Non-alcoholic fatty liver disease (NAFLD) has gradually become the most prevalent chronic liver disease in the world, but its pathogenesis has not been fully elucidated. Ferroptosis is a novel type of programmed cell death caused by iron-dependent lipid peroxidation. Heme oxygenase-1 is a recognized antioxidant enzyme and an important regulatory factor in ferroptosis that modulates ferroptosis through various pathways and, in turn, regulates NAFLD. This paper reviews the regulatory mechanism of heme oxygenase-1 on NAFLD in ferroptosis pathway, with a view to clarifying the occurrence and development mechanisms of NAFLD and providing new vision and targets for its prevention and treatment.

Objective:To compare percutaneous Kirschner wiring and elastic intramedullary nailing after ultrasound-guided reduction in the treatment of radial neck fractures in children.Methods:A retrospective study was conducted to analyze the 96 children with radial neck fracture who had been admitted to Department of Orthopedics, Children's Hospital of Anhui Province from January 2020 to January 2023. They were 51 boys and 45 girls with an age of (7.0±2.5) years. By the Judet classification, there were 74 cases of type Ⅲ and 22 cases of type IV. Twenty-one cases were treated with percutaneous Kirschner wiring after ultrasound-guided reduction (Kirschner wire group) while 75 cases with elastic intramedullary nailing after ultrasound-guided reduction (intramedullary nail group). The surgical time, fluoroscopy frequency, fracture healing time, and incidence of complications were compared between the 2 groups. Their postoperative X-ray films were evaluated according to the Métaizeau criteria, and elbow joint function was evaluated according to the Steel and Gtrham scoring at the last follow-up.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The 96 pediatric patients were followed up for (10.6±4.2) months after surgery. The surgical time [(18.5±2.6) minutes] and fluoroscopy frequency [4.0 (3.0, 4.0) times] in the Kirschner wire group were significantly less than those in the intramedullary nail group [(30.9±2.7) minutes, 8.0 (7.0, 9.0) times] ( P<0.05). There was no statistically significant difference in fracture healing time, good and excellent rate of postoperative reduction by the Métaizeau criteria, good and excellent rate of elbow joint function by the Steel and Gtrham scoring at the last follow-up, or incidence of complications ( P>0.05). Conclusion:In the treatment of radial neck fractures in children, both ultrasound-guided percutaneous Kirschner wiring and elastic intramedullary nailing after ultrasound-guided reduction can lead to similar therapeutic effects, but the former can shorten surgical time, reduce intraoperative fluoroscopy frequency, and spare a secondary surgery.

Objective:To observe the protective effect of Panax notoginseng total saponins(PNS)on oxidative stress damage induced by hydrogen peroxide(H 2O 2)in human renal tubular epithelial cells(HK-2)and its mechanism. Methods:HK-2 was cultured and divided into experimental groups: Normal group(without any intervention factors), H 2O 2 group(400 μmol/L H 2O 2 was added into the cell culture system for 6 h)and PNS group(which was divided into three groups: PNS 25 μg/ml, 50 μg/ml and 100 μg/ml were added into the cell culture system for 4 h, and then 400 μmol/l H 2O 2 was added into the cell culture system for 6 h), and the apoptosis of HK-2 induced by H 2O 2 was observed. Results:Compared with the normal group, the cell survival rate of H 2O 2 group decreased to(45.67±2.52)% and the cell apoptosis rate increased to(19.23±1.63)%(all P<0.01), while the cell survival rate of PNS group was(55.12±2.33)%, (65.37±4.72)% and(83.46±1.52)%, and the apoptosis rate was reduced to(15.53±0.70)%, (12.53±1.30)% and(7.17±0.35)%, respectively.The levels of reactive oxygen species(ROS)in HK-2 cells in 50 μg/ml and 100 μg/ml PNS groups were(845.7±17.79)and(353.3±26.1), respectively.With the increase of PNS dose, super oxide dismutase(SOD)and glutathione peroxidase(GSH-Px)activities increased and malonic dialdehyde(MDA)production decreased in the 3 PNS groups, compared with the H 2O 2 group, the differences were statistically significant(all P<0.01). Conclusions:PNS can protect HK-2 cells against oxidative damage by enhancing the activity of intracellular antioxidant enzymes, the effect is enhanced with the increase of the dose.

Objective To investigate the multi spiral computed tomography(MSCT)characteristics and biological behaviors of advanced gastrointestinal signet ring cell carcinoma(SRCC),so as to provide accurate preoperative type,stage and personalized choice of treatment strategy in clinical practice.Methods The clinical manifestations,five tumor markers and MSCT imaging data of 26 cases(group A)with advanced gastrointestinal SRCC confirmed by surgical or endoscopic biopsy and pathological immunohistochemistry were analyzed retrospectively,and 44 cases(group B)of advanced non-signet ring cell carcinoma(NSRCC)during the same period were randomly selected as the control group.The clinical manifestations,five tumor markers and MSCT imaging features of groups A and B were analyzed.Results There were no significant differences in gender,tumor location,tumor thickness(T)and length(L),and five tumor markers between groups A and B(P＞0.05).There were significant differences in age,main symptoma,tumor thickness-to-length ratio(TLR),angle between cancerous edge and normal tissue(CNA)(P＜0.05).However,age of group A and group B[group A≤50 years old(12/26,46％),group B＞50 years old(42/44,95％)],main symptom(x2=19.085,P＜0.05),tumor TLR(Z=-2.044,P＜0.05)and CNA(x2=14.776,P＜0.05)were significantly different(P＜0.05).Conclusion SRCC affects younger patients and is more likely to originate from the middle and lower parts of the stomach and rectum,with lower TLR,obtuse angle of CNA,and"caterpillar-like"characteristics of colorectal SRCC.

Objective:To clarify the clinical efficacy of first-line oral antiviral drugs tenofovir alafenamide (TAF), tenofovir disoproxil fumarate (TDF), and entecavir (ETV) in the treatment of chronic hepatitis B (CHB) and their safety profiles with lipid, bone, and kidney metabolism.Methods:458 CHB cases diagnosed and treated at the Department of Hepatology of Integrated Traditional Chinese and Western Medicine of the Third Hospital of Hebei Medical University from February 2010 to November 2022 were selected. TAF (175 cases), TDF (124 cases), and ETV (159 cases) were used as therapies. At 24 and 48 weeks, the virology, biochemical response, changes in liver stiffness measurement (LSM), and bone, kidney, and blood lipid metabolism safety profiles were compared and analyzed.Results:After 24 and 48 weeks of TAF, TDF, and ETV therapy, HBV DNA load decreased by 3.28, 2.69, and 3.14 log10 IU/ml and 3.28, 2.83, and 3.65 log10 IU/ml, respectively, compared with the baseline, and the differences between the three groups were statistically significant, P < 0.001. The complete virological response rates were 73.95%, 66.09%, 67.19%, and 82.22%, 72.48%, and 70.49%, respectively. The incidence rates of low-level viremia were 16.67%, 21.70%, and 23.08%, while poor response rates were 1.11%, 3.67%, and 4.10%. ALT normalization rates were 64.00%, 63.89%, 67.96%, and 85.33%, 80.56%, 78.64%, respectively, and there was no statistically significant difference among the groups. LSM was significantly improved in patients treated with TAF for 48 weeks, P = 0.022. Serum phosphorus level gradually decreased with the prolongation of TDF treatment. The TAF treatment group had a good safety profile for kidney, bone, and phosphorus metabolism, with no dyslipidemia or related occurrences of risk. Conclusion:There are some differences in the therapeutic effects of first-line anti-HBV drugs. TAF has the lowest incidence of low-level viremia after 48 weeks of treatment and has a good safety profile in kidney, bone, and blood lipid metabolism.

Objective:To investigate the clinical efficacy of Kirschner wire reconstruction of periosteal hinge combined with "rolling pin" technique assisting closed reduction and percutaneous Kirschner wire fixation versus closed reduction and percutaneous Kirschner wire fixation in the treatment of flexion-radial deviated supracondylar fracture of the humerus in children.Methods:A retrospective cohort study was used to analyze the clinical data of 85 patients with flexion-radial deviated supracondylar fracture of the humerus treated in Anhui Provincial Children ′s Hospital from January 2017 to December 2021, including 53 males and 32 females; aged 4-14 years [(7.4±2.7)years]. There were 49 patients treated by Kirschner wire reconstruction of periosteal hinge combined with "rolling pin" technique assisting closed reduction and percutaneous Kirschner wire fixation (study group) and 36 patients by closed reduction and percutaneous Kirschner wire fixation (control group). The operation time, number of intraoperative fluoroscopy, rate of incision after failure of closed reduction (hereinafter referred to as rate of incision), fracture healing time, and elbow joint function by Flynn score at the last follow-up were compared between the two groups. Complications were observed at 2 months after operation, such as infection and irritation of the Kirschner pin tail. Results:All patients were followed up for 2-12 months [(6.2±2.2)months]. The operation time and number of intraoperative fluoroscopy was (62.4±21.4)minutes and (34.8±7.1)times in control group, significantly longer or more than (31.2±14.1)minutes and (22.5±5.1) times in study group ( P<0.05 or 0.01). The incision rate was 17% in control group, but was 0 in study group ( P<0.01). The fracture healing time had no significant difference between control group and study group [(4.5±0.8)weeks vs. (4.6±0.6)weeks] ( P>0.05). According to Flynn score at the last follow-up, the excellent and good rate of elbow function was 89% in control group (excellent in 26 patients, good in 6, fair in 4, poor in none), not significantly different from 94% in study group (excellent in 41 patients, good in 5, fair in 3, poor in none) ( P>0.05). There was no infection or irritation of the Kirschner pin tail in the two groups at 2 months after operation. Conclusion:Kirschner wire reconstruction of periosteal hinge combined with "rolling pin" technique assisting closed reduction and percutaneous Kirschner wire fixation has similar effect to closed reduction and percutaneous Kirschner wire fixation in the treatment of flexion-radial deviated supracondylar fracture of the humerus, but the former has relatively shorter operation time, less intraoperative fluoroscopy and lower incision rate.

Methods:Two thousand standard sections images werre collected from 2 000 clinical retrospective pediatric hip ultrasound videos from January 2019 to January 2021. All standard sections were annotated by the annotation team through the self-designed software based on Python 3.6 environment for image cross-media data annotation and manual review standardization process with unified standards. Among them, 1 753 were randomly selected for training the deep learning system, and the remaining 247 were used for testing the system. Further, 200 standard sections were randomly selected from the test set, and 8 clinicians independently completed the film reading annotation. The 8 independent results were then compared with the AI results.Results:The testing set consists of 247 patients. Compared with the clinician's measurements, the area under the receiver operating characteristic curve (AUC) of diagnosing hip joint maturity was 0.865, the sensitivity was 76.19%, and the specificity was 96.9%. The AUC of AI system interpretation under Graf detailed typing was 0.575, the sensitivity was 25.90%, the specificity was 89.10%. The 95% LoA of α-angle determined by Bland-Altman method, of -4.7051° to 6.5948° ( Bias -0.94, P<0.001), compared with clinicians' measurements. The 95% LoA of β-angle, of -7.7191 to 6.8777 ( Bias -0.42, P=0.077). Compared with those from 8 clinicians, the results of AI system interpretation were more stable, and the β-angle effect was more prominent. Conclusion:The AI system can quickly and accurately measure the Graf correlation index of standard DDH ultrasonic standard diagnosis plane.

Objective:To summarize the clinical and genetic characteristics of catecholaminergic polymorphic ventricular tachycardia (CPVT) in children caused by CASQ2 gene variants. Methods:The clinical data of 8 children (4 males and females, respectively) with CPVT caused by CASQ2 gene variants admitted to Beijing Children′s Hospital, Capital Medical University from January 2017 to November 2018 were retrospectively analyzed.The targeted next generation sequencing was employed to identify CASQ2 variants and Sanger sequencing was conducted to conform the candidate variants and determine the parental origin. Results:As for 8 children in this study, the average age of onset was 6.4 years, the mean age at diagnosis was 9.4 years, and the average interval from onset to diagnosis was 3 years.Only 2 cases had clearly diagnosis at onset, other 6 cases had a delay to diagnosis and 3 cases of them were diagnosed at other hospitals as having epilepsy and did not respond to anti-epileptic therapy.During physical activity and/or emotional stress, 8 cases presented with recurrent syncope and were able to regain consciousness after a few minutes.They had no a history of sudden cardiac death or family history.There was no abnormality on resting electrocardiogram during the paroxysmal interval in 6 cases and mild sinus bradycardia in 2 cases.Typical bidirectional ventricular tachycardia (VT) and/or polymorphic VT were detected in 8/8 cases and 5/5 cases, respectively, based on Holter electrocardiography and cardiac stress test.The CASQ2 gene variant was found in all children, with 6 cases carrying compound heterozygous variants and 2 cases carrying homozygous variants.A total of 9 different CASQ2 variants were detected in 8 cases, of which 5 had not been previously reported.According to the family-line verification, all of them had a familial variant, with no novel variants.All 8 cases were treated orally with β-blockers, with asymptomatically recurrent episodes, with a mean follow-up of 1.5 years, during which implantable cardioverter defibrillation was performed in 1 case owing to severe sinus bradycardia.There was no death case among them. Conclusions:CPVT with CASQ2 variants is characterized by early onset before preschool age, recurrent syncope after exercise or emotional stress and bidirectional/polymorphic VT.Early diagnosis of CPVT remains challenging due to delayed diagnosis or misdiagnosis.Treatment with β-blockers can achieve favorable effectiveness and safety.Five novel variants in this study would further expand the database of CASQ2 genes.

Objective:To determine the diagnostic value of plasma heme oxygenase 1 (HO-1) in the occurrence, development, and pathological stages of chronic hepatitis B-related liver fibrosis.Methods:211 outpatients and inpatients with chronic hepatitis B (CHB) and 57 healthy controls who visited the Third Hospital of Hebei Medical University were selected. Simultaneously, clinical data, peripheral blood routine and serum biochemical test results of the research subjects were collected. Plasma HO-1 levels were detected by enzyme-linked immunosorbent assay (ELISA). Liver fibrosis (S1 ~ 4) was staged according to liver biopsy and liver stiffness measurement (LSM). Statistical analysis: binary logistic regression was used to analyze the independent risk factors of hepatitis B-related liver fibrosis to establish a diagnostic model, and the receiver operating characteristic curve (ROC) was used to compare and analyze the staging efficiency of HO-1, new model, FIB-4 and APRI for the diagnosis of liver fibrosis.Results:Plasma HO-1 levels were significantly higher in CHB patients than healthy controls [10.11 (7.08 ~ 13.12) ng/ml and 6.71 (5.56 ~ 8.45) ng/ml, ( P < 0.001)]. There were 37, 38, 38, and 98 cases with liver fibrosis stages S1, S2, S3, and S4, respectively and plasma HO-1 level was (6.91 ± 2.80) ng/ml, (8.24 ± 2.44) ng/ml, (9.96 ± 3.46) ng/ml, (12.65 ± 3.70) ng/ml, P < 0.001. HO-1, albumin, and platelets (PLT) were independent risk factors for liver fibrosis. A HAP model was established. HAP, FIB-4 and APRI sensitivity and specificity for the diagnosis of liver fibrosis staging were as follows: ≥S2 were 84.62%, 72.35 %, 81.18% and 83.78%, 81.08%, 67.57%; ≥S3 were 80.15%, 82.09%, 85.82% and 88.64%, 76.19%, 60.32%; S4 were 90.82%, 82.29%, 86.46% and 74.37%, 65.77%, 48.65%, respectively. Conclusion:Plasma HO-1 level can reflect the severity of liver fibrosis. HAP diagnostic model can more accurately mirror the process of liver fibrosis than FIB-4 and APRI, and point clinical diagnosis and prognosis assessment.

Objective:To investigate the relationship between plasma Golgi protein 73 (GP73) levels and the occurrence and development of non-alcoholic fatty liver disease (NAFLD), and to establish a diagnostic model based on this combination with lipid metabolism indicators to clarify its diagnostic efficacy and clinical application value for NAFLD.Methods:225 cases with NAFLD [diagnosed by ultrasound, transient elastography (FibroScan502) and liver biopsy (some patients)] and 108 healthy controls were selected from the Department of Hepatology and Physical Examination Center of Integrated Traditional Chinese and Western Medicine, The Third Hospital of Hebei Medical University. Clinical data, routine peripheral blood and serum biochemical test results were collected. The plasma GP73 level was detected by enzyme-linked immunosorbent assay. SPSS 21.0 statistical software was used for statistical analysis. Binary logistic regression model was used to calculate the NAFLD diagnostic model. Receiver operating characteristic curve was used to evaluate the NAFLD constructed model diagnostic efficacy.Results:NAFLD incidence was significantly reduced in younger age group, mostly in young and middle-aged male. However, the NAFLD incidence was increased with increasing age in female. The analysis of age ratio composition showed that the average age for NAFLD onset was 20 ~ 50 years old, and the incidence rate was as high as 47% in among 30 ~ 39 years old, but the incidence rate was significantly decreased in over 60 years old (4.00%). GP73 was an independent risk factor for the occurrence and development of NAFLD. The diagnostic models of GBT, GB and GT were established by GP73 (G) combined with body mass index (BMI, B) and serum triglyceride (TG, T), and the results showed that the areas under the curves of GBT, GB and GT models were 0.969, 0.937 and 0.909, respectively. The sensitivity and the specificity were 84.90%, 77.80% and 84.00%, and 95.40%, 95.40% and 82.40%, respectively, P < 0.05. The GBT model had efficacy of best diagnostic performance. Conclusion:NAFLD is more common in young and middle-aged male, but with advanced age, the incidence of female patients gradually increases. Plasma GP73 levels are related to the occurrence and development of NAFLD. The GBT model can be used as a new model for non-invasive diagnosis and one of the indicators for clinical evaluation of diagnostic efficacy of NAFLD.