BACKGROUND:The traditional fixation method for femoral neck fractures is three hollow screws inverted triangle fixation,and the optimal fixation method for femoral neck fractures that have not achieved anatomical reduction is inconclusive. OBJECTIVE:To compare the biomechanical properties of cannulated screws internal fixation for sub-capitated femoral neck fracture with different reduction qualities based on finite element analysis. METHODS:The three-dimensional digital model was reconstructed using CT data of the proximal femur from a healthy male volunteer.The femur was modeled to sub-capitated femoral neck fractures.Fracture models were divided into anatomical reduction group,coxa vara group,and coxa valgus group.All fracture model groups were transferred using the standard group,screw depression group,and screw elevation group.A vertical downward stress of 1 400 N was applied to the femoral head at the top of the acetabulum.The displacement and stress distribution of the femur and internal fixator under different fixation methods were observed,and the maximum stress and displacement of the femur and fixator were compared. RESULTS AND CONCLUSION:(1)For anatomical reduction femoral neck fracture,the peak stress of fixation in the standard group,screw depression group and screw elevation group was 41.35,31.27 and 43.32 MPa,respectively.The maximum peak stress of the femur was found on the screw elevation group(28.58 MPa),and the standard group had the maximum peak displacement.(2)During hip varus,the stresses in the three subgroups were relatively dispersed and even.The peak stress of the femur in the standard group was the smallest,but the peak displacement was the largest.The stability of fixation might be poor.The peak displacement of the femur in the screw depression group was the smallest.(3)In the hip valgus,obvious screw stress concentration appeared in the screw depression group,and the peak displacement was the largest among the three subgroups,and an in-out-in phenomenon appeared.The peak stress of the screws in the screw elevation group was the largest among the three subgroups,but the peak displacement was the smallest.(4)It is concluded that for sub-capitated femoral neck fractures that are completely anatomically reduced,it is recommended to use standard inverted triangular nails for fixation.When the hip varus and hip valgus occur within the allowable range of the reduction standard,it is recommended to use the inverted triangle screw to fix it by rotating the corresponding angle in the same direction as the hip varus or valgus.

Forest encephalitis is a natural focal disease transmitted through the bite of hard ticks, and its pathogen is the tick-borne encephalitis virus from the Flaviviridae family. The mortality rate of forest encephalitis is relatively high, making laboratory testing significant in diagnosing this disease. This article elaborates on the etiological diagnostic methods and recent research progress in forest encephalitis. Laboratory tests for forest encephalitis mainly include routine examinations, serological tests, virus isolation, and molecular biological testing. The detection of serum-specific IgM antibodies against the forest encephalitis virus is of great importance for early diagnosis, and specific IgG antibodies serve as a "gold standard" for differentiation from other diseases. Techniques such as enzyme-linked immunosorbent assay (ELISA) or indirect immunofluorescence assay for detecting specific IgM antibodies in serum and/or cerebrospinal fluid, the serum hemagglutination inhibition test or serum complement fixation test, and the double serum hemagglutination inhibition test or complement fixation test all contribute to the early diagnosis. The development of molecular testing methods is rapid, and techniques such as metabolomics, digital PCR, and matrix metalloproteinases are also applied in the early diagnosis of forest encephalitis.

Forest encephalitis is a natural focal disease transmitted through the bite of hard ticks, and its pathogen is the tick-borne encephalitis virus from the Flaviviridae family. The mortality rate of forest encephalitis is relatively high, making laboratory testing significant in diagnosing this disease. This article elaborates on the etiological diagnostic methods and recent research progress in forest encephalitis. Laboratory tests for forest encephalitis mainly include routine examinations, serological tests, virus isolation, and molecular biological testing. The detection of serum-specific IgM antibodies against the forest encephalitis virus is of great importance for early diagnosis, and specific IgG antibodies serve as a "gold standard" for differentiation from other diseases. Techniques such as enzyme-linked immunosorbent assay (ELISA) or indirect immunofluorescence assay for detecting specific IgM antibodies in serum and/or cerebrospinal fluid, the serum hemagglutination inhibition test or serum complement fixation test, and the double serum hemagglutination inhibition test or complement fixation test all contribute to the early diagnosis. The development of molecular testing methods is rapid, and techniques such as metabolomics, digital PCR, and matrix metalloproteinases are also applied in the early diagnosis of forest encephalitis.

Objective To compare the clinical efficacy of CT-guided high-voltage long-duration pulsed radiofrequency(PRF)with that of pudendal nerve block(NB)in the treatment of pudendal neuralgia(PN).Methods A total of 91 patients with confirmed PN were enrolled in this study.The patients were randomly divided into PRF group and NB group.The patients of the PRF group received CT-guided high-voltage long-duration PRF of the pudendal nerve,and the patients of the NB group received CT-guided pudendal nerve block.The visual analogue scale(VAS)score of pain,the time of keeping a sitting position,and the PHQ9-score were determined separately at one day,2 weeks,one month,3 months,and 6 months after treatment,and all procedure-related complications were recorded.Results A 6-month follow-up was accomplished in 87 patients,including 45 in the PRF group and 42 in the NB group.On the first day after operation,the VAS scores became significantly lower in both groups as compared with the preoperative VAS scores(P＜0.01),and the VAS score in the NB group was strikingly lower than that in the PRF group(P=0.039).The postoperative one-month,3-month and 6-month VAS scores in the PRF group were remarkably lower than those in the NB group(P＜0.05).The time of keeping a sitting position and PHQ9-scores at 3 months and 6 months after treatment in the PRF group were obviously better than those in the NB group(P＜0.01).No procedure-related serious adverse reactions were observed in both groups.Conclusion CT-guided high-voltage long-duration PRF is superior to NB in more effectively relieving pain,prolonging the time of keeping a sitting position,and improving the depressed status of the patients with PN.(J Intervent Radiol,2023,32:1216-1220)

Objective To standardize the selection of clinical research outcome indicators,which can objectively evaluate the clinical efficacy or effect of traditional Chinese medicine in the treatment of myasthenia gravis.This study aims to standardize the construction of the core outcome set of clinical research of traditional Chinese medicine in the treatment of myasthenia gravis.Methods We followed the core outcome set development specification(COS-STAD)to carry out research,established a research working group,which set up a Delphi-method advisory group.Two graduate students of working group conducted a document research and meetings of patients to establishe an outcome set item pool of myasthenia gravis in clinical trials of Chinese medicine under the instruction of other members.With the questionnaire based on the content of item pool,we then carried out Delphi-method expert consultations and a consensus meeting.Results The core outcome set of clinical research on myasthenia gravis treated with traditional Chinese medicine included five outcome domains:endpoint outcome,myasthenia gravis symptom evaluation,medication evaluation,quality of life evaluation and safety outcome;Nine outcome measures:recurrence rate,incidence of hormone complications,incidence of crisis,QMGS scale(MGFA quantitative myasthenia gravis score),daily activity scale of MG patients(ADL),analysis of immunosuppressant dosage,analysis of glucocorticoid dosage,analysis of cholinesterase inhibitor dosage,and incidence of adverse events.Conclusion The five outcome domains and nine outcome measures included in the core outcome set can be used as outcome options for the efficacy evaluation of myasthenia gravis clinical research.

ObjectiveTo observe the effect of Banxia Xiexintang on the autophagy of interstitial cells of Cajal （ICCs） in the gastric antrum of rats with gastric electric dysrhythmia， and explore the protective effect and regulatory mechanism. MethodThirty-two SD rats were randomly assigned into a normal group， a model group， a Banxia Xiexintang （24.68 g·kg^-1） group， and a positive drug （2.7 mg·kg^-1） group. The rat model of gastric electric dysrhythmia was established by the method of dieting every other day and drinking dilute hydrochloric acid， and Banxia Xiexintang and the positive drug were administrated for intervention. The body weight of each rat was recorded weekly. The gastric electric activity was recorded by the biological function experimental system. The ultrastructural changes of the gastric antrum tissue were observed by a transmission electron microscope. The co-expression of receptor tyrosine kinase （c-kit）/mammalian homolog of yeast Atg6 （Beclin1） in the gastric antrum tissue was detected by double immunofluorescence labeling method. The expression of microtubule-associated protein 1 light chain 3B （LC3B） and p62 protein in the gastric antrum tissue was determined by Western blot， and the LC3BⅡ/Ⅰ ratio was calculated. ResultCompared with the normal group， the modeling reduced the body weight （P<0.01） and decreased the dominant frequency and dominant power of gastric electricity （P<0.01）. In addition， the modeling caused ultrastructural damage of ICCs in gastric antrum， degeneration and necrosis of organelles， and appearance of a small number of autophagic vesicles. The results of double immunofluorescence labeling showed that the modeling inhibited the positive expression of c-kit and promoted the positive expression of Beclin1 in gastric antrum tissue. Western blot results showed that the modeling increased the ratio of LC3BⅡ/Ⅰ （P<0.01） and down-regulated the expression of p62 protein （P<0.01） in the gastric antrum tissue. Compared with the model group， Banxia Xiexintang and the positive drug increased the body weight （P<0.01） and the dominant frequency and dominant power of gastric electricity （P<0.01）， repaired the ultrastructural damage of ICCs in gastric antrum tissue， promoted the positive expression of c-kit and inhibited the positive expression of Beclin1 in the gastric antrum tissue. Furthermore， Banxia Xiexintang up-regulated the expression of p62 （P<0.05） and inhibited the transformation of LC3BⅠ into LC3BⅡ in gastric antrum tissue （P<0.05）. ConclusionBy regulating the expression of autophagy-related proteins， Banxia Xiexintang can reduce the autophagy and regulate the number and structure of ICCs and thus improve the gastric electric rhythm of rats， which preliminarily explains the mechanism of Banxia Xiexintang in the treatment of epigastric stuffiness.

Objective:To study the effect of graphene oxide (GO) on adipose-derived mesenchymal stem cells (Ad-MSCs) to promote diabetic skin wound healing.Methods:Ad-MSCs were cultured with GO at concentration of 100, 200, and 400 μg/mL and with 25 mmol/L of glucose for 48 h. The apoptosis of Ad-MSCs was detected by flow cytometry and Western blotting. Eighteen BALB/c thymus free female nude mice were selected to establish the skin defect model of diabetic nude mice. Then phosphate-buffered saline, Ad-MSCs, and GO+ Ad-MSCs were injected into the damaged skin of nude mice by intradermal injection for treatment, thereby created the control group, Ad-MSCs group, and GO+ Ad-MSCs group, 6 mice each group. The survival of wound cells and skin healing of mice were observed after surgery, and the wound healing was determined by HE staining and Masson staining.The level of epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), and interleukin 6 (IL-6) were determined by enzyme-linked immunosorbent assay (ELISA).Results:Compared with the high glucose group without GO(control group), the apoptosis rate of Ad-MSCs co-culture with GO was significantly reduced( P<0.05), and the apoptosis rate decreased with the increase of GO concentration. The expression level of Bax protein decreased, and the expression level of Bcl-2 protein increased ( P<0.05). Diabetic skin defect model showed that the survival rate of Ad-MSCs and wound healing degree in GO+ Ad-MSCs group were significantly increased ( P<0.05), and the degree of epithelialization and thickness of collagen regeneration were better than those in other groups. ELISA results showed that the expressions of EGF and VEGF were significantly increased in GO+ Ad-MSCs group ( P<0.05), while the expressions of TNF-α and IL-6 were significantly decreased ( P<0.05). Conclusion:GO can inhibit the apoptosis of Ad-MSCs in vitro. In vivo, Ad-MSCs treated with GO have higher survival rate, faster wound healing, and better effect than Ad-MSCs treated alone.

Objective:To explore the prognostic value of lymphocyte subsets in adult hemophagocytic syndrome (HPS).Methods:A total of 172 adult HPS patients diagnosed in 8 medical centers from January 2013 to August 2020 were selected for the study, of whom 87 were male (50.6%, 87/172), and 85 were female (49.4%, 85/172), with 68 survivors and 104 deaths. The clinical data were summarized, and variables such as lymphocyte subsets, immunoglobulin characteristics and fibrinogen were retrospectively analyzed, and the correlation between the mentioned variables and patient prognosis was analyzed. The optimal cut-off values of continuous variables were calculated by MaxStat, and the prognostic factors of HPS patients were screened based on the Cox proportional hazard regression model.Results:The median age of HPS patients was 56 (42, 66) years old, and the 5-year cumulative survival rate was 37.4% (37.4/100). The median age, platelet and albumin were 48 (27, 63) years, 84×10 9/L and 32.3 g/L in the survival group, and 59 years, 45.5×10 9/L, and 27.3 g/L in the death group, respectively. The differences between the two groups was statistically significant ( Z=?3.368, P=0.001; Z=?3.156, P=0.002; Z=?3.431, P=0.001). Patients with differentiated cluster 8+(CD8+)<11.1%, CD3+<64.9%, CD4+>51%, and CD4/CD8 ratio>2.18 had poor prognosis (χ 2=7.498, P=0.023; χ 2=4.169, P=0.041; χ 2=4.316, P=0.038; χ 2=9.372, P=0.002). Multivariable analysis showed that CD4/CD8 ratio, age, fibrinogen and hemoglobin were independent prognostic factors in HPS patients ( HR=2.435, P=0.027; HR=5.790, P<0.001; HR=0.432, P=0.018; HR=0.427, P=0.018). Conclusion:Peripheral blood lymphocyte subsets can be used to evaluate the prognosis of patients with HPS; CD4/CD8 ratio, age, fibrinogen, and hemoglobin are independent prognostic factors in HPS patients.

Objective:To understand the prevalence and genotype characteristics of enterovirus and Coxsackie virus in hand, foot and mouth disease (HFMD) patients in Qinghai province from 2015 to 2018.Methods:The throat swabs of HFMD patients were collected for virus isolation and RT-PCR in Qinghai province. The nucleotide sequence of the amplified products was determined and analyzed, and the gene evolution tree was constructed with reference to the sequence of some strains of NCBI.Results:From 2015 to 2018, 1 738 samples of clinical diagnosis positive cases were collected, including 326 EV-A71 cases, accounting for 18.76%, 237 CV-A16 cases, accounting for 13.64%, 628 CV-A6 cases, accounting for 36.13%. There were statistically significant differences among different genotypes in 4 years (EV-A71, χ2=245.315, P<0.001; CV-A16, χ2=27.680, P<0.001; CV-A6, χ2=702.713, P<0.001). A total of 317 cell culture isolates were obtained after isolation with RD cells. After sequence, DNA sequences of typical genotypes were selected for sequence analysis, from 2017 to 2018. The homology of all genotypes of VP1 was between 59% and 100%, the homology was 93% to 100% in 19 strains of EV-A71, the homology was 92% to 100% in 20 strains of CV-A16, the homology was 97% to 99% in 6 strains of CV-A6. According to the evolutionary tree, the sequences of EV-A71 strains are all on the C4a branch of the evolutionary tree in Qinghai province; 18 strains of CV-A16 were B1b and 2 stains were 1D; 5 strains of CV-A6 were D3 and 1 was B1. Conclusions:From 2015 to 2018, the prevalent genotypes of HFMD shifted from EV-A71 to CV-A16 and CV-A6 in Qinghai province, The EV-A71 genotype in Qinghai province has always been C4a genotype. There are different genotypes of CV-A16 and CV-A6. The nucleotide sequence differences between different genotypes are large, and the sequence variation among the same gene is small.

Objective:To study the genomic sequence of Coxsackievirus A8 (CV-A8) associated with hand, foot and mouth disease (HFMD) from 2013 to 2018 in China and to analyze the genetic evolution of each coding region of the full-length genome.Methods:The genome sequences of 11 CV-A8 strains isolated from patients with HFMD in different regions of China from 2013 to 2018 were determined. Sequence alignment and genetic evolution analysis were performed by Sequencher 5.0 and MEGA 7.0 software, etc.Results:Sequence alignment showed that the genome length of 11 CV-A8 strains ranged from 7 393 bp to 7 400 bp. There was no base insertion or deletion in the coding region compared with the prototype strain, but there were individual base insertion or deletion in the non-coding region. The nucleotide and amino acid similarities in the VP1 region of 11 CV-A8 strains were 78.3%-98.6% and 92.6%-99.7%, respectively, and the nucleotide and amino acid sequences identities with the CV-A8 prototype strain were 78.3%-98.2% and 92.6%-99.7%, respectively. Based on the phylogenetic analysis of VP1 region sequences, the CV-A8 can be divided into five genotypes: A, B, C, D and E. The 11 CV-A8 strains in this study belonged to genotypes C (1 strain), D (2 strains) and E (8 strains). The nucleotide and amino acid similarities of 11 CV-A8 full-length genomes were 81.3%-98.8% and 95.9%-99.5%, respectively. The phylogenetic tree of the P2 region showed that the eight E genotypes CV-A8 had the closest evolutionary distance with CV-A4, CV-A14, and CV-A16. The phylogenetic tree of the P3 region showed that the eight E genotypes CV-A8 had a close evolutionary distance with CV-A5, CV-A16, CV-A14 and CV-A4.Conclusions:The 11 CV-A8 stains in this study showed significant intra-genotype diversity in capsid region and recombinant diversity in non-capsid region which indicated that CV-A8 quasispecies were still undergoing dynamics variation. CV-A8 may become an important pathogen of HFMD and the monitoring of CV-A8 needs to be further strengthened.