OBJECTIVES: To investigate the changes in blood levels of calcium and bone metabolism biochemical markers in patients with primary osteoporosis receiving treatment with denosumab. METHODS: Seventy-three patients with primary osteoporosis treated in our Department between December, 2021 and December 2023 were enrolled. All the patients were treated with calcium supplements, vitamin D and calcitriol in addition to regular denosumab treatment every 6 months. Blood calcium, parathyroid hormone (PTH), osteocalcin (OC), type I procollagen amino-terminal propeptide (PINP), and type I collagen carboxy-terminal telopeptide β special sequence (β‑CTX) data before and at 3, 6, 9, and 12 months after the first treatment were collected from each patient. RESULTS: Three months after the first denosumab treatment, the bone turnover markers (BTMs) OC, PINP, and β-CTX were significantly decreased compared to their baseline levels by 39.5% (P<0.001), 56.2% (P<0.001), and 81.8% (P<0.001), respectively. At 6, 9, and 12 months of treatment, OC, PINP, and β-CTX remained significantly lower than their baseline levels (P<0.001). Blood calcium level was decreased (P<0.05) and PTH level increased (P<0.05) significantly in these patients at months of denosumab treatment, but their levels were comparable to the baseline levels at 6, 9, and 12 months of the treatment (P>0.05). CONCLUSIONS Denosumab can suppress BTMs and has a good therapeutic effect in patients with primary osteoporosis, but reduction of blood calcium and elevation of PTH levels can occur during the first 3 months in spite of calcium supplementation. Blood calcium and PTH levels can recover the baseline levels as the treatment extended, suggesting the importance of monitoring blood calcium and PTH levels during denosumab treatment.
Humans ; Denosumab/therapeutic use* ; Calcium/blood* ; Parathyroid Hormone/blood* ; Biomarkers/blood* ; Osteoporosis/blood* ; Osteocalcin/blood* ; Procollagen/blood* ; Female ; Collagen Type I/blood* ; Peptide Fragments/blood* ; Bone Density Conservation Agents/therapeutic use* ; Bone and Bones/metabolism* ; Male ; Middle Aged ; Vitamin D ; Peptides/blood* ; Aged

Objective To explore the mechanisms of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) in improvement of renal injury in rats with diabetic nephropathy (DN) by regulating mammalian target of rapamycin (mTOR)/p70 ribosome protein S6 kinase (S6K1)/coiled-coil myosin-like Bcl-2-interacting protein (Beclin 1) pathway. Methods The model of SD rats with DN was established by a method of high-fat diet combined with intraperitoneal injection of streptozotocin, and they were randomly divided into model group, MSC-EVs group, and MSC-EVs+MHY1485 (mTOR activator) group, with 12 rats in each group. Another 12 SD rats were normally fed for 6 weeks and then intraperitoneally injected with an equal dose of sodium citrate solution as controls. After grouping with MSC-EVs and MHY1485, blood glucose and levels of renal function indicators [blood urea nitrogen (BUN), serum creatinine (Scr), and urinary microalbumin (UmALB)] in rats were detected. HE staining was used to detect the pathological morphology of renal tissue in rats of each group; immunohistochemistry was used to detect the expression of mTOR/S6K1/Beclin 1 pathway related proteins in the renal tissues of rats in each group; the Western blot was used to detect the mTOR/S6K1/Beclin 1 pathway and autophagy-related protein expression in the renal tissues of rats in each group. Results Compared with the control group, the renal tissue morphology of rats in the model group were impaired, and the blood glucose, BUN, Scr, UmALB, relative positive expressions of p-mTOR and p-S6K1, p-mTOR/mTOR, p-S6K1/S6K1 increased significantly (P < 0.05), while microtubule associated protein 1A/1B light chain 3 (LC3) Ⅱ/LC3Ⅰ, expression of Beclin 1 protein, and relative positive expression of Beclin 1 significantly reduced (P < 0.05); compared with the model group, the MSC-EVs group had less impairment in the renal tissue morphology, and the blood glucose, BUN, Scr, UmALB, relative positive expressions of p-mTOR and p-S6K1, p-mTOR/mTOR, and p-S6K1/S6K1 decreased significantly (P < 0.05), while expression of LC3Ⅱ/LC3Ⅰ, Beclin 1 protein, and relative positive expression of Beclin 1 increased significantly (P < 0.05); compared with the MSC-EVs group, the impairment of the renal tissue morphology was worse in the MSC-EVs+MHY1485 group, and the blood glucose, BUN, Scr, UmALB, relative positive expressions of p-mTOR and p-S6K1, expression of p-mTOR/mTOR, and p-S6K1/S6K1 increased significantly (P < 0.05), while the expression of LC3Ⅱ/LC3Ⅰ, Beclin 1 protein, and relative positive expression of Beclin 1 decreased significantly (P < 0.05). Conclusion MSC-EVs can enhance autophagy, reduce levels of blood glucose, Scr, BUN and urinary protein in rats with DN, alleviate renal tissue damage, and the mechanism may be achieved by inhibiting the activation of the mTOR/S6K1/Beclin 1 pathway.

Objective:To analyze the risk factors for ankle varus deformity after McFarland fracture surgery in children.Methods:A total of 48 children with McFarland fracture who underwent surgical treatment in the Second General Hospital of Fuzhou from January 2015 to December 2022 were retrospectively analyzed, including 24 males and 24 females, aged 11.2±3.2 years (range, 2-14 years), 19 cases on the left side and 29 cases on the right side. Salter-Harris classification: 34 cases of type III and 14 cases of type IV. Causes of injuries: 28 cases of sports injuries, 15 cases of fall injuries, and 5 cases of car accident injuries. The time from injury to operation was 2.6±1.7 d (range, 1-7 d). The reduction methods included closed reduction in 38 cases and open reduction in 10 cases. Tibial internal fixation: 42 cases of hollow screws, 6 cases of Kirschner pins. There were 30 cases of combined fibula fracture, 20 cases were fixed with plate, 8 cases were fixed with Kirschner's pin, and 2 cases were not treated with internal fixation. The internal fixation survival time was 6.4±2.8 months (range, 1-12 months). The lateral distal tibial angle (LDTA) was used to determine whether the child had ankle varus deformity. The general data and perioperative indicators of the two groups were compared, and the indicators with statistically significant differences were included in binary logistic regression analysis to determine the independent risk factors for ankle varus deformity after McFarland fracture surgery in children. The receiver operating characteristic curve was drawn and the area under the curve of each independent risk factor was calculated.Results:All patients successfully completed the operation and were followed up for 39.2±21.8 months (range, 15-98 months). At the last follow-up, all the 48 children with McFarland fracture had bone union and the internal fixation was successfully removed, and 5 of them had ankle varus deformity. The LDTA of the affected side was 98.6°±4.8° (range, 94°-106°) in the ankle varus deformity group and 89.0°±0.8° (range, 87°-91°) in the non-ankle varus deformity group. The age of children in the ankle varus deformity group was 6.6±5.1 years, which was younger than that in the non-ankle varus deformity group (11.7±2.5 years), and the difference was statistically significant ( t=3.772, P<0.001). The survival time of internal fixation in the ankle varus deformity group was 4.4±2.2 months, which was shorter than that in the non-ankle varus deformity group (6.6±2.8 months), and the difference was statistically significant ( t=1.750, P=0.087). There was no significant difference in gender, side, cause of injury, fracture type, initial displacement distance, fibular fracture, time from injury to operation, reduction method, or fixation method between the two groups ( P>0.05). Age and duration of internal fixation were included in binary logistic regression analysis. The results showed that age ( OR=0.717, 95% CI: 0.543, 0.945, P=0.018) was an independent risk factor for postoperative ankle varus deformity in children with McFarland fracture. The receiver operating characteristic curve of independent risk factors predicting postoperative ankle varus deformity in children with McFarland fracture was drawn and the area under the curve was calculated. The results showed that the best cut-off value of age was 5.5 years, and the area under the curve was 0.807, and the prediction efficiency of the prediction model was good. Conclusion:Age<5.5 years is an independent risk factor for postoperative varus ankle deformity in children with McFarland fracture.

Novel coronavirus Omicron variant infection can cause severe illness and even death in certain populations. Omicron variant infection may lead to systemic inflammatory response, coagulation disorder, multi-organ dysfunction and other pathophysiological changes, which are different from other Novel coronavirus variants to a certain extent, so therapeutic strategies should not be the same. The National Medical Center for Major Public Health Events invited experts in fields of infectious diseases, respiratory medicine, intensive care, pediatrics and fever clinic to develop this quick guideline based on the current best evidence and extensive clinical practices. This quick guideline aims to standardize the diagnosis and treatment of novel coronavirus Omicron infection, and to improve the disease management abilities of clinicians.

The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.

Objective: To understand the characteristics of KAP (knowledge, attitude and practice) related to the prevention of AIDS among young male MSM (man sex with man) in China, and to evaluate the comprehensive ability of AIDS prevention and associated factors to provide a scientific basis for the development of MSM AIDS prevention and control. Methods: From November to December 2019, sampling was recruited by using snowball sampling methods centered on Beijing and Tianjin. A cross-sectional survey of 222 young students MSM was conducted through an online questionnaire with information of general demographic characteristics, sexual behavior and HIV testing, psychological status and comprehensive ability to prevent AIDS. Results: Average score on comprehensive AIDS prevention knowledge was (87.64±6.41),with knowledge,attitude,and behavior score of (11.32±1.67)(54.87±3.36) and (52.18±4.30) respectively.The pass rate of knowledge, attitude, practice related to AIDS prevention were respectively 95.5%, 56.3%, and 27.0%. The separation rate of knowledge from belief was 42.8%, the separation rate of knowledge from behavior was 71.2%, and the separation rate of faith from information was 48.2%. Whether have received AIDS prevention education was related to knowledge qualification rate (P<0.01). Conclusion Current AIDS education is associated with the knowledge level of AIDS prevention among young MSM groups, but it is not enough to improve their attitudes and behaviors. The comprehensive ability of MSM in preventing AIDS among young students is still not optimistic. Intervention measures need to be further strengthened to improve the comprehensive ability of young students MSM group to prevent AIDS.

Objective: To identify the characteristics of social network and the association between ego-centric network and HIV status among young MSM Chinese students. Methods: The cross-sectional study was conducted in Chongqing, Tianjin, Harbin and Xi an city from April to December 2017 and from March to May 2018. A mixed recruitment method of snowball sampling and RDS approach was used to recruit participants who reported information on social network and received HIV test. The Multiple Regression Analysis method was used to for the analysis of association between ego-centric social network and HIV status of men who have sex with men (MSM) among young students. Results: The sample included 547 participants who nominated 1 088 social partners in total with average age of 13 to 60 years old. The MSM with different sexual orientation from their social members (aOR=0.38), embedded in a large network (aOR=0.63), with a high individual betweenness centrality (aOR=0.27) were at lower risk of HIV-positive status; while MSM who differed greatly in education level with their social members(aOR=1.60), existed in sexual networks(aOR=1.41), existed in the “risky networks” (aOR=1.88) , with high network density (aOR=1.91) and a high individual degree (aOR=4.10) had higher risk of HIV-positive status(P<0.05). Conclusion MSM with great difference in education level from social members, existed in sexual networks, with a large network density and a high degree were exposed to higher risk of HIV-positive status.

Objective: To develop the Evaluation Sacle for the Comprehensive Ability of HIV/AIDS prevention among Chinese Young Students(hereinafter referred to as the Evaluation Scale). Methods: The Evaluation Scale was preliminarily developed according to standardized preparation procedures of the scales. Firstly, the item pool of the Evaluation Scale was established via literature review and group discussions, and based on the Fourteen Core knowledge of young students HIV/AIDS prevention and control formulated by the Chinese Center for Disease Control and Prevention. Secondly, the Evaluation Scale was preliminarily formed via using the Delphi method to select items. Results: The Evaluation Scale with 85 items was finally formed including four vertical dimensions of knowledge, attitude, behavior and skills and four horizontal dimensions of hazard, prevention, detection and treatment, laws and regulations via literature research, group discussion and two rounds of Delphi method. Conclusion The Evaluation Scale developed in this paper is scientific and reasonable for constructing is assumed to be a scientific and reasonable proxy tool for the evaluation of the comprehensive ability of young students to prevent AIDS. It can be used for AIDS prevention education or effect assessment before and after intervention.

Objective To investigate the effect of effective fractions from Radix Vitis Davidii Foex. on fracture healing. Methods SD rats were randomly divided into model control group,Yunnan Baiyao group,and effective fraction group (n= 36 each group). Fracture models were established. Rats in the Yunnan Baiyao group and effective fraction group were given 3.0 g?kg-1?d-1 of Yunnan Baiyao and effective fraction from Radix Vitis Davidii Foex.,respectively,and rats in the model control group was treated with the same volume of pure water. Alkaline phosphatase and Ca concentration in serum were determined.For radius fracture structure,digital radiography and RT-PCR detection of VEGF mRNA expression were performed. Results The peak concentration of the alkaline phosphatase and Ca concentration in serum were significantly higher in the effective fraction group than in the Yunnan Baiyao group,and peak value appeared earlier,fracture healing score was higher, fracture line disappeared earlier,and VEGF mRNA expression was significantly higher in three weeks after the fracture (all P<0. 01) . Conclusion The effect of the effective fraction from RadixVitis Davidii Foex.on the fracture healing is strong.

BACKGROUND:There are many methods in the clinic to treat pelvic fractures, mainly conservative treatment, internal fixation and external fixation. Conservative treatment often causes complications due to poor reduction after fractures. Fixation has good effects on repair of unstable fractures, but fixation is seldom used for pelvic fractures.
OBJECTIVE:To observe the effects of internal fixation on unstable pelvic fractures, and compare with conservative treatment and external fixation.
METHODS:126 cases of unstable pelvic fractures from Longhua District People’s Hospital of Shenzhen City from January 2008 to June 2014 were divided into three groups:conservative treatment group, external fixation group and internal fixation group (n=42). After treatment, patients received X-ray examination. Lindahl imaging criteria were used as evidence. The quality of fracture reduction was evaluated. Patients were regularly fol owed up after treatment. The recovery of limb function was evaluated according to Majeed standard. Repair effects, the excel ent and good rates of fracture healing and cal us growth were evaluated in the last fol ow-up.
RESULTS AND CONCLUSION:During the last fol ow-up, the total efficiency was 81%in the internal fixation group, 69%in the conservative treatment group, and 71%in the external fixation group, and results were significantly better in the internal fixation group than in the other two groups (P<0.05). The Lindahl and Majeed scores were significantly higher in the internal fixation group than in the other two groups (P<0.05). These results suggest that internal fixation for unstable pelvic fracture obtained better recovery effects and efficiency than conservative treatment and external fixation. Thus, the internal fixation is more suitable for patients with unstable pelvic fractures.