Objective:To examine the prevention effecacy and safety of preprotein convertase subtilisin-kexin 9 (PCSK9) inhibitors in stroke in patients with atherosclerotic cardiovascular disease (ASCVD) at primary and secondary prevention.Methods:PubMed, Embase, Web of Science, Cochrane Library, and Wanfang and CNKI databases were searched for randomized controlled trials comparing evolocumab, alirocumab, tafolecimab or inclisiran (experimental group) with placebo or conventional therapy (control group) in hyperlipidemia and ASCVD from inception to March 2024. Valid data were extracted after screening and applying Cochrane Literature quality assessment tool to assess the literature quality. Efficacy outcome (incidences of stroke and ischemic stroke) and safety outcome (cardiovascular mortality, and incidences of aminotransferase increased by more than 3 times, creatine kinase increased by more than 3 times, allergic reaction and hemorrhagic stroke) were recorded. Meta analysis of the extracted data was conducted using Stata software to calculate the risk difference ( RD). Results:Twenty articles (21 randomized controlled trials) were included with 62 799 patients. For primary prevention, no significant difference was found between PCSK9 inhibitors and control groups in stroke incidence ( RD=0.000, 95% CI: -0.002-0.003, P=0.905) or ischemic stroke incidence ( RD=0.001, 95% CI: -0.005-0.006, P=0.824); incidence of creatine kinase increased by more than 3 times in the PCSK9 inhibitors group was significantly decreased compared with that in the control group ( RD=-0.005, 95% CI: -0.010-0.000, P=0.039). For secondary prevention, PCSK9 inhibitors group had significantly reduced stroke incidence ( RD=-0.004, 95% CI: -0.006--0.002, P<0.001) and ischemic stroke incidence ( RD=-0.003, 95% CI: -0.005--0.002, P<0.001) compared with control group; no significant differences in cardiovascular mortality, or incidences of aminotransferase increased by more than 3 times, creatine kinase increased by more than 3 times, allergic reaction and hemorrhagic stroke were noted between the PCSK9 inhibitors group and control group ( P>0.05). Conclusion:PCSK9 inhibitors in primary prevention have no significant effect on stroke or ischemic stroke incidences, but can decrease the incidence of creatine kinase increased by more than 3 times; PCSK9 inhibitors in secondary prevention can reduce stroke and ischemic stroke incidences without increasing complications and thus enjoying certain safety.

Objective:To explore the comparison of imaging characteristics and diagnostic value between ultrasound and CT in patients with pulmonary tuberculosis in Tibetan population in plateau region.Methods:From May 2022 to November 2023,a total of 100 patients with pulmonary tuberculosis of Tibetan population in plateau region,who admitted to Qinghai Provincial Hospital of Traditional Chinese Medicine,were selected as the study objects.All of them were examined by ultrasound and CT.The ultrasonic imaging characteristics of the lesions of patients with pulmonary tuberculosis in plateau region were dynamically observed.And then,the diagnostic effects of ultrasound and CT on pulmonary tuberculosis in the Tibetan population in the plateau region were compared.Results:There was no significant difference in the positive rate of pulmonary tuberculosis in Tibetan population of plateau region between ultrasound and CT examinations(x2=0.421,P＞0.05).The diagnostic sensitivity,diagnostic specificity and Yoden index of ultrasound diagnosis were respectively 97.80%,44.44%and 42.24%,and these of CT diagnosis were respectively 96.77%,42.86%and 39.63%,and the differences were not significant(x2=0.184,0.004,0.272,P＞0.05),respectively.There was no significant difference in detection rate of the distribution of pulmonary tuberculosis lesions in Tibetan population in plateau region between ultrasound and CT examinations(x2=2.011,P＞0.05).There were no significant differences in the detection rates of atelectasis,cavity,calcification and accompany of pleural effusion between ultrasound and CT examinations in patients with pulmonary tuberculosis in Tibetan population in plateau region(x2=0.190,0.197,0.190,0.046,P＞0.05).Conclusion:There are no significant differences in positive detection rate,the detection rate of the distribution of diseased lung lobes,the detection rates of the complication of pulmonary tuberculosis or associated signs such as atelectasis,cavity,calcification and accompany of pleural effusion between ultrasound and CT examinations.The medical resource of plateau region is lack,which is shorter of large examination equipment.Therefore,using ultrasound examination to conduct general survey and preliminary diagnosis for pulmonary tuberculosis is more suitable to the plateau region that lacks CT equipment or is affected by electricity

Objective:To compare the efficacy between olecranon sled fixation and tension band wiring fixation in the treatment of Mayo ⅡA olecranon fractures.Methods:A retrospective study was conducted to analyze the data of 54 patients with Mayo ⅡA olecranon fracture who had been admitted to Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital from October 2018 to February 2021. There were 20 males and 34 females with an age of (45.5±17.7 years), and 36 left and 18 right sides. They were divided into 2 groups according to different methods of internal fixation. Group A (25 cases) was subjected to olecranon sled fixation and group B (29 cases) to tension band wiring fixation. Preoperative data, operation time, reoperations and complications during follow-up were recorded and compared between the 2 groups. In both groups at the last follow-up, the range of the elbow motion, the Mayo elbow performance score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score were recorded to evaluate the elbow function.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). There were no significant differences between the 2 groups either in follow-up time [(32.8±8.9) months for group A and (35.8±9.0) months for group B] or in operation time [60.0 (60.0, 82.5) min for group A and 60.0 (60.0, 67.5) min for group B] ( P>0.05). At the last follow-up in group A and group B, respectively, the flexion and extension of the elbow was 141.0°±8.4° and 140.0 (140.0, 150.0)°, the pronation-supination 180.0 (175.0, 180.0)° and 180.0 (175.0, 180.0)°, the MEPS score 100.0 (85.0, 100.0) and 100.0 (92.5, 100.0), and the DASH score 4.2 (1.7, 6.3) and 5.8 (1.3, 8.3), all showing no statistically significant differences between the 2 groups ( P>0.05). Olecranon skin irritation occurred in 5 patients (20.0%,5/25) in group A and in 15 patients (51.7%,15/29) in group B, and 7 patients (28.0%,7/25) in group A and 21 patients (72.4%,21/29) in group B underwent removal of internal fixation, both showing statistically significant differences between the 2 groups ( P<0.05). Conclusion:In the treatment of Mayo ⅡA olecranon fractures, compared with tension band wiring fixation, olecranon sled fixation may lead to comparable efficacy in fixation and functional recovery, but significantly reduced rates of complications and internal fixation removal.

Objective:To evaluate the preventive role and safety of evolocumab and alirocumab in ischemic stroke in hyperlipidemia and atherosclerotic high-risk cardiovascular patients.Methods:PubMed, Embase, Web of Science, Cochrane Library, Wanfang, and CNKI databases were searched for randomized controlled trials (RCTs) comparing evolocumab or alirocumab (experimental group) with placebo or usual care (control group) in hyperlipidemia and atherosclerotic high-risk cardiovascular patients from database inception to March 2023. References were screened and data were extracted according to the preset inclusion and exclusion criteria; incidence of ischemic stroke was as the efficacy index, and incidences of cardiovascular death, cognitive impairment, aminotransferase increased for more than 3 times and creatine kinase increased for more than 3 times were as the safety index. Cochrane Reviewer Handbook 2.0 was used to evaluate the RCTs literature quality. Meta analysis was performed using Stata software.Results:A total of 11 articles were included, including 12 studies with a total of 53 666 patients. Compared with the control group, the incidence of ischemic stroke in the experimental group was significantly decreased (risk difference [ RD]=-0.004, 95% CI: -0.005--0.002, P<0.001); there were no significant differences in the incidence of cardiovascular death, cognitive impairment, aminotransferase increased for more than 3 times and creatine kinase increased for more than 3 times between the 2 groups ( RD=-0.001, 95% CI: -0.004-0.001, P=0.401; RD=0.000, 95% CI: -0.003-0.002, P=0.638; RD=-0.001, 95% CI: -0.004-0.002, P=0.443; RD=-0.001, 95% CI: -0.003-0.000, P=0.137). Subgroup analysis was performed according to drugs: compared with the control group, the incidence of ischemic stroke was significantly reduced in the evolocumab group and alirocumab group ( RD=-0.004, 95% CI: -0.007--0.001, P=0.006; RD= -0.003, 95% CI: -0.006-0.000, P=0.024); there were no significant differences in incidences of cardiovascular death ( RD=0.001, 95% CI: -0.002-0.004, P=0.619; RD=-0.003, 95% CI: -0.007-0.001, P=0.100), cognitive impairment ( RD=0.001, 95% CI:-0.002-0.004, P=0.463; RD=-0.002, 95% CI: -0.005-0.001, P=0.145), aminotransferase increased for more than 3 times ( RD=0.000, 95% CI: -0.003-0.003, P=0.888; RD=-0.002, 95% CI: -0.007-0.003, P=0.392) or creatine kinase increased for more than 3 times ( RD=0.000, 95% CI: -0.002-0.002, P=0.668; RD=-0.002, 95% CI: -0.005-0.000, P=0.106) between the evolocumab group and alirocumab group. Subgroup analysis was performed according to the medication duration: compared with the control group, no significant differences in incidences of cardiovascular death ( RD=0.000, 95% CI:-0.022-0.022, P=1.000; RD=-0.003, 95% CI: -0.009-0.002, P=0.193; RD=-0.001, 95% CI:-0.004-0.002, P=0.521), cognitive impairment ( RD=-0.003, 95% CI: -0.014-0.008, P=0.569; RD=-0.001, 95% CI: -0.006-0.004, P=0.696; RD=0.000, 95% CI: -0.003-0.002, P=0.735), aminotransferase increased for more than 3 times ( RD=-0.002, 95% CI: -0.016-0.012, P=0.749; RD=-0.002, 95% CI: -0.013-0.010, P=0.773; RD=-0.001, 95% CI: -0.004-0.002, P=0.489) or creatine kinase increased for more than three times ( RD=-0.015, 95% CI: -0.032-0.003, P=0.099; RD= -0.011, 95% CI: -0.025-0.002, P=0.104; RD=0.000, 95% CI: -0.002-0.001, P=0.722) were noted among medication duration<1 year group, medication duration of 1-2 years group and medication duration>2 years group. Conclusion:Both evolocumab and alirocumab can reduce the incidence of ischemic stroke in hyperlipidemia and atherosclerotic high-risk cardiovascular patients, with good safety.

Objective:To study the locational distribution characteristics of the heterotopic ossification (HO) following traumatic elbow stiffness and the risk factors for HO development at different locations.Methods:Consecutively included according to our inclusion criteria in the present study were the patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2018 to December 2018 for elbow release due to traumatic elbow stiffness but developed postoperative HO. Their baseline data and CT data were collected and processed using Mimics 20.0. The HO distribution for each patient was characterized at the anteromedial, anterolateral, posteromedial, posterolateral, posterior, medial, lateral, and proximal radioulnar locations. The patient's original injury was categorized into 5 types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. After the univariate analysis with the HO occurrence at a specific location as the dependent variable and the original injury and baseline data as the independent variables, the factors with P value less than 0.1 were included in the logistic regression analysis to determine the risk factors for HO at each location.Results:A total of 91 patients were included in this study. Of them, 88 had posteromedial HO (96.7%, 88/91), 62 posterior HO (68.1%, 62/91), 60 posterolateral HO (65.9%, 60/91), 41 anteromedial HO (45.1%, 41/91), 26 anterolateral HO (28.6%, 26/91), 13 proximal radioulnar HO (14.3%, 13/91), 8 lateral HO (8.8%, 8/91), and 7 medial HO (7.7%, 7/91). Logistic regression analysis showed that presence of ulnar nerve symptoms ( OR=4.354, P=0.017) and presence of original elbow dislocation ( OR=2.927, P=0.042) were the independent risk factors for the anteromedial HO development and that presence of original olecranon fracture ( OR=0.277, P=0.023) was the protective factor for the anteromedial HO development. Presence of original radial head fracture was the independent risk factor for the anterolateral HO development ( OR=2.891, P=0.033) and the posterolateral HO development ( OR=3.123, P=0.043). Conclusions:HO development in patients with post-traumatic elbow stiffness is closely related to their original injury. Posteromedial HO may develop in almost all the patients. Patients with ulnar nerve symptoms and original elbow dislocation are more prone to anteromedial HO development, but patients with original olecranon fracture are less likely to develop anteromedial HO. Patients with original radial head fracture are more likely to develop anterolateral and posterolateral HO.

Objective:To investigate the therapeutic effects of sled board internal fixation on the treatment of olecranon fractures.Methods:The clinical data were retrospectively analyzed of the 21 patients with olecranon fracture who had been treated with sled board internal fixation at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital from May 2019 to January 2021. They were 11 males and 10 females with 14 left and 7 right sides affected, aged from 18 to 68 years (mean, 42.0 years). By the preoperative Mayo classification for olecranon fractures, one case was type ⅠA, 11 cases were type ⅡA and 9 cases type ⅡB; by the Schatzker classification, one case was type A, 4 cases were type B and 16 cases type C. The operation time and the complications were recorded; at the last follow-up, the range of motion of the elbow joint was recorded and the elbow function and pain were evaluated by the Mayo elbow performance score (MEPS) and visual analogue scale (VAS).Results:The 21 patients were followed up for 13 to 34 months (mean, 19.6 months) after operation. At the last follow-up, the flexion and extension of the affected elbow averaged 139.8° (from 125° to 160°), and the pronation-supination 177.9° (from 160° to 180°). The operation time averaged 77.8 min (from 40 to 135 min). Postoperative olecranon skin discomfort developed in 4 patients, 2 of whom underwent removal of internal fixation; no such complication as internal fixation breakage, screw loosening, incision infection or elbow stiffness was observed in the other 17 cases. At the last follow-up, the MEPS scores averaged 97.9 points (from 85 to 100 points) and the VAS scores 0.2 points (from 0 to 2 points).Conclusion:The sled board internal fixation can result in good therapeutic effects on the treatment of olecranon fractures.

Nowadays, the popularization of endoscopic technology makes a substantial increase in the diagnosis rate of esophageal multiple primary carcinoma. However, the multiple primary carcinoma combined with esophageal cancer, lung cancer and cardiac cancer is relatively rare. This paper reported a 64-year-old male with multiple primary cancer who received one-stage complex radical surgery, including radical resection of esophageal cancer, lung cancer and cardiac cancer. After the operation, the patient presented chylothorax and conservative treatment was ineffective. Then we preformed ligation of thoracic duct through single-portal thoracoscope. The patient recovered successfully after surgery and the follow-up results showed well.

Objective: The aim of this study was to evaluate the influence of concomitant carcinoma in situ (CCIS) on tumor survival for the upper tract urinary carcinoma (UTUC) through systematic review and meta-analysis. Methods: In the light of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic search of Web of Science, PubMed and EMBASE China National Knowledge Infrastructure (CNKI) and Wanfang database by key words "upper urinary tract urothelial carcinoma" "renal sputum cancer" "concomitant carcinoma in situ" , and "radical ureterectomy" were performed for all reports that included detailed results on the predictors of CCIS. The search deadline is June 2019, and the search terms are English and Chinese. Methodological quality evaluation was performed using the QUIPS tool, and statistical analysis of the relevant data was performed using Stata 12.0 and RevMan 5.3 software. Results: Sixteen articles were included in this study and all published between 2012 and 2019. A total of 11 131 patients with UTUC, including 1 774 (15.9%) patients with CCIS. According to our final results, there was a significant correlation of CCIS with worse cancer-specific survival (CSS) (HR=1.10, 95%CI 1.05-1.16, P<0.001), recurrence-free survival (RFS) (HR=1.15, 95%CI 1.09-1.21, P<0.001) and overall survival (OS) (HR=1.10, 95%CI 1.03-1.17, P=0.003). Begg′s bias analysis showed no significant publication bias in CSS (P=0.822), RFS (P=0.348), and OS (P=0.452). Conclusions This study demonstrated that CCIS was associated with poor oncological outcome and could serve as a independent prognostic factor for patient with UTUC after radical nephroureterectomy.

Adenosine 5'-monophosphate-activated protein activated protein kinase (AMPK), a heterotrimeric complex, is an important kinase to regulate glycolipid metabolism and energy balance involved in a variety physiological processes in human body. Many research indicated that the function and activity of AMPK were closely related to inflammation, diabetes and cancers. Recent reports show that inhibition of metformin (a first-line drug) on hepatic glucose in patients with hyperglycemia is associated with AMPK pathway, suggesting that targeting AMPK may be one of the effective strategies for the prevention and treatment of a variety of chronic diseases. Here, we review research progress on the structure, activation and regulation of AMPK in glycolipid metabolism to provide an insight into the basic and clinical research of diabetes therapy.
AMP-Activated Protein Kinases ; Adenosine ; Adenosine Monophosphate ; Energy Metabolism ; Enzyme Activation ; Glycolipids ; Humans

Objective: To investigate the diagnostic value of superb microvascular imaging(SMI), advanced dynamic flow(ADF) and color Doppler flow imaging(CDFI) in breast microcarcinoma, and to compare the correlation coefficients between these three indicators and postoperative pathological tumor microvascular density(MVD). Methods: A total of 85 patients(87 lesions) with BI-RADS 4 and the maximum diameter≤1 cm were selected, of which, 46 lesions were benign(benign group) and 41 lesions were malignant(malignant group). All the patients and the corresponding lesions were examined by SMI, ADF and CDFI. Blood flow grading was performed on the images using Adler grade of blood flow, and the difference of blood flow among the 3 methods was compared. The expression level of MVD in pathological tumor tissues was detected and analyzed for its correlation with Adler classification by three detection techniques. Results: The areas under the ROC curve(AUR) of CDFI, ADF and SMI were 0.694, 0.705 and 0.776 respectively based on the gold standard with pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CDFI were 78.0%, 54.3%, 60.4%, 73.5%, and 65.5%, respectively; those of ADF were 75.6%, 60.9%, 63.3%, 73.7% and 67.8%, respectively; and those of SMI were 78.0%, 69.6%, 69.6%, 78.0% and 73.6%, respectively. The Adler grades of CDFI, ADF and SMI were positively correlated with MVD(P<0.05), which the highest correlation coefficient between SMI and MVD (r=0.430, P<0.001). Conclusions SMI is superior to ADF and CDFI in detecting the abundance of breast microcarcinoma, and has the highest correlation coefficient among those 3 detection techniques with tumor pathological MVD, which indicates that SMI may be used for differential diagnosis of breast microcarcinoma and indirectly evaluate the prognosis of patients.