Objective:To systematically evaluate the qualitative study on the sexual health needs of patients with ostomy based on theoretical domains framework (TDF), providing reference for clinical care and practice.Methods:A comprehensive search was conducted for qualitative studies on the sexual experience of ostomy patients in the China National Knowledge Infrastructure, Wanfang Data, VIP database, China Biology Medicine, PubMed, Embase, Web of Science, Cochrane Library, Elton B. Stephens Company (EBSCO), Elsevier Scopus (SCOPUS), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, with a timeframe of from the creation of the databases to April 15, 2024. The Joanna Briggs Institute Evidence Based Healthcare Center Critical Appraisal Tool was used to evaluate the quality of eligible literature, and the theoretical domain framework was used to integrate the extracted results.Results:A total of 11 articles were included and 51 results were extracted. Based on the theoretical framework, map the sexual health needs of ostomy patients to six core areas: knowledge, skills, optimism, outcome beliefs, environment and resources, and emotions.Conclusions:Medical staff should pay attention to the sexual health needs of patients with intestinal stomas. Based on the six core areas of knowledge, skills, optimism, outcome beliefs, environment and resources, and emotions, they should deeply explore the factors that affect their sexual health, provide professional guidance and comprehensive care, and improve their sexual health level and quality of life.

Objective:To investigate the role and related mechanisms of Musashi RNA binding protein 2 (MSI2) in hepatocellular carcinoma (HCC).Methods:The mRNA expression data of HCC patients from the cancer genome atlas (TCGA) and the genotype-tissue expression (GTEX) as well as the corresponding clinical information were obtained, and the expression level of MSI2 was evaluated in 50 pairs of matched tumor/normal HCC samples. Furthermore, the protein-protein interaction (PPI) network, the Kyoto encyclopedia of genes and genomes (KEGG) and the encyclopedia of RNA interactions (ENCORI) databases were used to explore how MSI2 affects the progression of HCC. Three pairs of short hairpin RNA (shRNA) sequences targeting MSI2 and β-catenin were designed and cloned into lentiviral vectors and transfected into HepG2, MHCC97H and MHCC97L cells as knockdown plasmids for the construction of MSI2 knockdown group cells (HepG2 sh-MSI2 group, MHCC97H sh-MSI2 group) and β-catenin knockdown group cells (MHCC97L sh-β-catenin group) and their respective negative control cells (HepG2 sh-Ctrl group, MHCC97H sh-Ctrl group, and MHCC97L sh-Ctrl group). The overexpression level of MSI2 was detected by Western blotting. CCK-8 and colony formation assay were used to detect the proliferation of hepatocellular carcinoma cells. Cell suspensions of HepG2 sh-Ctrl group, HepG2 sh-MSI2 group, MHCC97L sh-Ctrl group and MHCC97L sh-β-catenin group were injected subcutaneously into the front thighs of the nude mice in each group. Nude mice were sacrificed after 4 weeks, and tumors were removed for volume measurement. Results:The analysis based on TCGA and GTEX databases showed that the expression of MSI2 in 50 pairs of matched tumors was higher than that in normal samples (2.073±0.767 vs. 1.256±0.260), and the difference was statistically different ( P<0.001). The results showed that MSI2 was positively correlated with β-catenin ( r=0.455, P<0.001), transcription factor 7 (TCF7) ( r=0.142, P=0.006) and lymphatic enhancement factor 1 (LEF1) ( r=0.246, P<0.001) in HCC. Compared with the HepG2 sh-Ctrl group, the expressions of MSI2, β-catenin, TCF7 and LEF1 in the HepG2 sh-MSI2 group were down-regulated, and the expressions of MSI2, β-catenin, TCF7 and LEF1 in the MHCC97H sh-MSI2 group were down-regulated compared with the MHCC97H sh-Ctrl group, and the differences were statistically significant (all P<0.001). Compared with the MHCC97L sh-Ctrl group, the expression of β-catenin in the MHCC97L sh-β-catenin group decreased statistically significant ( P<0.001). The results of CCK-8 proliferation assay showed that the activity of HCC cells in the HepG2 sh-MSI2 group was reduced compared with the HepG2 sh-Ctrl group, in the MHCC97H sh-MSI2 group was decreased compared with the MHCC97H sh-Ctrl group, and compared with the MHCC97L sh-Ctrl group, the activity of HCC cells in the MHCC97L sh-β-catenin group was decreased (all P<0.001). The results of colony formation experiments showed that the ability of HCC cells to form colonies in the HepG2 sh-MSI2 group was reduced compared with the HepG2 sh-Ctrl group, and in the MHCC97H sh-MSI2 group was reduced compared with the MHCC97H sh-Ctrl group, furthermore, compared with the MHCC97L sh-Ctrl group, the ability in the MHCC97L sh-β-catenin group was significantly lower (all P<0.001). Compared with the HepG2 sh-Ctrl group, the tumor volume of nude mice in the HepG2 sh-MSI2 group decreased [(160.19±60.22) mm 3 vs. (480.46±65.28) mm 3], compared with the MHCC97L sh-Ctrl group, the tumor volume in the MHCC97L sh-β-catenin group also decreased [(456.48±38.23) mm 3 vs. (845.67±33.19) mm 3], and the differences were statistically significant (both P<0.05). Conclusion:Up-regulation of MSI2 expression promotes the proliferation of HCC cells through the Wnt/β-catenin signaling pathway.

Objective:A novel anatomic posterior malleolus locking plate for Chinese people was designed, researched, developed, and tested biomechanically.Methods:An anatomic parameter database of posterior malleolus of Chinese people was established by collecting CT images of ankle joints from 100 healthy volunteers in Shanghai Tongji hospital from June 2022 to May 2023. Combined with relevant computer-aided technologies, a novel anatomic posterior malleolus locking plate for Chinese people was designed and produced. In addition, model verification and biomechanical test were carried out on vertical displacements under different fixation modes and different axial loads (500, 1 000, and 1 500 N). Failure loads at a displacement of 2 mm and maximum failure loads at the complete failure of internal fixation were also tested and recorded.Results:Based on the imaging anatomic measurement, the width quartile of posterior malleolus was 19.4, 26.6, 35.0 mm. The 3D reconstruction models of ankle joint CT corresponded to small, medium, and large basic posterior malleolus plates. Height of the screw safety zone was 5.5(5.3, 5.7) mm. The tip-back angle was 153.0°(148.5°, 157.5°) and tip-back height was 20.0(19.7, 20.9) mm. The novel anatomic posterior malleolus locking plate based on tibiofibular and ankle joint CT scan and relevant computer-aided technologies fit well with posterior malleolus of tibia, showing anatomic fitting. Based on the associate biomechanical test, the novel plate fixation had smaller vertical displacements of posterior malleolus fragment under axial loads of 500, 1 000, and 1 500 N compared with the control plate, but greater failure loads when the vertical displacement of the posterior malleolus fragment was 2 mm and greater maximum failure loads at complete failure of the internal fixation. At an axial load of 500 N, the vertical displacements of the posterior malleolus fragment after posterior malleolus fixation with a control plate, a 6-hole anatomical locking plate, and a 5-hole anatomical locking plate were 0.60±0.02, 0.45±0.04, and 0.52±0.04 mm, respectively with significant difference ( F=88.287, P<0.001); at an axial load of 1 000 N, the vertical displacements were 2.22±0.03, 1.10±0.03, and 1.15±0.03 mm for the three fixation modes, respectively, and the difference was statistically significant ( F=10 061.890, P<0.001); At an axial load of 1 500 N, the vertical displacements were 2.81±0.04, 1.50±0.03 and 1.67±0.03 mm for the three fixation modes, respectively with significant difference ( F=9 774.019, P<0.001). When the vertical displacement of the posterior malleolus fragment was 2 mm, the failure loads for the three fixation modes were 0.80(0.73, 0.80)、2.00(1.93, 2.00) and 1.70(1.70, 1.70) kN, respectively with significant differences ( H=54.245, P<0.001). The maximum failure loads at complete failure of the internal fixation for the three fixation modes were 1.90(1.90, 1.98)、4.30(4.30, 4.30) and 3.70(3.63, 3.70) kN, respectively with significant differences ( H=53.863, P<0.001). Conclusions:The novel anatomic posterior malleolus locking plate for Chinese people was well matched to the posterior malleolus with high mechanical strength and good stability, showing a promising future for clinical application.

Objective:To compare the efficacy of staged versus elective operation for treating acute closed fracture-dislocation of tarsometatarsal joint complex.Methods:A retrospective cohort study was used to analyze the clinical data of 26 patients with acute closed fracture-dislocation of tarsometatarsal joint complex admitted to Tongji Hospital of Tongji University from January 2017 to January 2021, of whom 18 were males and 8 were females, aged 32-52 years [(44.3±5.2)years]. According to the time from injury to admission, 14 patients admitted within 8 hours after injury underwent staged surgical treatment (staged group), and 12 patients admitted more than 8 hours after injury underwent elective surgery (elective group). In the staged group, emergency reduction and temporary internal fixation with K-wire were done under the supervision of a C-arm X-ray machine in the first stage, while after the swelling subsided, open reduction and internal fixation were done for tarsometatarsal joint fracture-dislocation in the second stage. In the elective group, open reduction and internal fixation were performed for tarsometatarsal joint fracture-dislocation on a scheduled basis after the swelling subsided. The operation time, hospitalization time and fracture healing time were recorded. The visual analogue score (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) midfoot score were evaluated before operation, at 1, 6, 12 months after operation and at the final follow-up. The rate of complications was observed after operation.Results:All patients were followed up for 12-24 months [(18.5±3.8)months]. The operation time, hospitalization time and fracture healing time in the staged group were (77.3±5.6)minutes, (14.3±2.2)days and (12.3±1.2)weeks, respectively, significantly shorter than those in the elective group [(101.5±7.5)minutes, (20.3±5.2)days and (14.3±2.2)weeks] (all P<0.01). VAS significantly decreased and AOFAS midfoot score significantly increased in both groups as postoperative time increased (all P<0.05). There were no significant differences in VAS between the two groups before operation, at 12 months after operation or at the final follow-up (all P>0.05). The VAS at 1, 6 months after operation was (4.4±0.8)points and (2.1±0.4)points in the staged group, significantly lower than those in the elective group [(6.0±1.0)points and (3.5±0.6)points] (all P<0.01). There was no significant difference in preoperative AOFAS midfoot score between the two groups ( P>0.05). The AOFAS midfoot score at 1, 6, 12 months after operation and at the final follow-up was (67.6±4.5)points, (75.7±5.2)points, (83.6±2.2)points and (85.9±4.3)points in the staged group, significantly higher than those in the elective group [(60.2±3.9)points, (70.2±3.4)points, (75.4±3.3)points and (78.7±4.4)points] (all P<0.01). The rate of complications was 14.3% (2/14) in the staged group, significantly lower than that in the elective group [33.3% (4/12)] ( P<0.05). Conclusion:Compared to traditional elective surgery, staged surgery for acute closed fracture-dislocation of tarsometatarsal joint complex has the advantages of shortened operation time, hospitalization time and fracture healing time, eary pain relief, improved functional recovery of the foot and reduced postoperative complications.

Objective: To analyze the suicide attitude and influencing factors of college students with mental disorders in Shaoxing City, and to provide a basis for improving the attitude of college students with mentaldisorders towards suicide. Methods: From January 2018 to December 2021, 1 100 college students, among which 110 were previously confirmed by medical institutions to have mental disorders, were selected from two schools in Shaoxing, including Shaoxing University and Yuexiu Foreign Languages College, to participate in a questionnaire survey. Univariate and multivariate Logistic regression analysis were used to identify the main factors affecting the suicide attitude of college students with mental disorders. Results: Univariate analysis showed that the influence of different nature of college students with mental disorders on suicide attitude was related to age, gender, origin, suicide ideation, whether suicidal thoughts can be controlled, impulsive personality type, problem solving style, the differences were statistically significant ( χ 2/t=9.01, 15.05, 5.90, 5.86, 6.47, 4.92, 13.48, P <0.05). Multivariate Logistic regression analysis showed that age, gender, origin, suicidal ideation, uncontrolled suicidal thoughts, impulsive personality type, problem solving style were the main factors influencing the suicidal attitude of college students with mental disorders ( OR=3.13, 3.06, 2.89, 3.22, 3.25, 3.13 , 3.16, P <0.05). Conclusion problem solving and other factors. The selection of targeted treatment plan can improve the mental disorder condition of college students and promote the recovery of the disease.

OBJECTIVE: To establish the finite element model of varus-type ankle arthritis and to implement the finite element mechanical analysis of different correction models for tibial anterior surface angle (TAS) in supramalleolar osteotomy. METHODS: A female patient with left varus-type ankle arthritis (Takakura stage Ⅱ, TAS 78°) was taken as the study object. Based on the CT data, the three-dimensional model of varus-type ankle arthritis (TAS 78°) and different TAS correction models [normal (TAS 89°), 5° valgus (TAS 94°), and 10° valgus (TAS 99°)] were created by software Mimics 21.0, Geomagic Wrap 2021, Solidworks 2017, and Workbench 17.0. The 290 N vertical downward force was applied to the upper surface of the tibia and 60 N vertical downward force to the upper surface of the fibula. Von Mises stress distribution and stress peak were calculated. RESULTS: The finite element model of normal TAS was basically consistent with biomechanics of the foot. According to biomechanical analysis, the maximum stress of the varus model appeared in the medial tibiotalar joint surface and the medial part of the top tibiotalar joint surface. The stress distribution of talofibular joint surface and the lateral part of the top tibiotalar joint surface were uniform. In the normal model, the stress distributions of the talofibular joint surface and the tibiotalar joint surface were uniform, and no obvious stress concentration was observed. The maximum stress in the 5° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress distribution of medial tibiotalar joint surface was uniform. The maximum stress of the 10° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress on the medial tibiotalar joint surface increased. CONCLUSION With the increase of valgus, the stress of ankle joint gradually shift outwards, and the stress concentration tends to appear. There was no obvious obstruction of fibula with 10° TAS correction. However, when TAS correction exceeds 10° and continues to increase, the obstruction effect of fibula becomes increasingly significant.
Humans ; Female ; Tibia/surgery* ; Finite Element Analysis ; Ankle ; Arthritis ; Fibula/surgery* ; Ankle Joint/surgery*

Objective To explore the effectiveness of virtual autopsy-based postmortem computed tomography(PMCT)liver three dimensional slicer(3D slicer)artificial intelligence(AI)volume reconstruction to assist forensic practice.Methods Twenty cases of the deceased who underwent both virtual autopsy and traditional autopsy in our center were selected and subjected to liver volume segmentation by 3D slicer method,Tada's formula method and literature method,and the data obtained from the traditional autopsy were compared and analyzed to obtain the accuracy rate.Results The 3D slicer method yielded higher consistency(95%confidence interval),lower volumetric variability(standard deviation),and a smaller region(variance)of uncertainty than the Tada formula method and the methods mentioned in the literature.Conclusion 3D slicer AI reconstruction based on virtual autopsy can visualize virtual anatomy,help increase the diagnostic accuracy of traditional autopsy,assist in pathological diagnosis,and provide new directions and tools for the development of imaging histology of virtual autopsy.

Objective:To analyze the correlation between the posterior malleolus fracture and fixation and the rotational stability of the ankle and to explore the surgical indications for posterior malleolus fracture aiming to provide the theories for the diagnosis and treatment of disorder.Methods:Twenty fresh frozen cadaver specimens were selected. Further, the extent of the tibial insertion of the posterior inferior tibiofibular ligament (PITFL) and inferior transverse tibiofibular ligament (ITTFL) complex was dissected and measured. Based on the tibial insertion of the ligament complex, the model for the supination-external rotation degree 3 ankle fracture with a posterior malleolar fragment and syndesmosis diastasis was created. Moreover, the area threshold of the posterior tibial insertion of posterior malleolus fracture was biomechanically assessed. The difference of the antirotating ability of the ankle-stiffness between simple posterior malleolus fixation and simple syndesmotic fixation was analyzed statistically.Results:The PITFL and ITTFL were presented in all specimens with relatively broad in PITFL tibial insertion. The PITFL was attached to the posterolateral tibia. The distance between the highest point of the tibial insertion and the articular line was 45.2±5.6 mm, while the ITTFL was attached to the posterior distal tibia. The distance between the highest point of the tibial insertion and the articular line was 5.5±1.0 mm. The width of the tibial insertion of the PITFL and ITTFL complex decreased as the distance from the joint line increased. Biomechanical analysis showed that the threshold of posterior area of posterior malleolus fracture was 1/4S. The stiffnesses of posterior malleolus fixation and syndesmosis stabilization were 0.264±0.080 N·m/° and 0.164 ± 0.061 N·m/°, respectively. The percentage of stiffness restored by posterior ankle fixation was 60.9%±10.2%, which was greater than that by syndesmosis stabilization 37.5%±7.9% ( t=17.09, P<0.001) . Conclusion:The surgical technique for posterior malleolus fracture should consider restoration of the axial and rotational stability of the ankle simultaneously. Posterior malleolus fracture fixation is recommended when the syndesmosis is unstable with the area ratio of posterior tibial insertion of posterior malleolus fracture greater than or equal to 1/4. Syndesmotic fixation is proposed to restore and maintain the rotational stability of the ankle when the syndesmosis is unstable with the area ratio less than 1/4. Regardless of the area ratio, the surgical indications for stable syndesmosis depend on the impact of the posterior malleolus fracture on the axial stability of tibiotalar joint, on the involved articular surface area and on the displacement degree of posterior malleolus fragment.

Objective:To investigate the mechanism that how Musashi RNA-binding protein 2 (MSI2) regulates HCC growth.Methods:Short hairpin RNA (shRNA) was transfected to inhibit MSI2 expression, and cells were divided into transfection control plasmid (sh-Ctrl) group and sh-MSI2 group. In the MSI2 overexpression experiment, cells were divided into control group (Vector group, transfected with blank plasmid Vector) and overexpression group (MSI2 group, transfected with MSI2 recombinant plasmid). Cell proliferation was detected by CCK-8 and plate cloning assays. Western blotting was used to detect the expressions of β-catenin, transcription factor 7 (TCF7) and lymphoid enhancer factor 1 (LEF1) after MSI2 intervention. In the Rescue recovery experiment, cells were divided into MSI2+ sh-Ctrl group (transfected with MSI2 recombinant plasmid and sh-Ctrl plasmid at the same time) and MSI2+ sh-β-catenin group (transfected with MSI2 recombinant plasmid and sh-β-catenin plasmid at the same time). On the basis of overexpression of MSI2, β-catenin was knocked down to detect the proliferation ability of HCC cells.Results:The proliferation rates of HepG2 and MHCC97H cells in the sh-MSI2 group were lower than those in the sh-Ctrl group, and the difference was statistically significant ( P<0.05). The proliferation rates of SMMC-7721 cells and MHCC97L cells in the MSI2 group were higher than those in the Vector group, and the difference was statistically significant ( P<0.05). The results of the clone formation experiment showed that compared with the sh-Ctrl group, the number of HepG2 cell clones in the sh-MSI2 group [(129.7±6.5) vs. (286.0±12.8)] and the number of MHCC97H cell clones [(134.0±6.7) vs. (248.0±14.1)] were reduced, and the differences were statistically significant ( P<0.05); compared with the Vector group, the number of SMMC-7721 cell clones [(242.0±5.6) vs. (135.3±8.7)] and MHCC97L cell clones [(308.0±9.0) vs. (149.7±5.9)] in the MIS2 group were increased, and the difference was statistically significant ( P<0.05). The mRNA and protein expression of β-catenin, TCF7 and LEF1 in HepG2 and MHCC97H cells in the sh-MSI2 group were lower than those in the sh-Ctrl group, and the differences between groups were statistically significant ( P<0.05). In contrast, compared with the Vector group, the mRNA and protein expression levels of β-catenin, TCF7 and LEF1 in SMMC-7721 and MHCC97L cells in the MSI2 group were all increased, and the differences were statistically significant ( P<0.05). Compared with the MSI2+ sh-Ctrl group, the cell proliferation ability of the MSI2+ sh-β-catenin group was decreased, and the difference was statistically significant ( P<0.05). Plate cloning experiments showed that the number of cell clones in the MSI2+ sh-β-catenin group was less than that in the MSI2+ sh-Ctrl group [(138.3±7.0) vs. (246.3±8.0), P=0.028]. Conclusion:MSI2 promotes HCC cell proliferation through Wnt/β-catenin signaling pathway, leading to tumor progression.

Objective:To investigate the effects of highly active anti-retroviral therapy (HAART) on the activation of T lymphocytes and expression of CD4 + CD45RA + T cell subsets in HIV/AIDS patients. Methods:This study prospectively analyzed 105 HIV/AIDS patients undergoing HAART and 35 HIV-1-negative cases (healthy controls). Flow cytometry was used to detect the activation of T lymphocytes and the percentages of CD4 + CD45RA + T cell subsets in whole blood samples taken from healthy controls and HIV/AIDS patients before and after therapy. Results:The activation of T lymphocytes was significantly enhanced in the 105 HIV/AIDS patients than in the healthy controls before treatment ( P<0.01). The activated T lymphocytes gradually decreased after HAART. Firstly, CD4 + CD38 + HLA-DR + , CD8 + CD38 + and CD8 + HLA-DR + T lymphocytes decreased one month after therapy ( P<0.05). Then, four indicators of T lymphocyte activation including the expression of CD8 + CD38 + HLA-DR + T lymphocytes decreased significantly six months after therapy ( P<0.01). The percentage of CD8 + CD38 + HLA-DR + T lymphocytes detected 12 months after therapy was significantly lower than that analyzed six months after therapy ( P<0.01). No significant difference was found in the expression of the other three indicators for activation ( P>0.05). Twelve months after therapy, the four indicators for T lymphocyte activation in HIV/AIDS patients were still significantly higher than those of the control group ( P<0.01). The percentages of CD4 + CD45RA + T lymphocytes in HIV/AIDS patients were significantly lower than those in healthy controls before and 12 months after treatment ( P>0.05). Conclusions:HAART could reduce immune activation after six months of treatment, but could not reverse the activation nor restore the expression of CD4 + CD45RA + T lymphocytes in HIV/AIDS patients.