BackgroundDepression as a major mental health condition is commonly found in junior high school students. Peer attachment， emotional resilience and childhood abuse have been found to be associated with depressive symptoms， and it has been hypothesized that peer attachment and emotional resilience may play a chained effecting path in the relationship between childhood abuse and depressive symptoms in junior high school students. ObjectiveTo explore the relationship between childhood abuse and depressive symptom in junior high school students， analyze the effecting path of peer attachment and emotional resilience， thus to provide references for improving the mental health of junior high school students. MethodsFrom May to July 2022， a cluster sampling technique was utilized to recruit 1 781 junior high school students from a junior high school in Anhui province. Childhood Trauma Questionnaire Short Form （CTQ-SF）， Revised version of Inventory of Parent and Peer Attachment （IPPA-R）， Adolescent' Emotional Resilience Questionnaire （AERQ） and Center for Epidemiological Studies Depression Scale （CES-D） were used as the measurement tools. Pearson correlation coefficient was calculated to assess the correlation among above scales. Process4.2 and Bootstrapping method were employed to verify the effecting path of peer attachment and emotional resilience in the relationship between childhood abuse and depressive symptoms. ResultsCTQ-SF score was negatively correlated with IPPA-R peer attachment subscale score and AERQ score （r=-0.527， -0.495， P<0.01） and positively correlated with CES-D score （r=0.669， P<0.01） in junior high school students. IPPA-R peer attachment subscale score was positively correlated with AERQ score （r=0.556， P<0.01） and negatively correlated with CES-D score （r=-0.599， P<0.01） in junior high school students. AERQ score was negatively correlated with CES-D score （r=-0.698， P<0.01） in junior high school students. Childhood abuse in junior high school students was shown to be a positive predictor of depressive symptoms （β=0.675， P<0.01） and a negative predictor of peer attachment （β=-0.824， P<0.01） and emotional resilience （β=-0.305， P<0.01）. Peer attachment and emotional resilience were independent effecting path between childhood abuse and depressive symptoms， with indirect effect size of 0.093 （95% CI： 0.066~0.122） and 0.108 （95% CI： 0.084~0.133）， respectively. Peer attachment and emotional resilience affected as a chain effecting path between childhood abuse and depressive symptoms， with indirect effect size of 0.087 （95% CI： 0.071~0.105）， accounting for 12.89% of the total effect. ConclusionChildhood abuse in junior high school students can affect the presence of depressive symptom both directly and indirectly through either separate or chained effecting path of peer attachment and emotional resilience. ［Funded by 2020 Provincial General Scientific Research Project of West Anhui Health Vocational College （number， KJ2020B006）； 2024 Provincial University Natural and Humanities Sciences Research Project of West Anhui Health Vocational College （number， 2024AH053467）］

The sources of common knee valgus deformities were classified in order to better plan the orthopedic methods, matching prostheses and soft tissue repair of knee valgus deformities.Based on the analysis of typical clinical cases and the operability of classification standards in practical clinical practice, it is of great significance to establish a reasonable morphological classification of knee valgus deformity, in order to grasp the characteristics and patterns of the onset of valgus deformity. According to the origin of the deformity and the tension of the medial and lateral collateral ligaments, the classification of the genu valgus deformity can be divided into the classification of the traditional Genu valgum deformity origin and the classification of the new Genu valgum deformity origin. Although both of them highlight the skeletal characteristics and soft tissue conditions of the valgus deformity, they are quite different. Traditional classification is based on femoral tibial angle, valgus angle, etc; The new classification is divided into mechanical angle, anatomical angle, distal condylar angle, etc. The origin of Genu valgum deformity is generally complex. The traditional classification cannot fully reflect the origin of valgus deformity and the tension state of soft tissue. The new classification, especially based on the classification of anatomical angle valgus deformity, can not only reflect the morphological and anatomical details of knee valgus deformity, but also reflect the tension state of the medial and lateral collateral ligaments and local soft tissue stress state that determine the stability of the knee joint. At present, the commonly used surgical methods for valgus deformity of the knee include periarticular osteotomy of the knee and total knee Joint replacement. The former focuses on correcting extraarticular deformity without over repairing ligaments, and the latter focuses on force line correction, which is the final treatment for terminal valgus deformity. The application of digital technology in clinical orthopedics can improve the accuracy of implant placement. Implant placement needs to be based on the patient's bone characteristics and degree of deformity. For patients with severe deformity, the application of digital technology can improve the accuracy of implant placement and assist in the treatment of knee valgus deformity.

Objective:To analyze the morphology and distribution characteristics of subchondral bone cysts of the talus by CT three-dimensional reconstruction.Methods:A total of 176 patients diagnosed with subchondral bone cyst of the talus after CT scan of the ankle or foot from 2015 to 2020 were retrieved from the imaging report database of Tianjin Hospital, including 77 males and 99 females, aged 14-84 years［(56.1±14.0)years］. After three-dimensional reconstruction of the talus and cyst area by Mimics 20.0 software, an equal 2×2 grid configuration was constructed to divide the domed articular surface into four regions: anteromedial, anterolateral, posteromedial and posterolateral. For subchondral cyst of the talus, area involved under grid localization, gender, age and side of the onset were recorded. The anteroposterior diameter, transverse diameter, depth, surface area and volume of the subchondral bone cyst of the talus were measured.Results:Subchondral cyst of the talus was anteromedial in 131 patients (74.4%), anterolateral in 5(2.8%), posteromedial in 34(19.3%), and posterolateral in 6(3.4%). Subchondral cyst of the talus occurred in the older aged (≥60 years) for 78 patients (44.3%), in the middle aged (45-59 years) for 62(35.2%), in young adults for 32(18.2%), and in preadolescents for 4(2.3%). The age composition of the subchondral cyst of the talus involving the anteromedial, anterolateral, posteromedial and posterolateral regions was 59(49, 64)years, 44(39, 45)years, 61(54, 68)years and 40(22, 58) years, respectively (all P<0.01). There were no statistically significant differences in gender and side of the onset (all P>0.05). The anteroposterior diameter of the subchondral bone cysts located anteromedially, anterolaterally, posteromedially and posterolaterally was (9.7±4.4)mm, (3.5±1.1)mm, (10.3±4.4)mm and (2.1±0.8)mm, respectively; the transverse diameter was (5.4±1.7)mm, (3.9±1.8)mm, (5.9±2.2)mm and (3.4±1.1)mm, respectively; the depth was (7.1±2.4)mm, (3.2±2.2)mm, (8.2±3.0)mm and (3.9±1.9)mm, respectively; the surface area was 156.1(82.6, 198.2)mm 2, 23.0(21.4, 28.9)mm 2, 180.0(75.1, 230.4)mm 2 and 28.0(20.3, 36.7)mm 2, respectively; the volume was 77.1(37.1, 129.1)mm 3, 23.9(14.2, 37.8)mm 3, 104.6(37.7, 157.4)mm 3 and 13.0(10.4, 16.0)mm 3, respectively. When comparing the anteroposterior diameter, transverse diameter, depth, surface area and volume of the subchondral bone cysts in the anteromedial and posteromedial regions with the anterolateral and posterolateral regions, the differences were statistically significant (all P<0.01) except for the transverse diameter of the subchondral bone cysts in the anteromedial region and the anterolateral region ( P>0.05). In addition, the depth of subchondral bone cysts in the anteromedial region was significantly greater than that in the posteromedial region ( P<0.05). Conclusions:Subchondral bone cysts of the talar are commonly found in the middle- and old-aged population. Anteromedial lesions of the talar dome are the most commonly seen, with large and deeply involved cysts, followed by posteromedial lesions of the dome, while anterolateral and posterolateral lesions of the dome are less common and have smaller cyst sizes. An equal 2×2 grid configuration for talar cysts is useful in positioning and characterizing bone cysts, and can assist clinicians in accurately diagnosing and treating bone cysts.

Objective:To investigate the effect of different imaging classifications of prostate cancer seminal vesicle invasion on positive surgical margins (PSM) after laparoscopic radical prostatectomy(LRP).Methods:114 patients with pT 3b stage prostate cancer admitted to Peking University Third Hospital from August 2009 to December 2020 were retrospectively analyzed. The age of the patients was (68.2±7.7) years old, the median pre-biopsy PSA was 20.20 (3.45-186.30) ng/ml, and the patients with biopsy Gleason score of ≤7, and ≥8 was 33 and 81 cases, respectively. The median prostate volume was 33.2 (12.1-155.4) ml. According to the imaging of the seminal vesicle invasion of prostate cancer, the patients were divided into the following types: type Ⅰ, the tumor directly invades the seminal vesicle along the vas deferens; type Ⅱa, the tumor invades the basal capsule of the prostate and invades the seminal vesicle; type Ⅱb, the tumor invades the periprostatic fat and retrogradely invades the seminal vesicles; type Ⅲ, solitary lesions in the seminal vesicles that do not continue with the prostate cancer. All patients underwent LRP, and the PSM were recorded as the base, bilateral, posterior, anterior and apical parts of the prostate. The differences in clinicopathological data of patients with different seminal vesicle invasion imaging types were compared, and the independent risk factors of PSM in pT 3b prostate cancer were evaluated by multivariate analysis. Results:The operative time of 114 cases in this group was (229.4±62.2) min, and the blood loss was 100(20-1 800)ml. The postoperative gross pathological Gleason score was ≤7 in 17 cases and ≥8 in 97 cases. In the imaging classification of prostate cancer with seminal vesicle invasion, there were 28 cases (24.6%) of type Ⅰ, 39 cases (34.2%) of type Ⅱa, 47 cases (41.2%) of type Ⅱb, and no type Ⅲ patients. There was no significant difference in age, body mass index, pre-biopsy PSA, prostate volume, and operation time among patients with type Ⅰ, Ⅱa, and Ⅱb seminal vesicle invasion ( P>0.05). There was a statistically significant difference in blood loss among the three types ( P = 0.001), and the difference in the proportion of lymph node metastasis was statistically significant ( P = 0.013). In the classification of prostate cancer seminal vesicle invasion, the PSM rates of type Ⅰ, Ⅱa and Ⅱb were 28.6% (8/28), 38.5% (15/39) and 70.2% (33/39), and the difference was statistically significant ( P=0.001). The PSM rates of type Ⅰ, Ⅱa, and Ⅱb were 21.4% (6/28), 23.1% (9/39), and 34.0% (16/47), respectively. The results of univariate analysis showed that the biopsy Gleason score ( P = 0.063) and the type of seminal vesicle invasion ( P<0.001) entered into multivariate analysis, and the results of multivariate logistic regression analysis showed that the type of seminal vesicle invasion ( P=0.001) was independent risk factor for PSM after LRP. Conclusions:The PSM rate in patients with type Ⅱb seminal vesicle invasion is significantly higher. The higher imaging type of seminal vesicle invasion is the independent risk factor of PSM after LRP.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Posttraumatic ankle arthritis caused by trauma, a common articular disease, mainly destroys the biomechanical balance of the ankle joint and results in degeneration of the joint.It often occurs in young people, leading to articular pain and stiffness and other symptoms which may deteriorate to end-stage posttrau-matic ankle arthritis with no intervention.At present, a variety of therapies are available for the disease. However, no domestic literature has addressed the choice and application of its treatment methods.To be useful in clinic, this review deals with the etiology, diagnosis and treatment (including choice, efficacy, indications and contraindications) of the disease.

Objective To investigate the effect of insulin pump combined with dipeptidyl peptidase-Ⅳ (DPP-Ⅳ) inhibitor on the treatment of newly diagnosed type 2 diabetes mellitus (T2 DM). Methods Totally 51 newly diagnosed patients with T2 DM were randomly divided into experimental group (insulin pump combined with DPP-Ⅳ inhibitor) and control group (insulin pump alone). After 15 days of treatment, the clinical effect was compared between two groups. Results After treatment, the blood sugar related indexes in both groups significantly improved (P ＜ 0. 05), and the blood sugar control of the experimental group was significantly better than that of the control group (P ＜ 0. 05). The pancreatic β cell function index, area under curve of C-peptide and insulin resistance index in the experimental group were significantly better than those in the control group (P ＜0. 05). The dosage of insulin, the ratio of patients with blood sugar reaching the standard completely, the time of blood sugar reaching the standard and the increase value of body mass in the experimental group were significantly better than those in the control group (P ＜ 0. 01). The incidence rate of hypoglycemia was 8. 00％ (2/26) in the experimental group and 12. 00％ (3/25) in the control group, and there was no significant difference between the two groups (P＞ 0. 05). During the treatment, no severe hypoglycemic events and liver and kidney function damage occurred in both groups. Conclusion Insulin pump combined with DPP-Ⅳ inhibitor is effective in the treatment of newly diagnosed T2 DM, which can effectively control blood sugar, reduce insulin resistance and weight gain.

Objective To investigate the effect of insulin pump combined with dipeptidyl peptidase-Ⅳ (DPP-Ⅳ) inhibitor on the treatment of newly diagnosed type 2 diabetes mellitus (T2 DM). Methods Totally 51 newly diagnosed patients with T2 DM were randomly divided into experimental group (insulin pump combined with DPP-Ⅳ inhibitor) and control group (insulin pump alone). After 15 days of treatment, the clinical effect was compared between two groups. Results After treatment, the blood sugar related indexes in both groups significantly improved (P ＜ 0. 05), and the blood sugar control of the experimental group was significantly better than that of the control group (P ＜ 0. 05). The pancreatic β cell function index, area under curve of C-peptide and insulin resistance index in the experimental group were significantly better than those in the control group (P ＜0. 05). The dosage of insulin, the ratio of patients with blood sugar reaching the standard completely, the time of blood sugar reaching the standard and the increase value of body mass in the experimental group were significantly better than those in the control group (P ＜ 0. 01). The incidence rate of hypoglycemia was 8. 00％ (2/26) in the experimental group and 12. 00％ (3/25) in the control group, and there was no significant difference between the two groups (P＞ 0. 05). During the treatment, no severe hypoglycemic events and liver and kidney function damage occurred in both groups. Conclusion Insulin pump combined with DPP-Ⅳ inhibitor is effective in the treatment of newly diagnosed T2 DM, which can effectively control blood sugar, reduce insulin resistance and weight gain.

Objective The three-dimensional finite element analysis was done to analyze the mechanical stability of double screw internal fixation for talus neck fracture,the methods with different approaches and different placement methods as well as the optimal biomechanical environment of fracture section were discussed so as to provide reliable mechanical arguments for the selection of clinical internal fixators.Methods The acquired male adult ankle CT data were imported into Mimics for 3D reconstruction of the ankle joint model.After the model was fitted with the surface by Geomagic software,the model was imported into Solidwork software to establish the talus neck fracture model and the corresponding screw.The fixtures were assembled with the anterior-posterior parallel double screw,the anterior-posterior cross-double screw,the posterior-anterior parallel double screw,and the posterioranterior cross-double screw,respectively.The model data were imported to Abaqus 6.14 for analysis and calculation,followed by the meshing pretreatment using software Hypermesh 13.0.The Von Mises stress distribution of the lag screw and displacement of the fracture end were observed under different fixation modes.Results In the displacement and stress cloud diagrams of the fracture ends of the four groups,the displacement peaks of the fractures of the anterior to posterior double-screw parallel and cross-fixed groups were 0.399 3 mm and 0.418 6 mm,and the peak pressures were 7.721 MPa and 8.124 MPa,respectively.The displacement peaks of posterior to anterior double-screw parallel and cross-groups were 0.418 3 mm and 0.418 5 mm,the fracture end peak pressures were 4.848 MPa and 5.692 MPa,respectively.In the screw stress cloud diagram of the four internal fixation modes,the Von Mises stress peaks of the anterior-posterior parallel screw group and cross-screw group were 45.11 MPa and 50.18 MPa,and those of the posterior-anterior parallel screw group and cross-screw group were 30.65 MPa and 37.68 MPa,respectively.Conclusion In the posterior-anterior parallel screw fixation,the fracture end has the lowest stress,and the screw has dispersive stress and the stress peak is the lowest,which is superior to other three groups.Therefore,the posterior-anterior screw is better than anterior-posterior fixation,and the parallel fixation is better than cross fixation.

Objective To explore the application of body mass index(BMI)and the increased value of postpradial 2h C peptide [2hCP minus fasting C-peptide(FCP), ΔCP]as indexes to adjust the antidiabetic plan after intensive blood glucose control in poorly controlled patients with type 2 diabetes mellitus(T2DM).Methods The insulin intensive therapy with injections of insulin four times a day was applied to 156 type 2 diabetic in-patients with poorly glycemic control.Islet function was evaluated after glucostasis in all patients.According to FCP≥1 ng/ml, addition of basal insulin to oral antidiabetic drugs was applied(as plan A, A group).The insulin intensive therapy was continued if FCP<1ng/ml(as plan B,B group).The treatment plan was adjusted from plan A to B when plasma glucose was poorly controlled after a week(as B group).The baseline data of sex, age, diabetes duration, BMI, fasting plasma glucose(FPG), 2 hours postpradial plasma glucose(2hPG), HbA1C, triglyceride(TG), total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, FCP, 2hCP, 2hCP/FCP, and ΔCP were analyzed.Insulin dose, the incidence of hypoglycemia, and the targeted rate of glucose control were compared between two groups before grouping and one month after treatment.Results The results showed that BMI, TG, FCP, 2hCP, 2hCP/FCP, and ΔCP in A group were higher than those in B group(P<0.01), while FPG, 2hPG and HbA1C were lower(P<0.01).There were no differences in insulin dose, the incidence of hypoglycemia, the targeted rate of FPG and 2hPG between two groups when grouping.After one-month treatment, insulin dose and the incidence of hypoglycemia in group A were lower than those in group B, while the targeted rates of FPG and 2hPG in group A were better than group B(P<0.05 or P<0.01).The results of binary logistic regression analysis showed that BMI and ΔCP were independent factors for choosing antidiabetic plan A(β=0.26, 0.90,P<0.01).The areas under receiver operator characteristic curve of BMI and ΔCP were 0.72 and 0.84, respectively(P<0.01), and their cut-off points to choose antidiabetic plan A were 23.14 kg/m2 and 1.32 ng/ml.Conclusions BMI and ΔCP can be used as the predictive indexes for choosing an antidiabetic plan for poorly controlled type 2 diabetic patients.