Objective: To investigate the characteristics of breakthrough cases of varicella in Haishu District, Ningbo City, Zhejiang Province from 2017 to 2022, so as to provide the evidence for varicella prevention and control. Methods: Information on reported cases of varicella and vaccination in Haishu District from 2017 to 2022 were collected through the China Infectious Disease Reporting Management Information System and the Immunization Program Information Management System of Zhejiang Province. The breakthrough cases who had received 1 or 2 doses of varicella vaccine 42 days before the onset of disease were selected. The distribution of sex, age, region and the interval between onset and last immunization were descriptively analyzed. Results: A total of 1 563 varicella cases were reported from 2017 to 2022. There were 928 breakthrough cases (59.37%), of which 660 cases with 1-dose immunization history (42.23%) and 268 cases with 2-dose immunization history (17.15%). The proportion of 1-dose breakthrough cases in total annual cases showed a decreasing trend (P<0.05) from 2017 to 2022, while there was no significant tendency on the proportion of cases with 2-dose immunization history (P>0.05). There were 392 males (59.39%) and 268 females (40.61%) with 1-dose immunization history. There were 150 males (55.97%) and 118 females (44.03%) with 2-dose immunization history. Breakthrough cases with 1- and 2- dose immunization history had an median age of 13.00 (interquartile range, 4.00) and 9.00 (4.00) years, respectively, and the difference was statistically significant (P<0.05). The regional distribution of the breakthrough cases with 1- and 2- dose immunization history was mainly in the rural-urban fringe, with 319 cases (48.33%) and 137 cases (51.12%), respectively, and the difference was statistically significant (P<0.05). The median interval between onset and last immunization was 12.00 (interquartile range, 3.00) and 4.00 (3.00) years, respectively, and the difference was statistically significant (P<0.05). Conclusions The breakthrough cases of varicella in Haishu District from 2017 to 2022 were mainly cases with 1-dose immunization history, males, and residents in rural-urban fringe. The age was older and the interval between onset and the last immunization was longer in cases with 1-dose immunization history than in cases with 2-dose immunization history.

[Objective] To explore the efficacy and safety of retrograde intrarenal surgery (RIRS) using a flexible negative pressure suction sheath in the treatment of upper urinary tract stones >2 cm in diameter, to provide reference for the diagnosis and treatment of such disease. [Methods] Clinical data of 155 patients who underwent surgery for upper urinary tract stones during Nov.2022 and Nov.2023 at the Second Affiliated Hospital of Shaanxi University of Chinese Medicine were retrospectively analyzed.The patients were divided into 3 groups: percutaneous nephrolithotripsy (PCNL) group (n=54), conventional sheath RIRS group (n=41), and flexible sheath RIRS group (n=60). The general and clinical data of the 3 groups were compared. [Results] The PCNL group had more patients with severe hydronephrosis (22.22% vs. 4.88%, 5.00%, P=0.027) and smaller IPA involving the lower calyx [(36.17±17.6)° vs. (48.57±17.56)°, (47.41±10.82)°, P=0.014] than the conventional sheath RIRS group and flexible sheath RIRS group.Three days after operation, the stone-free rate (SFR) was 90.74%, 53.66% and 78.33% in the PCNL, conventional sheath RIRS, and flexible sheath RIRS groups, respectively (P<0.05). At 1 month postoperatively, the SFR was 92.59%, 73.17%, and 81.67%, with no statistically significant difference between the PCNL and flexible sheath RIRS groups (P>0.05), but was higher than that in the conventional sheath RIRS group (P<0.05). The PCNL group had shorter operation time than the two RIRS groups [(65.22±17.67) min vs. (91.73±20.57) min, (94.38±24.75) min, P<0.001], longer postoperative hospital stay [(5.0(4.0, 7.0) d vs.3.0(2.0, 4.0) d, 3.0(2.0, 4.0) d, P<0.001], greater decrease in hemoglobin level [(18.00±5.78) g/L vs. (5.57±5.16) g/L, (7.42±5.09) g/L, P<0.001], and higher visual analogue scale (VAS) score [(4.83±1.48) min vs. (2.95±1.07) min, (3.05±1.21) min, P<0.001], while there was no difference between the two RIRS groups (P>0.05). The costs were lower in the flexible sheath RIRS group than in the conventional sheath RIRS group but higher than in the PCNL group [(23 311.19±1 341.20)yuan vs.(24 550.49±1 172.51)yuan, (15 351.97±1 101.4)yuan, P<0.001]. The overall incidence of complications was similar among the three groups, but stone street occurred only in the conventional sheath RIRS group. [Conclusion] For the treatment of patients with upper urinary tract stones >2 cm, RIRS has shorter postoperative hospital stay, lower hemoglobin decrease, and lower VAS score compared to PCNL; the early postoperative SFR of flexible sheath RIRS is superior to that of conventional sheath RIRS, and the 1-month SFR is comparable to that of PCNL, with a low incidence of stone street.

Objective:To propose a novel refined subtyping of Neer type Ⅵ proximal humerus fracture-dislocation and explore its clinical application.Methods:A retrospective study was conducted to analyze the data of 36 patients who had been admitted to Department of Orthopaedics, Beijing Friendship Hospital between January 2018 and December 2022 for surgical treatment with proximal humeral internal locking system (PHILOS) for Neer type Ⅵ proximal humerus fracture-dislocation. There were 25 males and 11 females with an age of (46.1±4.7) years. According to the fracture-dislocation and the separation between the humeral head and the stem, the patients with Neer type Ⅵ proximal humerus fracture-dislocation were further subdivided into 3 subtype groups (known as STAB subtypes): subtype-T group (dislocation of the shoulder joint with macro-capitellar fracture, n=14), subtype-A group (proximal humerus fracture-dislocation without separation of the humeral head from the humeral stem, n=12), and subtype-B group (dislocation of the proximal humerus fracture with separation of the humeral head from the humeral stem, n=10). STAB subtyping was performed on the same imaging data from all the patients at admission and 2 weeks later by 4 surgeons with different qualifications. Interobserver and intraobserver agreements of the STAB typing were verified. The operation time, fracture healing time, visual analogue scale (VAS) pain score, Constant-Murley score, and complications were recorded for patients in the 3 subtype groups. Results:The differences in the preoperative general data were not statistically significant between the 3 subtype groups, indicating comparability ( P>0.05). All patients were followed up for (11.2±4.2) months. The inter-observer and intra-observer Kappa values for STAB subtyping were 0.94 and 0.95, respectively. For subtype-T group, subtype-A group, and subtype-B group, respectively, the operation time was (68.9±5.6) min, (90.0±5.2) min, and (113.0±9.2) min; the fracture healing time was (9.0±0.8) weeks, (10.3±1.2) weeks, and (11.8±0.9) weeks; the VAS scores at the last follow-up were 1.0(1.0, 2.0) points, 2.0(1.0, 2.0) points, 2.0(2.0, 3.0) points; the Constant-Murley scores at the last follow-up were (83.6±2.8) points, (74.5±3.0) points, and (62.7±5.5) points. The differences between the 3 subtype groups in the above items were statistically significant ( P<0.05). The overall success rate of closed reduction was 61.1% (22/36). In subtype-T, subtype-A, and subtype-B groups, respectively, the number of patients with successful closed reduction was 13, 7, and 2, while complications occurred in 2, 3, and 6 patients. The differences in closed reduction and complications among the 3 groups were statistically significant ( P<0.05). Conclusions:The STAB subtyping proposed in this study demonstrates strong intra- and inter-group consistency. Because the refined STAB subtyping can reveal differences among all the Neer type Ⅵ proximal humeral fractures and dislocations, it may provide more precise guidance for personalized clinical decision-making.

Purpose/Significance To classify the elderly according to their heterogeneous health status,and to explore the potential categories and influencing factors status,so as to promote the precision of health information services for the elderly.Method/Process Based on the data of the China health and retirement longitudinal study(CHARLS)database in 2018,the elderly are classified according to their health status by the method of latent class analysis,and the main influencing factors are identified by regression analysis.Result/Conclusion The elderly could be divided into 4 categories according to their health status.Age,sex,education level and retirement sta-tus are significant factors affecting the health grouping of the elderly.According to the heterogeneous health characteristics of the elderly,the service optimization strategy should be provided to promote the physical and mental health of the elderly.

Objective:To explore the clinical value of syndecan-1 (SDC1), asymmetric dimethylarginine (ADMA) assessment in the early diagnosis and course monitoring of patients with type 2 diabetic kidney disease (DKD).Methods:This is a cross-sectional study. A total of 232 patients with type 2 diabetes admitted to the Department of Endocrinology of Kailuan General Hospital from December 2020 to December 2021 were included. The general biochemical indexes, SDC1 and ADMA were detected. According to urinary albumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), patients were divided into simple diabetes group (50 cases) and DKD group (182 cases). According to the risk of progression of DKD, the DKD group was further divided into low-progression diabetic nephropathy (LDKD) subgroup (90 cases), medium-progression diabetic nephropathy(MDKD)subgroup (55 cases), and high-progression diabetic nephropathy(HDKD) subgroup (37 cases). Forty healthy people undergoing physical examination during the same period in our hospital were selected as the healthy control group. According to the quartile value of N-acetyl-β-D-glucosaminase/urinary creatinine (NAG/Ucr), the DKD group was divided into Q1- Q4 subgroups, with 45, 45, 46 and 46 cases, respectively. Spearman correlation was used to analyze the correlation between SDC1, ADMA and glomerular and renal tubule injury indexes in DKD patients. Multifactor ordered Logistic regression was used to analyze the influencing factors of the progression risk of DKD and renal tubular injury. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of SDC1 and ADMA for DKD. Results:The levels of systolic blood pressure, diastolic blood pressure, triglyceride (TG), serum creatinine (Scr), uric acid (UA), NAG/Ucr, SDC1 and ADMA in DKD group were higher than those in SDM group and healthy control group (all P<0.05). The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB), and hemoglobin A1c (HbA 1c) in DKD group were higher than those in healthy control group, and the level of high density lipoprotein cholesterol (HDL-C) was lower than that in healthy control group (all P<0.05). The SDC1 level in HDKD subgroup was higher than that in SDM group and LDKD subgroup, and the ADMA level was higher than that in SDM group and lower than that in LDKD subgroup (all P<0.05). SDC1 level in MDKD subgroup was higher than that in SDM group and LDKD subgroup, ADMA level was higher than that in SDM group, but lower than that in LDKD subgroup (all P<0.05).The levels of SDC1 and ADMA in LDKD subgroup were higher than those in SDM group (all P<0.05). The levels of TC, AporB, HbA 1c, Scr, UACR and SDC1 in NAG/Ucr Q4 subgroup were higher than those in Q1 subgroup, the levels of Scr, UACR and SDC1 were higher than those in Q2 subgroup, and the levels of HbA 1c, Scr, UACR and SDC1 in Q3 subgroup were higher than those in Q1 subgroup (all P<0.05). Spearman correlation analysis showed that SDC1 was positively correlated with UACR, NAG/Ucr ( r=0.757, 0.566, all P<0.05),and was negatively correlated with eGFR ( r=-0.337, P<0.05). ADMA was positively correlated with UACR, NAG/Ucr ( r=0.197, 0.142, all P<0.05). Multifactor ordered Logistic regression analysis showed that SDC1, NAG/Ucr and Scr were the independent influencing factors of progression risk in DKD patients ( OR=2.043, 1.067, 1.047, 0.660, 1.394, all P<0.05), while SDC1, HbA 1c and ACR were the independent influencing factors of renal tubule injury in DKD patients ( OR=1.177, 1.193, 1.002,all P<0.05). ROC curve showed that the area under the curve (AUC) of SDC1 for DKD diagnosis was 0.979, the sensitivity was 92.31%, and the specificity was 92.22%, while the AUC of ADMA for DKD diagnosis was 0.745, the sensitivity was 81.32%, and the specificity was 60.00%. The AUC, sensitivity and specificity of the combined diagnosis of DKD were 0.981, 90.66% and 95.66%. Conclusions:SDC1 is an independent risk factor of DKD progression and tubular injury in DKD patients, which can be used to diagnose early DKD and monitor the progression of DKD. ADMA is suitable for early screening of DKD.

Chondroitin sulfate is an important component of extracellular matrix (ECM) in animal and human body. In recent years, chondroitin sulfate has been proven to have potential efficacy in biomedical application and has been widely used in bone regeneration and osteogenesis, especially in craniofacial reconstruction and dental medicine. Research shows that chondroitin sulfate derivatives and chondroitin sulfate composite scaffolds have great potential in promoting osteogenesis and biomineralization. However, due to the variety of chondroitin sulfate and various application forms, study on its mechanism of osteogenic repair is still insufficient. In this paper, biological characteristics, bone regeneration and osteogenesis of chondroitin sulfate, its application in different biomaterial design and future prospect are discussed.

Objective To investigate the effect of genistein on the proliferation,migration and invasion of prostate cancer cells and its molecular mechanism.Methods Prostate cancer LNCaP and CWR22RV1 cells were divided into the control group(conventional culture)and the experimental group(50μmol/L genistein treatment).The effect of genistein on the proliferation of prostate cancer cells were analyzed by MTT assay.The effect of genistein on the migration and invasion of prostate cancer cells were analyzed by cell scratch assay and Transwell assay.The protein levels of epithelial interstital transformation(EMT)intermediate markers E-Cadherin,N-Cadherin,Vimentin,and tumor stem cell markers CD44 and Oct-4 were detected by Western blot assay.Results MTT assay showed that genistein could inhibit the proliferation of prostate cancer cells.The scratch closure rates of LNCaP and CWR22RV1 cells were significantly reduced in the experimental group compared with those in the control group,and the number of cells passing through the Transwell membrane was significantly reduced(P＜0.05).Western blot assay showed that genistein could down-regulate the expression levels of N-Cadherin,Vimentin,CD44 and Oct4 in prostate cancer cells,and up-regulate the expression of E-Cadherin in epithelial cells(P＜0.01).Conclusion Genistein reduces the dryness of prostate cancer cells by inhibiting the EMT process,thus reducing the proliferation,migration and invasion of prostate cancer cells.

With the development of modern economy and society, trauma has become an important global public health problem. Bone trauma is an important part. Whether it is high-energy complex trauma or low-energy osteoporotic fracture, it puts forward higher requirements for the improvement of mortality and long-term quality of life, and brings new challenges to the traumatic orthopedics.The application of new technologies and the development of treatment strategies have further improved the treatment level of traumatic orthopedics. This article will comment on the research progress of related techniques of traumatic orthopedics in recent years.

Objective:To investigate the ultrasound characteristics of benign and malignant endometrial lesions in postmenopausal women terminology.Methods:Patients with endometrial lesions who underwent transvaginal ultrasound examination in Beijing Tiantan Hospital affiliated to Capital Medical University from January 2019 to November 2021 were selected.Pathological diagnosis after surgery was used as the gold standard, and endometrial lesions were divided into a benign group(including endometrial hyperplasia and endometrial polyps)and a malignant group(endometrial cancer)according to surgical pathology results.Endometrial thickness and Doppler flow parameters were compared between the benign group and the malignant group.The chi-square test was used to compare the echogenicity, the presence or absence of cystic areas, the integrity of the endometrial-myometrial junction, the blood flow score, and the blood supply vessels between the benign and malignant groups.A prediction model was established according to the ultrasonic characteristics.Results:A total of 136 participants received surgery at our hospital with definitive pathological diagnoses, including 72 patients in the benign group and 64 patients in the malignant group.Peak systolic velocity(PSV) and end diastolic velocity(EDV) in malignant lesions were higher than those in benign lesions[(28.75±14.66)cm/s vs.(22.94±13.62)cm/s, (14.75±8.10)cm/s vs.(11.56±6.21)cm/s]. The thickness of malignant lesions was significantly greater than that of benign lesions[(19.31±8.97)mm vs.10.14±4.31)mm], and the blood flow resistance index was lower than that of benign lesions(14.75±8.10 vs.11.56±6.21). The differences were statistically significant( t=2.393, 2.597, 7.452, 2.028, all P<0.05). The prediction model was established based on the above ultrasonic characteristics.The area under the ROC curve for ultrasound physicians to diagnose benign and malignant endometrial lesions was 0.905( P<0.001), indicating that the prediction model had high diagnostic value. Conclusions:Both benign and malignant endometrial lesions in postmenopausal women have different ultrasonic characteristics.Malignant lesions tend to have a larger lesion thickness, an interrupted or irregular endometrial-myometrial junction, higher blood flow signal scores, and multiple blood supply patterns.The ultrasonic prediction model has high diagnostic value for benign and malignant endometrial lesions.

Objective:To explore the clinical efficacy and safety of different surgical procedures of Mayo level Ⅳ inferior vena cava tumor thrombus(IVC-TT).Methods:The clinical and pathological data of 36 patients with Mayo level Ⅳ tumor thrombus were collected in three large clinical centers in China, including 18 cases in PLA General Hospital, 7 cases in Nanfang Hospital, and 11 cases in Renji Hospital. There were 25 males and 11 females.The median age was 56.5 years (53-67 years old). The average body mass index was 24.18±2.55 kg/m 2. The average diameter of renal tumors was 8.24±3.25 cm. The average length of inferior vena cava tumor thrombus was 12.89±2.50 cm. Mayo level Ⅳ tumor thrombus were divided into level Ⅳa and level Ⅳb (301 classification) based on the criterion of whether the proximal end of the thrombus has invaded the right atrium. Among them, level Ⅳa patients underwent robot-assisted inferior vena cava thrombectomy without cardiopulmonary bypass(CPB-free group, 6 cases). Level Ⅳb patients underwent robot-assisted inferior vena cava thrombectomy with cardiopulmonary bypass(CPB group, 12 cases) or cardiopulmonary bypass with deep hypothermic circulatory arrest assisted inferior vena cava thrombectomy(CPB/DHCA group, 18 cases). The baseline data of the three groups of patients were comparable. The perioperative results and long-term survival data after surgery were compared with different surgical methods for grade Ⅳcancer thrombosis. Results:All operations were successfully completed. Compared with the CPB group, the CPB-free group had a shorter first portal blocking time[17.5(15-36)min vs. 36.5(12-102)min, P=0.044], less intraoperative bleeding [2 350(1 000-3 000)ml vs. 3 500 (1 500-12 000)ml, P=0.043] and a lower allogeneic blood transfusion [1 250(500-2 000)ml vs. 2 185(700-5 800)ml, P=0.049]. Compared with the CPB/DHCA group, the CPB-free group had an advantage in reducing intraoperative allogeneic blood transfusion [1 250(500-2 000)ml vs. 2 700(1 200-10 000)ml, P=0.003]. There were no significant differences between groups in terms of duration of surgery and postoperative hospital stay. Among the 36 patients in this group, 23(64%) developed major complications (level Ⅲ or above), including 9 (25%) grade Ⅲ, 12 (33%) grade Ⅳ, and 2 (6%) grade Ⅴ. The CPB-free group had a relatively low complication rate of grade Ⅳ or above [ 17% (1/6) vs.42% (5/12) vs.44% (8/18)]. There were no statistical differences in median progression-free survival (16.4 vs.12.3 vs.18.0 months, P=0.695) and overall survival (30.1 vs.30.2 vs.37.7 months, P=0.674) between the groups. Conclusions:Robot-assisted inferior vena cava thrombectomy without cardiopulmonary bypass has the advantages of short ischemia time of organs, less intraoperative bleeding, and low incidence of major complications, which can be used as a safe and feasible surgical strategy for selected level Ⅳ tumor thrombus.