OBJECTIVE: To investigate short-term effectiveness of using expert adolescent lateral femoral nail (EALFN) in treating femoral shaft fractures in older children and adolescents. METHODS: A retrospective analysis was conducted on the clinical data of 17 patients with femoral shaft fractures who met the inclusion criteria and were admitted between July 2020 and June 2024. All fractures were fixed with EALFN after reduction. There were 11 males and 6 females, with a mean age of 13.3 years (range, 11-16 years). The average body weight was 51.2 kg (range, 40-84 kg), and the average height was 162.1 cm (range, 150-172 cm). The causes of injury included traffic accidents ( n=9), falling from height ( n=1), and simple falls ( n=7). One patient had an open fracture treated with an external fixator and experienced delayed fracture healing. The remaining patients were closed fractures, with an average time from injury to operation of 5.8 days (range, 2-10 days). Operation time and postoperative hospital stay were documented. During follow-up, X-ray films were taken to observe the fracture healing, and the bilateral femoral length, femoral neck-shaft angle, widest femoral neck diameter (FND), and articular trochanteric distance (ATD) were measured at last follow-up. Hip function was assessed using the Harris score. The differences in the all indicators between the healthy and affected sides were compared. RESULTS: The operation time ranged from 65 to 130 minutes (mean, 94.1 minutes). Postoperative hospital stay ranged from 5 to 40 days (mean, 16.7 days). All patients were followed up 7-36 months (mean, 14.4 months). One patient exhibited delayed fracture healing during follow-up. The distal locking nail was removed at 6 months after operation, and partial weight-bearing was initiated following dynamic fracture stabilization. The fracture healing was achieved, and the intramedullary nail was removed at 24 months after operation. The other fractures healed with the healing time of 6-20 months (mean, 9.6 months), and the intramedullary nails were removed. During follow-up, no femoral fracture, abnormal development of the greater trochanter, or ischemic necrosis of the femoral head occurred. At last follow-up, there was no significant difference in femoral length, femoral neck-shaft angle, FND, ATD, or Harris score between the affected and healthy sides ( P>0.05). CONCLUSION For older children and adolescents with femoral neck fractures, the application of EALFN fixation aligns more closely with the principles of intramedullary central fixation and rapid rehabilitation. This approach is associated with fewer complications and superior short-term effectiveness.
Humans ; Male ; Femoral Fractures/surgery* ; Female ; Child ; Adolescent ; Retrospective Studies ; Bone Nails ; Fracture Fixation, Intramedullary/instrumentation* ; Fracture Healing ; Treatment Outcome

Objective:To explore the effectiveness of E-Coach health education in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) .Methods:A total of 112 patients with AMI admitted to the Second Affiliated Hospital of Wenzhou Medical University between January and December 2023 were selected using convenience sampling. Using a random number table, the patients were assigned to a control group ( n=56) and an intervention group ( n=56). The control group received modified cardiac rehabilitation, while the intervention group received E-Coach health education in addition to the same rehabilitation protocol. Cardiac function, ability of daily living, and self-management ability were compared between the two groups before and after the intervention. Results:After 3 months of intervention, the intervention group had a higher left ventricular ejection fraction and lower left ventricular end-diastolic and end-systolic dimension compared to the control group, and the differences were statistically significant ( P<0.05). In addition, the Barthel Index and all dimensions of the Self-management Scale scores were higher in the intervention group than in the control group after 3 months of intervention, and the differences were statistically significant ( P<0.05) . Conclusions:E-Coach health education can improve cardiac function, daily living ability, and self-management ability in patients with AMI after PCI.

Objective:To explore the effectiveness of E-Coach health education in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) .Methods:A total of 112 patients with AMI admitted to the Second Affiliated Hospital of Wenzhou Medical University between January and December 2023 were selected using convenience sampling. Using a random number table, the patients were assigned to a control group ( n=56) and an intervention group ( n=56). The control group received modified cardiac rehabilitation, while the intervention group received E-Coach health education in addition to the same rehabilitation protocol. Cardiac function, ability of daily living, and self-management ability were compared between the two groups before and after the intervention. Results:After 3 months of intervention, the intervention group had a higher left ventricular ejection fraction and lower left ventricular end-diastolic and end-systolic dimension compared to the control group, and the differences were statistically significant ( P<0.05). In addition, the Barthel Index and all dimensions of the Self-management Scale scores were higher in the intervention group than in the control group after 3 months of intervention, and the differences were statistically significant ( P<0.05) . Conclusions:E-Coach health education can improve cardiac function, daily living ability, and self-management ability in patients with AMI after PCI.

Objective To establish a recurrence risk prediction model for meningioma based on HOXA9 DNA methylation.Methods Meningioma-related datasets were downloaded from GEO database for screening homeobox genes(HOXs)with prognostic values using differential methylation and ROC curve analysis and Cox regression analysis.The differentially methylated CpG sites with high predictive efficacy were selected to establish the risk prediction model using Lasso-Cox regression analysis,based on which the patients were divided into high-and low-risk groups by the cutoff value.The methylation levels of CpG sites were verified at the cell and tissue levels using methylation-specific PCR(MS-PCR).Clinical meningioma tissue samples were used to validate the predictive efficacy of the model.Results HOXA9 methylation level was significantly up-regulated in meningiomas(P<0.001)and showed a high diagnostic efficiency(AUC=0.884)as an independent risk factor for overall survival(P<0.01)positively correlated with the degree of malignancy and poor prognosis of meningioma(P<0.05).Risk stratification by HOXA9 methylation was more accurate than WHO grading for predicting recurrence and patient survival time.The AUCs of the sites cg03217995 and cg21001184 were both above 0.8 for meningioma diagnosis and above 0.6 for predicting recurrence.The patients'clinical characteristics differed significantly between the high-and low-risk groups(P<0.001),and the prediction score of the model was an independent prognostic factor for meningioma(P<0.05).MS-PCR results showed that the methylation levels of the two sites increased significantly in meningioma cells.In clinical samples,the combined model showed a high prediction efficiency(AUC=0.857),and the predicted risk of progression was highly consistent with the patients'actual condition.Conclusion High HOXA9 methylation level is a predictor for poor prognosis of meningiomas,and the combined prediction model based on its CpG sites provides a new approach to early screening of meningioma patients at risk of progression.

Objective To establish a recurrence risk prediction model for meningioma based on HOXA9 DNA methylation.Methods Meningioma-related datasets were downloaded from GEO database for screening homeobox genes(HOXs)with prognostic values using differential methylation and ROC curve analysis and Cox regression analysis.The differentially methylated CpG sites with high predictive efficacy were selected to establish the risk prediction model using Lasso-Cox regression analysis,based on which the patients were divided into high-and low-risk groups by the cutoff value.The methylation levels of CpG sites were verified at the cell and tissue levels using methylation-specific PCR(MS-PCR).Clinical meningioma tissue samples were used to validate the predictive efficacy of the model.Results HOXA9 methylation level was significantly up-regulated in meningiomas(P<0.001)and showed a high diagnostic efficiency(AUC=0.884)as an independent risk factor for overall survival(P<0.01)positively correlated with the degree of malignancy and poor prognosis of meningioma(P<0.05).Risk stratification by HOXA9 methylation was more accurate than WHO grading for predicting recurrence and patient survival time.The AUCs of the sites cg03217995 and cg21001184 were both above 0.8 for meningioma diagnosis and above 0.6 for predicting recurrence.The patients'clinical characteristics differed significantly between the high-and low-risk groups(P<0.001),and the prediction score of the model was an independent prognostic factor for meningioma(P<0.05).MS-PCR results showed that the methylation levels of the two sites increased significantly in meningioma cells.In clinical samples,the combined model showed a high prediction efficiency(AUC=0.857),and the predicted risk of progression was highly consistent with the patients'actual condition.Conclusion High HOXA9 methylation level is a predictor for poor prognosis of meningiomas,and the combined prediction model based on its CpG sites provides a new approach to early screening of meningioma patients at risk of progression.

Zhishi Xiebai Guizhi Tang， derived from Synopsis of the Golden Chamber （《金匮要略》， Han dynasty， ZHANG Zhongjing）， is a famous classical prescription commonly used for chest impediment. By means of bibliometrics， the authors collected 63 ancient Chinese medical books related to Zhishi Xiebai Guizhi Tang and screened 36 effective books for statistical analysis of the historical origin， composition， main indications， dosage， processing， decocting method and other aspects of the prescription. The findings revealed that Zhishi Xiebai Guizhi Tang was composed of five medicinal herbs， namely， Aurantii Fructus Immaturus， Allii Macrostemonis Bulbus， Cinnamomi Ramulus， Magnoliae Officinalis Cortex， and Trichosanthis Fructus， with the function of activating Yang， dissipating mass， dispelling phlegm and lowering Qi. The prescription was mainly used to treat chest impediment， chest fullness， chest pain， wheezing， coughing and shortness of breath caused by suppressed Yang Qi， stagnant heart Qi， stagnant phlegm and stasis， and phlegm evil blocking heart， chest or lungs. Additionally， it was found that there were 70 modern literature recording the clinical applications of Zhishi Xiebai Guizhi Tang， and the main system diseases treated were circulatory system （51， 72.85%）， endocrine system （4， 5.7%）， respiratory system （9， 12.85%） and digestive system （6， 8.57%）， of which circulatory system is dominated by coronary heart disease （chest impediment in traditional Chinese medicine）. The involved medical syndrome types mainly included internal obstruction of phlegm heat and turbidity， obstruction of phlegm turbidity and stasis， congealing cold， phlegm， stasis and Qi stagnation， chest Yang depression and combined phlegm and stasis. Ancient medical records and modern clinical application are the keys to ensure the safety and effectiveness of famous classical prescriptions and compound preparations. Therefore， this paper sorted and mined ancient medical books of Zhishi Xiebai Guizhi Tang and statistically analyzed its modern clinical application， aiming to provide a literature reference for the research and development of new drugs and clinical application of the prescription.

Objective:To retrospectively analyze the risk factors for the development of liver cancer in patients with hepatitis B-related liver cirrhosis (LC) treated and fully managed with long-term nucleos(t)ide analogues (NAs).Methods:The study subjects were derived from the follow-up cohort of chronic hepatitis B and liver cirrhosis who received antiviral therapy in the Department of Infectious Diseases of the First Affiliated Hospital of Guangxi Medical University from February 2004 to September 2019. LC patients who met the inclusion criteria were enrolled. The life-table method was used to calculate the incidence of liver cancer. Multivariable Cox regression model was used to analyze the risk factors that may affect the development of liver cancer in patients with LC. A subgroup analysis was conducted in liver cirrhotic patients who developed liver cancer to evaluate the effectiveness of antiviral treatment compliance. The 2 test was used for rate comparison. Results:The median follow-up time of 198 LC cases treated with NAs was 6.0 years (1.0-15.3 years). By the end of the visit: (1) 16.2% (32/198) of LC patients had developed liver cancer, and the cumulative incidence of liver cancer in 1, 3, 5, 7, and 9 years were 0, 8.9%, 14.3%, 18.6%, and 23.4%, respectively, with an average annual incidence of 3.1%. Among the 32 cases with liver cancer, 68.7% had developed small liver cancer (22/32). (2) Univariate Cox model analysis showed that the development of liver cancer was related to four factors, i.e., the presence or absence of LC nodules, whether the baseline was first-line medication, the family history of liver cancer, and patient compliance. The results of multivariate Cox model analysis showed that poor patient compliance and baseline non-first-line medication were risk factors for liver cancer. (3) The results of log-rank test subgroup analysis showed that the 5-year cumulative incidence of liver cancer in patients with hardened nodules was significantly higher than that of patients without hardened nodules (21.7% vs. 11.5%, P = 0.029). The 5-year cumulative incidence of liver cancer in patients with non-first-line drugs was significantly higher than that of patients with first-line drugs (22.0% vs.8.2%, P = 0.003). The 5-year cumulative incidence of liver cancer in patients with poor compliance was significantly higher than that of patients with good compliance (21.3% vs. 12.7%, P = 0.014). The 5-year cumulative incidence of liver cancer in patients with a family history of liver cancer was significantly higher than that of patients without a family history of liver cancer (22.3% vs. 8.1%, P = 0.006). (4) Compared with patients with poor compliance, patients with good compliance had higher HBV DNA negative serconversion rate (98.7% vs. 87.8%, P = 0.005), and a lower virological breakthrough rate (12.1% vs. 29.3%, P = 0.007). Conclusion:The long-term NAs antiviral therapy can reduce the risk of liver cancer, but it cannot completely prevent the development of liver cancer, especially in patients with a family history of liver cancer and baseline hardened nodules (high risk of liver cancer). Furthermore, the complete management can improve patient compliance, ensure the efficacy of antiviral therapy, and reduce the risk of liver cancer development, so to achieve secondary prevention of liver cancer, i.e., early detection, diagnosis and treatment.

Objective:To retrospectively analyze the serological, virological, biochemical, liver histological status and clinical outcomes in HBeAg-negative chronic hepatitis B (CHB) patients with low HBV viral load, and to explore the necessity of antiviral therapy for these patients.Methods:A total of 99 HBeAg-negative CHB patients with HBV DNA level < 4 lg copies/ml who performed liver biopsy at the baseline were enrolled from the follow-up cohort. Among them, 23 cases received the second liver biopsy during follow-up. The relationships among the degree of inflammation and fibrosis of liver tissues, the status of HBsAg and HBcAg, age, gender, family history, HBV DNA load, serological markers and other indicators were analyzed. The pathological differences between two liver biopsy examinations were compared. The effect of nucleos(t)ide analogues (NAs) treatment on patient’s clinical outcomes were analyzed. For multivariate analysis, a binary logistic regression model was performed. Log-rank test was used to compare the cumulative incidence of hepatocellular carcinoma (HCC) in NAs-treated and non-NA streated patients.Results:Baseline liver histology status showed that 58.6% (58/99) patients had obvious liver tissue damage in their baseline liver tissue pathology (G≥2 and /or S≥2). Univariate logistic regression analysis showed that a liver cirrhosis (LC) family history, a HBsAg-positive family history, baseline alanine aminotransferase and aspartate aminotransferase levels were positively correlated factors for liver tissue damage. Multivariate logistic regression analysis showed that a LC family history was the main risk factor for liver tissue damage. Twenty-three cases had received a second liver biopsy after an interval of 4.5 years. In 10 untreated cases, the second liver biopsy results showed the rate of obvious liver tissue damage (G≥2 and/ or S≥2) increased from 50.0% to 90.0%. In the other 13 cases who received NAs treatment, the second liver biopsy showed improvement in liver histology, and the rate of obvious liver tissue damage decreased from 61.5% to 46.2%. The 5-year HCC cumulative incidence in non-NAs-treated patients was significantly higher than that of in NAs-treated patients (17.7% vs. 3.8%, P = 0.046). Conclusion:For most HBeAg-negative CHB patients with low viral load, liver tissue pathology result suggests that it meets the indications for antiviral therapy, especially in patients with a LC familial history. Without antiviral therapy, liver tissue damage for these patients will progressively worse with the high incidence of HCC. Therefore, it is suggested that antiviral therapy should be started as soon as possible for the HBeAg-negative CHB patients with low viral load regardless of the alanine aminotransferase level, especially in patients over 30 years-old with a LC or HCC family history.

Objective To observe the incidence of spontaneous clearance of hepatitis B virus (HBV) DNA in chronic hepatitis B (CHB) patients ,and to investigate the related factors of the spontaneous clearance of HBV DNA and to determine the time to start antiviral therapy .Methods Patients who met the inclusion criteria were recruited from the follow-up cohort of chronic HBV infection from January 2008 to August 2017 for observation .The liver function including alanine aminotransferase (ALT) levels ,HBV DNA load and serum markers of HBV were measured at baseline ,month 1 ,month 3 and month 6 of follow-up . Evaluation index included cumulative HBV DNA negative conversion rate and cumulative HBeAg negative conversion rate .Multivariable analysis was used to analyze the factors associated with the spontaneous clearance of HBV DNA .Results A total of 116 patients were recruited in this study .All the patients showed ALT level elevation at baseline .Without antiviral treatment ,the cumulative HBV DNA negative conversion rate was 12 .9％ after 6-month observation .HBeAg negative conversion rate was 22 .5％ .Multivariable analysis showed that patients without a family history of HBV infection ,baseline ALT level >3 times the upper limit of normal (ULN) and HBV DNA level <6 lg copies/mL had higher cumulative HBV DNA spontaneous clearance rate .HBV DNA negative conversion rate in patients whomet all the above three conditions was up to 75％ .Conclusions In CHB patients and ALT level elevation for the first time , some patients could achieve spontaneous clearance of HBV DNA without antiviral therapy .Patients without a family history of HBV infection ,baseline ALT level >3 ULN and HBV DNA level <6 lg copies/mL have higher rate of cumulative HBV DNA spontaneous clearance .

Objective To investigate the clinical application effect of independently designed subcutaneous tunnel in endo‐scopic thyroid operation .Methods A total of 480 cases of endoscopic thyroid operation were completed in our department from February 2005 to December 2014 ,in which 315 cases adopted the independently designed subcutaneous tunnel for separating the subcutaneous tissues in anterior thoracic region and the other 165 cases used the puncture stick for separating and constructing the subcutaneous tunnel .Results Using independently designed subcutaneous tunnel for constructing the subcutaneous tunnel in the anterior thoracic region had statistical difference in the operative time and intraoperative bleeding amount compared with the punc‐ture stick(P<0 .05) ,and the difference of postoperative complications between the two groups was statistically signifficant (P<0 .05) .Conclusion Adopting the independently designed subcutaneous tunnel for constructing subcutaneous tunnel has the advan‐tages of short time consuming ,less bleeding and fewer complications .The level and size of the constructed subcutaneous tunnel are easy to grasp ,so which is more convenient for endoscopic thyroid operation .