Objective:To investigate the clinicopathological characteristics of giant cell tumor of bone (GCTB) in children.Methods:A total of 35 cases of GCTB diagnosed at Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiaotong University School from 2016 to 2023 were collected, and a retrospective analysis of clinicopathological features and imaging findings was conducted.Results:Pediatric GCTB accounted for approximately 4.6% of total GCTB cases during the study period. There were 11 males and 24 females. The onset age ranged from 9 to 18 years (mean age 15 years, median age 16 years), with 8 cases (8/35, 22.9%) experiencing postoperative recurrence. Twenty-eight cases (28/35, 80%) primarily affected long bones, while 7 cases involved small or irregular bones. Imaging revealed osteolytic changes as the predominant feature, with 3 cases exhibited open physis, one of which had the tumor primarily at the diaphysis without crossing the physis. Histologically, pediatric GCTB resembled adult cases, characterized by mononuclear cells and osteoclast-like giant cells. Seven cases with denosumab treatment demonstrated degrees of giant cell disappearance, increased fibrous tissue and reactive bone proliferation in the stroma. One case was diagnosed as pediatric multicentric GCTB, and three cases as pediatric primary malignant GCTB, with malignant transformation into osteosarcoma. In all 35 cases, mutations in the H3F3A gene were identified, comprising 32 cases with H3.3 p.G34W mutations, one case with H3.3 p.G34V mutation, and 2 cases with H3.3 p.G34L mutations. Notably, the former two categories were successfully validated at the protein level through immunohistochemical staining, utilizing highly specific antibodies tailored for these mutation types: H3.3 p.G34W antibody and H3.3 p.G34V antibody. However, immunohistochemical staining was not available for the last category.Conclusions:Pediatric GCTB predominantly affects females and occurs primarily in long bones, mainly around the knee joint, the majority of tumors predominantly arise in the epiphysis and extend into the metaphysis; however, in cases where the epiphyseal plates are still unclosed, the tumors may be restricted to the metaphysis. Detection of H3F3A gene mutation is crucial for the diagnosis and differential diagnosis of pediatric GCTB.

Objective:To compare the efficacy and safety of internal fixation using the olecranon osteotomy approach versus the bilateral triceps approach for the treatment of AO type C distal humeral fractures.Methods:We conducted a systematic search of China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Chinese Medical Journal Full-Text Database, PubMed, Embase, Web of Science, and Cochrane Library for clinical studies comparing the olecranon osteotomy approach with the bilateral triceps approach for the treatment of AO type C distal humeral fractures. The search period was from January 2017 to March 2023. A meta-analysis was performed on the included studies. Random-effects models were used for analyses with high inter-group heterogeneity, while fixed-effects models were applied for those with low inter-group heterogeneity.Results:A total of 15 studies were included in the meta-analysis, comprising 480 cases treated via the olecranon osteotomy approach and 443 cases via the bilateral triceps approach. Meta-analysis results showed that the olecranon osteotomy approach was associated with longer operative time [ SMD=0.96, 95% CI(0.23, 1.70), P=0.010] and more intraoperative blood loss [ SMD=1.00, 95% CI(0.22, 1.78), P=0.012]compared to the bilateral triceps approach. There were no statistically significant differences between the two groups in postoperative Mayo Elbow Performance Score [ SMD=0.55, 95% CI(-0.23, 1.32), P=0.167], excellent and good reduction rate [ OR=0.98, 95% CI(0.75, 1.27), P=0.856], postoperative complication rate [ OR=1.27, 95% CI(0.77, 2.09), P=0.344], healing time [ SMD= -0.13, 95% CI(-0.37, 0.11), P=0.280], and range of motion of the elbow joint [ SMD=-0.02, 95% CI(-0.29, 0.26), P=0.891]. Conclusion:The bilateral triceps approach for internal fixation of AO type C distal humeral fractures is associated with shorter operative time and lower intraoperative blood loss compared to the olecranon osteotomy approach. The bilateral triceps approach for internal fixation of AO type C distal humeral fractures is associated with shorter operative time and lower intraoperative blood loss compared to the olecranon osteotomy approach.

Heart sound is one of the common medical signals for diagnosing cardiovascular diseases. This paper studies the binary classification between normal or abnormal heart sounds, and proposes a heart sound classification algorithm based on the joint decision of extreme gradient boosting (XGBoost) and deep neural network, achieving a further improvement in feature extraction and model accuracy. First, the preprocessed heart sound recordings are segmented into four status, and five categories of features are extracted from the signals based on segmentation. The first four categories of features are sieved through recursive feature elimination, which is used as the input of the XGBoost classifier. The last category is the Mel-frequency cepstral coefficient (MFCC), which is used as the input of long short-term memory network (LSTM). Considering the imbalance of the data set, these two classifiers are both improved with weights. Finally, the heterogeneous integrated decision method is adopted to obtain the prediction. The algorithm was applied to the open heart sound database of the PhysioNet Computing in Cardiology(CINC) Challenge in 2016 on the PhysioNet website, to test the sensitivity, specificity, modified accuracy and F score. The results were 93%, 89.4%, 91.2% and 91.3% respectively. Compared with the results of machine learning, convolutional neural networks (CNN) and other methods used by other researchers, the accuracy and sensibility have been obviously improved, which proves that the method in this paper could effectively improve the accuracy of heart sound signal classification, and has great potential in the clinical auxiliary diagnosis application of some cardiovascular diseases.
Algorithms ; Databases, Factual ; Heart Sounds ; Neural Networks, Computer

Objective To verify the reliability of novel 3D classification of intertrochanteric fractures by comparing the consistency between conventional and novel classifications.Methods Included for the present study were the preoperative X-ray and CT images of 189 patients with intertrochanteric fracture who had been hospitalized at Department of Orthopaedics,Beijing Chao Yang Hospital,Capital Medical University from 1 January,2017 to 1 January,2019.The patients' intertrochanteric fractures were classified by 6 orthopedic surgeons independently using Evans classification,Jensen classification,AO classification and novel 3D classification,respectively.One month later,the original images of the 189 patients were renumbered and classified again in the same way.The Kappa values between observers and within observers were calculated for the classifications of intertrochanteric fractures based on X-ray and CT images.Results In Evans classification,Jensen classification,AO classification and novel 3D classification,the interobserver Kappa values of X-ray films were 0.54 ± 0.03,0.53 ± 0.03,0.45 ± 0.03 and 0.63 ± 0.02,respectively,and the interobserver Kappa values of the CT images were 0.49 ± 0.03,0.49 ± 0.03,0.44 ± 0.04 and 0.63 ± 0.03.The intraobserver Kappa values of the X-ray films were 0.53 ± 0.02,0.54 ± 0.03,0.44 ±0.04 and 0.65 ± 0.02,respectively,and the intraobserver Kappa values of the CT images were 0.52 ± 0.03,0.52 ±0.03,0.41 ±0.02 and 0.64 ±0.03.In the novel classification based on X-ray and CT images,the interobserver and intraobserver Kappa values were both significantly higher than those in Evans,Jensen and AO classifications (P ＜ 0.05).Conclusion The novel 3D classification of intertrochanteric fractures is more reliable than the conventional ones.

The current treatment of medical implant-associated infections is still challenging.The infections are particularly persistent because the bacteria attaching to the implant surfaces produce a protective matrix which establishes itself as biofilms,shielding the bacteria from antibiotics.Biofilm bacteria are resistant to antimicrobics at levels 500 to 5,000 times higher than those needed to kill non-biofilm bacteria.In vitro experiments have shown that electric current has anti-infection effect and can enhance the activity of some antimicrobial agents against certain bacteria in the biofilms.Direct electrical stimulation has already been safely used in humans for fracture healing.In this article,we review the current state and development in research on the anti-infection effect of electrical stimulation.

BACKGROUND:Previous studies have found that endogenous gaseous signaling molecules such as NO, CO, H2S and SO2 play an important role in acute lung injury;there also have other gases participation, such as carbonyl sulfide.
OBJECTIVE:To investigate the effect of carbonyl sulfide for limb ischemia-reperfusion induced acute lung injury and its mechanism in rats.
METHODS:A total of 64 Sprague-Dawley rats were randomly divided into eight groups. Control group:without treatment;model group:limb ischemia for 4 hours and then reperfusion for 2 hours. Low-, moderate-and high-dose carbonyl sulfide groups were intraperitoneal y injected with 0.2, 0.5, 1.0 mL carbonyl sulfide respectively at 20 minutes before ischemia for 4 hours and reperfusion for 2 hours. Low-, moderate-and high-dose air groups were intraperitoneal y injected with 0.4, 1.0, 2.0 mL air respectively at 20 minutes before ischemia for 4 hours and reperfusion for 2 hours. 2 hours after reperfusion, the morphological changes of lung tissues and the change of lung coefficient were observed. The expressions of tumor necrosis factor-a, interleukin-1βand interleukin-6 both in lung tissue and serum were detected by enzyme linked immunosorbent assay. Cel apoptosis was measured by TUNEL assay.
RESULTS AND CONCLUSION:(1) Compared with the control group, significant damage of lung tissue was seen, and the lung coefficient increased significantly in the model group (P<0.05). The expressions of tumor necrosis factor-a, interleukin-l and interleukin-6 both in lung tissue and plasma increased (P<0.05), and apoptotic rate increased. (2) Compared with the model group, low-, moderate-and high-doses of carbonyl sulfide could mitigate the degree of lung injury, and reduce pulmonary coefficient and apoptotic rate. The low dose showed the most obvious effect. Low-and moderate-dose carbonyl sulfide could significantly decrease expressions of tumor necrosis factor-a, interleukin-1βand interleukin-6 both in lung tissue and plasma (P<0.05). (3) No significant difference in each index was visible in the low-, moderate-and high-dose air groups compared with the model group. (4) Results suggested that low dose of exogenous carbonyl sulfide through anti-inflammatory, anti-oxidant effects plays the protective role on limb ischemia/reperfusion-induced acute lung injury in rats.

Objective To explore the influence of brief ischemic on fracture healing.Methods Two hundred and forty wistar rats (weight was 200 g and half male) were made the right tibial midpiece closed fracture model.1.0 mm K-wires were used to fix the fractures.Rats were divided into 4 groups.Group A was 24 hours,group B was 48 hours,group C was 72 hours,and group D was the control group.Tourniquet was used on the root of the thigh of right lower limb.Tourniquet was inflated 10 min,then released 10 min,and repeated 3 times to make the brief ischemic model.48 rats were made brief ischemic at 24 hours after the fracture fixed.Then group A was at every 24 hours,group B was at every 48 hours,and group C was at every 72 hours made brief ischemic.Group D at every 24 hours after the fracture fixed was used tourniquet on the root of thigh of right lower limb each time 1 hour,but the tourniquet was not inflated.Group A,B,and C were made brief ischemic 5 weeks.Group D was tourniquet treated 5 weeks.Group A and D at 1 day,3 days,5 days,and 7 days after fracture fixed were detected the serum VEGF.All groups of rats were X-ray examinated and detected of serum VEGF at every two weeks after the fracture fixed.Every two weeks,every group randomly selected 12 rats to do immunohistochemical staining.We used the Image Pro Plus software to quantitative compare the IGF-2 positive cells in the fracture area.Results X-ray results were used three points method for analyzing.The scores of group A,B,and C were significantly higher than group D at 2 weeks,4 weeks,6 weeks after fracture fixed (P ＜ 0.05).The scores between group A,B,and C were no significant statistical difference at 2 weeks,4 weeks,6 weeks after fracture fixed (P ＞ 0.05).The levels of serum VEGF of group A were significantly higher than group D at 3days,5days,and 7 days after fracture fixed (P ＜ 0.05).The levels of serum VEGF of group B and C were obviously higher than group A and D at 2 weeks (P ＜ 0.05),and there was no obvious difference between group B and C (P =0.79,P =0.90,P =0.88).The same result was found between group A and D (P =0.94,P =0.551,P =0.53).There were no significant difference between four groups on the levels of serum VEGF at 8 weeks (P =0.66).Immunohistochemical results were that group B,group C VEGF positive cells were significantly higher than group A and group D at 2 weeks,4 weeks,6 weeks (P ＜0.05).There was no significant difference in group B and group C (P =0.19,P =0.10,P =0.38),or group A and group D (P =0.07,P =0.17,P =0.18).There was no significantly different in four groups at 8 weeks (P =0.08).Conclusions Brief ischemic can promote the healing of fracture and stimulate the expression of VEGF.The mechanism may be related to the signal channels of VEGF and other biological factors.This study will give new idea to clinic for promoting fracture healing.

Background:MicroRNA?506 (miR?506) has been reported to function in several tumors as a tumor suppressor gene or oncogene. However, the expression and role of miR?506 in pancreatic ductal adenocarcinoma (PDAC) remains unclear. In this study, we aimed to evaluate the phenotype of miR?506 in PDAC. Methods:Using miRNA insitu hybridization, we examined the expression of miR?506 in 113 PDACs and 87 paired normal pancreatic tissues. We evaluated miR?506 expression in PDAC cells, normal pancreatic ducts, and acinus/islands, and we analyzed the associations between miR?506 expression and the clinicopathologic characteristics of PDAC patients. Results:miR?506 expression was higher in PDAC than in matched normal pancreatic ductal cells (P<0.001). On the other hand, the combined group of well and moderately differentiated PDACs showed higher levels of miR?506 than the poorly differentiated ones (P=0.023). Moreover, miR?506 expression was negatively associated with pathologic T category (P=0.004) and lymph node metastasis (P=0.033), suggesting that miR?506 might inhibit the progression of PDAC. Conclusions:Our results suggest that miR?506 either plays a role as an oncogene in the tumorigenesis and a tumor suppressor in the progression or serves as a house?keeping, tumor?suppressing miRNA, whose expression can be activated by oncogenic signals in early development to hinder the progression of PDAC.

Objective To investigate the expression and clinical significance of Smac and HtrA2 in children with acute leukemia(AL).Methods Bone marrow samples were obtained from 77 children with AL (including 32 newly diagnosed children,33 complete remission children and 12 relapsed children)and the control group of 15 children without malignant blood disease.The expressions of Smac and HtrA2 protein were measured by streptavidin/peroxidase immunoperoxidase technique(SP) in all children.SPSS 13.0 software was applied to analyze the statistical data.Results Protein Smac was detected only in some samples,but HtrA2 was detected in all samples.The levels of Smac and HtrA2 protein in newly diagnosed AL children were both higher than those of the complete remission children (x2 =17.38,F =2.36,all P ＜ 0.05) and normal controls (x2 =12.89,F =5.26,all P ＜ 0.05),there was a statistical significance,but compared with those in the relapsed children,the difference had no statistical significance (x2 =1.18,F =1.57,all P ＞ 0.05).The levels of Smac and HtrA2 protein in complete remission children were both higher than those of the normal controls,and the difference had no statistical sigmficance(x2 =1.20,F =2.23,all P ＞ 0.05).In the newly diagnosed children,the levels of Smac and HtrA2 protein in children with acute lymphocytic leukemia(ALL) were higher than those of the acute myeloid leukemia(AML),but the differences had no statistical significance(x2 =0.113,t =1.024,all P ＞ 0.05).In newly diagnosed AL children,the complete remission(CR) rate of the negative expression of Smac(Smac-,90.9％) and the low expression of HtrA2(HtrA2low,84.6％) in the level of protein were higher than those of the positive expression of Smac(Smac +,47.6％) and the high expression of HtrA2 (HtrA2high,47.4％),and there was statistical significance respectively(x2 =5.772,4.596,all P ＜ 0.05).The CR rate of Smac-HtrA2low group (100％) was higher than that of Smac+ HtrA2high group(30.8％)in the children with AL,and the statistical data were of great significance(x =9.692,P ＜0.01).The protein level of Smac in newly diagnosed AL children was correlatedwith HtrA2 (r =0.979,P ＜ 0.001).Conclusions Pro-apoptotic protein Smac and HtrA2 may be involved in and af-fected each other in the pathogenesis and progression in AL,but levels of Smac and HtrA2 protein may be not correlatedwith the types of AL.In newly diagnosed AL children,the high expression of protein Smac and HtrA2 predicts poorprognosis.

AIM:To investigate the role of PI3K/Akt and JAK2/STAT3 pathways in the protection of sulfur dioxide (SO2) against limb ischemia/reperfusion (I/R)-induced acute lung injury (ALI) in rats.METHODS:ALI was induced by limb I/R in the SD rats.Na2 SO3 (0.54 mmol/kg, ip)/NaHSO3 (0.18 mmol/kg, ip) as SO2 donor was injec-ted at 20 min before reperfusion.The inhibitors of JAK2/STAT3 and PI3K/Akt pathways, Stattic (3 mg/kg, iv) and LY294002 (40 mg/kg, iv), respectively, were injected at 1 h before reperfusion.Peripheral blood and lung tissues were collected for determining the contents of the cytokines, the protein levels of the molecules related to the signaling pathways, apoptosis and histopathologic changes by ELISA, TUNEL and Western blot.RESULTS:Compared with control group, the content of MDA, the activity of MPO, lung coefficient, apoptotic index, cytokine expression, and the protein levels of p-Akt and p-STAT3 in I/R group all increased significantly, and administration of Na2 SO3/NaHSO3 attenuated the damage in the lung.Besides, the results of Western blot showed that the rat lung tissues expressed p-STAT3 protein and p-Akt pro-tein.After I/R, the protein levels of p-STAT3 and p-Akt were increased.After using Na2 SO3/NaHSO3 , p-Akt was in-creased, but p-STAT3 was decreased (P<0.05).CONCLUSION:Both JAK2/STAT3 and PI3K/Akt pathways are like-ly involved in the protective effect of SO2 against limb I/R-induced ALI in rats.The activation of JAK2/STAT3 signaling pathway increases I/R injury.Reversely, the activation of PI3K/Akt signaling pathway reduces I/R injury.Besides, JAK2/STAT3 and PI3K/Akt signaling pathways may have crosstalk during I/R-induced ALI and JAK2/STAT3 pathway may have an impact on the P13K/Akt pathway.