Objective: To examine the reciprocal relationships of anxiety and depressive symptoms,uncertainty stress with academic buoyancy among college students, providing evidence for mental health promotion and academic resilience enhancement. Methods: A multi stage cluster random sampling method was used to selected 741 undergraduates from grade 1 to 2 of a university in Xuzhou, Jiangsu Province. Participants completed two waves of surveys (T1: October 2022; T2: October 2023) using the Uncertainty Stress Scale, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Academic Buoyancy Scale. Cross lagged models analyzed bidirectional relationships between three mental health variables and academic buoyancy, followed by latent variable modeling integrating all mental health dimensions. Results: Cross lagged model results revealed that T1 uncertainty stress negatively predicted T2 academic buoyancy ( β =-0.14), while T1 academic buoyancy negatively predicted T2 uncertainty stress ( β =-0.11); T1 depressive symptom negatively predicted T2 academic buoyancy ( β =-0.08), while T1 academic buoyancy negatively predicted T2 depressive symptom ( β =-0.09); furthermore, T1 academic buoyancy negatively predicted T2 anxiety symptom( β =-0.10) ( P <0.05). Results from the latent variable cross lagged model of psychological problems (constructed from the three mental health variables) indicated that T1 psychological problems negatively predicted T2 academic buoyancy ( β =-0.09), while T1 academic buoyancy negatively predicted T2 psychological problems ( β =-0.09) ( P <0.05). Conclusions Longitudinal bidirectional relationships exist between mental health status and academic buoyancy in college students. Better mental health facilitates higher academic buoyancy.

Biliary tract cancers (BTC), a heterogeneous disease with poor prognosis, including gallbladder cancer (GBC), intrahepatic cholangiocarcinoma (ICC), and extrahepatic cholangiocarcinoma (ECC). Although surgery is currently the primary regimen to treat BTC, most BTC patients are diagnosed at an advanced stage and miss the opportunity of surgical eradication. As a result, non-surgical therapy serves as the main intervention for advanced BTC. In recent years, immunotherapy has emerged as one of the most promising therapies in a number of solid cancers, and it includes immune checkpoint inhibitors (ICIs) monotherapy or combined therapy, tumor vaccines, oncolytic virus immunotherapy, adoptive cell therapy (ACT), and cytokine therapy. However, these therapies have been practiced in limited clinical settings in patients with BTC. In this review, we focus on the discussion of latest advances of immunotherapy in BTC and update the progress of multiple current clinical trials with different immunotherapies.

Chinese Medical Association and L'Oréal Group jointly launched the "China Skin & Hair Grant" from 2003 to 2018 to support Chinese dermatologists in skin and hair research. This program has not only helped improve the research capability of Chinese dermatologists, but also yielded abundant valuable Chinese population-based clinical and basic research results, and further enabled active academic communication through Chinese and international journals and conferences. This article summarizes main results from skin-related research projects based on program records and publications.

Objective:To evaluate the clinical efficacy of cannulated screws combined with suture anchor in the treatment of comminuted patellar fractures.Methods:A retrospective study was conducted to analyze the data of 72 patients who had been admitted to Department of Orthopaedics, The Second Hospital of Shanxi Medical University for comminuted patellar fractures between January 2020 and June 2023. The patients were divided into 2 groups based on the surgical techniques used. In group A of 34 patients subjected to fixation using cannulated screws combined with suture anchors, there were 22 males and 12 females with an age of 49 (39, 58) years, and 7 cases of AO type 34-C2 and 27 cases of AO type 34-C3. In group B of 38 patients subjected to fixation using cannulated screws combined with titanium cables, there were 19 males and 19 females with an age of 55 (40, 62) years, and 11 cases of AO type 34-C2 and 27 cases of AO type 34-C3. Comparisons were made between the 2 groups regarding general preoperative data, postoperative range of knee motion, fracture healing time, complications, soft tissue irritation, secondary surgery, postoperative pain assessed by visual analogue scale (VAS), postoperative Bostman knee score, and postoperative Levack knee score.Results:The 2 groups were comparable because there were no statistically significant differences in the general preoperative data and follow-up time between them ( P>0.05). There were no statistically significant differences between the 2 groups either in postoperative range of knee motion, fracture healing time, or Bostman knee score or Levack knee score at the last follow-up (all P>0.05). In group A, the VAS pain score and the rate of soft tissue irritation at the last follow-up were respectively 0.0 (0.0, 1.0) and 0% (0/34), significantly lower than those in group B [1.0 (0.0, 1.3) and 15.8% (6/38)] ( P<0.05). The overall incidence of complications and secondary surgery rate in group A were respectively 5.9% (2/34) and 2.9% (1/34), lower than those in group B [21.1% (8/38) and 15.8% (6/38)], but showing no statistically significant difference between the 2 groups ( P>0.05). Conclusions:In the treatment of comminuted patellar fractures, fixation using cannulated screws combined with both titanium cables and suture anchors can lead to comparable clinical efficacy, but fixation using cannulated screws and suture anchors can reduce soft tissue irritation, alleviate pain, and improve the quality of life of patients.

BACKGROUND:Overactive osteoclasts disrupt bone homeostasis and play a bad role in the pathological mechanisms of related skeletal diseases,such as osteoporosis,fragility fractures,and osteoarthritis.Studies have confirmed that ellagic acid and ellagtannin have the potential to inhibit osteoclast differentiation.As their natural metabolites,urolithin A has antioxidant,anti-inflammatory,anti-proliferative and anti-cancer effects,but its effect on osteoclast differentiation and its underlying molecular mechanisms remain unclear. OBJECTIVE:To explore the effect of urolithin A on osteoclast differentiation induced by receptor activator for nuclear factor-κB ligand and its mechanism. METHODS:Mouse mononuclear macrophage leukemia cells(RAW264.7)that grew stably were cultured in vitro.Toxicity of urolithin A(0,0.1,0.5,1.5,2.5 μmol/L)to RAW264.7 cells were detected by cytotoxic MTS assay to screen out the safe concentration.Different concentrations of urolithin A were used again to intervene with receptor activator for nuclear factor-κB ligand-induced differentiation of RAW264.7 cells in vitro.Then,tartrate-resistant acid phosphatase staining and F-actin ring and nucleus staining were performed to observe its effect on the formation and function of osteoclasts.Finally,the expressions of urolithin A on upstream and downstream genes and proteins in the MAPK signaling pathway were observed by western blot and RT-qPCR assays. RESULTS AND CONCLUSION:Urolithin A inhibited osteoclast differentiation and F-actin ring formation in a concentration-dependent manner and 2.5 μmol/L had the strongest inhibitory effect.Urolithin A inhibited the mRNA expression of Nfatc1,Ctsk,Mmp9 and Atp6v0d2 and the protein synthesis of Nfatc1 and Ctsk,related to osteoclast formation and bone resorption.Urolithin A inhibited the activity of osteoclasts by downregulating the phosphorylation of p38 protein to inhibit the mitogen-activated protein kinase signaling pathway.

BACKGROUND:Studies have shown that imbalance of bone metabolism during glucocorticoid-induced osteonecrosis of the femoral head necrosis is closely related to oxidative stress. OBJECTIVE:To investigate the pathological mechanism by which oxidative stress-induced ferroptosis promote apoptosis in osteoblasts involved in steroid-induced osteonecrosis of the femoral head. METHODS:General data and serum specimens were collected from 47 patients with steroid-induced osteonecrosis of the femoral head.In addition,six femoral head specimens were collected from these patients.According to the Association Research Circulation Osseous(ARCO)staging system,serum specimens were grouped into ARCO Ⅱ,Ⅲ,and IV,while femoral head specimens were classified into ARCO Ⅲ and IV.Serum levels of malondialdehyde and superoxide dismutase 1 were measured.The protein expression of superoxide dismutase 1,glutathione peroxidase 4,Bcl-2 in the femoral head was detected and verified by Data independent acquisition(DIA)for quantitative sequencing,western blot and alkaline phosphate detection. RESULTS AND CONCLUSION:The ARCO stage of patients with steroid-induced osteonecrosis of the femoral head was independent of age,sex and necrotic side.The serum levels of malondialdehyde and superoxide dismutase 1 were higher in patients with ARCO stage Ⅲ compared with those with ARCO stage Ⅱ and IV.The results of DIA protein quantification showed that the function of differential proteins was mainly related to redox.The levels of superoxide dismutase 1,glutathione peroxidase 4,and Bcl-2 in the necrotic region were lower than in the normal region,as well as lower in ARCO stage IV than in ARCO stage Ⅲ.Western blot verified the results of DIA protein quantification.The alkaline phosphatase activity was lower in the necrotic region than in the normal region,as well as lower in ARCO stage IV than in ARCO stage Ⅲ.In the necrotic and sclerotic regions,the function of differential proteins was also related to redox,and superoxide dismutase 1,glutathione peroxidase 4,Bcl-2 protein expression and alkaline phosphatase activity were lower in the necrotic area than in the sclerotic region,as well as lower in ARCO stage IV than in ARCO stage Ⅲ.To conclude,glucocorticoids can influence the progression of steroid-induced osteonecrosis of the femoral head by upregulating oxidative stress levels,inducing osteoblast ferroptosis,and inhibiting osteogenic function.

Objective:To compare the clinical outcomes between percutaneous Kirschner wire leverage plus plaster fixation and elastic intramedullary nailing in the treatment of radial neck fractures in children.Methods:A retrospective study was conducted to analyze the 60 children with radial neck fracture who had been treated by percutaneous Kirschner wire leverage plus plaster fixation at Department of Pediatric Orthopedics, Children's Hospital of Soochow University from January 2016 to July 2023 (set as an internal fixation-free group). They were 30 males and 30 females (34 left and 26 right sides) with an age of (7.7±3.0) years. At the same time, another cohort of 60 patients were chosen as an intramedullary nailing group who had been treated by percutaneous Kirschner wire leverage plus elastic intramedullary nailing and matched in age and gender with those in the internal fixation-free group. The preoperative fracture angulation, operative time, hospitalization time, fracture angulation on the first postoperative day, fracture angulation at 1 month postoperatively, rate of angulation loss after reduction, Mayo elbow performance score (MEPS) at the last follow-up and complications were compared between the 2 groups.Results:There was no significant difference between the 2 groups in their preoperative general data, showing comparability ( P<0.05). The 120 pediatric patients were followed up for (7.5±3.2) months. The operative time [(27.4±15.0) min] and hospitalization time [(3.4±1.9) d] in the internal fixation-free group were significantly shorter than those in the intramedullary nailing group [(45.4±13.5) min and (4.4±1.3) d] ( P<0.05). The preoperative fracture angulation (50.8°±1.9°), fracture angulation on the first postoperative day (11.3°±1.2°), fracture angulation at 1 month postoperatively (12.1°±1.3°), rate of angulation loss after reduction (2.9%±0.5%), and MEPS at the last follow-up [(90.4±2.0) points] in the internal fixation-free group showed no significant differences from those in the intramedullary nailing group [49.5°±1.7°, 11.1°±1.2°, 13.3°±1.5°, 3.9%±1.4%, and (90.2±2.3) points] ( P>0.05). None of the patients in the internal fixation-free group developed pin-tail irritation sign or premature epiphyseal closure after surgery, whereas 3 patients in the intramedullary nailing group developed pin-tail irritation sign and 2 ones premature epiphyseal closure after surgery, showing a significant difference in the complication rate between the 2 groups [0 (0/60) versus 8.3% (5/60)] ( P<0.05). Conclusions:Percutaneous Kirschner wire leverage plus plaster fixation and close elastic intramedullary nailing can both achieve satisfactory outcomes in the treatment of radial neck fractures in children. However, percutaneous Kirschner wire leverage plus plaster fixation needs shorter operative time and hospitalization time, leads to fewer complications, and requires no reoperation to remove internal fixation.

Based on introducing the total price adjustments in pilot cities and analyzing the existing problems,it further analyzes the objectives of the total price adjustment allocation of medical service items,the characteristics of various types of medical service items and the possible impact of price adjustment,concludes that the priority of the total price adjustment allocation should be as follows:new items,special tasks,complex items,general items,and medical services for special needs.It also combines the practical experience of the pilot cities to establish the total price adjustment allocation mechanism,and provides opinions on the total price adjustment allocation before the dynamic adjustment of medical service prices in the future.

Based on introducing the total price adjustments in pilot cities and analyzing the existing problems,it further analyzes the objectives of the total price adjustment allocation of medical service items,the characteristics of various types of medical service items and the possible impact of price adjustment,concludes that the priority of the total price adjustment allocation should be as follows:new items,special tasks,complex items,general items,and medical services for special needs.It also combines the practical experience of the pilot cities to establish the total price adjustment allocation mechanism,and provides opinions on the total price adjustment allocation before the dynamic adjustment of medical service prices in the future.

Based on introducing the total price adjustments in pilot cities and analyzing the existing problems,it further analyzes the objectives of the total price adjustment allocation of medical service items,the characteristics of various types of medical service items and the possible impact of price adjustment,concludes that the priority of the total price adjustment allocation should be as follows:new items,special tasks,complex items,general items,and medical services for special needs.It also combines the practical experience of the pilot cities to establish the total price adjustment allocation mechanism,and provides opinions on the total price adjustment allocation before the dynamic adjustment of medical service prices in the future.