BACKGROUND:The most common complication of traumatic femoral neck fractures after internal fixation is femoral head necrosis.Currently,many studies have reported on the risk factors that affect the occurrence and development of postoperative femoral head necrosis,but there is still a lack of tools to predict the risk of femoral head necrosis after internal fixation of femoral neck fractures.OBJECTIVE:To develop a predictive model that estimates the risk of femoral head necrosis shortly after patients with femoral neck fractures receive cannulated screw internal fixation.METHODS:A retrospective analysis reviewed clinical records of 172 patients who underwent cannulated screw internal fixation for femoral neck fractures at Department of Orthopedics of Mianyang Central Hospital from January 2013 to June 2023.Patients were categorized into two groups based on the presence or absence of femoral head necrosis within one year post-operation:the necrosis group and the non-necrosis group.Univariate analysis,Lasso regression,and multivariate Logistic regression techniques were employed to identify the determinants of femoral head necrosis.A nomogram prediction model was constructed using R language's"rms"package,version 4.0.The receiver operating characteristic curve was used to evaluate the discriminatory ability of the model.The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model,and the decision curve analysis was used to determine its clinical application benefits.Internal validation of the study was conducted using the Bootstrap method,involving 1 000 repeated samplings.To delve deeper into the primary factors influencing femoral head necrosis post-internal fixation of the femoral neck,this paper employed the SHAP method for data set analysis.RESULTS AND CONCLUSION:(1)The risk factors leading to femoral head necrosis in the short term after cannulated screw fixation of femoral neck fractures include:smoking,diabetes,Garden classification,fracture line location,reduction quality,age,and operation time.(2)The prediction model demonstrated robust performance,evidenced by an area under the curve of 0.940(95％Confidence Interval:0.903 to 0.977),indicating a high level of prediction accuracy.The model achieved a sensitivity of 90.2％and a specificity of 87.6％,indicating that its diagnostic performance was stable.The Hosmer-Lemeshow goodness-of-fit test yielded a chi-square value of 6.593 with a P-value of 0.581,confirming that the model's predictions closely align with the observed outcomes.(3)The calibration curve of the model also performed well,and its overall trend was very close to the ideal curve,further proving the high accuracy of the model.(4)The internal validation was carried out by the Bootstrap method with 1 000 repeated samplings,and the area under the curve of the model internal validation was still as high as 0.939,proving that the model had good stability.(5)Through the decision curve,it is found that within the probability threshold range of 1％to 92％,the model can obtain the maximum net benefit value.(6)The SHAP analysis results show that among the risk factors analyzed in this study,the location of the fracture line serves as the most significant predictor of femoral head necrosis following internal fixation with cannulated screws in femoral neck fractures,and subcapital fractures are extremely prone to femoral head necrosis after surgery.(7)It is concluded that the validated prediction model demonstrates strong discriminative power and reliability,offering practical clinical utility.It serves as a useful reference tool for short-term risk assessment of femoral head necrosis following internal fixation of femoral neck fractures.

BACKGROUND:The most common complication of traumatic femoral neck fractures after internal fixation is femoral head necrosis.Currently,many studies have reported on the risk factors that affect the occurrence and development of postoperative femoral head necrosis,but there is still a lack of tools to predict the risk of femoral head necrosis after internal fixation of femoral neck fractures.OBJECTIVE:To develop a predictive model that estimates the risk of femoral head necrosis shortly after patients with femoral neck fractures receive cannulated screw internal fixation.METHODS:A retrospective analysis reviewed clinical records of 172 patients who underwent cannulated screw internal fixation for femoral neck fractures at Department of Orthopedics of Mianyang Central Hospital from January 2013 to June 2023.Patients were categorized into two groups based on the presence or absence of femoral head necrosis within one year post-operation:the necrosis group and the non-necrosis group.Univariate analysis,Lasso regression,and multivariate Logistic regression techniques were employed to identify the determinants of femoral head necrosis.A nomogram prediction model was constructed using R language's"rms"package,version 4.0.The receiver operating characteristic curve was used to evaluate the discriminatory ability of the model.The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model,and the decision curve analysis was used to determine its clinical application benefits.Internal validation of the study was conducted using the Bootstrap method,involving 1 000 repeated samplings.To delve deeper into the primary factors influencing femoral head necrosis post-internal fixation of the femoral neck,this paper employed the SHAP method for data set analysis.RESULTS AND CONCLUSION:(1)The risk factors leading to femoral head necrosis in the short term after cannulated screw fixation of femoral neck fractures include:smoking,diabetes,Garden classification,fracture line location,reduction quality,age,and operation time.(2)The prediction model demonstrated robust performance,evidenced by an area under the curve of 0.940(95％Confidence Interval:0.903 to 0.977),indicating a high level of prediction accuracy.The model achieved a sensitivity of 90.2％and a specificity of 87.6％,indicating that its diagnostic performance was stable.The Hosmer-Lemeshow goodness-of-fit test yielded a chi-square value of 6.593 with a P-value of 0.581,confirming that the model's predictions closely align with the observed outcomes.(3)The calibration curve of the model also performed well,and its overall trend was very close to the ideal curve,further proving the high accuracy of the model.(4)The internal validation was carried out by the Bootstrap method with 1 000 repeated samplings,and the area under the curve of the model internal validation was still as high as 0.939,proving that the model had good stability.(5)Through the decision curve,it is found that within the probability threshold range of 1％to 92％,the model can obtain the maximum net benefit value.(6)The SHAP analysis results show that among the risk factors analyzed in this study,the location of the fracture line serves as the most significant predictor of femoral head necrosis following internal fixation with cannulated screws in femoral neck fractures,and subcapital fractures are extremely prone to femoral head necrosis after surgery.(7)It is concluded that the validated prediction model demonstrates strong discriminative power and reliability,offering practical clinical utility.It serves as a useful reference tool for short-term risk assessment of femoral head necrosis following internal fixation of femoral neck fractures.

OBJECTIVE To ensure the safety of patients’ drug use and control the risk of medical insurance expenditure by upgrading the pre-prescription review system to conduct pre-review on prescriptions from internet hospitals and external prescriptions， as well as to review the payment methods of drugs （including in-hospital and external drug dispensing）. METHODS The data interfaces of prescriptions from internet hospitals and external prescriptions were integrated to achieve real-time rational drug use intervention. Additionally， an intelligent review project for payment method was added to precisely intervene in the medical insurance payment methods of drugs. The effect of the system upgrade was evaluated by comparing the qualification rates of prescriptions from internet hospitals and external prescriptions and the suspected amounts of drug violations from January to April 2025 （before the system upgrade） and May to August 2025 （after the system upgrade）. RESULTS After the upgrade of the pre-prescription review system， the qualification rates of prescriptions from internet hospitals and external prescriptions increased by 3.5% [95% confidence interval （CI）＝0.3%-6.7%， P ＝0.037 ] ； the suspected amounts of drug violations decreased to 52.9% of the pre-upgrade level （95%CI＝31.6%-88.5%， P ＝0.026）， and the average monthly sequential decrease was 29.5% （95%CI＝12.2%-43.4%， P ＝0.012）. Moreover， the addition of the intelligent review project for payment methods promoted the management of off-label drug use in our hospital. After the upgrade， a total of 79 filling valid applications for off-label drug use were received and archived. CONCLUSIONS The upgrade of the pre-prescription review system effectively improves the review qualification rates of prescriptions from internet hospitals and external prescriptions and the accuracy of medical insurance payment for drugs， and strengthens the supervision of off-label drug use， achieving dual guarantees of clinical rationality and medical insurance compliance.

Aim To mine the competing ceRNA net-works associated with programmed cell death in the pathophysiological mechanisms of atherosclerosis(AS)based on bioinformatics,in order to identify new targets for the diagnosis and treatment of AS.Methods Firstly,the GSE97210 and GSE28858 datasets were screened from the GEO database.Differentially ex-pressed lncRNA,mRNA and miRNA were identified,following which a IncRNA-miRNA-mRNA regulatory network was constructed in Cytoscape 3.7.2 software based on ceRNA theory.Second,GO and KEGG en-richment analysis of mRNA in the ceRNA network was performed.Finally,the mRNAS within the ceRNA net-work were compared with genes related to autophagy,pyroptosis and ferroptosis to establish a ceRNA network related to programmed cell death.Results A total of 1208 DElncRNAS,4723 DEmRNAS and 139 DEmiR-NAS were identified.A ceRNA network was estab-lished,comprising 64 lncRNAS,8 miRNAS and 167 mRNAS.The mRNAS within the CeRNA network were mainly enriched in biological processes such as positive regulation of transcription and migration,protein bind-ing,and signaling pathways including PI3K-Akt signa-ling pathway,and mTOR signaling pathway.Finally,this study established 7 lncRNA-mediated ceRNA regu-latory pathways associated with pyroptosis and 23 ln-cRNA-mediated regulatory pathways for ferroptosis and autophagy.Conclusion This study has successfully constructed a ceRNA network related to programmed cell death,which helps us understand the mechanism by which programmed cell death leads to AS.

Objective To investigate whether successful percutaneous coronary intervention(PCI)could improve symptoms and quality of life(QOL)in left main disease and/or 3-vessel disease patients with diabetes.Methods Patients with left main disease and/or 3-vessel disease who underwent PCI in the First Affiliated Hospital of Air Force Medical University from April 2018 to May 2021 were consecutively enrolled and subdivided into 2 groups:diabetes and no diabetes.Detailed baseline characteristics,symptoms,including dyspnea and angina,assessed with the Rose dyspnea scale(RDS),Seattle angina questionnaire(SAQ),the European quality of life-5 dimensions(EQ-5D)and 12-item short-form health survey(SF-12)questionnaire respectively,procedural details,and 1 month and 1 year follow-up data were collected.Results Among 440 left main disease and/or 3-vessel disease patients,disease was present in 176(40.00％),who had more hypertension,peripheral artery disease,and LCX lesion(all P＜0.05).The incidence of major adverse cardiovascular events(MACE)and all-cause mortality were similar between the two groups(both P＞0.05)at 1 month follow-up,while all-cause mortality in diabetes patients was significantly higher than those without diabetes at 1 year follow-up(P=0.013).Low left ventricular ejection fraction was an independent risk factor for MACE and all-cause mortality at 1 month and 1 year follow-up after successful revascularization(all P＜0.05).Most importantly,symptoms,including dyspnea and angina,and QOL were markedly improved regardless of diabetes both at 1 month and 1 year follow-up(all P＜0.05).Diabetes patients showed improved dyspnea and QOL at similar degree to the non-diabetes patients(all P＞0.05)and a more significantly relieved angina(P=0.013).Additionally,the number of chronic total occlusion(CTO)per patient was identified as an independent risk factor of dyspnea(OR 0.723,95％CI 0.525～0.997,P=0.048)and angina relief(OR 0.686,95％CI 0.473～0.995,P=0.047),and the contrast volume(OR 0.995,95％CI 0.992～0.999,P=0.008)as an independent risk factor of QOL improvement in diabetic patients.Conclusions Successful PCI is beneficial for relieving symptoms and improving quality of life in patients with diabetes who have left main disease and/or 3-vessel disease.

Aim To mine the competing ceRNA net-works associated with programmed cell death in the pathophysiological mechanisms of atherosclerosis(AS)based on bioinformatics,in order to identify new targets for the diagnosis and treatment of AS.Methods Firstly,the GSE97210 and GSE28858 datasets were screened from the GEO database.Differentially ex-pressed lncRNA,mRNA and miRNA were identified,following which a IncRNA-miRNA-mRNA regulatory network was constructed in Cytoscape 3.7.2 software based on ceRNA theory.Second,GO and KEGG en-richment analysis of mRNA in the ceRNA network was performed.Finally,the mRNAS within the ceRNA net-work were compared with genes related to autophagy,pyroptosis and ferroptosis to establish a ceRNA network related to programmed cell death.Results A total of 1208 DElncRNAS,4723 DEmRNAS and 139 DEmiR-NAS were identified.A ceRNA network was estab-lished,comprising 64 lncRNAS,8 miRNAS and 167 mRNAS.The mRNAS within the CeRNA network were mainly enriched in biological processes such as positive regulation of transcription and migration,protein bind-ing,and signaling pathways including PI3K-Akt signa-ling pathway,and mTOR signaling pathway.Finally,this study established 7 lncRNA-mediated ceRNA regu-latory pathways associated with pyroptosis and 23 ln-cRNA-mediated regulatory pathways for ferroptosis and autophagy.Conclusion This study has successfully constructed a ceRNA network related to programmed cell death,which helps us understand the mechanism by which programmed cell death leads to AS.

Objective:To investigate the role of microglial polarization modulated by triggering receptor expressed on myeloid cells 2/insulin-like growth factor-1(TREM2/IGF-1) in hypertensive model mice exposed to diesel exhaust particulate matter (DPM), with a focus on its implications for anxious- and depressive-like behaviors.Methods:SPF-grade male C57BL/6J mice were divided into the control group, the hypertension group, the DPM group, and the hypertension+ DPM group according to the principle of weight-matching, with 10 mice in each group. The hypertension model was established by intraperitoneal injection of angiotensin Ⅱ (AngⅡ) in hypertension group and hypertension+ DPM group, and mice in the control group and DPM group were intraperitoneally injected with an equivalent amount of 0.9% NaCl solution.DPM suspension was instilled into the nasal cavity of the mice in DPM group and hypertension+ DPM group(1 μg/μL, 10 μL, once a day for 56 days).Behavioral tests, including the sucrose preference test, tail suspension test, elevated plus maze test, and open field test, were conducted to evaluate anxious- and depressive-like behaviors.TREM2-overexpressing BV2 cell model was established through plasmid transfection technology.Western blot was applied to measure the protein expression of IL-1β, IL-6, TNF-α, iNOS, Arg-1, TREM2 and IGF-1.SPSS 23.0 software was used for statistical analysis, one-way ANOVA was used for comparison among multiple groups, and LSD- t test was used for post-hoc testing. Results:(1)There were statistically significant differences in the sucrose preference rate, immobility time in the tail suspension test, percentage of time and number of entries into the open arms in the elevated plus maze, as well as the total distance, percentage of time spent in the central area in the open field test among the four groups of mice( F=22.82, 21.60, 36.17, 20.99, 5.85, 13.24, all P<0.01).The sucrose preference rate, percentage of time spent in the open arms, percentage of number of entries into the open arms, total distance and percentage of time spent in the central area of the DPM group and the hypertension group were lower than those of the control group( P<0.05), while the immobility time of the two group was higher than that of the control group( P<0.05). The sucrose preference rate((55.62±4.46)%) and percentage of time spent in the open arms((4.17±0.62)%) of the hypertension+ DPM group were lower than those of the DPM group((60.78±3.21)%, (6.44±0.89)%) and the hypertension group((66.26±4.25)%, (6.53±1.29)%)(all P<0.05), while the immobility time((155.42±12.50)s) was higher than that of the DPM group((129.03±5.43)s) and the hypertension group((129.28±10.55)s)(both P<0.05).(2)Western blot analysis revealed statistically significant differences in protein expression of IL-1β, IL-6, TNF-α, iNOS, Arg-1, and TREM2/IGF-1 in the medial prefrontal cortex(mPFC) among the four experimental groups( F=12.23, 10.51, 33.89, 145.40, 11.85, 15.56, 33.11, all P<0.05).The hypertension+ DPM group demonstrated significantly higher protein expression of IL-1β and IL-6 compared to the hypertension group (all P<0.05). Relative to the hypertension+ DPM group, TNF-α and iNOS protein expression was elevated in both the hypertension group and DPM group, whereas Arg-1 protein expression was lower in the hypertension group(all P<0.05). Additionally, TREM2 and IGF-1 protein expression in the hypertension and DPM groups were lower than those in the control group but higher than those in the hypertension+ DPM group(all P<0.05).(3)The protein expressions of IL-1β, IL-6 and TNF-α in BV2 cells of the DPM+ AngⅡ-TREM2 overexpression group were lower than those of the DPM+ AngⅡ group. The expression of iNOS was lower than that in the DPM+ AngⅡ group, while the expression of Arg-1 was higher than that in the DPM+ AngⅡ group(all P<0.05). Conclusion:DPM exposure aggravates anxious- and depressive-like behaviors in hypertensive model mice, with TREM2/IGF-1-regulated microglial polarization playing a significant role in this process.

Objective:To investigate the role of microglial polarization modulated by triggering receptor expressed on myeloid cells 2/insulin-like growth factor-1(TREM2/IGF-1) in hypertensive model mice exposed to diesel exhaust particulate matter (DPM), with a focus on its implications for anxious- and depressive-like behaviors.Methods:SPF-grade male C57BL/6J mice were divided into the control group, the hypertension group, the DPM group, and the hypertension+ DPM group according to the principle of weight-matching, with 10 mice in each group. The hypertension model was established by intraperitoneal injection of angiotensin Ⅱ (AngⅡ) in hypertension group and hypertension+ DPM group, and mice in the control group and DPM group were intraperitoneally injected with an equivalent amount of 0.9% NaCl solution.DPM suspension was instilled into the nasal cavity of the mice in DPM group and hypertension+ DPM group(1 μg/μL, 10 μL, once a day for 56 days).Behavioral tests, including the sucrose preference test, tail suspension test, elevated plus maze test, and open field test, were conducted to evaluate anxious- and depressive-like behaviors.TREM2-overexpressing BV2 cell model was established through plasmid transfection technology.Western blot was applied to measure the protein expression of IL-1β, IL-6, TNF-α, iNOS, Arg-1, TREM2 and IGF-1.SPSS 23.0 software was used for statistical analysis, one-way ANOVA was used for comparison among multiple groups, and LSD- t test was used for post-hoc testing. Results:(1)There were statistically significant differences in the sucrose preference rate, immobility time in the tail suspension test, percentage of time and number of entries into the open arms in the elevated plus maze, as well as the total distance, percentage of time spent in the central area in the open field test among the four groups of mice( F=22.82, 21.60, 36.17, 20.99, 5.85, 13.24, all P<0.01).The sucrose preference rate, percentage of time spent in the open arms, percentage of number of entries into the open arms, total distance and percentage of time spent in the central area of the DPM group and the hypertension group were lower than those of the control group( P<0.05), while the immobility time of the two group was higher than that of the control group( P<0.05). The sucrose preference rate((55.62±4.46)%) and percentage of time spent in the open arms((4.17±0.62)%) of the hypertension+ DPM group were lower than those of the DPM group((60.78±3.21)%, (6.44±0.89)%) and the hypertension group((66.26±4.25)%, (6.53±1.29)%)(all P<0.05), while the immobility time((155.42±12.50)s) was higher than that of the DPM group((129.03±5.43)s) and the hypertension group((129.28±10.55)s)(both P<0.05).(2)Western blot analysis revealed statistically significant differences in protein expression of IL-1β, IL-6, TNF-α, iNOS, Arg-1, and TREM2/IGF-1 in the medial prefrontal cortex(mPFC) among the four experimental groups( F=12.23, 10.51, 33.89, 145.40, 11.85, 15.56, 33.11, all P<0.05).The hypertension+ DPM group demonstrated significantly higher protein expression of IL-1β and IL-6 compared to the hypertension group (all P<0.05). Relative to the hypertension+ DPM group, TNF-α and iNOS protein expression was elevated in both the hypertension group and DPM group, whereas Arg-1 protein expression was lower in the hypertension group(all P<0.05). Additionally, TREM2 and IGF-1 protein expression in the hypertension and DPM groups were lower than those in the control group but higher than those in the hypertension+ DPM group(all P<0.05).(3)The protein expressions of IL-1β, IL-6 and TNF-α in BV2 cells of the DPM+ AngⅡ-TREM2 overexpression group were lower than those of the DPM+ AngⅡ group. The expression of iNOS was lower than that in the DPM+ AngⅡ group, while the expression of Arg-1 was higher than that in the DPM+ AngⅡ group(all P<0.05). Conclusion:DPM exposure aggravates anxious- and depressive-like behaviors in hypertensive model mice, with TREM2/IGF-1-regulated microglial polarization playing a significant role in this process.

Objective:To observe the safety and short-term efficacy of using an autologous fascia lata sling (AFLS) for tension-free mid-urethral sling (MUS) in the treatment of stress urinary incontinence (SUI).Methods:Between February 2022 and December 2023, 11 patients with SUI underwent AFLS-MUS. Preoperative data were recorded, including basic patient information and completion of urinary distress inventory 6 (UDI-6). During surgery, AFLS was harvested through a small incision using a tendon extractor, and used as a sling for transobturator or retropubic MUS. Perioperative indicators were recorded, including surgical approach, operation time, intraoperative blood loss, postoperative hospital stay, duration of catheterization, perioperative complications (Clavien-Dindo classification), and surgical costs. Follow-ups included outpatient physical examination at 2 months postoperatively, and telephone follow-up at 6 months, 1 year, and annually thereafter. Follow-up content included the presence or absence of urinary leakage symptoms, UDI-6, satisfaction, patient global impression of improvement (PGI-I), and complications.Results:The age of the 11 patients was (54.8±10.9) years (range: 41-72 years), with body mass index of (23.9±1.8) kg/m2 (range: 21.4-27.3 kg/m2). All patients experienced urinary leakage after coughing, sneezing and physical activity, with positive SUI provocation tests. The preoperative UDI-6 was 50.0±21.6 (range: 16.7-79.2), the result of 1-hour pad test was (18.9±12.0) g (range: 2.5-71.2 g). Four cases underwent MUS only, with operation time of (98.0±13.3) minutes (range: 86-117 minutes), and intraoperative blood loss of (17.5±5.0) ml (range: 10-20 ml); 7 cases also underwent pelvic floor repair simultaneously. The postoperative hospital stay was (3.5±2.0) days (range: 2-9 days). The duration of catheterization was (4.5±3.8) days (range: 2-11 days), with postoperative urinary retention in three cases, one of which underwent sling release surgery due to severe postoperative voiding difficulty 1 week after MUS, with no other complications of Clavien-Dindo grade 2 or above. The cost of AFLS harvest plus MUS was (2 762±293) yuan. At the 2-month outpatient follow-up, all patients were free of urinary leakage symptoms, with UDI-6 of 2.3±1.9 (range: 0-8.3); satisfaction was "very satisfied" in 10 cases and "fairly satisfied" in 1 case, with PGI-I all being "much better", and pelvic examinations were normal. Telephone follow-up showed one case lost to follow-up, and the remaining 10 cases had follow-up time of (18.6±4.9) months (range: 7-26 months), all without urinary leakage, with UDI-6 of 2.7±2.6, satisfaction rated as "very satisfied", and PGI-I all "much better".Conclusion:This modified AFLS-MUS for the treatment of SUI shows good short-term efficacy and high safety in harvest site, with the need for more data accumulation and long-term follow-up.

Objectives:To investigate the association between the triglyceride-glucose(TyG)index and risk of non-alcoholic fatty liver disease(NAFLD)in young and middle-aged(<60 years)adults.Methods:From June 2006 to October 2007,47 675 employees of Kailuan Group with no liver disease were selected as the study objects.Based on the TyG index quartile,participants were divided into Q1 group(TyG index≤8.08,n=11 924),Q2 group(8.0836.46,n=11 919),the association between TyG index,cum-TyG and cumulative exposure time and the risk of NAFLD was analyzed.Results:The average age of the study population was(44.3±8.7)years,36 345 participants were males(76.23%).During a median follow-up period of 11.55(7.28,13.89)years,4 635(9.72%)participants developed new-onset NAFLD.After adjusting for confounders,cox regression analysis showed that compared with the Q1 group,the HR(95%CI)for NAFLD in the Q2 to Q4 groups were 1.328(1.191-1.480),1.591(1.430-1.770),and 2.106(1.861-2.384),respectively,Ptrend<0.001.Compared with the cum-Q1 group,the HR(95%CI)for NAFLD in the cum-Q2 to cum-Q4 groups were 1.571(1.426-1.730),2.123(1.935-2.330)and 2.593(2.367-2.840),respectively,Ptrend<0.001.Compared with the TyG index for 0 year,the HR(95%CI)of NAFLD for 2,4 and 6 years was 1.333(1.196-1.486),1.879(1.690-2.088)and 3.184(2.860-3.545),respectively,Ptrend<0.001.Conclusions:Increased TyG index is an independent risk factor for the new-onset NAFLD in young and middle-aged population.