Objective:To compare and analyze the clinical efficacy of using a posterior "S" shape incision versus a medial small incision with suture anchors in the treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament (PCL).Methods:A retrospective study was conducted on clinical data from patients with PCL tibial avulsion fractures who met surgical criteria and were treated at Department of Joint 2, Tangshan Second Hospital from March 2021 to May 2023. Among those patients, there were 25 cases classified as Meyers-McKeever type Ⅱ and 41 cases as type Ⅲ. 32 patients who underwent surgery through the posterior "S" shape incision served as the control group; based on matched baseline characteristics, 34 patients who underwent surgery through the medial small incision were selected as the observation group. Both groups received fixation of the avulsion fracture with suture anchors. Surgical indicators, as well as Lysholm scores, International Knee Documentation Committee (IKDC) scores, visual analogue scale (VAS) scores, range of motion (ROM) of the injured knee, the difference in posterior tibial translation between both sides (calculated by measuring the posterior translation on both sides), and the incidence of postoperative complications were collected at 1, 3, and 6 months post-surgery. Comparative analyses were conducted to evaluate postoperative functional recovery. Chi-square tests were used for categorical data comparison, and t-tests were employed for normally distributed continuous data.Results:The observation group had shorter incision lengths ((5.71±1.85) cm), less intraoperative blood loss ((74.87±20.74) mL), and shorter operation times ((48.76±6.46) min) compared to the control group ((12.45±1.52) cm, (120.29±31.12) mL, (61.14±10.23) min), and the differences were statistically significant ( t values were 16.21, 7.02, 5.92, respectively; all P<0.001). At 3 and 6 months post-surgery, the Lysholm ((79.67±3.08), (91.16±2.23) points) and IKDC scores ((84.67±5.08), (93.16±3.23) points) in the observation group were significantly higher than those ((65.29±3.84), (79.52±2.98), (79.29±4.84), (85.32±3.98) points) in the control group, and the differences were statistically significant ( t values were 16.72, 18.04, 4.40, 8.81, respectively; all P<0.001). At 3 and 6 months, the VAS scores ((2.83±0.38), (2.12±0.34) points) in the control group were significantly higher than those ((2.41±0.25), (1.73±0.49) points) in the observation group ( t values were 5.34 and 3.73 respectively, both P<0.001). At 6 months post-surgery, all fractures had healed, in the observation group and control group the ROM ((130.56±5.96)° and (121.45±7.32)°) of the injured knee had increased, and the difference in posterior tibial translation ((1.17±0.61) and (1.94±0.57) mm) had decreased. However, the ROM in the observation group was significantly greater than that in the control group, and the difference in posterior tibial translation was significantly lower in the observation group, with statistically significant differences ( t values were 5.56 and 5.29 respectively; both P<0.001). Conclusions:Compared to the posterior "S" shape incision approach, the medial small incision approach with suture anchors for treating PCL tibial avulsion fractures offers advantages such as reduced trauma, shorter operation time, and less intraoperative blood loss, which is more beneficial for knee joint functional recovery.

Objective:To compare and analyze the clinical efficacy of using a posterior "S" shape incision versus a medial small incision with suture anchors in the treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament (PCL).Methods:A retrospective study was conducted on clinical data from patients with PCL tibial avulsion fractures who met surgical criteria and were treated at Department of Joint 2, Tangshan Second Hospital from March 2021 to May 2023. Among those patients, there were 25 cases classified as Meyers-McKeever type Ⅱ and 41 cases as type Ⅲ. 32 patients who underwent surgery through the posterior "S" shape incision served as the control group; based on matched baseline characteristics, 34 patients who underwent surgery through the medial small incision were selected as the observation group. Both groups received fixation of the avulsion fracture with suture anchors. Surgical indicators, as well as Lysholm scores, International Knee Documentation Committee (IKDC) scores, visual analogue scale (VAS) scores, range of motion (ROM) of the injured knee, the difference in posterior tibial translation between both sides (calculated by measuring the posterior translation on both sides), and the incidence of postoperative complications were collected at 1, 3, and 6 months post-surgery. Comparative analyses were conducted to evaluate postoperative functional recovery. Chi-square tests were used for categorical data comparison, and t-tests were employed for normally distributed continuous data.Results:The observation group had shorter incision lengths ((5.71±1.85) cm), less intraoperative blood loss ((74.87±20.74) mL), and shorter operation times ((48.76±6.46) min) compared to the control group ((12.45±1.52) cm, (120.29±31.12) mL, (61.14±10.23) min), and the differences were statistically significant ( t values were 16.21, 7.02, 5.92, respectively; all P<0.001). At 3 and 6 months post-surgery, the Lysholm ((79.67±3.08), (91.16±2.23) points) and IKDC scores ((84.67±5.08), (93.16±3.23) points) in the observation group were significantly higher than those ((65.29±3.84), (79.52±2.98), (79.29±4.84), (85.32±3.98) points) in the control group, and the differences were statistically significant ( t values were 16.72, 18.04, 4.40, 8.81, respectively; all P<0.001). At 3 and 6 months, the VAS scores ((2.83±0.38), (2.12±0.34) points) in the control group were significantly higher than those ((2.41±0.25), (1.73±0.49) points) in the observation group ( t values were 5.34 and 3.73 respectively, both P<0.001). At 6 months post-surgery, all fractures had healed, in the observation group and control group the ROM ((130.56±5.96)° and (121.45±7.32)°) of the injured knee had increased, and the difference in posterior tibial translation ((1.17±0.61) and (1.94±0.57) mm) had decreased. However, the ROM in the observation group was significantly greater than that in the control group, and the difference in posterior tibial translation was significantly lower in the observation group, with statistically significant differences ( t values were 5.56 and 5.29 respectively; both P<0.001). Conclusions:Compared to the posterior "S" shape incision approach, the medial small incision approach with suture anchors for treating PCL tibial avulsion fractures offers advantages such as reduced trauma, shorter operation time, and less intraoperative blood loss, which is more beneficial for knee joint functional recovery.

Objective:To investigate the value of quantitative parameters of amide proton transfer-weighted (APTw) imaging and dynamic contrast-enhanced (DCE)-MRI for preoperative assessment of human epidermal growth factor receptor 2 (Her-2) gene expression in endometrial cancer (EC).Methods:This research conducted a diagnostic pilot study involving 68 patients with pathologically confirmed EC at the First Hospital of Dalian Medical University from August 2019 to August 2023. Patients were categorized into Her-2-positive group (33 cases) and Her-2-negative group (35 cases) based on postoperative Her-2 gene expression results. Utilizing the APTw and DCE-MRI sequences, quantitative parameters including the asymmetric magnetization transfer ratio (MTR asym) for APTw and the volumetric transfer constant (K trans), plasma volume fraction (V p), extracellular mesenchymal space (V e), and rate constant (K ep) for DCE-MRI were acquired for the lesion site. Statistical differences in the values of each quantitative parameter between the two groups were evaluated using two independent sample t test or Mann-Whitney U test. The study incorporated quantitative parameters and clinicopathological data of patients to identify independent predictors of EC Her-2 gene expression through logistic regression analysis. A diagnostic model was developed using binary logistic regression analysis. The effectiveness of the parameters and diagnostic model was evaluated using receiver operating characteristic curves. DeLong test was used to compare the differences between the areas under the curves (AUC). Results:The study found statistically significant differences in MTR asym, K trans, and V e between the Her-2-positive group and the Her-2-negative group ( Z=2.55, P=0.011; t=-2.03, P=0.047; t=-2.13, P=0.037). However, the differences in V p and K ep were not statistically significant ( Z=0.58, P=0.560; Z=0.19, P=0.849). MTR asym emerged as a significant independent predictor of Her-2 gene expression in EC ( OR=1.016, 95% CI 1.003-1.030, P=0.014). Incorporating MTR asym, K trans, and V e, the diagnostic model yielded an AUC (95% CI) of 0.745 (0.625-0.864). The AUC (95% CI) for MTR asym, K trans, and V e alone were 0.680 (0.551-0.808), 0.623 (0.485-0.760), and 0.656 (0.523-0.789) respectively. The differences in AUC between the diagnostic model and individual predictors MTR asym, K trans, and V e were not found to be statistically significant ( Z=1.40, 1.92, 1.37, P=0.163, 0.055, 0.171). Conclusion:The quantitative parameters of APTw and DCE-MRI sequences can preoperatively assess EC Her-2 gene expression from a different perspective, with MTR asym potentially serving as a valuable independent predictor.

Tirzepatide is the first-in-class dual agonist of glucagon-like peptide-1 (GLP-1) receptor and glucose-dependent insulinotropic peptide (GIP) receptor, which plays a variety of physiological effects by imitating natural GLP-1 and GIP. In the completed large phase III series of clinical studies of SURPASS and SURMOUNT, Tirzepatide has demonstrated excellent effects in decreasing glycosylated hemoglobin, reducing weight, improving blood lipid and other metabolic indicators, and is superior to the currently approved GLP-1 receptor agonist. Gastrointestinal reaction is the most common adverse event of the drug, which is generally mild to moderate, and decreases with continuous administration. On May 13, 2022, Tirzepatide was approved for listing by FDA, the current indication is to improve glycemic control of adult patients with type 2 diabetes (T2D) as an adjunct of diet and exercise. In addition to T2D and obesity, there are also extensive and in-depth studies on other metabolic fields. This paper makes a systematic overview of this.

Objective:To investigate the correlation between fasting plasma glucose (FPG) and new-onset carotid plaque through latent class trajectory models.Methods:A total of 953 observation objects came from the first affiliated hospital of Zhengzhou University in accordance with the inclusion criteria. According to the FPG values of the observed subjects during the annual physical examination from January 2017 to December 2019, the following four different FPG trajectories groups were determined by latent class trajectory modelling tools: the low-stable group, the medium stable group, the medium-high stable group, and the high stable group. Carotid plaque incidence in each group was followed up in 2020 to compare the differences of the cumulative incidences of the four groups. The Cox proportional risk regression model was used to analyze the correlation between different FPG trajectories and new-onset carotid plaque.Results:The incidence of carotid plaque increased with the increase of FPG trajectories by 11.13%, 19.70%, 23.44%, 23.81%, respectively, with significance ( P<0.001). After adjusting gender, age, BMI and other confounding factors with the cox proportional risk regression model, the risk of carotid plaque in the FPG medium stable group, medium and high stable group, high-stable group was still 1.895 (95% CI: 1.296-2.769), 2.273 (95% CI: 1.241-4.161), 2.527 (95% CI: 1.219-5.241) times of the low stable group (all P<0.05). Conclusion:The long-term high FPG levels are independent risk factors for the incidence of carotid plaque, and controlling FPG at a low level steadily can reduce the risk of carotid plaque.

Objective To reduce the perioperative complications of simultaneous pancreas and kidney transplantation (SPK ) and boost the clinical efficacy by exploring its perioperative management in diabetics with end-stage renal disease .Methods Retrospective analysis was performed for the clinical data of 5 diabetics with end-stage renal disease undergoing SPK since 2017 .Results The cold ischemic time of all allografts was under 8 hours .No surgical complications occurred in recipients post-transplantation .Two patients were complicated with hyperkalemia and their serum potassium levels normalized after treatment .One case of bleeding in abdominal cavity was cured conservatively . Renal functions of two patients with delayed renal function post-transplantation gradually recovered after hematodialysis . One case of peritransplant fluid collection recovered after debridement and drainage .Another case of acute left heart failure and cardiac arrest at 45 days post-transplantation resumed normal heart rhythm after rescue .However ,his consciousness could not be restored and his families gave up subsequent treatments . Transplanted kidneys and pancreases of these 4 patients normalized .Follow-up was conducted until March 20 , 2019 . They became insulin and dialysis independent and serum creatinine and blood glucose normalized .Diabetic complications were relieved and their quality-of-life also improved significantly .Conclusions SPK is an effective treatment for diabetics with end-stage renal disease .While maintaining normal serum creatinine and blood glucose , it may liberate patients from insulin dosing and dialytic maintenance ,lower diabetic complications and improve quality-of-life .

Epidermal growth factor receptor (EGFR) is a multi-functional receptor distributed throughout the metazoa. Study on its ligands so far remained mainly on mammals, including how ligands are processed into active forms, their interaction with EGFR, and the signaling pathway they induce. However, in invertebrates, ligands are more divergent among species. Currently, except for Drosophila, less is known about the insect EGFR ligands. Here, we identified two EGFR ligands in Bombyx mori by homology search, domain prediction, analysis of the potential translation initiation sequence and construction of phylogenetic tree, termed as BmEGF-1 and BmEGF-2. BmEGF-1 shows the greatest similarity to Drosophila Spitz and their Rhomboid-recognition motifs are highly identical. BmEGF-2 is a homolog to Drosophila Vein. Then we purified BmEGF-1 extracellular domain expressed in E. coli, and performed pull-down assay with BmEGFR extracellular domain secreted by Sf9 cells. The result confirmed their interaction. Lastly, we found the phosphorylation level of ERK and p38 MAPK was elevated after expression of BmEGF-1 in BmE cells, which suggested that BmEGF-1 is not only able to activate the canonical ERK signaling pathway, but may participate in other cellular processes by inducing p38 MAPK signaling pathway. Our study provides reference to further study of the biological function of BmEGF in silkworm.

Objective To investigate the value of diffusion kurtosis imaging (DKI)quantitative parameters in evaluating patholog-ical grade of cervical squamous cell carcinoma (CSCC).Methods The DKI images of 45 patients with CSCC were analyzed retrospec-tively.According to the results of pathology,22 cases were divided into poorly differentiated group and 23 cases well-moderately dif-ferentiated group.The DKI parameters of two groups were measured by two observers,which included mean kurtosis (MK),axial kurtosis (Ka),radial kurtosis (Kr),fractional anisotropy of kurtosis (FAk),mean diffusivity (MD),axial diffusivity (Da),radial diffusivity (Dr)and fractional anisotropy (FA).The intra-class correlation coefficients (ICC)was used to test the consistency of the parameters measured results on two observers.The two independent samples t test was used to compare the parameters of two groups,and the ROC curve was used to evaluate the effectiveness of each parameter in order to evaluate the poorly differentiated CSCC and find the boundary values.Results The data consistency of two observers were good (ICC>0.75).The MK,Ka and Kr values on poorly differentiated CSCC were greater than that on well-moderately differentiated (P<0.05),the MD,Da and Dr values were less than that on well-moderately differentiated (P<0.05),the FAk and FA values had no difference (P>0.05).Thearea un-der curve (AUC)of MK,Ka,Kr,MD,Da and Dr values to diagnose poorly differentiated CSCC were 0.914,0.831,0.865,0.850, 0.778 and 0.865,respectively.The boundary values of diagnosing poorly differentiated CSCC were MK≥0.973,Ka≥1.075,Kr≥0.823, MD≤0.974μm2/ms,Da≤1.185μm2/ms and Dr≤0.762μm2/ms,respectively.Conclusion DKI can effectively predict the patho-logical grading of CSCC,which has a good clinical application prospects.

Objective To evaluate the feasibility of multi-parameter MRI in diagnosing ovarian endometrial cysts. Methods Pelvic MRI of 68 patients with confirmed pathological diagnosis were retrospectively reviewed. The patients were divided into ovarian endometriosis (35 patients with 42 lesions, group A) and other cystic lesions (33 patients with 38 lesions , group B).The signal intensity value of T1WI, T2WI of cyst fluid and iliopsoas, ADC value, phase values and R2*values were obtained, cyst fluid/iliopsoas ratios (T1R and T2R) were calculated. The non-parametric Mann-Whitney U test was employed to compare parameter values between the two groups. The values of diagnostic performance were analyzed by using receiver operating characteristic curve (ROC). Use the Logistics regression parameters of diagnostic efficacy to select the highest Youden index for the best parameter association after combining the parameters step by step. Results The median of T1R, T2R, ADC, phase, T1R and R2*values for group A were 3.39, 5.28, 1.20×10-3 mm2/s,2.19×10-2, 15.08 Hz respectively, and that of group B were 0.91, 10.85, 2.64×10-3mm2/s,2.67×10-2, 3.01 Hz, respectively. There were statistically significant difference between the two groups (P<0.01).The AUC of T1R, T2R, ADC value, phase values and R*2 value were 0.930, 0.874, 0.891, 0.685 and 0.924 respectively, and there was no difference among them (P>0.05). When combining T1R, ADC value, R2*value together, the Youden index (0.849 7) was highest. Conclusion Combining T1R, ADC and R2* values can provide an effective way to discriminate endometrial ovarian cyst from other ovary cystic lesions.

Objective To study the clinical efficacy of external fixator and combined screwing at iliac crests and pubic symphysis for the treatment of unstable pelvic fractures.Methods From January 2013 to February 2014,12 cases of unstable pelvic fracture were treated at our department.They were 8 men and 4 women,from 32 to 57 years of age (average,42.5 years).Seven cases were caused by a traffic accident,and 5 by falling from a height.By Tile classification,8 cases were type B (including type B1 in 3 cases,type B2 in 3 and type B3 in 2),and 4 cases type C1.Associated injury included shock in 7 cases,bladder injury in one,limb long bone fracture in 6,joint injury in 3,and thoracic and lumbar injury in 4.The interval from injury to operation averaged 4 days,ranging from 12 hours to 7 days.The type B fractures were treated with an external fixator and combined screwing at iliac crests and pubic symphysis while the type C1 fractures with internal fixation with percutaneous S1 sacroiliac screws in addition to what was used for the type B fractures.Results The 12 patients were followed up for 5 to 12 months(average,9 months).No one died in this group.The fractures healed after 8 to 13 weeks (average,11.3 weeks).All the patients recovered normal walking.Superficial infection at the pin hole occurred in 7 cases,but there was no deep infection.Screw loosening was observed in only one case,and no reduction loss,injury to nerves or urinary canal was observed.According to the Majeed criteria,the efficacy was evaluated as excellent in 10 cases,good in one,and moderate in one.Conclusion External fixator and combined screwing at iliac crests and pubic symphysis can restore the stability of anterior pelvic ring,leading to good clinical outcomes.