Objective:To compare the effectiveness of ultrasound-guided closed reduction with Kirschner wire fixation and open reduction with Kirschner wire fixation in the treatment of humeral lateral condyle fracture (HLCF) in children. Methods:A clinical data of 53 children with HLCF admitted between May 2020 and April 2023 and met selective criteria was retrospectively analyzed. Of these, 25 cases were managed with closed reduction and Kirschner wire fixation under ultrasound guidance (closed group), while 28 cases underwent open reduction and Kirschner wire fixation (open group). There was no significant difference between the two groups in terms of gender, age, cause of injury, fracture side, fracture classification, and time from injury to operation ( P>0.05). The following variables were recorded and compared between the two groups: operation time, intraoperative fluoroscopy frequency, fracture healing time, incidence of complications, and the Flynn elbow function score at last follow-up. Results:In the closed group, the fractures were successfully reduced under ultrasound guidance, with no nerve damage reported in either group. The operation time and intraoperative fluoroscopy frequency were significantly less in the closed group than in the open group ( P<0.05). One case of infection (Kirschner wire irritation) was observed in the closed group, while 3 cases in the open group (2 of Kirschner wire irritation and 1 of incision infection). However, the difference in the incidence of infection between the two groups was not significant ( P>0.05). All patients in both groups were followed up 6-18 months (mean, 10.2 months). X-ray examinations confirmed that fractures had healed in both groups, with no significant difference in healing time ( P>0.05). During follow-up, 5 cases of lateral humeral process formation were observed in the closed group, compared to 12 cases in the open group, although this difference was not significant ( P>0.05). At last follow-up, the excellent and good rate of elbow joint function was evaluated as 96.0% (24/25) in the closed group and 92.9% (26/28) in the open group according to the Flynn scoring criteria, with no significant difference between the two groups ( P>0.05). Both groups showed no occurrence of ossifying myositis or elbow internal/external rotation. Conclusion:The effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation in the treatment of HLCF in children is comparable to open reduction and Kirschner wire fixation, but the former can reduce operation time and intraoperative fluoroscopy frequency, and obtain lower the incidence of complications.

Abstract Background:Developmental hip dysplasia(DDH) is a common pediatric disease.For patients younger than 6 months of age,ultrasound diagnosis is more suitable for screening and assessment of hip development.At present,there is an urgent need for a reproducible and reliable ultrasound screening method for DDH diagnosis. Purpose: To construct and verify an artificial intelligence-assisted deep learning system for ultrasound diagnosis of developmental hip dysplasia in children. Materials and Methods: 2021 standard sections were selected from January 2019 to January 2021. All standard sections were annotated using unified standards through the image transmedia data annotation and audit system.1753 images were randomly selected to train the deep learning system,the remaining 268 were used to test the system. Results: 268 patients were tested. The AUC for diagnosing hip joint maturity was 0.941, (sensitivity 90.5%, specificity 97.8%),while the AUC for Graf classification was 0.685(sensitivity 45.3% specificity 91.7%),compared with clinicians’ measurements. According to the Bland–Altman method, the 95% limits of agreement of α angle was-6.426°~4.811°(Bias=-0.8075,P < 0.001), that of β angle was -5.545°~6.507°(Bias=0.4812,P=0.057). 7 key points measured by AI were statistically different from the clinician values. Conclusions: The artificial intelligence system could quickly and accurately measure the Graf correlation index of standard hip joint ultrasound images.

ObjectiveTo construct an artificial intelligence system to measure acetabular index and evaluate its accuracy in clinical application.MethodsA total of 10,219 standard anteroposterior pelvic radiographs were collected retrospectively from April 2014 to December 2018 in our hospital. Of these, 9,219 radiographs were randomly selected to train and verify the system. The remaining 1,000 radiographs were used to compare the system's and the clinicians' measurement results. All plain pelvic films were labeled by an expert committee through PACS system based on a uniform standard to measure acetabular index. Subsequently, eight other clinicians independently measured the acetabular index from 200 randomly selected radiographs from the test radiographs. Bland–Altman test was used for consistency analysis between the system and clinician measurements.ResultsThe test set included 1,000 cases (2,000 hips). Compared with the expert committee measurement, the 95% limits of agreement (95% LOA) of the system was −4.02° to 3.45° (bias = −0.27°, P < 0.05). The acetabular index measured by the system within all age groups, including normal and abnormal groups, also showed good credibility according to the Bland–Altman principle. Comparison of the measurement evaluations by the system and eight clinicians vs. that of, the expert committee, the 95% LOA of the clinician with the smallest measurement error was −2.76° to 2.56° (bias = −0.10°, P = 0.126). The 95% LOA of the system was −0.93° to 2.86° (bias = −0.03°, P = 0.647). The 95% LOA of the clinician with the largest measurement error was −3.41° to 4.25° (bias = 0.42°, P < 0.05). The measurement error of the system was only greater than that of a senior clinician.ConclusionThe newly constructed artificial intelligence system could quickly and accurately measure the acetabular index of standard anteroposterior pelvic radiographs. There is good data consistency between the system in measuring standard anteroposterior pelvic radiographs. The accuracy of the system is closer to that of senior clinicians.

We explored the risk factors for avascular necrosis (AVN) after surgery using open reduction, pelvic osteotomy, and femoral osteotomy for Tönnis grade IV developmental dysplasia of the hip (DDH). In this retrospective study, we collected data of patients with Tönnis grade IV DDH treated with open reduction and pelvic osteotomy combined with femoral osteotomy from January 2012 to May 2020. The patients were divided into the AVN group and non-AVN group using the Kalamchi–MacEwen classification system. The clinical and imaging data of the two groups were collected, and the possible risk factors were included in the analysis. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors and odds ratios of AVN. In all, 254 patients (mean age; 2.6±0.9 years, 278 hips) were included. The mean follow-up time was 3.8±1.5 years. A total of 89 hips (32

Objectives:To investigate the effect of different locations of ulnar osteotomy point on the curative effect of missed Monteggia fracture in children.Methods:A retrospective cohort study was conducted to analyze the clinical data of 68 children with missed Monteggia fracture admitted to Anhui Provincial Children's Hospital from June 2015 to June 2021, including 42 males and 26 females aged 3-12 years old with an average of (6.6±2.4) years. The interval from injury to operation was 1-60 months (mean, 8.6 months). According to Bado classification, 60 cases were type Ⅰ, and 8 cases were type Ⅲ. All patients were treated with proximal ulna osteotomy. Intraoperatively, the ulna was truncated at the most obvious location of ulnar deformity. The patients were divided into three groups according to the ratio of the length from the proximal ulna to the osteotomy point to the length of the ulna,: group A (proportion≤25%, 27 cases), group B (25%0.05). (2) All children in the three groups successfully completed the operation. The operation time of groups A, B, C were (100.6±31.7), (133.0±24.2), and (94.9±28.6)min, respectively. No statistically significant differences in operation time were found in the three groups ( F=1.02, P=0.367). Re-examination on the third postoperative day of the elbow joint anteroposterior and lateral radiographs showed that the brachioradial relationship was restored to normal. In group A, incision infection was found in one case during dressing change after operation, which healed after anti-inflammatory treatment. All 68 patients were followed up for 6-36 months with an average of 8.7 months. The postoperative redislocation of the brachioradialis joint occurred in three cases, and subluxation occurred in three cases in group A. Subluxation occurred in three cases in group B; subluxation in two cases and delayed ulna healing in one case were noted in group C; and no significant differences in the incidence of complications were found among the three groups (all P values >0.05). No significant differences in the healing time of ulnar osteotomy were noted in the three groups ( F=0.01, P=0.989). (3) No significant differences in elbow pronation, supination, elbow extension, elbow flexion angles, and Kim elbow function were observed among the three groups before taking out the internal fixation (all P values >0.05). No significant differences in the postoperative radiographic Nakamura grading of elbow function were found among the three groups after the removal of internal fixation ( Z=1.73, P=0.422). Conclusion:In the surgical treatment of children with missed Monteggia fractures, when the ulna was truncated at the most obvious point of ulnar deformity, the choice of different osteotomy points has no significant effect on the prognosis.

Rheumatoid arthritis (RA) is an autoimmune disease that can induce joint deformities and functional impairment, significantly impacting the overall well-being of individuals. Exosomes, which are cellularly secreted vesicles, possess favorable biological traits such as biocompatibility, stability, and minimal toxicity. Additionally, they contain nucleic acids, lipids, proteins, amino acids, and metabolites, serving as mediators in cellular communication and information exchange. Recent studies have demonstrated the association between exosomes and the pathogenesis of RA. Exosomes derived from mesenchymal stem cells, dendritic cells, and neutrophils exert influence on the biological functions of immune cells and joint cells, however, the precise mechanism remains largely unclarified. This comprehensive review systematically analyzes and summarizes the biological characteristics and functionalities of exosomes derived from diverse cellular sources, thus establishing a scientific foundation for the utilization of exosomes as diagnostic targets and therapeutic modalities in the context of RA.

Methods:Two thousand standard sections images werre collected from 2 000 clinical retrospective pediatric hip ultrasound videos from January 2019 to January 2021. All standard sections were annotated by the annotation team through the self-designed software based on Python 3.6 environment for image cross-media data annotation and manual review standardization process with unified standards. Among them, 1 753 were randomly selected for training the deep learning system, and the remaining 247 were used for testing the system. Further, 200 standard sections were randomly selected from the test set, and 8 clinicians independently completed the film reading annotation. The 8 independent results were then compared with the AI results.Results:The testing set consists of 247 patients. Compared with the clinician's measurements, the area under the receiver operating characteristic curve (AUC) of diagnosing hip joint maturity was 0.865, the sensitivity was 76.19%, and the specificity was 96.9%. The AUC of AI system interpretation under Graf detailed typing was 0.575, the sensitivity was 25.90%, the specificity was 89.10%. The 95% LoA of α-angle determined by Bland-Altman method, of -4.7051° to 6.5948° ( Bias -0.94, P<0.001), compared with clinicians' measurements. The 95% LoA of β-angle, of -7.7191 to 6.8777 ( Bias -0.42, P=0.077). Compared with those from 8 clinicians, the results of AI system interpretation were more stable, and the β-angle effect was more prominent. Conclusion:The AI system can quickly and accurately measure the Graf correlation index of standard DDH ultrasonic standard diagnosis plane.

The aims of the present study is to evaluate the roles of collagen I and III in the hip capsule in the postoperative clinical function of patients with developmental dysplasia of the hip (DDH). Hip capsules from 155 hips of 120 patients were collected during surgery. The patients were divided into three groups according to age: I: 2–3.5 years; II: 3.5–5 years; and III: 5–6 years. Patient clinical function and radiographic outcomes were evaluated with the McKay scores and Severin classification. The expression of collagen I and III was detected through immunohistochemistry and quantitative reverse transcription polymerase chain reaction (RT-PCR) and analyzed according to age, sex, degree of dislocation and McKay classification. All patients received open reduction and pelvic osteotomy and/or femoral shortening osteotomy and achieved good results on the basis of postoperative X-ray imaging. The average follow-up time was 3.4 years (range 2–4.3 years). There were no changes in the expression of collagen III in the different groups. The expression of collagen I according to age and sex was not significantly different. Lower expression of collagen I was observed in DDH patients with a higher degree of dislocation according to the Tonnis grade. The highest expression of collagen I was detected in the group with poor clinical function according to the McKay classification. Collagen I is correlated with the degree of dislocation and is a risk factor for poor clinical function in DDH patients. Collagen I is correlated with the degree of hip dislocation and poor clinical function in DDH patients.

Ubiquitination of target proteins is mediated via different ubiquitin lysine (K) linkages and determines the protein fates. In particular, K48 ubiquitin linkage targets proteins for degradation, whereas K63 ubiquitin linkage plays a nondegradative role. Parkinson's disease is an age-onset neurodegenerative disorder, which shows selective loss of dopamine neurons in substantia nigra pars compacta (SNC) and ubiquitinated protein aggregates. However, age-related expression of K48 and K63 ubiquitin linkages in SNC dopamine neurons remains elusive. We thus sought to explore the expression of K48 and K63 ubiquitin linkages in dopamine neurons in SNCs of mice at different ages with morphological and biochemical assays. Here our results indicated that in 5-week-old mice, dopamine neurons presented higher levels of K48 and K63 ubiquitin linkages than nondopamine neural cells. Aging promoted the formation of protein aggregates that are positive for both K48 and K63 ubiquitin linkages, together with tyrosine hydroxylase, a dopamine neuron marker. Moreover, 21-month-old mice showed fewer neural cells and tyrosine hydroxylase positive neurons in the SNCs than younger mice. Through biochemical analysis, the 21-month-old mice were shown to express more K48 ubiquitin linkages and less tyrosine hydroxylase and NeuN than the 5-week-old mice. These results suggest the first time that expression of K48 and K63 ubiquitin lysine linkages in midbrain dopamine neurons is age-related and may be involved in the loss of dopamine neurons.

目的:改良人胰腺癌细胞系PANC-1细胞的体外培养方法,简化细胞培养步骤.方法:在人胰腺癌细胞系PANC-1细胞培养过程中,复苏及传代时,避免使用离心机离心这一步骤.结果:通过和传统细胞培养方法对比,这种改良的方法,培养PANC-1细胞,污染的机会少,特别适用于新手.