Objective:To compare the clinical outcomes of APTT-HTO and Biplanar-high tibial osteotomy (Biplanar-HTO) in treating medial compartment knee osteoarthritis.Methods:A non-randomized controlled trial was conducted. Twenty-eight patients with medial compartment knee osteoarthritis who underwent HTO at the Affiliated Hospital of Guizhou Medical University from August 2021 to January 2022 were enrolled. Based on the patients' surgical preference, they were assigned to either the APTT-HTO group ( n=15) or the Biplanar-HTO group ( n=13), followed up for 12 months postoperatively. Postoperative pain Visual Analog Scale (VAS) scores, Knee Society Score (KSS), changes in patellar height (Caton-Deschamps Index, CDI), and posterior tibial slope (PTS) were compared between the two groups. Results:The APTT-HTO group demonstrated a significantly shorter operative time (64.13±4.85 min) compared to the Biplanar-HTO group (81.54±6.09 min) ( P<0.05). No significant differences were observed in intraoperative correction (APTT-HTO: 12.19°±4.85°; Biplanar-HTO: 11.23°±3.02°) or postoperative drainage volume (APTT-HTO: 47.00±13.79 ml; Biplanar-HTO: 47.00±11.17 ml) ( P>0.05). At 12-month follow-up (APTT-HTO: 13.93±2.05 months; Biplanar-HTO: 14.08±2.14 months; no dropouts), the APTT-HTO group showed no significant changes in PTS (9.32°±2.04° vs. preoperative 8.82°±1.89°) or CDI (0.95±0.11 vs. 0.98±0.11) ( P>0.05), while the Biplanar-HTO group exhibited increased PTS (13.27°±1.99° vs. 8.86°±1.99°) and decreased CDI (0.64±0.10 vs. 0.97±0.16) ( P<0.05). The differences in PTS and CDI between the APTT HTO group and the Biplanar HTO group at 12 months after surgery were statistically significant ( P<0.05). Both groups achieved significant clinical improvements: in APTT-HTO, VAS decreased (preopreation 4.80±1.01 to postopreation 1.06±0.88), KSS knee scores increased (47.67±12.03 to 87.93±4.38), and KSS function scores improved (48.00±4.93 to 67.00±5.91); in Biplanar-HTO, VAS reduced (5.08±1.12 to 1.85±1.14), KSS knee scores rose (46.85±11.48 to 85.85±5.11), and KSS function scores enhanced (46.92±5.60 to 66.92±5.22) ( P<0.05 for all). Complications included soft tissue irritation (2 cases per group), with Biplanar-HTO additionally reporting deep vein thrombosis (1 case), hinge fracture (1 case), and patella baja (3 cases). Conclusions:Both APTT-HTO and Biplanar-HTO effectively treat medial compartment knee osteoarthritis. However, APTT-HTO outperforms Biplanar-HTO in preventing postoperative patella infera and minimizing alterations in PTS.

Background and Aims:Extrahepatic cholangiocarcinoma(ECCA)is a malignancy with insidious onset,strong invasiveness,and poor prognosis,characterized by a high postoperative recurrence rate and a 5-year overall survival of less than 20％.Most existing prognostic models are based on the Cox proportional hazards model,which is limited by the proportional hazards assumption and linearity constraints.The random survival forest(RSF)model,a novel machine learning algorithm,can capture complex interactions and nonlinear effects among variables;however,its application in ECCA remains scarce.Therefore,this study developed a prognostic model for ECCA patients after radical resection using the RSF algorithm,aiming to provide precise and individualized prognostic assessments and support clinical decision-making.Methods:A total of 515 postoperative ECCA patients from the SEER database(2016-2021)were retrospectively enrolled and randomly divided into a training set(n=361)and a test set(n=154).Demographic and clinical variables were collected.Cox models were developed using univariate and multivariate regression,while RSF models were constructed using variable importance(VIMP)and minimal depth methods.Model performance was evaluated using the concordance index(C-index),time-dependent area under the curve(AUC),Brier scores,calibration plots,and decision curve analysis.Survival differences were assessed using Kaplan-Meier analysis,and interpretability was enhanced through the use of SurvSHAP and SurvLIME.Results:Multivariate Cox regression identified seven independent prognostic factors:age,race,income,T stage,N stage,tumor size,and chemotherapy.The RSF model selected four key predictors:age,tumor size,lymph node positive rate,and chemotherapy.In the test cohort,the RSF model achieved a C-index of 0.751,outperforming the Cox model(0.711).The RSF model yielded AUCs of 0.843,0.749,and 0.814 at 1,2,and 3 years,respectively,with superior calibration,overall performance,and net clinical benefit.Nonlinear associations were observed for lymph node positive rate,age,and tumor size,while chemotherapy was associated with reduced mortality risk.Stratified survival curves indicated poorer prognosis in patients without chemotherapy,lymph node positive rate＞0.1,age＞70 years,or tumor size＞20 mm.Conclusion:The RSF model,based on only four readily available clinical variables,demonstrated superior predictive performance compared with the Cox model.It provides a reliable tool for individualized prognosis and postoperative management in ECCA patients.The integration of interpretability frameworks further enhances its clinical applicability,offering potential to improve survival outcomes and quality of life.

Objective:To compare the clinical outcomes of APTT-HTO and Biplanar-high tibial osteotomy (Biplanar-HTO) in treating medial compartment knee osteoarthritis.Methods:A non-randomized controlled trial was conducted. Twenty-eight patients with medial compartment knee osteoarthritis who underwent HTO at the Affiliated Hospital of Guizhou Medical University from August 2021 to January 2022 were enrolled. Based on the patients' surgical preference, they were assigned to either the APTT-HTO group ( n=15) or the Biplanar-HTO group ( n=13), followed up for 12 months postoperatively. Postoperative pain Visual Analog Scale (VAS) scores, Knee Society Score (KSS), changes in patellar height (Caton-Deschamps Index, CDI), and posterior tibial slope (PTS) were compared between the two groups. Results:The APTT-HTO group demonstrated a significantly shorter operative time (64.13±4.85 min) compared to the Biplanar-HTO group (81.54±6.09 min) ( P<0.05). No significant differences were observed in intraoperative correction (APTT-HTO: 12.19°±4.85°; Biplanar-HTO: 11.23°±3.02°) or postoperative drainage volume (APTT-HTO: 47.00±13.79 ml; Biplanar-HTO: 47.00±11.17 ml) ( P>0.05). At 12-month follow-up (APTT-HTO: 13.93±2.05 months; Biplanar-HTO: 14.08±2.14 months; no dropouts), the APTT-HTO group showed no significant changes in PTS (9.32°±2.04° vs. preoperative 8.82°±1.89°) or CDI (0.95±0.11 vs. 0.98±0.11) ( P>0.05), while the Biplanar-HTO group exhibited increased PTS (13.27°±1.99° vs. 8.86°±1.99°) and decreased CDI (0.64±0.10 vs. 0.97±0.16) ( P<0.05). The differences in PTS and CDI between the APTT HTO group and the Biplanar HTO group at 12 months after surgery were statistically significant ( P<0.05). Both groups achieved significant clinical improvements: in APTT-HTO, VAS decreased (preopreation 4.80±1.01 to postopreation 1.06±0.88), KSS knee scores increased (47.67±12.03 to 87.93±4.38), and KSS function scores improved (48.00±4.93 to 67.00±5.91); in Biplanar-HTO, VAS reduced (5.08±1.12 to 1.85±1.14), KSS knee scores rose (46.85±11.48 to 85.85±5.11), and KSS function scores enhanced (46.92±5.60 to 66.92±5.22) ( P<0.05 for all). Complications included soft tissue irritation (2 cases per group), with Biplanar-HTO additionally reporting deep vein thrombosis (1 case), hinge fracture (1 case), and patella baja (3 cases). Conclusions:Both APTT-HTO and Biplanar-HTO effectively treat medial compartment knee osteoarthritis. However, APTT-HTO outperforms Biplanar-HTO in preventing postoperative patella infera and minimizing alterations in PTS.

Background and Aims:Extrahepatic cholangiocarcinoma(ECCA)is a malignancy with insidious onset,strong invasiveness,and poor prognosis,characterized by a high postoperative recurrence rate and a 5-year overall survival of less than 20％.Most existing prognostic models are based on the Cox proportional hazards model,which is limited by the proportional hazards assumption and linearity constraints.The random survival forest(RSF)model,a novel machine learning algorithm,can capture complex interactions and nonlinear effects among variables;however,its application in ECCA remains scarce.Therefore,this study developed a prognostic model for ECCA patients after radical resection using the RSF algorithm,aiming to provide precise and individualized prognostic assessments and support clinical decision-making.Methods:A total of 515 postoperative ECCA patients from the SEER database(2016-2021)were retrospectively enrolled and randomly divided into a training set(n=361)and a test set(n=154).Demographic and clinical variables were collected.Cox models were developed using univariate and multivariate regression,while RSF models were constructed using variable importance(VIMP)and minimal depth methods.Model performance was evaluated using the concordance index(C-index),time-dependent area under the curve(AUC),Brier scores,calibration plots,and decision curve analysis.Survival differences were assessed using Kaplan-Meier analysis,and interpretability was enhanced through the use of SurvSHAP and SurvLIME.Results:Multivariate Cox regression identified seven independent prognostic factors:age,race,income,T stage,N stage,tumor size,and chemotherapy.The RSF model selected four key predictors:age,tumor size,lymph node positive rate,and chemotherapy.In the test cohort,the RSF model achieved a C-index of 0.751,outperforming the Cox model(0.711).The RSF model yielded AUCs of 0.843,0.749,and 0.814 at 1,2,and 3 years,respectively,with superior calibration,overall performance,and net clinical benefit.Nonlinear associations were observed for lymph node positive rate,age,and tumor size,while chemotherapy was associated with reduced mortality risk.Stratified survival curves indicated poorer prognosis in patients without chemotherapy,lymph node positive rate＞0.1,age＞70 years,or tumor size＞20 mm.Conclusion:The RSF model,based on only four readily available clinical variables,demonstrated superior predictive performance compared with the Cox model.It provides a reliable tool for individualized prognosis and postoperative management in ECCA patients.The integration of interpretability frameworks further enhances its clinical applicability,offering potential to improve survival outcomes and quality of life.

Acute myeloid leukemia (AML) is a common malignant disease of the hematological system, with high EVI1 expression accounting for 8%-10% of adult AML. Studies have shown that high EVI1 expression plays an important role in the treatment and prognosis of AML. In recent years, researchers have continuously revealed the structure and role of EVI1, but its mechanism of mediating AML has not been fully clarified. Therefore, systematically exploring the role of EVI1 in AML may provide a useful reference for the precise treatment of AML patients with high EVI1 expression.

Anaplastic lymphoma kinase(ALK)fusion is commonly observed in lung adenocarcinoma,with an incidence rate of 5%-7%.Due to the tumor heterogeneity in advanced non-small cell lung cancer,ALK fusion can also occur in lung squamous cell carcinoma.A mul-tidisciplinary team(MDT)combines various professional opinions and evidence-based medical principles to provide personalized treatment recommendations,particularly for complex cases.This study presents the MDT diagnostic and treatment approach for a patient with lung squamous cell carcinoma with an ALK mutation.Following initial diagnosis at stage ⅢB,the patient exhibited rapid disease progression with liver and brain metastases after sequence chemoradiotherapy.After genetic testing revealed ALK fusion,the patient was treated with the ALK inhibitor,lorlatinib,which resulted in tumor regression and a persistent partial response.

Objective:To observe the clinical effect of extracorporeal shock wave treatment in the treatment of functional disorders after a palm crush injury.Methods:Forty patients who had experienced a hand crush injury more than 3 months previously were randomly divided into a control group and a combination group, each of 20. Both groups were given routine joint mobilization, ultrasound treatment, muscle strength training and occupational therapy every day in ten day units for 2 months. The combination group also received extracorporeal shock wave therapy three times a week for the two months. Before the experiment and after one and two months of treatment, both groups′ upper limb functioning was evaluted using the DASH score, grip strength and hand flexibility in the 9-hole wood board test.Results:After 2 months of treatment, significant improvement was observed in all of the measurements with both groups. The average scores of the combination group on all three tests were by then significantly better than the control group′s averages.Conclusions:Adding extracorporeal shock wave therapy to routine rehabilitation can improve the rough and fine functioning of a crushed hand.

Objective To analyze the risk factors for persistent corneal epithelial defects (PCED) after pars plana vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).Methods A total of 201 PDR patients (201 eyes) who received PPV were enrolled in this retrospective study.There were 86 males (86 eyes) and 115 females (115 eyes).The patients aged from 30 to 81 years,with the mean age of (57.94±9.65) years.Among them,159 patients were ≥50 years of age,and 42 patients were ＜50 years of age.There were 36 patients with HbA1c ＜7.0％,165 patients with HbA1c ≥7.0％.There were 93 right eyes and 108 left eyes.There were 93 right eyes and 108 left eyes.The diabetic retinopathy stages were as follows:stage Ⅳ in 24 eyes,stage Ⅴ in 78 eyes and stage Ⅵ in 99 eyes.The operation time was ranged from 1 to 4 hours,with an average of 2 hours.Among the 201 eyes,corneal epidermis were scraped on 25 eyes;70 eyes were combined with cataract surgery;a laser photocoagulation count ＜ 1000 points was performed in 78 eyes,and ＞ 1000 points were performed in 123 eyes.Sixty-one eyes involved intravitreal silicone oil tamponade,18 eyes involved intravitreal tamponade with C3F8,and 122 eyes were not involved with intraocular tamponade.Postoperative persistent intraocular hypertension was defined as an intraocular pressure (IOP) ≥21 mmHg (1 mmHg=0.133 kPa) after PPV with necessary treatment using IOP-lowering medications for ≥ 2 weeks.The diagnostic criteria for corneal epithelial defects were taken from the Expert Consensus on Clinical Diagnosis and Treatment of Corneal Epithelial Defect in China (2016).The corneal epithelial defect was diagnosed as PCED if it was treated with common methods such as a lacrimal substitute or corneal contact lens,but showed no improvement and no signs of healing for ≥2 weeks.The incidence of PCED after eye surgery was recorded and its related risk factors were analyzed.A multivariate logistic regression was used to analyze the risk factors for PCED,which were expressed as a odds ratio (OR) and a 95％ confidence interval (CI).Results Of 201 eyes,16 eyes (7.96％) presented with PCED after surgery and 185 eyes (92.04％) with no PCED.There was no significant difference in the age,sex,and eyes between the patients with or without PCED (x2=6.548,0.927,0.044;P=0.011,0.336,0.833).A multivariate logistic regression showed that intraoperative epithelial debridement (OR=1 3.239,95％CI 2.999-58.442,P=0.001),intraoperative treatment in combination with cataract surgery (OR=7.448,95％CI 1.975-28.091,P=0.003),intravitreal tamponade with C3F8 (OR=11.344,95％CI 2.169-59.324,P=0.004),and postoperative persistent intraocular hypertension (OR=10.462,95％CI 2.464-44.414,P=0.001) were risk factors for PCED after PPV.Conclusion Intraoperative epithelial debridement,intraoperative treatment in combination with cataract surgery,intravitreal tamponade with C3F8,and postoperative persistent intraocular hypertension are risk factors for PCED in patients with PDR after PPV.

OBJECTIVETo explore genetic mutation and clinical treatment for a patient with globozoospermia.

METHODSHistomorphology of the sperms was studied by Wright-Giemsa staining and transmission electron microscopy. Potential mutation of the DPY19L2 gene was detected by PCR amplification and Sanger sequencing.

RESULTSWright-Giemsa staining showed that all spermatozoa from the patient were round-headed and lacked the acrosome, with the nuclei of sperm head stained in dark and full. Transmission electron microscopy revealed large round sperm heads, with an even layer of unit membrane surrounding the nuclei and dispersed cytoplasmic vacuoles but no acrosomal structure. The patient has harbored a homozygous deletion of the DPY19L2 gene. With intracytoplasmic sperm injection (ICSI) treatment, fertilization rate of the oocytes has reached 28.6%, which resulted in a successful pregnancy. A healthy male was born.

CONCLUSIONThe homozygous deletion of DPY19L2 probably underlies the globozoospermia in this case, for which ICSI has provided an effective treatment. However, there is still a risk of low oocyte fertilization rate or fertilization failure. Further studies are required.

Adult ; DNA Mutational Analysis ; Humans ; Infant, Newborn ; Male ; Membrane Proteins ; genetics ; Mutation ; Sperm Injections, Intracytoplasmic ; Teratozoospermia ; genetics

Objective Negative pressure aspirator clogging ( OSAC) frequently occurs in orthopedic surgery .This study was to investigate the frequency , location , and mechanisms of OSAC in China by analysis of the current status and clinical observation of OSAC so as to provide evidence for the solution of the problem . Methods Using the two-stage random sampling method , we conduc-ted a questionnaire survey on OSAC among 738 clinical orthopedists during the 16th and 17th Chinese Orthopedic Association Confer-ences.Totally, 160 out 1200 orthopedic surgeries were randomly selected in the time order of operation , including 38 cases of total hip arthroplasty ( THA) , 39 cases of total knee arthroplasty ( TKA) , 43 cases of extremity and spinal fractures surgery , and 40 cases of other orthopedic surgeries .We also obtained the satisfaction scores with the existing aspirators from related medical professionals . Results Among the 738 respondents included into the analysis , 706 (95.7%) thought that OSAC often occurred during surgery , 631 (85.5%) considered THA to be the leading cause of OSAC , and 714 (96.7%) regarded the tip and hose joint of the aspirator as the common causes . The mean satisfaction score with the existing aspirators was 7.62 ±0.74.Clinical observation showed the mean frequency of OSAC to be 2.55 ±1.62 in THA, 1.95 ±1.33 in TKA, 1.52 ±1.18 in extremity and spinal fracture surgeries , and 0.95 ± 0.68 in other orthopedic surgeries , and the satisfaction score to be 7.36 ±0.84. Conclusion OSAC has a high incidence rate during orthopedic surgeries in China , thus affecting orthopedic surgery and reducing orthopedists'satisfaction with the aspirators . The current negative pressure aspirator system demands prompt improvement .