Objective:To compare the therapeutic efficacy between femoral neck system (FNS) and cannulated compression screws (CCS) in the fixation of femoral neck fractures in the elderly patients aged 65 to 75 years old.Methods:A retrospective study was conducted to analyze the data of 39 patients aged 65 to 75 years old who had been treated for femoral neck fractures at Department of Trauma Surgery, Hospital Affiliated to Qingdao University from January 2015 to September 2022. The patients were divided into 2 groups according to their internal fixation methods. In the FNS group of 18 cases subjected to FNS fixation, there were 8 male and 10 females with an age of (71.1±2.8) years. In the CCS group of 21 cases subjected to CCS fixation, there were 7 males and 14 females with an age of (70.1±2.9) years. The 2 groups were compared in terms of intraoperative fluoroscopy frequency, surgical time, intraoperative bleeding, hospitalization costs, fracture healing time, internal fixation failure, and Harris hip score, changes in neck shaft angle, and femoral neck shortening at 1 year after surgery.Results:The differences were not statistically significant in the preoperative general data or follow-up time between the 2 groups, indicating comparability ( P>0.05). In the FNS group, the intraoperative fluoroscopy frequency [(15.1±2.3) times] was significantly lower than that in the CCS group [(19.5±3.5) times], the surgical time [(49.2±5.2) minutes] was significantly shorter than that in CCS group [(62.4±11.2) minutes], and the intraoperative bleeding [(74.2±15.6) mL] and hospitalization costs [(39,928.7±1,438.3) yuan] were significantly higher than those in the CCS group [(53.1±17.3) mL and (23,527.9±2,126.3) yuan] (all P<0.05). The difference in fracture healing time was not statistically significant between the 2 groups ( P>0.05). In the FNS group, the decreased neck shaft angle (2.65°±1.66°) and femoral neck shortening (3.9±1.3 mm) were significantly smaller than those in the CCS group [4.18°±2.13° and (6.3±2.5) mm] at 1 year after surgery, and the Harris hip score [(82.2±7.2) points] was significantly higher than that in the CCS group [(76.4±5.9) points] (all P<0.05). Internal fixation failure occurred in 1 case in the FNS group and in 4 cases in the CCS group, respectively, showing no statistically significant difference ( P>0.05). Conclusions:Compared with CCS fixation, FNS fixation may lead to better therapeutic efficacy in patients with femoral neck fracture aged 65 to 75 years old. However, the risk of internal fixation failure should also be taken into consideration.

Objective To investigate the effects of eicosanoic acid(C20DC)on the proliferation and migration of human retinal endothelial cells(HRECs)and its mechanism.Methods The optimal working concentration of C20DC in human retinal pigment epithelium 19(ARPE-19)cells and HRECs was determined as 30 mg·L-1 and 25 mg·L-1,respec-tively.HRECs were divided into the C20DC treatment group(HRECs treated with C20DC)and the control group[HRECs treated with dimethyl sulfoxide(DMSO)].The effects of C20DC on the migration and proliferation of HRECs were detec-ted by cell proliferation and migration experiments.The molecular docking method was used to simulate the binding ability of C20DC to peroxisome proliferator-activated receptor δ(PPARδ).ARPE-19 cells were divided into the C20DC+ARPE-19 group(ARPE-19 cells treated with C20DC)and the DMSO+ARPE-19 group(ARPE-19 cells treated with DMSO).The ex-pression levels of PPARδ and angiopoietin-like protein 4(ANGPTL4)in ARPE-19 cells and ANGPTL4 protein in HRECs were detected using Western blot.The ANGPTL4 protein expression levels in ARPE-19 cells and HRECs were quantitatively analyzed using enzyme-linked immunosorbent assay(ELISA).Results Compared with the control group,the prolifera-tion and migration of cells in the C20DC treatment group significantly increased(both P＜0.05),and C20DC could stably bind to PPAR8(binding energy:-7.20 kcal·mol-1).Western blot showed that the expression level of ANGPTL4 protein in the C20DC+ARPE-19 group was higher than that in the DMSO+ARPE-19 group,and the difference was statistically sig-nificant(P＜0.05);there was no statistically significant difference in the expression level of PPARδ receptor protein be-tween the two groups(P＞0.05).The expression level of ANGPTL4 protein in the C20DC treatment group was higher than that in the control group,and the difference was statistically significant(P＜0.05).ELISA quantitative analysis showed that the expression level of ANGPTL4 in the C20DC+ARPE-19 group was higher than that in the DMSO+ARPE-19 group(P＜0.001);the expression level of ANGPTL4 in the C20DC treatment group was higher than that in the control group,and the difference was statistically significant(P＜0.05).Conclusion C20DC can promote the expression of ANGPTL4 pro-tein by binding to PPARδ and thus increase the proliferation and migration of retinal related cells(HRECs and ARPE-19 cells).Its mechanism may be related to the increased angiogenesis in retinopathy of prematurity.

Objective:To explore the effect of ultrasound-guided superficial cervical plexus block on chronic pain after intracranial space-occupying resection by suboccipital retrosigmoid approach.Methods:A single-center, randomized, double-blind, parallel controlled trial was conducted on 106 consecutive patients who underwent selective resection of acoustic neuromas in the cerebellopontine angle through the suboccipital retrosigmoid approach in Beijing Tiantan Hospital, Capital Medical University from November 2019 to April 2021. The patients were divided into experimental group and control group by random number table method, with 53 cases in each group. The patients in experimental group underwent superficial cervical plexus block with 0.5% ropivacaine under ultrasound-guided, and the patients in control group received an equal volume of 0.9% sodium chloride. Three months after surgery, the patients were followed up for chronic postoperative pain and the chronic postoperative pain rating scale (NRS) score via telephone. The nature of chronic pain was evaluated using the short-form McGill pain questionnaire-2 (SF-MPQ-2).Results:The incidence of chronic postoperative pain and the NRS score of chronic postoperative pain in experimental group were slightly lower than those in control group: 39.6% (21/53) vs. 50.9% (27/53) and 0 (0, 2) scores vs. 1 (0, 3) scores, but there were no statistical difference between the two groups ( P>0.05). There were no statistical difference in SF-MPQ-2 various scores and total score after surgery between the two groups ( P>0.05). Conclusions:Ultrasound-guided superficial cervical plexus block has a certain analgesic effect on chronic pain after intracranial space-occupying resection by suboccipital retrosigmoid approach, but it still requires further verification through an adequate sample size.

Establishing a comprehensive mechanism for the initiation and review of investigator-initiated trial(IIT) plays an important role in ensuring the scientific validity of clinical research and improving research quality.Since 2021, Zhongshan Hospital affiliated to Fudan University had actively explored improvements in the project management of IIT. The hospital had established a standardized grading review management process, developed an integrated clinical research management system, established a three-level clinical research training system, built a methodological support platform, and formulated research plan templates, gradually formed a standardized grading project approval review management mode. As of February 2024, the hospital had completed 400 quick reviews and more than 400 expert letter reviews based on the integrated clinical research management system. The efficiency and quality of IIT project approval had been improved. At the same time, over 40 academic salons and forums had been held, cultivating a group of young clinical research talents, providing data management training for more than 30 clinical departments, and promoting the improvement of the quality of research protocol. In the future, hospitals should further optimize their information systems, expand the influence of their training systems, enhance the capabilities of their methodological support platforms, and improve the efficiency of the application of clinical research protocol templates, so as to escort the establishment and implementation of high-quality clinical research projects and provide references for other hospitals′ IIT project management.

Objective:To evaluate the clinical outcomes of internal fixation using double reverse traction reducers in the treatment of tibial plateau fractures.Methods:This study retrospectively examined the medical records of 48 patients who underwent surgical intervention for tibial plateau fractures at the Affiliated Hospital of Qingdao University between January 2021 and September 2022. The cohort, aged between 35 to 68 years (mean: 53.0±7.9 years), included 23 males and 25 females. Fractures were classified according to the Schatzker system, with 9 type III, 23 type IV, 11 type V, and 5 type VI fractures recorded. Patients were divided into two groups based on the surgical approach: the minimally invasive group underwent treatment with double reverse traction reducers for reduction and internal fixation in 24 cases, while the open group received conventional open reduction and internal fixation in 24 cases. Comparative parameters included operation duration, intraoperative blood loss, hospital stay, early postoperative knee mobility, and weight-bearing timelines. Postoperative radiographic images were appraised using the Rasmussen imaging score, and knee functionality was assessed at the final follow-up with the Hospital for Special Surgery (HSS) score and the International Knee Documentation Committee (IKDC) score.Results:The preoperative general data were statistically indifferent between groups ( P>0.05). All patients were followed for 13.5±4.3 months (range, 9.5-24 months). In the minimally invasive group, operative time was 88.96±19.04 minutes, intraoperative blood loss was 65±32 ml, and hospital stay was 11.8±3.9 days. Early postoperative knee joint activity commenced at 8.96±2.84 days, significantly earlier compared to the open group, which recorded 178.63±67.75 minutes of surgery, 114.16±65.05 ml blood loss, a 15.3±4.8 days hospital stay, and 16.83±4.09 days to knee joint movement. The difference was statistically significant ( P<0.05). No significant variation was observed in the time to bone healing between the minimally invasive group at 12.6±3.8 weeks and the open group at 13.21±4.98 weeks ( P>0.05). Rasmussen imaging criteria revealed 21 excellent and 3 good outcomes in the minimally invasive group, and 19 excellent and 5 good in the open group, with no statistical significance in the excellent-good rate differentiation ( P>0.05). Bone healing occurred within 3.2±0.8 months (range, 2.5-6.0 months), with 79% (19/24) in the minimally invasive group and 75% (18/24) in the open group achieving healing within 3 months. The open group had one incidence of superficial skin infection, and one patient in the minimally invasive group developed deep vein thrombosis (DVT); no other related complications were documented. Conclusion:Minimally invasive treatment of tibial plateau fractures using double reverse traction reducers offers significant benefits, including reduced surgical time, minimal blood loss, less soft tissue trauma, and enhanced joint function recovery. This approach is particularly advantageous in managing complex tibial plateau fractures compared to traditional open reduction and internal fixation methods.

Objective:To evaluate the relationship of rotator cuff muscle function with shoulder abduction function after posterior superior rotator cuff tear via dynamic biomechanical study.Methods:By using the customized dynamic shoulder biomechanical testing system, seven freshly frozen cadaveric shoulders were used to stimulate shoulder abduction at 90° under four statuses: (1) intact rotator cuff with activation (normal rotator cuff group); (2) posterior superior rotator cuff tear with activation (posterior superior rotator cuff tear with activation group); (3) posterior superior rotator cuff tear with posterior superior rotator cuff deactivation (posterior superior rotator cuff tear with deactivation group); (4) none rotator cuff tissue above the geometric rotation center of the humeral head with deactivation (global tear group). The peak and stable value of middle deltoid force were used to evaluate biomechanical status in different rotator cuff tear conditions during shoulder abduction procedure. The peak subacromial pressure, average subacromial pressure, subacromial contact area, and subacromial force were used to evaluate subacromial pressed conditions under different rotator cuff tear conditions. The peak and stable ratio of glenohumeral contact force/middle deltoid force were used to evaluate shoulder stability under different rotator cuff tear conditions.Results:During dynamic abduction at 90°, the peak and stable value of middle deltoid force were (42.1±8.7)N and (29.9±7.4)N in normal rotator cuff group, (45.7±10.3)N and (30.5±7.2)N in posterior superior rotator cuff tear with activation group, and (48.4±13.4)N and (29.9±4.8)N in posterior superior rotator cuff tear with deactivation group (all P>0.05). But the peak and stable value of middle deltoid force were (69.7±9.7)N and (53.7±8.9)N in global tear group, significantly increased compared with other three groups (all P<0.05). The elevated middle deltoid force increased the subacromial contact pressure between glenohumeral head and acromion. The peak subacromial pressure, average subacromial pressure, subacromial contact area, and subacromial force were (0.40±0.05)MPa, (0.22±0.03)MPa, (7.71±5.09)mm 2, and (1.66±1.06)N respectively in normal rotator cuff group, (0.41±0.05)MPa, (0.26±0.07)MPa, (12.71±11.35)mm 2, and (2.93±2.46)N respectively in posterior superior rotator cuff tear with activation group, and (0.50±0.12)MPa, (0.26±0.07)MPa, (17.29±9.11)mm 2, and (4.09±1.46)N respectively in posterior superior rotator cuff tear with deactivation group (all P>0.05). However, the peak subacromial pressure, average subacromial pressure, subacromial contact area, and subacromial force were (3.64±1.70)MPa, (0.98±0.49)MPa, (47.63±11.91)mm 2, and (45.48±23.86)N respectively in global tear group, significantly higher than those in other three groups (all P<0.05). The peak and stable ratio of glenohumeral contact force/middle deltoid force were 2.24±0.30 and 2.46±0.13 in normal rotator cuff group, 2.21±0.19 and 2.52±0.08 in posterior superior rotator cuff tear with activation group, and 2.03±0.14 and 2.42±0.16 in posterior superior rotator cuff tear with deactivation group (all P>0.05). However, the peak and stable ratio of glenohumeral contact force/middle deltoid force were 1.40±0.14 and 1.52±0.41 in global tear group, significantly higher than those in other three groups (all P<0.05). No significant differences of the above parameters were observed in posterior superior rotator cuff tear with activation group, posterior superior rotator cuff tear with deactivation group and global tear group (all P>0.05). Conclusions:After posterior superior rotator cuff tear, rotator cuff muscle function does not affect the whole abduction function of shoulder. When the size of rotator cuff tear involves the whole superior humeral head rotation center, the normal abduction function of shoulder will be significantly impaired.

Objective : To investigate the prevalence of comorbid chronic obstructive pulmonary disease (COPD) and osteoporosis (OP) and its influencing factors among residents aged 40 years and older in Zhangjiagang City, Jiangsu Province, so as to provide insights into prevention of comorbid COPD and OP. Methods: Permanent residents aged 40 years and older were sampled using a multi-stage stratified cluster random sampling method in Zhangjiagang City in 2019, and their pulmonary functions and bone mineral density were measured. The prevalence of comorbid COPD with OP was estimated. The demographic features, smoking, diet, exercises and physical examinations were collected, and factors affecting the prevalence of comorbid COPD with OP were identified using a logistic regression model. Results: Totally 3 140 subjects were enrolled, including 1 315 men (41.88%) and 1 825 women (58.12%), and a mean age of (62.89±9.13) years. A total of 137 subjects were detected with comorbid COPD and OP, with prevalence of 4.36%. The patients with COPD alone included 19 cases with mild, 133 cases with moderate, 87 cases with severe and 26 cases with very severe COPD, and the patients with comorbid COPD and OP included 10 cases with mild, 56 cases with moderate, 56 cases with severe and 15 cases with very severe COPD. The grade of pulmonary functions was higher in patients with comorbid COPD and OP than in patients with COPD alone (Z=-12.304, P<0.001). Multivariable logistic regression analysis identified ages of 65 years and older (OR=2.703, 95%CI: 1.862-3.923), women (OR=2.897, 95%CI: 1.915-4.384) and physical labor (OR=1.540, 95%CI: 1.083-2.189) as factors affecting the development of comorbid COPD and OP. Conclusion The prevalence of comorbid COPD and OP was 4.36% among residents at ages of 40 years and older in Zhangjiagang City, and moderate and severe degree was the predominant grade of pulmonary functions. The elderly, women and physical labors are at a high risk of developing comorbid COPD and OP.

Objective: To explore the value of an oral squamous cell carcinoma (OSCC) diagnostic model constructed by using principal component analysis (PCA) to analyze a database of differentially expressed genes in OSCC and to provide a reference for clinical diagnosis and treatment. Methods: RNA-seq expression data of OSCC and normal control samples were obtained from The Cancer Genome Atlas (TCGA) database, and then, normalized and differentially expressed genes (DEGs) were identified by R software. DEGs were enriched by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis to identify their main biological characteristics. 70% of DEGs expression data in RNA-seq were randomly selected as the training set and 30% were selected as the test set. Then, the PCA method was applied to analyze the training set data and extract the principal components (PCs) related to the diagnosis of OSCC in order to construct a PCA model. Then, the receiver operating characteristic (ROC) curves of PCA models in the training set and the test set were respectively drawn, and the area under curve (AUC) was calculated to evaluate the accuracy of the PCA model in the diagnosis of OSCC. Results: RNA-seq expression data of OSCC and normal control samples obtained from TCGA database included 330 samples and 32 samples, respectively. Using false discovery rate (FDR) <0.001 and |log2 fold change| (|log2FC|) >4 as the thresholds, a total of 159 downregulated and 248 upregulated DEGs were identified, which were mainly enriched in cellular components such as intermediate fiber and melanosomal membrane, pigment and salivation-related biological processes and mainly involved in salivary secretion and tyrosine metabolism pathways (P.adjust<0.05 and Q<0.05). The DEGs were proposed as tumor markers for OSCC, and PCA analysis of the training set showed that the cumulative ratio of variance of PC1, PC2 and PC3: [including submaxillary gland androgen regulated protein 3B (SMR3B), proline rich 27 (PRR27), histatin 3 (HTN3), statherin (STATH), cystatin D (CST5), BPI fold containing family A member 2 (BPIFA2), proline rich protein Hae Ⅲ subfamily 2 (PRH2), keratin 35(KRT35), histatin 1 (HTN1), amylase alpha 1B (AMY1B)] were 0.873, 0.100 and 0.023, respectively, and the total weight of the three was 0.996. The PCA diagnostic model of OSCC was further constructed by combining the eigenvectors of the above three components. The ROC curves of the training set and test set showed that the AUC values of the PCA model were 0.852 and 0.844, respectively, which were higher than those of other single genes. Conclusion The OSCC diagnostic model based on the expression levels of SMR3B, PRR27, HTN3, STATH, CST5, BPIFA2, PRH2, KRT35, HTN1 and AMY1B constructed with the PCA method and DEGs has a high diagnostic advantage. This study provides a theoretical basis for the early genetic diagnosis of OSCC and the application of the PCA model in clinical diagnosis.

Objective:To investigate the levels of serum pyrolysis-related factors cysteine protease-1 (caspase-1) and interleukin-18 (IL-18) in patients with gestational diabetes mellitus (GDM) and their relationship with insulin resistance (IR) .Methods:A total of 102 GDM patients admitted to Kaifeng Traditional Chinese Medicine Hospital from Apr. 2019 to Mar. 2021 were selected as the GDM group, and 102 healthy pregnant women undergoing obstetric examination in the same period were included as the normal group. The age, gestational week, fasting insulin (FINS) , pre-pregnancy body mass index (BMI) , triglycerides (TG) , fasting blood glucose (FBG) , total cholesterol (TC) , and homeostatic model insulin resistance index (HOMA-IR) and other materials were compared between the GDM group and the normal group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of serum caspase-1 and IL-18; Pearson method was used to analyze the correlation between serum caspase-1 and IL-18 levels and HOMA-IR in GDM patients; Logistic regression method was used to analyze the influencing factors of GDM.Results:The levels of TG [ (2.94±0.99) mmol/L vs (2.09±0.70) mmol/L], FBG [ (5.87±1.94) mmol/L vs (4.90±1.67) mmol/L], TC [ (5.72±1.92) mmol/L vs (5.03±1.68) mmol/L], FINS [ (11.45±3.87) mIU/L vs (6.92±2.34) mIU/L], HOMA-IR [ (3.05±0.78) vs (1.51±0.40) ] and levels serum caspase-1 [ (86.27±28.78) pg/mL vs (40.98±13.54) pg/mL] and IL-18 [ (44.26±14.56) pg/L vs (30.45±10.12) pg/L] in the GDM group were higher than those in the normal group (t=7.080, 3.827, 2.731, 10.116, 17.743, 14.381, 7.866, P<0.05) ; the levels of serum caspase-1 and IL-18 in GDM patients were positively correlated with HOMA-IR ( r=0.518, 0.555, P<0.05) ; FBG, TG, FINS, HOMA-IR, caspase-1, IL-18 were risk factors affecting the occurrence of GDM (95% CI=1.578-3.826, 1.454-3.311, 1.477-3.405, 1.678-4.265, 1.406-3.141, 1.511-3.551, P<0.05) . Conclusions:The levels of serum caspase-1 and IL-18 in patients with GDM are relatively high, which are significantly related to IR. Caspase-1 and IL-18 may be potential targets for the treatment of GDM.

The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.