OBJECTIVETo analyze the curative effects and feasibility of the self regulating simple localizer through anterior approach for the treatment of odontoid fracture in adults.

METHODSFrom June 2010 and December 2012, 6 patients with odontoid fracture underwent an anterior operation using a single hollow screw located by the self regulating simple localizer. There were 4 males and 2 females, aged from 28 to 55 years old with an average of 39.1 years. The injuries were caused by traffic accidents in 4 cases and falling injury from high in 2 cases. According to the classification of Anderson, 4 cases were type II and 2 cases were simple type III. All the patients underwent operations in 5 to7 days after injury with the mean of 5.9 days. None of the patients had a spinal cord injury. The safety and feasibility of the self made localizer were observed in follow up for fracture healing and clinical effects.

RESULTSAll the operations were successful with an average time of 50 min (ranged from 45 to 55 min) and the mean bleeding volume was 25 ml(ranged from 20 to 30 ml). No injuries of esophagus, trachea or nerve were found. All the patients were followed up from 8 to 16 months and all fractures were obtained bone healing. The flexion extension radiograph showed a well stability of atlantoaxial joint in last followed up.

CONCLUSIONSThe self regulating simple localizer is a minimally invasive, short time and safe method in treating odontoid fractures through anterior operation with hollow screw. It may be a reliable choice while without a professional localizer.

Dental Care ; Plasma Gases

Objective:To investigate the predictive value of preoperative aspartate aminotransferase to alanine aminotransferase ratio (AAR) for early recurrence after radical resection of single small hepatocellular carcinoma.Methods:A retrospective cohort study was conducted to analyze the clinical data of 137 patients who underwent radical resection of liver cancer at the General Hospital of Ningxia Medical University from January 2017 to July 2021. These patients were categorized into a recurrence group ( n = 72) and a non-recurrence group ( n = 65) based on early postoperative recurrence. Univariate and multivariate logistic regression analyses were conducted in the training cohort to identify independent risk factors for early recurrence of small hepatocellular carcinomas. Subsequently, the AARs were grouped, and patients with similar propensity scores estimated by the logistic model were matched 1:1 using the Propensity Score Match method with a caliper value of 0.02 to eliminate confounders. Logistic regression analysis was then repeated to assess the predictive value of the matched AAR for postoperative recurrence in patients with single small hepatocellular carcinoma. Results:Univariate analysis revealed that age ( χ2 = 4.22, P = 0.040), the ratio of fibrinogen to albumin ( χ2 = 8.26, P = 0.004), and the AAR ( χ2 = 5.83, P = 0.016) were significantly associated with early recurrence of small liver cancer after radical resection. Multivariate logistic regression analysis further identified age ( P = 0.042), the ratio of fibrinogen to albumin ( P = 0.024), and the AAR ( P = 0.018) as independent risk factors for early recurrence of single small hepatocellular carcinoma following radical surgery. After excluding confounding factors using the Propensity Score Match method, 25 patient pairs were successfully matched. Post-matching logistic regression analysis revealed that an AAR > 0.74 ( P = 0.005) and age > 60 years ( P = 0.024) were independent risk factors for early recurrence in patients with single small hepatocellular carcinoma following radical resection. Conclusion:Preoperative AAR is an independent risk factor for early recurrence in patients with single small hepatocellular carcinoma following surgery, demonstrating excellent predictive value.

Objective:To screen preoperative microvascular invasion (MVI)-related indicators in patients with hepatocellular carcinoma by machine learning, and to construct a predictive model for predicting MVI and evaluate it.Methods:The clinical data of hepatocellular carcinoma patients who underwent radical resection from January 2018 to March 2023 in General Hospital of Ningxia Medical University were retrospectively analyzed. A total of 437 patients were enrolled, including 325 males and 112 females, aged (56.3±13.6) years. The 437 patients were divided into a training set ( n=305) and a test set ( n=132) by computer-generated random numbers on a 7∶3 basis; the training set was used to construct the predictive model as well as to internally validate it by the five-fold cross-validation method, and the test set was used to externally validate the model. Two machine learning Boruta algorithm and LASSO regression, were used to screen MVI characteristic variables and construct multifactorial logistic regression prediction models. Receiver operating characteristic (ROC) curve, calibration curves, and decision curve were evaluated for predictive modeling, applying Shapley's additive explanatory analysis (SHAP) of the significance of key variables. Results:The intersection (5 variables) of 8 characteristic variables selected by Boruta algorithm and 8 variables selected by LASSO regression were selected: aspartate aminotransferase/lymphocyte ratio (ALR), tumor margin, intratumbral necrosis, tumor number and tumor maximum diameter, and the logistic regression model was constructed. The area under ROC curve for predicting the MVI were 0.77 (95% CI: 0.70-0.82) (training set), 0.76 (95% CI: 0.63-0.87) (validation set), and 0.84 (95% CI: 0.78-0.91) (test set). The prediction results of calibration curve logistic regression model were close to those of reagent, and the analysis of decision curve indicates that the model had good clinical application value. According to the mean absolute SHAP value, the order of importance was tumor margin, tumor maximum diameter, tumor number, ALR, and intratumoral necrosis. Conclusion:Tumor margin, tumor maximum diameter, tumor number, ALR and intratumoral necrosis were independent influencing factors for hepatocellular carcinoma associated with MVI, and the logistic regression model based on these factors was effective in predicting MVI.

Objective:To assess the relationship between body mass index (BMI) and death risk of cardiovascular disease (CVD) in rural male population.Methods:22 282 men aged 40 years older in Tanghe county and Fenghuang county from the cohort of the "Prospective Study on Adult Behavior and Health Risk Factors in China" were selected as subjects of this study. Cox regression model was used to calculate the hazard ratios ( HRs) of the death of CVD during the follow-up period with different BMI groups at baseline. Results:The average follow-up period in the two counties was (19.1±8.7) years and 10 828 (48.6%) people died during the follow-up period. 4 504 deaths were attributed to CVD. Among the deaths of CVD, 1 279 cases died of ischemic heart disease (IHD), ischemic stroke (IS) died in 1 201, cases died of died of 1 317 hemorrhagic stroke (HS), other 707 cases. Compared to population with BMI<18 kg/m 2, Cox regression model (adjusting factors of region, age, nationality, education level, occupation, smoking, drinking, blood pressure, blood pressure, etc.) showed that people with BMI between 20-22 kg/m 2 had the lowest risk of CVD death ( HR=0.95, 95 %CI: 0.83-1.09). But the difference was not statistically significant among each BMI group ( P>0.05). The risk of IHD death was the lowest in the population with BMI between 20-22 kg/m 2 ( P<0.05) ( HR=0.64, 95 %CI: 0.52-0.80). There was no statistically significant difference between the risk of IHD death in the population with BMI≥24 kg/m 2 and that in the population with BMI<18 kg/m 2 ( P>0.05). There was no statistically significant difference between the risk of IS death and BMI ( P>0.05). The death risk of HS in the population with BMI between 18-24 kg/m 2 was higher than that in the population with BMI<18 kg/m 2 ( P<0.05). The death risk of the population with BMI between 26-28 kg/m 2 was the highest ( HR=1.88, 95 %CI:1.18-2.99). Conclusions:The mortality risk of CVD and IHD was the lowest in lean or normal weight group, and HS was higher in overweight group. Maintaining a reasonable weight can reduce the risk of death in patients with CVD.

Objective:To investigate the predictive values of clinical test indexes and imaging indexes for early postoperative recurrence of hepatitis B virus (HBV)-related small hepatocellular carcinoma.Methods:Clinical case data of 163 patients with HBV-related small hepatocellular carcinoma undergoing radical hepatectomy at the Department of Hepatobiliary Surgery in the General Hospital of Ningxia Medical University from January 2017 to August 2021 were retrospectively collected. The patients were categorized into 87 cases in an early recurrence group and 76 cases in a non-early recurrence group according to whether or not they had recurrence within 2 years after surgery. After excluding the covariance of various indicators, independent risk factors for postoperative tumor recurrence were established using univariate analysis and multivariate logistic regression analysis. A clinical prediction model was constructed and presented visually in a nomogram diagram, and the predictive ability of the nomogram diagram model was evaluated using receiver operating characteristic curves as well as calibration curves. Cox regression analysis was used to determine the relationship between independent risk factors and time to recurrence.Results:Univariate analysis showed that in the early recurrence group, the number and proportion of patients with preoperative gamma-glutamyl transferase to lymphocyte count ratio (GLR) > 35.79 [41.38% (36/87)], tumor multiplicity [25.29% (22/87)], the presence of peritumoral edema [45.98% (40/87)], intratumoral small arterial clusters [50.58% (44/87)], and age ≥ 60 years [74.71% (65/87)] were significantly higher than those in the non-early recurrence group ( χ2 = 5.73, 3.78, 3.97, 3.73, 3.75, all P < 0.05). Multivariate logistic regression analysis showed that GLR > 35.79 and the presence of peritumoral edema were independent risk factors for early recurrence after radical hepatectomy of HBV-related small hepatocellular carcinomas [odds ratio ( OR) = 2.22, 1.99, 95% confidence interval ( CI): 1.10-4.59, 1.00-3.99, P < 0.05]. The nomogram diagram prediction model was established, with a C index of 0.70 (95% CI: 0.60-0.79) in the receiver operating characteristic curve and a Brier Score of 0.22 in the calibration curve, which demonstrated good model differentiation and accuracy. Cox regression analysis showed that a GLR > 35.79 and the presence of peritumoral edema were risk factors affecting the time to recurrence after resection of HBV-associated small hepatocellular carcinomas. Conclusion:GLR > 35.79 and the presence of peritumoral edema are independent risk factors for early recurrence after radical hepatectomy of HBV-related small hepatocellular carcinoma. The constructed clinical prediction model has good predictive efficacy.

OBJECTIVE Alzheimer disease(AD)is a neurodegenerative disease with clinical hallmarks of pro-gressive cognitive impairment.Synergistic effects of Aβ-tau cascade reaction are tightly implicated in AD patholo-gy,and microglial NLRP3 inflammasome activation drives neuronal tauopathy through microglia and neurons cross-talk.However,the underlying mechanism of how Aβ medi-ates NLRP3 inflammasome remains unclear.Shab related potassium channel member 1(Kv2.1)as a voltage gated po-tassium channel widely distributed in the central nervous system and plays an important role in regulating the out-ward potassium flow in neurons and glial cells.In current work,we aimed to explore the underlying mechanism of Kv2.1 in regulating Aβ/NLRP3 inflammasome/tau axis by using a determined Kv2.1 inhibitor drofenine(Dfe).METHODS Cell-based assays including Western blot-ting and immunofluorescence staining against primary microglia or neurons were carried out to expound the role of Kv2.1 channel in NLRP3 inflammasome activa-tion and subsequent neuronal tau hyperphosphorylation.For animal studies,new object recognition,Y-maze and Morris water maze were performed to evaluate the ame-lioration of Kv2.1 inhibition through either Kv2.1 inhibitor Dfe treatment or adeno-associated virus AAV-ePHP-si-Kv2.1injectionon5×FADADmodel mice.Assays of histol-ogy and immunostaining of tissue sections and Western blotting of brain tissues were performed to verify the con-clusion of cellular assays.RESULTS We reported that oligomeric Aβ(o-Aβ)bound to microglial Kv2.1 and pro-moted Kv2.1-dependent potassium leakage to activate NLRP3 inflammasome through JNK/NF-κB pathway sub-sequently resulting in neuronal tauopathy.Treatment of either Kv2.1 inhibitor Dfe or AAV-ePHP-si-Kv2.1 for brain-specific Kv2.1 knockdown deprived o-A β of its capability in inducing microglial NLRP3 inflammasome activation and neuronal tau hyperphosphorylation,while improved the cognitive impairment of 5×FAD AD model mice.CONCLUSION Our results have highly addressed that Kv2.1 channel is required for o-Aβ driving NLRP3 inflammasome activation and neuronal tauopathy in AD model mice and highlighted that Kv2.1 inhibition is a prom-ising therapeutical strategy for AD and Dfe as a Kv2.1 inhibitor shows potential in the treatment of this disease.

Solitary fibrous tumor is a rare mesenchymal tumor associated with NAB2-STAT6 fusion gene, which is rarely seen in kidney. A 16-year-old boy was hospitalized because of left back pain for more than 3 years. Abdominal CT/MRI identified a huge space-occupying lesion in the left kidney. Laparoscopic radical left nephrectomy was performed initially. Nevertheless, laparoscopic-to-open procedure was adopted due to the huge size of the tumor. The pathological diagnosis was renal solitary fibrous tumor. The symptoms of the patient disappeared and no recurrence was observed at the 2-month follow-up after the surgery.

Objective:To study the influence of non-thermal atmospheric pressure plasma (NTAPP) on dentine surface temperature, wettability and morphology of collagen fibrils under different treatment condition.Methods:Helium was used as the operating gas at the flow rate of 3, 4, 5 L/min respectively. The plasma jet was operated at various input power of 8, 9, 10, 11 W. Thermal accumulation on human dentine surface (6 specimens per group, acquired from Department of Stomatology, The First Affiliated Hospital of Xi′an Medical University and Department of Stomatology, The Second Affiliated Hospital of Xi′an Medical University) of each group was measured continuously at 5 s intervals for 60 s by infrared thermography. Mean values were calculated and temperature curves were drawn. Dentine surface contact angles were measured after NTAPP treatment for 5, 10, 15, 20 s with gas flow rate and input power described above. The micro structure of the collagen fibrils of the negative control group (without NTAPP treatment) and NTAPP treatment groups (5 L/min gas flow rate, input power of 8, 9, 10, 11 W and treating time for 5, 10, 15, 20 s) was observed by field emission scanning electron microscopy (FE-SEM). All data were analyzed by SPSS 18.0.Results:Input power, gas flow and treatment time all showed significant influences on dentine surface temperature and wettability ( P<0.01). Dentine temperature rose along with time. The greater input power was, the higher dentine temperature was. The greater gas flow rate was, the faster the temperature rose. Dentine surface temperature reached the highest point of (35.10±0.24) ℃ with NTAPP treatment for 60 s, at input power of 11 W and flow rate of 5 L/min. The contact angles of each experimental group decreased with time, and significant differences were found in the contact angles between the experimental groups and the negative control group (75.57°±1.45°). The contact angles showed a decreasing trend as the input power and the gas flow rate increased. The contact angles reached the lowest point of 13.19°±2.01° with NTAPP treatment for 20 s, at input power of 10 W and flow rate of 5 L/min. The FE-SEM results showed that, along with the increase of input power and extension of time, the demineralized collagen fibrils were destroyed in varying degrees. The collagen fibrils were curled, fractured, fused, and even disappeared. Conclusions:NTAPP could significantly increase the surface temperature, modify dentine wettability and alter the micro structure, which was significantly influenced by input power, gas flow rate and treating time.

Objective:To investigate the effects of continuous renal replacement therapy (CRRT) on plasma concentration, clinical efficacy and safety of colistin sulfate.Methods:Clinical data of patients received with colistin sulfate were retrospectively analyzed from our group's previous clinical registration study, which was a prospective, multicenter observation study on the efficacy and pharmacokinetic characteristics of colistin sulfate in patients with severe infection in intensive care unit (ICU). According to whether patients received blood purification treatment, they were divided into CRRT group and non-CRRT group. Baseline data (gender, age, whether complicated with diabetes, chronic nervous system disease, etc), general data (infection of pathogens and sites, steady-state trough concentration, steady-state peak concentration, clinical efficacy, 28-day all-cause mortality, etc) and adverse event (renal injury, nervous system, skin pigmentation, etc) were collected from the two groups.Results:A total of 90 patients were enrolled, including 22 patients in the CRRT group and 68 patients in the non-CRRT group. ① There was no significant difference in gender, age, basic diseases, liver function, infection of pathogens and sites, colistin sulfate dose between the two groups. Compared with the non-CRRT group, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) were higher in the CRRT group [APACHE Ⅱ: 21.77±8.26 vs. 18.01±6.34, P < 0.05; SOFA: 8.5 (7.8, 11.0) vs. 6.0 (4.0, 9.0), P < 0.01], serum creatinine level was higher [μmol/L: 162.0 (119.5, 210.5) vs. 72.0 (52.0, 117.0), P < 0.01]. ② Plasma concentration: there was no significant difference in steady-state trough concentration between CRRT group and non-CRRT group (mg/L: 0.58±0.30 vs. 0.64±0.25, P = 0.328), nor was there significant difference in steady-state peak concentration (mg/L: 1.02±0.37 vs. 1.18±0.45, P = 0.133). ③ Clinical efficacy: there was no significant difference in clinical response rate between CRRT group and non-CRRT group [68.2% (15/22) vs. 80.9% (55/68), P = 0.213]. ④ Safety: acute kidney injury occurred in 2 patients (2.9%) in the non-CRRT group. No obvious neurological symptoms and skin pigmentation were found in the two groups. Conclusions:CRRT had little effect on the elimination of colistin sulfate. Routine blood concentration monitoring (TDM) is warranted in patients received with CRRT.