Objective:To investigate the risk factors for tibial tuberosity avulsion fractures (TTAF) in adolescents and develop a clinically applicable nomogram prediction model for rapid risk assessment and identification of high-risk populations.Methods:A retrospective study was conducted to analyze the data of 58 adolescent patients (61 sides) who had been treated for TTAF at Department of Orthopaedics, Children's Hospital of Soochow University between January 2018 and October 2024. There were 57 males and 1 female, with an age of 14.0 (13.0, 14.0) years, designated as the observation group. The control group enrolled another contemporary 52 patients who, matched with age and gender, had a clear history of trauma and clinical symptoms of knee injury but no bone continuity destruction of the knee joint by the final imaging examination. They were 50 males and 2 females, with an age of 13.5 (12.0, 15.0) years. Baseline characteristics, pre-injury physical activity profiles, and imaging-derived anatomical parameters were compared between the 2 groups. Variables with P<0.05 in the univariate analysis were included in a multivariable logistic regression model to identify independent risk factors for adolescent TTAF, based on which a nomogram prediction model was developed and internally validated using bootstrapping (1,000 resamples). Results:Multivariable logistic regression analysis identified the following independent risk factors for adolescent TTAF: short-term high-frequency exercise ( OR=5.653, 95% CI: 1.068 to 29.918, P=0.042), a large body mass index (BMI) ( OR=1.445, 95% CI: 1.197 to 1.743, P<0.001), a large posterior tibial slope (PTS) ( OR=1.637, 95% CI: 1.140 to 2.353, P=0.008), and an increased tibial tubercle-trochlear groove (TT-TG) distance ( OR=1.227, 95% CI: 1.021 to 1.474, P=0.029). The area under the receiver operating characteristic curve (AUC) was 0.927 for the model incorporating CT-derived variables and 0.907 for the model excluding CT variables. Decision curve analysis (DCA) and calibration curves demonstrated favorable clinical utility and alignment between predicted and observed outcomes in both models. Conclusions:Short-term high-frequency exercise, a large body mass index, a large PTS, and an increased TT-TG distance are risk factors for adolescent TTAF. The established prediction model is suitable for rapid clinical assessment and demonstrates good predictive capability.

Objective:To investigate the risk factors for tibial tuberosity avulsion fractures (TTAF) in adolescents and develop a clinically applicable nomogram prediction model for rapid risk assessment and identification of high-risk populations.Methods:A retrospective study was conducted to analyze the data of 58 adolescent patients (61 sides) who had been treated for TTAF at Department of Orthopaedics, Children's Hospital of Soochow University between January 2018 and October 2024. There were 57 males and 1 female, with an age of 14.0 (13.0, 14.0) years, designated as the observation group. The control group enrolled another contemporary 52 patients who, matched with age and gender, had a clear history of trauma and clinical symptoms of knee injury but no bone continuity destruction of the knee joint by the final imaging examination. They were 50 males and 2 females, with an age of 13.5 (12.0, 15.0) years. Baseline characteristics, pre-injury physical activity profiles, and imaging-derived anatomical parameters were compared between the 2 groups. Variables with P<0.05 in the univariate analysis were included in a multivariable logistic regression model to identify independent risk factors for adolescent TTAF, based on which a nomogram prediction model was developed and internally validated using bootstrapping (1,000 resamples). Results:Multivariable logistic regression analysis identified the following independent risk factors for adolescent TTAF: short-term high-frequency exercise ( OR=5.653, 95% CI: 1.068 to 29.918, P=0.042), a large body mass index (BMI) ( OR=1.445, 95% CI: 1.197 to 1.743, P<0.001), a large posterior tibial slope (PTS) ( OR=1.637, 95% CI: 1.140 to 2.353, P=0.008), and an increased tibial tubercle-trochlear groove (TT-TG) distance ( OR=1.227, 95% CI: 1.021 to 1.474, P=0.029). The area under the receiver operating characteristic curve (AUC) was 0.927 for the model incorporating CT-derived variables and 0.907 for the model excluding CT variables. Decision curve analysis (DCA) and calibration curves demonstrated favorable clinical utility and alignment between predicted and observed outcomes in both models. Conclusions:Short-term high-frequency exercise, a large body mass index, a large PTS, and an increased TT-TG distance are risk factors for adolescent TTAF. The established prediction model is suitable for rapid clinical assessment and demonstrates good predictive capability.

This study was aimed at analyzing the epidemiological characteristics of cutaneous anthrax in Ningxia from 2019 to 2023,to provide a basis for continued epidemic prevention and control,and the formulation of strategic measures.Data from the China Infectious Disease Surveillance and Reporting Management system were analyzed.The case flow reports came from data reported by city and county(district)CDCs.The above information was collated to establish a database.SPSS 26.0 soft-ware was used for statistical analysis.Counting data by rate were assessed with the chi-square test(P＜0.05 indicated a statisti-cally significant difference).A total of 132 cases of cutaneous anthrax were reported from 2019 to 2023.The average annual re-ported incidence was 0.37 per 100 000 people.The reported incidence increased each year since 2020(x2ternd=29.954,P＜0.05).The incidence of category B infectious diseases increased.The proportion and incidence sequence of natural and insect-borne in-fectious diseases increased each year(x2trend=42.336,P＜0.05).The reported cases covered 72.73％of the counties.Seven counties reported more cases than the regional average.The top five highest reported incidences were in Yongning County,He-lan County,Xixia District,Litong District,and Yuanzhou District.Yinchuan accounted for 67.42％of the cases,and Yongning county accounted for 46.07％of the cases in Yinchuan.A total of 65.91％of cases were reported between July and September.Males had higher incidence rates than females,primarily in the 35-59 year age group(62.12％).Farmers accounted for 82.57％,and tertiary and infectious disease hospitals accounted for 77.27％of the reports.A total of 121 samples(91.67％)were positive for any one of the samples,among which the positivity rate of nucleic acid tests was highest(84.09％).In recent years,the epidemic of cutaneous anthrax in Ningxia has been widespread and sustained at a high level.The epidemiological characteristics and exposure patterns were similar to those of the entire country.Recommendations include investigation of natural foci,inclusion of diverse specimen collection types,and improve-ment in the ability to identify outbreaks among humans and ani-mals.This study may provide a scientific basis for future responses to outbreaks,and the formulation and evaluation of intervention strategies.

This study was aimed at analyzing the epidemiological characteristics of cutaneous anthrax in Ningxia from 2019 to 2023,to provide a basis for continued epidemic prevention and control,and the formulation of strategic measures.Data from the China Infectious Disease Surveillance and Reporting Management system were analyzed.The case flow reports came from data reported by city and county(district)CDCs.The above information was collated to establish a database.SPSS 26.0 soft-ware was used for statistical analysis.Counting data by rate were assessed with the chi-square test(P＜0.05 indicated a statisti-cally significant difference).A total of 132 cases of cutaneous anthrax were reported from 2019 to 2023.The average annual re-ported incidence was 0.37 per 100 000 people.The reported incidence increased each year since 2020(x2ternd=29.954,P＜0.05).The incidence of category B infectious diseases increased.The proportion and incidence sequence of natural and insect-borne in-fectious diseases increased each year(x2trend=42.336,P＜0.05).The reported cases covered 72.73％of the counties.Seven counties reported more cases than the regional average.The top five highest reported incidences were in Yongning County,He-lan County,Xixia District,Litong District,and Yuanzhou District.Yinchuan accounted for 67.42％of the cases,and Yongning county accounted for 46.07％of the cases in Yinchuan.A total of 65.91％of cases were reported between July and September.Males had higher incidence rates than females,primarily in the 35-59 year age group(62.12％).Farmers accounted for 82.57％,and tertiary and infectious disease hospitals accounted for 77.27％of the reports.A total of 121 samples(91.67％)were positive for any one of the samples,among which the positivity rate of nucleic acid tests was highest(84.09％).In recent years,the epidemic of cutaneous anthrax in Ningxia has been widespread and sustained at a high level.The epidemiological characteristics and exposure patterns were similar to those of the entire country.Recommendations include investigation of natural foci,inclusion of diverse specimen collection types,and improve-ment in the ability to identify outbreaks among humans and ani-mals.This study may provide a scientific basis for future responses to outbreaks,and the formulation and evaluation of intervention strategies.

To explore the predictive value of preoperative serum CYFRA 21-1 in colorectal cancer (CRC) resection patients. In this retrospective study, 456 patients with CRC who received surgical treatment in the Department of General Surgery, Affiliated Hospital of Nantong University from January 2016 to February 2018 were analyzed. Preoperative CYFRA 21-1, CEA, CA19-9 and pathological data of the study subjects were collected. Determine the cut-off value of CYFRA 21-1 based on the X-tile. Chi-square test or Fisher exact probability test were used to compare clinicopathological features in different CYFRA 21-1 level groups. Univariate and multivariate regression analysis of factors affecting 5-year overall survival (OS) and disease-free survival (DFS). Kaplan-Meier survival curves were used to analyze 5-year differences in OS and DFS in CRC patients with different levels of CYFRA 21-1, CEA and CA19-9. Receiver operating characteristic(ROC) was adopted. ROC curves were used to analyze the prognostic efficacy of CYFRA21-1 for CRC, and nomogram maps were used to predict 1, 3, and 5-year survival rates. The results showed that the optimal cut-off values of serum CYFRA 21-1, CEA and CA19-9 were 4.9 ng/ml, 29.2 ng/ml and 72.8 U/ml, respectively. Different gender, tumor size, location, degree of differentiation, depth of invasion, lymph node metastasis and tumor node metastasis (TNM) classification stage were significantly different between the two groups with high and low CYFRA 21-1, the P-values were 0.018,<0.001,<0.001,<0.001, 0.002, 0.001, 0.003, respectively. CYFRA 21-1 (≥4.9 ng/ml) was an independent risk factor for 5-year OS (HR: 4.008, 95%CI: 2.309-6.958, P<0.001) and DFS (HR: 3.75, 95%CI: 2.227-6.314, P<0.001) in CRC patients. CYFRA 21-1 predicts a 5-year AUC of 0.725 and 0.720 for OS and DFS, respectively, and 0.804 and 0.827 for the combination of CEA and CA19-9. Based on the results of multivariate Cox regression analysis, nomogram graphs of OS and DFS were established, the C-indexes were 0.799 and 0.803, respectively. In conclusion, preoperative serum CYFRA 21-1 level may be an independent risk factor affecting the prognosis of patients with colorectal cancer. The prognostic model established by CYFRA 21-1 combined with CEA, CA19-9 and TNM stages may provide references for the prevention of CRC recurrence and clinical decision-making.
Humans ; Colorectal Neoplasms/pathology* ; CA-19-9 Antigen ; Retrospective Studies ; Neoplasm Staging ; Neoplasm Recurrence, Local/pathology* ; Biomarkers, Tumor

To explore the predictive value of preoperative serum CYFRA 21-1 in colorectal cancer (CRC) resection patients. In this retrospective study, 456 patients with CRC who received surgical treatment in the Department of General Surgery, Affiliated Hospital of Nantong University from January 2016 to February 2018 were analyzed. Preoperative CYFRA 21-1, CEA, CA19-9 and pathological data of the study subjects were collected. Determine the cut-off value of CYFRA 21-1 based on the X-tile. Chi-square test or Fisher exact probability test were used to compare clinicopathological features in different CYFRA 21-1 level groups. Univariate and multivariate regression analysis of factors affecting 5-year overall survival (OS) and disease-free survival (DFS). Kaplan-Meier survival curves were used to analyze 5-year differences in OS and DFS in CRC patients with different levels of CYFRA 21-1, CEA and CA19-9. Receiver operating characteristic(ROC) was adopted. ROC curves were used to analyze the prognostic efficacy of CYFRA21-1 for CRC, and nomogram maps were used to predict 1, 3, and 5-year survival rates. The results showed that the optimal cut-off values of serum CYFRA 21-1, CEA and CA19-9 were 4.9 ng/ml, 29.2 ng/ml and 72.8 U/ml, respectively. Different gender, tumor size, location, degree of differentiation, depth of invasion, lymph node metastasis and tumor node metastasis (TNM) classification stage were significantly different between the two groups with high and low CYFRA 21-1, the P-values were 0.018,<0.001,<0.001,<0.001, 0.002, 0.001, 0.003, respectively. CYFRA 21-1 (≥4.9 ng/ml) was an independent risk factor for 5-year OS (HR: 4.008, 95%CI: 2.309-6.958, P<0.001) and DFS (HR: 3.75, 95%CI: 2.227-6.314, P<0.001) in CRC patients. CYFRA 21-1 predicts a 5-year AUC of 0.725 and 0.720 for OS and DFS, respectively, and 0.804 and 0.827 for the combination of CEA and CA19-9. Based on the results of multivariate Cox regression analysis, nomogram graphs of OS and DFS were established, the C-indexes were 0.799 and 0.803, respectively. In conclusion, preoperative serum CYFRA 21-1 level may be an independent risk factor affecting the prognosis of patients with colorectal cancer. The prognostic model established by CYFRA 21-1 combined with CEA, CA19-9 and TNM stages may provide references for the prevention of CRC recurrence and clinical decision-making.
Humans ; Colorectal Neoplasms/pathology* ; CA-19-9 Antigen ; Retrospective Studies ; Neoplasm Staging ; Neoplasm Recurrence, Local/pathology* ; Biomarkers, Tumor

Child ; Humans ; Tuberculosis, Spinal/diagnosis* ; Spondylitis/diagnosis* ; Thoracic Vertebrae ; Suppuration/diagnosis* ; Diagnostic Errors

Objective To evaluate the effects of early exercise intervention in patients who have undergone primary isolated valve surgery. Methods Forty patients scheduled for mitral, aortic, and/or tricuspid valve surgery were allocated to receive a supervised exercise intervention consisting of cycling for 3 min/d at the bedside after operation (intervention group, n=20, mean age [49.05±3.728] years) or to receive no exercise intervention (control group, n=20, mean age [47.95 ± 3.214] years). Oxygen saturation (SpO2) was measured by pulse oximetry continuously before and after the 6-minute walk test. Psycho-educational counseling was provided, and patients were assessed using standard patient questionnaires. Results The arterial SpO2 level increased significantly in the intervention group after exercise compared with the control group (P<0.05). Heart rate returned to baseline in the intervention group postoperatively and was significantly lower than that in the control group (P<0.05). Conclusions A small amount of supervised cycling exercise at the bedside is a safe activity that may improve peripheral arterial SpO2 and reduce heart rate to the baseline level following longer distance walk before discharge in patients who have undergone isolated valve surgery.

Objective: To describe the actual efficacy of programmed death-1 (PD-1)/ programmed-death ligand 1 (PD-L1) inhibitors in patients with metastatic non-small cell lung cancer (NSCLC) and explore potential prognostic predictive biomarkers. Methods: Patients with metastatic NSCLC who were treated with PD-1/PD-L1 inhibitors at Cancer Hospital, Chinese Academy of Medical Sciences from January 2016 to December 2019, either as monotherapy or in combination with other agents, were consecutively enrolled into this study. We retrospectively collected the data of demographics, clinical information and pathologic assessment to evaluate the therapeutic efficacy and conduct the survival analysis. Major endpoint of our study is progression-free survival (PFS). Secondary endpoints include objective response rate (ORR), disease control rate (DCR) and overall survival (OS). Results: The ORR of 174 patients who underwent PD-1/PD-L1 inhibitor was 28.7%, and the DCR was 79.3%. Immune-related adverse events (irAEs) occurred in 23 patients (13.2%). Brain metastasis, line of treatment, and treatment patterns were associated with the ORR of metastatic NSCLC patients who underwent immunotherapy (P<0.05). After a median follow-up duration of 18.8 months, the median PFS was 10.5 months (ranged from 1.5 to 40.8 months) while the median OS was not reached. The 2-year survival rate was estimated to be 63.0%. The pathologic type was related with the PFS of metastatic NSCLC patients who underwent immunotherapy (P=0.028). Sex, age, brain metastasis and autoimmune diseases were associated with OS (P<0.05). Analysis of the receptor characteristic curve (ROC) of neutrophil/lymphocyte ratio (NLR) predicting ORR of immunotherapy in metastatic NSCLC showed that the areas under the curve of NLR before immunotherapy (NLR(C0)), NLR after one cycle of immunotherapy (NLR(C1)) and ΔNLR were 0.600, 0.706 and 0.628, respectively. Multivariate logistic regression analysis showed that NLR(C1) was an independent factor of the ORR of metastatic NSCLC patients who underwent immunotherapy (OR=0.161, 95% CI: 0.062-0.422), and the efficacy of combination therapy was better than that of single agent (OR=0.395, 95% CI: 0.174-0.896). The immunotherapy efficacy in patients without brain metastasis was better than those with metastasis (OR=0.291, 95% CI: 0.095-0.887). Multivariate Cox regression analysis showed that NLR(C1) was an independent influencing factor of PFS of metastatic NSCLC patients after immunotherapy (HR=0.480, 95% CI: 0.303-0.759). Sex (HR=0.399, 95% CI: 0.161-0.991, P=0.048), age (HR=0.356, 95% CI: 0.170-0.745, P=0.006) were independent influencing factors of OS of metastatic NSCLC patients after immunotherapy. Conclusions: PD-1/PD-L1 inhibitors are proved to be efficacious and have tolerable toxicities for patients with metastatic NSCLC. Patients at advanced age could still benefit from immunotherapy. Brain metastasis is related to compromised response. Earlier application of immunotherapy in combination with other modalities enhances the efficacy without elevating risk of irAEs. NLR(C1) is an early predictor of clinical outcome. The OS of patients younger than 75 years may be improved when treated with immunotherapy.
B7-H1 Antigen/metabolism* ; Brain Neoplasms/drug therapy* ; Carcinoma, Non-Small-Cell Lung/pathology* ; Humans ; Immune Checkpoint Inhibitors ; Lung Neoplasms/pathology* ; Prognosis ; Programmed Cell Death 1 Receptor ; Retrospective Studies

ObjectiveTo investigate the effect of Biejiajian Wan （BJJW） on transforming growth factor-β₁ （TGF-β₁）-induced epithelial-mesenchymal transition （EMT） of HepG2 cells， and explore its mechanism against EMT of hepatocellular carcinoma cells. MethodHepG2 cells were randomly divided into a blank group， a TGF-β₁ model group （10 μg·L^-1 TGF-β₁）， a low-dose BJJW group （10 μg·L^-1 TGF-β₁+0.55 g·kg^-1 BJJW）， a medium-dose BJJW group （10 μg·L^-1 TGF-β₁+1.1 g·kg^-1 BJJW）， a high-dose BJJW group （10 μg·L^-1 TGF-β₁+2.2 g·kg^-1 BJJW）， and a sorafenib group （10 μg·L^-1 TGF-β₁+0.03 g·kg^-1 sorafenib）. The EMT model was induced by 10 μg·L^-1 TGF-β₁ in HepG2 cells. After treatment with corresponding medicated serum， cell counting kit -8 （CCK-8） assay was used to detect cell proliferation. Cell migration ability was detected by the Transwell assay and wound healing assay. The protein expression related to EMT and nuclear factor-kappa B （NF-κB） signaling pathway was detected by cell immunofluorescence assay and Western blot. ResultCompared with the blank group 4 days later， the TGF-β₁ model group showed fusiform and loose cells with widened gap and antennae reaching out， decreased protein expression of E-cadherin （P<0.05）， and increased protein expression of N-cadherin and vimentin （P<0.05）， which indicated that the EMT model was properly induced in HepG2 cells by TGF-β₁ stimulation for 4 days. After 48 hours of treatment with the corresponding medicated serum， each medication group showed inhibited proliferation of HepG2 cells that had undergone EMT， especially the low- and high-dose BJJW groups （P<0.01）， and the medium-dose BJJW group showed increased E-cadherin protein expression （P<0.05） and decreased p-p65， N-cadherin， and vimentin protein expression （P<0.05）， as compared with the TGF-β₁ model group. As revealed by the transwell assay and wound healing assay， TGF-β₁ enhanced the migration ability of HepG2 cells （P<0.05， P<0.01） compared with the results in the blank group， compared with the TGF-β₁ model group， the medication groups showed inhibited migration ability of HepG2 cells （P<0.05， P<0.01）. Compared with the blank group， the TGF-β₁ model group promoted the expression of p65 and Snail into the nucleus. Compared with the TGF-β₁ model group， the medication groups inhibited the expression of p65 and Snail into the nucleus. ConclusionBJJW may inhibit the EMT， proliferation， and migration of HepG2 cells induced by TGF-β₁ by suppressing the NF-κB signaling pathway to exert an anti-hepatocellular carcinoma effect.