BACKGROUND:We have successfully established an animal model of small ear pig in southern Yunnan province with internal tension relieving technique combined with autologous Achilles tendon for anterior cruciate ligament reconstruction,and verified the stability and reliability of the model.However,whether internal tension relieving technique can promote the ligamentalization process of autologous Achilles tendon graft has not been studied. OBJECTIVE:To investigate the differences in the process of ligamentalization between conventional reconstruction and internal reduction reconstruction of the anterior cruciate ligament by gross view,histology and electron microscopy. METHODS:Thirty adult female small ear pigs in southern Yunnan province were selected.Anterior cruciate ligament reconstruction was performed on the left knee joint with the ipsilateral knee Achilles tendon(n=30 in the normal group),and anterior cruciate ligament reconstruction was performed on the right knee joint with the ipsilateral knee Achilles tendon combined with the internal relaxation and enhancement system(n=30 in the relaxation group).The autogenous right forelimb was used as the control group;the anterior cruciate ligament was exposed but not severed or surgically treated.At 12,24,and 48 weeks after surgery,10 animals were sacrificed,respectively.The left and right knee joint specimens were taken for gross morphological observation to evaluate the graft morphology.MAS score was used to evaluate the excellent and good rate of the ligament at each time point.Hematoxylin-eosin staining was used to evaluate the degree of ligament graft vascularization.Collagen fibers and nuclear morphology were observed,and nuclear morphology was scored.Ultrastructural remodeling was evaluated by scanning electron microscopy and transmission electron microscopy. RESULTS AND CONCLUSION:(1)The ligament healing shape of the relaxation group was better at various time points after surgery,and the excellent and good rate of MAS score was higher(P<0.05).Moreover,the relaxation group could obtain higher ligament vascularization score(P<0.05).(2)The arrangement of collagen bundles and fiber bundles in the two groups gradually tended to be orderly,and the transverse fiber connections between collagen gradually increased and thickened,suggesting that the strength and shape degree of the grafts were gradually improved,but the ligament remodeling in the relaxation group was always faster than that in the normal group at various time points after surgery.(3)The diameter,distribution density,and arrangement degree of collagen fibers in the relaxation group were better than those in the normal group at all time points,especially in the comparison of collagen fiber diameter between and within the relaxation group(P<0.05).

Objective:To explore the effects of adjuvant therapy by hyperbaric oxygen for high-energy lower limb fractures.Methods:This prospective case-control study enrolled the patients with high-energy lower extremity fracture who had been admitted to Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University from January 2021 to December 2022. Their fracture types included tibial plateau ones, pilon ones, ankle ones complicated with dislocation, and calcaneal ones. The patients were randomly divided into a control group receiving routine orthopedic treatment and a trial group receiving adjuvant therapy by hyperbaric oxygen in addition to routine orthopedic treatment using a random number table. The first adjuvant therapy by hyperbaric oxygen was conducted in the trial group within 48 h after injury before the timing for surgery was decided according to the soft tissue swelling at the affected limb. Follow-up was conducted until one year after surgery. The early and late wound complications, time from injury to surgery, and hospital stay were compared between the 2 groups.Results:A total of 160 patients with high-energy lower extremity fracture were enrolled in this study. Eventually, 7 patients were excluded, 72 patients [48 males and 24 females, with an age of (46.3±12.5) years] included in the trial group and 81 patients [61 males and 20 females, with an age of (47.8±13.4) years] in the control group. There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The incidence of early wound complications in the trial group was 5.6% (4/72), significantly lower than that in the control group [18.5% (15/81)] ( P<0.05). The incidences of late wound complications in the trial and control groups were 12.5% (9/72) and 9.9% (8/81) respectively, showing no statistically significant difference ( P>0.05). The time from admission to surgery was respectively 4 (2, 8) days and 4 (2, 6) days, and the hospital stay respectively 10 (7, 14) days and 9 (6, 12) days for the trial and control groups, showing no statistically significant differences between the 2 groups ( P>0.05). Conclusion:In the treatment of high-energy lower extremity fractures, adjuvant therapy by hyperbaric oxygen can reduce the incidence of early wound complications without increasing the hospital stay, but it does not reduce the incidence of late wound complications or shorten the preoperative waiting time.

OBJECTIVE To evaluate the influence of pharmaceutical quality control on the efficiency and outcomes of standardized medication therapy management （MTM） services for patients with coronary heart disease by using Economic， Clinical and Humanistic Outcomes （ECHO） model. METHODS This study collected case data of coronary heart disease patients who received MTM services during January-March 2023 （pre-quality control implementation group， n＝96） and June-August 2023 （post-quality control implementation group， n＝164）. Using propensity score matching analysis， 80 patients were selected from each group. The study subsequently compared the economic， clinical， and humanistic outcome indicators of pharmaceutical services between the two matched groups. RESULTS There were no statistically significant differences in baseline data between the two groups after matching （P＞0.05）. Compared with pre-quality control implementation group， the daily treatment cost （16.26 yuan vs. 24.40 yuan， P＜0.001）， cost-effectiveness ratio [23.12 yuan/quality-adjusted life year （QALY） vs. 32.32 yuan/QALY， P＜0.001]， and the incidence of general adverse drug reactions （2.50% vs. 10.00%， P＝0.049） of post-quality control implementation group were decreased significantly； the utility value of the EuroQol Five-Dimensional Questionnaire （0.74± 0.06 vs. 0.71±0.07， P＝0.003）， the reduction in the number of medication related problems （1.0 vs. 0.5， P＜0.001）， the medication adherence score （[ 6.32±0.48） points vs. （6.10±0.37） points， P＝0.001]， and the satisfaction score （[ 92.56±1.52） points vs. （91.95±1.56） points， P＝0.013] all showed significant improvements. Neither group experienced serious adverse drug reactions. There was no statistically significant difference in the incidence of new adverse reactions between the two groups （1.25% vs. 3.75%， P＝0.310）. CONCLUSIONS Pharmaceutical quality control can improve the quality of pharmaceutical care， and the ECHO model can quantitatively evaluate the effect of MTM services， making pharmaceutical care better priced and more adaptable to social needs， thus being worthy of promotion.

Objective:To examine the validity and reliability of the Chinese version of the Transgender Atti-tudes and Beliefs Scale(TABS)in the general adult population.Methods:A total of 1 656 residents aged≥18 years were recruited by convenient sampling method,and were equally divided into sample 1 and sample 2 accord-ing to age group.The total sample was used for item analysis and internal consistency reliability test.Sample 1 was used for exploratory factor analysis,Sample 2 was used for confirmatory factor analysis,and 60 residents were se-lected for retesting at a 2-week interval.Results:The TABS Chinese version included a total of 26 items,with the content validity index(I-CVI)of each item ranging from 0.83 to 1.00,and the content validity index(S-CVI)of the scale being 0.98.Exploratory factor analysis extracted 3 common factors,namely interpersonal comfort,gender beliefs,and human value,with a cumulative total variance of 57.13％.Confirmatory factor analysis showed that the scale fit was acceptable(x2/df=2.95,RMSEA=0.05,GFI=0.92,AGFI=0.90).The Cronbach α coefficients of the total score of the scale and the scores of the 3 factors were 0.95,0.95,0.88 and 0.86.The retest reliabilities were 0.88,0.78,0.65 and 0.91.Conclusion:The Chinese version of the Transgender Attitudes and Beliefs Scale(TABS)has good validity and reliability in assessing general adults'attitudes toward the transgender community.

Objective:To examine the validity and reliability of the Chinese version of the Transgender Atti-tudes and Beliefs Scale(TABS)in the general adult population.Methods:A total of 1 656 residents aged≥18 years were recruited by convenient sampling method,and were equally divided into sample 1 and sample 2 accord-ing to age group.The total sample was used for item analysis and internal consistency reliability test.Sample 1 was used for exploratory factor analysis,Sample 2 was used for confirmatory factor analysis,and 60 residents were se-lected for retesting at a 2-week interval.Results:The TABS Chinese version included a total of 26 items,with the content validity index(I-CVI)of each item ranging from 0.83 to 1.00,and the content validity index(S-CVI)of the scale being 0.98.Exploratory factor analysis extracted 3 common factors,namely interpersonal comfort,gender beliefs,and human value,with a cumulative total variance of 57.13％.Confirmatory factor analysis showed that the scale fit was acceptable(x2/df=2.95,RMSEA=0.05,GFI=0.92,AGFI=0.90).The Cronbach α coefficients of the total score of the scale and the scores of the 3 factors were 0.95,0.95,0.88 and 0.86.The retest reliabilities were 0.88,0.78,0.65 and 0.91.Conclusion:The Chinese version of the Transgender Attitudes and Beliefs Scale(TABS)has good validity and reliability in assessing general adults'attitudes toward the transgender community.

Objective:To explore the effects of adjuvant therapy by hyperbaric oxygen for high-energy lower limb fractures.Methods:This prospective case-control study enrolled the patients with high-energy lower extremity fracture who had been admitted to Department of Orthopaedics, Beijing Luhe Hospital, Capital Medical University from January 2021 to December 2022. Their fracture types included tibial plateau ones, pilon ones, ankle ones complicated with dislocation, and calcaneal ones. The patients were randomly divided into a control group receiving routine orthopedic treatment and a trial group receiving adjuvant therapy by hyperbaric oxygen in addition to routine orthopedic treatment using a random number table. The first adjuvant therapy by hyperbaric oxygen was conducted in the trial group within 48 h after injury before the timing for surgery was decided according to the soft tissue swelling at the affected limb. Follow-up was conducted until one year after surgery. The early and late wound complications, time from injury to surgery, and hospital stay were compared between the 2 groups.Results:A total of 160 patients with high-energy lower extremity fracture were enrolled in this study. Eventually, 7 patients were excluded, 72 patients [48 males and 24 females, with an age of (46.3±12.5) years] included in the trial group and 81 patients [61 males and 20 females, with an age of (47.8±13.4) years] in the control group. There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The incidence of early wound complications in the trial group was 5.6% (4/72), significantly lower than that in the control group [18.5% (15/81)] ( P<0.05). The incidences of late wound complications in the trial and control groups were 12.5% (9/72) and 9.9% (8/81) respectively, showing no statistically significant difference ( P>0.05). The time from admission to surgery was respectively 4 (2, 8) days and 4 (2, 6) days, and the hospital stay respectively 10 (7, 14) days and 9 (6, 12) days for the trial and control groups, showing no statistically significant differences between the 2 groups ( P>0.05). Conclusion:In the treatment of high-energy lower extremity fractures, adjuvant therapy by hyperbaric oxygen can reduce the incidence of early wound complications without increasing the hospital stay, but it does not reduce the incidence of late wound complications or shorten the preoperative waiting time.

Background Long-term exposure to ambient fine particulate matter (PM_2.5) may increase the risk of diabetes, and a healthy diet can effectively control fasting blood glucose levels. However, it is unclear whether dietary factors have a moderating effect on the risk of diabetes associated with atmospheric PM_2.5 exposure. Objective To investigate the association between long-term exposure to PM_2.5 and diabetes in rural areas of Ningxia, and potential interaction of long-term exposure to atmospheric PM_2.5 and diet on diabetes. Methods The study subjects were selected from the baseline survey data of the China Northwest Cohort-Ningxia (CNC-NX) , a natural population cohort. A total of 13917 subjects were included, excluding participants with missing covariate information. We utilized the annual average ambient PM_2.5 concentration from 2014 to 2018 as the long-term exposure level. Logistic regression and multiple linear regression were employed to analyze the associations of long-term atmospheric PM_2.5 exposure with diabetes and fasting blood glucose levels. Stratification by frequency of vegetable consumption, frequency of fruit consumption, and salty taste was used to examine moderating effects on the diabetes risk associated with atmospheric PM_2.5 exposure. Results The mean age of the 13917 subjects was (56.8±10.0) years, and the prevalence of diabetes was 9.8%. Between 2014 and 2018, the average annual concentration of PM_2.5 was (38.10±4.67) μg·m⁻³. The risk (OR) of diabetes was 1.018 (95%CI: 1.005, 1.032) and the fasting blood glucose was increased by 0.011 (95%CI: 0.004, 0.017) mmol·L⁻¹ for each 1 μg·m⁻³ increase in PM_2.5 concentration. Compared to those who consumed vegetables < 1 time per week, individuals who consume vegetables 1-3 times per week and ≥4 times per week had a reduced risk of developing diabetes by 27.1% (OR=0.729, 95%CI: 0.594, 0.893) and 16.8% (OR=0.832, 95%CI: 0.715, 0.971) respectively. Similarly, when compared to those who consumed fruits <1 time per week, individuals who consumed fruits 1-3 times per week and ≥4 times per week exhibited a reduced risk of diabetes by 16.4% (OR=0.836, 95%CI: 0.702, 0.998) and 18.2% (OR=0.818, 95%CI: 0.700, 0.959) respectively. Fasting blood glucose decreased by 0.202 (95%CI: -0.304, -0.101) mmol·L⁻¹ in participants who ate vegetables 1-3 times per week. The effect of salty taste on diabetes and fasting blood glucose was not significant. The results of stratified analysis by dietary factors and PM_2.5 concentration showed that the risks of diabetes were increased in the low PM_2.5 pollution-low vegetable intake frequency group and the high PM_2.5 pollution-low vegetable intake frequency group compared with the low PM_2.5 pollution-high vegetable intake frequency group, with OR values of 3.987 (95%CI: 2.943, 5.371) and 1.433 (95%CI: 1.143, 1.796) respectively. The risk of diabetes was 50.1% higher in participants with high PM_2.5 pollution and low fruit intake frequency than in participants with low PM_2.5 pollution and high fruit intake frequency (OR=1.501, 95%CI: 1.171, 1.926). No interaction was found between salty taste and PM_2.5 on diabetes. Conclusion Long-term exposure to ambient PM_2.5 is associated with an increased fasting blood glucose and an elevated risk of diabetes in rural Ningxia population. Increasing the frequency of weekly consumption of vegetables or fruits may have a certain protective effect against diabetes occurrence, as well as a moderating effect on diabetes and fasting blood glucose levels associated with long-term exposure to atmospheric PM_2.5.

To have better clinical understanding of Schimke immuno-osseous dysplasia(SIOD) through analyzing the clinical features, treatment, and prognosis of four patients with SIOD.

Objective:To explore the relationship among subjective well-being and depression-anxiety-stress and dispositional mindfulness in professional athletes,and the role of cognitive fusion and experiential avoidance and age in the relationship.Methods:Totally 423 professional athletes were selected and assessed with the Satisfac-tion with Life Scale(SWLS),Positive Affect Scale(PAS),Depression-Anxiety-Stress Scale(DASS-21),Five Fac-et Mindfulness Questionnaire(FFMQ),Cognitive Fusion Questionnaire(CFQ),and Acceptance and Action Ques-tionnaire-Ⅱ(AAQ-Ⅱ).Results:After controlling for gender,the FFMQ scores were positively correlated with SWB scores(β=0.35),and negatively correlated with DASS-21 scores(β=-0.40).The scores of CFQ and AAQ-Ⅱplayed a sequential mediating role in the relationship between FFMQ scores and the scores of SWB and DASS-21(β=0.04,-0.12).Age moderated the relationship between the scores of FFMQ and SWB(β=-0.01).Conclu-sion:The subjective well-being and depression-anxiety-stress may be related to dispositional mindfulness in profes-sional athletes,and age could moderate the relationship between subjective well-being and dispositional mindful-ness.

Background The impact of atmospheric fine particulate matter (PM_2.5) and ozone (O₃) on the mortality of circulatory system diseases cannot be ignored. However, whether the interaction between PM_2.5 and O₃ can affect population health is rarely reported and requires study. Objective To investigate the individual and interactive impacts of atmospheric PM_2.5 and O₃ on the mortality of circulatory system diseases in the population of Ningxia region. Methods The data of 119647 deaths due to circulatory system diseases, daily average concentrations of atmospheric pollutants, and meteorological data in Ningxia from 2013 to 2020 were retrieved. PM_2.5 was divided into low, medium, and high concentrations according to the primary and secondary national limits (35 and 75 μg·m⁻³) of the Ambient air quality standards. Similarly, O₃ was divided into low, medium, and high concentrations according to the national limits (100 and 160 μg·m⁻³). Using a generalized additive mixed model based on quasi Poisson distribution, the impacts of atmospheric PM_2.5 and O₃ as well as their interaction on the mortality of circulatory system diseases were analyzed using the population data of Ningxia region. Results During the target period, males and the ≥ 65 year group accounted for larger proportions of deaths due to circulatory system diseases (55.47% and 79.87% respectively). The daily average concentration of PM_2.5 (40.25 μg·m⁻³) exceeded the national primary limit. In the single pollution model, the highest cumulative lag effects for mortality from circulatory system diseases were PM_2.5 exposure over previous 1 d (lag01) and O₃ exposure for previous 2 d (lag02), and their excess risk (ER) values were 1.03% (95%CI: 0.67%, 1.40%) and 1.02% (95%CI: 0.57%, 1.50%), respectively. The results of concentration stratification analysis showed that the most significant risks of death from circulatory system diseases [ER (95%CI): 1.12% (0.32%, 1.92%) and 0.95% (0.13%, 1.79%) respectively] were found at medium PM_2.5 and O₃ concentrations. The interaction analysis revealed that under, a synergistic effect on the risk of death from circulatory system diseases was identified (relative excess risk due to interaction=3.08%, attributable proportion of interaction=2.90%, synergy index=1.89) when considering the coexistence of PM_2.5 and O₃ above the primary limit. As the concentrations of PM_2.5 and O₃ increased, the synergistic effect increased the risk of death from circulatory system diseases in the general population, men, women, and the ≥ 65 years group. Conclusion Both atmospheric PM_2.5 and O₃ can increase the risk of death from circulatory system diseases, and the two pollutants have a synergistic effect on the risk of death from circulatory system diseases.