Objective: To analyze the association between insufficient sleep and score of depressive symptoms among junior and senior high school students, so as to provide a scientific reference for targeted early intervention measures of adolescents depressive symptoms. Methods: From September to November 2023, a stratified cluster random sampling method was used to select 96 080 junior and senior high school students from 409 schools in 113 districts and counties in Shaanxi Province. A questionnaire survey was conducted using the 2023 Shaanxi Provincial Common Student Diseases and Health Influencing Factors Survey Form, and their height and weight were measured. Propensity score (PS) matched (1∶1) analysis was used to match participants with insufficient sleep to those sufficient sleep students. Through the gradual correction of the confounders, three multilevel linear models were established to analyze the association between insufficient sleep and depressive symptoms score, and subgroup analysis was conducted afterward. Results: A total of 70 135 (73.00%) students had insufficient sleep. After PS matching, 25 894 pairs were matched. Before PS matching, after adjusting for gender, educational stage, region, adolescent characteristics, boarding status, smoking, alcohol consumption, outdoor activities and body mass index grouping, linear regression analysis results showed that compared with students who got adequate sleep, students who lacked sleep had an increase of 1.39 scores ( B=1.39, 95%CI =1.28-1.51) in depressive symptoms; after PS matching, students with insufficient sleep got an increase of 1.32 scores ( B=1.32, 95%CI =1.17- 1.45 ) in depressive symptoms score compared with those who had adequate sleep (both P <0.05). Conclusions The insufficient sleep is associated with the increase of the depressive symptoms score of junior and senior high school students. It is recommended that junior and senior high school students should keep a good sleeping habit, so as to reduce the prevalence of depressive symptoms.

Pemphigus vulgaris (PV) is a group of autoimmune bullous diseases characterized by life-threatening intradermal blisters. Hashimoto thyroiditis (HT) is a kind of autoimmune disease with abnormal increase of thyroid peroxidase autoantibody (TPOAb), which is the thyroid specific antibody, leading to hypothyroidism. In recent years, the probability of HT in patients with PV is increasing, and the co-disease may be related to the effect of TPOAb autoantibody on oral keratinocytes. This article reviews the epidemiological relationship between PV and HT and the mechanism of TPOAb in their co-disease, in order to provide ideas for the diagnosis and treatment of both.

Objective:To evaluate the application of the reaming-irrigation-aspirator (RIA) technique in autologous bone grafting for non-union of lower limb fracture.Methods:A retrospective analysis was conducted of the data of 16 patients with non-union of lower limb fracture who had undergone autologous bone grafting using the RIA technique at Department of Lower Limb Orthopaedics Ⅰ, Zhengzhou Orthopaedic Hospital from July 2023 to March 2024. There were 12 males and 4 females with an age of (47.2±14.3) years. Sites of non-union: the femur in 14 cases and the tibia in 2 cases. Initial surgical fixation: intramedullary nail fixation in 5 cases, plate fixation in 10 cases, and intramedullary nail plus plate fixation in 1 case. The time for fracture non-union was (21.0±12.0) months. Intraoperatively, autologous bone reaming was conducted using a drill bit of RIA system, and simultaneous flushing using irrigation fluid. The bone debris carried out by the irrigation fluid was collected into a filtration device through negative pressure aspiration. After the filter was opened to squeeze out congestion, bone paste was taken out for standby. Internal fixation methods were adjusted according to the non-union condition of the fractures. Finally, the bone paste was implanted into bone defects. The time for autologous bone harvest, amount of bone harvested, intraoperative blood loss, postoperative pain at a donor site, fracture healing, functional recovery of a lower limb and occurrence of complications were recorded.Results:In 2 of the 16 patients, fracture of the RIA drill bit occurred when bone marrow was harvested from the tibia, and their operation was completed only after the drill bits were replaced. In the 16 patients, time for bone harvest was (31.4±6.1) min, bone harvest volume (42.6±9.5) mL, and intraoperative blood loss (815.6±238.6) mL. The incisions in this cohort healed primarily after operation, and 4-week follow-up revealed that no patients had pain symptoms at a donor site. The 16 patients were followed up for (8.0±2.0) months after operation. All patients achieved bone union after (4.4±0.5) months. Follow-ups showed that no patients had complications like delayed infection, donor site fracture, or loosening or fracture of an internal fixator. According to the rating scale for lower limb function at the last follow-up, the function of affected limb was evaluated as excellent in 7 cases, as good in 8 cases, and as fair in 1 case.Conclusion:Application of RIA technique for autologous bone grafting to treat non-union of lower limb fracture can lead to fine fracture healing and good lower limb function, but no long-term pain symptoms in the donor area for the patients.

Pemphigus vulgaris (PV) is a group of autoimmune bullous diseases characterized by life-threatening intradermal blisters. Hashimoto thyroiditis (HT) is a kind of autoimmune disease with abnormal increase of thyroid peroxidase autoantibody (TPOAb), which is the thyroid specific antibody, leading to hypothyroidism. In recent years, the probability of HT in patients with PV is increasing, and the co-disease may be related to the effect of TPOAb autoantibody on oral keratinocytes. This article reviews the epidemiological relationship between PV and HT and the mechanism of TPOAb in their co-disease, in order to provide ideas for the diagnosis and treatment of both.

Objective:To evaluate the application of the reaming-irrigation-aspirator (RIA) technique in autologous bone grafting for non-union of lower limb fracture.Methods:A retrospective analysis was conducted of the data of 16 patients with non-union of lower limb fracture who had undergone autologous bone grafting using the RIA technique at Department of Lower Limb Orthopaedics Ⅰ, Zhengzhou Orthopaedic Hospital from July 2023 to March 2024. There were 12 males and 4 females with an age of (47.2±14.3) years. Sites of non-union: the femur in 14 cases and the tibia in 2 cases. Initial surgical fixation: intramedullary nail fixation in 5 cases, plate fixation in 10 cases, and intramedullary nail plus plate fixation in 1 case. The time for fracture non-union was (21.0±12.0) months. Intraoperatively, autologous bone reaming was conducted using a drill bit of RIA system, and simultaneous flushing using irrigation fluid. The bone debris carried out by the irrigation fluid was collected into a filtration device through negative pressure aspiration. After the filter was opened to squeeze out congestion, bone paste was taken out for standby. Internal fixation methods were adjusted according to the non-union condition of the fractures. Finally, the bone paste was implanted into bone defects. The time for autologous bone harvest, amount of bone harvested, intraoperative blood loss, postoperative pain at a donor site, fracture healing, functional recovery of a lower limb and occurrence of complications were recorded.Results:In 2 of the 16 patients, fracture of the RIA drill bit occurred when bone marrow was harvested from the tibia, and their operation was completed only after the drill bits were replaced. In the 16 patients, time for bone harvest was (31.4±6.1) min, bone harvest volume (42.6±9.5) mL, and intraoperative blood loss (815.6±238.6) mL. The incisions in this cohort healed primarily after operation, and 4-week follow-up revealed that no patients had pain symptoms at a donor site. The 16 patients were followed up for (8.0±2.0) months after operation. All patients achieved bone union after (4.4±0.5) months. Follow-ups showed that no patients had complications like delayed infection, donor site fracture, or loosening or fracture of an internal fixator. According to the rating scale for lower limb function at the last follow-up, the function of affected limb was evaluated as excellent in 7 cases, as good in 8 cases, and as fair in 1 case.Conclusion:Application of RIA technique for autologous bone grafting to treat non-union of lower limb fracture can lead to fine fracture healing and good lower limb function, but no long-term pain symptoms in the donor area for the patients.

Stroke is a major disease that endangers the health of human beings.Since 2015,mechanical thrombectomy has emerged as the primary therapeutic method for acute ischemic stroke.Present guidelines lean towards treating patients with mechanical thrombectomy within a therapeutic window,while the efficacy of thrombectomy beyond 24-hour remains a matter of contention.The authors manuscript undertook a retrospective review of extant clinical research,scrutinizing its safety and efficacy from the standpoint of research design,and offering a detailed synthesis concerning on predictive factors and imaging modalities for selection.

Ischemic stroke is characterized by high rates of prevalence,mortality and recurrence.Atrial fibrillation(AF)is the most common arrhythmia in adults.AF significantly increases the risk of ischemic stroke and stroke recurrence.This review summarized the current research progress on AF screening in ischemic stroke patients,the relationship between AF characteristics,biomarkers and ischemic stroke,as well as the research progress on secondary prevention strategies for patients with concomitant AF,aiming to assist clinicians detect AF at an early stage and prevent stroke recurrence.

Objective:To explore the strategies for reduction of irreducible intertrochanteric fractures according to our self-designed new classifications.Methods:A retrospectively study was conducted to analyze the data of 124 patients with irreducible intertrochanteric fracture who had been admitted to Department of Minimally Invasive Orthopaedics, Zhengzhou Orthopaedics Hospital from January 2019 to December 2021. There were 56 males and 68 females with a mean age of (76.8±13.2) years. According to the displacement pattern of the proximal head-neck fragment of the fracture, the irreducible intertrochanteric fractures of the femur were classified into 3 types. In type 1 (rotational type) of 65 cases, there were 24 cases of subtype 1.1 (the lesser trochanter attached to the distal fracture fragment), 8 cases of subtype 1.2 (the lesser trochanter attached to the proximal fracture fragment), and 33 cases of subtype 1.3 (the lesser trochanter floating). In type 2 (locked type) of 18 cases, there were 13 cases of subtype 2.1 (lesser trochanter floating), no case of subtype 2.2 (the lesser trochanter attached to the proximal fracture fragment), and 5 cases of subtype 2.3 (the lesser trochanter attached to the distal fracture fragment). In type 3 (reverse trochanter type) there were 41 cases. Under the guidance of our new classification, the patients were treated by fixation with intramedullary nails after reduction with corresponding techniques (like prying, clamping, pulling, and temporary fixation with Kirschner wires). Operation time, intraoperative blood loss, fracture reduction quality and Harris hip score at the last follow-up were recorded.Results:The operation time was (53.0±20.7) min and blood loss (132.1±81.3) mL in this cohort. According to the criteria proposed by Chang and Kim et al., the quality of fracture reduction was evaluated as excellent in 101 cases, as good in 17 cases, as fair in 4 cases, and as poor in 2 cases, resulting in an excellent and good rate of 95.2% (118/124). All the 124 patients were followed up for an average of (12.4±3.7) months. First-stage fracture union was achieved in 120 patients, and fracture union was achieved in 2 patients of type 3 with breakage of the main nail only after replacement of the intramedullary nail. The mean healing time for the 122 patients was (5.1±1.4) months. In addition, hemiarthroplasty was performed in 2 patients of type 1.3 whose femoral head had been cut by a head nail. Postoperatively, urinary tract infection occurred in 5 cases but responded to appropriate symptomatic treatment. The Harris hip score was (94.2±5.4) points at the last follow-up, and 103 cases were excellent, 17 cases good, and 4 cases poor, giving an excellent and good rate of 96.8% (120/124).Conclusion:It is easy to understand and master the new classification of irreducible intertrochanteric fractures based on the displacement of the proximal head and neck bone which can directly and effectively guide the intraoperative reduction, leading to satisfactory reduction and fixation.

Objective:To investigate the effect of follicular size on the clinical outcomes of frozen-thawed embryo transfer induced by human chorionic gonadotropin (hCG) of natural cycles on ovulation.Methods:Clinical data of 427 cycles of frozen-thawed single blastocyst transfer in Nanjing Drum Tower Hospital from January 2016 to December 2019 were retrospectively analyzed. The patients were divided into 15-16 mm group (15≤diameter≤16 mm, n=66), 16-17 mm group (1620 mm group (diameter>20 mm, n=26), according to the maximum follicle diameter on the induction day of hCG ovulation induction. The estradiol and luteinizing hormone (LH) levels, and clinical pregnancy rate, abortion rate and live birth rate were compared in five groups. Results:There were statistically significant differences in estradiol and LH levels among the five groups on the day of hCG induction (all P<0.05). Estradiol levels in 15-16 mm group to >20 mm group gradually increased on the day of hCG induction, and estradiol level in 15-16 mm group was significantly lower than those in 17-18 mm group, 18-20 mm group and >20 mm group (median: 1 002.3 vs 1 103.3 vs 1 171.2 vs 1 539.0 pmol/L), with statistical significances ( P=0.034, P<0.001, P=0.002). On the day of hCG induction, LH levels in 15-16 mm group to >20 mm group showed a decreasing trend, and LH level in 15-16 mm group was significantly higher than those in 17-18 mm group and >20 mm group (median: 37.73 vs 28.24 vs 24.11 U/L), with statistically significant differences ( P=0.007, P=0.006). There were no significant differences in clinical pregnancy rate, abortion rate and live birth rate in 15-16 mm group to >20 mm group (all P>0.05). Conclusion:In the natural cycle protocol of hCG induced ovulation, the small follicle group could achieve similar clinical outcomes compared with normal sized follicles in the single blastocyst transfer of frozen-thawed embryos.

Objective:To compare the early outcome of proximal femoral nail antirotation (PFNA) and bipolar hemiarthroplasty in treatment of intertrochanteric fractures in elderly patients aged 90 years or more.Methods:A retrospective case-control study was conducted to analyze the clinical data of 43 elderly patients aged 90 years or more with intertrochanteric fractures admitted to Henan Provincial People's Hospital from January 2017 to June 2018. There were 12 males and 31 females, aged 90-102 years [(92.3±2.5)years]. A total of 31 patients were treated by PFNA (PFNA group) and 12 patients by bipolar hemiarthroplasty (hemiarthroplasty group). Comparisons were made between the two groups in terms of operation time, intraoperative blood loss, time of weight bearing after operation, rate of blood transfusion, incidence of complications 2 weeks and 3 months after operation, Harris score 12 months after operation and mortality 12 months after operation.Results:All patients were followed up for 1-30 months [(19.1±9.8)months] in PFNA group and for 0.5-29 months [(18.6±10.6)months] in hemiarthroplasty group. Operative time was (95.8±31.0)minutes in PFNA group, shorter than (128.8±40.5)minutes in hemiarthroplasty group ( P<0.05). Intraoperative blood loss was (71.3±25.7)ml in PFNA group and (212.5±113.1)ml in hemiarthroplasty group ( P<0.05). Time of weight bearing after operation was (43.9±31.9)days in PFNA group, longer than (5.9±2.8)days in hemiarthroplasty group ( P<0.05). The perioperative blood transfusion rate in PFNA group (29%) was less than hemiarthroplasty group (75%) ( P<0.05). Incidence of complications 2 weeks after operation was similar between PFNA group (23%) and hemiarthroplasty group (42%) ( P>0.05). Incidence of complications 3 months after operation in PFNA group was 26%, similar with 42% in hemiarthroplasty group ( P>0.05). Harris score 12 months after operation in PFNA group was (56.3±32.3)points, comparable to (59.3±36.7)points in hemiarthroplasty group ( P>0.05). Mortality rate 12 months after operation was 19% in PFNA group and 25% in hemiarthroplasty group ( P>0.05). Conclusion:For intertrochanteric fractures in elderly patients aged 90 years or more, PFNA and bipolar hemiarthroplasty are both effective treatments, but PFNA may be a better choice with shorter operation time and less intraoperative blood loss.