Objective To compare the clinical efficacies among three surgical methods in the treatment of stage Ⅲ Kümmell's disease without neurological symptoms.Methods A total of 71 patients with stage Ⅲ Kümmell's disease without neurological symptoms admitted and treated in the orthopedics department of Af-filiated Yueyang Hospital of Hunan Normal University from September 2019 to April 2022 were selected and divided into three groups:29 cases in the percutaneous vertebroplasty (PVP) group (group A),19 cases in the percutaneous pedicle screw+lesioned vertebral PVP group (group B) and 21 cases in the percutaneous bone cement screw combined with lesioned vertebral PVP group (group C) according to the operation methods.The imaging,perioperative and follow-up indexes were compared among the three groups.Results All patients successfully completed the operation,no serious complications occurred after operation,and the follow-up time was more than 1 year.The sagittal position index (SI value) in the affected vertebra,visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score at each time point (postoperative 1,3 months,1 year) after surgery in the group A were improved compared with before operation (P<0.05).The affected vertebra SI value,kyphosis Cobb angle,spinal canal stenosis rate,VAS score and ODI score at postoperative time points in the group B and C were improved compared with before operation (P<0.05).The affected ver-tebra SI value,kyphosis Cobb angle,spinal canal stenosis rate and ODI score at postoperative time points in the group B and C all were superior to those in the group A (P<0.05),while the affected vertebra SI value,kyphosis Cobb angle and spinal canal stenosis rate in postoperative 1 year in the group C were superior to those in the group B (P<0.05).The operative time,intraoperative bleeding volume,postoperative hospitaliza-tion duration and affected vertebral cement injection volume in the group A were significantly less than those in the group B and C (P<0.05).The operation time in the group B was less than that in the group C (P<0.05).Conclusion The three surgical methods for the treatment of stage Ⅲ Kümmell's disease without neu-rological symptoms all could relieve the symptoms and restore the function.The two surgical methods of pedi-cle screw reduction could more effectively restore the height of the affected vertebra,correct kyphosis malfor-mation and improve spinal stenosis than PVP alone.The pedicle screw has more advantages in maintaining mechanical support and stability after bone cement reinforcement.

Objective To investigate the value of T2 mapping sequence combined with apparent diffusion coefficient(ADC)values in identifying benign and malignant breast lesions.Methods Ninety-two patients with breast mass were retrospectively selected,all patients received MRI examination,T2 mapping sequence and ADC values were selected for image analysis,and all patients underwent surgical biopsy and pathological diagnosis,the clinical value of T2 mapping sequence combined with ADC values in differential diagnosis of benign and malignant breast lesions was observed.Results After pathological examination,52 patients were diagnosed as malignant breast lesions and the remaining 40 were diagnosed as benign breast lesions.Among 52 patients with malignant lesions,51 were diag-nosed as malignant and 1 was diagnosed as benign by ADC values.Among the 40 cases of benign lesions,16 were diagnosed as malig-nant and 24 were diagnosed as benign by ADC values.The difference between the mean T2 values of benign breast lesions and malig-nant breast lesions was not significant(P＞0.05);but the coefficient of variation(CV)of T2 values of malignant breast lesions was significantly higher than that of benign breast lesions,and the difference was significant(P＜0.05),and the diagnostic efficacy of T2 mapping and ADC value single examination was lower than that of the combined examination(P＜0.05).Conclusion T2 mapping sequence and ADC value in MRI have the ability to diagnose and distinguish benign and malignant breast,especially the value of the joint application of the two is more prominent,improve the diagnostic accuracy,sensitivity and specificity,and can provide more accurate reference information for clinical practice,which is worth popularizing.

Objective:To understand the health needs of patients with non-dementia cognitive impairment after stroke, to provide reference for targeted interventions.Methods:Using the convergent mixed research method, convenience sampling was used to select post-stroke patients with non-dementia cognitive impairment in China-Japan Friendship Hospital and Beijing University of Chinese Medicine Third Affiliated Hospital, a cross-sectional survey was conducted on 191 patients with non-dementia cognitive impairment after stroke using the health needs questionnaire in March to August 2023. A descriptive study was used to conduct semi-structured interviews with 16 patients.Results:A total of 191 questionnaires were distributed and 191 valid questionnaires were collected, including 103 male and 88 female patients, aged from 34 to 90 years old. The items of the post-stroke health questionnaire were (3.47 ± 0.54), with the highest need for understanding the rehabilitation program (148/191); multiple linear regression analysis showed that gender and primary caregiver type were factors influencing their health needs ( t = 2.39, 2.73, both P<0.05). A total of 16 patients with non-dementia cognitive impairment after stroke, 10 males and 6 females, aged from 58 to 90 years old, were interviewed. Four themes were extracted, namely, information support and behavioral guidance needs, psychological care needs, social support needs, and pre-established medical care plan needs. Conclusions:The health needs of patients with non-dementia cognitive impairment after stroke are at an above medium level and have diversified characteristics. Medical staff should conduct systematic health management based on patients′specific conditions and actual needs to help patients recover or maintain cognitive function.

Objective:To investigate the correlation between serum uric acid to albumin ratio (UAR) and large-artery atherosclerosis (LAA), its severity and short-term outcome.Methods:Patients with acute ischemic stroke admitted to the Department of Neurology, the Affiliated Hospital of Qingdao University from September 2017 to August 2022 were retrospectively enrolled. They were classified into LAA and non-LAA according to the TOAST etiological criteria. Patients with LAA were further divided into mild stroke group (≤8) and moderate to severe stroke group (>8) according to the National Institutes of Health Stroke Scale score at admission, and good outcome group (≤2) and poor outcome group (>2) according to the modified Rankin Scale score at discharge. Multivariate logistic regression analysis was used to determine the correlation between UAR and LAA, its severity and short-term outcome. The predictive value of UAR for poor outcomes in patients with LAA was evaluated by receiver operating characteristic (ROC) curve. Results:A total of 4 178 patients with acute ischemic stroke were enrolled, including 2 751 males (65.8%), aged 61.95±10.73 years. There were 2 000 (47.9%) patients with LAA, including 1 112 (55.6%) mild stroke and 888 (44.4%) moderate to severe stroke; 813 (40.65%) had good short-term outcomes and 1 187 (59.35%) had poor outcomes. UAR in the LAA group was significantly higher than that in the non-LAA group ( P<0.05). In patients with LAA, the UAR of the moderate to severe stroke group and the short-term poor outcome group were significantly higher than that of the mild stroke group and the short-term good outcome group, respectively (all P<0.05). Multivariate logistic regression analysis showed that the UAR was an independent risk factor for LAA (odds ratio [ OR] 1.043, 95% confidence interval [ CI] 1.016-1.071; P=0.002), its severity ( OR 2.000, 95% CI 1.860-2.151; P<0.001), and short-term poor outcomes ( OR 1.456, 95% CI 1.379-1.537; P<0.001). ROC curve analysis showed that the area under the curve of UAR for predicting short-term poor outcomes in patients with LAA was 0.727 (95% CI 0.704-0.750; P<0.001). The optimal cutoff value was 6.62, and the sensitivity and specificity were 86.6% and 56.7%, respectively. The area under the curve of UAR for predicting short-term poor outcomes in patients with LAA was greater than that predicted solely by uric acid and albumin. Conclusions:UAR is associated with LAA, its severity and poor prognosis, and has higher predictive value for poor outcomes in patients with LAA.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Objective: To study the survival time and its risk factors of patients with occupational pneumoconiosis. Methods: A total of 11 011 newly diagnosed occupational pneumoconiosis patients in Guangdong Province from 1980 to 2019 were selected as study subjects. The life table method was used for survival analysis. The influencing factors of survival time of occupational pneumoconiosis patients were analyzed using the WilCoxon (Gehan) test and Cox proportional hazards regression model. Results: The median survival time of pneumoconiosis patients was 26.0 years. The median survival period of stage Ⅰpatients was 3.5 years longer than that of stage Ⅱ patients and 10.1 years longer than that of stage Ⅲ patients. The median survival time of patients with an initial diagnosis age under 40.0 years old was 34.8 years longer than that of patients with an initial diagnosis age over 60.0 years old. The median survival time of patients with dust exposure duration under 25.0 years old was 13.6 years longer than patients with dust exposure duration age over 45.0 years old. The results of the Cox proportional hazards regression model showed that the initial diagnosis stage, initial diagnosis age, dust exposure duration, and medical insurance were risk factors of the survival time of occupational pneumoconiosis patients (all P<0.01). The risk of reduced survival time for patients with stage Ⅱ and stage Ⅲ as the initial diagnosis stage was 1.15 and 2.04 times higher, respectively, compared with stage Ⅰ patients (both P<0.01). The risk of reduced survival time for patients without medical insurance was 60.22 times higher than those with medical insurance (P<0.01). Conclusion: The risk factors of the survival time of occupational pneumoconiosis patients in Guangdong Province are initial diagnosis stage, initial diagnosis age, the dust exposure age, and medical insurance. Earlier detection, earlier diagnosis, and improvement of medical insurance coverage for patients can effectively improve the survival time of occupational pneumoconiosis patients.

This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
Humans ; China/epidemiology* ; Cross Infection/epidemiology* ; Intensive Care Units/statistics & numerical data* ; Quality Control ; Quality Indicators, Health Care/statistics & numerical data* ; Sepsis/therapy* ; East Asian People/statistics & numerical data*

Unlike healthy, non-transformed cells, the proteostasis network of cancer cells is taxed to produce proteins involved in tumor development. Cancer cells have a higher dependency on molecular chaperones to maintain proteostasis. The chaperonin T-complex protein ring complex (TRiC) contains eight paralogous subunits (CCT1-8), and assists the folding of as many as 10% of cytosolic proteome. TRiC is essential for the progression of some cancers, but the roles of TRiC subunits in osteosarcoma remain to be explored. Here, we show that CCT4/TRiC is significantly correlated in human osteosarcoma, and plays a critical role in osteosarcoma cell survival. We identify a compound anticarin-β that can specifically bind to and inhibit CCT4. Anticarin-β shows higher selectivity in cancer cells than in normal cells. Mechanistically, anticarin-β potently impedes CCT4-mediated STAT3 maturation. Anticarin-β displays remarkable antitumor efficacy in orthotopic and patient-derived xenograft models of osteosarcoma. Collectively, our data uncover a key role of CCT4 in osteosarcoma, and propose a promising treatment strategy for osteosarcoma by disrupting CCT4 and proteostasis.

Objective:To investigate the predictive value of the National Institutes of Health Stroke Scale (NIHSS) score at baseline and 24 h after the onset for the outcomes after endovascular mechanical thrombectomy (EMT) in patients with acute ischemic stroke.Methods:Patients with anterior circulation large vessel occlusive acute ischemic stroke received EMT in the Affiliated Hospital of Qingdao University from July 2018 to June 2020 were enrolled prospectively. According to the modified Rankin Scale scores at 3 months after the onset, they were divided into good outcome group (0-2) and poor outcome group (3-6). The demographic and clinical data between the groups were compared. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcomes. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the independent influencing factors for outcomes. Results:A total of 124 patients were included. Their age was 65.23±12.40 years, 80 were males (64.5%). The baseline NIHSS score was 15 (interquartile range, 11-19). Seventy-two patients (58.1%) had a good outcome and 52 (41.9%) had a poor outcome. Univariate analysis showed that there were significant differences in age, degree of vascular recanalization, baseline and 24 h NIHSS score after onset, and whether having intracranial hemorrhage or not between the good outcome group and the poor outcome group ( P<0.05). Multivariate logistic regression analysis showed that there was a significant independent correlation between the NIHSS score at 24 h after onset and the poor outcome (odds ratio [ OR] 1.243, 95% confidence interval [ CI] 1.125-1.373; P<0.001). ROC curve analysis showed that the area under the curve of poor outcome predicted by baseline NIHSS score was 0.639 (95% CI 0.542-0.737), and the predictive sensitivity and specificity were 80.8% and 45.8% respectively. The area under the curve of poor outcome predicted by NIHSS score at 24 h after onset was 0.830 (95% CI 0.759-0.902), and the predictive sensitivity and specificity were 94.2% and 65.3% respectively. Conclusion:In patients with anterior circulation large vessel occlusive acute ischemic stroke receiving EMT, the NIHSS score at 24 h after onset has higher predictive value for poor outcomes at 3 months after onset, and is significantly better than the baseline NIHSS score.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.