BACKGROUND:Anterior cruciate ligament avulsion fracture at tibial insertion is a special type of intra-articular fracture,which is mostly seen in sports injuries.At present,there are relatively few anatomical studies on this disease,but a large number of studies focus on the injury of the anterior cruciate ligament.It is generally believed that the increase in the posterior slope of the tibial plateau,the decrease of the depth of the medial tibial plateau,and the decrease in the width index of the femoral intercondylar notch are the risk factors for the injury of the anterior cruciate ligament.It is unclear whether avulsion fractures of the anterior cruciate ligament at the tibial insertion point are also related to it. OBJECTIVE:To investigate the correlation between the avulsion fracture of the anterior cruciate ligament at the tibial insertion and the posterior tibial slope,the medial tibial depth,the notch width index of the femoral intercondylar fossa,and the coronal slope angle of the tibial plateau. METHODS:A retrospective analysis was made on 101 patients who were admitted to the Department of Orthopedics of Affiliated Hospital of Xuzhou Medical University due to anterior knee pain from January 2019 to December 2022.Totally 51 patients with tibial insertion avulsion fracture of anterior cruciate ligament who received arthroscopy treatment were taken as the observation group,and 50 patients with anterior knee pain but no knee joint injury confirmed by physical examination and imaging examination were taken as the control group in the same period.The posterior tibial slope,anatomical parameters such as the medial tibial depth,and the notch width index of the femoral intercondylar fossa,were statistically analyzed for the anatomical risk factors leading to the tibial insertion avulsion fracture of the anterior cruciate ligament. RESULTS AND CONCLUSION:(1)There was no significant difference between the two groups in the comparison of the lateral posterior tibial slope,the posterior slope ratio of the lateral/medial tibial plateau,the notch width index of the femoral intercondylar fossa,and the coronary slope angle of the tibial plateau(P>0.05).The medial posterior tibial slope in the observation group was significantly higher than that in the control group(P<0.05).The medial tibial depth in the observation group was significantly lower than that in the control group(P<0.05).(2)Multifactor logistic regression analysis showed that the medial posterior tibial slope and the medial tibial depth were independent risk factors for tibial insertion avulsion fracture of anterior cruciate ligament(P<0.05).(3)The receiver operating characteristic curve shows that the medial posterior tibial slope and the medial tibial depth had certain predictive values for the tibial insertion avulsion fracture of the anterior cruciate ligament.(4)It is indicated that the increased medial posterior tibial slope and the shallower medial tibial depth are the anatomical risk factors for the avulsion fracture of the tibial insertion of the anterior cruciate ligament.

AIM:To observe the effect of icariin-astragaloside Ⅳ-puerarin mixture(Yin-Huang-Ge mixture,YHG)on cognitive function and ferroptosis amino acid metabolism pathway in hepcidin(HAMP)knockout APPswe/PS1dE9(APP/PS1 HAMP-/-)mice.METHODS:The mice were divided into 7 groups:negative control(C57BL/6 mice)group,APP/PS1 group,APP/PS1 HAMP-/-group,APP/PS1+YHG group,APP/PS1 HAMP-/-+YHG group,APP/PS1+de-ferasirox(DFX)group,and APP/PS1 HAMP-/-+DFX group,with 6 mice in each group.The YHG and DFX were adminis-tered intragastrically,while the mice in C57 group,APP/PS1 group and APP/PS1 HAMP-/-group were given intragastric administration of distilled water,once a day for 2 months.The iron content in mouse brain tissues was detected by tissue iron kit.The morphological changes of the mitochondria in hippocampal neurons were observed by transmission electron microscopy.Morris water maze was used to detect the learning and memory ability of the mice.The content of neuronal nu-clear antigen(NeuN)in mouse brain tissues was detected by immunofluorescence staining.The expression of glutathione(GSH)in mouse brain tissues was detected by biochemical kit.The expression levels of glutamate-cysteine ligase catalytic subunit(GCLC)and glutamatase 2(GLS2)in mouse brain tissues were detected by Western blot.RESULTS:Compared with C57BL/6 mice,the brain iron content of APP/PS1 mice was significantly increased(P＜0.01),the mitochondria were seriously damaged,the learning and memory ability was significantly decreased(P＜0.05),the brain neurons were seri-ously damaged(P＜0.01),and the expression levels of GSH,GCLC and GLS2 were significantly decreased(P＜0.01).Compared with APP/PS1 mice,the brain iron content of APP/PS1 HAMP-/-mice was significantly increased(P＜0.01),the mitochondria were seriously damaged,the learning and memory ability was significantly decreased(P＜0.05),the brain neurons were seriously damaged(P＜0.01),and the expression levels of GSH,GCLC and GLS2 were significantly decreased(P＜0.05).After treatment with YHG and DFX,the brain iron content was significantly decreased(P＜0.01),the mitochondrial damage was alleviated,the learning and memory ability was significantly increased(P＜0.05),the brain neuron damage was alleviated(P＜0.01),and the expression levels of GSH,GCLC and GLS2 were significantly increased(P＜0.05).CONCLUSION:The YHG can improve the cognitive function of APP/PS1 HAMP-/-mice,and its mechanism may be related to the regulation of ferroptosis amino acid metabolism and the enhancement of antioxidant capacity.

Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.

Objective:To evaluate the influence of 25-hydroxyvitamin D[25(OH)D]on dyslipidemia in elderly female patients with type 2 diabetes(T2DM)mellitus aged 60 or over.Methods:We retrospectively reviewed the clinical records of 175 type 2 diabetic older women meeting the inclusion criteria, admitted to the Department of Endocrinology, Beijing Chuiyangliu Hospital, between January and December 2020, with an average age of 66(63, 70)years.According to the diagnostic criteria of dyslipidemia(cholesterol ≥6.2 mmol/L, high density lipoprotein cholesterol <1.0 mmol/L, low-density lipoprotein cholesterol ≥4.1 mmol/L or triglycerides ≥2.3 mmol/L), 110 participants(62.9%)were divided into a dyslipidemia group and 65 participants(37.1%)were assigned into a normal blood lipid group.Logistic regression was employed to investigate factors influencing dyslipidemia.Spearman correlation analysis was employed to analyze the correlation between serum 25(OH)D and blood lipid indexes.Results:The median serum 25(OH)D level of the 175 subjects was 10.92(8.1, 15.2)μg/L.For the dyslipidemia group, it was 9.1(5.8, 12.9)μg/L, lower than 11.9(8.4, 22.6)μg/L in the normal blood lipid group.The proportion of people with hypertension in the dyslipidemia group was higher than in the normal blood lipid group.The dyslipidemia group also had higher BMI, waist circumference and homocysteine levels( P<0.05). Results of multivariate logistic regression analysis demonstrated that hypertension, waist circumference, and homocysteine were significant risk factors for dyslipidemia in elderly women with T2DM, whereas serum 25(OH)D was a protective factor( P<0.05). Correlation analysis results identified that cholesterol and low density lipoprotein cholesterol were inversely correlated to 25(OH)D while high density lipoprotein cholesterol was positively correlated to it( P<0.05). Conclusions:There is a serious deficiency of serum 25(OH)D in older women with T2DM.25(OH)D is protective factor in elderly T2DM women against dyslipidemia.Clinicians should pay attention to vitamin D deficiency in patients during diagnosis and treatment and correct the deficiency.

Objective:To observe the application effect of standard management-flexible teaching-pay attention to comprehensive quality improvement-correct evaluation (SFPC) teaching on the internship teaching of nursing students in department of obstetrics and gynecology.Methods:Forty-five nursing students who interned in the department of obstetrics and gynecology from July to December 2019 were classified as the control group, and the traditional teaching was adopted. Another 47 nursing students who interned from January to June 2020 were taken as research group, and SFPC was applied. The rotation assessment scores, clinical communication ability and comprehensive ability before and after the internship, and satisfaction with teaching of these nursing students were compared between the two groups. SPSS 23.0 was used for t test, chi-square test and rank sum test. Results:The results of theoretical and operational assessment of obstetrics and gynecology in the research group were significantly higher than those in the control group[(94.28±5.77) vs. (83.91±5.19); (91.85±5.27) vs. (81.07±5.24)]. The scores of building harmonious relationship, identifying patients' problems, keen listening, passing effective information, joint participation and verification of feelings after the teaching were significantly higher than those before teaching ( P<0.05). The scores of ideological quality, teaching activities, ability evaluation and other activities in the comprehensive ability assessment were significantly higher than those before teaching ( P<0.05), and those of research group were significantly higher than those of the control group ( P<0.05). The were significant differences in the grade distribution of teaching satisfaction between the two groups ( P<0.05), and the total satisfaction rate of nursing students in the study group was higher than that in the control group (95.74% vs. 80.00%). Conclusion:The application of SFPC teaching in the clinical teaching of nursing students in department of obstetrics and gynecology can significantly improve the performances of nursing students, clinical communication ability, comprehensive ability and nursing students' satisfaction with teaching.

Objective:In general, patients with seropositive rheumatoid arthritis (RA) are considered to show an aggressive disease course. However, the relationship between the two subgroups in disease severity is controversial. Our study is aimed to compare the clinical characteristics and prognosis of double-seropositive and seronegative RA in China through a real-world large scale study.Methods:RA patients who met the 1987 American College of Rheumatology (ACR) classification criteria or the 2010 ACR/European Anti-Rheumatism Alliance RA classification criteria, and who attended the 10 hospitals across the country from September 2015 to January 2020, were enrolled. According to the serological status, patients were divided into 4 subgroups [rheumatoid factor (RF)(-) anti-cyclic citrullinated peptide (CCP) antibody (-), RF(+), RF(+) anti-CCP antibody(+), anti-CCP antibody(+)] and compared the disease characteristics and treatment response. One-way analysis of variance was used for measurement data that conformed to normal distribution, Kruskal-Wallis H test was used for measurement data that did not conform to normal distribution; paired t test was used for comparison before and after treatment within the group if the data was normally distributed else paired rank sum test was used; χ2 test was used for count data. Results:① A total of 2 461 patients were included, including 1 813 RF(+) anti-CCP antibody(+) patients (73.67%), 129 RF(+) patients (5.24%), 245 RF(-) anti-CCP antibody(-) patients (9.96%), 74 anti-CCP antibody(+) patients (11.13%). ② Regardless of the CCP status, RF(+) patients had an early age of onset [RF(-) anti-CCP antibody(-) (51±14) years old, anti-CCP antibody(+) (50±15) years old, RF(+) anti-CCP antibody(+) (48±14) years old, RF(+)(48±13) years old, F=3.003, P=0.029], longer disease duration [RF(-) anti-CCP antibody(-) 50 (20, 126) months, anti-CCP antibody(+) 60(24, 150) months, RF(+) anti-CCP antibody(+) 89(35, 179) months, RF(+) 83(25, 160) months, H=22.001, P<0.01], more joint swelling counts (SJC) [RF(-) anti-CCP antibody(-) 2(0, 6), Anti-CCP antibody(+) 2(0, 5), RF(+) anti-CCP antibody(+) 2(0, 7), RF(+) 2(0, 6), H=8.939, P=0.03] and tender joint counts (TJC) [RF(-) anti-CCP antibody(-) 3(0, 8), anti-CCP antibody(+) 2(0, 6), RF(+) anti-CCP antibody(+) 3(1, 9), RF(+) 2(0, 8), H=11.341, P=0.01] and the morning stiff time was longer [RF(-) anti-CCP antibody(-) 30(0, 60) min, anti-CCP antibody(+) 20(0, 60) min, RF(+) anti-CCP antibody(+) 30(10, 60) min, RF(+) 30(10, 60) min, H=13.32, P<0.01]; ESR [RF(-) anti-CCP antibody(-) 17(9, 38) mm/1 h, anti-CCP antibody(+) 20(10, 35) mm/1 h, RF(+) anti-CCP antibody(+) 26(14, 45) mm/1 h, RF(+) 28(14, 50) mm/1 h, H=37.084, P<0.01] and CRP [RF(-) anti-CCP antibody(-) 2.3 (0.8, 15.9) mm/L, Anti-CCP antibody(+) 2.7(0.7, 12.1) mm/L, RF(+) anti-CCP antibody(+) 5.2(1.3, 17.2) mm/L, RF (+) 5.2(0.9, 16.2) mm/L, H=22.141, P<0.01] of the RF(+)patients were significantly higher than RF(-) patients, and RF(+) patients had higher disease severity(DAS28-ESR) [RF(-) anti-CCP antibody(-) (4.0±1.8), anti-CCP antibody(+) (3.8±1.6), RF(+) anti-CCP antibody(+) (4.3±1.8), RF(+) (4.1±1.7), F=7.269, P<0.01]. ③ The RF(+) anti-CCP antibody(+) patients were divided into 4 subgroups, and it was found that RF-H anti-CCP antibody-L patients had higher disease severity [RF-H anti-CCP antibody-H 4.3(2.9, 5.6), RF-L anti-CCP antibody-L 4.5(3.0, 5.7), RF-H anti-CCP antibody-L 4.9(3.1, 6.2), RF-L anti-CCP antibody-H 2.8(1.8, 3.9), H=20.374, P<0.01]. ④ After 3-month follow up, the clinical characteristics of the four groups were improved, but there was no significant difference in the improvement of the four groups, indicating that the RF and anti-CCP antibody status did not affect the remission within 3 months. Conclusion:Among RA patients, the disease activity of RA patients is closely related to RF and the RF(+) patients have more severe disease than RF(-) patients. Patients with higher RF titer also have more severe disease than that of patients with low RF titer. After 3 months of medication treatment, the antibody status does not affect the disease remission rate.

One hundred and ten patients with obstinate facial palsy were randomly divided into study group and control group with 55 cases in each group. Both groups received electropuncture on face acupoints five times a week, the study group received additional acupuncture on Zhongzhen six acupoints, subsequently fire needles were used for Yangbai (GB 14), Quanliao (SI 18), Dicang (ST 4) and Jiachengjiang (Extra) acupoints twice a week. And the treatment courses lasted for four weeks. The House-Brackmann (HB) scale and Self-Rating Anxiety Scale (SAS) were used for evaluation of facial nerve function and anxiety status before and after treatment, respectively. One hundred and four cases completed the treatment in the two groups. Before treatment there were no significant differences in HB and SAS scores between study and control groups (Z=-0.271, P=0.79; Z=-1.689, P=0.09). After 4 weeks of treatment the HB and SAS scores in both group were significantly improved (Z=-5.652, Z=-5.038, all P<0.01; Z=-6.050, Z=-5.332, all P<0.01); however, there were significant differences in HB scale and SAS scores after treatment between two groups (Z=-2.066, Z=-2.884, all P<0.05). The electric acupuncture on face acupoints plus Zhongzhen six acupoints combined with fire acupuncture can effectively improve facial nerve function and anxiety state in patients with obstinate facial palsy.

Collagen is the building component of temporomandibular joint (TMJ) discs and is often affected by inflammation in temporomandibular disorders.The macromechanical properties of collagen are deteriorated by chronic inflammation.However,the mechanism by which inflammation influences disc function remains unknown.The relationship between the ultrastructure and nanomechanical properties of collagen in inflamed discs should be clarified.Seven-week-old female Sprague-Dawley rats were randomly divided into two groups.Chronic TMJ inflammation was induced by intra-articular injection of complete Freund's adjuvant,and samples were harvested after 5 weeks.Picrosirius staining revealed multiple colours under polarized light,which represented alternative collagen bundles in inflamed discs.Using atomic force microscopy scanning,the magnitude of Young's modulus was reduced significantly accompanied with disordered collagen fibril arrangement with porous architecture of inflamed discs.Transmission electron microscopy scanning revealed a non-uniform distribution of collagen fibres,and oversized collagen fibrils were observed in inflamed discs.Fourier transform infrared microspectroscopy revealed a decrease in 1 338 cm-1/amide Ⅱ area ratio of collagen in different regions.The peak positions of amide Ⅰ and amide Ⅱ bands were altered in inflamed discs,indicating collagen unfolding.Our results suggest that sustained inflammation deteriorates collagen structures,resulting in thedeterioration of the ultrastructure and nanomechanical properties of rat TMJ discs.

Objective To evaluate glucose metabolism in elderly inpatients with primary hypertension. Methods Based on the results of the oral glucose tolerance test (OGTT) ,130 elderly patients with primary hypertension were divided into the normal glucose tolerance (NGT )group ,the impaired fast glucose(IFG)group ,the impaired glucose tolerance(IGT)group and the type 2 diabetes mellitus (T2DM )group.Clinical characteristics and morbidity were compared among the groups. Results Among patients with grade 1 ,2 or 3 hypertension ,14(32.6％ ) ,9(20.5％ )and 7(16.3％ )had NGT ,3(7.0％ ) ,5(11.4％ )and 4(9.3％ )had IFG ,16(37.2％ ) ,18(40.8％ )and 19(44.2％ )had IGT , and 10 (23.2％ ) ,12 (27.3％ ) and 13 (30.2％ ) had T2DM ,respectively.Moreover ,there was a significant difference in levels of 2 hours postprandial blood glucose between patients with grade 1 hypertension and those with grade 3 hypertension in the T2DM group(P< 0.05). Conclusions Abnormal glucose metabolism and diabetes mellitus are highly prevalent in elderly inpatients with essential hypertension.

OBJECTIVETo observe the effects of's neck acupuncture combined with swallowing rehabilitation on swallowing function and quality of life in patients with post-stroke pseudobulbar palsy.

METHODSOne hundred patients were randomly assigned in to an observation group and a control group, 50 cases in each one. The patients in the control group were treated with basic pharmaceutical treatment, including neurotrophy medication and free radical scavenging medication as well as swallowing rehabilitation; the patients in the observation group, on the basis of those in the control group, were treated with's neck acupuncture at Fengchi (GB 20), Yiming (EX-HN 14), Gongxue (Extra), Lianquan (CV 23), Wai Jinjin Yuye (Extra), Tunyan (Extra), Zhiqiang (Extra), Fayin (Extra), once a day, five times a week for continuous eight weeks. The Repetitive saliva-swallowing test (RSST), standardized swallowing assessment (SSA) and swallow quality-of-life questionnaire (SWAL-QOL) before and after treatment in the two groups were observed; the relationship between disease location and frequency and efficacy of's neck acupuncture was explored in the observation group.

RESULTSAfter treatment, the RSST, SSA and SWAL-QOL were superior to those before treatment (all<0.01), with more significant results in the observation group (all<0.01). The total effective rate was 91.7% (44/48) in the observation group, which was superior to 75.5% (37/49) in the control group (<0.01). The frequency of disease onset was one in 11 patients and 2 and above in 37 patients in the observation group, and the efficacy of one onset of disease was 100.0% (11/11), which was superior to two and above of onset 89.2% (33/37,<0.01). The number of patients with disease location at cortex and subcortex was 21, while that at capsula interna and basal ganglia was 27 in the observation group, the efficacy of two was similar (>0.05).

CONCLUSIONS 's neck acupuncture combined with swallowing rehabilitation could effectively improve dysphagia and quality of life in patients with post-stroke pseudobulbar palsy. No correlation of lesion locations on acupuncture efficacy is observed, while onset frequency is inversely proportional to efficacy.