BACKGROUND:Zinc-based alloy medical implant materials have excellent mechanical properties,complete degradability and good biocompatibility,and are mainly used in orthopedic implants,cardiovascular stents,bile duct stents,tracheal stents,nerve catheters,etc. OBJECTIVE:To review the research progress of biodegradable zinc-based alloys in bone defect repair and prospect the promising research direction and achievements of zinc-based materials. METHODS:After searching PubMed,Web of Science,WanFang Data,and CNKI databases from the establishment of the database to June 2023,various relevant articles on biodegradable zinc-based alloys for bone implant material research were collected.The basic characteristics of biodegradable zinc based alloys were summarized,and the role of zinc-based alloys in promoting bone tissue repair was sorted and summarized.The current research hotspots and shortcomings were discussed. RESULTS AND CONCLUSION:(1)Zinc-based alloys have good biocompatibility.Using zinc-based alloys as the matrix material,with the help of scaffold structure construction technology and coating optimization process,the bone conductivity of zinc-based alloys will be effectively improved,and their degradation products will have efficient bone induction to regulate the gene expression of osteoblasts and osteoclasts,thereby promoting the repair and reconstruction of bone defects.(2)However,in the research on optimizing zinc-based alloys,the coating process is relatively insufficient,and additive loading technology is still lacking.(3)Zinc-based alloys have excellent mechanical and biological properties.Through special processes,their bone conductivity and osteoinductivity can be increased to effectively improve their ability to promote bone repair and reconstruction,and it is expected to further achieve the development of personalized transplant materials.Further research and development are needed to optimize the integration of coating and additive loading technologies into zinc-based alloys.

BACKGROUND:Exosomes can be detected in synovial fluid and plasma at levels that vary with the progression of osteoarthritis in patients with osteoarthritis,and may play a relieving role in the local inflammation of osteoarthritis,cartilage calcification,and osteoarthritic joint degradation. OBJECTIVE:To comprehensively understand the function and mechanism of exosomes from different stem cells in the diagnosis and treatment of osteoarthritis,and to present the prospects and challenges of exosome therapy for osteoarthritis. METHODS:We searched the articles published from October 2003 to October 2023 included in PubMed and CNKI databases with the keywords of"exosomes,osteoarthritis,mesenchymal stem cells,stem cells"in Chinese and English,respectively.A total of 99 articles were finally included for review. RESULTS AND CONCLUSION:The appearance of exosomes brings hope to the diagnosis and treatment of osteoarthritis.The differences of RNA,protein,and lipid content in exosomes can be used as biomarkers for the diagnosis of osteoarthritis.At the same time,exosomes from various stem cells can effectively protect chondrocytes,relieve inflammation,maintain cartilage matrix metabolism,and regulate angiogenesis and subchondral bone remodeling,showing excellent potential in the treatment of osteoarthritis.The engineered exosomes break through the traditional limitations and enhance the specificity and efficiency of treatment by modulating the expression of specific non-coding RNA,providing a new strategy for the treatment of osteoarthritis.

Objective: To investigate the efficacy，safety and feasibility of regional lymph node dissection in laparoscopic radical surgery for bladder cancer under the guidance of indocyanine green fluorescence imaging. Methods: A total of 30 patients with muscle invasive bladder cancer (T2/T3NxM0) who volunteered to enter the clinical trial were randomly divided into the indocyanine green imaging guided laparoscopic regional lymph node dissection group (n=15) and the standard pelvic lymph node dissection group (n=15).The number of positive lymph nodes，operation time，intraoperative bleeding volume，incidence of lymph leakage，and tumor recurrence and metastasis rate 2-year after surgery were collected. Results: The number of positive lymph nodes was (4.20±1.66) and (4.60±1.72) respectively in the indocyanine green and standard groups，with no statistically significant difference (P>0.05).There were no statistically significant difference in the tumor recurrence and metastasis rates 2-year after surgery between the two groups (P>0.05).However，the indocyanine green group had shorter operation time，less intraoperative bleeding volume，and lower incidence of lymphatic leakage than the standard group (P<0.05). Conclusion: Indocyanine green fluorescence imaging guided laparoscopic lymph node dissection has comparable clinical efficacy to standard lymph node dissection，but with fewer complications.

An efficient vacuum suction system is a necessary prerequisite for the smooth operation of the oral diagnosis and treatment.During the use of the dental units,there is often a situation of vacuum suction weakness,resulting in the inability to discharge the mixture of blood,saliva,dental tissue and other mixtures in time,which affects the doctor's treatment field and increases the risk of aspiration pneumonia and cross-infection in patients.The working principle,pipeline system,filters and other aspects of the vacuum suction system that may affect the suction efficiency was analyzed.The causes and solutions of vacuum suction weakness were discussed,and operation suggestions were proposed to ensure the safe and effective use of equipment and ensure the safety of diagnosis and treatment.

Objective:To compare the medium and long-term efficacy between the deltoid split approach and the conventional deltopectoral approach in locking plate fixation for proximal humerus fractures.Methods:A retrospective study was performed in the 65 patients with proximal humerus fracture who had been operatively treated at Department of Orthopedics, The Third People's Hospital of Nantong from January 2018 to December 2020. They were 20 males and 45 females with an age of (64.6±9.2) years. Of them, 34 were assigned to fixation with proximal humerus internal locking system (PHILOS) through the deltoid split approach (minimally invasive group), and 31 to PHILOS fixation through the deltopectoral approach (conventional group). The 2 groups were compared in terms of general data, operation time, intraoperative blood loss, hospital stay, fracture union time, intraoperative fluoroscopy, postoperative 2-year imaging scores, and Constant-Murley shoulder score at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). In the minimally invasive group and the conventional group, respectively, the intraoperative blood loss was (97.9±16.6) mL and (155.8±27.4) mL, and the frequency of intraoperative fluoroscopy (12.0±1.8) times and (6.7±1.8) times, both showing a statistically significant difference ( P<0.05). There was no significant difference in operation time, hospital stay, or fracture union time ( P>0.05). All patients were followed up for (43.9±5.5) months. There was no statistically significant difference between the 2 groups in postoperative 2-year imaging scores ( P>0.05). Compared with the conventional group, patients in the minimally invasive group had significantly lower Constant-Murley strength scores and significantly lower Constant-Murley scores for the Neer four-part fractures ( P<0.05). Postoperatively, one case of screw protrusion and one case of complete ischemic necrosis occurred in both groups while one case of partial ischemic necrosis was observed in the minimally invasive group and 3 cases of partial ischemic necrosis were observed in the conventional group. Conclusions:In locking plate fixation for proximal humerus fractures, compared with the deltopectoral approach, the deltoid split approach shows advantages of less soft tissue damage, less intraoperative bleeding, and less destruction of the blood supply to the humeral head. However, the deltopectoral approach may be more appropriate for the Neer four-part fractures.

Objective:To investigate the incidence of radiation pneumonitis (RP) induced by 125I seed implantation for the treatment of malignant lung tumors and analyze related dosimetric parameters. Methods:A retrospective analysis was conducted on 31 cases of malignant lung tumors treated with 125I seed implantation from January 2017 to December 2022 at Hebei Provincial Tumor Radioactive Seeds Implantation Diagnosis and Treatment Center. These cases consisted of eight patients with squamous cell carcinoma, 10 patients with adenocarcinoma, and 13 patients with metastatic cancer in other sites. At 1-6 months after treatment, these patients received postoperative chest CT scans, with the efficacy evaluated based on the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), including the objective response rate (ORR) and the disease control rate (DCR). The efficacy of RP was evaluated using the Radiation Therapy Oncology Group (RTOG) criteria. Postoperative dosimetric parameters, including D90 (minimum peripheral dose received by 90% of the target volume), V8 (percentage of lung volume receiving 8 Gy), V32 (percentage of lung volume receiving 32 Gy), and Dmean (mean radiation dose) of the affected lung, were statistically analyzed. The relationships of the RP occurrence with postoperative D90, V8, V32, and Dmean were analyzed by comparison with relevant external radiotherapy data, to identify the parameters that are correlated closely with RP occurrence. Results:All the patients underwent successful surgeries. The postoperative efficacy evaluation after six months showed complete response (CR) in 11 cases, partial response (PR) in 11 cases, stable disease (SD) in eight cases, and progressive disease (PD) in one case, with an overall response rate (ORR) of 71.0%, and a disease control rate (DCR) of 96.8%. Three patients suffered RP, with an incidence rate of 9.7%. Postoperative V8, V32, and Dmean could not serve as predictive indicators for RP. Follow-up observation revealed that three RP cases (3/5) exhibited postoperative D90 exceeding 170 Gy and no RP cases (0/26) showed postoperative D90 below 170 Gy. Conclusions:In the treatment of malignant lung tumors with 125I seed implantation, there is a certain correlation between RP and postoperative D90, while there is no correlation between it and V8, V32, and Dmean.

Objective:To explore the effective indicators that can predict the poor prognosis of neonates with congenital heart disease after surgery.Methods:178 cases of neonatal congenital heart disease were retrospectively analyzed. According to the outcome, they were divided into normal prognosis group (132 cases) and poor prognosis group (46 cases).Results:15 (8.4%) patients died in hospital. There were statistical differences between the two groups in terms of whether PGE and vasoactive drugs were needed before surgery, preoperative respiratory support mode, blood lactate level from anesthesia induction to 24 h after surgery, VIS and VVR scores, whether delayed sternal closure or peritoneal dialysis were needed ( P<0.05). Logistic regression analysis showed that elevated lactate levels and VVR scores on 24 h after surgery were independent risk factors for death or other poor postoperative prognosis in neonates ( P<0.05). Conclusion:The levels of lactate and VVR scores in 24 h after operation are sensitive indicators for monitoring the severity of the condition, guiding treatment and judging prognosis of neonatal congenital heart disease surgery.

Objective To investigate the value of computer-assisted quantification of pulmonary embolism volume(PEV)in identifying mild-to-high-risk acute pulmonary embolism(APE).Methods We retrospectively enrolled 143 patients with suspected APE confirmed by computed tomography pulmonary angiography(CTPA)at Yan'an University Affiliated Hospital from January 2017 to December 2020.According to the 2018 Chinese Guidelines for Diagnosis,Treatment and Prevention of Pulmonary Thromboembolism,all the patients were divided into low-risk group(n=88)and mild-to-high-risk group(n=55).We collected the patients'basic demographic data,clinical manifestations,and serum levels of N-terminal-B type natriuretic peptide precursor(NT-proBNP)and D-dimer.Based on CTPA images,the degree of pulmonary thromboembolism was artificially evaluated to obtain the pulmonary artery occlusion index(PAOI).The thrombus was segmented using the pulmonary embolism detection tool based on digital lung,and PEV was calculated.We compared the differences in clinical and laboratory indicators and PAOI and PEV between the two risk groups.We analyzed the value of PAOI and PEV in identifying mild-to-high-risk APE using receiver operating characteristic(ROC)curves,and used Logistic regression analysis to identify independent risk factors in predicting mild-to-high-risk APE.Different models were established.Results Compared with the low-risk group,APE patients in the mild-to-high-risk group were older(P＜0.05),had lower diastolic blood pressure(P＜0.05),higher levels of D-dimer and NT-proBNP(P＜0.05),lower levels of platelet count,arterial oxygen partial pressure and arterial carbon dioxide partial pressure(P＜0.05),and higher levels of PAOI and PEV(P＜0.001).ROC curve analysis showed that the area under the curve for PEV in identifying mild-to-high-risk APE was 0.809(95％CI:0.734-0.884),while that for PAOI was 0.753(95％CI:0.667-0.839).Logistic regression analysis showed that PEV and NT-proBNP were independent risk factors for mild-to-high-risk APE(P＜0.05).Conclusion PEV and NT-proBNP are independent risk factors for mild-to-high-risk APE.

ObjectiveTo investigate the application value of liver/spleen CT value （CT_L/S）， controlled attenuation parameter （CAP）， and magnetic resonance imaging-proton density fat fraction （MRI-PDFF） in chronic hepatitis B （CHB） patients with hepatic steatosis. MethodsA retrospective analysis was performed for the clinical data of 213 CHB patients who underwent liver CT， CAP， and MRI-PDFF examinations in Affiliated Hospital of Yan’an University from October 2018 to December 2022. According to MRI-PDFF， the 213 patients were divided into CHB group with 111 patients （MRI-PDFF<5%） and CHB+hepatic steatosis group with 102 patients （MRI-PDFF≥5%）， among whom there were 69 patients with mild hepatic steatosis and 33 patients with moderate to severe hepatic steatosis. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The Bland-Altman plot was used to evaluate the consistency in MRI-PDFF measurement between two physicians. The Spearman’s correlation coefficient was used to analyze the correlation between CT_L/S and MRI-PDFF and between CAP and MRI-PDFF. The receiver operating characteristic （ROC） curve was plotted and the area under the ROC curve （AUC） was calculated to investigate the value of CT_L/S and CAP in the diagnosis of different degrees of hepatic steatosis， and the DeLong test was used to compare the AUCs of the two radiological examinations. ResultsMRI-PDFF had relatively high repeatability and stability in CHB patients. There is a significant negative correlation between CT_L/S and MRI-PDFF （r=-0.800， P<0.001） and a significant positive correlation between CAP and MRI-PDFF （r=0.692， P<0.001）. Both CT_L/S and CAP had a relatively high accuracy in the diagnosis of hepatic steatosis in CHB patients， with an AUC of 0.951 and 0.902， respectively， and CT_L/S had a better accuracy than CAP （P<0.05）. In the diagnosis of mild and moderate-to-severe hepatic steatosis， CT_L/S had an AUC of 0.921 and 0.895， respectively， and CAP had an AUC of 0.859 and 0.825， respectively， suggesting that CT_L/S had a slightly higher diagnostic efficiency than CAP. ConclusionMRI-PDFF has high repeatability and stability in CHB patients， and CT_L/S and CAP have a high diagnostic value for different degrees of hepatic steatosis in CHB patients.

Objective:To investigate the therapeutic effectiveness and related factors of fertility preservation therapy(referred to as conservation therapy)using Levonorgestre-releasing intrauterine system(LNG-IUS)com-bined with Metformin in patients with atypical endometrial hyperplasia and early endometrial cancer.Methods:A retrospective analysis was conducted on the clinical data of 41 patients with atypical endometrial hyperplasia and 11 patients with early endometrial cancer who required fertility preservation therapy and admitted to Shenyang Women and Children's Hospital from January 1,2015 to December 30,2021.According to different treatment methods,they were divided into a study group(26 cases,LNG-IUS+metformin)and a control group(26 cases,high efficiency progesterone+metformin).Regularly review endometrial pathology and analyze the differences in complete remission rate,recurrence rate,and pregnancy outcomes between the two groups.Univariate Logistic regression was used to analyze the factors affecting complete remission,recurrence,and pregnancy outcomes in those patients.Results:There was no statistically significant difference in general clinical data between the two groups(P＞0.05).Compared with the control group,the study group had higher complete remission rate,shorter average complete remission time,less recurrence rate,and higher live birth rate,with a statistically significant be-tween the two groups(P＜0.05).Logistic regression analysis found that body mass index(BMI)≥30 kg/m2was a risk factor for complete remission(P＜0.05);BMI ≥30 kg/m2 and patients with diabetes or insulin resistance were the risk factors for recurrence after treatment(P＜0.05);BMI≥30 kg/m2 and diseases associated with fe-male reproductive system were the risk factors for pregnancy after preserving fertility therapy(P＜0.05).Conclu-sions:LNG-IUS combined with metformin has a more satisfactory therapeutic effect and pregnancy outcomes,compared to high efficiency progesterone combined with metformin in preserving fertility therapy.At the same time,BMI＜30 kg/m2 can increase the complete remission rate,reduce the recurrence rate after cure,and in-crease the pregnancy rate after preserving fertility therapy.