Background Polystyrene microplastics (PS-MPs) attract widespread public attention due to their adverse effects on mammalian reproductive systems. However, it is currently unclear whether ferroptosis is related to testicular damage and decreased sperm quality in mice exposed to PS-MPs. Objective To clarify the reproductive damage in male mice exposed to PS-MPs and investigate the mechanism of ferroptotic effects. Methods Five-week-old male BALB/c mice were randomly divided into four experimental groups, including one control group and three PS-MPs groups at low dose (0.5 mg·kg⁻¹), medium dose (5 mg·kg⁻¹), and high dose (50 mg·kg⁻¹), respectively, with 6 mice in each group. The treatment was delivered by gavage for 35 consecutive days (one time per day). After the mice were neutralized, the wet weights of testis and epididymis were measured, and organ coefficients were then calculated. Sperm was counted by hematimetry, and sperm motility and adenosine triphosphate (ATP) level were evaluated using CCK-8 and CellTiter Glo ® Kit 2.0 Assay respectively. In addition, serum testosterone, follicle-stimulating hormone, and luteinizing hormone were determined using ELISA kit, total testicular iron content was measured using tissue iron kit, and pathological changes in testicular tissue were observed after hematoxylin-eosin (HE) staining. We also used glutathione (GSH), malondialdehyde (MDA), and superoxide dismutase (SOD) assays to examine their changes to better understand the physiological status of testicular tissue. Finally, the expression levels of ferroptosis-associated proteins glutathione peroxidase 4 (GPX4) and solute carrier family 7 member 11 (SLC7A11) were detected by Western blotting. Results Compared with the control group, the testicular index in the high dose group decreased, and the epididymal index decreased in all dose groups (P<0.05). The results of sperm quality analysis showed that the sperm count in each dose group was lower than that of the control group; the sperm motility decreased, sperm malformation rate increased, and ATP level in sperm decreased in the medium and high dose groups. The results of HE staining showed that the spermatogenic epithelium was disordered and the arrangement of spermatogenic cells were loose in the low dose group, the spermatogenic gap was enlarged in the middle dose group, and the cells in the high dose group were vacuolated and even azoospermic. The results of serum sex hormone levels showed that the serum testosterone levels decreased in each dose group, the serum follicle-stimulating hormone levels decreased in the medium and high dose groups, and the serum luteinizing hormone levels decreased in the high dose group (P<0.05). The iron content in the testicular tissue homogenate of the high dose group increased (P<0.05). The levels of GSH and SOD in the homogenate of testicular tissue decreased in the medium and high dose groups, while the levels of MDA increased (P<0.05). The results of Western blotting showed that the protein expression level of GPX4 in the testis in the high dose group was lower than that in the control group. The protein expression levels of SLC7A11 in the medium and high dose groups were lower than that in the control group. The results of correlation analysis showed that the expression level of GPX4 was positively correlated with sperm count, and negatively correlated with MDA level (P<0.05). SLC7A11 expression level was positively correlated with sperm count, and negatively correlated with sperm malformation rate and MDA level (P<0.05). Conclusion PS-MPs exposure leads to decreased sperm quality, testicular damage, and decreased serum sex hormone levels in male mice, and its mechanism of action may involve ferroptosis.

Purpose: Molecular residual disease (MRD) is a promising biomarker in colorectal cancer (CRC) for prognosis and guiding treatment, while the whole-exome sequencing (WES) based tumor-informed assay is standard for evaluating MRD based on circulating tumor DNA (ctDNA). In this study, we assessed the feasibility of a fixed-panel for evaluating MRD in CRC. Materials and Methods: Seventy-five patients with resectable stage I-III CRC were enrolled. Tumor tissues obtained by surgery, and preoperative and postoperative day 7 blood samples were collected. The ctDNA was evaluated using the tumor-agnostic and tumor-informed fixed assays, as well as the WES-based and panel-based personalized assays in randomly selected patients. Results: The tumor-informed fixed assay had a higher preoperative positive rate than the tumor-agnostic assay (73.3% vs. 57.3%). The preoperative ctDNA status failed to predict disease-free survival (DFS) in either of the fixed assays, while the tumor-informed fixed assay-determined postoperative ctDNA positivity was significantly associated with worse DFS (hazard ratio [HR], 20.74; 95% confidence interval [CI], 7.19 to 59.83; p < 0.001), which was an independent predictor by multivariable analysis (HR, 28.57; 95% CI, 7.10 to 114.9; p < 0.001). Sub-cohort analysis indicated the WES-based personalized assay had the highest preoperative positive rate (95.1%). The two personalized assays and the tumor-informed fixed assay demonstrated same results in postoperative landmark (HR, 26.34; 95% CI, 6.01 to 115.57; p < 0.001), outperforming the tumor-agnostic fixed panel (HR, 3.04; 95% CI, 0.94 to 9.89; p=0.052). Conclusion Our study confirmed the prognostic value of the ctDNA positivity at postoperative day 7 by the tumor-informed fixed panel. The tumor-informed fixed panel may be a cost-effective method to evaluate MRD, which warrants further studies in future.

Traumatic brain injury (TBI) has been recognized as a risk factor for developing dementia. Currently, around 69 million people worldwide suffer from TBI each year, while the overall incidence of TBI among Chinese residents is on a rapid rise. Such a large population of TBI patients may lead to a future surge in the number of dementia patients, bringing heavy burdens on families and societies. However, it seems to be suggested by numerous studies that not all TBI patients are associated with an increased risk of dementia. Dementia can result in disability as well as interfere with caregivers ′ normal lives. Therefore, it will be significant to clarify the relationship between TBI and dementia as well as explain the process of onset and development of post-TBI dementia. In this study, the authors summarize post-TBI dementia from aspects of influencing factors and pathogenic mechanisms, so as to provide relevant references for related studies, therapy, and prophylaxis of post-TBI dementia.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Objective:To evaluate the clinical efficacy of channel screw guided by O-arm navigation for the treatment of type II fragile fracture of pelvis (FFP) in the elderly.Methods:A retrospective cohort analysis was performed on clinical data of 37 patients with type II FFP admitted to Shanghai Pudong Hospital, Fudan University Pudong Medical Center from September 2019 to April 2021. There were 9 males and 28 females, aged 65-82 years [(71.8±10.1)years]. A total of 15 patients receipt channel screw fixation under O-arm navigation (surgical group) and 22 patients were treated conservatively (non-surgical group). The visual analogue scale (VAS) and Majeed functional score were compared between the two groups at emergency visit and at 1 week, 1 month, 3 months, 6 months after treatment. The accuracy of screw insertion and complications were also recorded during treatment and follow-up.Results:All patients were followed up for 6-18 months [(13.2±5.1)months]. There were no significant differences in the VAS and Majeed functional score between the two groups at emergency visit (all P>0.05). In both groups, lower VAS and higher Majeed functional score were found at 6 month after treatment as compared with those at emergency visit (all P<0.01). The VAS in surgical group was 2(1, 4)points at 1 week after treatment, lower than 4(3, 5)points in non-surgical group ( P<0.01). The VAS in surgical group was 1(1, 2)points at 1 month after treatment, lower than 3(2, 5)points in non-surgical group ( P<0.05). The Majeed functional score in surgical group was (50.2±4.2)points at 1 week after treatment, higher than (40.2±5.6)points in non-surgical group ( P<0.01). The Majeed functional score in surgical group was (73.8±5.2)points at 1 month after treatment, higher than (62.4±5.0)points in non-surgical group ( P<0.01). The two groups had no significant differences in VAS and Majeed functional score at 3 months and 6 months after treatment (all P>0.05). The accuracy of screw insertion in surgical group was 93% (14/15). In surgical group, the complication rate was 13%(2/15), including urinary tract infection in 1 patient and intraoperative screw penetration in 1, with no screw loosening or nerve and vascular injuries. In non-surgical group, the complication rate was 50%(11/22), including urinary tract infection in 5 patients, penetrating pneumonia in 5 and deep vein thrombosis in 1. The complication rate was significantly different between the two groups ( P<0.05). Conclusions:Compared with non-surgical treatment, the channel screw insertion guided by O-arm navigation can achieve precise screw placement, relieve pain early, promote functional recovery, realize accurate insertion of the screw and reduce the complication rate for type II FFP in the elderly.

With the improvement of diagnostic techniques, the diagnostic rate of pancreatic tumors has increased significantly, with a tendency of an earlier age of onset. Since the pancreas is an important endocrine organ, the loss of pancreatic function will have a serious impact on the quality of life of patients. Therefore, function-preserving laparoscopic pancreatic surgery with little trauma is an ideal method for the treatment of benign and low-grade malignant pancreatic lesions and is also a direction for exploration in pancreatic surgery. Pancreatic tumor enucleation, duodenum-preserving pancreatic head resection, and spleen-preserving distal pancreatectomy are commonly used surgical procedures for preserving pancreatic function in clinical practice nowadays. This article introduces commonly used surgical procedures for function-preserving laparoscopic pancreatic surgery and provides some surgical skills to help choose a reasonable surgical procedure and make individualized decisions on pancreatic surgery for patients.

Objective    To evaluate the effectiveness of the artificial intelligence-assisted diagnosis and treatment system in distinguishing benign and malignant lung nodules and the infiltration degree. Methods    Clinical data of 87 patients with pulmonary nodules admitted to the First Affiliated Hospital of Xiamen University from January 2019 to August 2020 were retrospectively analyzed, including 33 males aged 55.1±10.4 years, and 54 females aged 54.5±14.1 years. A total of 90 nodules were included, which were divided into a malignant tumor group (n=80) and a benign lesion group (n=10), and the malignant tumor group was subdivided into an invasive adenocarcinoma group (n=60) and a non-invasive adenocarcinoma group (n=20). The malignant probability and doubling time of each group were compared and its ability to predict the benign and malignant nodules and the invasion degree was analyzed. Results    Between the malignant tumor group and the benign lesion group, the malignant probability was significantly different, and the malignant probability could better distinguish malignant nodules and benign lesions (87.2%±9.1% vs. 28.8%±29.0%, P=0.000). The area under the curve (AUC) was 0.949. The maximum diameter of nodules in the benign lesion group was significantly longer than that in the malignant tumor group (1.270±0.481 cm vs. 0.990±0.361 cm, P=0.026); the doubling time of benign lesions was significantly longer than that of malignant nodules (1 083.600±258.180 d vs. 527.025±173.176 d, P=0.000), and the AUC was 0.975. The maximum diameter of the nodule in the invasive adenocarcinoma group was longer than that of the non-invasive adenocarcinoma group (1.350±0.355 cm vs. 0.863±0.271 cm, P=0.000), and there was no statistical difference in the probability of malignancy between the invasive adenocarcinoma group and the non-invasive adenocarcinoma group (89.7%±5.7% vs. 86.4%±9.9%, P=0.082). The AUC was 0.630. The doubling time of the invasive adenocarcinoma group was significantly shorter than that of the non-invasive adenocarcinoma group (392.200±138.050 d vs. 571.967±160.633 d, P=0.000), and the AUC was 0.829. Conclusion    The malignant probability and doubling time of lung nodules calculated by the artificial intelligence-assisted diagnosis and treatment system can be used in the assessment of the preoperative benign and malignant lung nodules and the infiltration degree.

Objective To investigate the high risk factors for wheezing of low birth weight premature infants with wheezing.Methods A cohort study of 143 premature infants,whose gestation less than 37 weeks and birth weight less than 2 500 g,were collected from Neonatal Intensive Care Unit of Kunming Children's Hospital,from December 2012 to November 2013.Follow-up investigation was conducted,and those with wheezing were enrolled in the study.Many possible factors causing wheezing were analyzed,such as general conditions in the neonatal period,family conditions,and treatment.SPSS 17.0 statistical software was used to analyze the data.Single factor analysis was used by x2 test and rank sum test to evaluate the possible risk factors.Multiple factors analysis was made by Logistic regression analysis.P ＜ 0.05 was viewed as having statistical difference.Results (1) The risk factors for wheezing in the premature infants were:continuous positive airway pressure (CPAP) noninvasive ventilation (x2 =8.531,P =0.003),ventilation (x2 =4.800,P =0.028),caesarean section (x2 =6.787,P =0.009),the use of pulmonary surfactant (x2 =5.455,P =0.020),using antibiotics used at hospital (x2 =5.192,P =0.023),father smoking(x2 =5.406,P =0.020),maternal smoking (x2 =8.531,P =0.003),maternal allergic history (x2 =8.297,P =0.004),compatriot history of allergies (x2 =8.297,P =0.004) or asthma (x2 =9.774,P =0.002),family environment with dust and excitant gas (x2 =12.831,P =0.000) were the risk factors for the wheezing in the low birth weight premature infants.(2)Multi-factor classification Logistic regression analysis showed that CPAP (OR =58.414,95 ％ CI:3.317-1 028.646,P =0.005),mother smoking during pregnancy (OR =11.953,95 ％ CI:1.309-109.120,P =0.028),compatriot history of allergies (OR=135.769,95％ CI:4.914-3 751.419,P =0.004),family environment(OR =83.738,95％ CI:4.416-1 587.982,P =0.003),were independent risk factors for wheezing in low birth weight premature infants;natural labor was protective factor for wheezing in low birth weight premature infants (OR =0.045,95％ CI:0.004-0.574,P =0.017).(3)The sensitivity and specificity of risk factors were analyzed.The highest sensitivity was estimated for the father's history of allergy(83.3％).The highest specificity was estimated for the use of antibiotics at hospital (76.7％).Conclusions The study shows that CPAP noninvasive ventilation,mother smoking during pregnancy,allergy history of their brothers and sisters,family environment with dust and excitant gas are independent risk factors for wheezing in the low birth weight premature infants.There is no single risk factor with both high sensitivity and high specificity.

BACKGROUND:Steroid-induced osteonecrosis of the femoral head (SONFH) is a common bone disease characterized as high morbidity and poor prognosis,but the pathogenesis is unclear.Oxidative stress treatment is closely related to the occurrence and development of SONFH,and has tremendous potential in the treatment of SONFH,which can be realized by Nano-Se.OBJECTIVE:To observe the protective effect of porous Se@SiO2 nanocomposite on chondrocytes by antioxidant stress,and to further explore its mechanism of protection and treatment of SONFH.METHODS:(1) In vitro experiment:The rat chondrocytes were isolated,cultured and identified.Then,the chondrocytes were cultured with porous Se@SiO2 nanocomposite to suppress the production of reactive oxygen species (ROS).(2) In vivo experiment:A total of 36 rats were randomly divided into three groups.Steroid-induced group and experimental group were treated with intraperitoneal injection of lipopolysaccharide and intramuscular injection of methylprednisolone to induce SON FH models.Seven days after modeling,the experimental group was intraperitoneally injected with porous Se@SiO2 nanocomposite.No intervention was done in control group (blank control).At 8 weeks after modeling,rat bilateral femoral heads were taken for hematoxylin-eosin staining and Micro-CT scanning.RESULTS AND CONCLUSION:Results from the ROS detection and TUNEL apoptosis tests showed that the level of ROS in the chondrocytes was significantly reduced after intervention with Se@SiO2 (P ＜ 0.05).Micro-CT scanning findings showed that the bone mineral density,bone volume,bone area/bone volume,trabecular number,trabecular thickness,and trabecular separation in the steroid-induced and experimental groups were significantly different from those in the control group (P ＜ 0.05).Hematoxylin-eosin staining results showed smooth femoral head,normal bone cells,chondrocytes and trabecular bone,as well as few empty bone lacunae and fat cells in the control group,while in the steroid-induced group,there was bone trabecular fracture,fat cell hypertrophy fusion,a large number of empty bone lacunae and obvious osteonecrosis.These manifestations were significantly improved in the experimental group.To conclude,the porous Se@SiO2 nanocomposite has good antioxidative stress ability,suppresses the ROS production and exerts therapeutic effects on SONFH.

ObjectiveTo find incidence rate of no-suicide self injury (NSSI) of junior school students in Dalian city,and to provide some evidences for interventions for them.MethodsRandomly drawn out 1463 junior school students were served as study objects.All objects were evaluated with Ottawa Self-Injury Inventory (OSI) and self-made investigate questionnaire,75 no-suicide self-injury were screening out.ResultsThe incidence ratio of NSSI of junior school students was 5.4％,there were no significant different between the male and female students.The highest incidence ratio was found at 13 years old.The average age for first-time self-harm was (12.24±1.344) years old.There were no significant different between the male and the female students( t=- 1.415,P =0.163 ) ; Cutting Skin was the most common way of NSSI ( 12.0％ ) ; Ideation of 80％ of the NSSI was from their Own Idea.2.7％ of the NSSI can Feel Relief through NSSI behavior.93％ of NSSI was to regulate their mood.100％ students of NSSI against NSSI behavior byReading Books or Listening Music,in which 60％ of NSSI believe the method was helpful to relax their mind.78.5％ of the NSSI resisted NSSI behavior by Watching TV or Playing Games,but they did not get enough effects.60％ NSSI considered themselves without the need to treat.41.3％ of NSSI had never been to treat.2.5％ of NSSI went to hospital for the wound.ConclusionNSSI is often be found in junior school students,and highest ratio is at 13 years old.The most common method of NSSI is Cutting Skin.More NSSI aim is to release their emotion,and self-injury behavior accordance with their inner thoughts.NSSI behavior often is secret,and reading and listening to music is cut off from the relative effective way to conduct.NSSI are seldom to initiative doctor,and education organ,parents and society in a three-dimensional one of the system is necessary.