Objective:To explore the effect of mobile medical intelligent software combined with OBE-CBCL dual-track teaching method in standardized training of orthopaedic residents.Methods:The orthopedic residents who received resident standardized training in our hospital from Jan 2022 to Sep 2022 were selected as the study subjects.The orthopedic residents who received regular teaching method from Jan 2022 to Mar 2022 were group A,orthopedic residents who received mobile medical intelligent software + regular teaching method from Apr 2022 to Jun 2022 were group B,and the orthopedic residents who received mobile medical intelligent software + OBE-CBCL dual-track teaching method from Jul 2022 to Sep 2022 were group C.All three groups participated in the relevant professional theoretical knowledge assessment,Mini-CEX,and satisfaction survey at the time of discharge.Results:The scores of professional theoretical knowledge assessment in groups B and C were higher than that in groups A,and it was higher in group C than that in group B(P＜0.05).The scores of each item of Mini-CEX in groups B and C were higher than those in group A(P＜0.05).Except for clinical judgment ability,the scores of the other items of Mini-CEX in group C was higher than those in group B(P＜0.05).In the satisfaction survey,the scores of deepening knowledge mastery in groups B and C were higher than that in group A,and that in group C was higher than that in group B(P＜0.05).The scores of improving clinical thinking and stimulating learning interest in groups B and C were higher than those in group A(P＜0.05),and the scores of improving team assistance and overall satisfaction in group C were higher than those in groups A and B(P＜0.05).Conclusion:Mobile medical intelligent software combined with OBE-CBCL dual-track teaching can significantly improve teaching effect of orthopaedic resident standardized training.

Objective:To explore the characteristics of glucose and lipid metabolism and intrauterine growth indicators in fetuses with selective intrauterine growth restriction (sIUGR) in twins.Methods:Sixty cases of sIUGR type I twin fetuses who were registered, underwent regular prenatal care, and were hospitalized for delivery at the Fujian Maternity and Child Health Hospital from January 2021 to January 2023 were selected as the research subjects. Selected 30 fetuses with growth restriction from sIUGR pregnant patients were taken as the observation group, while the 30 fetuses with non-growth-restricted served as the control group. During cesarean section, the umbilical vein blood of two fetuses was collected after the fetus was delivered and before the placenta was delivered, and the factors regulating growth, development and metabolism in the umbilical vein blood were detected: adiponectin, leptin, insulin-like growth factor-1 (IGF-1), blood glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1, apolipoprotein B and other indicators. The measurement data of normal distribution are presented as xˉ± s, and the comparison of means between the two groups is performed using paired t-tests. P<0.05 was considered statistically significant. Results:(1) The levels of adiponectin (83.60±8.91) μg/L, leptin (7.11±0.53) μg/L, and IGF-1 (43.43±0.68) μg/L in the umbilical cord blood of the case group were significantly lower than those of the control group (92.50±10.52) μg/L, leptin (12.00±0.66) μg/L, and IGF-1 (70.34±1.44) μg/L, with statistically significant differences ( t-values of 2.94, 31.33, 99.70, respectively; P values of 0.006, <0.001, <0.001, respectively). (2) There was no statistically significant difference in the levels of blood glucose, triglycerides, HDL-C, and apolipoprotein A1 in umbilical cord blood between the two groups of fetuses (all P>0.05). (3) The total cholesterol (2.626±0.764) mmol/L, LDL-C (1.168±0.482) mmol/L, and apolipoprotein B (0.359±0.133) mmol/L in the umbilical cord blood of the case group were significantly higher than those in the control group, with total cholesterol (2.351±0.725) mmol/L and LDL-C (1.043±0.418) mmol/L. Apolipoprotein B was (0.317±0.107) mmol/L, and there was a statistically significant difference between the two groups ( t-values were 3.42, 3.10, and 3.67, respectively; and P values were 0.002, 0.004, and 0.001, respectively). Conclusion:There are abnormalities in lipid metabolism present in the cord blood of growth-restricted infants. Clinically, adiponectin, leptin, IGF-1, total cholesterol, LDL-C, and apolipoprotein B in twin umbilical blood can be served as key indicators for assessing fetal intrauterine development.

Objective To validate the mechanism of Mori Cortex-Lycii Cortex(MCLC)in intervening acute lung injury(ALI)based on network pharmacology,molecular docking combined with animal experiments.Methods The TCMSP database was used to obtain the active components of MCLC;the SwissTargetPrediction database was used to predict the targets of active components;the GeneCards database and DisGeNET database were used to collect the disease targets of ALI;the key targets were screened by constructing a PPI network,and the key targets were subjected to GO and KEGG pathway enrichment;a drug-component-target-pathway network was constructed using Cytoscape software;AutoDock and PyMOL software were used to validate the molecular docking of some of the compounds and targets;LPS was used to establish a mouse model of ALI for experimental validation,and experimental validation was performed to main targets and pathways.Results Totally 44 active components of MCLC and 138 action targets were obtained;26 potential targets of MCLC intervention in ALI were obtained,mainly TNF,EGFR,NFKB1,MPO,TNFRSF1A,NOX4,etc.,and the key pathways were MAPK signaling pathway,IL-17 signaling pathway,NF-κB signaling pathway,etc.;molecular docking results showed that the core active components of MCLC and the main targets had strong binding activities;animal experiments showed that MCLC at medium and high dosages could effectively improve the lung histopathological damage in ALI mice,decrease the contents of IL-6 and TNF-α in serum(P<0.01),and increase IL-10 content(P<0.01);MCLC inhibited protein expressions of EGFR,PI3K,AKT,NF-κB p65 in lung tissue(P<0.01).Conclusion MCLC may intervene ALI by components such as quercetin and buddleoside,acting on targets including EGFR and TNF,through ulti-pathways of EGFR/PI3K/NF-κB signaling pathway,etc.

Heat shock proteins (HSPs) widely exist in all organisms, the structures of which are usually extraordinarily conservative. They are also well-known stress proteins that are involved in response to physical, chemical and biological stresses. HSP70 is an important member of the HSPs family. In order to study the roles of amphibians HSP70 during infection, the cDNA sequence of Rana amurensis hsp70 family genes were cloned by homologous cloning method. The sequence characteristics, three-dimensional structure and genetic relationship of Ra-hsp70s were analyzed by bioinformatics methods. The expression profiles under bacterial infection were also analyzed by real-time quantitative PCR (qRT-PCR). Expression and localization of HSP70 protein were tested by immunohistochemical techniques. The results showed that three conservative tag sequences of HSP70 family, HSPA5, HSPA8 and HSPA13, were found in HSP70. Phylogenetic tree analysis indicated four members are distributed in four different branches, and members with the same subcellular localization motif are distributed in the same branch. The relative expression levels of the mRNA of four members were all significantly upregulated (P < 0.01) upon infection, but the time for up-regulating the expression levels were diverse in different tissues. The immunohistochemical analysis showed that HSP70 was expressed to different degrees in the cytoplasm of liver, kidney, skin and stomach tissue. The four members of Ra-hsp70 family have ability to respond bacterial infection to varying degrees. Therefore, it was proposed that they are involved in biological processes against pathogen and play different biological functions. The study provides a theoretical basis for functional studies of HSP70 gene in amphibians.
Heat-Shock Proteins/genetics* ; Phylogeny ; Amino Acid Sequence ; HSP70 Heat-Shock Proteins/metabolism* ; Stress, Physiological

OBJECTIVE: To investigate the effect of ultrasonic bone curette in anterior cervical spine surgery. METHODS: A clinical data of 63 patients with cervical spondylosis who were admitted between September 2019 and June 2021 and met the selection criteria was retrospectively analyzed. Among them, 32 cases were operated with conventional instruments (group A) and 31 cases with ultrasonic bone curette (group B). There was no significant difference between the two groups (P>0.05) in gender, age, surgical procedure, surgical segment and number of occupied cervical space, disease type and duration, comorbidities, and preoperative Japanese Orthopaedic Association (JOA) score, cervical dysfunction index (NDI), and pain visual analogue scale (VAS) score. The operation time, intraoperative bleeding, postoperative drainage, postoperative hospital stay, and the occurrence of postoperative complications were recorded in both groups. Before operation and at 1, 3, and 6 months after operation, the JOA score and NDI were used to evaluate the function and the postoperative JOA improvement rate was calculated, and VAS score was used to evaluate the pain improvement. The anteroposterior and lateral cervical X-ray films were taken at 1, 3, and 6 months after operation to observe whether there was any significant loosening and displacement of internal fixators. RESULTS: Compared with group A, group B had shorter operation time and postoperative hospital stay, less intraoperative bleeding and postoperative drainage, and the differences were significant (P<0.05). All incisions healed by first intention in the two groups, and postoperative complications occurred in 5 cases (15.6%) in group A and 2 cases (6.5%) in group B, showing no significant difference (P>0.05). All patients were followed up 6-12 months (mean, 7.9 months). The JOA score and improvement rate gradually increased in groups A and B after operation, while the VAS score and NDI gradually decreased. There was no significant difference in VAS score between 3 months and 1 month in group B (P>0.05), and there were significant differences between the other time points of each indicator in the two groups (P<0.05). At 1, 3, and 6 months after operation, the JOA score and improvement rate in group B were better than those in group A (P<0.05). X-ray films examination showed that there was no screw loosening or titanium plate displacement in the two groups after operation, and the intervertebral cage or titanium mesh significantly sank. CONCLUSION Compared with traditional instruments, the use of ultrasonic bone curette assisted osteotomy in anterior cervical spine surgery has the advantages of shorter operation time, less intraoperative bleeding, less postoperative drainage, and shorter hospital stay.
Humans ; Ultrasonics ; Retrospective Studies ; Titanium ; Postoperative Complications/epidemiology* ; Bone Plates ; Cervical Vertebrae/surgery*

OBJECTIVE: To investigate the early effectiveness of the Ti-Robot assisted femoral neck system (FNS) in the treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures. METHODS: A retrospective analysis was conducted on the clinical data of 41 elderly patients with Garden type Ⅱ and Ⅲ femoral neck fractures who were admitted between December 2019 and August 2022 and met the selection criteria. Among them, 21 cases were treated with Ti-Robot assisted FNS internal fixation (study group), and 20 cases were treated solely with FNS internal fixation (control group). There was no significant difference in baseline data, including gender, age, side, cause of injury, time from injury to surgery, fracture Garden classification, and fracture line classification, between the two groups ( P>0.05). Surgical effectiveness was evaluated based on parameters such as operation time (including incision time and total operation time), reduction level, number of dominant pin insertions, intraoperative fluoroscopy frequency, incision length, whether to extend the incision, need for assisted reduction, postoperative hospital stay, fracture healing time, incidence of osteonecrosis of the femoral head, postoperative visual analogue scale (VAS) score at 1 day, and Harris hip score at last follow-up. RESULTS: The study group showed significantly shorter incision time, fewer dominant pin insertions, fewer instances of extended incisions, fewer intraoperative fluoroscopy frequency, and smaller incisions than the control group ( P<0.05). There was no significant difference in total operation time, reduction level, and assisted reduction frequency between the two groups ( P>0.05). Both groups achieved primary wound healing postoperatively, with no complications such as incision leakage or skin infection. All patients were followed up 12-24 months with an average of 14.6 months. Fractures healed in both groups, with no significant difference in healing time ( P>0.05). There was no significant difference in postoperative hospital stay between the two groups ( P>0.05). The study group showed significantly better VAS score at 1 day after operation and Harris hip score at last follow-up when compared to the control group ( P<0.05). No complication such as internal fixation failure, fracture displacement, or hip joint varus occurred in both groups during the follow-up. Osteonecrosis of the femoral head occurred in 1 patient of the control group, while no was observed in the study group, and the difference in the incidence of osteonecrosis of the femoral head between the two groups was not significant ( P=0.488). CONCLUSION Compared to sole FNS internal fixation treatment, Ti-Robot assisted FNS internal fixation for elderly Garden typeⅡ and Ⅲ femoral neck fractures can reduce incision time, achieve minimally invasive and accurate nail implantation, and decrease intraoperative fluoroscopy frequency, leading to improved postoperative hip joint function recovery.
Humans ; Aged ; Femur Neck ; Robotics ; Retrospective Studies ; Treatment Outcome ; Titanium ; Femoral Neck Fractures/surgery* ; Fracture Fixation, Internal ; Osteonecrosis ; Surgical Wound

Objective:To analyze the factors influencing the success rate of external cephalic version (ECV) and to create a preoperative scoring scale for stratified management of pregnant women who were preparing for ECV.Methods:This prospective study was conducted on singleton pregnant women who underwent ECV without anesthesia in Fujian Maternity and Child Health Hospital from January 1, 2017, to December 31, 2019. Univariate (two independent samples t-test, Mann-Whitney U test, and Chi-square test) and multivariate logistic regression were used to screen the clinical characteristics affecting the success of ECV, and receiver operating characteristic (ROC) curve was used to determine the cut-off value and convert quantitative variables into dichotomous variables. The independent variables were scored according to the regression coefficient in multivariate logistic regression analysis, and then a preoperative scoring scale was created. The ROC curve was used to calculate the cut-off value for the scoring scale. The subjects were divided into low and high score groups according to the cut-off value. The area under the ROC curve was used for evaluating the effectiveness of the scale in predicting the success of ECV. The success rate of ECV, difficulty of the operation and mode of delivery were compared between the two groups. Results:A total of 1 338 pregnant women met the inclusion criteria during the study period. After the exclusion of 885 women, 165 refused ECV in favor of direct cesarean section, 27 spontaneously converted to cephalic position before ECV, 261 who voluntarily accepted ECV were finally enrolled. ECV succeeded in 202 cases and failed in 59. (1) Favorable factors for ECV without anesthesia were the distance between the fetal breech and ischial spine <－3.5 cm ( OR=0.177, 95% CI: 0.071-0.438, P=0.009), the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm ( OR=0.225, 95% CI: 0.094-0.537, P=0.001), amniotic fluid index ≥12 cm ( OR=0.399, 95% CI: 0.164-0.969, P=0.042), the surgeon's ability to hold the fetal head or breech with one hand ( OR=0.241, 95% CI: 0.098-0.589, P=0.002; OR=0.219, 95% CI: 0.087-0.546, P=0.001), and the fetal head located on the right or left upper abdomen of the mother ( OR=0.184, 95% CI: 0.059-0.568, P=0.003; OR=0.253, 95% CI: 0.084-0.760, P=0.014). (2) The area under the ROC curve of the preoperative score for predicting the success of ECV was 0.881 (95% CI: 0.821-0.941) and the cut-off value was 5.5. The subjects were divided into low (0-5 scores) and high (6-11 scores) score groups and the area under the ROC curve for predicting the success of ECV by grouping was 0.843 (95% CI: 0.774-0.912). Compared with the low score group, the high score group had a shorter ECV duration [2.0 min (0.5-10.0 min) vs 10.0 min (0.9-25.8 min), Z=－6.83, P<0.001], less attempts [1.0 times (1.0-4.0 times) vs 3.0 times (1.0-5.0 times), Z=－8.41, P<0.001], higher success rate [92.7% (190/205) vs 21.4% (12/56), χ2=127.64, P<0.001], higher rate of vaginal birth [75.4% (147/195) vs 18.5% (10/54)] and lower cesarean section rate [24.6% (48/195) vs 81.5% (44/54)] ( χ2=58.70, P<0.001). Conclusions:Preoperative scoring based on the factors influencing the success rate of ECV (the distance between the fetal breech and ischial spine, the sum of the fundal height and the station of the fetal breech based on the ischial spine <30.25 cm, amniotic fluid index ≥12 cm, the surgeon's ability to hold the fetal head or breech with one hand, and the fetal head locating on the right or left upper abdomen of the mother) is conducive to the individualized evaluation of the difficulty and the success rate of ECV as well as the success rate of vaginal delivery after ECV, which can provide a reference for clinical stratified management of ECV patients.

Preeclampsia is a kind of idiopathic disease during pregnancy. Its pathogenesis may involve many factors, such as mother, placenta and fetus. The study found that the abnormal metabolism of blood glucose and blood lipid during pregnancy may be closely related to the onset of preeclampsia. This paper reviews the research progress of abnormal glycolipid metabolism in preeclampsia at home and abroad in order to better guide the management of related aspects during pregnancy.

Objective:To study the effects of trioxygen pretreatment on cerebral ischemia/reperfusion (I/R) injury in rats.Methods:A total of 24 clean grade male Sprague-Dawley (SD) rats were randomly divided into Sham group, brain I/R group (I/R group) and Ozone pretreatment group (Ozone group), with 8 rats in each group. The animals were routinely fed, and the operation was performed 5 days after the intervention of Ozone group by intraperitoneal injection of trioxygen water (concentration 80 mg/L, 0.01 mL/g), and the Sham group and I/R group were injected with equal volume normal saline. The Sham group only separated the arteries without ligation, and the I/R group and Ozone group established the rat cerebral I/R model. Neurological deficit score (NDS) was performed 2 hours after ischemia and modified neurological deficit score (mNSS) was performed 24 hours after reperfusion. Brain tissue was collected after anesthesia. Cerebral infarction was observed by 2, 3, 5-triphenyltetrazolium chloride (TTC) staining and the percentage of cerebral infarction volume was calculated. Protein expression of metabolic glutamate receptor 5 (mGluR5) and ionic glutamate α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPAR) subunit GluA2 in cerebral ischemic penumbra was determined by Western blotting.Results:Compared with the Sham group, NDS score, mNSS score and percentage of cerebral infarction volume in I/R group were increased [NDS score: 2.63±0.52 vs. 0, mNSS score: 9.63±1.19 vs. 1.13±0.64, cerebral infarction volume: (41.25±2.93)% vs. 0%, all P < 0.05], and expressions of mGluR5 and GluA2 in penumbra area of cerebral ischemia were decreased [mGluR5 protein (mGluR5/β-actin): 0.44±0.14 vs. 1.00±0.10, GluA2 protein (GluA2/β-actin): 0.23±0.08 vs. 1.00±0.25, both P < 0.05]. Compared with the I/R group, mNSS score and percentage of cerebral infarction volume in the Ozone group were decreased [mNSS score: 7.00±1.20 vs. 9.63±1.19, cerebral infarction volume: (27.23±6.21)% vs. (41.25±2.93)%, both P < 0.05], and mGluR5 and GluA2 expressions in the penumbra of cerebral ischemia were up-regulated [mGluR5 protein (mGluR5/β-actin): 0.81±0.10 vs. 0.44±0.14, GluA2 protein (GluA2/β-actin): 0.76±0.13 vs. 0.23±0.08, both P < 0.05]. Conclusion:Trioxygen preconditioning can alleviate cerebral I/R injury in rats, and its mechanism may be related to the upregulation of GluR5 and GluA2 in the ischemic penumbra.

Objective:The aim of this study is to analyze risk factors and perinatal outcomes of fetal growth restriction (FGR) in the third trimester to improve pregnancy outcomes.Methods:The retrospective study collected 676 fetus, included 338 FGR and 338 appropriate for gestational infants. All samples were collected between January 1st 2014 and January 1st 2016 from Fujian Provincial Maternity and Children's Hospital. Multivariate logistic regression analysis was used to analyze the risk factors and pregnancy outcomes of fetal growth restriction between FGR and control group.Results:⑴ Multivariate logistic regression analysis showed that the independent risk factor of FGR was severe preeclampsia for 28-33 + 6 weeks FGR. The independent risk factors of 37-40 + 6 weeks FGR were severe preeclampsia, oligohydramnios, velum attachment of cord and cord around neck. ⑵ Compared with the control group of the same gestational week, the fetal distress rate, 1 minute asphyxia rate of newborn and cesarean section rate of FGR in the 28-33 + 6 gestational week group were all higher than those in the same gestational week group ( P<0.05). ⑶ The fetal distress in FGR group was more than in cesarean delivery that in vaginal delivery at 28-33 + 6 weeks of gestation, and that in FGR group was more than that in vaginal delivery at 34-36 + 6 weeks of gestation ( P<0.05). Conclusions:Severe preeclampsia, oligohydramnios, velum attachment of umbilical cord and cord around the neck are the independent risk factors of FGR in the third trimester. During pregnancy, early intervention such as screening in high risk pregnant women and fetal intrauterine monitoring should be carried out to improve the perinatal outcome.