The LIDPAD Mouse Model Captures the Multisystem Interactions and Extrahepatic Complications in MASLD.

Metabolic dysfunction-associated steatotic liver disease (MASLD) represents an impending global health challenge. Current management strategies often face setbacks, emphasizing the need for preclinical models that faithfully mimic the human disease and its comorbidities. The liver disease progression aggravation diet (LIDPAD), a diet-induced murine model, extensively characterized under thermoneutral conditions and refined diets is introduced to ensure reproducibility and minimize species differences. LIDPAD recapitulates key phenotypic, genetic, and metabolic hallmarks of human MASLD, including multiorgan communications, and disease progression within 4 to 16 weeks. These findings reveal gut-liver dysregulation as an early event and compensatory pancreatic islet hyperplasia, underscoring the gut-pancreas axis in MASLD pathogenesis. A robust computational pipeline is also detailed for transcriptomic-guided disease staging, validated against multiple harmonized human hepatic transcriptomic datasets, thereby enabling comparative studies between human and mouse models. This approach underscores the remarkable similarity of the LIDPAD model to human MASLD. The LIDPAD model fidelity to human MASLD is further confirmed by its responsiveness to dietary interventions, with improvements in metabolic profiles, liver histopathology, hepatic transcriptomes, and gut microbial diversity. These results, alongside the closely aligned changing disease-associated molecular signatures between the human MASLD and LIDPAD model, affirm the model's relevance and potential for driving therapeutic development.

Metal-Organic Framework-Based Hetero-Phase Nanostructure Photocatalysts with Molecular-Scale Tunable Energy Levels.

As an effective method to modulate the physicochemical properties of materials, crystal phase engineering, especially hetero-phase, plays an important role in developing high-performance photocatalysts. However, it is still a huge challenge but significant to construct porous hetero-phase nanostructures with adjustable band structures. As a kind of unique porous crystalline materials, metal-organic frameworks (MOFs) might be the appropriate candidate, but the MOF-based hetero-phase is rarely reported. Herein, we developed a secondary building unit (SBU) regulating strategy to prepare two crystal phases of Ti-MOFs constructed by titanium and 1,4-dicarboxybenzene, i.e., COK and MIL-125. Besides, COK/MIL-125 hetero-phase was further constructed. In the photocatalytic hydrogen evolution reaction, COK/MIL-125 possessed the highest H2 yield compared to COK and MIL-125, ascribing to the Z-Scheme homojunction at hetero-phase interface. Furthermore, by decorating with amino groups (i.e., NH2-COK/NH2-MIL-125), the light absorbing capacity was broadened to visible-light region, and the visible-light-driven H2 yield was greatly improved. Briefly, the MOF-based hetero-phase possesses periodic channel structures and molecularly adjustable band structures, which is scarce in traditional organic or inorganic materials. As a proof of concept, our work not only highlights the development of MOF-based hetero-phase nanostructures, but also paves a novel avenue for designing high-performance photocatalysts.

Boosting Osmotic Energy Harvesting from Organic Solutions by Ultrathin Covalent Organic Framework Membranes.

Extracting osmotic energy from waste organic solutions via reverse electrodialysis represents a promising approach to reuse such industrial wastes and helps to mitigate the ever-growing energy needs. Herein, a molecularly thin membrane of covalent organic frameworks is engineered via interfacial polymerization to investigate its ion transport behavior in organic solutions. Interestingly, a significant deviation from linearity between ion conductance and reciprocal viscosity is observed, attributed to the nanoscale confinement effect on intermolecular interactions. This finding suggests a potential strategy to modulate the influence of apprarent viscosity on transmembrane transport. The osmotic energy harvesting of the ultrathin membrane in organic systems was studied, achieving an unprecedented output power density of over 84.5 W m-2 at a 1000-fold salinity gradient with a benign conversion efficiency and excellent stability. These findings provide a meaningful stepping stone for future studies seeking to fully leverage the potentials of organic systems in energy harvesting applications.

Identification and Verification of Error-Related Potentials Based on Cerebellar Targets.

The error-related potential (ErrP) is a weak explicit representation of the human brain for individual wrong behaviors. Previously, ErrP-related research usually focused on the design of automatic correction and the error correction mechanisms of high-risk pipeline-type judgment systems. Mounting evidence suggests that the cerebellum plays an important role in various cognitive processes. Thus, this study introduced cerebellar information to enhance the online classification effect of error-related potentials. We introduced cerebellar regional characteristics and improved discriminative canonical pattern matching (DCPM) in terms of data training and model building. In addition, this study focused on the application value and significance of cerebellar error-related potential characterization in the selection of excellent ErrP-BCI subjects (brain-computer interface). Here, we studied a specific ErrP, the so-called feedback ErrP. Thirty participants participated in this study. The comparative experiments showed that the improved DCPM classification algorithm proposed in this paper improved the balance accuracy by approximately 5-10% compared with the original algorithm. In addition, a correlation analysis was conducted between the error-related potential indicators of each brain region and the classification effect of feedback ErrP-BCI data, and the Fisher coefficient of the cerebellar region was determined as the quantitative screening index of the subjects. The screened subjects were superior to other subjects in the performance of the classification algorithm, and the performance of the classification algorithm was improved by up to 10%.

Structuring Cu Membrane Electrode for Maximizing Ethylene Yield from CO2 Electroreduction.

Electrocatalytic ethylene (C2H4) evolution from CO2 reduction is an intriguing route to mitigate both the energy and environmental crises; however, to acquire industrially relevant high productivity and selectivity at low energy cost remains to be challenging. Membrane assembly electrode has shown great prospect and tailoring its architecture for maximizing C2H4 yield at minimum voltage with long-term stability becomes critical. Here a freestanding Cu membrane cathode is designed and constructed by electrochemically depositing mesoporous Cu film on Cu foam to simultaneously manage CO2, electron, water, and product transport, which shows an extraordinary C2H4 Faradaic efficiency of 85.6% with a full cell power conversion efficiency of 33% at a current density of 368 mA cm-2, heading the techno-economic viability for electrocatalytic C2H4 production.

Unraveling the Impact of Cerebellar Stimulation on Attentional Performance: A Behavioral Study.

Attentional processes play a crucial role in our ability to perceive and respond to relevant stimuli. The cerebellum, traditionally associated with motor control, has recently garnered attention as a potential contributor to attention modulation. This study aimed to investigate the effects of cerebellar intermittent theta-burst stimulation (iTBS) on attentional performance using three behavioral tasks: dot counting, target selection, and multi-tasking. Seventeen healthy participants underwent either real or sham iTBS stimulation over seven days, and their performance on the tasks was assessed. Results revealed that dot counting performance did not significantly differ between the real and sham stimulation groups. However, notable improvements were observed over time, suggesting a learning effect. In contrast, significant effects of iTBS stimulation were found in the target selection task, with participants receiving real stimulation demonstrating enhanced discrimination between targets and distractors. Additionally, the multi-tasking task exhibited significant main effects of both iTBS stimulation and time, indicating improved performance with stimulation and progressive enhancements over the study period. These findings highlight the potential of cerebellar iTBS stimulation to enhance attentional performance in specific task domains. The significant effects observed in the target selection and multi-tasking tasks provide promising evidence for the modulatory role of the cerebellum in attention. Further investigations into the underlying mechanisms and optimal stimulation parameters are warranted to refine our understanding of how cerebellar iTBS stimulation influences attentional processes.

The genomic landscape of swine influenza A viruses in Southeast Asia.

Swine are a primary source for the emergence of pandemic influenza A viruses. The intensification of swine production, along with global trade, has amplified the transmission and zoonotic risk of swine influenza A virus (swIAV). Effective surveillance is essential to uncover emerging virus strains; however gaps remain in our understanding of the swIAV genomic landscape in Southeast Asia. More than 4,000 nasal swabs were collected from pigs in Cambodia, yielding 72 IAV-positive samples by RT-qPCR and 45 genomic sequences. We unmasked the cocirculation of multiple lineages of genetically diverse swIAV of pandemic concern. Genomic analyses revealed a novel European avian-like H1N2 swIAV reassortant variant with North American triple reassortant internal genes, that emerged approximately seven years before its first detection in pigs in 2021. Using phylogeographic reconstruction, we identified south central China as the dominant source of swine viruses disseminated to other regions in China and Southeast Asia. We also identified nine distinct swIAV lineages in Cambodia, which diverged from their closest ancestors between two and 15 B.P., indicating significant undetected diversity in the region, including reverse zoonoses of human H1N1/2009 pandemic and H3N2 viruses. A similar period of cryptic circulation of swIAVs occurred in the decades before the H1N1/2009 pandemic. The hidden diversity of swIAV observed here further emphasizes the complex underlying evolutionary processes present in this region, reinforcing the importance of genomic surveillance at the human-swine interface for early warning of disease emergence to avoid future pandemics.

Aberrant temporal correlations of ongoing oscillations in disorders of consciousness on multiple time scales.

Changes in neural oscillation amplitude across states of consciousness has been widely reported, but little is known about the link between temporal dynamics of these oscillations on different time scales and consciousness levels. To address this question, we analyzed amplitude fluctuation of the oscillations extracted from spontaneous resting-state EEG recorded from the patients with disorders of consciousness (DOC) and healthy controls. Detrended fluctuation analysis (DFA) and measures of life-time and waiting-time were employed to characterize the temporal structure of EEG oscillations on long time scales (1-20 s) and short time scales (< 1 s), in groups with different consciousness states: patients in minimally conscious state (MCS), patients with unresponsive wakefulness syndrome (UWS) and healthy subjects. Results revealed increased DFA exponents that implies higher long-range temporal correlations (LRTC), especially in the central brain area in alpha and beta bands. On short time scales, declined bursts of oscillations were also observed. All the metrics exhibited lower individual variability in the UWS or MCS group, which may be attributed to the reduced spatial variability of oscillation dynamics. In addition, the temporal dynamics of EEG oscillations showed significant correlations with the behavioral responsiveness of patients. In summary, our findings shows that loss of consciousness is accompanied by alternation of temporal structure in neural oscillations on multiple time scales, and thus may help uncover the mechanism of underlying neuronal correlates of consciousness. Supplementary Information: The online version contains supplementary material available at 10.1007/s11571-022-09852-9.

Dysfunctional Autophagy, Proteostasis, and Mitochondria as a Prelude to Age-Related Macular Degeneration.

Retinal pigment epithelial (RPE) cell dysfunction is a key driving force of AMD. RPE cells form a metabolic interface between photoreceptors and choriocapillaris, performing essential functions for retinal homeostasis. Through their multiple functions, RPE cells are constantly exposed to oxidative stress, which leads to the accumulation of damaged proteins, lipids, nucleic acids, and cellular organelles, including mitochondria. As miniature chemical engines of the cell, self-replicating mitochondria are heavily implicated in the aging process through a variety of mechanisms. In the eye, mitochondrial dysfunction is strongly associated with several diseases, including age-related macular degeneration (AMD), which is a leading cause of irreversible vision loss in millions of people globally. Aged mitochondria exhibit decreased rates of oxidative phosphorylation, increased reactive oxygen species (ROS) generation, and increased numbers of mitochondrial DNA mutations. Mitochondrial bioenergetics and autophagy decline during aging because of insufficient free radical scavenger systems, the impairment of DNA repair mechanisms, and reductions in mitochondrial turnover. Recent research has uncovered a much more complex role of mitochondrial function and cytosolic protein translation and proteostasis in AMD pathogenesis. The coupling of autophagy and mitochondrial apoptosis modulates the proteostasis and aging processes. This review aims to summarise and provide a perspective on (i) the current evidence of autophagy, proteostasis, and mitochondrial dysfunction in dry AMD; (ii) current in vitro and in vivo disease models relevant to assessing mitochondrial dysfunction in AMD, and their utility in drug screening; and (iii) ongoing clinical trials targeting mitochondrial dysfunction for AMD therapeutics.

Distinct armchair and zigzag charge transport through single polycyclic aromatics.

In aromatic systems with large π-conjugated structures, armchair and zigzag configurations can affect each material's electronic properties, determining their performance and generating certain quantum effects. Here, we explore the intrinsic effect of armchair and zigzag pathways on charge transport through single hexabenzocoronene molecules. Theoretical calculations and systematic experimental results from static carbon-based single-molecule junctions and dynamic scanning tunneling microscope break junctions show that charge carriers are preferentially transported along the hexabenzocoronene armchair pathway, and thus, the corresponding current through this pathway is approximately one order of magnitude higher than that through the zigzag pathway. In addition, the molecule with the zigzag pathway has a smaller energy gap. In combination with its lower off-state conductance, it shows a better field-effect performance because of its higher on-off ratio in electrical measurements. This study on charge transport pathways offers a useful perspective for understanding the electronic properties of π-conjugated systems and realizing high-performance molecular nanocircuits toward practical applications.

Effectiveness and safety of Suhuang Zhike capsule as adjuvant treatment for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and Meta-analysis.

OBJECTIVE: To evaluate the efficacy and safety of Suhuang Zhike capsule in the adjuvant treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: The database including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure Database, China Science and Technology Journal Database, Chinese Biomedical Literature Database and Wanfang Data was searched. The retrieval time was from database establishment to May 2021. Randomized controlled trial (RCT) of Suhuang zhike capsule adjuvant treatment for AECOPD was included. The quality of the studies was independently evaluated and cross-checked by two reviewers, and Meta-analysis was performed by using RevMan5.3 software. RESULTS: Thirteen RCT results were included with a total sample number of 1195 cases, including 597 in the experimental group and 598 in the control group. The results showed that Suhuang zhike capsule adjuvant treatment of AECOPD could improve the total clinical effect rate compared with conventional treatment. Suhuang zhike capsule adjuvant treatment could improve forced vital capacity (FVC), forced expiratory volume in one second (FEV), FEV/FVC, peak expiratory flow (PEF) and other pulmonary function indexes; decrease C-reactive protein (CRP), white blood cells, neutrophils and other infectious indicators; besides, the 1-year recurrence rate of the disease was decreased (all 0.05). CONCLUSIONS: Suhuang Zhike capsule can improve the lung function and clinical efficacy of AECOPD, thus increasing the exercise endurance, and reducing the infection and recurrence rate in AECOPD patients.

Preparation of a novel iron oxychloride (FeOCl) auxiliary electrode in promoting electrokinetic remediation of Cr(VI) contaminated soil: An experimental and DFT calculation analysis.

The utilization of auxiliary electrode can improve substantially the electrokinetic remediation efficiency of heavy metal contaminated soil. The increase in the auxiliary electrode performance is the key to further promote the electrokinetic remediation efficiency. In this study, two kinds of auxiliary electrodes, pure FeOCl and doped FeOCl with W and S, were prepared and used in the electrokinetic remediation of Cr(VI) contaminated soil. The system equipped with the auxiliary electrode doped FeOCl brought more stable system current (202 mA) and more uniform electric field than blank group (130 mA). The reduction rate of Cr(VI) was increased by 50% due to the presence of Fe2+ and S2-. The accelerating migration of ions by auxiliary electrode was responsible for the improvement in electrokinetic remediation efficiency. Density functional theory (DFT) calculation showed that Cl vacancy formation energies of pure FeOCl, S-doped FeOCl (S/FeOCl) and W-doped FeOCl (W/FeOCl) were 1.29, 1.15 and 1.49 eV respectively, and the ion diffusion barriers were 0.093, 0.099 and 0.148 eV respectively. Calculation results indicated that the doping of S was conducive to the diffusion of Cl ions, and the bonding of W-Cl was stronger than Fe-Cl. The charging and discharging process of auxiliary electrode became easier due to the formation of lower vacancy in S-doped FeOCl, which could bring a higher current for the electrokinetic remediation system. The electrochemical performance of FeOCl doped with W and S was improved obviously. This study provided a further explanation for the positive role of auxiliary electrode in electrokinetic remediation system.

Effect of MELK Inhibitor OTSSP167 on Diffuse Large B-Cell Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To investigate the effect of MELK inhibitor OTSSP167 against diffuse large B-cell lymphoma (DLBCL).@*METHODS@#The effect of OTSSP167 on activity, proliferation, and apoptosis of DLBCL cell line (SUDHL2 and HBL1) was detected by CCK-8 assay, 5-ethynyl-2'-deoxyuridine (EdU) staining, and Annexin V-FITC/PI double staining, respectively. DLBCL cells were inoculated into nude mice, after 4 weeks of OTSSP167 treatment, the effect of OTSSP167 on DLBCL growth in vivo was detected. Caspase-GloTM 3/7 enzyme activity assay kit was used to detect the effect of OTSSP167 on Caspase 3/7 enzyme activity of DLBCL cells. The expression levels of apoptosis and cycle-related proteins were detected by Western blot.@*RESULTS@#OTSSP167 significantly inhibited the activity of SUDHL2 and HBL1 cells in a dose-dependent manner (r =-0.61, r =-0.52). EdU staining showed that OTSSP167 could significantly inhibit the proliferation of SUDHL2 and HBL1 cells. Annexin V-FITC/PI result showed that OTSSP167 could significantly promote the apoptosis of SUDHL2 and HBL1 cells (P <0.001). The result of in vivo experiment showed that OTSSP167 could inhibit the growth of SUDHL2 cells in nude mice. The result of TUNEL staining of tumor further confirmed that OTSSP167 could promote the apoptosis of SUDHL2 cells. Caspase 3/7 enzyme activity test demonstrated that OTSSP167 could significantly increase caspase activity in SUDHL2 and HBL1 cells (r =0.98, r =0.87). Western blot showed that OTSSP167 could dose-dependently inhibit the expression of PARP, Bcl-xL, and Bcl-2 in apoptosis signaling pathway (r =-0.93, r =-0.66, r =-0.87), while p53 protein was significantly up-regulated (r =0.82). The expression of cell cycle-related proteins cdc2, Cyclin E1, Cyclin A2, and Cyclin B1 also showed a dose-dependent down-regulation (r =-0.89, r =-0.83, r =-0.61, r =-0.93).@*CONCLUSION@#The MELK inhibitor OTSSP167 can inhibit the proliferation and promote the apoptosis of DLBCL cells by inhibiting the expression of cycle-related proteins and anti-apoptosis-related proteins.

MDM2 Inhibitor RG-7388 Promotes Apoptosis and Cell Cycle Arrest of Diffuse Large B Cell Lymphoma / 肿瘤防治研究

Objective To investigate the effect of MDM2 inhibitor RG-7388 on the proliferation, cell cycle, and apoptosis of diffuse large B-lymphoma (DLBCL) cells. Methods DLBCL cell strains SUDHL2 and HBL1 were treated with 2, 4, and 8 μmol/LRG7388, respectively. Cell proliferation was detected by CCK8 and EdU methods. Apoptosis was measured by Annexin V–FITC/PI double staining and Caspase 3/7-Glo enzyme activity methods. Cell cycle was assessed by flow cytometry. Changes in the expression of cell cycle and apoptosis-related proteins were determined by Western blot. Results The IC50 of RG7388 for inhibiting SUDHL2 and HBL1 cells were 3.36 and 3.76 μmol/L, respectively, and the inhibitory effect of RG7388 was dose dependent. The proportions of G1 phase and apoptotic cells in the SUDHL2 and HBL1 cells treated with different doses of RG7388 were significantly higher than those in the control group (all P<0.05). The activity of Caspase 3/7 increased gradually with RG7388 concentration, compared with that in the control group. The expression levels of p53, p27, p21, and PARP increased, whereas the expression of Mcl-1 and Bcl-xL was down-regulated (all P<0.05). Conclusion MDM2 inhibitor RG-7388 inhibits the proliferation of DLBCL cells, triggers cell cycle arrest in the G1 phase, and induces apoptosis through the p53 pathway.

Genetic analysis of unexplained neonatal encephalopathy / 中华围产医学杂志

Objective:To explore the potential genetic causes of unexplained neonatal encephalopathy.Methods:This retrospective study enrolled 113 infants diagnosed with unexplained neonatal encephalopathy and underwent genetic testing in the Children's Hospital of Hunan Province from January 2019 to May 2021. Perinatal data, clinical manifestations, electroencephalograph, brain MRI findings, genetic information, and prognosis of those patients were analyzed. T-test or Chi-square test were used for data analysis. Results:Of the 113 infants enrolled, 74 (65.5%) were males. The gestational age at birth was (38.6±1.5) weeks, and the birth weight was (2 957±561) g. The most common clinical manifestation was the disturbance of consciousness (83/113, 73.5%), followed by seizures (39/113, 34.5%). There were 38.2% (34/89) of the patients with abnormal brain MRI, and 80.4% (74/92) presented abnormal electroencephalography. Among the 113 infants, 60 (53.1%) had genetic abnormalities, including 48 with single nucleotide variations, eight with copy number variations, and four with chromosome abnormalities. Single nucleotide variations in the 48 patients were classified into syndromic ( n=18, 37.5%), metabolic ( n=16, 33.3%), epileptic ( n=11, 22.9%) and mitochondrial-related genes ( n=3, 6.3%), of which 14 were not included in any database. Among the 103 cases which were successfully followed up until December 31, 2021, 75 (72.8%) had a poor prognosis, including 52 (50.5%) death cases and 23 (22.3%) cases of development retardation. Birth weight and the incidence of seizures in the poor prognosis group were both lower than those in the non-poor prognosis group [(2 876±536) vs (3 254±554) g, t=3.15; 29.3% (22/75) vs 53.6% (15/28), χ2=5.20; both P<0.05], while the incidence of disturbance of consciousness was higher [80.0% (60/75) vs 53.6% (15/28), χ2=7.19, P<0.05]. The proportion of infants with genetic abnormalities in the poor prognosis group was higher than that in the non-poor prognosis group, but the difference was not statistically significant [53.3% (40/75) vs 46.4% (13/28), χ2=0.39, P=0.533]. Conclusions:Genetic abnormality is one of the leading causes of unexplained neonatal encephalopathy. Nucleotide variation is the most common genetic type. Syndromic, metabolic, and epileptic variants are frequently detected in these patients.

Age-related changes in liver functional reserve measured by the L-1- 13C-phenylalanine breath test / 中华老年医学杂志

Objective:To evaluate liver functional reserve in healthy subjects of different age groups using the L-[1- 13C]-phenylalanine breath test( 13C-pheBT)and to investigate the patterns of changes in liver functional reserve with aging in comparison with elderly cirrhosis patients. Methods:Thirty-seven healthy volunteers were divided into a young and middle-aged group(n=10), an early elderly group(n=9), an advanced elderly group(n=9)and a longevity group(n=9). Eight elderly patients with liver cirrhosis were selected as the control group.An oral dose of 100 mg 13C-phe was administered to each subject.Expired breath samples were collected at pre-dose and at 12 different time points within 150 minutes post-dose.Isotope ratio mass spectrometer was used to measure the abundance of 13C.The percentage of the 13C excretion rate( 13CO 2ERt), the percentage of 13C cumulative excretion( 13Ccumt)at different time points, and the percentage of the 13C peak excretion rate( 13CO 2ERmax)after drug administration were calculated.In addition, associations between 13C-pheBT and common liver function parameters were analyzed. Results:Compared with healthy volunteers, 13CO 2ER 30, 13CO 2ER 45, 13CO 2ER 60, 13Ccum 45, 13Ccum 60, 13Ccum 75, 13Ccum 90 and 13Ccum 105, 13Ccum 120, 13Ccum 135, 13Ccum 150 showed significant differences in the longevity group, the young and middle-aged group and the young elderly group.There were statistically significant differences between the elderly cirrhosis group and the healthy volunteers in each subgroup(all P<0.05); The mean values of 13CO 2ERmax, 13CO 2ER 30, 13Ccum 45, 13Ccum 60, 13Ccum 75, 13Ccum 90, 13Ccum 105, 13Ccum 120, 13Ccum 135, 13Ccum 150 decreased following the order of the young and middle-aged group, the early elderly group, the advanced elderly group, the longevity group, and the elderly cirrhosis group(all P<0.05). In healthy volunteers, the 13CO 2 exclusion rate curve and the cumulative exclusion rate curve showed that the curves of the young and middle-aged group and the early elderly group almost overlapped, while the curves of the advanced group and the longevity group decreased with age, and the difference between the longevity group and the young and middle-aged group and between the longevity group and the early elderly group was markedly prominent. Conclusions:13C-pheBT is a safe, sensitive and reliable test for quantitation of liver function.Our recommendations include collecting samples within an hour of drug administration and using 13CO 2ERmax, 13CO 2ER 30, 13Ccum 45 and 13Ccum 60 as the main parameters.Overall, the functional reserve and compensatory capability of the liver are robust.The decline in liver functional reserve in healthy individuals is a gradual and slow process, with a significant decrease after age 80 and more so after age 90.

Clinical efficacy of the "3-2-1" surface positioning method assisted by proximal femoral anti-rotation nailing in the treatment of femoral subtrochanteric fractures / 中华骨科杂志

Objective:To investigate the clinical efficacy of proximal femoral nail anti-rotation (PFNA) assisted by the "3-2-1" surface positioning method in the treatment of femoral subtrochanteric fractures.Methods:A total of 97 patients with subtrochanteric fractures admitted to the Second Hospital of Fuzhou from January 2015 to December 2020 were retrospectively analyzed. They were divided into two groups according to whether the "3-2-1" surface positioning method (3 longitudinal axes, 2 preset incisions, and 1 auxiliary incision) was used. There were 44 patients in the surface positioning group, including 25 males and 19 females, aged 61.59±18.43 years (range, 22-90 years). According to the Seinsheimer classification, there were 13 cases of type II, 11 cases of type III, 6 cases of type IV, and 14 cases of type V. The mechanism of injury was low energy injury in 26 cases and high energy injury in 18 cases. There were 53 patients in the traditional positioning group, including 30 males and 20 females, aged 56.38±17.24 years (range, 24-90 years). According to the Seinsheimer classification, there were 9 cases of type II, 22 cases of type III, 9 cases of type IV, and 13 cases of type V. According to the mechanism of injury, there were 30 cases of low energy injury and 23 cases of high energy injury. The length of incision, operation time, and blood loss were recorded. At 1, 3, 6, and 12 months after operation, the anteroposterior and lateral X-ray films of the hip were taken to evaluate the imaging indicators (neck-shaft angle, anteroposterior and lateral displacement, and angulation), fracture healing, and complications (infection, malunion, loosening and breakage of the internal fixation, and periprosthetic fracture). The Harris hip score and EuroQol five dimensions questionnaire (EQ-5D) were evaluated.Results:All patients successfully completed the operation and were followed up for 15.12±1.54 months (range, 12-18 months). The operation time, incision length, dominant blood loss and hidden blood loss in the surface positioning group were 1.78(1.50, 2.00) h, 8(8, 9) cm, 300(200, 400) ml and 843(629, 1 130) ml, respectively, which were less than 2.10(1.69, 2.38) h, 10(9, 12) cm, 400(300, 500) ml and 1 030(954, 1 266) ml in the traditional positioning group, and the difference was statistically significant ( P<0.05). The neck-shaft angle in the surface positioning group was 135.54°±2.83°, which was larger than 132.33°±3.37° in the traditional positioning group, and the difference was statistically significant ( t=5.02, P<0.001). The anterolateral and lateral displacement and lateral image angle in the surface positioning group were 4.70±1.60 cm, 4.52±1.71 cm and 9.36°±2.94°, respectively, which were lower than 6.14±2.57 cm, 5.98±2.70 cm and 11.46°±4.68° in the traditional positioning group, and the difference was statistically significant ( P<0.05). One year after operation, the Harris hip score and EQ-5D score of the surface positioning group were 92(84, 99) points and 0.90(0.73, 1.00) points, respectively, which were higher than 88(74, 96) points and 0.81(0.72, 0.94) points of the traditional positioning group ( P<0.05). Conclusion:The "3-2-1" surface positioning method assisted PFNA internal fixation in the treatment of femoral subtrochanteric fracture can improve the quality of reduction, reduce intraoperative blood loss, and improve hip function and quality of life.

Surgical methods and treatment effects of the adult anterior dislocation of the sacroiliac joint / 中华骨科杂志

Objective:To explore the surgical methods and treatment effects of adult anterior dislocation of the sacroiliac joint (AADSJ).Methods:A multi-center retrospective case series study was conducted to analyze the clinical data of 25 cases admitted in 5 clinical centers (affiliations of authors in this article) from January 2016 to January 2021. There were 18 males and 7 females, aged 38.8±15.5 years (range, 18-83 years). The AADSJ clinical classification system was formulated based on the radiographic morphology of anterior dislocation of the sacroiliac joint, which includes two types. Type I: complete anterior dislocation of the sacroiliac joint, and displacement of the entire iliac auricular surface to the front of the sacrum. Type II: fracture of the sacroiliac joint combined with anterior dislocation, subdivided into 3 subtypes. Type IIa: iliac fracture involves the anterior 1/3 of the sacroiliac joint, and dislocation of the ilium anterior to the sacrum. Type IIb: iliac fracture involves the posterior 2/3 of the sacroiliac joint, and dislocation of the ilium anterior to the sacrum. Type IIc: iliac fracture involves the posterior 2/3 of the sacroiliac joint, and dislocation of the ilium anteromedial to the sacrum. The reliability and repeatability of the clinical classification, Tile classification and Young-Burgess classification were performed based on the results of two-phase assessments in four observers. The operations were performed by the lateral-rectus approach and the ilioinguinal approach. The operation time and intraoperative bleeding were recorded. Pelvic X-ray and CT scan were rechecked after the operation. The quality of fracture reduction was evaluated according to Matta score. The postoperative functional rehabilitation was evaluated according to the Majeed rehabilitation standard at one-year follow-up.Results:Among 25 cases in this study, there were 3 cases of Type I, 5 cases of Type IIa, 9 cases of Type IIb and 8 cases of Type IIc according to the clinical classification system. The Kappa values of reliability tests for the clinical classification, Tile classification and Young-Burgess classification were 0.681, 0.328 and 0.383, respectively. The Kappa values of repeatability tests for the clinical classification, Tile classification and Young-Burgess classification were 0.690, 0.221 and 0.395, respectively. The reliability and repeatability of the AADSJ clinical classification were significantly better than other classifications. There were 14 cases underwent lateral rectus abdominis approach and 11 cases underwent ilioinguinal approach. The operative time for managing anterior dislocation of the sacroiliac joint was 122.0±50.7 min (range, 65-148 min) through the lateral rectus abdominis approach, and through the ilioinguinal approach was 178.0±49.9 min (range, 110-270 min), with a significant difference ( t=2.76, P=0.011). The amount of intraoperative blood loss through the lateral rectus approach was 680±330 ml (range, 350-2,120 ml), which was significantly less than that through the ilioinguinal approach (1,660±968 ml, 680-3,300 ml), with a significant difference ( t=3.55, P=0.002). The follow-up period was 1-3 years. At one week after surgery, the quality of fracture reduction evaluated by Matta score showed that the excellent and good reduction rate of the lateral-rectus approach was 79% (11/14), and that of the ilioinguinal approach was 73% (11/14), with no statistically significant difference ( P=1.000). At a one-year follow-up, according to Majeed's criteria, the overall excellent and good rate of the lateral-rectus approach was 64% (9/14), which is similar to 64% (7/11) of that of the ilioinguinal approach. No fracture reduction loss or internal fixation loosening failure occurred. Conclusion:The AADSJ clinical classification system can accurately describe the imaging features and clinical manifestations of AADSJ, with high reliability and repeatability. The AADSJ can be treated by the lateral-rectus approach or the ilioinguinal approach, with similar therapeutic effects but the former having less trauma.

Clinical analysis of 172 cases of neonatal death after giving up treatment / 中国医师杂志

Objective:To summarize the situation of dead newborns and their parents after parents gave up treatment, and analyze the reasons and emotional needs of parents who gave up treatment, so as to provide reference for reducing neonatal mortality and negative emotions of parents.Methods:A retrospective study was conducted to collect the data of neonates and mothers who died after giving up treatment reported in Hunan Children′s Hospital from January 2019 to December 2021. The general information, perinatal risk factors, and the incidence of in-hospital diseases were analyzed. Then, semi-structured interviews were conducted with parents of newborns who died after giving up treatment from February to December 2021. Understand why parents give up treatment and their emotional needs.Results:A total of 172 newborns died after giving up were included in the analysis, including 103 males (59.88%) and 74 premature infants (43.02%); Umbilical cord, placenta and amniotic fluid abnormalities were 21 cases (12.21%), 39 cases (22.67%) and 25 cases (14.53%), respectively. Birth asphyxia was 31 cases (18.02%), including severe asphyxia in 18 cases (10.46%); There were 21 (12.21%), 35 (20.35%) and 30 (17.44%) cases of maternal infection in the third trimester, hypertension in pregnancy and diabetes in pregnancy, respectively. The top three causes of death were septicemia (18.02%), congenital malformation (16.86%) and severe pneumonia (10.47%). The main reason why parents give up treatment was that the child′s disease was critical and irreversible, and parents had strong emotional needs for hospice care in their hearts.Conclusions:There are many high risk factors of perinatal death of newborns after giving up treatment. Sepsis is the primary cause of death, and strengthening perinatal health care is fundamental. Parents have a strong demand for hospice care, so it is of practical significance to implement family-centered hospice care model for such special newborns.