% CI: 2.572-9.018), LH ( OR=4.998, 95% CI: 2.669-9.357), and FSH ( OR=4.802, 95% CI: 2.565-8.991) were risk factors for osteoporosis in postmenopausal women with rheumatoid arthritis (all P<0.05); bone mineral density of lumbar vertebrae t1-4 ( OR=0.203, 95% CI: 0.108-0.381), left hip ( OR=0.214, 95% CI: 0.114-0.401), right hip ( OR=0.211, 95% CI: 0.113-0.396), serum calcium ( OR=0.199, 95% CI: 0.106-0.372), and E 2 ( OR=0.210, 95% CI: 0.112-0.383) were protective factors (all P<0.05). The Nomogram model for predicting osteoporosis in postmenopausal patients with rheumatoid arthritis had a sensitivity of 0.86(95% CI: 0.73-0.92), a specificity of 0.83(95% CI: 0.72-0.95), and an area under the curve of 0.918(95% CI: 0.865-0.973). Conclusions:Age, DAS28-ESR, β-CTX, LH, FSH, bone mineral density of lumbar vertebrae t1-4, left hip, right hip, serum calcium, and E 2 are related to osteoporosis in postmenopausal patients with rheumatoid arthritis. The established prediction model is helpful for early identification of the risk of osteoporosis.

Objective:To explore the risk factors for osteoporosis in postmenopausal patients with rheumatoid arthritis and establish a prediction model for early identification.Methods:A retrospective analysis was conducted on the clinical data of 128 postmenopausal patients with rheumatoid arthritis who visited Northwest Women′s and Children′s Hospital from May 2021 to December 2023. According to their bone mineral density, the patients were divided into the osteoporosis group (T-score ≤-2.5, n=16) and the non-osteoporosis group (T-score >-2.5, n=112). Clinical data of the two groups were compared. Pearson correlation analysis was used to analyze the correlation of various indicators. Multivariate logistic regression analysis was applied to screen the influencing factors for osteoporosis in postmenopausal patients with rheumatoid arthritis, and a Nomogram model for predicting the risk of osteoporosis in such patients was established. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of the model. Results:The age, Disease Activity Score 28 based on Erythrocyte Sedimentation Rate (DAS28-ESR), β-cross-linked C-telopeptide of type I collagen (β-CTX), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in the osteoporosis group were higher than those in the non-osteoporosis group, while the bone mineral density of lumbar vertebrae t1-4, left hip, right hip, serum calcium, and estradiol (E 2) levels were lower (all P<0.05). Pearson correlation analysis showed that DAS28-ESR was negatively correlated with bone mineral density of lumbar vertebrae t1-4 ( r=-3.026, P=0.002), left hip ( r=-3.409, P<0.001), and right hip ( r=-4.125, P<0.001). Multivariate logistic regression analysis showed that age ( OR=4.697, 95% CI: 2.509-8.795), DAS28-ESR ( OR=4.889, 95% CI: 2.611-9.154), β-CTX ( OR=4.816, 95% CI: 2.572-9.018), LH ( OR=4.998, 95% CI: 2.669-9.357), and FSH ( OR=4.802, 95% CI: 2.565-8.991) were risk factors for osteoporosis in postmenopausal women with rheumatoid arthritis (all P<0.05); bone mineral density of lumbar vertebrae t1-4 ( OR=0.203, 95% CI: 0.108-0.381), left hip ( OR=0.214, 95% CI: 0.114-0.401), right hip ( OR=0.211, 95% CI: 0.113-0.396), serum calcium ( OR=0.199, 95% CI: 0.106-0.372), and E 2 ( OR=0.210, 95% CI: 0.112-0.383) were protective factors (all P<0.05). The Nomogram model for predicting osteoporosis in postmenopausal patients with rheumatoid arthritis had a sensitivity of 0.86(95% CI: 0.73-0.92), a specificity of 0.83(95% CI: 0.72-0.95), and an area under the curve of 0.918(95% CI: 0.865-0.973). Conclusions:Age, DAS28-ESR, β-CTX, LH, FSH, bone mineral density of lumbar vertebrae t1-4, left hip, right hip, serum calcium, and E 2 are related to osteoporosis in postmenopausal patients with rheumatoid arthritis. The established prediction model is helpful for early identification of the risk of osteoporosis.

Objective To observe the effects of different surgical approaches on the complications and tumor markers of patients undergoing radical resection of esophageal cancer.Method A prospective study was conducted on 100 patients with esophageal cancer who underwent radical surgery in our hospital from October 2019 to October 2022.They were randomly divided into an observation group and a control group using a random number table method,with 50 patients in each group,he right thoracic approach was used in the observation group and the left thoracic approach was used in the control group.Perioperative indexes,inflammatory factors[Substance P(SP),hypersensitive C-reactive protein(hs-CRP),interleukin6(IL-6)],tumor markers[cytokeratin 19 fragment antigen(CYFRA21-1),squamous cell carcinoma antigen(SCC-Ag)and carbohydrate antigen 199(CA199)]and lung function of the two groups were compared before and after surgery Indicators[vital capacity(VC),forced vital capacity(FVC),and forced expiratory volume in the first second(FEV1)]and complication rate.Result The operating time,blood loss,indwelling time,hospitalization time,and number of lymph node dissection in the observation group were(247.65±27.33)minutes,(211.82±25.49)ml,(6.97±2.12)days,(16.11±3.81)days,and(19.67±5.21),respectively,which were higher than those in the control group[(217.63±23.69)minutes,(175.67±22.13)ml,(5.43±1.80)days,(12.68±3.24)days,(15.45±4.12)](P＜0.05).On average,there was a significant increase in SP,hs CRP,and IL-6 levels in both groups 3 days after surgery(P＜0.05).The levels of SP,hs CRP,and IL-6 in the observation group were(273.96±35.45)ng/L,(11.35±2.12)mg/L,and(8.19±1.67)p.g/ml,respectively,which were lower than the control group[(298.33±38.42)ng/L,(14.29±2.68)mg/L,(10.35±1.82)pg/ml](P＜0.05);One month after surgery,there was a significant decrease in CYFRA21-1,SCC-Ag,and CA199 in both groups(P＜0.05),and in the observation group,the data of CYFRA21-1,SCC-Ag,and CA199 were(2.59±0.37)μg/L,(45.62±6.18)pg/L and(59.37±6.12)U/ml,respectively,which were lower than those in the control group[(3.12±0.43)μg/L,(60.27±7.35)pig/L,(63.28±6.49)U/ml](P＜0.05);One month after surgery,there was a significant decrease in VC,FVC,and FEV1 in both groups(P＜0.05).However,the VC,FVC,and FEV1 in the observation group were(67.21±8.69)％,(70.33±9.41)％,and(72.88±10.12)％,respectively,which were higher than those in the control group[(54.35±8.27)％,(61.65±8.79)％,(65.37±9.24)％](P＜0.05).There was no significant difference in the incidence of complications between the two groups(P＞0.05).Conclusion Both approaches can effectively treat esophageal cancer.Among them,the right chest approach can significantly improve the effect of lymph node dissection,inhibit inflammatory reactions,reduce tumor marker levels,and have less impact on lung function,without significantly increasing the risk of complications.However,the surgical time,bleeding volume,and postoperative recovery time are relatively long.Therefore,a suitable approach should be selected in clinical practice based on the patient's actual situation.

Objective To analyze the risk factors of lower limb deep vein thrombosis(DVT)after the closed Pilon fracture surgery,and to build a nomograph prediction model.Methods A total of 182 patients with closed Pilon fracture who underwent surgical treatment in our hospital from June 2019 to June 2022 were retrospectively analyzed,according to the occurrence of postoperative DVT,the patients were divided into two groups:43 cases in DVT group and 139 cases in non-DVT group.Univariate and multivariate Logistic regression analysis was applied to screen the risk factors of lower limb DVT after closed Pilon fracture surgery;R software was applied to build a nomograph model for predicting lower limb DVT after closed Pilon fracture surgery,and receiver operating characteristic(ROC)and calibration curve were applied to verify the nomograph model.Results Logistic regression analysis showed that the history of diabetes mellitus,risk assessment of thrombosis as medium and high risk,and postoperative infection were independent risk factors for lower limb DVT after closed Pilon fracture surgery(P＜0.05).The area under the ROC curve was 0.716(95％CI:0.629-0.804).The slope of calibration curve was close to 1,and H-L goodness of fit test x2=2.556,P=0.635.Conclusion The history of diabetes,the result of thrombosis risk assessment as"medium-high risk",and the postoperative infection occurred at the surgical site are independent risk factors for lower limb DVT after closed Pilon fracture surgery.The nomogram prediction model constructed by integrating the above three independent risk factors can effectively predict lower limb DVT after closed Pilon fracture surgery,with high differentiation and consistency.

Objective The aim of this study was to explore the impact of implant robots on the oral func-tion and aesthetic effects of immediate implant patients in the aesthetic area of anterior teeth.Methods A total of 68 patients with single anterior tooth defects admitted to the hospital from January 2021 to January 2023 were enrolled and divided into a study group of 34 cases and a control group of 34 cases randomly.In the study group,anterior tooth immediate implantation was performed with the assistance of an oral implantation robot,while the control group underwent conventional immediate anterior tooth implantation.The implantation accuracy,postopera-tive bite function,aesthetic restoration,and occurrence of complications were compared between the two groups,and complications were all recorded.Results After final restoration,all patients were followed up for 2 years,and the implant success rate was 100%(68/68 cases).The study group exhibited significantly lower postoperative apical point error and implant angle error compared to the control group(P＜0.05).There was no significant differ-ence in speech clarity,bite pressure,and pain intensity between the two groups(P＞0.05).The ratio of implant bite pressure to that of the contralateral homonymous tooth was higher in the study group than in the control group(P＜0.05).The postoperative pink esthetic score(PES)and white esthetic score(WES)in the study group were higher than those in the control group(P＜0.05).There was no statistically significant difference in the incidence of complications between the two groups(P＞0.05).Patient satisfaction in the study group was higher than that in the control group(P＜0.05).Conclusion The use of oral implantation robots for immediate implantation in the aesthetic zone of anterior teeth resulted in higher intraoperative positioning accuracy and yielded favorable outcomes in postoperative restoration of bite function and aesthetics.

Objective:To establish and validate a reliable and sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the detection of 12 ceramides in human plasma.Methods:From October 2021 to October 2022, 438 apparently healthy individuals were enrolled in the Affiliated Hospitals of Zunyi Medical University for reference intervals of 12 ceramides in this population. Plasma samples were collected, and separated using the ACQUITY UPLC BEH C18 (2.1×50 mm, 1.7 μm) column, deuterated isotopes were used as internal standards. The mobile phase is water (containing 0.1% formic acid) and isopropanol: acetonitrile (1∶1, v/v, containing 0.1% formic acid) at a flow rate of 0.4 ml/min with gradient elution. The detection method was established using the Qlife Lab 9000 Plus triple quadrupole mass spectrometer. The performance of the method was evaluated in terms of linearity, the lower limit of quantification, precision, recovery, and stability.Results:The method passed the performance evaluation in terms of linearity, the lower limit of quantification, recovery, precision, and stability. The intra-and inter-batch precision of the 12 ceramides ranged from 1.3% to 14.3%, the correctness was verified by spiked recovery experiments, and the recoveries ranged from 91.9% to 111.0%. The lower limit of quantification ranged from 0.001 to 0.100 μmol/L. Standard curve showed good linearity (correlation coefficient r>0.990). Stability tests showed that the 12 ceramides were stable in the biological matrix and after processing under different conditions for a specified period of time. The corresponding biological reference intervals were established for each of the 12 ceramides: 0.103-0.326 μmol/L for Cer(d18∶1/16∶0), 0.018-0.098 μmol/L for Cer(d18∶1/18∶0), 0.933-3.919 μmol/L for Cer(d18∶1/24∶0), 0.243-1.072 μmol/L for Cer(d18∶1/24∶1), 0.001-0.007 μmol/L for Cer(d18∶1/14∶0), 0.022-0.095 μmol/L for Cer(d18∶1/20∶0), 0.185-0.835 μmol/L for Cer(d18∶1/22∶0), 0.003-0.022 μmol/L for Cer(d18∶0/16∶0), 0.001-0.016 μmol/L for Cer(d18∶0/18∶0), 0.017-0.156 μmol/L for Cer(d18∶0/24∶0), 0.008-0.074 μmol/L for Cer(d18∶0/24∶1), and 0.106-0.721 μmol/L for LacCer(d18∶1/24∶1). Conclusion:Our study shows that the newly established LC-MS/MS method for the determination of 12 ceramides in human plasma is reliable, and suitable for clinical application.

Objective: To investigate the effects of apoptotic bodies (ABs) derived from dental pulp stem cells (DPSCs) on macrophage polarization and inflammation response in vivo. Methods : Human DPSCs were extracted, cultured and identified. Staurosporine was used to apoptosis induction and differential methods were performed for ABs identification. The in vitro cultured macrophages were divided into 3 groups: solvent control, lipopolysaccharide (LPS), and the LPS+ABs. The macrophages were stimulated with LPS to induce inflammation followed by ABs treatment. In the untreated group, macrophages were added with an equal amount of solvent. The specific uptake of ABs by macrophages, the expression level of CD206 and the levels of inflammatory cytokines were analyzed. The mouse models of cutaneous wounds and dextran sulfate sodium (DSS)-induced colitis were established, and the mice were randomly divided into 3 groups: the PBS-treated group, the DPSCs-treated group, and the ABs-treated group. The mice were injected with the same volume of PBS, DPSCs and ABs, respectively. The body weight, histological pathology, the expression levels of CD206 and cytokines, and the extent of tissue regeneration were measured. Results : DPSCs and ABs derived from DPSCs were successfully isolated and characterized. ABs could be taken up by macrophage. While lipopolysaccharide(LPS) induced production of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), ABs significantly reduced the levels of these pro-inflammatory cytokines and increased the expression of transforming growth factor-β (TGF-β) and CD206 (P < 0.01). In the cutaneous inflammatory wound model, the wound closure rate in mice intravenously injected with ABs was significantly accelerated (P < 0.05). The administration of ABs markedly reduced the pro-inflammatory factors levels and increased the CD206+ cell number. In the colitis model, treatment with ABs markedly reduced the loss in bodyweight (P < 0.05), recovered the colon length (P < 0.01), and significantly increased the CD206+ cell number. Conclusion DPSCs-derived ABs could enhance macrophage M2 polarization and attenuate inflammation. Therefore, ABs could be used as a promising cell replacement for inflammatory regulation and tissue regeneration.