Role of savolitinib in advanced gastric adenocarcinoma with meningeal carcinomatosis and cerebellar metastasis: A case report.

BACKGROUND: Brain metastases (BM) are very rare in gastric adenocarcinoma (GaC), and patients with BMs have a higher mortality rate due to stronger tumor aggressiveness. However, its pathogenesis remains unclear. Genetic testing revealed cellular-mesenchymal epithelial transition factor receptor (MET) amplification. Therefore, treatment with savolitinib, a small molecule inhibitor of c-Met, was selected. CASE SUMMARY: A 66-year-old woman was diagnosed with advanced GaC 6 months prior to presentation due to back pain. Cerebellar and meningeal metastases were observed during candonilimab combined with oxaliplatin and capecitabine therapy. The patient experienced frequent generalized seizures and persistent drowsiness in the emergency department. Genetic testing of cerebrospinal fluid and peripheral blood revealed increased MET amplification. After discussing treatment options with the patient, savolitinib tablets were administered. After a month of treatment, the intracranial lesions shrank considerably. CONCLUSION: BM is very rare in advanced GaC, especially in meningeal cancer, that is characterized by rapid disease deterioration. There are very few effective treatment options available; however, technological breakthroughs in genomics have provided a basis for personalized treatment. Furthermore, MET amplification may be a key driver of BM in gastric cancer; however, this conclusion requires further investigation.

Polymetal-Chelated Fabrication of Bimetallic Nanophosphides as Electrocatalysts for Zinc-Air Batteries.

Bimetallic phosphides are considered as promising electrocatalysts for zinc-air batteries toward oxygen evolution reaction (OER) and oxygen reduction reaction (ORR). To address the semi-conductor inherent low electronic conductivity and catalytic activity, a polymetal-chelated strategy is employed to in situ fabricate bimetallic nanophosphides within carbon matrix anchoring by chemical bonding. The employment of biomolecule polydopamine (PDA) efficiently anchors various transition metal ions due to its strong chelating capability via inherent functional groups. Furthermore, the chelation of multi-metal ion is proved to promote the formation of graphitic nitrogen. The bimetallic FexCoyP phosphides nanoparticles are intimately encapsulated in carbon matrix through in situ carbonization and phosphatization processes. When utilized in Zinc-air batteries, Fe0.20Co0.80P anchored within N, P co-doped sub-microsphere (Fe0.20Co0.80P /PNC) exhibit a maximum power density of 167 mW cm-2 and cycle life up to 270 cycles, with a round-trip voltage of 0.955 V. The mechanisms for catalytic activity passivation are ascribed to the etching of nitrogen and oxidation of phosphorus in carbon matrix, as well as the oxidation of the surface phosphide on the sub-microspheres. This study presents a promising candidate for advancing the further development of energy conversation catalysis.

Isorhamnetin ameliorates cisplatin-induced acute kidney injury in mice by activating SLPI-mediated anti-inflammatory effect in macrophage.

OBJECTIVE: Isorhamnetin (IH) has been reported to have significant anti-inflammatory effects in various diseases, but its role and mechanism in AKI remain unclear. This study aimed to explore the potential role and mechanism of isorhamnetin in inhibiting macrophage related inflammation and improving AKI injury. METHODS: We established an AKI mouse model by intraperitoneal injection of cisplatin in vivo, and constructed an inflammatory cell model by stimulating RAW264.7 cells with LPS. Creatinine and urea nitrogen were measured to evaluate the changes of renal function in AKI mice. The changes of renal pathological structure were observed by H&E staining. The inflammatory factor-related proteins and RNA expression levels were detected by Western blot and real time PCR. RESULTS: Isorhamnetin protected the kidney from cisplatin induced AKI and significantly inhibited the mRNA and protein levels of inflammatory cytokines (IL-1ß, IL-6, and TNF-α) both in AKI kidney and LPS-stimulated RAW264.7 cells. Interestingly, the data also demonstrated that isorhamnetin significantly upregulated the expression of secretory leukocyte peptidase inhibitor (SLPI), an anti-inflammatory factor, in AKI kidney and LPS-stimulated macrophages, as well as inhibited the M1 macrophage and activated M2 macrophage in vitro. Blocking of SLPI by siRNA activated Mincle-associated inflammatory signaling in macrophages, and the inhibitory effect of isorhamnetin on inflammation was significantly attenuated. CONCLUSION: Isorhamnetin inhibits macrophage inflammation and protects kidney in AKI may be related to downregulating Mincle/Syk/NF-κB-maintained macrophage phenotype by activating SLPI.

Dupliumab therapy for alopecia areata: a case series and review of the literature.

BACKGROUND: A growing body of research supports the important role of the TH2 axis in alopecia areata (AA). Dupilumab is a humanized monoclonal antibody against IL-4Rα that downregulates TH2 response. Although efficacy has been shown in clinical trials, real-world data on the use of dupilumab in AA patients is limited. OBJECTIVES: To report on a case series of 10 patients with AA who were treated with dupilumab and provide real-world evidence regarding its efficacy in treating severe AA. METHODS: In this retrospective single-center study, all AA patients treated with dupilumab treatment were included between May 2022 and October 2023. Clinical outcome measures (Severity of Alopecia Tool, SALT) and adverse events (AEs) were analyzed. In addition, a literature review was conducted to summarize the efficacy of AA with dupilumab and the characteristics of patients previously reported in the literature. RESULTS: We identified 10 patients with AA who were or are being treated with dupilumab, with a median (range) treatment duration of 8 (3-15) months. Of these, four patients have high serum immunoglobulin E (IgE) levels (≥200IU/ml). The mean (IQR) pretreatment SALT score was 79% (52-100). Seven of 10 patients achieved at least 50% re-growth. Of those who improved, the mean (IQR) percentage change in SALT score at 3 months and the end of follow-up was 57% (29%-89%) and 95% (68-100), respectively. Notably, seven patients (70%) had white hair regrowth, with the white hair slowly decreasing over time and the proportion of pigmented black hair increasing. Dupilumab was well tolerated by all patients. No adverse events were reported. CONCLUSIONS: Overall, our research supports dupilumab as another candidate that possesses potential benefits for AA. High levels of IgE may be not prerequisites for dupilumab's successful treatment response.

Biotemplate-Assisted Growth of ZnO in Gas Sensors for ppb-Level NO2 Detection.

With the growing concern over the adverse effects of environmental pollution on human health, the combination of environmentally friendly and nontoxic biomaterials with metal oxide semiconductor materials for electronic devices has emerged as a prominent trend in current research. In this study, we utilized 150 mg apple biotemplates to assist in the hydrothermal synthesis of ZnO nanospheres. It successfully achieved high sensitivity for detecting 35 and 350 ppb NO2 at room temperature, with responses of 13.74 and 132.44%, respectively. Simultaneously, the 5-cycle repeatability and multiple-gas selectivity exhibited significant improvements. The ZnO nanospheres demonstrated enhanced sensing performance compared to pure ZnO nanorods, which is attributed to the following mechanisms: reason I, the modified surface morphology increasing the surface-to-volume ratio; reason II, an increase in oxygen vacancies, leading to reduced crystallinity and a higher electron concentration; reason III, incorporation of carbon elements on the nanostructure surface to increase active sites. The novel gas sensor assisted by the apple pectin biotemplate offers a promising solution for NO2 gas detection, featuring low operating temperatures, low concentrations, and high response sensitivity.

Flexible Organic Photovoltaic-Powered Hydrogel Bioelectronic Dressing With Biomimetic Electrical Stimulation for Healing Infected Diabetic Wounds.

Electrical stimulation (ES) is proposed as a therapeutic solution for managing chronic wounds. However, its widespread clinical adoption is limited by the requirement of additional extracorporeal devices to power ES-based wound dressings. In this study, a novel sandwich-structured photovoltaic microcurrent hydrogel dressing (PMH dressing) is designed for treating diabetic wounds. This innovative dressing comprises flexible organic photovoltaic (OPV) cells, a flexible micro-electro-mechanical systems (MEMS) electrode, and a multifunctional hydrogel serving as an electrode-tissue interface. The PMH dressing is engineered to administer ES, mimicking the physiological injury current occurring naturally in wounds when exposed to light; thus, facilitating wound healing. In vitro experiments are performed to validate the PMH dressing's exceptional biocompatibility and robust antibacterial properties. In vivo experiments and proteomic analysis reveal that the proposed PMH dressing significantly accelerates the healing of infected diabetic wounds by enhancing extracellular matrix regeneration, eliminating bacteria, regulating inflammatory responses, and modulating vascular functions. Therefore, the PMH dressing is a potent, versatile, and effective solution for diabetic wound care, paving the way for advancements in wireless ES wound dressings.

Recent advance of ATP citrate lyase inhibitors for the treatment of cancer and related diseases.

ATP citrate lyase (ACLY), a strategic metabolic enzyme that catalyzes the glycolytic to lipidic metabolism, has gained increasing attention as an attractive therapeutic target for hyperlipidemia, cancers and other human diseases. Despite of continual research efforts, targeting ACLY has been very challenging. In this field, most reported ACLY inhibitors are "substrate-like" analogues, which occupied with the same active pockets. Besides, some ACLY inhibitors have been disclosed through biochemical screening or high throughput virtual screening. In this review, we briefly summarized the cancer-related functions and the recent advance of ACLY inhibitors with a particular focus on the SAR studies and their modes of action. We hope to provide a timely and updated overview of ACLY and the discovery of new ACLY inhibitors.

Efficacy of horizontal plate plus raft screws above the acetabulum in the treatment of acetabular fractures combined with dome impaction in the aged patients / 中华创伤杂志

Objective:To compare the efficacy of the horizontal plate plus raft screws above the acetabulum and fixation with screws only for acetabular fractures combined with dome impaction in the aged patients.Methods:A retrospective cohort study was conducted to analyze the clinical data of 20 aged patients with acetabular fractures combined with dome impaction, who were admitted to Tianjin hospital between May 2013 and January 2023, including 5 males and 15 females, aged 61-84 years [(72.2±7.3)years]. According to Letournel and Judet classification, 13 patients had anterior column fracture, 5 anterior column fracture combined with posterior transverse fracture and 2 two-column fracture. All the patients underwent open reduction and internal fixation through an anterior approach. Of them, 11 patients were treated with the fixation with the horizonal plate plus raft screws above the acetabulum (plate plus raft screw group) and 9 with the screws only (screw only group). The operative time, intraoperative blood loss, and intraoperative fluoroscopy times were compared between the two groups. The quality of fracture reduction was evaluated with the Matta′s radiographic criteria at 3 days after surgery and the function of the hip joint was assessed with Merle D′Aubigné and Postel scoring system at 3 months after surgery and at the last follow-up as well as the excellent and good rate at te last follow-up. The occurrence of postoperative complications was observed.Results:All the patients were followed up for 6-18 months [(13.1±3.1)months]. There were no significant differences in the operative time, intraoperative blood loss or intraoperative fluoroscopy times between the two groups ( P>0.05). According to the Matta′s radiographic criteria at 3 days after surgery, patients with anatomical reduction and satisfactory reduction accounted 6 and 5 in the plate plus raft screw group, compared to 5 and 4 respectively in the screw only group ( P>0.05). The values of Merle D′Aubigné and Postel score at 3 months after surgery and at the last follow-up were (14.0±2.4)points and (15.8±2.2)points in the plate plus raft screw group, which were higher than those in the screw only group [(11.0±2.6)points and (13.0±3.1)points] ( P<0.01). The values of Merle D′Aubigné and Postel score at the last follow-up of both groups were further enhanced from those at 3 months after surgery ( P<0.01). At the last follow-up, 3 patients were rated excellent, 6 good, 1 fair and 1 poor in the plate plus raft screw group, with an excellent and good rate of 81.8%, while in the screw only group, 3 were rated good, 2 fair and 4 poor, with an excellent and good rate of 33.3% ( P<0.05). One patient in the plate plus raft screw group and 5 in the screw only group had displacement of the dome impaction fragment combined with traumatic arthritis after surgery ( P<0.05). Conclusion:For acetabular fractures combined with dome impaction in the aged patients, the horizontal plate plus raft screw above the acetabulum can effectively improve the function restoration of the hip joint and reduce the occurrence of the displacement of the dome impaction fragment and traumatic arthritis after surgery compared to the fixation with screws only.

Anatomical study and clinical application of osseous fixation pathway in pelvic and acetabular fracture management / 中华骨科杂志

Closed reduction percutaneous screw fixation offers significant biological and biomechanical advantages and can be employed independently for the surgical treatment of pelvic acetabular fractures, as well as serving as a complementary method to open reduction internal fixation. The osseous fixation pathway (OFP) constitutes the anatomical foundation for the minimally invasive approach to pelvic and acetabular fracture management. The pelvis's OFP can be categorized into anterior, middle, and posterior parts. The anterior OFP encompasses both the superior pubic/anterior column and inferior pubic OFPs. The former is primarily utilized for addressing transverse and T-shaped acetabular fractures, as well as anterior column and superior pubic fractures. The latter is predominantly applied to inferior pubic fractures. The middle OFP includes the anterior inferior iliac spine to the posterior iliac crest (LC-II) OFP, the gluteus medius column OFP, and the iliac crest OFP. The LC-II OFP is primarily designated for pelvic crescent, iliac wing, and select high anterior column acetabular fractures. The gluteus medius column OFP is used for the treatment of some iliac fractures or acetabular fractures. And the iliac crest OFP is used for the treatment of simple iliac wing fractures or acetabular fractures involving the iliac crest. The posterior OFP includes the posterior column of the acetabulum OFP, sacroiliac OFP, and sacral OFP. The posterior column of the acetabulum OFP is used for the treatment of acetabular fractures involving the posterior column; the sacroiliac OFP is mainly utilized for a range of pelvic injuries, including pelvic rotational or vertical unstable pelvic injury, sacroiliac dislocation or fracture dislocation; open injury of the posterior ring of the pelvis with relatively mild contamination; elderly sacral (incomplete) fractures; residual gap at the end of sacral fracture after pubic symphysis and plate internal fixation; certain traumatic spinopelvic dissociation ; in combination with lumbopelvic fixation for the treatment of pelvic fractures with lumbosacral junction injury. Sacral OFP is advised for treating bilateral sacroiliac dislocation and certain crescent-like pelvic fractures; bilateral sacral fractures; sacral fractures involving Denis III zone, osteoporotic sacral incomplete fractures. The pursuit of minimally invasive treatment modalities for pelvic and acetabular fractures comes with challenges. A comprehensive understanding of OFP morphology and intraoperative imaging, coupled with a commitment to enhancing fracture reduction quality and surgical proficiency, is imperative for the precise management of such injuries.

Regulation of heterogeneous electron transfer reactivity by defect engineering through electrochemically induced brominating addition.

Enhancing the electrochemical activity of graphene holds great significance for expanding its applications in various electrochemistry fields. In this study, we have demonstrated a facile and quantitative approach for modulating the defect density of single-layer graphene (SLG) via an electrochemically induced bromination process facilitated by cyclic voltammetry. This controlled defect engineering directly impacts the heterogeneous electron transfer (HET) rate of SLG. By utilizing Raman spectroscopy and scanning electrochemical microscopy (SECM), we have established a correlation between the HET kinetics and both the defect density (nD) and mean distance between defects (LD) of SLG. The variation of the HET rate (k0) with the defect density manifested a distinctive three-stage behavior. Initially, k0 increased slightly with the increasing nD, and then it experienced a rapid increase as nD further increased. However, once the defect density surpassed a critical value of about 1.8 × 1012 cm-2 (LD < 4.2 nm), k0 decreased rapidly. Notably, the results revealed a remarkable 35-fold enhancement of k0 under the optimal defect density conditions compared to pristine SLG. This research paves the way for controllable defect engineering as a powerful strategy to enhance the electrochemical activity of graphene, opening up new possibilities for its utilization in a wide range of electrochemical applications.

A study on using comprehensive geriatric assessment to improve the teaching level of doctor-patient communication from the perspective of Johari Window / 中华医学教育探索杂志

Based on the theory of "Johari Window", this study introduced how to stimulate information content obtained in doctor-patient communication and how to apply the comprehensive geriatric assessment creatively from the four modules of open area, blind area, hidden area and unknown area in the model. It helped students to gain the trust and cooperation of patients, rapidly narrow down the blind area, hidden area and unknown area, guide patients to actively extend the open area, improve the teaching quality of doctor-patient communication in a scientific way.

Treatment of transverse with posterior wall fractures of acetabulum using robot-aided percutaneous anterior column screw combined with posterior plate / 中华骨科杂志

Objective:To explore the effectiveness and safety of robot-aided percutaneous anterior column screw combined with posterior plate fixtation treatment for transverse acetabular fractures with posterior wall.Methods:A retrospective analysis was conducted on the data of 13 patients with transverse acetabular fractures and posterior wall fractures treated by robot-aided percutaneous anterior column screws combined with posterior plate in Tianjin Hospital from May 2016 to May 2021. There were 9 males and 4 females, aged 49.1±8.5 years (range, 25-65 years), 9 cases of vehicle accidents, 2 cases of falling injuries, 2 cases of impact injuries, 7 cases of combined posterior hip dislocations, and 1 case of sciatic nerve injury. Apply Kocher-Langenbeck approach for reduction and fixation of the posterior wall and the posterior column and indirect reduction of the anterior column. Use robot navigation for percutaneous anterior column screw fixation, and record the time of inserting anterior column screws, incision length, and complications. The quality of fracture reduction was evaluated using Matta imaging, and the degree of ectopic ossification was evaluated using Brooker classification. The Matta modified Postel Merle D'Aobigne score was used to evaluate the function at 3, 6 months after surgery and at the last follow-up.Results:All 13 patients successfully completed the surgery. The insertion time of the anterior column screw was 19.4±4.0 min (range, 17-23 min), and the incision length was 8.0±1.4 mm (range, 6-10 mm). Postoperative imaging examination showed that all anterior column screws were located within the bone canal, with a screw length of 108.3±11.2 mm (range, 90-130 mm), and no complications such as nerve or vascular injury or incision infection occurred. All 13 patients were followed up for a period of 12-36 months, with an average of 18.6 months; All fractures healed, with a healing time of 2-6 months, average 3.4 months. According to the Matta imaging evaluation method, 11 of 13 patients had anatomical reduction of fractures, and 2 were evaluated as incomplete reduction due to a 1-2 mm gap in the anterior column. The anatomical reduction rate was 84%. At postoperative 3, 6 months and the last follow-up, the modified Postel Merle D'Aobigne scores were 13.4±1.1, 15.8±1.5, and 17.0±1.7, respectively, with statistically significant differences ( F=7.78, P=0.007). The difference between the last follow-up and postoperative 3 months was statistically significant ( P=0.002), and there was no statistically significant difference compared to postoperative 6 months ( P=0.222). At the last follow-up, 8 cases were excellent, 4 cases were good, and 1 case was fair, with an excellent and good rate of 92%. There was no occurrence of ectopic ossification, traumatic arthritis, or necrosis of the femoral head. Conclusion:Robot-aided percutaneous anterior column screw combined with posterior plate treatment for transverse acetabular fractures with posterior wall is safe and effective, and is worthy of clinical promotion.

Robot-assisted sacroiliac screw fixation to treat fragility fractures of the sacrum in the elderly / 中华骨科杂志

Objective:To evaluate the clinical outcome of Robot-assisted sacroiliac screw fixation in the treatment of fragility fracture of the sacrum in the elderly.Methods:From March 2016 to June 2022, a retrospective analysis was performed on 30 patients with fragility fractures of the sacrum in the elderly who accepted robot-assisted sacroiliac screw to treat fragility fractures of the sacrum in our hospital. There were 12 males and 18 females with average age 71.03±8.25 years (range, 60-89 years). According to the classification of fragility fractures of the pelvis (FFP) in the elderly, there were 22 patients with FFP II, 2 patients with FFP III, and 6 patients with FFP IV. Surgical planning was based on the average CT value of S 1 channel and whether there is a transsacral screw channel. Robot-assisted sacroiliac screw fixation was performed during surgery. The pain of pre-operation and post-operation was evaluated using the visual analogue scale (VAS), the position of sacroiliac screws was evaluated by Gras grading, and the degree of functional recovery after surgery was evaluated using the Majeed function score. Results:All 30 patients successfully completed the operation. The mean operation time was 27.00±6.68 min (range, 18-35 min), the mean fluoroscopy times were 27.13±5.16 (range, 18-34), and the mean blood loss was 30.53±6.61 ml (range, 23-38 ml). All patients were followed up, and the mean follow-up time was 19.03±7.8 months (range, 8-25 months). The VAS was 5(5, 6), 4(3, 4), 3(2, 3), 0(0, 1) points before surgery, 1 week, 2 months and 6 months after surgery, respectively, and the difference was statistically significant ( H=103.26, P<0.001). After the surgery of 2 months, 6 months and the last follow-up time, the Majeed function scores were 88(83, 90), 91(87, 92), 92(90, 93) points, respectively, and the difference was statistically significant ( H=19.59, P<0.001). Screw position was evaluated according to Gras grading at 3 days after surgery, including 28 cases of level I, 2 cases of level II, and no screw penetrated the cortical bone or entered the sacral canal or sacral foramen. No vascular or nerve injury occured during the operation. 28 patients with FFS met the fracture healing criteria, and the healing time was 4.54±1.57 months (range, 3-7 months). Two patients had bone nonunion, one of whom underwent anterior ring plate removal due to infection of the pelvic anterior wound, and one month later, pelvic CT scan revealed loosening of the sacroiliac screw; the other one is considered to be related to too early weight bearing. Conclusion:For fragility fractures of the sacrum in elderly, Robot-assisted sacroiliac screw is an effective minimally invasive treatment, with high accuracy of screw placement, effective pain reduction, improved fracture healing rate, and achieve the satisfactory clinical efficacy.

Imaging and clinical study on the relationship between abnormal development of the proximal sacrum and precise insertion of sacroiliac screws / 中华骨科杂志

Objective:To investigate the clinical efficacy of robot-assisted sacroiliac screw implantation in the treatment of proximal dysplasia sacral fractures.Methods:A retrospective analysis was conducted on 191 patients admitted to the Pelvic Department of Tianjin Hospital from May 2016 to January 2021 who underwent robot assisted sacroiliac screw implantation with sacral fractures, including 105 males and 86 females, aged 38.5±6.5 years (ranging from 19 to 69 years old). Among them, there were 85 patients with dysplasia of proximal sacrum. According to the classification of proximal sacral dysplasia, the patients were divided into five groups: the steep sacral alar slope group ( n=60), the mastoid protrusion group ( n=30), the lumbar sacralization group ( n=25), the sacral foramen oval degeneration group ( n=23) and the S 1 anterior cortical depression group ( n=10). The remaining 106 patients were normal group. Iliac cortical density (ICD) line typing was recorded in the 85 patients. The the completion of sacroiliac screw implantation, the Gras score of screw position after operation, the postoperative complications, the minimum diameter of S 1 screw channel (R1), the angle ∠A between the S 1 sacroiliac screw in the coronal plane and the cephalic side, and the angle ∠B between the S 1 sacroiliac screw in the water plane and the ventral side were recorded and compared with those of normal development patients. Results:The incidence of steep sacral alar slope was the highest (31.4%, 60/191). There were 2 or more developmental abnormalities in 24 cases. In 85 cases with dysplasia of proximal sacrum, ICD line type I was found in 8 cases, type II in 12 cases and type III in 65 cases. 49 patients (58.8%, 49/85) were able to complete the implantation of S 1 sacroiliac screw, while 36 patients (35.3%, 36/85) were only able to complete the implantation of S 2 sacroiliac screw. The Gras score of postoperative screw position was 90.05% for grade I, 9.94% for grade II, and 0 for grade III. In 1 case the sacroiliac screw pierced through the anterior cortex of the sacrum, and in 1 case the screw partially threaded into the sacral foramen, and there were no symptoms of iatrogenic nerve injury. The R1 values of the preoperative steep sacral alar slope group, the mastoid protrusion group, the sacral foramen oval degeneration group, the lumbar sacralization group, the sacral foramen oval degeneration group and normal development patient group were 11.4±3.0, 11.6±3.2, 9.8±3.0, 8.8±4.2, 6.5±4.4, and 11.4±3.4 mm, respectively. The differences between the lumbar sacralization group, the sacral foramen oval degeneration group, and the S1 anterior cortical depression group with the normal development patients were statistically significant, respectively ( t=-3.05, P=0.005; t=-2.32, P=0.022; t=-3.45, P=0.006). The postoperative angle ∠A of the above six groups were 33.8°±4.2°, 20.8°±3.5°, 25.8°±2.5°, 35.5°±4.5, 27.8°±3.5° and 26.8°±5.0°, respectively. The postoperative angle ∠B of the above six groups were 27.8°±3.5°, 36.2°±3°, 26.3°±1.8°, 29.8°±2.7°, 14.8°±1.5° and 37.2±4.2°, respectively. The differences between the ∠A of the steep sacral alar slope group, the mastoid protrusion group, and tthe lumbar sacralization group with that of the normal development patients were statistically significant, respectively ( t=9.17, -7.48, 7.97, P<0.001). The differences between the ∠B of the steep sacral alar slope group, the lumbar sacralization group, the sacral foramen oval degeneration group, and the S 1 anterior cortical depression group with that of the normal development patients were statistically significant, respectively ( t=-14.68, -10.93, -19.79, -35.8, P<0.001). Conclusion:This study proposes the "absolute stenosis" of the S 1 screw channel; In the treatment of patients with abnormal proximal sacral fracture, attention should be paid to S 1 anterior cortical depression and lumbar sacralization, and robot-assisted sacroiliac screw implantation can further improve the safety and accuracy of sacroiliac screw implantation.

Robot-assisted screws fixation for the treatment of fragility fractures of the pelvis / 中华骨科杂志

Objective:To investigate the clinical outcomes of fragility fractures of the pelvis (FFP) treated with robot-assisted screws, minimally reduction according to the pelvic osseous pathways.Methods:A retrospective analysis was performed on the data of 50 elderly patients with FFP treated by the Department of Trauma and Pelvic Trauma of Tianjin Hospital from March 2016 to October 2021, and the 50 patients with FFP were divided into robotic-assisted screw fixation group (robot group) and open reduction steel plate fixation group (open group) according to the fixation method. There were 30 patients in the Robot group, 6 males and 24 females, average age 75.03±7.32 years (range, 60-90 years). According to Rommens and Hofmann FFP classification, there were 4 cases of IIc type, 8 cases of IIIa type, 1 case of IIIb type, 12 cases of IIIc type, 3 cases of IVa type, 2 cases of IVb type. There were 20 patients in the open group, 5 males and 15 females, average age 71.90±5.51 years (range, 62-85 years). According to Rommens and Hofmann FFP classification, there were 2 cases of IIc type, 6 cases of IIIa type, 9 cases of IIIc type, 3 cases of IVa type. The two groups were compared with age, pelvic fracture classification, operation time, intraoperative blood loss, fracture reduction quality, visual analogue scale (VAS), Majeed score, and wound healing or not.Results:All patients were followed up for 12.72 months (range, 6-24 months). In the robot group, the operation time was 50.17±19.32 min (range, 30-120 min), and intraoperative blood loss was 55.50±28.60 ml (range, 10-150 ml); in the open group, the operation time was 92.25±27.55 min (range, 60-180 min), and intraoperative blood loss was 217.50±67.20 ml (range, 150-400 ml), there were statistical differences ( t=6.36, P<0.001; t=11.72, P<0.001). According to Mears and Velyvis imaging evaluation criteria, in the robot group, anatomical reduction were achieved in 10 cases, satifactory reduction were achieved in 20 cases; in the open group, anatomical reduction were achieved in 14 cases, satifactory reduction were achieved in 6 cases, there were statistical differences (χ 2=6.46, P=0.011). In the robot group, VAS for pelvic pain was 7.33±1.32 points (range, 4-9 points) before operation, 4.13±1.07 points (range, 3-8 points) one week after surgery, and 2.30±0.84 points (range, 1-5 points) at the last follow-up; in the open group, VAS for pelvic pain was 7.45±1.23 points (range, 5-9 points) before operation, 5.25±1.25 points (range, 3-8 points) one week after surgery, and 2.80±1.24 points (range, 1-6 points) at the last follow-up, the difference between the two groups was statistically significant ( F=162.18, P<0.001; F=70.18, P<0.001), the difference between the two groups was statistically significant 1 week after surgery ( t=3.37, P=0.001), and there was no statistically significant difference between the two groups before surgery and the last follow-up ( P>0.05). The Majeed score was 82.10±4.80 (range, 65-95) in the robot group, 77.60±5.40 (range, 70-93) in the open group at the last follow-up, there were statistical differences ( t=3.09, P=0.003). There was no wound complication in the robot group, there were 4 cases with wound infection or rupture in the open group. One LC-II screw loosen in the robot group, which needed reoperation with cement, there was also 1 screw of plate loosening in the open group with no reoperation. Conclusion:Robot-assisted screws fixation with minimally reduction based pelvic osseous pathways shows satisfactory clinical outcomes, satisfactory reduction, effective pain relief, and fewer postoperative complications in treatment of elderly FFP.

The application of orthopaedic positioning robot in the surgical treatment of pelvic and acetabular fractures / 中华骨科杂志

The development of modern science and technology continues to promote the advancement of surgical methods, the era of surgical surgery led by robots has arrived. Orthopaedic positioning robot is a kind of auxiliary treatment equipment to realize surgical planning by means of spatial mapping of target images. It is composed of movable robotic arm, optical tracking device and surgical planning navigation system. During the operation, the path navigation of surgical instruments can be planned and implemented according to the predetermined procedure, and the precise placement of orthopedic internal fixation can be completed with the participation of the surgeon. It is mainly used in trauma orthopaedics, joint replacement and spine surgery fields. It has clinical advantages such as accurate operation, stable performance and good repeatability. Robot assisted minimally invasive pelvic acetabular fracture surgery is mainly realized by assisted placement of the LC-II screw, sacral iliac screw, iliac lumbar triangular fixation, iliac lumbar fixation, acetabular anterior column screw, acetabular posterior column screw, Magic screw and other osseous fixation pathway screws. It has the advantages of relatively simple operation, small systematic error, accurate spatial positioning and safe screw insertion. The clinical introduction of robot-assisted surgery provides effective solutions and advanced technical supports for optimizing the surgical treatment of pelvic acetabular fractures and promoting the enhanced recovery after surgery. The continuous improvement of the application level of robots has created favorable conditions and technical support for promoting the development of intelligent, individualized, minimally invasive and precise treatment of pelvic and acetabular fractures.

Research progress in the treatment of traumatic spinopelvic dissociation / 中华骨科杂志

Traumatic spinopelvic dissociation is trauma-induced complete separation of the pelvis and spine anatomy. It is characterized by longitudinal fracture lines on both sides of the sacral bone with transverse fractures, multiplane unstable fractures, more common in high-energy violent injury, more combined injuries, high incidence of sacral nerve injury, improper treatment can easily lead to fracture re-displacement, painful deformity healing, secondary nerve injury, dysfunction and other adverse consequences. The difficulty in the surgical treatment of traumatic spinopelvic dissociation lies in the reduction and fixation of fractures. Among them, it is still controversial whether the reduction method of fracture should be open reduction or closed minimally invasive reduction, the internal fixation should be simple sacroiliac screw or plate, iliolumbar fixation or triangular fixation, and whether the sacral nerve injury needs direct decompression. With the improvement of the understanding of spinopelvic dissociation injuries and clinical application of closed minimally invasive reduction technology, minimally invasive sacroiliac screws, iliolumbar fixation, and triangular fixation are increasingly used in clinical treatment, postoperative wound complications are significantly reduced, patient function prognosis is good, indirect decompression of the injured sacral nerve after fracture reduction helps to restore nerve function, but when the fracture displacement is large with a narrow sacral canal and the nerve is compressed by the fracture or free bone mass, direct decompression by laminectomy is recommended.

Application of artificial intelligence ECG recognition system in training of primary medical staff and general practice trainees / 中华全科医师杂志

From July to August 2021, 60 medical staff and general practice trainees in primary care institutions were randomly assigned in two groups with 30 in each group. The control group received conventional ECG training and the study group received ECG training with artificial intelligence image recognition system. The quantitative assessment was conducted before and 2 months after training. There was no significant difference in baseline scores between two groups (43.33±9.94 vs. 44.33±10.33, P>0.005); while the scores of the study group was significantly higher than that of the control group after training (76.00±11.92 vs. 68.00±9.61, P<0.05). Compared with the control group, the correct rates of atrial fibrillation/atrial flutter, sinus arrhythmia and atrioventricular block in study group were significantly higher than those in control group (100.0% vs. 70.0%, 96.7% vs. 73.3%, 86.7% vs. 43.3%; all P<0.05). It is suggested that the application of artificial intelligence ECG recognition system can significantly increase the teaching effect in primary medical training.

The imaging evaluation and clinical significance of sacral vestibule / 中华骨科杂志

Objective:To measure the anatomical parameters of three-dimensional available space of S 1 and S 2 vestibules on Chinese adults by imaging methods, and discuss their clinical values. Methods:Data of 200 cases of pelvic CT with complete posterior ring were collected from January 2015 to January 2021, included 110 males and 90 females. The ages ranged from 21 to 63 years (average, 40.72±10.70 years). Then the parameters of both the left vestibule and the right vestibule of S 1 and S 2 such as vestibular width, vestibular height and vestibular area were measured by the three-dimensional CT reconstructions. Statistical analyses were performed among the groups which were classified according to the gender, side of vestibule to compare the difference of vestibular morphological characteristics among different groups. Results:The average vestibular area of S 1 was 425.71± 45.07 mm 2 (range, 296.3-604.4 mm 2), which was 449.80±28.62 mm 2 (range, 338.3-604.4 mm 2) in males and 388.25±34.01 mm 2 (range, 296.3-498.4 mm 2) in females. The average vestibular width was 28.52±4.34 mm (range, 17.1-36.3 mm), 31.77±2.33 mm (range, 22.46-36.30 mm) in males and 24.55±2.55 mm (range, 17.1-26.1 mm) in females. The mean vestibular height was 21.05±2.29 mm (range, 17.5-32.0 mm), with 21.34±2.37 mm (range, 18.5-32.0 mm) of men and 20.69±1.60 mm (range, 17.5-25.6 mm) of women. The mean S 2 vestibular area was 230.19±35.57 mm 2 (range, 142.5-297.3 mm 2), which was 258.91±28.04 mm 2 (range, 218.3-297.3 mm 2) in males and 205.61±24.12 mm 2 (range, 142.5-258.6 mm 2) in females. The average vestibular width was 15.94±1.72 mm (range, 12.4-20.3 mm), 16.51±1.59 mm (range, 14.4-20.3 mm) in male and 15.25±1.63 mm (range, 12.4-18.1 mm) in female. The mean vestibular height was 14.30±1.20 mm (range, 12.9-17.8 mm), 15.49±1.46 mm (range, 13.6-17.8 mm) in males and 13.73±0.93 mm (range, 12.9-16.1 mm) in females. There were significant differences in vestibular width, height and area between S 1 and S 2 (vestibular width t=3.934, P< 0.001; vestibular height t=3.692, P< 0.001; vestibular area t=4.816, P< 0.001). There were significant differences in S 1 vestibular width, S 1 vestibular height, S 1 and S 2 vestibular area between male groups and female groups (S 1 vestibular width: t=2.969, P=0.003; S 1 vestibular height: t=0.316, P=0.049; S 1 vestibular area: t=1.975, P=0.049; S 2 vestibular area: t=2.023, P=0.044). While there was no significant difference in S 2 vestibular width and height between the two gender groups. There were significant differences in S 1 and S 2 vestibular width, height and area between male and female groups ( P < 0.001). There were no significant difference in parameters between the left and right values of the same vestibular site. Conclusion:The parameters of S 1 sacral vestibule are larger than that of S 2. It implies that S 1 was more feasible to insert iliosacral screws than S 2; lesser diameter iliosacral screws should be selected to insert into S 2. The female S 1 vestibule is smaller than the male, so the iliosacral screws placement has more stringent requirements on the selection of the insertion point and the direction of the screw. And the surgeon can utilize the intact contralateral sacral vestibule as the damaged side to proceed the iliosacral screw inserted simulation.