Objective:To investigate the association between small vulnerable newborn (SVN) phenotypes and the risk of neurodevelopmental delay at the age of 1 year.Methods:A prospective cohort study was conducted. A total of 25 860 singleton infants from "The Born in Guangzhou Cohort Study" who completed the Gesell developmental scale assessment at 1 year of age between January 2013 and June 2025 were included. Maternal sociodemographic characteristics, and other information were collected using a self-administered questionnaire, and maternal pregnancy-related information and neonatal birth data were extracted from medical records. Global developmental delay (GDD) was defined as a developmental quotient below 86 in ≥3 domains of the Gesell developmental scale, which assesses the adaptive, gross motor, fine motor, language, and personal-social domains. The random forest algorithm was employed for missing data imputation. Based on prematurity, small for gestational age (SGA), and low birth weight (LBW), newborns were categorized into 6 phenotypes: preterm-SGA-LBW, preterm-appropriate for gestational age (AGA)-LBW, preterm-AGA-nonLBW, term-SGA-LBW, term-LBW-only or term-SGA-only, and term-AGA-nonLBW phenotype. Among these, the first 5 were classified as SVN phenotypes, and the last one served as the reference group. Inter-group comparisons were performed using analysis of variance (ANOVA), χ2 tests, or Kruskal-Wallis test, as appropriate.?? Multivariable robust Poisson regression models were applied to analyze the association of different SVN phenotypes with the risks of GDD and developmental delays in specific domains, with stratified analyses by sex. Results:Among the 25 860 infants, 13 719 (53.1%) were male and 12 141 (46.9%) were female. The gestational age at birth was 39.4 (38.6, 40.0) weeks. The overall detection rate of GDD at 1 year of age was 3.7% (962/25 860). The rates of delay across developmental domains, in descending order, language in 8 134 cases (31.5%), gross motor in 4 488 cases (17.4%), personal-social in 1 271 cases (4.9%), adaptive in 1 262 cases (4.9%), and fine motor in 621 cases (2.4%). Compared with the reference group, preterm-AGA-LBW, preterm-SGA-LBW, preterm-AGA-noneLBW, and term-SGA-LBW phenotypes were all associated with an increased risk of GDD, with the adjusted RR (95% CI) of 6.07(5.01-7.35), 4.81(3.11-7.46), 2.10(1.54-2.88) and 1.89(1.29-2.76) respectively.The preterm-AGA-noneLBW phenotype was all associated with an increased risk of delay in gross motor, language and personal-social functional domains (all P<0.05). The term-SGA-LBW phenotype was associated with an increased risk of delay in gross motor, fine motor and personal-social functional domains (all P<0.01). Whereas the term-LBW-only or term-SGA-only phenotype showed no statistically association with developmental delay in any functional domain (all P≥0.05). Conclusion:The combined classification based on gestational age and birth weight helps identify infants at high risk for neurodevelopmental delay at 1 year of age, suggesting that it may offer a reference for the rational allocation of clinical resources.

Objective:To investigate the association between small vulnerable newborn (SVN) phenotypes and the risk of neurodevelopmental delay at the age of 1 year.Methods:A prospective cohort study was conducted. A total of 25 860 singleton infants from "The Born in Guangzhou Cohort Study" who completed the Gesell developmental scale assessment at 1 year of age between January 2013 and June 2025 were included. Maternal sociodemographic characteristics, and other information were collected using a self-administered questionnaire, and maternal pregnancy-related information and neonatal birth data were extracted from medical records. Global developmental delay (GDD) was defined as a developmental quotient below 86 in ≥3 domains of the Gesell developmental scale, which assesses the adaptive, gross motor, fine motor, language, and personal-social domains. The random forest algorithm was employed for missing data imputation. Based on prematurity, small for gestational age (SGA), and low birth weight (LBW), newborns were categorized into 6 phenotypes: preterm-SGA-LBW, preterm-appropriate for gestational age (AGA)-LBW, preterm-AGA-nonLBW, term-SGA-LBW, term-LBW-only or term-SGA-only, and term-AGA-nonLBW phenotype. Among these, the first 5 were classified as SVN phenotypes, and the last one served as the reference group. Inter-group comparisons were performed using analysis of variance (ANOVA), χ2 tests, or Kruskal-Wallis test, as appropriate.?? Multivariable robust Poisson regression models were applied to analyze the association of different SVN phenotypes with the risks of GDD and developmental delays in specific domains, with stratified analyses by sex. Results:Among the 25 860 infants, 13 719 (53.1%) were male and 12 141 (46.9%) were female. The gestational age at birth was 39.4 (38.6, 40.0) weeks. The overall detection rate of GDD at 1 year of age was 3.7% (962/25 860). The rates of delay across developmental domains, in descending order, language in 8 134 cases (31.5%), gross motor in 4 488 cases (17.4%), personal-social in 1 271 cases (4.9%), adaptive in 1 262 cases (4.9%), and fine motor in 621 cases (2.4%). Compared with the reference group, preterm-AGA-LBW, preterm-SGA-LBW, preterm-AGA-noneLBW, and term-SGA-LBW phenotypes were all associated with an increased risk of GDD, with the adjusted RR (95% CI) of 6.07(5.01-7.35), 4.81(3.11-7.46), 2.10(1.54-2.88) and 1.89(1.29-2.76) respectively.The preterm-AGA-noneLBW phenotype was all associated with an increased risk of delay in gross motor, language and personal-social functional domains (all P<0.05). The term-SGA-LBW phenotype was associated with an increased risk of delay in gross motor, fine motor and personal-social functional domains (all P<0.01). Whereas the term-LBW-only or term-SGA-only phenotype showed no statistically association with developmental delay in any functional domain (all P≥0.05). Conclusion:The combined classification based on gestational age and birth weight helps identify infants at high risk for neurodevelopmental delay at 1 year of age, suggesting that it may offer a reference for the rational allocation of clinical resources.

Objective:Micro-and nanostructures with sharp disordered and rounded ordered features were fabricated on titanium surfaces,respectively,and their osteogenic potential was evaluated both in vitro and in vivo.Methods:Sharp disordered titanium surfaces(SLA-Ti)and rounded ordered titanium surfaces(Laser-Ti)were prepared using sandblast acid etching and high-repeti-tion-rate femtosecond laser,respectively.Smooth titanium(Ti)was used as the control group,SLA-Ti and Laser-Ti were used as the experimental groups.Characterization was conducted using scanning electron microscopy coupled with hydrophilicity assess-ments.The adhesion,elongation,and osteogenic differentiation capabilities of osteoblasts in vitro were evaluated through cell mor-phology observations,cytoskeletal fluorescence staining,cell viability assays,and PCR experiments.Osteogenic potential in vivo of rabbits was assessed through Micro CT scans and histological staining(HE and Masson).Results:The surface of Laser-Ti exhibits a rounded,ordered,multi-scale micro-and nano-morphology with the best hydrophilicity(P＜0.01).In vitro,it promotes cell adhe-sion,extension,and osteogenic differentiation,while in vivo,it enhances bone regeneration around the implants.Overall,a trend of Laser-Ti＞SLA-Ti＞Ti is observed,with a higher bone volume fraction(BV/TV)(P＜0.05),greater trabecular thickness(Tb.Th)(P＜0.05),an increased number of trabeculae(Tb.N)(P＜0.05),and a larger area of bone around the implants(P＜0.05).Conclusion:The rounded ordered micro-and nano-structures fabricated using high-repetition-rate fem-tosecond laser demonstrate enhanced osteoinductive capac-ity both in vitro and in vivo.

Objective:To investigate the interplay between childhood traumatic experiences,mental disorders,and cognitive function among patients with alcohol use disorder(AUD).Methods:A cross-sectional study was con-ducted involving 160 patients with AUD hospitalized in the department of alcohol dependence.They were catego-rized into three groups based on their symptoms,namely the simple alcohol dependence group(AD group,n=86),the alcohol dependence with hallucinatory delusion group(ADHD group,n=43),and the alcohol dependence with delirium tremens group(ADDT group,n=31).The adverse childhood experiences,cognitive function,and child-hood trauma were assessed with the Adverse Childhood Experiences International Questionnaire(ACE-IQ),Mont-real Cognitive Assessment(MoCA),and Childhood Trauma Questionnaire(CTQ-SF).Results:The MoCA scores were significantly higher in the AD group than in the ADHD and ADDT groups[21.0(19.0,23.0)vs.19.0(15.0,22.0)vs.18.0(16.0,22.0),P＜0.01].The ADDT group had higher sexual abuse scores of CTQ-SF than the AD group.Lower MoCA score was associated with hallucination and delusion(OR=0.82,P＜0.01)or deliri-um tremens(OR=0.81,P＜0.01)in AUD patients.Higher ACE-IQ score was associated with hallucination and delusion in AUD patients(OR=1.51,P＜0.01).Conclusion:Mostpatients with alcohol use disorder have child-hood trauma and cognitive dysfunction.Poor cognitive function and adverse childhood experiences are risk factors for mental disorders among patients with alcohol use disorder.

Objective To observe the changes in the serum level of tumor necrosis factor-α(TNF-α)during pegylated interferon-alpha(PEG-IFN-α)treatment in inactive HBsAg carriers(IHCs),to investigate the association between the dynamic changes of TNF-α and HBsAg clearance,and to assess the value of TNF-α as a potential biomarker for predicting the therapeutic efficacy of PEG-IFN-α.Methods A prospective study was conducted among 455 IHCs who attended our hospital from January 2018 to March 2023,and they were divided into treatment group and IHC control group.The 210 IHCs in the treatment group voluntarily received PEG-IFNα-2b treatment for 48 weeks,followed by follow-up for 24 weeks,and the 245 IHCs in the IHC control group were followed up for 72 weeks without treatment.The serum level of TNF-α was measured at baseline(week 0)and at weeks 12,24,48,and 72,and at week 72,the treatment group was further divided into HBsAg clearance group and non-clearance group.The serum level of TNF-α at different time points was compared between groups.The logistic regression analysis was used to assess the value of TNF-α in predicting HBsAg clearance.The t-test was used for comparison of normally distributed continuous data between two groups,and a one-way analysis of variance used for comparison between multiple groups;the repeated measures analysis of variance was used for comparison of normally distributed repeated measurement data within each group and between groups;the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.Univariate and multivariate logistic regression analyses were used to investigate the predictive factors for HBsAg clearance,and the receiver operating characteristic(ROC)curve was used to determine the cut-off value of TNF-α in predicting HBsAg clearance.Results At week 72,compared with the IHC control group,the treatment group had significantly higher HBsAg clearance rate(46.2%vs 1.2%,χ2=133.333,P<0.001)and seroconversion rate(34.8%vs 0.8%,χ2=94.650,P<0.001).The HBsAg clearance group and the non-clearance group had a significant increase in the serum level of TNF-α during treatment,which gradually returned to the baseline level after drug withdrawal(F=351.733 and 76.434,both P<0.001).Comparisons between groups showed that the HBsAg clearance group had the highest serum level of TNF-α at weeks 12,24,and 48,followed by the non-clearance group and the IHC control group(all P<0.001).The multivariate logistic regression analysis showed that baseline HBsAg level(odds ratio[OR]=0.329,95%confidence interval[CI]:0.189-0.571,P<0.001),baseline HBV DNA<20 IU/mL(OR=1.414,95%CI:1.057-1.787,P=0.045),ALT≥2×upper limit of normal at week 12(OR=1.127,95%CI:1.028-1.722,P=0.043),TNF-α level at week 12(OR=1.336,95%CI:1.018-1.754,P=0.037),and TNF-α level at week 24(OR=1.879,95%CI:1.477-2.391,P<0.001)were independent predictive factors for HBsAg clearance.The ROC analysis showed that TNF-α level at week 12 had an area under the ROC curve(AUC)of 0.846(95%CI:0.814-0.889)in predicting HBsAg clearance at week 72,with a sensitivity of 76.3%and a specificity of 81.0%,while TNF-α level at week 24 had an AUC of 0.912(95%CI:0.758-0.972),with a sensitivity of 81.4%and a specificity of 96.2%.Conclusion PEG-IFN-α can increase the serum level of TNF-α in IHCs,and the serum level of TNF-α at weeks 12 and 24 can effectively predict HBsAg clearance induced by PEG-IFN-α.

Objective:To analyze the clinical efficacy of the pelvic unlocking reduction device in assisting closed reduction and internal fixation for the treatment of AO/OTA 61-C3 type pelvic fractures.Methods:A retrospective analysis was conducted on 27 patients with AO/OTA 61-C3 pelvic fractures treated with the pelvic unlocking reduction device-assisted reduction and internal fixation between January 2020 and January 2024 in Fourth Medical Center of the People's Liberation Army General Hospital. The cohort included 11 males and 16 females, with a mean age of 30.2±13.9 years (range, 13-55 years). The time from injury to surgery was 16.0 (10.0, 28.0) d (range, 6-175 d). According to the AO/OTA classification, there were 8 cases of type 61-C3.1, 10 cases of type C3.2, and 9 cases of type C3.3. Among them, 10 patients presented with associated lumbosacral nerve injuries, classified as Gibbons grade II in 5 cases, grade III in 1 case, and grade IV in 4 cases. All patients underwent closed reduction and internal fixation assisted by the pelvic unlocking reduction device. Postoperative outcomes were assessed using the visual analogue scale (VAS) for pain, the Majeed pelvic score, and the Harris hip score. Fracture reduction quality was evaluated using the Matta criteria, and overall health status was assessed using the 36-Item Short Form Health Survey (SF-36).Results:All patients successfully underwent the surgery and were followed up for 31.6±12.3 months (range, 12-48 months). The fracture reduction time was 33.45±12.18 min, the total operative time was 283.0±87.9 min, the number of fluoroscopies was 71.33±32.77, and the intraoperative blood loss was 314.1±252.6 ml. At the 12-month postoperative assessment, VAS score was 1.78±0.85, Majeed pelvic score was 87.52±15.03; SF-36 score was 88.93±11.27; and Harris Hip Score was 90.59±11.43. All patients achieved an "excellent" rating according to the Matta radiographic assessment criteria at 12 months postoperatively. Fracture union was confirmed in all cases, with a healing time of 2.9±0.4 months (range, 2.5-3.5 months). No postoperative complications such as shock, nonunion, delayed union, surgical site infection, implant loosening, or deep vein thrombosis were observed. Three patients experienced numbness in the lateral thigh region postoperatively, which was attributed to lateral femoral cutaneous nerve injury. The symptoms resolved completely following removal of the INFIX internal fixator.Conclusion:The pelvic unlocking reduction device-assisted closed reduction and internal fixation demonstrates safety and efficacy in treating AO/OTA 61-C3 type pelvic fractures, yielding satisfactory fracture union and early functional scores.

Conventional surgical management of pelvic fractures entails incision and reduction with internal fixation, a procedure associated with significant bleeding, trauma, and a high surgical risk. The advent of advanced imaging techniques and sophisticated surgical instruments has led to a paradigm shift towards minimally invasive surgery as the prevailing treatment modality for such injuries. The efficacy of reduction is pivotal in determining the clinical prognosis of pelvic fractures, underscoring the importance of enhancing the quality of reduction in the minimally invasive surgery. The advent of 3D printing technology, intelligent orthopaedic surgical robots, mixed reality augmentation technology and high-precision optical localization tracking has catapulted minimally invasive pelvic fracture reduction to the forefront of research in the field of orthopaedics. Studies have demonstrated encouraging outcomes. This paper reviews relevant literature, mainly focusing on the evaluation and measurement, open reduction techniques, minimally invasive closed reduction techniques, and surgical robot assisted reduction techniques in treatment of pelvic fractures, to summarize the technical research progress in minimally invasive closed surgical reduction for pelvic fractures.

Pelvic fractures, the most severe bone trauma, account for approximately 3% of all fractures. As they are caused by high-energy injuries, their rates of mortality and disability are high. Over the past two centuries, the treatment strategies for these fractures have evolved from conservative therapy to open reduction and plate fixation, then to closed reduction and percutaneous screw fixation, and recently to screw fixation assisted by artificial intelligence. In the past 40 years, constant progress has been made in the treatment of pelvic fractures. It is generally acknowledged that a personalized treatment plan should be formulated based on each patient's age, fracture type, comorbidities, functional requirements and other factors when an appropriate treatment mode is chosen. The primary aim of treatment is to accelerate functional recovery, decrease the rate of disability after injury, and improve the quality of daily life of the patient. This paper reviews the treatment history of pelvic fractures, discusses the advantages and disadvantages of current treatment options, and looks ahead to future prospects, aiming to offer valuable references for related clinical practice.

Objective To observe the changes in the serum level of tumor necrosis factor-α(TNF-α)during pegylated interferon-alpha(PEG-IFN-α)treatment in inactive HBsAg carriers(IHCs),to investigate the association between the dynamic changes of TNF-α and HBsAg clearance,and to assess the value of TNF-α as a potential biomarker for predicting the therapeutic efficacy of PEG-IFN-α.Methods A prospective study was conducted among 455 IHCs who attended our hospital from January 2018 to March 2023,and they were divided into treatment group and IHC control group.The 210 IHCs in the treatment group voluntarily received PEG-IFNα-2b treatment for 48 weeks,followed by follow-up for 24 weeks,and the 245 IHCs in the IHC control group were followed up for 72 weeks without treatment.The serum level of TNF-α was measured at baseline(week 0)and at weeks 12,24,48,and 72,and at week 72,the treatment group was further divided into HBsAg clearance group and non-clearance group.The serum level of TNF-α at different time points was compared between groups.The logistic regression analysis was used to assess the value of TNF-α in predicting HBsAg clearance.The t-test was used for comparison of normally distributed continuous data between two groups,and a one-way analysis of variance used for comparison between multiple groups;the repeated measures analysis of variance was used for comparison of normally distributed repeated measurement data within each group and between groups;the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups.Univariate and multivariate logistic regression analyses were used to investigate the predictive factors for HBsAg clearance,and the receiver operating characteristic(ROC)curve was used to determine the cut-off value of TNF-α in predicting HBsAg clearance.Results At week 72,compared with the IHC control group,the treatment group had significantly higher HBsAg clearance rate(46.2%vs 1.2%,χ2=133.333,P<0.001)and seroconversion rate(34.8%vs 0.8%,χ2=94.650,P<0.001).The HBsAg clearance group and the non-clearance group had a significant increase in the serum level of TNF-α during treatment,which gradually returned to the baseline level after drug withdrawal(F=351.733 and 76.434,both P<0.001).Comparisons between groups showed that the HBsAg clearance group had the highest serum level of TNF-α at weeks 12,24,and 48,followed by the non-clearance group and the IHC control group(all P<0.001).The multivariate logistic regression analysis showed that baseline HBsAg level(odds ratio[OR]=0.329,95%confidence interval[CI]:0.189-0.571,P<0.001),baseline HBV DNA<20 IU/mL(OR=1.414,95%CI:1.057-1.787,P=0.045),ALT≥2×upper limit of normal at week 12(OR=1.127,95%CI:1.028-1.722,P=0.043),TNF-α level at week 12(OR=1.336,95%CI:1.018-1.754,P=0.037),and TNF-α level at week 24(OR=1.879,95%CI:1.477-2.391,P<0.001)were independent predictive factors for HBsAg clearance.The ROC analysis showed that TNF-α level at week 12 had an area under the ROC curve(AUC)of 0.846(95%CI:0.814-0.889)in predicting HBsAg clearance at week 72,with a sensitivity of 76.3%and a specificity of 81.0%,while TNF-α level at week 24 had an AUC of 0.912(95%CI:0.758-0.972),with a sensitivity of 81.4%and a specificity of 96.2%.Conclusion PEG-IFN-α can increase the serum level of TNF-α in IHCs,and the serum level of TNF-α at weeks 12 and 24 can effectively predict HBsAg clearance induced by PEG-IFN-α.