Objective:To investigate the effects of thoracolumbar vertebral fracture with incomplete spinal cord injury on male sexual function and postoperative prognosis.Methods:A retrospective review was conducted on data from 144 male patients with thoracolumbar vertebral fractures and incomplete spinal cord injuries treated between May 2009 and May 2021 in the Department of Traumatology and Orthopedics at Peking University Third Hospital. Patients ranged in age from 19 to 55 years (mean: 38.6±10.6 years) and underwent posterior incision and reduction internal fixation. The International Index of Erectile Function-5 (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the International Spinal Cord Injury Male Sexual Function Basic Data Set were used for sexual function evaluation. Based on the American Spinal Injury Association (ASIA) Spinal Cord Injury classification, changes in neurological and sexual function were assessed at the pre-injury stage, 3 months post-injury, 2 years postoperatively, and at the final follow-up. Factors influencing sexual dysfunction and recovery were analyzed. Spearman correlation analysis was used to identify factors affecting sexual function injury and recovery.Results:A total of 117 patients were included in the final analysis. Follow-up duration ranged from 26.2 to 161.7 months (mean: 74.6±40.5 months). After injury, ASIA grades were distributed as follows: 43 patients with grade B, 41 with grade C, and 33 with grade D. At the 2-year follow-up, 30 patients were grade E, 63 grade D, 19 grade C, and 5 grade B. Improvement in ASIA classification was observed in 90.6% (106/117) of patients: 79 improved by one grade, 27 by two grades, 8 remained unchanged, 1 worsened by one grade, and 2 worsened by two grades. Mean IIEF-5 scores were 19.5±6.4 pre-injury, 8.7±8.0 at 3 months post-injury, and 17.5±7.1 at 2 years postoperatively, with statistically significant differences ( F=123.247, P<0.001). Differences between 3 months post-injury vs. pre-injury and 2 years postoperatively vs. 3 months post-injury were statistically significant ( P<0.05). Mean PEDT scores were 5.3±3.1 pre-injury, 6.9±5.2 at 3 months post-injury, and 6.4±5.1 at 2 years postoperatively, with statistically significant differences ( F=17.014, P<0.001). The difference between 3 months post-injury and pre-injury was statistically significant ( P<0.05), but not between 2 years postoperatively and 3 months post-injury ( P>0.05). At the 2-year follow-up, 96 patients had their IIEF-5 classification restored to pre-injury levels, 85 restored PEDT classifications, and 83 restored both. Post-injury ASIA classification was positively correlated with a decrease in IIEF-5 score and an increase in PEDT score at 3 months post-injury ( P<0.05). Injury segment was positively correlated with the decrease in IIEF-5 score ( P<0.05). Time from injury to surgery showed a positive correlation with increased PEDT score at 3 months ( P<0.05). Post-injury ASIA grade, injury segment, time to surgery, age, intraoperative decompression, and spinal cord function recovery all showed significant correlations with changes in IIEF-5 and (or) PEDT scores at 2 years postoperatively ( P<0.05). According to the International Spinal Cord Injury Male Sexual Function Basic Data Set, the proportion of patients willing to discuss sexual issues increased from 29.9% at 3 months post-injury to 47.9% at 2 years postoperatively ( P<0.05). The proportion of patients with absent or diminished psychogenic erections remained stable (48.7% vs. 48.9%, P>0.05), while those with normal reflexive erections increased from 34.2% to 65.0% ( P<0.05). Conclusion:Thoracolumbar fractures with incomplete spinal cord injury result in reduced erectile function and increased incidence of premature ejaculation. The degree of spinal cord injury and the level of the injured segment are strongly correlated with the extent of sexual dysfunction. At the 2-year postoperative follow-up, 70.9% of patients had recovered sexual function to pre-injury levels.

Objective:To investigate the effects of thoracolumbar vertebral fracture with incomplete spinal cord injury on male sexual function and postoperative prognosis.Methods:A retrospective review was conducted on data from 144 male patients with thoracolumbar vertebral fractures and incomplete spinal cord injuries treated between May 2009 and May 2021 in the Department of Traumatology and Orthopedics at Peking University Third Hospital. Patients ranged in age from 19 to 55 years (mean: 38.6±10.6 years) and underwent posterior incision and reduction internal fixation. The International Index of Erectile Function-5 (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the International Spinal Cord Injury Male Sexual Function Basic Data Set were used for sexual function evaluation. Based on the American Spinal Injury Association (ASIA) Spinal Cord Injury classification, changes in neurological and sexual function were assessed at the pre-injury stage, 3 months post-injury, 2 years postoperatively, and at the final follow-up. Factors influencing sexual dysfunction and recovery were analyzed. Spearman correlation analysis was used to identify factors affecting sexual function injury and recovery.Results:A total of 117 patients were included in the final analysis. Follow-up duration ranged from 26.2 to 161.7 months (mean: 74.6±40.5 months). After injury, ASIA grades were distributed as follows: 43 patients with grade B, 41 with grade C, and 33 with grade D. At the 2-year follow-up, 30 patients were grade E, 63 grade D, 19 grade C, and 5 grade B. Improvement in ASIA classification was observed in 90.6% (106/117) of patients: 79 improved by one grade, 27 by two grades, 8 remained unchanged, 1 worsened by one grade, and 2 worsened by two grades. Mean IIEF-5 scores were 19.5±6.4 pre-injury, 8.7±8.0 at 3 months post-injury, and 17.5±7.1 at 2 years postoperatively, with statistically significant differences ( F=123.247, P<0.001). Differences between 3 months post-injury vs. pre-injury and 2 years postoperatively vs. 3 months post-injury were statistically significant ( P<0.05). Mean PEDT scores were 5.3±3.1 pre-injury, 6.9±5.2 at 3 months post-injury, and 6.4±5.1 at 2 years postoperatively, with statistically significant differences ( F=17.014, P<0.001). The difference between 3 months post-injury and pre-injury was statistically significant ( P<0.05), but not between 2 years postoperatively and 3 months post-injury ( P>0.05). At the 2-year follow-up, 96 patients had their IIEF-5 classification restored to pre-injury levels, 85 restored PEDT classifications, and 83 restored both. Post-injury ASIA classification was positively correlated with a decrease in IIEF-5 score and an increase in PEDT score at 3 months post-injury ( P<0.05). Injury segment was positively correlated with the decrease in IIEF-5 score ( P<0.05). Time from injury to surgery showed a positive correlation with increased PEDT score at 3 months ( P<0.05). Post-injury ASIA grade, injury segment, time to surgery, age, intraoperative decompression, and spinal cord function recovery all showed significant correlations with changes in IIEF-5 and (or) PEDT scores at 2 years postoperatively ( P<0.05). According to the International Spinal Cord Injury Male Sexual Function Basic Data Set, the proportion of patients willing to discuss sexual issues increased from 29.9% at 3 months post-injury to 47.9% at 2 years postoperatively ( P<0.05). The proportion of patients with absent or diminished psychogenic erections remained stable (48.7% vs. 48.9%, P>0.05), while those with normal reflexive erections increased from 34.2% to 65.0% ( P<0.05). Conclusion:Thoracolumbar fractures with incomplete spinal cord injury result in reduced erectile function and increased incidence of premature ejaculation. The degree of spinal cord injury and the level of the injured segment are strongly correlated with the extent of sexual dysfunction. At the 2-year postoperative follow-up, 70.9% of patients had recovered sexual function to pre-injury levels.

Objective To perform a bibliometric analysis of researches on the Plasmodium falciparum repetitive interspersed families of polypeptides (RIFIN) protein from 1993 to 2022 and identify the hot topics in the RIFIN protein research, so as to provide insights into future researches on RIFIN protein. Methods RIFIN protein-associated publications were retrieved in the Web of Science Core Collection from 1993 to 2022 and all bibliometric analyses were performed using the software CiteSpace 6.2.4.0. The annual number of RIFIN protein-associated publications was analyzed from 1993 to 2022, and country, author and institution collaboration networks were created. Keywords were extracted from RIFIN protein-associated publications for plotting keyword co-occurrence, clustering, burst and timeline maps to identify the hot topics in the RIFIN protein research. Results A total of 745 English RIFIN protein-associated publications were included in the final bibliometric analysis, and there were 18 to 36 publications each year from 1993 to 2022. The top three countries with the highest activity in the RIFIN protein research included the United States, the United Kingdom and France, universities and research institutes were highly active in the RIFIN protein research; however, no authors were identified with a high activity in the RIFIN protein research. There were three keyword clusters in the RIFIN protein-associated publications, including repetitive DNA sequence, molecular epidemiology and antigenic variation. Keyword co-occurrence, burst and timeline analyses showed that previous RIFIN protein-associated publications mainly focused on gene properties and functions, involving keywords of repetitive DNA sequence and evolution, and recent hot topics for the RIFIN protein research shifted to genetic diversity and immune response, involving keywords of genetic diversity, antigenic variation and binding. Conclusions The annual number of RIFIN protein-associated publications was relatively stable from 1993 to 2022. This bibliometric analysis may provide insights into future researches on the RIFIN protein.

Objective To investigate the expression and clinical significance of circular RNA(circRNA)051778 in lung adenocarcinoma-malignant pleural effusion(LA-MPE)and tuberculous pleural effusion(TPE).Methods This is a cross-sectional study.A total of 212 patients were recruited from the Jiangxi Chest Hospital between October 2018 and September 2019,and their pleural effusion samples and/or plasma samples were collected.The exosomal circRNA profile was sketched by circRNA microarray.Differentially expressed circRNAs(DECs)were verified by droplet digital PCR.In addition,a putative circRNA-miRNA-mRNA network was constructed,and Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway analyses were performed to predict the functions of the DECs.The diagnostic value of circRNA_051778 was evaluated by binary logistic regression and receiver operating characteristic curve.Results The expression level of circRNA_051778 in the LA-MPE samples was(3.92±0.48)copies/100 ng cDNA,while that in the TPE samples was(21.53±2.22)copies/100 ng cDNA.Compared to that in the TPE samples,circRNA_051778 was significantly downregulated in the LA-MPE samples(P＜0.001).The potential targets of circRNA_051778 were enriched in positive regulation of GTPase activity,cytoplasm,protein binding,and cancer-related pathways.The area under the curve(AUC)for the combined assessment of circRNA_051778 with liquid-based thin-layer cytology(TCT),erythrocyte sedimentation rate(ESR),and tuberculosis antibody(TBA)was 0.98(95％confidence interval:0.97-1.00),with the sensitivity being 88.0％and the specificity being 100.0％.Conclusion Exosomal circRNA_051778 is downregulated in LA-MPE.According to the findings from the GO and KEGG analyses,exosomal circRNA_051778 may play a role in cancer development and has the potential to serve as a marker for differential diagnostic of LA-MPE and TPE when it is used in combination with TCT,ESR,and TBA.

Objective To compare the efficacy of anterior-posterior and posterior-anterior screw fixation for posterior malleolar fractures surgery.Methods A retrospective analysis of 376 cases of posterior malleolar fractures treated with lag screws from January 2011 to October 2022 with more than 12 months of follow-up period was conducted.The patients were divided into two subgroups based on the thickness of the fracture fragment,with 167 cases in the small fracture subgroup having a fracture fragment thickness＜17 mm(screw thread length)and 209 cases in the large fracture subgroup having a fracture fragment thickness ≥ 17 mm.Each subgroup was further divided into anterior-posterior and posterior-anterior groups based on the direction of screw fixation in the posterior malleolar fracture surgery.In the small fracture subgroups,there were 74 cases in the anterior-posterior group and 93 cases in the posterior-anterior group.In the large fracture subgroup,there were 88 cases in the anterior-posterior group and 121 cases in the posterior-anterior group.The American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score was measured at the last follow-up.The displacement of the fracture fragment in the direction of the fracture line(Dn)and perpendicular to the fracture line(Dt)were measured on the first day after surgery and at the last follow-up,and the displacement of the fracture fragment was calculated,which was the difference between Dn+Dt at the last follow-up and Dn+Dt on the first day after surgery.Results On the first day after surgery,X-ray showed no significant difference in Dn and Dt between the anterior-posterior and posterior-anterior groups in both of the small and large fracture subgroups(P＞0.05).The entire group was followed up for 12-85 months,with an average of 19.3 months.In the small fracture subgroup,the displacement of the fracture fragment in the posterior-anterior group[(0.11±0.19)mm]was superior to that in the anterior-posterior group[(0.19±0.21)mm;P=0.011],and the AOFAS score was also superior to that in the anterior-posterior group[(80.2±8.4)points vs.(76.2±8.6)points,P=0.003].In the large fracture subgroup,there was no significant difference in fracture displacement between the posterior-anterior group[(0.11±0.18)mm]and the anterior-posterior group[(0.12±0.19)mm;P=0.630],and there was also no significant difference in AOFAS scores[(84.1±7.8)points vs.(82.8±7.6)points,P=0.246].Conclusions There is no significant difference in the reduction effect between anterior-posterior and posterior-anterior lag screw internal fixation for posterior malleolar fractures in trimalleolar fractures.For patients with fracture thickness＜17 mm,posterior-anterior fixation is superior to anterior-posterior fixation;for patients with fracture thickness ≥17 mm,there is no significant difference in the efficacy between anterior-posterior and posterior-anterior fixation.

Objective:To evaluate of the general practice residency training bases in Hebei Province.Methods:Based on the 2020 Standardized Residency Training Base Evaluation Index-General Practitioners of Chinese Medical Doctor Association,24 training bases in Hebei Province were assessed;and the satisfaction questionnaire survey and in-depth interview were conducted among 124 general practice trainees who were randomly selected in November 2020. Results:All 24 bases set the general practice department in the hospitals as required. However, the annual outpatient visits in department of general practice were less than 20000 in 45.83% (11/24) bases, only 41.67% (10/24) bases met the teaching requirements of general practice, and 33.33% (8/24) bases fulfilled the provincial target for general practice residency training enrollment; only 3 bases (13.64%) had the pass rate≥85% in medical licensing examination in the previous year. For the training satisfaction, 66.94% (83/124) trainees were satisfied with residency training, and 33.06% (41/124) were moderately satisfied. There was significantly difference in the satisfaction degrees among trainees with different expectations of career prospects (χ 2=24.436, P<0.05). Conclusions:Basically, the management system of general practice residency training bases has been completed and the construction of teaching teams has been standardized in Hebei Province. But the job attraction of general practitioner is inadequate, the training bases need to be strengthened, and the training quality needs to be improved.

Objective:To analyze the current status of faculty development in general practice residency training bases in Hebei Province.Methods:A questionnaire survey with deep interview was conducted among 79 faculty from 24 general practice residency training bases in Hebei Province during November to December 2020.Results:Among 79 participants, 21 were males (26.58%) and 58 were females (73.42%), 41 (51.90%) of whom were aged 31-40 years; 44 (55.70%) were general practitioners, and 35 (44.30%) were specialists. There were no significant differences in sex, age, education background, professional title, between faculty with general practice background and specialist background (all P>0.05); while there were significant differences in job-transfer training, teaching training for general practice, the training form, teaching method grasped, understanding the work contents of general practice, the view and prospect for general practice between general practitioner faculty and specialist faculty (all P<0.05). The score of ward round teaching of general practice faculty was significantly higher than that of specialist faculty ( P<0.05) The interview showed that all faculty members were willing to teach, most of them had increased work pressure after engagement in teaching, and there was lack of incentive policies for teaching in some bases. Conclusions:The current status of faculty development in the general practice residency training base in Hebei Province is basically satisfactory, but there is lack of general practice training for faculty with specialist background; the professional identity of general practitioner need to be enhanced, and their status and treatment need to be improved.

Objective:To compare the short-term outcomes of femoral neck system (FNS) and dynamic hip screw (DHS) in the treatment of femoral neck fractures.Methods:A retrospective analysis was performed of the 105 patients with fresh femoral neck fracture who had been treated by FNS fixation from September 2019 to October 2020 or by DHS fixation from January 2018 to October 2020 at Department of Orthopaedics, The Third Hospital Affiliated to Peking University. In the FNS group of 54 cases, there were 18 males and 36 females with a mean age of (60.7±15.2) years; in the DHS group of 51 cases, there were 14 males and 37 females with a mean age of (63.3±13.2) years. The 2 groups were compared in terms of hospital stay, operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy frequency, qualify of reduction, and femoral neck shortening length, Harris hip score and complications at the last follow-up.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data or follow-up time ( P>0.05). In the FNS group, the median operation time [45.0 (40.0, 59.0) min], intraoperative blood loss [30.0 (20.0, 50.0) mL], incision length [4.0 (4.0, 5.0) cm], intraoperative fluoroscopy frequency [10.5 (9.0, 12.0) times] and hospital stay [2.0 (2.0, 4.0) d] were significantly superior to those in the DHS group [72.0 (55.0, 89.0) min, 50.0 (30.0, 50.0) mL, 7.0 (6.0, 8.0) cm, 18.0 (15.0, 19.0) times, and 3.0 (3.0, 6.0) d] (all P<0.05). There were no statistical differences between the 2 groups in quality of reduction, length of femoral neck shortening, failure rate of internal fixation or Harris hip score at the last follow-up ( P>0.05). There were no such surgical complications as deep infection or femoral head necrosis in either of the 2 groups. Conclusions:In the fixation of femoral neck fractures, both FNS and DHS may lead to fine short-term outcomes. However, compared with DHS, FNS exhibits advantages of simplicity, minimal invasion, less surgical trauma and intraoperative fluoroscopy frequency, and reduced operation time and hospital stay.

Treatment of extremity bone defects,especially large segmental ones,is a difficult problem encountered by orthopedic surgeons in the clinic.Despite a variety of treatment techniques available,lack of uniform protocols causes patients to suffer enormous physical and psychological pain during their medical treatment.Now that new materials and new techniques are constantly evolving and patients' requirements for functional and morphological recovery of the injured limb become more demanding,it has become a great challenge for orthopedic surgeons to provide an optimal individualized treatment protocol for each patient.This review intends to help surgeons with brief update information on the research progress in the treatment of extremity bone defects.

Objective: To identify the risk factors for failure of internal fixation with proximal femoral nail antirotation (PFNA) for reverse intertrochanteric hip fractures. Methods: A retrospective study was conducted of the 45 patients with reverse intertrochanteric hip fracture who had been treated with PFNA fixation from January 2006 through January 2018 at the Department of Traumatic Orthopaedics, The Third Affiliated Hospital to Peking University. They were 19 males and 26 females, aged from 19 to 97 years (average, 71.9 years). According to the AO/OTA classification, there were 7 cases of type 31-A3.1, 4 cases of type 31-A3.2 and 34 cases of type 31-A3.3. Fracture healing was judged according to the X-ray at the time of last follow-up. The patients were assigned into a healed group and a failed group. The 2 groups were compared in terms of gender, age, body mass index (BMI), mechanism of injury, AO classification, type of main fracture line, reduction method, reduction quality, status of lateral femoral wall and tip-apex distance. A multivariate logistic regression model was designed to analyse the dependent variable 'implant failure’ with a set of independent variables as risk factors. Results: The 45 patients were followed up for 12 to 62 months (average, 28.4 months). Implant failure was observed in a total of 6 patients (13.3%), 3 of whom had helical blade perforation, 2 main screw breakage, and one cut-out of helical blade. The single factor analysis revealed significant differences in reduction quality and type of main fracture line between the patients with successful fixation and those with failed fixation (P<0.05). The multiple logistic regression analysis identified poor reduction quality (OR=30.809, 95%CI: 1.052~902.298, P=0.047) and a transverse fracture line (OR=25.639, 95%CI: 1.636~401.917, P=0.021) as risk factors for implant failure. Conclusion Poor reduction quality and a transverse fracture line may be predictors of implant failure in reverse intertrochanteric hip fractures treated with PFNA fixation.