Objective:To explore the correlation of bone metabolism with vitamin D and vitamin K levels in children with glucocorticoid-induced osteoporosis (GIOP) .Methods:A total of 120 GIOP children admitted to Neonatal Department of the First People’s Hospital of Chenzhou City, Hunan Province from Oct. 2022 to Dec. 2024 (GIOP group) and children without osteoporosis who received glucocorticoid therapy during the same period (the control group) were studied. Bone mineral density (BMD), biochemical indexes of bone metabolism and serum 25-hydroxyvitamin D (25 (OH) D), vitamin K1 (VitK1) and VitK2 were determined. BMD and bone metabolism indexes of GIOP children with different levels of 25 (OH) D, VitK1 and VitK2 were compared and their correlation was analyzed. Multiple linear regression analysis was conducted to analyze the independent factors affecting low BMD in GIOP children.Results:GIOP group had lower BMD, serum 25 (OH) D, VitK1 and VitK2 levels ( t=33.03, 42.22, 65.30, 86.16, P<0.05), while higher PINP, β-CTX and N-MID levels ( t=17.98, 34.78, 2.58, P<0.05); The levels of VitK1, VitK2, BMD, PINP, β-CTX and N-MID in GIOP children with different vitamin D and K levels were statistically significant ( F =54.31, 36.77, 82.32, 32.40, 22.80, 5.23), among which BMD was the lowest and PINP, β-CTX and N-MID levels were the highest ( P<0.05); The levels of 25 (OH) D, VitK1 and VitK2 were positively correlated with BMD ( r=0.54, 0.39, 0.47, P<0.05), but negatively correlated with PINP, β-CTX and N-MID ( r = -0.43, -0.34, -0.38, -0.39, -0.45, -0.44, -0.29, -0.32, -0.51, P<0.05); 25 (OH) D, VitK1 and VitK2 were protective factors for low BMD ( t=-2.76, -2.55, -3.51, P<0.05), while PINP, β-CTX, N-MID and hormone use time were risk factors ( t=2.48, 2.19, 2.22, 2.06, P<0.05) . Conclusions:The level of bone metabolism in children with GIOP is closely related to the levels of vitamin D and vitamin K. With the decrease of vitamin D and vitamin K levels, the decrease of BMD is more obvious. Therefore, vitamin D and vitamin K should be supplemented in a timely and reasonable manner for such children.

Objective:To investigate the clinical efficacy of posterior midline incision combined with anteromedial approach in the treatment of complex olecranon fracture-dislocation.Methods:A retrospective analysis was performed on 26 patients (15 males and 11 females) with olecranon fracture-dislocation who were admitted from January 2020 to January 2024, including 5 cases of anterior transolecranon fracture-dislocation (2 cases of upper ulnar-radial joint dislocation), 21 cases of posterior transolecranon fracture-dislocation (5 cases of them were accompanied by upper ulnar-radial joint dislocation). Among them, there were 13 cases of traffic accidents, 7 cases of falling from heights, and 6 cases of walking falls. The average age is 45.1±15.3 years old (21-84 years old).Results:The operation time was 151.2±41.9 minutes, average tourniquet time was 93.7±22.6 minutes, and the intraoperative blood loss was 76.2±20.2 ml. The average follow-up was 16(12, 23) months, and the VAS score decreased significantly and the MEPS score increased significantly over time. At the last follow-up, the VAS score was 2(1, 2), and the MEPS score was 86.5±10.3, with 16 cases excellent, 7 cases good, and 3 cases medium, with an excellent rate of 89%. The range of motion of flexion-extension and pronation-supination were 119.3°±13.5°and 138.6°±15.2° respectively. Complications included 16 cases of ectopic ossification, of which 4 patients with significant effects on elbow function underwent surgical release 3-6 months after surgery. 1 case of ulnar nerve injury symptoms improved after emergency ulnar nerve release, and 1 case of elbow subluxation due to inaccurate coronoid process reduction and fixation. There were no serious complications such as vascular injury, internal fixation failure, fracture nonunion, and incision infection.Conclusion:The posterior midline incision combined with anteromedial approach can effectively treat complex olecranon fracture-dislocation and meet the requirements of early postoperative elbow rehabilitation.

Objective:To explore the correlation of bone metabolism with vitamin D and vitamin K levels in children with glucocorticoid-induced osteoporosis (GIOP) .Methods:A total of 120 GIOP children admitted to Neonatal Department of the First People’s Hospital of Chenzhou City, Hunan Province from Oct. 2022 to Dec. 2024 (GIOP group) and children without osteoporosis who received glucocorticoid therapy during the same period (the control group) were studied. Bone mineral density (BMD), biochemical indexes of bone metabolism and serum 25-hydroxyvitamin D (25 (OH) D), vitamin K1 (VitK1) and VitK2 were determined. BMD and bone metabolism indexes of GIOP children with different levels of 25 (OH) D, VitK1 and VitK2 were compared and their correlation was analyzed. Multiple linear regression analysis was conducted to analyze the independent factors affecting low BMD in GIOP children.Results:GIOP group had lower BMD, serum 25 (OH) D, VitK1 and VitK2 levels ( t=33.03, 42.22, 65.30, 86.16, P<0.05), while higher PINP, β-CTX and N-MID levels ( t=17.98, 34.78, 2.58, P<0.05); The levels of VitK1, VitK2, BMD, PINP, β-CTX and N-MID in GIOP children with different vitamin D and K levels were statistically significant ( F =54.31, 36.77, 82.32, 32.40, 22.80, 5.23), among which BMD was the lowest and PINP, β-CTX and N-MID levels were the highest ( P<0.05); The levels of 25 (OH) D, VitK1 and VitK2 were positively correlated with BMD ( r=0.54, 0.39, 0.47, P<0.05), but negatively correlated with PINP, β-CTX and N-MID ( r = -0.43, -0.34, -0.38, -0.39, -0.45, -0.44, -0.29, -0.32, -0.51, P<0.05); 25 (OH) D, VitK1 and VitK2 were protective factors for low BMD ( t=-2.76, -2.55, -3.51, P<0.05), while PINP, β-CTX, N-MID and hormone use time were risk factors ( t=2.48, 2.19, 2.22, 2.06, P<0.05) . Conclusions:The level of bone metabolism in children with GIOP is closely related to the levels of vitamin D and vitamin K. With the decrease of vitamin D and vitamin K levels, the decrease of BMD is more obvious. Therefore, vitamin D and vitamin K should be supplemented in a timely and reasonable manner for such children.

Objective:To investigate the clinical efficacy of posterior midline incision combined with anteromedial approach in the treatment of complex olecranon fracture-dislocation.Methods:A retrospective analysis was performed on 26 patients (15 males and 11 females) with olecranon fracture-dislocation who were admitted from January 2020 to January 2024, including 5 cases of anterior transolecranon fracture-dislocation (2 cases of upper ulnar-radial joint dislocation), 21 cases of posterior transolecranon fracture-dislocation (5 cases of them were accompanied by upper ulnar-radial joint dislocation). Among them, there were 13 cases of traffic accidents, 7 cases of falling from heights, and 6 cases of walking falls. The average age is 45.1±15.3 years old (21-84 years old).Results:The operation time was 151.2±41.9 minutes, average tourniquet time was 93.7±22.6 minutes, and the intraoperative blood loss was 76.2±20.2 ml. The average follow-up was 16(12, 23) months, and the VAS score decreased significantly and the MEPS score increased significantly over time. At the last follow-up, the VAS score was 2(1, 2), and the MEPS score was 86.5±10.3, with 16 cases excellent, 7 cases good, and 3 cases medium, with an excellent rate of 89%. The range of motion of flexion-extension and pronation-supination were 119.3°±13.5°and 138.6°±15.2° respectively. Complications included 16 cases of ectopic ossification, of which 4 patients with significant effects on elbow function underwent surgical release 3-6 months after surgery. 1 case of ulnar nerve injury symptoms improved after emergency ulnar nerve release, and 1 case of elbow subluxation due to inaccurate coronoid process reduction and fixation. There were no serious complications such as vascular injury, internal fixation failure, fracture nonunion, and incision infection.Conclusion:The posterior midline incision combined with anteromedial approach can effectively treat complex olecranon fracture-dislocation and meet the requirements of early postoperative elbow rehabilitation.

Objective:To investigate the impact of early cleavage on the pregnancy and obstetric outcomes of fresh cycle single cleavage embryo and single blastocyst transfer.Methods:A retrospective study was conducted to analyze 794 patients who underwent single cleavage embryo transfer and 1466 patients who underwent single blastocyst transfer in the reproductive medicine center of our hospital from August 2018 to December 2022 during the fresh cycle treatment of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).The patients were divided into two groups according to whether the transferred embryos underwent normal early cleavage.In the single cleavage embryo transfer,there were 383 cases in the normal early cleavage group(early cleavage group)and 411 cases in the non normal early cleavage group(non-early cleavage group);in the single blastocyst transfer,there were 815 cases in the early cleavage group and 651 cases in the non-early cleavage group.The pregnancy and obstetric outcomes of the early cleavage group and non-early cleavage group were compared in single cleavage embryo transfer and single blastocyst transfer.Results:In the single cleavage embryo transfer,the human chorionic gonadotropin(hCG)positive rate,clinical pregnancy rate,and live birth rate in the early cleavage group were significantly higher than those in the non-early cleavage group(64.0％vs.55.7％,P=0.018;54.6％vs.47.0％,P=0.032;46.7％vs.38.7％,P=0.022).There were no significant differ-ences in biochemical abortion rate,multiple pregnancy rate,abortion rate,early abortion rate,premature delivery rate,low birth weight rate,macrosomia rate,and birth defect rate compared with the non-early cleavage group(P＞0.05);in the single blastocyst transfer,there were no significant differences in pregnancy outcomes and obstetric indicators between the early cleavage group and the non-early cleavage group(P＞0.05).Multivariate Logistic regression analysis showed that after adjusting for confounding factors on pregnancy outcomes,in the single cleavage embryo transfer,the hCG positive rate(aOR 1.54,95％CI 1.12-2.11,P=0.008),clinical preg-nancy rate(aOR 1.49,95％CI 1.09-2.04,P=0.012),and live birth rate(aOR 1.53,95％CI 1.12-2.09,P=0.008)in the early cleavage group were significantly higher than those in the non-early cleavage group;in the sin-gle blastocyst transfer,there were no significant differences for these indicators between the early cleavage group and the non-early cleavage group(P＞0.05).Conclusions:Transplantation of single cleavage embryo with nor-mal early cleavage can significantly improve the clinical pregnancy rate and live birth rate.Early cleavage during single blastocyst transplantation had no significant effect on clinical pregnancy outcome.Early cleavage had no significant effect on the obstetric outcomes of single cleavage embryo and single blastocyst transfer.

Objective To explore the effect of ionizing radiation on the fertility of male mice and its offspring and the intergenerational and transgenerational genetic effect mechanism of ionizing radiation through sperm DNA methylation sequencing.Methods Eight-week-old(8 w)C57BL/6 male mice were irradiated with 60Co radiation source at a dose of 3 Gy(3 Gy-F0 group,n=60)and non-irradiated mice of the same age were used as controls(0 Gy-F0 group,n=60).Afetr 5-,6-,7-,8-,9-,10-,11-,and 12-week radiation,the mice began to breed with healthy females,and the first generation(F1 generation)male mice then breed with healthy female mice to obtain the offspring(F2 generation)male mice.The structure of testis was detected by hematoxylin-eosin staining;serum follicle-stimulating hormone(FSH),testosterone(T)and luteinizing hormone(LH)levels were determined by enzyme-linked immunosorbent assay.Automatic sperm analysis system was used to detect sperm concentration and activity.The DNA of F0 generation sperm was extracted and analyzed by genome-wide DNA methylation sequencing.MassARRAY methylation sites were detected in sperm DNA of F1 generation mice and verified by quantitative polymerase chain reaction(qPCR).Results Compared with the 0 Gy-F0 group,male mice in the 3 Gy-F0 group gradually regained their reproductive ability 7 weeks after ionizing radiation.There was no significant difference in the number of surviving offspring between the 3 Gy-F0 group and 0 Gy-F0 group 10-11 weeks after radiation(P＞0.05).There were no significant differences in body weight,testicular morphology,or sperm concentration of F1 generation mice between the 3 Gy-F1 group and the 0 Gy-F1 group(all P＞0.05).However,compared with the 0 Gy-F1 group,the contents of LH,FSH and T in the 3 Gy-F1 group were all decreased(all P＜0.05),the testicle volume,total sperm motility rate,forward motility rate and the fertility were considerably decreased(all P＜0.05).DNA methylation sequencing showed that more differentially methylated genes were enriched in the pathway regulating microtubule formation.MassARRAY methylation sites analysis showed that the methylation level of Mid1 was significantly increased(P＜0.05 or P＜0.01).Mid1 was verified down-regulated in Fl and F0 sperm by qPCR(P＜0.05 or P＜0.01).However,there were no significant differences in volume of testes,testicular index,sperm concentration,sperm motility,hormone levels or Mid1 expression level between 0 Gy-F2 and 3 Gy-F2 mice in F2 generation male mice(all P＞0.05).Conclusion Sperm damage in mice caused by ionizing radiation at a dose of 3 Gy can recover by itself.However,it may decrease sperm activity by regulating Mid1 methylation level of sperm in F1 mice,thus affect the fertility of F1 mice,but has no effect on the fertility of male F2 mice.

Objective To investigate the effect and mechanisms of celecoxib on right heart function in mice with acute high-altitude hypoxia exposure.Methods Male C57BL/6J mice(7 weeks old)were housed in a hypobaric chamber simulating an altitude of 5 800 m for 2 d to establish an animal model of acute hypobaric hypoxia.①Eighteen mice were randomly assigned to plain+saline(P+S),high-altitude hypoxia exposure+saline(H+S),and high-altitude hypoxia exposure+celecoxib(H+Cel).Body weight and routine blood indicators were measured,and cardiac ultrasound examination were performed for heart rate(HR),pulmonary artery acceleration time to ejection time ratio(AT/ET),tricuspid annular plane systolic excursion(TAPSE),tricuspid annular systolic velocity(S'),and left ventricular ejection fraction(LVEF)and fractional shortening(FS).Targeted metabolomic profiling was applied to detect the cardiac arachidonic acid(AA)metabolite levels.The contents of 12,13-dihydroxy-9Z-octadecenoic acid(12,13-diHOME)in the heart,liver,brown adipose tissue,and plasma were quantified by ELISA.② Eighteen mice were randomly assigned into plain+saline(P+S),high-altitude hypoxia exposure+saline(H+S)and high-altitude hypoxia exposure+12,13-diHOME(H+di)groups.Body weight,routine blood tests,and echocardiography were performed as above.③ Thirty-two mice were randomly divided into high-altitude hypoxia exposure+saline(H+S),high-altitude hypoxia exposure+celecoxib(H+Cel),high-altitude hypoxia exposure+soluble epoxide hydrolase inhibitor(sEHI)(H+sEHI),and high-altitude hypoxia exposure+sEHI+celecoxib(H+sEHI+Cel)groups.Body weight,routine blood tests,and echocardiography were performed as above.Cardiac and plasma contents of 12,13-diHOME and epoxyeicosatrienoic acids(EETs)were measured by ELISA.Results ① Compared to the P+S group,the H+S group exhibited significantly reduction of cardiac 12,13-diHOME level(P<0.001),increased counts of white blood cells(WBC)and neutrophils(P<0.01)and decreased TAPSE,S'and AT/ET both at resting state and under stress(P<0.01,P<0.001).Compared to the H+S group,the H+Cel group exhibited significantly increase of cardiac 12,13-diHOME level(P<0.05),reduced WBC and lymphocyte counts(P<0.01,P<0.05)and improved TAPSE and S'levels at resting state and under stress(P<0.01,P<0.001).② Compared to the H+S group,the H+di group demonstrated significantly improvement of TAPSE at basal and under stress(P<0.001)and a trend towards improved TAPSE at resting state(P=0.0532),but no obvious differences was observed in WBC and neutrophil counts between the H+di group and the H+S group.③ Compared to the H+Cel group,both the H+sEHI and H+sEHI+Cel groups exhibited significantly reduction of cardiac 12,13-diHOME level(P<0.01,P<0.05)though no statistical changes in cardiac function indicators.Compared to the H+S group,WBC counts and lymphocyte were decreased,and serum EETs level was incrased in the H+Cel group,H+sEHI group and H+sEHI+Cel group(P<0.01,P<0.001).Conclusion Celecoxib can elevate cardiac level of 12,13-diHOME and improves right heart function in mice after acute high-altitude hypoxia exposure through the CYP450-sEH metabolic pathway.

Objective To explore the clinical efficacy of ultra-micro 8.0 mm single-port thoracoscopic nerve resection through areola incision in the treatment of primary palmar hyperhidrosis(PPH).Methods 84 patients with PPH from January 2018 to January 2022,were divided into the observed group[(inframammary approach,IMA)group,n=42]and control group[axillary approach(AA)group,n=42].The observed group was treated with ultra-micro 8.0 mm IMA single-port endoscopic thoracic sympathectomy(ETS),the control group used the traditional AA single-port ETS.The visual analogue scale(VAS)score,serum C-reactive protein(CRP),cortisol(Cor),interleukin-6(IL-6)levels,the postoperative cosmetic effect and compensatory hyperhidrosis of the two groups were compared.Results The VAS scores of 2,12 and 24 h after surgery in the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);At 12 and 24 h postoperation,the levels of CPR,Cor,and IL-6 levels in both groups of patients were significantly higher than preoperation,but those in the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);The total satisfaction rate of postoperative incision in the observation group was significantly higher than that of the control group,the difference was statistically significant(P<0.05);There was no statistically significant difference of the incidence of compensatory hyperhidrosis between the two groups(P>0.05).Conclusion The clinical efficacy of ultra-micro 8.0 mm IMA single-port ETS through areola incision in the treatment of PPH is good.Compared with the traditional axillary single-port thoracoscopic method,it has the advantages of small trauma,less bleeding,less patient pain,high safety and high patient satisfaction.It is worthy of clinical promotion and application.

Objective To explore the clinical efficacy of ultra-micro 8.0 mm single-port thoracoscopic nerve resection through areola incision in the treatment of primary palmar hyperhidrosis(PPH).Methods 84 patients with PPH from January 2018 to January 2022,were divided into the observed group[(inframammary approach,IMA)group,n=42]and control group[axillary approach(AA)group,n=42].The observed group was treated with ultra-micro 8.0 mm IMA single-port endoscopic thoracic sympathectomy(ETS),the control group used the traditional AA single-port ETS.The visual analogue scale(VAS)score,serum C-reactive protein(CRP),cortisol(Cor),interleukin-6(IL-6)levels,the postoperative cosmetic effect and compensatory hyperhidrosis of the two groups were compared.Results The VAS scores of 2,12 and 24 h after surgery in the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);At 12 and 24 h postoperation,the levels of CPR,Cor,and IL-6 levels in both groups of patients were significantly higher than preoperation,but those in the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05);The total satisfaction rate of postoperative incision in the observation group was significantly higher than that of the control group,the difference was statistically significant(P<0.05);There was no statistically significant difference of the incidence of compensatory hyperhidrosis between the two groups(P>0.05).Conclusion The clinical efficacy of ultra-micro 8.0 mm IMA single-port ETS through areola incision in the treatment of PPH is good.Compared with the traditional axillary single-port thoracoscopic method,it has the advantages of small trauma,less bleeding,less patient pain,high safety and high patient satisfaction.It is worthy of clinical promotion and application.

Objective:To investigate the impact of early cleavage on the pregnancy and obstetric outcomes of fresh cycle single cleavage embryo and single blastocyst transfer.Methods:A retrospective study was conducted to analyze 794 patients who underwent single cleavage embryo transfer and 1466 patients who underwent single blastocyst transfer in the reproductive medicine center of our hospital from August 2018 to December 2022 during the fresh cycle treatment of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).The patients were divided into two groups according to whether the transferred embryos underwent normal early cleavage.In the single cleavage embryo transfer,there were 383 cases in the normal early cleavage group(early cleavage group)and 411 cases in the non normal early cleavage group(non-early cleavage group);in the single blastocyst transfer,there were 815 cases in the early cleavage group and 651 cases in the non-early cleavage group.The pregnancy and obstetric outcomes of the early cleavage group and non-early cleavage group were compared in single cleavage embryo transfer and single blastocyst transfer.Results:In the single cleavage embryo transfer,the human chorionic gonadotropin(hCG)positive rate,clinical pregnancy rate,and live birth rate in the early cleavage group were significantly higher than those in the non-early cleavage group(64.0％vs.55.7％,P=0.018;54.6％vs.47.0％,P=0.032;46.7％vs.38.7％,P=0.022).There were no significant differ-ences in biochemical abortion rate,multiple pregnancy rate,abortion rate,early abortion rate,premature delivery rate,low birth weight rate,macrosomia rate,and birth defect rate compared with the non-early cleavage group(P＞0.05);in the single blastocyst transfer,there were no significant differences in pregnancy outcomes and obstetric indicators between the early cleavage group and the non-early cleavage group(P＞0.05).Multivariate Logistic regression analysis showed that after adjusting for confounding factors on pregnancy outcomes,in the single cleavage embryo transfer,the hCG positive rate(aOR 1.54,95％CI 1.12-2.11,P=0.008),clinical preg-nancy rate(aOR 1.49,95％CI 1.09-2.04,P=0.012),and live birth rate(aOR 1.53,95％CI 1.12-2.09,P=0.008)in the early cleavage group were significantly higher than those in the non-early cleavage group;in the sin-gle blastocyst transfer,there were no significant differences for these indicators between the early cleavage group and the non-early cleavage group(P＞0.05).Conclusions:Transplantation of single cleavage embryo with nor-mal early cleavage can significantly improve the clinical pregnancy rate and live birth rate.Early cleavage during single blastocyst transplantation had no significant effect on clinical pregnancy outcome.Early cleavage had no significant effect on the obstetric outcomes of single cleavage embryo and single blastocyst transfer.