Objective:To explore the optimal index of rotational displacement of femoral neck fractures by modeling the axial rotational displacement of femoral neck fractures after reduction and based on X-ray projections.Methods:Six dry human femur specimens, comprising 2 males and 4 females, were utilized in the study. Design and manufacture a proximal femur ortholateral and oblique X-ray casting jigs and mounts. The femoral neck fracture was modeled on the femoral specimen, with Pauwells 30°, 50°, and 70° models (2 each) made according to Pauwells typing. The fractures were manually repositioned with residual anterior 20°, 40° and 60° axial rotational displacements. Each fracture model was projected at different angles (pedicled 40°, pedicled 20°, vertical 0°, cephalad 20°, and cephalad 40°), and the trabecular angle and Garden's alignment index of the model were measured to observe the imaging characteristics of the fracture line on the medial oblique and lateral oblique radiographs.Results:In the presence of a 20° and 40° anterior rotational displacement following reduction of a femoral neck fracture, the trabecular angle in the rotationally displaced group was not significantly different from that of the anatomically repositioned group in various projection positions. However, when a residual rotational displacement of 60° was present, the trabeculae appeared blurred at most projection angles in the Pauwells 30° and 50° models, failing to measure trabecular angles. In the Pauwells 70° fracture model, the trabecular angle in the rotational displacement group was significantly different from that in the anatomical reduction group. In anteroposterior radiographs, when the anterior rotation displacement was 60° in the Pauwells 70° group, Garden's contralateral index showed an unsatisfactory restoration (150°, 142°), whereas all rotationally displaced models in the Pauwells 30° and Pauwells 50° groups had a Garden's contralateral index of >155°, which achieved an acceptable restoration. In lateral radiographs, all rotational displacement models with Garden's alignment index>180° failed to achieve acceptable repositioning, and the larger the Pauwells angle the greater the Garden's alignment index at the same rotational displacement. In the internal oblique position with a bias towards the foot side, the image showed partial overlap between the femoral head and the shaft, making it difficult to assess the quality of the reduction. Conversely, when projected cephalad, the femoral neck appeared longer, particularly at a projection angle of 40° cephalad, allowing for clear observation of the fracture line and the anatomy of the proximal femur. The trabeculae were not well visualized in the external oblique position.Conclusion:There are limitations in applying the trabecular angle to assess the axial rotational displacement of the femoral head after reduction of femoral neck fractures. The Pauwells 70° with residual rotational anterior displacement of 60° was the only way to detect axial rotational displacement of the femoral head on anteroposterior radiographs Garden's alignment index. For the determination of axial rotational displacement of the femoral head, the Garden's alignment index on lateral radiographs provides higher reliability.

Objective:To investigate the expression of serum human epididymal protein 4 (HE4) in colorectal cancer patients and its relationship with recurrence and metastasis.Methods:A prospective study was conducted to collect 100 patients with colorectal cancer admitted to the First Affiliated Hospital of Hebei North University from January to December 2018 as the observation group, and 50 healthy volunteers as the control group. All patients underwent radical surgery for colorectal cancer, and serum samples were collected before surgery. Enzyme linked immunosorbent assay (ELISA) was used to detect serum HE4 levels, and the relationship between serum HE4 levels and clinical pathological characteristics in the observation group was analyzed. The relationship between preoperative serum HE4 levels and postoperative recurrence and metastasis of colorectal cancer in the observation group was also analyzed. The COX proportional risk model was used to analyze the influencing factors of postoperative recurrence and metastasis of colorectal cancer, and the receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of preoperative serum HE4 levels in the observation group for postoperative recurrence and metastasis of colorectal cancer.Results:The serum HE4 level in the observation group was significantly higher than that in the control group, and the difference was statistically significant ( P<0.05). The serum HE4 levels in patients with low differentiation were higher than those in patients with medium and high differentiation, while those with lymph node metastasis had higher serum HE4 levels than those without lymph node metastasis (all P<0.05). The postoperative recurrence and metastasis rate of colorectal cancer in patients with low serum HE4 levels was significantly lower than that in patients with high levels ( P<0.05). The COX proportional risk model showed that differentiation degree, lymph node metastasis, and serum HE4 levels were influencing factors for postoperative recurrence and metastasis of colorectal cancer (all P<0.05). The sensitivity and specificity of preoperative serum HE4 levels in predicting postoperative recurrence and metastasis of colorectal cancer were 72.7% and 73.1%, respectively. Conclusions:Serum HE4 is highly expressed in colorectal cancer and is closely related to postoperative recurrence and metastasis of colorectal cancer.

Objective:To investigate the preparation of sustained-release microspheres of brain-derived neurotrophic factor (BDNF) and its repairing effects on hypoxic-ischemic brain damage as well as the regulation of the tyrosine receptor kinase B (TrkB)/cAMP-response element binding protein (CREB) pathway in rats.Methods:BDNF sustained-release microspheres were prepared by emulsification-solvent evaporation method and polymer alloying method. The morphology of the microspheres was observed by a transmission electron microscope. The particle size and Zeta potential of the microspheres were measured by a Malvern ZS90 particle size analyzer, and the encapsulation rate and plasmid loading of the BDNF sustained-release microspheres were determined. The sustained release of the microspheres in vitro was also detected. A total of 45 SD rats were randomly divided into the sham-operation group, the model group, and the treatment group, with 15 rats in each group. Except for the sham-operation group, ischemic-hypoxic brain injury models were established in the other two groups by ligating the right common carotid artery and in a hypoxia environment. The rats in the treatment group were injected with 100 mg/kg of BNDF sustained-release microsphere solution via the tail vein once a day for 4 weeks, while the rats in the sham-operation group and the model group were injected with an equal amount of blank microsphere solution via the tail vein. At the end of the intervention, the neurological function scores, brain tissue water content, cerebral infarction area, malondialdehyde (MDA), and superoxide dismutase (SOD) levels were measured. The levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected by enzyme-linked immunosorbent assay (ELISA). The protein expressions of BDNF, TrkB, and phosphorylated CREB (p-CREB) were detected by Western Blot. Results:The appearance of BDNF sustained-release microspheres was round or oval, with a smooth surface and uniform size distribution. No interfused microspheres were observed. The size of microspheres was (221.49 ± 5.75) nm, the Zeta potential was (?27.03 ± 4.22) mV, and the encapsulation rate was (80 ± 2) %. The microspheres (1 mg) could carry (1.55 ± 0.04) μg of BDNF plasmid, and the sustained release of the drug stabilized at day 28. Compared with the model group, the neurological function score, brain tissue water content, cerebral infarction area, MDA, TNF-α, and IL-6 levels were decreased, and the SOD level and the protein expression of BDNF, TrkB, and p-CREB were increased in the treatment group (all P < 0.05). Conclusions:BDNF sustained-release microspheres can promote the repair of neurological damage caused by cerebral ischemia and hypoxia, reduce inflammation response and oxidative stress, and alleviate cerebral edema and cerebral infarction, which may play a role by activating the BDNF/TrkB/CREB pathway.

Objective To investigate the nutritional status of children with Crohn's Disease (CD) at diagnosis and its association with clinical characteristics. Methods A retrospective analysis was performed for the clinical data and nutritional status of 118 children with CD who were admitted to Beijing Children's Hospital,Capital Medical University,from January 2016 to January 2024. A multivariate logistic regression analysis was used to investigate the risk factors for malnutrition. Results A total of 118 children with CD were included,among whom there were 68 boys (57.6％) and 50 girls (42.4％),with a mean age of (11±4) years. Clinical symptoms mainly included recurrent abdominal pain (73.7％,87/118),diarrhea (37.3％,44/118),and hematochezia (32.2％,38/118),and 63.6％ (75/118) of the children had weight loss at diagnosis. The incidence rate of malnutrition was 63.6％ (75/118),and the children with moderate or severe malnutrition accounted for 67％ (50/75). There were 50 children (42.4％) with emaciation,8 (6.8％) with growth retardation,and 9 (7.6％) with overweight or obesity. Measurement of nutritional indices showed a reduction in serum albumin in 83 children (70.3％),anemia in 74 children (62.7％),and a reduction in 25 hydroxyvitamin D in 15 children (60％,15/25). The children with malnutrition had significantly higher disease activity,proportion of children with intestinal stenosis,and erythrocyte sedimentation rate and a significant reduction in serum albumin (P<0.05). The multivariate logistic regression analysis showed that intestinal stenosis was an independent risk factor for malnutrition in children with CD (OR=4.416,P<0.05). Conclusions There is a high incidence rate of malnutrition in children with CD at diagnosis,which is associated with disease activity and disease behavior. The nutritional status of children with CD should be closely monitored.

Objective To identify and conduct antimicrobial susceptibility testing on Vibrio species isolated from blood culture specimens of two patients with bloodstream infection(BSI),analyze the microbiological characteristics of non-O1/non-O139 Vibrio cholerae(NOVC),and provide evidence for the diagnosis,prevention and control of Vibrio cholerae infection.Methods Two Vibrio strains were identified by matrix-assisted laser desorption/ioniza-tion time-of-flight mass spectrometry(MALDI-TOF MS),API bacterial biochemical reaction identification test strip,VITEK 2 Compact identification instrument and 16S rRNA gene sequencing.Serological typing,virulence gene molecular detection,and drug resistance phenotype detection were performed to the Vibrio strains.Results Two strains were identified as Vibrio cholerae,classified as NOVC by serological typing,and were negative for ctxAB virulence gene detection.Antimicrobial susceptibility testing showed that one strain was sensitive to ampici-llin,azi-thromycin,doxycycline and chloramphenicol,while resistant to tetracycline and trimethoprim-sulfametho-xazole.The other strain was sensitive to all tested antimicrobial agents.Conclusion BSI caused by NOVC is rarely reported in China.Accurate identification,typing and drug-resistant phenotype detection of Vibrio cholerae isolated from blood culture specimens are valuable for the diagnosis,treatment,prevention and control of Vibrio cholerae-associated infection.

Objective To investigate the relationship between the expression of serum microRNA-326(miR-326)and microRNA-623(miR-623)in non-small cell lung cancer(NSCLC)patients and their clinical pathological characteristics and prognosis.Methods A total of 114 NSCLC patients diagnosed in our hospital from March 2019 to June 2020 were collected as study subjects as case group,123 healthy individuals who underwent physical examination were as the control group.According to the 3-year prognosis,patients were separated into a survival group of 71 cases and a death group of 43 cases.Patient related clinical data were collected,real-time fluorescence quantitative PCR method was applied to detect the expression levels of miR-326 and miR-623 in various serum samples;Kaplan-Meier method was applied to analyze the relationship between the expression levels of serum miR-326 and miR-623 in NSCLC patients and their 3-year prognosis;Cox proportional risk regression model was applied to analyze the influencing factors of 3-year prognosis in NSCLC patients.Results The expression levels of serum miR-326 in the case group and control group were 0.64±0.15 and 1.02±0.23,respectively,and the expression levels of miR-623 were 0.56±0.10 and 0.98±0.15,respectively.The difference between the two groups was statistically significant(P＜0.05).The proportions of patients with low expression of miR-326 and miR-623 in low differentiation,TNM stage Ⅲ+Ⅳ,and lymph node metastasis were higher than those in high differentiation,TNM stage Ⅰ and Ⅱ,and no lymph node metastasis(P＜0.05).The 3-year survival rates of patients with low expression of miR-326(20/55,36.36％)and miR-623(27/61,44.26％)in the serum of NSCLC patients were lower than those of patients with high expression of miR-326(51/59,86.44％)and miR-623(44/53,83.02％)(Log Rank x2=32.060,22.812,P＜0.05).Serum miR-326[(0.55±0.09)vs.(0.69±0.11)]and miR-623 levels[(0.48±0.08)vs.(0.61±0.10)]of patients in the death group were significantly lower than those in the survival group(P＜0.05).The area under the curve(AUC)for poor prognosis of serum miR-326 and miR-623 alone and in combination in patients diagnosed with NSCLC were 0.828(95％CI:0.754 to 0.901),0.763(95％CI:0.671 to 0.855),and 0.903(95％CI:0.849 to 0.958),respectively.The proportions of patients with TNM stage Ⅲ+Ⅳ,lymph node metastasis,low expression of miR-326 and low expression of miR-623in the death group were higher than those in the survival group(P＜0.05).MiR-326 and miR-623 were protective factors affecting 3-year mortality in NSCLC patients,while TNM staging and lymph node metastasis were independent risk factors affecting 3-year mortality in NSCLC patients(P＜0.05).Conclusion The low expression of miR-326 and miR-623 may be involved in the occurrence and development of lung cancer,which is closely related to the clinical pathological characteristics and poor prognosis of patients.

Objective:To explore the latent profile and characteristics of social isolation in patients with hematologic malignancy, and to analyze its related influencing factors, and to provide reference for improving social phobia disorder in different patients and implementing targeted intervention.Methods:This study was a cross-sectional survey. A convenient sampling method was used to select hematologic malignancy patients who were treated in Qilu Hospital of Shandong University from January 2022 to January 2023. General information questionnaire, the General Alienation Scale (GAS), and the Social Support Rating Scale(SSRS) were used for investigation. Latent profile was analyzed using the categories of social isolation in patients with hematologic malignancy, and univariate and multinomial logistic regression analysis were used to analyze relevant influencing factors.Results:A total of 195 survey subjects were included, of which 108 males and 87 females, aged (49.78 ± 13.52) years. The scores of GAS and SSRS were (43.21 ± 6.09) and (42.52 ± 6.77) respectively. The social isolation in patients with hematologic malignancy could be divided into 3 latent profiles, namely low-risk isolation 15.4% (30/195), medium-risk isolation 68.2%(133/195), and high-risk isolation16.4% (32/195). Multinomial Logistic regression analysis showed that age ( OR=0.941, 95% CI 0.894-0.990), percapita monthly income of families ( OR=0.050, 95% CI 0.004-0.657), primary caregivers (parents) ( OR=0.025, 95% CI 0.003-0.227), place of residence (town)( OR=0.170, 95% CI 0.039-0.749), disease type (leukemia) ( OR=15.610, 95% CI 2.973-81.979), disease type(lymphoma) ( OR=10.986, 95% CI 2.032-59.413) were the influencing factors of medium-risk isolation (all P<0.05). Age ( OR=0.933, 95% CI 0.880-0.988), percapita monthly income of families ( OR=0.029, 95% CI 0.002-0.525), primary caregivers (parents) ( OR=0.076, 95% CI 0.006-0.900), disease type (leukemia)( OR=19.257, 95% CI 2.580-143.723), disease type (lymphoma)( OR=9.952, 95% CI 1.290-76.763), social support ( OR=0.877, 95% CI 0.786-0.980) were the influencing factors of high-risk isolation (all P<0.05). Conclusions:The social isolation among patients with hematologic malignancy had apparent classification characteristics. It could be divided into three potential profiles. It is suggested that medical staff should take targeted social and psychological support based on different types of patients, improve their psychological and social outcomes, and utilize existing resources to implement intervention measures to help them adapt and return to society.

Objective To observe the value of CT radiomics for differentiating spinal bone islands(BI)and osteoblastic metastases(OBM).Methods Data of 109 BI lesions in 98 patients and 282 OBM lesions in 158 patients(including 103 OBM in 48 lung cancer cases,86 OBM in 52 breast cancer cases and 93 OBM in 58 prostate cancer cases)from 3 medical institutions were retrospectively analyzed.Data obtained from institution 1 were used as the internal dataset and divided into internal training set and internal validation set at a ratio of 7∶3,from institution 2 and 3 were used as external dataset.All datasets were divided into female data subset(including OBM of female lung cancer and breast cancer)and male data subset(including OBM of male lung cancer and prostate cancer).Radiomics features were extracted and screened to construct 3 different support vector machine(SVM)models,including model1 for distinguishing BI and OBM,model2 for differentiating OBM of female lung cancer and breast cancer,and model3 for differentiating OBM of male lung cancer and prostate cancer.Diagnostic efficacy of model1,CT value alone and 3 physicians(A,B,C)for distinguishing BI and OBM were assessed,as well as differentiating efficacy for different OBM of model2 and model3.Receiver operating characteristic(ROC)curves were drawn,and area under the curves(AUC)were calculated and compared.The differential diagnostic efficacy of model2 and model3 were also assessed with ROC analysis and AUC.Results AUC of model1 for distinguishing spinal OBM from BI in internal training set,internal validation set and external dataset was 0.99,0.98 and 0.86,respectively.In internal training set,model1 had higher AUC for distinguishing BI and OBM than that of physician A(AUC=0.78),B(AUC=0.87)and C(AUC=0.93)as well as that of mean CT value(AUC=0.78,all P＜0.05).AUC in internal training set,internal validation set and external dataset of model2 for identifying female lung cancer and breast cancer OBM was 0.79,0.75 and 0.73,respectively,of model3 for discriminating male lung cancer from prostate cancer OBM was 0.77,0.74 and 0.77,respectively.Conclusion CT radiomics SVM model might reliablely distinguish OBM and BI.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

A 10-year follow-up case of aldosterone and cortisol-secreting adrenocortical carcinoma, a rare disease presenting as an adrenal space-occupying lesion accompanied with hypertension and hypokalemia was reported, and the medical record was investigated in detail. Through case presentation and literature review, it was noted that patients with adrenocortical carcinoma presented a difference in clinical manifestations, pathology, and biological behaviors. This paper may help clinicians enhance their understanding of adrenocortical carcinoma. Especially significant adrenal space-occupying lesions highly suspicious of recurrence and producing different types of endocrine hormones should be paid more attention.