BACKGROUND:Osteosarcoma has a complex pathogenesis and a poor prognosis.While advancements in medical technology have led to some improvements in the 5-year survival rate,substantial progress in its treatment has not yet been achieved. OBJECTIVE:To screen key molecular markers in osteosarcoma,analyze their relationship with osteosarcoma treatment drugs,and explore the potential disease mechanisms of osteosarcoma at the molecular level. METHODS:GSE99671 and GSE284259(miRNA)datasets were obtained from the Gene Expression Omnibus database.Differential gene expression analysis and Weighted Gene Co-expression Network Analysis(WGCNA)on GSE99671 were performed.Functional enrichment analysis was conducted using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes separately for the differentially expressed genes and the module genes with the highest positive correlation to the disease.The intersection of these module genes and differentially expressed genes was taken as key genes.A Protein-Protein Interaction network was constructed,and correlation analysis on the key genes was performed using CytoScape software,and hub genes were identified.Hub genes were externally validated using the GSE28425 dataset and text validation was conducted.The drug sensitivity of hub genes was analyzed using the CellMiner database,with a threshold of absolute value of correlation coefficient|R|>0.3 and P<0.05. RESULTS AND CONCLUSION:(1)Differential gene expression analysis identified 529 differentially expressed genes,comprising 177 upregulated and 352 downregulated genes.WGCNA analysis yielded a total of 592 genes with the highest correlation to osteosarcoma.(2)Gene Ontology enrichment results indicated that the development of osteosarcoma may be associated with extracellular matrix,bone cell differentiation and development,human immune regulation,and collagen synthesis and degradation.Kyoto Encyclopedia of Genes and Genomes enrichment results showed the involvement of pathways such as PI3K-Akt signaling pathway,focal adhesion signaling pathway,and immune response in the onset of osteosarcoma.(3)The intersection analysis revealed a total of 59 key genes.Through Protein-Protein Interaction network analysis,8 hub genes were selected,which were LUM,PLOD1,PLOD2,MMP14,COL11A1,THBS2,LEPRE1,and TGFB1,all of which were upregulated.(4)External validation revealed significantly downregulated miRNAs that regulate the hub genes,with hsa-miR-144-3p and hsa-miR-150-5p showing the most significant downregulation.Text validation results demonstrated that the expression of hub genes was consistent with previous research.(5)Drug sensitivity analysis indicated a negative correlation between the activity of methotrexate,6-mercaptopurine,and pazopanib with the mRNA expression of PLOD1,PLOD2,and MMP14.Moreover,zoledronic acid and lapatinib showed a positive correlation with the mRNA expression of PLOD1,LUM,MMP14,PLOD2,and TGFB1.This suggests that zoledronic acid and lapatinib may be potential therapeutic drugs for osteosarcoma,but further validation is required through additional basic experiments and clinical studies.

AIM: To evaluate the application value of artificial intelligence-assisted systems in diagnosing diabetic retinopathy(DR)by Meta-analysis.METHODS: PubMed, Web of Science, Embase, Cochrane Library, CBM, CNKI, WanFang Data and VIP database were searched to collect relevant literature on the diagnostic value of artificial intelligence-assisted systems for DR from January 2019 to September 2024. The QUADAS-2 tool was used to evaluate the quality of the included studies, and Meta-analysis was performed using Stata 17.0 and Meta Disc 1.4 software.RESULTS: A total of 23 studies were included. The results of Meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio were 0.92(95% CI: 0.89-0.94), 0.94(95% CI: 0.91-0.96), 15.6(95% CI: 10.6-22.9), 0.09(95% CI: 0.07, 0.12), 174(95% CI: 112-271), respectively, and the area under the ROC curve(AUC)was 0.97(95% CI: 0.96-0.98). Meta-regression and subgroup analyses indicated that the heterogeneity of the studies originated from study type, patient type, patient source, and AI algorithm type. Deeks' funnel plot test suggested no significant publication bias(P=0.15), indicating that the results were robust.CONCLUSION: The artificial intelligence-assisted system demonstrates high diagnostic value for DR, and can be widely implemented in the early screening and diagnosis of DR.

Objective To analyze the research status and trend of scarlet fever literature in China, and to provide reference for subsequent research. Methods Three major Chinese databases, CNKI, Wanfang, and VIP, as well as Web of Science English database, were used to search for literature related to scarlet fever from 2000 to 2023. Citespace6.2.R2 software was used to statistically analyze the number of publications, authors, institutions and journals, co-cited literature, keyword clustering, and other literature characteristics of the literature. Results From 2000 to 2023, a total of 1 011 Chinese literature were included in the three major Chinese databases. Since 2011, the number of publications had gradually increased, but in recent years, the number of publications had decreased. The organization with the most publications was the Shenyang Center for Disease Control and Prevention. The cluster analysis of key words mainly formed 9 cluster tags, and the high-frequency keywords mainly included epidemic characteristics, epidemiology, incidence rate, etc. A total of 84 English literature were included in the WOS database, with an overall upward trend in publication volume. The institution with the most publications was the China Center for Disease Control and Prevention, and the most frequently cited journal was ^“LANCET INFECT DIS^”.《Resurgence of scarlet fever in China: a 13-year population-based surveillance study》 was the most cited journal. After keyword cluster analysis, 9 cluster labels were mainly formed, and the keywords were mainly outbreak，Hong Kong, and Group A streptococcus. Conclusion Compared with the English literature, which mainly focuses on spatiotemporal aggregation, etiology and strain resistance, Chinese literature focuses more on epidemic surveillance, clinical features and quality nursing.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Objective To approach the effective treatment for simple bone cyst in adult. Methods Forty-eight cases were divided into two groups by visiting order, 20 cases (steroid group) were treated by prednisolone acetate and 28 cases (open resection and allograft group) were treated by open resection and allograft. The curative effect were contrasted between two groups. Results The follow-up time was 5-46(26.58 ± 10.81) months. Aecording to the Chigira's healing criteria for simple bone cyst, grade Ⅰ , Ⅱ , Ⅲ,V were 1, 2, 10 and 7 cases respectively in steroid group, contrasting to 0, 3, 5 and 20 cases respectively in open resection and allograft group. The recovery rate was 85.0%(17/20) in steroid group and 89.3%(25/28) in open resection and allograft group, which was no statistically significant difference between two groups (P＞0.05). Conclusions Although the two remedies are no obvious difference in curative effect,simple bone cyst at lower extremity of weight-bearing with obvious osteolysis in adult is recommended to open resection and allograft, otherwise or at upper extremity to steroid injection.

OBJECTIVE:To evaluate the feasibility and initial outcome of reconstructing the defect femur by unicondylar osteoarticular altograft after resection of distal femur tumor.METHODS:Between July 2003 and August 2008,a total of 12 patients with distal femur tumor treated by unicondylar resection and fresh-frozen unicondylar osteoarticular allograft reconstruction of bone defects were retrospectively reviewed at the Department of Orthopedics,General Hospital of Chinese PLA.Of 12 patients,5 medial and 7 lateral femoral condyles were involved.There are 8 patients suffering from giant cell tumor,including 2 patients complicating with pathologic fracture,3patients suffering from osteosamoma and 1 patient suffering from low-grade fibrosarcoma.Before transplantation,MRI and/or CT were used to determine that the tumor was definitely limited in half condyle.Three cycles of chemotherapy preoperatively and six cycles of chemotherapy postoperatively were conducted in patients suffering from osteosarcoma and fibrosarcoma.Patients with giant cell tumor did not receive any intraoperative adjuvant treatment.The surgical margin of resected tumors was evaluated by histological examination.All patients were followed by radiograph or CT.Postoperative function was evaluated by Musculoskeletal Tumor Society (MSTS) scoring system at the time of the latest follow-up.RESULTS:All patients were followed up.The patients were followed up mean 35 months after transplantation.None of the patient died.No local recurrences and metastases were found at the latest follow-up.No evident immune rejection and deep infection were seen.No plate loosening or breakage was observed.All patients had their grafts retained at the time of the latest follow-up.Three patient's allograft showed subchondral bone collapse and articular deterioration,but the function was good.Instability of the knee joint was noted in 3 patients.The mean MSTS functional score (totally 30 points) was 26 points.CONCLUSION:For some patients with giant cell tumor or malignant tumors with clearly defined margins after chemotherapy.When the lesions were limited in half condyle and enough surgical margins can be achieved,reconstruction of bone defect with unicondylar osteoarticular allografts after bone tumors were resected appears to be a reliable alternative.

Objective To analyze indications,complications and outcomes of amputation.Methods A total of 15 patients undergone amputation in field or at tent hospital were collected for analy-zing injury severity,place where amputation was done,whether open or closed amputation and stitch re-moval time. Results There were 9 males and 6 females.at an average age of 32 years(11-51years).There were 16 amputations including Gustilo IIIB in 2 patients, Gustilo IIIC in 9 and Tscheme Ⅲin 5 according to Gustiln classification or Tscheme classification.Four patients who received amputation in field or at tent hospital developed infection and had to receive amputation again at a higher level on the limb and drainage of open wounds because of a higher infection rate due to the amputation location.Ten patients received first amputation at higher levels with open wound at station hospital but only 2 manifested infected incision.High level amputation with one stage closure was done in 1 patient who was infected and suppurated after operation and even developed bacteremia. Conclusions Infection rate following am-putation 4n field and tent clinics is rather higher,so secondary open amputations should be performed at a higher level as soon as possible.One-time and high-level open amputation plays an important role in treat-ment of severe lower limb injuries following earthquake.

Objective To discuss the curative effect of arthroscopiclly assisted radiofrequency tenotomy of the sternocleidomastoid muscle for the treatment of congenital muscular torticollis in teenagers. Methods A total of 12 patients (right, 4 patients; left, 8 patients) were enrolled in the study. A 3-mm skin incision was made at the site 5 cm below the sternoclavicular joint. A dissector was inserted through the incision to perform blunt dissection subcutaneously until the attachment points of the sternocleidomastoid muscle. After a subcutaneous operative space 3 cm ? 3 cm in size was created, a 30? wide-angle arthroscope was placed. Another incision was located at the site 5 cm below the mid-clavicle for placing the bipolar radiofrequency probes (Arthrocare 2000). Under the assistance of arthroscopy, the sternocleidomastoid muscle was severed from the attachment at the both sides. Results The operation time was 15~30 min (mean, 20 min). No intraoperative hemorrhage or vascular and nervous injuries were observed. Follow-up for 5~10 months (mean, 7 months) in the 12 patients found normal appearance and no recurrence or diplopia. Conclusions Arthroscopiclly assisted radiofrequncy therapy for congenital muscular torticollis is characterized by simplicity of manipulation, micro-invasion, and satisfactory curative effect.

The influence of Cibotium barometz (L.) J. Sm. and its processed samples on thrombin-induced platelet aggregation in rabbits was studied. The results showed that all differently processed sam-ples tested could inhibit platelet aggregation, with activities in the decreasing order of Rhizoma Cibotiiroasted in stirring sand＞steamed after being salted＞steamed after steeped in wine＞simply steamed＞theunprocessed crude Rhizoma Cibotii.