Evaluation of the Construction and Application of Standardised Process Nursing Programme in the Management of Enteral Nutrition in Critically Ill Patients.

Objective: To observe the effect of implementing standardized flow management in enteral nutrition therapy for critically ill patients. Methods: We selected 241 critically ill patients admitted to our hospital from January 2020 to January 2023. Patients with enteral nutrition without standard process management were set as the control group (n = 109), while those with enteral nutrition and standard process management were set as the observation group (n = 132). The total protein, albumin, prealbumin, and hemoglobin were compared between the two groups on the 7th and 14th day of nutritional therapy. Immune indicators (IgM, IgA, and IgG), NUTRIC score, and the incidence of infectious complications were compared between the two groups. Results: On the 7th and 14th day of treatment, the total protein, albumin, prealbumin, hemoglobin, and immune indicators in the observation group were higher than those in the control group, and the differences were statistically significant (P < .05). On the 7th and 14th day of treatment, the NUTRIC score of the observation group was higher than that in the control group, with a statistically significant difference (P < .05). The incidence of infectious complications in the observation group was lower than that in the control group, and the difference was statistically significant (P < .05). Conclusion: Implementing standardized process management of EN for critically ill patients improves total protein, albumin, prealbumin, hemoglobin, immune indexes, NUTRIC score, and nutritional status, while reducing the incidence of infectious complications. These findings offer valuable insights for clinical practice and advocate for practical application.

Comparison of Callisphere Drug-Eluting Beads Transarterial Chemoembolization and Conventional Transarterial Chemoembolization for the treatment of Hepatocellular Carcinoma.

Objective: To compare the efficacy of CalliSphere drug-eluting beads (DEBs) and conventional (c) transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC). Methods: We retrospectively reviewed the clinical data of 125 patients with HCC who had received treatment in Affiliated Hospital of North Sichuan Medical College from January 2018 to February 2019. Sixty-one patients underwent DEB-TACE (observation group) and 64 patients underwent cTACE (control group). The clinical efficacies, overall survivals, and incidence of postoperative adverse reactions between the two groups were compared. Results: The objective response rate in the observation group (85.25%) was higher than that in the control group (70.31%; P<0.05). The disease control in the observation group (96.72%) was higher than that in the control group (85.94%; P<0.05). The median survival time of the observation group (24.85 months) was significantly higher than that in the control group (18.18 months; P<0.05). The incidence of adverse reactions in the observation group (4.92%) was lower than that in the control group (17.19%, P<0.05). Conclusions: In the treatment of HCC, Callisphere DEB-TACE has better efficacy and longer patient survival with fewer adverse reactions compared to cTACE.

Uncovering the diversity and contents of gene cassettes in class 1 integrons from the endophytes of raw vegetables.

Rapid spread of antibiotic resistance genes (ARGs) in pathogens is threatening human health. Integrons allow bacteria to integrate and express foreign genes, facilitating horizontal transfer of ARGs in environments. Consumption of raw vegetables represents a pathway for human exposure to environmental ARGs. However, few studies have focused on integron-associated ARGs in the endophytes of raw vegetables. Here, based on the approach of qPCR and clone library, we quantified the abundance of integrase genes and analyzed the diversity and contents of resistance gene cassettes in class 1 integrons from the endophytes of six common raw vegetables. The results revealed that integrase genes for class 1 integron were most prevalent compared with class 2 and class 3 integron integrase genes (1-2 order magnitude, P < 0.05). The cucumber endophytes harbored a higher absolute abundance of integrase genes than other vegetables, while the highest bacterial abundance was detected in cabbage and cucumber endophytes. Thirty-two unique resistance gene cassettes were detected, the majority of which were associated with the genes encoding resistance to beta-lactam and aminoglycoside. Antibiotic resistance gene cassettes accounted for 52.5 % of the functionally annotated gene cassettes, and blaTEM-157 and aadA2 were the most frequently detected resistance cassettes. Additionally, carrot endophytes harbored the highest proportion of antibiotic resistance gene cassettes in the class 1 integrons. Collectively, these results provide an in-depth view of acquired resistance genes by integrons in the raw vegetable endophytes and highlight the potential health risk of the transmission of ARGs via the food chain.

Surgical timing in neonatal brachial plexus palsy: A PRISMA-IPD systematic review.

BACKGROUND: Neonatal brachial plexus palsy (NBPP) is a serious complication of high-risk deliveries with controversy surrounding timing of corrective nerve surgery. This review systematically examines the existing literature and investigates correlations between age at time of upper trunk brachial plexus microsurgery and surgical outcomes. METHODS: A systematic screening of PubMed, Cochrane, Web of Science, and CINAHL databases using PRISMA-IPD guidelines was conducted in January 2020 to include full-text English papers with microsurgery in upper trunk palsy, pediatric patients. Spearman rank correlation analysis and two-tailed t-tests were performed using individual patient data to determine the relationship between mean age at time of surgery and outcome as determined by the Mallet, Medical Research Council (MRC), or Active Movement Scale (AMS) subscores. RESULTS: Two thousand nine hundred thirty six papers were screened to finalize 25 papers containing individual patient data (n = 256) with low to moderate risk of bias, as assessed by the ROBINS-I assessment tool. Mallet subscore for hand-to-mouth and shoulder abduction, AMS subscore for elbow flexion and external rotation, and MRC subscore for elbow flexion were analyzed alongside the respective age of patients at surgery. Spearman rank correlation analysis revealed a significant negative correlation (ρ = -0.30, p < .01, n = 89) between increasing age (5.50 ± 2.09 months) and Mallet subscore for hand-to-mouth (3.43 ± 0.83). T-tests revealed a significant decrease in Mallet hand-to-mouth subscores after 6 months (p < .05) and 9 months (p < .05) of age. No significant effects were observed for Mallet shoulder abduction, MRC elbow flexion, or AMS elbow flexion and external rotation. CONCLUSION: The cumulative evidence suggests a significant negative correlation between age at microsurgery and Mallet subscores for hand-to-mouth. However, a similar correlation with age at surgery was not observed for Mallet shoulder abduction, MRC elbow flexion, AMS external rotation, and AMS elbow flexion subscores.

[Follicle-stimulating hormone: new roles in metabolic regulation and aging].

Follicle-stimulating hormone (FSH) was once thought to play a role only in reproduction, promoting follicle development and maturation in women and spermgenesis in men. However, in recent ten years, FSH has been found to have new functions on metabolic regulation and aging. FSH regulates bone formation, fat metabolism, energy homeostasis, cholesterol production and cardiovascular disease by binding with its receptor FSHR. These newly discovered regulatory roles of FSH are exciting, as it is suggested that blocking FSH may have potential translational impacts on treatments of a series of age-related diseases, including osteoporosis, obesity, dyslipidemia, cardiovascular disease.

Men Receive Three Times More Industry Payments than Women Academic Orthopaedic Surgeons, Even After Controlling for Confounding Variables.

BACKGROUND: In 2016, orthopaedic surgeons received nearly USD 300 million from industry, with the top 10% of recipients making more than 95% of the total amount. The degree to which gender may be associated with industry compensation has not been well explored; however, this may be confounded by a number of variables, including academic productivity, experience, and other factors. We wished to explore the variability in payment distribution by gender after controlling for these factors. QUESTIONS/PURPOSES: (1) Do men or women academic orthopaedic surgeons receive more payments from industry? (2) To what degree do any observed differences between the genders persist, even after accounting for identifiable factors, including academic rank, scholarly productivity, regional location of university, subspecialty selection as identified by fellowships completed, and years since completion of residency? METHODS: This study was a cross-sectional retrospective analysis of surgeons practicing in orthopaedic surgery academic departments in the United States. Academic orthopaedic surgery departments were identified using the Fellowship and Residency Electronic Interactive Database. Publicly available data on gender, academic rank, scholarly productivity, regional location of university, fellowships completed, and years since residency graduation were collected from institutional websites. Industry funding data for 2016 were obtained from the Centers for Medicare & Medicaid Services Open Payments Database, and scholarly productivity data through 2017 were collected from Scopus. A total of 2939 academic orthopaedic surgeons, 2620 (89%) men and 319 (11%) women from 126 programs were identified. Men and women surgeons were different in most of the variables collected, and all except region of university were associated with differences in industry payments. RESULTS: The median payment for men surgeons was greater than that for women (USD 1027 [interquartile range USD 125-USD 9616] versus USD 177 [IQR USD 47-USD 1486]; difference of medians, USD 850; p < 0.001]. After accounting for potentially confounding variables like faculty rank, years since residency, H-index and subspecialty choice, women faculty members still received only 29% of payments received by otherwise comparable men orthopaedists (beta coefficient for gender = 0.29 [95% CI 0.20 to 0.44; p < 0.001]). CONCLUSIONS: Women academic orthopaedic surgeons received only 29% of the industry payments received by men, even after controlling for faculty rank, years since residency, H-index, and subspecialty selection. This gender-related disparity may hinder the career advancement of women orthopaedic surgeons. CLINICAL RELEVANCE: Increased transparency by companies can help guide orthopaedic surgeons who wish to receive industry funding.

Identification and biochemical characterization of carboxylesterase 001G associated with insecticide detoxification in Helicoverpa armigera.

Carboxylesterases (CarEs) are a major class of detoxification enzymes involved in insecticide resistance in various insect species. In this study, a novel CarE 001G was isolated from the cotton bollworm Helicoverpa armigera, one of the most destructive agricultural insect pests. The open reading frame of 001G has 2244 nucleotides and putatively encodes 747 amino acid residues. The deduced CarE possessed the highly conserved catalytic triads(Ser-Glu-His) and pentapeptide motifs (Gly-X-Ser-X-Gly), suggesting 001G is biologically active. The truncated 001G was successfully expressed in Escherichia coli, and the recombinant proteins were purified and tested. The enzyme kinetic assay showed the purified proteins could catalyze two model substrates, α-naphthyl acetate and ß-naphthyl acetate, with a kcat of 8.8 and 2.3 s-1, a Km of 9.6 and 16.2 µM, respectively. The inhibition study with pyrethroid, organophosphate and neonicotinoid insecticides showed different inhibition profile against the purified CarE. The HPLC assay demonstrated that the purified proteins were able to metabolize ß-cypermethrin, λ-cyhalothrin and fenvalerate insecticides, exhibiting respective specific activities of 1.7, 1.4 and 0.5 nM/min/mg protein. However, the purified proteins were not able to metabolize the chlorpyrifos, parathion-methyl, paraoxon-ethyl and imidacloprid. The modeling and docking analyses consistently demonstrated that the pyrethroid molecule fits snugly into the catalytic pocket of the CarE 001G. Collectively, our results suggest that 001G may play a role in pyrethroids detoxification in H. armigera.

Hollow Carbon Nanospheres with Tunable Hierarchical Pores for Drug, Gene, and Photothermal Synergistic Treatment.

Design and synthesis of porous and hollow carbon spheres have attracted considerable interest in the past decade due to their superior physicochemical properties and widespread applications. However, it is still a big challenge to achieve controllable synthesis of hollow carbon nanospheres with center-radial large mesopores in the shells and inner surface roughness. Herein, porous hollow carbon nanospheres (PHCNs) are successfully synthesized with tunable center-radial mesopore channels in the shells and crater-like inner surfaces by employing dendrimer-like mesoporous silica nanospheres (DMSNs) as hard templates. Compared with conventional mesoporous nanospheres, DMSN templates not only result in the formation of center-radial large mesopores in the shells, but also produce a crater-like inner surface. PHCNs can be tuned from open center-radial mesoporous shells to relatively closed microporous shells. After functionalization with polyethyleneimine (PEI) and poly(ethylene glycol) (PEG), PHCNs not only have negligible cytotoxicity, excellent photothermal property, and high coloading capacity of 482 µg of doxorubicin and 44 µg of siRNA per mg, but can also efficiently deliver these substances into cells, thus displaying enhanced cancer cell killing capacity by triple-combination therapy.

Efficacy of tamoxifen in combination with docetaxel in patients with advanced non-small-cell lung cancer pretreated with platinum-based chemotherapy.

The aim of this study was to evaluate the efficacy and safety of the combination of docetaxel (TXT) plus tamoxifen (TAM) in advanced non-small-cell lung cancer (NSCLC) patients who had received platinum-based first-line chemotherapy. A total of 120 advanced NSCLC patients pretreated with platinum-based chemotherapy were randomized into two treatment groups (the TXT and TXT+TAM groups) in a 1 : 1 ratio. Reversal of P-glycoprotein (P-gp) expression, tumor response, progression-free survival, overall survival, and safety were evaluated on an intention-to-treat basis. The median number of cycles of allocated chemotherapy was four in each treatment group (range: 2-6 cycles). The overall response rate and disease control rate in the TXT+TAM group were significantly higher than those in the TXT group (36.7 vs. 15.0% for overall response rate, P=0.007; 85.0 vs. 68.3% for disease control rate, P=0.031). The combination of TXT and TAM could effectively reverse P-gp expression in tumor tissues and provide a significant survival benefit for advanced NSCLC patients compared with TXT alone (11.6 vs. 9.1 months, P=0.030). In addition, in the TXT+TAM group, patients achieving P-gp reversal had a significantly greater median progression-free survival and overall survival than nonreversal patients. Furthermore, the combined therapy showed a safety profile comparable to that of TXT. The combination of TXT and TAM may be an effective and safe treatment option for advanced NSCLC patients who have already developed P-gp-mediated multidrug resistance.

Microvascular Decompression Surgery for Hemifacial Spasm.

OBJECTIVE: This study aims to investigate the operative efficacy, surgical complication rate, and surgical strategy of microvascular decompression (MVD) for hemifacial spasm (HFS). METHODS: Clinical data of 46 patients with HFS who underwent MVD were retrospectively analyzed. RESULTS: During surgery, it was found that the facial nerve root exit zone was compressed by the following arterial vessels: anterior inferior cerebellar artery in 24 patients (52.17%); posterior inferior cerebellar artery in 14 patients (30.43%); vertebral artery and a small artery in 7 patients (15.22%); and vertebral artery in 1 patient (2.18%). Symptoms of 38 patients were immediately remitted completely after surgery and symptoms of 8 patients were significantly reduced. Main complications included dizziness and tinnitus in 9 patients, hearing loss in 5 patients, cerebrospinal fluid leakage in 1 patient, and infection in 2 patients. No patient died during surgery. CONCLUSIONS: MVD is the preferred choice for treating idiopathic hemifacial spasm, and hearing impairment is the main complication. Skilled microsurgical techniques, as well as identifying and completely decompressing offending vessels, are the key to ensuring a successful microvascular decompression.

Catalyst-Free Regioselective C-3 Thiocyanation of Imidazopyridines.

A direct and straightforward approach for highly regioselective thiocyanation of imidazoheterocycles through sp(2) C-H functionalization has been realized at room temperature. Various C-3 thiocyanated imidazopyridines are formed in moderate to good yield. The present method exhibits a mild and selective access to a variety of imidazopyridine derivatives of pharmacological interest.

Safe zone for superolateral entry pin into the distal humerus in children: an MRI analysis.

BACKGROUND: The radial nerve is at risk for iatrogenic injury during placement of pins, screws, or wires around the distal humerus. Unlike adults, detailed anatomic information about the relationship of the nerve to the distal humerus is lacking in children. QUESTION/PURPOSES: This study evaluates the relationship of the radial nerve to the distal humerus in a pediatric population on conventional MRI and proposes an anatomic safe zone using easily identifiable bony landmarks on an AP elbow radiograph. METHODS: To determine the course of the radial nerve at the lateral distal humerus, we reviewed 23 elbow radiographs and MRIs of 22 children (mean age, 9 ± 4 years; range, 3-12 years) obtained as part of their workup for various elbow conditions. We described a technique using distance ratios calculated as a percentage of the patient's own transepicondylar distance, defined as the distance measured between the apices of the medial and lateral epicondyles, on the AP elbow radiograph and the midcoronal MR image. The cross-reference tool on a Picture Archiving and Communication System was then used to identify axial MR image at the level where the transepicondylar distance was measured. On this axial image, a line was drawn connecting the medial and lateral epicondyles (the transepicondylar axis) and its midpoint was determined. The radial nerve angle was measured by a line from the radial nerve to the midpoint of the transepicondylar axis and a line along the lateral half of the transepicondylar axis. On this axial slice, the closest distance from the nerve to the underlying cortex of the distal humerus was measured. To further localize the nerve along the distal humerus, predetermined percentages of the transepicondylar distance were projected proximally from the level of the transepicondylar axis along the longitudinal axis of the humerus on the midcoronal MR image. At these designated heights, the corresponding axial MR image was identified using the cross-reference tool and the nerve was mapped in a similar fashion. We then proposed a simpler method using a best-fit line drawn along the lateral supracondylar ridge on the AP radiograph to define the safe zone for lateral pin entry. RESULTS: On axial MR images, the radial nerve was located in the anterolateral quadrant with a mean radial nerve angle of 54° (range, 35°-87) at 0% transepicondylar distance (23 MRIs), 41° (range, 24°-63°) at 50% transepicondylar distance (23 MRIs), and ≥ 10° at 75% transepicondylar distance (on the 13 MRIs that extended this far cephalad). The mean closest distance between the radial nerve and the underlying humeral cortex was 10 mm (range, 3-26 mm) at 0% transepicondylar distance and 7 mm (3-16 mm) at 50% transepicondylar distance. On the AP elbow radiograph, the height of the lateral supracondylar ridge, determined by a best-fit line drawn along the lateral cortex of the ridge, diverged from the most proximal extent of the ridge at a point located at 60% transepicondylar distance (range, 51%-76%). At the corresponding location on the axial MR image, the nerve was located anterolaterally with a mean radial nerve angle of 39° (range, 15°-61°) and a mean distance of 6 mm (range, 2-10 mm) from the underlying humerus. CONCLUSIONS: Our data suggest that percutaneous direct lateral entry Kirschner wires and half-pins can be safely inserted in the distal humerus in children along the transepicondylar axis, either at or slightly posterior to the lateral supracondylar ridge, when placed caudal to the point located where the lateral supracondylar ridge line diverges from the proximal extent of the supracondylar ridge on AP elbow radiograph.

Do children with Blount disease have lower body mass index after lower limb realignment?

BACKGROUND: Children with Blount disease are typically obese. The goal of our study was to assess whether children with Blount disease had lower body mass index (BMI) after surgical correction of their lower limb deformity. METHODS: A surgical data base was used to identify children with Blount disease. Demographic information including age of disease onset, ethnicity, health insurance status, and laterality was noted. Preoperative and most recent BMI values were documented. Using full-length standing radiographs, the mechanical axis deviation (MAD) and leg length discrepancy (LLD) were measured preoperatively and at latest follow-up. The relationship of the change in BMI with various demographic and radiologic parameters was evaluated. RESULTS: Fifty-one children (32 males, 19 females) with Blount disease (23 early onset, 28 late onset) affecting 70 lower extremities (32 unilateral and 19 bilateral) underwent a variety of surgical procedures. All 47 children who underwent gradual correction with external fixation also underwent nutritional counseling while receiving inpatient rehabilitation. At an average follow-up of 48 months, MAD improved from 80.5 mm medial to 16.1 mm medial (P<0.0001) and LLD improved from 19.6 to 10.9 mm (P=0.0002). During the same time period, the BMI increased from 35 (95% confidence interval, 32-37) to 38 (95% confidence interval, 35-41; P=0.0006). Compared with their preoperative BMI, 76% of the children had an increase in their BMI at the latest follow-up. There was no association of the change in the patient's BMI with their age of disease onset, sex, ethnicity, health insurance status, final MAD, or LLD. There was a tendency for the patient's BMI to increase with longer follow-up (P=0.002). Using multivariate analysis, only the length of follow-up was associated with an increase in BMI (P=0.026). CONCLUSIONS: Despite improvement in limb alignment and LLD after surgery, the BMI of the majority of children with Blount disease increased over time. Other strategies for addressing obesity amongst these children are warranted. LEVEL OF EVIDENCE: Level IV--case series.

Low CO2 concentration, a key environmental factor for developing plateau adapted rapeseed.

BACKGROUND: Photosynthesis is a fundamental process that underlies the formation of crop yield, wherein light serves as the driving force and carbon dioxide (CO2) as the raw material. These two factors have a direct influence on the progress and efficiency of photosynthesis in crops. Rapeseed is one of the four major oilseed crops worldwide. Plateau rapeseed has now become a research hotspot. However, the lack of high-yielding rapeseed germplasm resources on the plateau and the highly efficient strategy for screening them severely affect the development of rapeseed industry in plateau. RESULTS: In the rapeseed experimental fields located on the plateau (Lhasa, Tibet), we measured abundant sunlight, characterized by an average daily photosynthetically active radiation (PAR) of 1413 µmol m-2 s-1. In addition, the atmospheric CO2 concentrations range from 300 to 400 ppm, which is only two-thirds of that in the plain (Chengdu, Sichuan). We found that under different measurement conditions of light intensity and CO2 concentration, different rapeseed genotypes showed significant differences in leaf photosynthetic efficiency during the seedling stage. Moreover, the rapeseed materials with high photosynthetic efficiency under low CO2 concentrations rather than high light intensity, exhibited significant advantages in biomass, yield, and oil content when cultivated on the plateau, indicating that the CO2 is the key environmental factor which limited rapeseed production in plateau. Based on photosynthetic efficiency screening under low CO2 concentrations, six rapeseed varieties SC3, SC10, SC25, SC27, SC29 and SC37, shown significantly higher yields in plateau environment compared to local control variety were obtained. In addition, the adaptability of rapeseed to plateau was found to be related to the activities of key Calvin cycle enzymes and the accumulation of photosynthetic products. CONCLUSIONS: This study established a screening strategy for plateau high-yielding rapeseed materials, obtained six varieties which were suitable for plateau cultivation, explored the mechanism of rapeseed response to the plateau environment, and thus provides a feasible strategy for plateau-adapted rapeseed breeding.

Venous thromboembolism in children: details of 46 cases based on a follow-up survey of POSNA members.

INTRODUCTION: On the basis of a recent survey of Pediatric Orthopedic Society of North America members, 59% of the respondents acknowledged having encountered at least 1 child with the diagnosis of venous thromboembolism (VTE). The current survey sought further information including patient demographics, underlying diagnosis, presence of certain risk factors for VTE, and the clinical outcome. METHODS: A follow-up web-based questionnaire was sent to 121 active members of Pediatric Orthopedic Society of North America who had provided their contact information in the prior survey. Thirty-eight respondents provided clinical details on 46 children. RESULTS: The mean age of the affected patients was 14.3 (95% confidence interval, 13.3-15.3) years and 61% were males. The average body mass index was 28 (95% confidence interval, 25-31). Forty-four percent of the patients were diagnosed with deep venous thrombosis (DVT) only, 26% with pulmonary embolism (PE) only, and 30% with both DVT and PE. Majority of the children had DVT involving the popliteal area or thigh (16 cases each). Lower extremity surgery (29 cases, including proximal femoral/tibial osteotomies, internal fixation of long bone fractures, anterior cruciate ligament reconstruction, and resection of osteochondroma around the knee) and adolescence (28 cases) were the 2 most commonly cited associations. Other cases were noted with spinal surgery (8 children) and musculoskeletal infections (7 children). Three patients developed a postphlebitic syndrome, 1 had recurrent DVT and 2 children died. Both deceased children were diagnosed with DVT and PE including a 9-year-old child with a positive family history of antithrombin-3 deficiency that was not noted preoperatively. CONCLUSIONS: Although uncommon, potentially fatal VTE can occur among children with a variety of musculoskeletal ailments. Obtaining a family history suggestive of thrombophilia preoperatively should be encouraged. Further investigation is warranted to ascertain the role of prophylaxis against VTE among children in an orthopaedic practice. LEVEL OF EVIDENCE: Level IV-case series.

Advanced bone age in children with Blount disease: a case-control study.

PURPOSE: Children with Blount disease are often obese and have muliplanar limb deformities including leg length discrepancy. Surgical options for these skeletally immature patients include guided growth and realignment osteotomy. Suboptimal outcomes such as persistent valgus overcorrection after proximal tibial osteotomy in children with early-onset Blount disease and undercorrection after guided growth treatment among adolescents with late-onset Blount disease can occur. Although obesity has been associated with precocious puberty, whether children with Blount disease have advanced skeletal maturity has not been previously investigated. We hypothesized that compared to their peers, children with Blount disease will have advanced skeletal (bone) age. METHODS: The relationship between skeletal and chronologic age was compared between 33 patients with Blount disease (12 early-onset, 21 late-onset) and 33 age-matched and sex-matched controls. The influence of variables such as the age of onset of Blount disease and patient's chronologic age on the discrepancy between skeletal and chronologic age was also evaluated. RESULTS: The mean body mass index was 39 kg/m2 in the Blount disease group and 23 kg/m2 in the control subjects (P<0.0001). Compared to their chronologic age, the bone age was advanced 16 months in Blount disease group (95% confidence interval, 10-22 mo) and 5 months in the control group (95% confidence interval, -1-10; P=0.003). On the basis of subgroup analysis, the bone age was advanced 26 months in early-onset and 10 months in late-onset Blount disease (P=0.01). The discrepancy between bone age and chronologic age decreased as chronologic age increased in both the control (r=-0.36, P=0.04) and Blount disease groups (r=-0.58, P=0.0004). CONCLUSION: Compared to their peers, children with Blount disease have advanced skeletal maturity. The difference between bone age and chronologic age decreases with growth. Since advanced skeletal maturity can impact the strategy for surgical realignment and magnitude of planned (over)correction of lower limb deformity, preoperative assessment of bone age should be considered when managing children with Blount disease. LEVEL OF EVIDENCE: Level III.

Posterior spinal fusion in children with flaccid neuromuscular scoliosis: the role of noninvasive positive pressure ventilatory support.

BACKGROUND: Noninvasive intermittent positive pressure ventilatory assistance/support (NIV) can permit long-term survival for patients with no autonomous ability to breathe. Its role was explored in the perioperative management of children with flaccid neuromuscular scoliosis. METHODS: Vital capacity (VC), peak cough flow, and the extent of ventilator dependence were documented before and after surgical correction of scoliosis for children with Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA) with VCs as low as 2%. All patients and their caretakers were trained in NIV and mechanically assisted coughing preoperatively. Postoperatively, all were extubated using a specific protocol irrespective of their extent of ventilator dependence. RESULTS: Thirty-four children (16 DMD, 18 SMA) underwent posterior spinal arthrodesis for scoliosis at 11.7 (range, 6.6 to 16.6 y) years of age. The Cobb angle decreased from a mean 66 (range, 20 to 135 degrees) to 16 (range, 10 to 51 degrees) degrees. Fifteen patients (5 DMD, 10 SMA) had preoperative VC<40% of normal. All were extubated successfully by postoperative day 3 despite 14 failing preextubation and postextubation spontaneous breathing trials and requiring continuous NIV for up to 21 days after extubation. None had postoperative respiratory complications or required reintubation or readmission for pulmonary issues for at least 6 months postoperatively. CONCLUSIONS: Noninvasive positive pressure ventilator support is an alternative to invasive airway intubation in the perioperative management of children with flaccid neuromuscular scoliosis. LEVEL OF EVIDENCE: Level IV-case series.

Dual Specificity Phosphatase 3 (DUSP3) Knockdown Alleviates Acute Myocardial Infarction Damage via Inhibiting Apoptosis and Inflammation.

BACKGROUND: Dual Specificity Phosphatase 3 (DUSP3) regulates the innate immune response and is associated with ischemia/reperfusion (I/R). However, the precise function of DUSP3 in acute myocardial infarction (AMI) remains to be established. METHODS: In this study, the AMI model in vivo was established in mice by permanent left anterior descending coronary artery (LAD) occlusion, and primary neonatal mouse cardiomyocytes were treated with hypoxia for 12 hours to mimic AMI in vitro. Sh-DUSP3 and AAV9-sh-DUSP3 were used to knock down the DUSP3 expression. LVEF%, LVFS%, SOD1, and HO-1 level, and TTC staining were used to test the cardiac function. Flow cytometric analysis, Western blot, and TUNEL staining were used to investigate the effect of DUSP3 knockdown on apoptosis. Moreover, we detect inflammatory factors expression and oxidative stress by ELISA. Besides, we investigate DUSP3 expression by RT-qPCR. RESULTS: Our findings determined the role of DUSP3 in the progression of AMI. And demonstrated that DUSP3 knockdown alleviated oxidative stress, inflammation, and apoptosis. In addition, our results indicated that DUSP3 knockdown could regulate the expression of p-NF-κB, ICAM1, and VCAM1. CONCLUSION: Our results demonstrated that the knockdown of DUSP3 could effectively alleviate AMI symptoms and be mediated through the NF-κB signaling pathway.

The potential role of CDC20 in tumorigenesis, cancer progression and therapy: A narrative review.

The cell division cycle 20 homologue (CDC20) is known to regulate the cell cycle. Many studies have suggested that dysregulation of CDC20 is associated with various pathological processes in malignant solid tumors, including tumorigenesis, progression, chemoradiotherapy resistance, and poor prognosis, providing a biomarker for cancer diagnosis and prognosis. Some researchers have demonstrated that CDC20 also regulates apoptosis, immune microenvironment, and tumor angiogenesis. In this review, we have systematically summarized the biological functions of CDC20 in solid cancers. Furthermore, we briefly synthesized multiple medicines that inhibited CDC20. We anticipate that CDC20 will be a promising and effective biomarker and therapeutic target for the treatment of human cancer.

Synchronous mucinous metaplasia and neoplasia of the female genital tract (SMMN­FGT): A case report and literature review.

The present study reported a case of Synchronous Mucinous Metaplasia and Neoplasia of the Female Genital Tract (SMMN-FGT), which occurred in a 47-year-old woman. The patient complained of pelvic mass during a physical examination a month ago. Ultrasound examination found an anechoic spot in the left ovary and several anechoic spots were detected in the cervix. The patient underwent left adnexectomy and the left ovarian frozen section revealed a mucinous borderline tumor. Total abdominal hysterectomy and right salpingo-oophorectomy were subsequently performed. Microscopically, multifocal mucinous lesions were involved in the female genital tract, including bilateral ovarian mucinous borderline tumor, cervical and endometrial mucinous adenocarcinoma and the bilateral fallopian tube epithelium showed mucinous metaplasia. Immunohistochemistry revealed that the tumor cells of the ovary, cervix and endometrium expressed MUC6, exhibiting features of gastric-type differentiation. The Ki-67 proliferative index was ~10-70%. Cumulative evidence established SMMN-FGT as the final histopathological diagnosis with International Federation of Gynecology and Obstetrics stage I. Following surgery, the patient received a course of pelvic radiotherapy and survived for 16 months.