Surgical stabilization of rib fractures (SSRF) is increasingly employed in the management of rib fractures. Current guidelines recommend performing SSRF within 48 to 72 h post-injury. This study aimed to validate this recommendation using data from a single center in China. We conducted a single-center retrospective analysis to investigate the effects of different surgical timings on the length of hospital stay, ICU stay, incidence of postoperative pulmonary infection, postoperative respiratory failure, pain scores at 1 week after surgery, and pain and quality of life scores at 1 and 6 months post-discharge in patients with rib fractures. A total of 3899 patients were analyzed. The early surgery group (≤ 72 h) had significantly shorter hospital and ICU stays compared to the delayed surgery group (> 72 h) (P ≤ 0.001). There were no significant differences in postoperative pulmonary infection, respiratory failure, or pain scores at 1 week, 1 month, and 6 months post-discharge between the two groups. However, quality of life scores at 1 and 6 months post-surgery were significantly higher in the early surgery group (P < 0.001). Additionally, within the early surgery group, those who underwent surgery within 48 h of injury had a shorter hospital stay (P = 0.003). SSRF performed early after injury can significantly shorten hospital and ICU stays and improve patients’ quality of life for six months. SSRF performed within 48 h post-injury is recommended to achieve better outcomes.

Background: Small nucleolar RNAs (snoRNAs) are emerging regulators of tumorigenesis, yet their pan-cancer landscape and immunological roles remain poorly defined. This study investigates the expression pattern, prognostic significance, and immune correlation of SNORA12 across cancers, with mechanistic validation in osteosarcoma. Methods: We integrated RNA-seq data from the TCGA, TARGET, and GTEx databases to evaluate SNORA12 expression and its prognostic value using Cox regression and Kaplan-Meier analyses (progression-free survival, PFS). The correlation between SNORA12 and the tumor immune microenvironment was assessed using six independent algorithms (TIMER, EPIC, CIBERSORT, IPS, MCP-counter, xCELL). In vitro, the regulatory effect of SNORA12 on the immune checkpoint TIGIT was validated by overexpression and knockdown experiments in osteosarcoma cell lines (SW1353, U2OS) and NK cells. Results: SNORA12 expression exhibited significant tumor-type specificity. High SNORA12 expression was associated with poor prognosis in glioma (HR = 1.31, p = 0.006) but favorable outcomes in pancreatic (HR = 0.51, p = 0.01) and breast cancer (HR = 0.56, p = 0.02). Immunologically, SNORA12 showed robust positive correlations with CD8+ T cell infiltration in thyroid carcinoma (THCA) and lung adenocarcinoma (LUAD) across multiple algorithms. Notably, SNORA12 expression was positively correlated with m6A modifiers METTL3 and YTHDF1, and negatively correlated with the demethylase FTO. Experimentally, overexpression of SNORA12 in osteosarcoma cells and primary NK cells significantly upregulated TIGIT at both the mRNA and protein levels, while SNORA12 knockdown in NK92 cells reduced TIGIT expression. Conclusions: This pan-cancer analysis positions SNORA12 as a tumor type-specific prognostic biomarker and reveals its novel role as a positive regulator of TIGIT in osteosarcoma, offering a potential mechanistic link between snoRNA dysregulation and immune evasion.

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in trauma patients, especially in patients with rib and spinal fractures. Early risk stratification remains challenging. This study aimed to develop and validate a machine learning model for predicting VTE risk in this patient population. This multicenter retrospective cohort study included patients with rib fractures combined with spinal fractures from Shanghai Sixth People’s Hospital (development cohort, n = 1007, randomly split 7:3 into training [n = 704] and internal validation [n = 303] sets) and Shanghai Fengxian District Central Hospital (external validation cohort, n = 203). The overall VTE incidence was 27.0

Background Rib fractures are a common and clinically significant consequence of blunt chest trauma. With the global population aging, elderly patients have become a significant component of thoracic trauma patients. Improvements in fixation materials and shifts in treatment approaches have changed how rib fractures are diagnosed and managed. Despite these advances, research focused specifically on rib fractures in older adults remains limited. Methods This retrospective study was conducted at Shanghai Sixth People's Hospital, the largest trauma center in Shanghai. We included elderly patients treated in the Department of Thoracic Surgery at Shanghai Sixth People's Hospital between June 2016 and June 2024. Using propensity score matching (PSM), we compared outcomes between patients who received conservative management and those who underwent surgical stabilization of rib fractures (SSRF). Subgroup analyses were performed to investigate treatment benefits across diverse patient populations. Results A total of 1,252 elderly patients were included in this study, comprising those who received conservative treatment (n = 626) and SSRF(n = 626). In terms of clinical outcomes and long-term prognosis, patients in the surgical group had longer hospital stays but significantly shorter intensive care unit (ICU) lengths of stay. Although they experienced a higher incidence of short-term pneumonia, none progressed to respiratory failure or died. Notably, patients in the surgical group demonstrated significantly greater improvement in long-term quality of life compared to those in the conservative group. Subgroup analysis revealed that male gender, overweight status (Body mass index > 24), specific comorbidities (coronary heart disease), and concomitant injuries (traumatic brain injury, pelvic fracture) were associated with variability in clinical outcomes. Conclusions SSRF can accelerate early recovery, shorten ICU length of stay, and improve short-term quality of life in elderly patients, albeit with an increased risk of short-term pneumonia. Clinical decisions should be individualized, taking into account comorbidities, functional status, and patient preferences.

In recent years, surgical stabilization of rib fractures (SSRF) has gained widespread acceptance, with a prevailing consensus that the procedure should be performed as promptly as possible. However, it remains uncertain whether patients with rib fractures sustained for more than one month experience significant benefits from undergoing SSRF. This study primarily investigates the effectiveness and safety of SSRF in patients who have suffered rib fractures for over one month. A retrospective analysis was performed on the clinical data of patients with rib fractures who were hospitalized between January 2017 and March 2023, specifically those who had sustained injuries for more than one month. All patients included in this study underwent SSRF. The analysis primarily focused on evaluating improvements in chest wall deformity, alleviation of chronic chest pain, and the incidence of postoperative complications following SSRF. This cohort consisted of 22 cases, among which 16 patients underwent SSRF within 1–3 months following their injuries, while the remaining 6 patients had SSRF performed after a period exceeding 3 months. In the early intervention group (1–3 months), comprising 16 patients, 12 (75

BACKGROUND:Intestinal flora, or gut microbiota, has increasingly been recognized for its potential role in cancer development and progression. Beyond direct interactions with systemic organs, gut microbiota and its metabolites can modulate epigenetic processes such as DNA methylation, histone modification, and non-coding RNA regulation. This study aims to bridge this gap by conducting a bibliometric and visualization analysis of the scientific literature on cancer associated with intestinal flora. METHODS:We utilized bibliometric software to examine publication trends, citation patterns, and collaborative networks within the field. Visualization techniques were applied to pinpoint influential authors, institutions, and countries. The analysis encompassed a comprehensive search of relevant databases to gather data on publications related to intestinal flora and cancer. RESULTS:Our findings indicate a substantial rise in publications over recent decades, signifying an intensifying focus on the intestinal flora-cancer connection. Key research hotspots identified include the microbiota's role in colorectal cancer, the interplay between microbiota and the host immune system, the epigenetic impacts of gut microbiota on cancer development, and the promise of microbiota-targeted therapies for cancer treatment. The analysis also revealed a network of prominent researchers, leading institutions, and countries at the forefront of this research area. CONCLUSIONS:This study offers a panoramic view of the current research on cancer associated with intestinal flora and underscores potential avenues for future exploration. The insights gleaned from our bibliometric and visualization analysis may guide the development of targeted strategies for cancer prevention and treatment, harnessing the power of the gut microbiota.

Background:There is no consensus on the effectiveness of surgical stabilization in multiple rib fractures in Asia, especially among patients with a non-flail rib fracture pattern. We aim to synthesize the evidence on the effectiveness of surgical stabilization of rib fractures (SSRF) in an Asian population with multiple non-flail rib fractures.Methods:The MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews were searched in this systematic literature review and meta-analysis to identify studies conducted in Asia that included patients with multiple non-flail rib fractures in at least one of their treatment groups. The intervention of interest was SSRF, and the comparator was a nonoperative treatment. The duration of mechanical ventilation (DMV) was the primary outcome. Posttreatment pain score, pneumonia, atelectasis, intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), need for tracheostomy, respiratory function, functional outcomes, quality of life (QoL), and mortality were identified as the secondary outcomes. A random effects model (REM) was used to pool data for outcomes reported in two or more studies.Results:A total of 12 studies (n=2,440 patients) were included. There was a significantly shorter DMV {mean difference (MD): -5.23 [95% confidence interval (CI): -9.64 to -0.81], P=0.02}, lower 4-week post-treatment pain score [standard mean difference (SMD): -2.24 (95% CI: -3.18 to -1.31), P<0.00001], lower risk for pneumonia [risk ratio (RR): 0.46 (95% CI: 0.23 to 0.95), P=0.04], lower risk for atelectasis [RR: 0.44, (95% CI: 0.29 to 0.65), P<0.0001], shorter ICU LOS [MD: -4.00 (95% CI: -6.33 to -1.66), P=0.0008], and shorter HLOS [MD: -6.54 (95% CI: -9.28 to -3.79), P<0.00001] in favor of SSRF. Effect estimates for the need for tracheostomy [RR: 0.67 (95% CI: 0.42 to 1.08), P=0.10] and mortality [RR: 0.94 (95% CI: 0.37 to 2.41), P=0.90] were nonsignificant.Conclusions:In the Asian population with mainly non-flail rib fracture patterns, SSRF was associated with shorter DMV, ICU LOS, and HLOS as well as lower risks for atelectasis and pneumonia, and pain scores after 4 weeks. The risk of mortality was comparable between treatment groups.

Background:Blunt chest trauma patients with pulmonary contusion are susceptible to pulmonary complications, and severe cases may develop respiratory failure. Some studies have suggested the extent of pulmonary contusion to be the main predictor of pulmonary complications. However, no simple and effective method to assess the severity of pulmonary contusion has been available yet. A reliable prognostic prediction model would facilitate the identification of high-risk patients, so that early intervention can be given to reduce pulmonary complications; however, no suitable model based on such an assumption has been available yet.Methods:In this study, a new method for assessing lung contusion by the product of the three dimensions of the lung window on the computed tomography (CT) image was proposed. We conducted a retrospective study on patients with both thoracic trauma and pulmonary contusion admitted to 8 trauma centers in China from January 2014 to June 2020. Using patients from 2 centers with a large number of patients as the training set and patients from the other 6 centers as the validation set, a prediction model for pulmonary complications was established with Yang's index and rib fractures, etc., being the predictors. The pulmonary complications included pulmonary infection and respiratory failure.Results:This study included 515 patients, among whom 188 developed pulmonary complications, including 92 with respiratory failure. Risk factors contributing to pulmonary complications were identified, and a scoring system and prediction model were constructed. Using the training set, models for adverse outcomes and severe adverse outcomes were developed, and area under the curve (AUC) of 0.852 and 0.788 were achieved in the validation set. In the model performance for predicting pulmonary complications, the positive predictive value of the model is 0.938, the sensitivity of the model is 0.563 and the specificity of the model is 0.958.Conclusions:The generated indicator, called Yang's index, was proven to be an easy-to-use method for the evaluation of pulmonary contusion severity. The prediction model based on Yang's index could facilitate early identification of patients at risk of pulmonary complications, yet the effectiveness of the model remains to be validated and its performance remains to be improved in further studies with larger sample sizes.

Vestibular schwannoma (VS) is a rare neurotology neoplasm that results in partial neurological defects. As we know, a comprehensive understanding of basic mechanisms and targeted therapy is vital for disease management. In VS, p53 has been proved to suppress tumor progression via a cooperative with the key protein, merlin, as well as regulation of the cell cycle. However, there are more potential mechanisms of p53 in VS needed to exploit. First, via genome-wide RNA expression analysis, we identified differentially expressed genes in VS compared with normal nerves, and then, bioinformatics analyses were used to analyze these differential expression data and suggested a high level of enrichment of cysteine and glutathione metabolism pathways in VS. Meanwhile, we observed a downregulation of SLC7A11/xCT, a component of the cystine/glutamate antiporter (also known as system xc−) involved in cystine uptake. Next, for a deeper study, our group extracted tumor cells from vestibular schwannoma tissues and established two immortalized cell lines named JEI-001 and JEI-002. Secondly, in our established cells, we demonstrated that ferroptosis participated in erastin-induced growth inhibition. As a novel cell death process, ferroptosis driven by iron-mediated lipid reactive oxygen species (lipid ROS), as well as cysteine and glutathione metabolism. Furthermore, ferroptosis contributes to the inhibitory effects of tumor suppressor p53. Here, we show that p53 sensitizes schwannoma cells to ferroptosis by repressing expression of SLC7A11/xCT. Finally, erastin combined with Nutlin-3, which s to p53 activation, triggered antitumor effects of ferroptosis on the growth of schwannoma cells in vitro. These findings present potential mechanism of p53 in schwannomas and raise the possibility of treatment strategies directed against this pathogenesis.

Background Elucidating the mechanism by which biallelic inactivation evolved could provide a mechanistic understanding for NF2 tumorigenesis and also a rationale for clinical management. Methods A cohort of 60 NF2 patients was recruited. Next-generation sequencing of tumor and paired control samples was used to explore how NF2 mutations evolve in determining the clinical phenotypes. Results In total, 60 blood samples (one from each patient) and 61 (from 35 patients) NF2-associated tumors were collected. Next-generation sequencing of the blood samples detected "first hit" NF2 mutation in 35/60 donors (58.3%), 82.9% of which (29/35) bear heterozygous germline mutations, and 17.1% (6/35) of which are mosaics with variable allelic frequency (VAF). While a number of NF2 patients were found without germline mutation, most (57/61, 93.4%) NF2-associated tumors were identified with NF2 somatic mutation. We calculated the correlation between the onset latency of mosaic and germline NF2 allele carriers with the mosaicism VAF. The mosaicism VAF is negatively and linearly correlated to clinical symptom onset latency (R-2 = 0.3677, P = .00351), suggesting biallelic inactivation probability is a linear function of "first hit" prevalence in the body. The second NF2 somatic mutation occurrence time positively correlates with the onset of clinical symptoms (R-2 = 0.4151, P = .02633), suggesting tumor growth is linearly proportional to the time after biallelic inactivation. Conclusions Our results suggested that biallelic inactivation of NF2 evolved through neutral drift and preexisting first hit NF2 allele determines certain aspects of the clinical symptoms. Genetic diagnosis should be included in the diagnostic criteria and treatment consideration of NF2.

Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

A stable, human sporadic vestibular schwannoma cell line is not currently available. By using a lentivirus-mediated transfection from a 41-year-old sporadic vestibular schwannoma patient, primary schwannoma cells were obtained, cultured and immortalized using the hHERT gene. The NF2 gene of the resulting JEI-001 cell line contains a specific Exon 5 mutation. The schwannoma cell origin of this cell line was confirmed using STR techniques and immunocytochemistry. A comparison between the primary tumor tissue and JEI-001 revealed a common mutation of the NF2 gene, which indicated that the JEI-001 cell line had retained most of its original tumor characteristics. The JEI-001 cell line was found to be non-tumorigenic in nude mice, but certain growth features had been altered, resulting in changes such as independence from the Schwann cell growth factors and a higher proliferation rate. This was the first known study to establish cell lines immortalized from human sporadic vestibular schwannoma that had different characteristics from that of HEI-193. This is a novel model system that can be used for the study of NF2 gene functions, in order to elaborate on the biological features of sporadic vestibular schwannoma, even including familial NF2 tumors, and to further explore the molecular pathogenesis and develop new adjuvant therapies.

Head and neck paragangliomas (HNPGLs) are rare neoplasms that represent difficult treatment paradigms in neurotology. Germline mutations in genes encoding succinate dehydrogenase (SDH) are the cause of nearly all familial HNPGLs. However, the molecular mechanisms underlying tumorigenesis remain unclear. Mutational analysis identified 6 out of 14 HNPGLs harboring clinicopathologic SDH gene mutations. The SDHB gene was most frequently mutated in these patients, and western blot showed loss of SDHB protein in tumors with SDHB mutations. The paraganglioma cell line (PGL-626) was established from a sample that harbored a missense SDHB mutation (c.649C > T). Spectrometric analysis using tandem mass tags identified 151 proteins significantly differentially expressed in HNPGLs compared with normal nerves. Bioinformatics analyses confirmed the high level of enrichment of oxidative phosphorylation and metabolism pathways in HNPGLs. The mitochondrial complex subunits NDUFA2, NDUFA10, and NDUFA4, showed the most significantly increased expression and were localized predominantly in the cytoplasm of PGL-626 cells. The mitochondrial complex I inhibitor metformin exerted dose-dependent inhibitory effects on PGL-626 cells via cooperative down-regulation of NDUFA2, 4, and 10, with a significant decrease in the levels of reactive oxygen species and mitochondrial membrane potential. Further metabolomic analysis of PGL-626 cells showed that metabolites involved in central carbon metabolism in cancer and sphingolipid signaling pathways, pantothenate and CoA biosynthesis, and tryptophan and carbon metabolism were significantly altered after metformin treatment. Thus, this study provides insights into the molecular mechanisms underlying HNPGL tumorigenesis and identifies target correction of metabolic abnormalities as a novel therapeutic approach for this disease.

Background This study aimed to investigate the pulmonary ventilation function (PVF) according to different types of rib fractures and pain levels. Methods This was a retrospective study of patients with thoracic trauma admitted to our ward from May 1, 2015, to February 1, 2017. Vital capacity (VC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF) were measured on admission. A numerical rating scale (NRS) was used for pain assessment. Results A total of 118 (85 males and 33 females) were included. The location of rib fractures did not affect the PVF. When the number of rib fractures was ≥5, the PVF was lower than in those with ≤4 fractures (VC: 0.40 vs. 0.47, P = 0.009; FEV1: 0.37 vs. 0.44, P = 0.012; PEF: 0.17 vs. 0.20, P = 0.031). There were no difference in PVF values between rib fractures with multiple locations and those with non-multiple locations (VC: 0.41 vs. 0.43, P = 0.202; FEV1: 0.37 vs. 0.39, P = 0.692; PEF: 0.18 vs. 0.18, P = 0.684). When there were ≥ 5 breakpoints, the PVF parameters were lower than those with ≤4 breakpoints (VC: 0.40 vs. 0.50, P = 0.030; FEV1: 0.37 vs. 0.45, P = 0.022; PEF: 0.18 vs. 0.20, P = 0.013). When the NRS ≥ 7, the PVF values were lower than for those with NRS ≤ 6 (VC: 0.41 vs. 0.50, P = 0.003; FEV1: 0.37 vs. 0.47, P = 0.040; PEF: 0.18 vs. 0.20, P = 0.027). Conclusions When the total number of fractured ribs is ≥5, there are ≥5 breakpoints, or NRS is ≥7, the VC, FEV1, and PEF are more affected. Trial registration The trial was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, and individual consent for this retrospectively registered analysis was waived.

Thoracic aortic injury is fatal but rare in blunt chest trauma, which usually requires urgent surgical treatment. It is mostly caused by posterior rib fractures. Chest wall stabilization (CWS) has been widely performed in patients with multiple rib fractures all over the world in the past two decades with satisfactory outcomes. However, the surgical treatment of posterior rib fracture within 2-3 cm from transverse process is still a difficult problem for thoracic surgeons. Under this circumstance, rib-transverse process internal fixation method was developed and widely performed for above patients at present. In this article, we presented a case of thoracic aortic injury caused by multiple rib fractures. A 54-year-old female was admitted to our hospital with dyspnea and severe chest pain caused by a falling object. Thoracic aortic injury with multiple rib fractures were diagnosed basing on image date and emergency CWS was performed for this patient. Rib-transverse process internal fixation was not performed in this case since the patients combined with transverse process fracture. We firstly performed transverse process resection combined with CWS for this patient. The results of our study showed this method is safe and feasible for patients with multiple rib fractures combined with transverse process fracture.

Objectives/Hypothesis Lipopolysaccharide (LPS), a key component of bacterial endotoxins, activates macrophages and triggers the release of inflammatory cytokines in mammalian tissues. Recent studies have shown that intratympanic injection of LPS simulates acute otitis media (AOM) and results in morphological and functional changes in the inner ear. Here we established an AOM mouse model with LPS to investigate the uptake of ototoxic gentamicin in the inner ear, and elucidated the underlying mechanism by focusing on cochlear inflammation as a result of AOM. Study Design Preclinical rodent animal model. Methods Fluorescently tagged gentamicin (GTTR) was systemically administered to mice with AOM. Iba1‐positive macrophage morphology and inner ear cytokine profile were evaluated by immunofluorescence technique and a mouse cytokine array kit, respectively. Results We observed characteristic symptoms of AOM in the LPS‐treated ears with elevated hearing thresholds indicating a conductive hearing loss. More importantly, the LPS‐induced AOM activated cochlear inflammatory responses, manifested by macrophage infiltration, particularly in the organ of Corti and the spiral ligament, in addition to the up‐regulation of proinflammatory cytokines. Meanwhile, GTTR uptake in the stria vascularis and sensory hair cells from all the LPS‐treated ears was significantly enhanced at 24, 48, and 72‐hour post‐treatment, as the most prominent enhancement was observed in the 48‐hour group. Conclusion In summary, this study suggests that the pathological cochlea is more susceptible to ototoxic drugs, including aminoglycosides, and justified the clinical concern of aminoglycoside ototoxicity in the AOM treatment. Laryngoscope , 131:E2573–E2582, 2021

第二届手术治疗肋骨骨折高峰论坛暨胸部创伤论坛于2021年7月16—17日在上海举行。与会专家围绕肋骨骨折手术和胸部创伤的诊治现状和发展前景展开热烈讨论。会议期间，上海市医师协会胸外科分会在上海交通大学附属第六人民医院胸外科正式设立加速康复外科（ERAS）示范病房。会议宣布成立中国胸部创伤临床研究协作组（CCIRS），是目前全国首个致力于胸部创伤临床研究的学术组织。笔者对会议内容进行简述。

Osteosarcoma (OS) is the most common primary bone malignancy with high rates of recurrence and metastasis. OS often spreads to lungs, an optimized model for studying lung metastatic OS cells may help develop potential therapies for patients with lung metastasis. Here we firstly report an organoid culture system for lung metastatic OS tissues. We provided a fully described formula that was required for establishing lung metastatic OS organoids (OSOs). Using this protocol, the lung OSOs were able to be maintained and serially propagated for at least six months; the OSOs can also be generated from cryopreserved patient samples without damaging the morphology. The patient-derived lung OSOs retained the cellular morphology and expression of OS markers (Vimentin and Sox9) that recapitulate the histological features of the human OS. The microenvironment of primary lung metastatic OSOs preserved a similar T cell distribution with the human lung OS lesions; this provided a possible condition to explore how OS cells may react to immunotherapy. OSOs established from this protocol can be further utilized for studying various aspects of OS biology (e.g., tumorigenesis and drug screen/discovery) for precision medicine.

Background: Although chest wall stabilization (CWS) has been widely performed for rib fractures in the past decade in China, consensus about operative indication, timing, and technical details for CWS is not formulated yet. The aim of this study is to investigate the existing situation of surgical treatment for rib fractures in China. Methods: Four hundred and fourteen questionnaires were sent out to surgeons in different hospitals in China and collected between January 2018 and April 2018. Data were reviewed and extracted for analysis.Results: Three-hundred and seventy-one valid questionnaires were included in this study. About 14500 cases of CWS for rib fracture were performed in the investigated hospitals in 2016 and about 17600 cases in 2017. There were 38.3% hospitals performed chest wall stabilization for single rib fracture and 44.9% hospitals performed chest wall stabilization for two rib fractures. About 92.1% of CWS cases were performed within two weeks while 42.2% surgeons performed CWS for patients with rib fracture more than two weeks. CWS of was performed in 95.6% of hospitals and 93.2% cases were performed by thoracic surgeons. Nickel-titanium memory alloy and pure titanium rib embracing device are mostly used in rib fixation. Only 33.93% of surgeons chose to remove internal fixator at one year after surgery.Conclusions: Although CWS has been widely performed in China, there are many controversies on the indications, timing, and technical details of CWS. Large-scale clinical trial, high-level literature, uniform standards of surgical indications are critical for the healthy development of CWS.

Facial nerve schwannomas (FNS) represents one of the more difficult treatment paradigms in neurotology. The aim of this study is to investigate the molecular alterations of FNS, thus providing potential targets treatable in the tumour. We for the first time suggest that the deficiency of merlin (the product of NF2 tumour suppressor) is probably one of the key mechanisms underlying FNS tumourigenesis, although no disease-causing NF2 mutations were demonstrated in tumour samples. TMT-labeled spectrometry analysis was used to identify the proteome of FNS relative to nerve controls. Eighty-four significantly deregulated proteins were identified, among which the PML tumour suppressor showed the most significantly increased expression. The PML protein was distributed in the nucleoplasm of non-tumorous Schwann cells, whereas it was preferentially confined to the cytoplasm of FNS cultures. Overexpression of PML and p53, partner proteins positively regulating each other to trigger apoptosis, was further confirmed in FNS tissues/cultures, and this correlated with a significant decrease in the proliferation of FNS cultures in comparison to Schwann cells. It is therefore probable that PML-p53 overexpression may occur as part of protective cellular mechanisms in response to the proliferation signal mediated by loss of merlin in FNS, in accordance with the fact that the tumour is benign slow-growing. This hypothesis was supported by the finding that the p53 activator nutlin-3 could exert dose-dependent inhibitory effects on FNS cultures via a cooperative induction of PML-p53 levels. Thus, the current study may present a potential treatment target directed on the molecular mechanisms of this disease.