Objective To compare the early clinical efficacy of arthroscopic bridge suture combined with strengthening thread fixation for posterior cruciate ligament(PCL)tibial insertion avulsion frac-tures and traditional open double-row anchor suture fixation,and to explore a safe,effective,and min-imally invasive reduction and fixation method for PCL tibial insertion fractures in knee joint under ar-throscopy.Methods This study was a retrospective study.Sixty patients with PCL tibial insertion frac-tures(Meyers&McKeever types II-IV)and admitted to the Department of Orthopedics of Kunming Hospital of Traditional Chinese Medicine between June 2021 and June 2023 were included,and ran-domly divided into a traditional group(age:39.56±3.24 years,male/female:16/14)and a minimally in-vasive group(age:40.32±4.38,male/female:18/12),each of 30,according to their admission or-der.All patients were of Grade III positive in the drawer test before surgery.The traditional group un-derwent posterior medial inlay incision,reduction under direct vision and double-row anchor suture fix-ation,while the minimally invasive group underwent reduction under total arthroscopy,suture-bridge suture at the tendon-bone junction of PCL,and one anchor suture placed at the femoral insertion of PCL,with the anchor suture line serving as the reinforcing suture.Then,the anchor and suture-bridge suture lines were respectively pulled into the two tunnels behind the tibia from the front and then pulled out from the front of the tibia,and the reinforcing suture was knotted in front of the tib-ia.The bridge suture line was fixed in front of the tibia with an external row anchor.Six months after surgery,both groups were evaluated the efficacy using the posterior drawer test and Lysholm score.Re-sults At the follow-up six months after the surgery,both groups had good fracture healing,with one wound infection and delayed healing in the traditional group and total one-stage heal in the other group.According to the physical examination 6 months after surgery,all were negative in the posterior drawer test,except one of degree II positive in the traditional group.Moreover,the average Lysholm score of the traditional group increased from 65.23±3.48 before surgery to 87.64±4.58 points after surgery(P<0.05),while that of the minimally invasive group increased from 64.35±2.52 to 86.82±2.58(P<0.05),showing no significant differences between the two groups(P>0.05).Conclusion Both techniques in this study can achieve excellent surgical outcomes in the treatment of posterior cruciate ligament avulsion fractures at the tibial insertion site.

Objective:To investigate the effect of acupoint massage combined with oral immune therapy (C-OIT) on oral feeding and growth and development of very low birth weight infants, so as to provide reference for healthy growth of very low birth weight infants.Methods:A prospective randomized controlled study was conducted. The very low birth weight infants admitted to the neonatal intensive care unit, Affiliated Hospital of Jining Medical University from January 2020 to December 2021 were selected using the convenience sampling method. They were divided into group A and group B using the random number table method, with 150 cases in each group. Group A received routine nursing and C-OIT. On this basis, group B received acupoint massage. Oral feeding, growth and development, and other indexes were compared between the two groups.Results:Finally, 150 cases were included in group A and group B, respectively. In group A, there were 78 male cases and 72 female cases, with gestational age of (30.49 ± 1.57) weeks. In group B, there were 74 male cases and 76 female cases, with gestational age of (30.61 ± 1.63) weeks. The time for abdominal distension to disappear, time to oral feeding initiation, time to full oral feeding and gastric tube indwelling time in group B [(4.35 ± 2.19), (4.26 ± 1.02), (19.03 ± 1.84), (6.27 ± 1.23) d] were shorter than those in group A[(8.03 ± 2.34), (8.63 ± 1.74), (20.49 ± 1.62), (9.34 ± 1.85) d], and the differences were statistically significant ( t values were 7.29-26.54, all P<0.05). The total score of the Preterm Oral Feeding Readiness Scale in group B (32.49 ± 1.52) was higher than that in group A (29.40 ± 3.14), and the difference was statistically significant ( t=10.84, P<0.05). At discharge, the difference values of weight, head circumference and height of group B [(0.92 ± 0.10) kg, (4.31 ± 0.61) cm and (4.08 ± 0.53) cm] were higher than those of group A[(0.81 ± 0.09) kg, (3.47 ± 0.57) cm and (3.81 ± 0.42) cm], and the differences were statistically significant ( t=10.01, 12.32, 4.89, all P<0.05). The length of hospitalization in group B (30.26 ± 4.91) d was shorter than that in group A (38.54 ± 5.27) d, and the difference was statistically significant ( t=14.07, P<0.05). Conclusions:Acupoint massage combined with C-OIT can shorten the time to oral feeding, and improve feeding intolerance of very low birth weight infants. It is expected to improve the growth and development status and quality of life of very low birth weight infants in early stage.

Objective To compare the early clinical efficacy of arthroscopic bridge suture combined with strengthening thread fixation for posterior cruciate ligament(PCL)tibial insertion avulsion frac-tures and traditional open double-row anchor suture fixation,and to explore a safe,effective,and min-imally invasive reduction and fixation method for PCL tibial insertion fractures in knee joint under ar-throscopy.Methods This study was a retrospective study.Sixty patients with PCL tibial insertion frac-tures(Meyers&McKeever types II-IV)and admitted to the Department of Orthopedics of Kunming Hospital of Traditional Chinese Medicine between June 2021 and June 2023 were included,and ran-domly divided into a traditional group(age:39.56±3.24 years,male/female:16/14)and a minimally in-vasive group(age:40.32±4.38,male/female:18/12),each of 30,according to their admission or-der.All patients were of Grade III positive in the drawer test before surgery.The traditional group un-derwent posterior medial inlay incision,reduction under direct vision and double-row anchor suture fix-ation,while the minimally invasive group underwent reduction under total arthroscopy,suture-bridge suture at the tendon-bone junction of PCL,and one anchor suture placed at the femoral insertion of PCL,with the anchor suture line serving as the reinforcing suture.Then,the anchor and suture-bridge suture lines were respectively pulled into the two tunnels behind the tibia from the front and then pulled out from the front of the tibia,and the reinforcing suture was knotted in front of the tib-ia.The bridge suture line was fixed in front of the tibia with an external row anchor.Six months after surgery,both groups were evaluated the efficacy using the posterior drawer test and Lysholm score.Re-sults At the follow-up six months after the surgery,both groups had good fracture healing,with one wound infection and delayed healing in the traditional group and total one-stage heal in the other group.According to the physical examination 6 months after surgery,all were negative in the posterior drawer test,except one of degree II positive in the traditional group.Moreover,the average Lysholm score of the traditional group increased from 65.23±3.48 before surgery to 87.64±4.58 points after surgery(P<0.05),while that of the minimally invasive group increased from 64.35±2.52 to 86.82±2.58(P<0.05),showing no significant differences between the two groups(P>0.05).Conclusion Both techniques in this study can achieve excellent surgical outcomes in the treatment of posterior cruciate ligament avulsion fractures at the tibial insertion site.

Objective:To investigate the effect of acupoint massage combined with oral immune therapy (C-OIT) on oral feeding and growth and development of very low birth weight infants, so as to provide reference for healthy growth of very low birth weight infants.Methods:A prospective randomized controlled study was conducted. The very low birth weight infants admitted to the neonatal intensive care unit, Affiliated Hospital of Jining Medical University from January 2020 to December 2021 were selected using the convenience sampling method. They were divided into group A and group B using the random number table method, with 150 cases in each group. Group A received routine nursing and C-OIT. On this basis, group B received acupoint massage. Oral feeding, growth and development, and other indexes were compared between the two groups.Results:Finally, 150 cases were included in group A and group B, respectively. In group A, there were 78 male cases and 72 female cases, with gestational age of (30.49 ± 1.57) weeks. In group B, there were 74 male cases and 76 female cases, with gestational age of (30.61 ± 1.63) weeks. The time for abdominal distension to disappear, time to oral feeding initiation, time to full oral feeding and gastric tube indwelling time in group B [(4.35 ± 2.19), (4.26 ± 1.02), (19.03 ± 1.84), (6.27 ± 1.23) d] were shorter than those in group A[(8.03 ± 2.34), (8.63 ± 1.74), (20.49 ± 1.62), (9.34 ± 1.85) d], and the differences were statistically significant ( t values were 7.29-26.54, all P<0.05). The total score of the Preterm Oral Feeding Readiness Scale in group B (32.49 ± 1.52) was higher than that in group A (29.40 ± 3.14), and the difference was statistically significant ( t=10.84, P<0.05). At discharge, the difference values of weight, head circumference and height of group B [(0.92 ± 0.10) kg, (4.31 ± 0.61) cm and (4.08 ± 0.53) cm] were higher than those of group A[(0.81 ± 0.09) kg, (3.47 ± 0.57) cm and (3.81 ± 0.42) cm], and the differences were statistically significant ( t=10.01, 12.32, 4.89, all P<0.05). The length of hospitalization in group B (30.26 ± 4.91) d was shorter than that in group A (38.54 ± 5.27) d, and the difference was statistically significant ( t=14.07, P<0.05). Conclusions:Acupoint massage combined with C-OIT can shorten the time to oral feeding, and improve feeding intolerance of very low birth weight infants. It is expected to improve the growth and development status and quality of life of very low birth weight infants in early stage.

Objective:To explore the clinical and genetic features of two Chinese pedigrees affected with Autosomal dominant intellectual developmental disorder 49 (MRD49).Methods:Two MRD49 pedigrees which were admitted to the Children′s Hospital Affiliated to Shandong University respectively on January 28, 2021 and November 10, 2022 were selected as the study subjects. Clinical data of the two pedigrees were collected and analyzed. Genomic DNA was extracted from peripheral blood samples of the probands and their family members. The probands were subjected to mutational analysis by high-throughput sequencing. Candidate variants were validated using real-time fluorescence quantitative PCR (q-PCR) or Sanger sequencing and bioinformatic analysis. This study was approved by the Medical Ethics Committee of the Children′s Hospital Affiliated to Shandong University (No. SDFE-IRB/T-2022002).Results:Proband 1 had presented with language delay, motor retardation and intellectual disability, and his maternal grandmother, mother, aunt and cousin all had various degrees of intellectual disability. Sequencing results showed that proband 1 had deletion of exons 3 ~ 7 of the TRIP12 gene. q-PCR verification showed that his mother, aunt, maternal grandmother and cousin had all harbored the same deletion. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was classified as pathogenic (PVS1+ PM2_Supporting+ PP1). Proband 2, who had mainly presented with language delay, motor retardation and intellectual disability, and was found to harbor a heterozygous c.3010C>T (p.Arg1004*) variant of the TRIP12 gene, which was verified to be de novo in origin. Based on the guidelines from the ACMG, the variant was classified as pathogenic (PVS1+ PS2+ PM2_Supporting). Conclusion:This study had diagnosed two MRD49 families through high-throughput sequencing. Above findings have enriched the phenotypic and mutational spectrum of MRD49 in China, which has also facilitated genetic counseling for the two pedigrees.

Objective:To study the locational distribution characteristics of the heterotopic ossification (HO) following traumatic elbow stiffness and the risk factors for HO development at different locations.Methods:Consecutively included according to our inclusion criteria in the present study were the patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2018 to December 2018 for elbow release due to traumatic elbow stiffness but developed postoperative HO. Their baseline data and CT data were collected and processed using Mimics 20.0. The HO distribution for each patient was characterized at the anteromedial, anterolateral, posteromedial, posterolateral, posterior, medial, lateral, and proximal radioulnar locations. The patient's original injury was categorized into 5 types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. After the univariate analysis with the HO occurrence at a specific location as the dependent variable and the original injury and baseline data as the independent variables, the factors with P value less than 0.1 were included in the logistic regression analysis to determine the risk factors for HO at each location.Results:A total of 91 patients were included in this study. Of them, 88 had posteromedial HO (96.7%, 88/91), 62 posterior HO (68.1%, 62/91), 60 posterolateral HO (65.9%, 60/91), 41 anteromedial HO (45.1%, 41/91), 26 anterolateral HO (28.6%, 26/91), 13 proximal radioulnar HO (14.3%, 13/91), 8 lateral HO (8.8%, 8/91), and 7 medial HO (7.7%, 7/91). Logistic regression analysis showed that presence of ulnar nerve symptoms ( OR=4.354, P=0.017) and presence of original elbow dislocation ( OR=2.927, P=0.042) were the independent risk factors for the anteromedial HO development and that presence of original olecranon fracture ( OR=0.277, P=0.023) was the protective factor for the anteromedial HO development. Presence of original radial head fracture was the independent risk factor for the anterolateral HO development ( OR=2.891, P=0.033) and the posterolateral HO development ( OR=3.123, P=0.043). Conclusions:HO development in patients with post-traumatic elbow stiffness is closely related to their original injury. Posteromedial HO may develop in almost all the patients. Patients with ulnar nerve symptoms and original elbow dislocation are more prone to anteromedial HO development, but patients with original olecranon fracture are less likely to develop anteromedial HO. Patients with original radial head fracture are more likely to develop anterolateral and posterolateral HO.

Background Environmental pollutants can affect N⁶-methyladenosine (m⁶A) level in the body, but the change of m⁶A level in kidney after being exposed to cadmium (Cd) and the molecular mechanism of renal injury need to be further studied. Objective To analyze the associations of m⁶A modification and methyltransferases/demethylases with microRNA-21 (miR-21) and transforming growth factor- β1 (TGF - β1) in kidney of rats exposed to Cd. Methods Twenty-four SPF male SD rats were divided into 4 groups, with 6 rats in each group, and were exposed to Cd by subcutaneous injection of 2.0, 1.0, and 0.5 mg·kg⁻¹ cadmium chloride (CdCl₂) and equal volume of normal saline for 2 weeks, 7 d a week, respectively. The levels of N-acetyl-β-D-glucosidase (UNAG) and albumin (UALB) in urine, and the levels of m⁶A methylation and TGF-β1 in kidney were detected by enzyme-linked immunosorbent assay (ELISA). The level of blood urea nitrogen (BUN) was measured by urease method. The levels of renal oxidative stress indicators such as malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were detected by total bile acid method, water-soluble tetrazolium asssay, and colorimetric method respectively. The relative levels of TGF-β1, methyltransferases, and demethylases in kidney were measured by reverse transcription-polymerase chain reaction. The expression of miR-21 in kidney was detected by fluorescent quantitative polymerase chain reaction. Results After 2 weeks of exposure to Cd, the body weights of rats in the 2.0 and 1.0 mg·kg⁻¹ cadmium chloride groups decreased, and the ratio of kidney/body weight and the levels of BUN, UNAG, and TGF-β1 mRNA and protein increased in the 2.0 mg·kg⁻¹ cadmium chloride group (P<0.05). The expression levels of m⁶A modification, methyltransferases METTL3, METTL14, Wilms’ tumor 1-associated protein (WTAP), and miR-21 were increased both in the 2.0 and 1.0 mg·kg⁻¹ cadmium chloride groups, with significant differences compared with the control group (P<0.05). The results of correlation analysis showed that the m⁶A modification level was negatively correlated with SOD (r=−0.4489, P<0.05) and GSH-Px (r=−0.4874, P<0.05), METTL3 was negatively correlated with MDA (r=−0.5158, P<0.05), while there was a positive correlation between FTO and GSH-Px (r=0.4802, P<0.05). In addition, miR-21 was positively correlated with METTL3 (r=0.7491), METTL14 (r=0.6157), and WTAP (r=0.6660) (P<0.05), TGF-β1 was positively correlated with METTL3 (r=0.5025, P<0.05) but negatively correlated with FTO (r=−0.5634, P<0.05) . Conclusion Cd can induce m⁶A methylation and up-regulation of METTL3, METTL14, WTAP, and miR-21 expression levels in rat kidney tissues, indicating that m⁶A and miR-21 may be associated with Cd-induced renal fibrosis.

Objective:To analyze the subsequent assisted pregnancy outcomes of recurrent implantation failure (RIF) and find out the key influencing factors.Methods:A case-control study was conducted to analyze the clinical data of 640 patients who received embryo transfer assisted fertility in the Center for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2019 and were diagnosed with RIF and received subsequent assisted fertility treatment. The main outcome measures were the live birth rate and the time to pregnancy after diagnosis of RIF.Results:The live birth rate, the biochemical pregnancy rate, the clinical pregnancy rate and the abortion rate of the first cycle, the second cycle, the third and above cycle after a diagnosis of RIF were not significantly different (all P>0.05). The time to pregnancy after diagnosis of RIF of 344 patients who achieved live births was 5.00(3.13, 8.52) months. After adjusting for confounding factors by using multivariate logistic regression, the results showed that the cumulative live birth probability of blastocyst transfer was significantly higher than that of cleavage embryo transfer [ P=0.002, RR (95% CI)=1.492(1.158-1.923)]; the cumulative live birth probability of patients less than 35 years old was significantly higher than older patients (≥35 years old)[ P=0.013, RR (95% CI)=0.694(0.521-0.925)]; the cumulative live birth probability of patients with endometrial thickness ≥8 mm on the embyro transfer day was significantly higher than that of patients with endometrial thickness <8 mm [ P=0.016, RR (95% CI)=1.943(1.132-3.335)]; compared with patients with 0 [ P=0.001, RR (95% CI)=0.625(0.474-0.825)] or 2 and more [ P=0.003, RR (95% CI)=0.414(0.233-0.736)] biochemical pregnancy in the RIF cycles, the cumulative live birth probability of patients with history of only 1 biochemical pregnancy in the RIF cycles was significantly higher. Conclusion:The type of embryos transferred, age, endometrial thickness on the embyro transfer day and the history of biochemical pregnancy in the RIF cycles are independent factors for subsequent cumulative live birth probability in RIF patients. Blastocyst transfer should be selected as much as possible, and fertility treatment should be performed as soon as possible through reasonable cycle management, the history of only 1 biochemical pregnancy in the RIF cycles heralds a better live birth outcome in the subsequent cycles of RIF.

Objective:To analyze the subsequent assisted pregnancy outcomes of recurrent implantation failure (RIF) and find out the key influencing factors.Methods:A case-control study was conducted to analyze the clinical data of 640 patients who received embryo transfer assisted fertility in the Center for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2019 and were diagnosed with RIF and received subsequent assisted fertility treatment. The main outcome measures were the live birth rate and the time to pregnancy after diagnosis of RIF.Results:The live birth rate, the biochemical pregnancy rate, the clinical pregnancy rate and the abortion rate of the first cycle, the second cycle, the third and above cycle after a diagnosis of RIF were not significantly different (all P>0.05). The time to pregnancy after diagnosis of RIF of 344 patients who achieved live births was 5.00(3.13, 8.52) months. After adjusting for confounding factors by using multivariate logistic regression, the results showed that the cumulative live birth probability of blastocyst transfer was significantly higher than that of cleavage embryo transfer [ P=0.002, RR (95% CI)=1.492(1.158-1.923)]; the cumulative live birth probability of patients less than 35 years old was significantly higher than older patients (≥35 years old)[ P=0.013, RR (95% CI)=0.694(0.521-0.925)]; the cumulative live birth probability of patients with endometrial thickness ≥8 mm on the embyro transfer day was significantly higher than that of patients with endometrial thickness <8 mm [ P=0.016, RR (95% CI)=1.943(1.132-3.335)]; compared with patients with 0 [ P=0.001, RR (95% CI)=0.625(0.474-0.825)] or 2 and more [ P=0.003, RR (95% CI)=0.414(0.233-0.736)] biochemical pregnancy in the RIF cycles, the cumulative live birth probability of patients with history of only 1 biochemical pregnancy in the RIF cycles was significantly higher. Conclusion:The type of embryos transferred, age, endometrial thickness on the embyro transfer day and the history of biochemical pregnancy in the RIF cycles are independent factors for subsequent cumulative live birth probability in RIF patients. Blastocyst transfer should be selected as much as possible, and fertility treatment should be performed as soon as possible through reasonable cycle management, the history of only 1 biochemical pregnancy in the RIF cycles heralds a better live birth outcome in the subsequent cycles of RIF.

Objective To investigate the incidence and associated factors of rotator cuff injuries in patients surgically treated for proximal humerus fracture.Methods A retrospective investigation was conducted in the patients over 40 years old who had been surgically treated for proximal humeral fracture from April 10th 2017 to December 1st 2017 at Department of Traumatic Orthopaedics,Beijing Jishuitan Hospital.Intraoperative direct visualization was used to collect their clinical data concerning rotator cuff injuries in combination with proximal humeral fracture.All the data were analyzed to find the incidence,gender ratio,age distribution and fracture type distribution concerning rotator cuff injuries.Results A total of 143 eligible patients were included in this investigation.Their average age was 61.95 years and their male-female ratio 1:2.3.The incidence was 46.2％ (66/143) for all the rotator cuff injuries in proximal humerus fracture and 23.1％ (33/143) just for rotator cuff tears.There were no significant differences in age,male to female ratio or distribution of Neer fracture type between patients with rotator cuff injury and those without rotator cuff injury (P ＞ 0.05).There was no significant difference in the age and or distribution of Neer fracture type between patients with rotator cuff tear and patients without rotator cuff tear (P ＞ 0.05).The proportion of females in patients with rotator cuff tears (84.8％,28/33) was significantly higher than that in patients with no rotator cuff tears (63.6％,21/33) (P ＜ 0.05).There was no significant difference between different age groups of the patients in incidence of combined rotator cuff injury (P ＞ 0.05).Conclusions Concomitant rotator cuff injuries are relatively common in patients over 40 years old with a proximal humerus fracture.About half of the injuries may be simple wear or wear plus degeneration while the other half rotator cuff tear happening mostly in female patients.The incidence of concomitant rotator cuff injury may increase with the age of the patients with a proximal humerus fracture.