BACKGROUND:There is still no consensus on the optimal internal fixation for the treatment of Pauwels Ⅲ femoral neck fracture,and most of the related finite element analyses have been performed using a single simplified loading condition,and the biomechanical properties of commonly used internal fixation devices need to be further investigated. OBJECTIVE:To analyze the biomechanical characteristics of Pauwels Ⅲ femoral neck fractures treated with cannulated compression screw,dynamic hip screw,and femoral neck system by finite element method under different loading conditions of single-leg standing loads and sideways fall loads. METHODS:The DICOM data of healthy adult femur were obtained by CT scanning,imported into Mimics 15.0 software to obtain the rough model of bone tissue.The data exported from Mimics were optimized by Geomagics software,and then three internal fixation models were built and assembled with the femur model according to the parameters of the clinical application of the cannulated compression screw,dynamic hip screw,and femoral neck system by using Pro/E software.Finally,the three internal fixation models were imported into Ansys software for loading and calculation to analyze the stress distribution and displacement of the femur and the internal fixation under different working conditions of single-leg standing loads and sideways fall loads,as well as the stress characteristics of the calcar femorale and Ward's triangle. RESULTS AND CONCLUSION:(1)Under the single-leg standing load and the sideways fall load,the proximal femoral stress of the three internal fixation models was mainly distributed above the fracture end of the femoral neck.The peak stress of the proximal femoral end,fracture end,Ward triangle,and calcar femorale of the three internal fixation models were the smallest in the femoral neck system model and the largest in the cannulated compression screw model.(2)Under the single-leg standing load and the sideways fall load,the peak displacement of the proximal femur of the three internal fixation models was all located at the top of the femoral head,and the peak displacement was the smallest in the femoral neck system model and the largest in the cannulated compression screw model.(3)The peak displacement of the three internal fixation models was all located at the top of the internal fixation device under the single-leg standing and sideways fall loading conditions,and the peak displacement values were the smallest in the femoral neck system internal fixation model and the largest in the cannulated compression screw internal fixation model.(4)The internal fixation stress of the three internal fixation models was mainly distributed in the area near the fracture end of the internal fixation device under the single-leg standing and sideways fall loads,and the peak value of internal fixation stress was the smallest in the femoral neck system model and the largest in the cannulated compression screw model.(5)These results suggest that the mechanical stability of the femoral neck system is the best,but there may be a risk of stress shielding of the fracture end and calcar femorale.The stress of the internal fixation device of the femoral neck system is more dispersed,and the risk of internal fixation break is lower.

Objective To investigate the inhibitory effect of Sauchinone(Sch)on renal tissue fibrosis and to explore its mechanism in unilateral ureteral obstruction(UUO)mice.Methods Forty male ICR mice were divided into Sham,UUO-Model,Sch Low-dose,Sch High-dose,and positive control(Val)groups.Mice in the sham group underwent isolation of the left renal ureter without ligation,and mice in the UUO-Model group underwent stripping of the left proximal ureter for double ligation.Starting on day 2 after surgery,the Sch Low-dose group received 10 mg/kg Sch,the Sch High-dose group received 30 mg/kg Sch,and the Val group received 100 mg/kg valsartan by gavage once daily for 4 weeks.At the end of drug administration,serum creatinine(SCr),blood urea nitrogen(BUN),and the inflammatory factors tumor necrosis factor(TNF)-α and interleukin(IL)-6 were measured.Superoxide dismutase(SOD)activity,and malondialdehyde(MDA)and reactive oxygen species(ROS)content were detected in renal tissues.TNF-α and IL-6 mRNA levels were detected in renal tissues by reverse transcription-quantitative polymerase chain reaction.Pathological changes and collagen deposition,as well as transforming growth factor(TGF)-β1,Smad3,and connective tissue growth factor(CTGF)protein expression in mouse renal tissues were detected by hematoxylin and eosin and Masson staining,and immunohistochemistry.Collagen Ⅰ,CTGF,Smad3,nuclear factor erythroid 2-related factor 2(Nrf2),heme oxygenase-1(HO-1),and nuclear factor(NF)-κB protein expression in renal tissues were detected by Western Blot.Results SCr,BUN,TNF-α,and IL-6 were all significantly reduced in Sch Low-dose and Sch High-dose mice compared with the UUO-Model group(P＜0.05 or P＜0.01),while SOD activity was significantly higher and MDA and ROS levels were significantly lower in renal tissues(P＜0.05 or P＜0.01),and TNF-α and IL-6 mRNA in renal tissues were significantly reduced(P＜0.05 or P＜0.01).Microscopic observation of swollen renal tubules with thylakoid hyperplasia and collagen fiber deposition was significantly improved.Immunohistochemistry showed a significant reduction in TGF-β1,Smad3,and CTGF protein expression in renal tissues,and Western Blot showed significantly reduced levels of Collagen Ⅰ,CTGF,Smad3,and NF-κB protein expression(P＜0.05 or P＜0.01),while Nrf2 and HO-1 protein expression levels were significantly elevated(P＜0.05 or P＜0.01).Conclusions The amelioration of renal tissue fibrosis by sauchinone may be mediated via anti-inflammatory and antioxidative stress effects that modulate the expression of pro-fibrotic proteins in the TGF-β1/Smad3 signaling pathway.

Purpose To explore the value of deep learning ultrasound radiomics nomogram in assessing the biological characteristics of invasive metastases in invasive breast cancer.Materials and Methods A retrospective collection of ultrasound imaging data from 180 pathologically confirmed invasive breast cancer between January 2021 to December 2022 in Maoming People's Hospital was conducted,with pathological reports indicating the status of lymph node metastasis(LNM),lymphovascular space invasion(LVSI)or perineural invasion(PNI),according to the LNM/LVSI/PNI status,the three indexes were divided into the training cohort and the verification cohort by 8∶2.Based on Pyradiomics and ResNet50 deep learning extractor,1 316 radiomic features and 2 048 deep learning features were extracted,respectively.The random forest machine learning algorithm was employed to develop evaluation models,and the model scores were calculated.The deep learning radiomics nomograms were developed based on the radiomic and deep learning model scores.The receiver operating characteristic curve was used to assess the performance of the models.The Delong test was applied to analyze the performance differences between different models.Results In the evaluation of LNM,LVSI and PNI status,the area under the curve of all the nomogram in the cohorts demonstrated moderate or above assessment performance(≥0.73),with accuracies all greater than 0.70.Specifically,in the LNM evaluation,the area under the curve of the training cohort was 0.97,the accuracy was 0.93,the sensitivity was 0.88 and the specificity was 0.96.Through the Delong test,the assessment performance of the nomograms was superior to the radiomics models(LNM,Z=2.04,P=0.04;LVSI,Z=2.80,P=0.01;PNI,Z=3.52,P<0.01),and was superior to or similar to the deep learning models(LNM,Z=4.52,P<0.01;LVSI,Z=1.86,P=0.06;PNI,Z=0.31,P=0.76)in the training cohort.Conclusion The deep learning radiomics nomogram can effectively evaluate the biological characteristics of invasion and metastasis in invasive breast cancer.The nomogram improves the assessment performance by integrating the radiomic and deep learning feature information.

Objective:To retrieve, evaluate, and integrate the best evidence for preoperative evaluation and management of adult day surgery patients.Methods:The guidelines, evidence summary, systematic review, expert consensus and randomized controlled trial on preoperative evaluation and management of adult day surgery patients were systematically searched on Guidelines International Network, Chinese Clinical Guidelines Library, Clinical Practice Guideline of Canadian Medical Association, Scottish Intercollegiate Guidelines Network, Yimaitong, New Zealand Guidelines Group, China Ambulatory Surgery Alliance, National Institute for Health and Clinical Excellence, Chinese Medical Journal Network, Agency for Healthcare Research and Quality, UpToDate, Cochrane Library, Australian Joanna Briggs Institute Evidence-Based Healthcare Center Database, British Medical Journal (BMJ) Best Practice, PubMed, Web of Science, CINAHL, Elsevier, Embase, Medline, WanFang Data, China National Knowledge Infrastructure, China Biomedical Literature Database and other databases. After conducting methodological quality evaluation, evidence was extracted and integrated based on the theme. The search period was from the establishment of the database to May 15, 2023. Two researchers trained in evidence-based knowledge conducted a rigorous literature quality evaluation, evidence extraction, and integration of all included literature.Results:A total of 12 articles were included, including two guidelines, six evidence summaries, three expert consensus and one randomized controlled trial. A total of 24 pieces of evidence were collected from five aspects, including evaluation timing and evaluation method, evaluation personnel, evaluation location, evaluation content, education and training, and quality improvement.Conclusions:The best evidence for preoperative evaluation and management of adult day surgery patients provides evidence basis for clinical medical and nursing staff to conduct preoperative evaluation and management comprehensively and effectively.

OBJECTIVE：To syst ematically evaluate the effectiveness and safety of ticagrelor versus clopidogrel in the treatment of acute coronary syndrome （ACS）patients in East Asia ，and to provide evidence-based references for clinical drug use. METHODS：Retrieved from Cochrane Library ，PubMed，Embase，CNKI，Wanfang database ，etc.，randomized controlled trials （RCTs）about ticagrelor （trial group ）versus clopidogrel （control group ）in the treatment of ACS patients in east Asia were collected. After literature screening and data extraction ，the quality of included literatures was evaluated by using biasrisk evaluation tool recommended by Co chrane system evaluation manual 5.1.0，and Meta-analysis was performed by using Rev Man 5.3 statistical software. RESULTS ：A total of 5 RCTs were included ，with a total of 4 511 cases. Meta-analysis showed that the incidence of major adverse cardiovascular events [OR ＝0.85，95％CI（0.68，1.04），P＝0.12]，the incidence of death from cardiovascular causes [OR ＝0.76，95％CI（0.57，1.03），P＝0.08] and the incidence of stroke [OR ＝0.77，95％CI（0.48，1.24），P＝0.28]， without statistical significance. The incidence of major bleeding events [OR ＝1.54，95％CI（1.19，1.99），P＝0.001] and minor bleeding events [OR ＝1.80，95％ CI（1.40，2.32），P＜0.000 01] in trial group were significantly higher than control group. CONCLUSIONS：Ticagrelor is comparable to clopidogrel in reduce the major adverse cardiovascular events，death from cardiovascular causes and stroke in ACS patients in East Asian ，but it can increase the risk of major and minor bleeding events.

Objective To explore the influence of prozone effect on anti-nuclear antibodies (ANA) testing by indirect immunofluorescence assay (IIFA).Methods The samples with high titer of ANA (≥1∶1 000) were selected from 880fresh serum samples, and were subsequently diluted in 1∶100, 1∶1 000and 1∶10 000ratio.Prozone effect was defined as fluorescence intensity from 1∶1 000dilution was stronger than that from1∶100dilution.The samples with prozone effect were determined manually or by Sprinter XL and EUROPattern.The samples with prozone effect were further characterized by combinations of fluorescence patterns, fluorescence intensities and autoantibody specificities.Results A total of 880samples were tested.Importantly, 34samples displayed prozone effect (3.86％in total and 29.57％in samples with ANA≥1∶1 000).Interestingly, prozone effect was identified by manual detection as well as by Sprinter XL with similar fluorescence patterns and fluorescence intensities.Notably, EUROPattern can only select the central area for identification.Among all samples with prozone effect, 74.42％samples exhibited fluorescence intensities of≥1∶10 000.Speckled pattern was the most prevalent fluorescence patterns in samples with prozone effect (46.51％).In addition, anti-RNP antibodies (62.79％) were the most popular autoantibodies in samples with prozone effect, followed by anti-dsDNA antibodies (51.16％) and anti-SSA antibodies (51.16％).Conclusion Prozone effect was present in ANA testing, especially in samples with high titers, resulting in underestimating the titers.The study highlighted that special attention should be paid to the prozone effect in clinical practice.

Objective This study aimed to assess the diagnostic value of anti-mutated citrullinated vimentin (MCV) antibodies in rheumatoid arthritis (RA) and its correlation with disease progression, extra-articular manifestations and overlap syndrome. Methods Retrospective Studies. Clinical data of 837 patients in PekingUnionMedicalCollegeHospitalfrom June to August 2017 were collected, including the result of anti-MCV, anti-cyclic citrullinated peptide (anti-CCP) antibodies, rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and High-sensitivity-C-reactive protein (CRP). According to the 1987 American College of Rheumatology classification criteria for rheumatoid arthritis, there were 323 patients diagnosed with RA, including 59 males and 264 females with the average age of 51 years. According to whether the RA patients have overlap syndrome with other autoimmune disease (AID) or have extra-articular manifestations, 258 cases were categorized into RA group, including 47 males and 211 females with the average age of 50 years; 14 cases were categorized into the group of overlap syndrome, including 1 male and 13 females with the average age of 36 years;51 cases were categorized into the group of extra-articular manifestations, including 11 males and 40 females with the average age of 59 years.According to 2010 rheumatoid arthritis classification criteria for destruction in joints, the radiographic changes were divided into 4 stages. There were 203 casesenrolled in our study, 88 caseswere fitted into early stage group (stage I)including 21 males and 67 females with the average age of 48 years; 115 caseswere fitted into progressive stage group, which compromisedstageⅡ (interim stage), stage Ⅲ (severe stage) and stage Ⅳ(final stage) cases, including 19 males and 96 females with the average age of 53 years. Mann-Whitney U test, x2 test, Receiver operating characteristic (ROC) curves and Spearmancorrelation coefficientwere used in Statistical analysis. Results Ⅰ Amongdiagnosed RA patients, 199 (61.6％) cases were positive for anti-MCV, anti-CCP and RFsimultaneously, 42 (13％) cases were positive for anti-MCV, which was higher than anti-CCP positive (1 cases, 0.3％) or RF positive (7cases, 2.2％). The difference was statistically significant(P<0.001, P<0.001). ⅡROC was calculated and MCV=35.95 U/ml was used as best-fit cut-off value. The AUC for anti-MCV was 0.867, while the sensitivity was 80.5％and specificity was 80.9％.ⅢThe detection levels of anti-MCV (682.8 (106.4-1000.0)), anti-CCP (407 (4.0-1536.0)) and RF (82.8 (21.1-244.9)) in the group of progressive stage were higher than those in the group of early stage (114.5 (28.5-1000.0), 62.5 (5.0-1020.7), 50.1 (6.7-127.1)), which showed a significant difference(P<0.05, P<0.05, P<0.05). The anti-MCV, anti-CCP and RF were positively related to the degree of joint destruction (r=0.229, P<0.05;r=0.187, P<0.05;r=0.167, P<0.05);anti-MCV and anti-CCP were positively related to extra-articular manifestation (r=0.152, P<0.05;r=0.136, P<0.05). Conclusion Anti-MCV antibodies are more sensitive in patients with RA, and have complementary diagnostic value for anti-CCP and RF-negative patients; high levels of anti-MCV and anti-CCP in RA patients are associated with RA progression and extra-articular involvement.

Autoantibodies are of great importance to diagnosis , differential diagnosis , curative effect observation and prognosis in autoimmune disease .Presently, there are many problems existing in detection of autoantibodies , such as non-standardized name , non-traceable reagent ,non-consistentdetection process , and results are not mutualrecognized .Administrative departments have attached importance to autoantibody testing, which will lead to the standardization , automation and intelligence of testing ,and will achieve mutual accreditation of laboratory results and better serve for clinics .

Objective To investigate the clinical efficacy of our self-designed sight used to guide thoracic vertebroplasty.Methods A retrospective analysis was conducted of the 52 patients (70 thoracic vertebrae) who had undergone percutaneous vertebroplasty (PVP) (n =36)or percataneous kyphoplasty (PKP) (n =34) of T1-T4 vertebral bodies at Department of Orthopaedics,The First Affiliated Hospital to Zhengzhou University form August 2012 to October 2013.The operation time,intraoperative bleeding,intraoperative radiation by C-arm roentgenography,and visual analogue scale (VAS) were compared between the patients whose surgery had been guided by our self-designed sight and those whose surgery had been not.Results All the patients were followed up for 18 to 36 months (average,22.3 months).Compared with those who had not used the sight,the patients who had used the sight incurred significantly shorter operation time (16.5 ± 3.2 min versus 26.5 ± 3.7 min),significantly less intraoperative bleeding (2.8 ± 1.3 mL versus 6.3 ± 1.7 mL) and significantly less radiation by C-arm roentgenography (5.6 ± 3.3 times versus 9.4 ± 3.1 times) (P ＜0.05).The VAS scores at postoperative 3 days and final follow-up were significantly decreased than the preoperative values in all the patients (P ＜ 0.05).There were no significant differences between the patients who had used the sight and those who had not in the the VAS scores at postoperative 3 days or final follow-up (P ＞ 0.05).Conclusions The upper thoracic PVP or PKP guided by our self-designed sight has theadvantages of short operation time,less intraoperative bleeding and less frequency of C-arm radiation.The sight is suitable for various vertebroplasties.

Objective To retrieve,appraise and summarize the available evidence on management and prevention of implantable venous access port occlusion in adult patients.Methods We searched the BMJ best practice,UpToDate,Cochrane Library,Joanna Briggs Institute Library,Registered Nurses' Association of Ontario,National Guideline Clearinghouse,PubMed,EMbase,CNKI and CBM to collect literatures including guidelines,evidence summary,best practice information sheet,recommended practice,systematic review and consensus.Results Five references including one guideline,one systematic review,two evidence summaries,and one expert consensus were included.A total of eight items of best evidence were summarized with regard to syringe size,flush volume,flush technique and frequency of administration,choose of needleless connectors,management of mechanical occlusion,drug/mineral precipitation,and thrombotic occlusion.Conclusion Healthcare workers should regulate the standard of venous access port flushing and locking and manage catheter occlusion in a timely manner,to avoid adverse incidents like interruptions in treatment,bacteremia,and venous thrombosis.