Objective To evaluate the value of measurement of the width of pars compacta of substantia nigra(SNc) and SNc's ratio to midbrain diameter in diagnosing Parkinson's disease(PD) and differentiating PD from vascular parkinsonism(VP) on routine MRI.Methods The width of SNc, midbrain diameter, and SNc's ratio to midbrain diameter were measured in 60 patients with PD (38 patients with Hoehn-Yahr stage Ⅰ～Ⅱ, 14 patients with Hoehn-Yahr stage Ⅲ, and 8 patients with Hoehn-Yahr stage Ⅳ), 60 patients with VP (26 patients with Hoehn-Yahr stage Ⅰ～Ⅱ, 20 patients with Hoehn-Yahr stage Ⅲ, and 14 patients with Hoehn-Yahr stage Ⅳ), and 60 age-matched heathly control subjects by means of routine axial T 2-weighted MRI. The results of measurement were analyzed and compared.Results Significant reduction was found in the width of SNc and SNc's ratio to midbrain diameter in PD compared those in VP and control subjects(P

Objective To investigate the killing effect of polymethylmethacrylate (PMMA) on spinal metastasis of transplanted VX2 carcinoma in experimental rabbit models. Methods Spinal metastasis of transplanted VX2 carcinoma model was successfully established in 18 rabbits. The experimental rabbits were randomly and equally divided into three groups with 6 rabbits in each group. Under CT guidance , PMMA or saline was injected into the center of VX2 tumor; in group A 0.3 ml of PMMA was used, in group B 0.1 ml of PMMA was used and in group C (control group) 0.3 ml saline was used. Twenty-four hours after the injection, the animals were sacrificed. Four tissue samples were obtained from the sites at 1 mm , 5 mm, 10 mm and 15 mm away from the PMMA mass in each rabbit of group A and group B , while four tissue samples were collected from different four sites from the tumor ’s center to border in each rabbit of group C. TdT-mediated dUTP nick-end labeling (TUNEL) method was used to determine the tumor cell apoptosis rate. Results After successful establishment of rabbit model, injection of PMMA was performed in sixteen among the eighteen rabbits. Technical success rates were 83.3% in both group A and B, and the success rate was 100% in group C. The difference in technical success rate was not significant. The mean tumor cell apoptosis rates of spinal VX2 carcinoma at 1 mm, 5 mm and 10 mm away from the PMMA mass in group A were (65.75±18.81)%, (50.00±14.24)% and(14.95±8.98)% respectively. The mean apoptosis rate in the control group was (9.79 ±5.24)%; the differences between the group A and the control group were statistically significant (P<0.05). The mean tumor cell apoptosis rate of spinal VX2 carcinoma at 15 mm away from the PMMA mass in group A was (10.30 ±8.13)%, which was not significantly different with that of the control group. The mean tumor cell apoptosis rates of spinal VX2 carcinoma at 1 mm and 5 mm away from the PMMA mass in group B were (49.20±15.57)% and(17.75±9.28)% respectively, which was significantly different with that of the control group(P<0.05); the mean tumor cell apoptosis rates at 10 mm and 15 mm away from the PMMA mass in group B were not significantly different with those of the control group. Statistically significant differences in the mean tumor cell apoptosis rates determined at 1 mm, 5 mm and 10 mm away from the PMMA mass existed between group A and group B(P<0.001). Conclusion PMMA can promote the apoptosis of tumor cells, properly increasing the injected amount of PMMA can enlarge the extent of tumor cell apoptosis.

BACKGROUND:There is a high risk for the elderly cervical spine surgery combined with cerebral infarction, whereas conservative treatment is often unable to resolve serious cervical lesions.
OBJECTIVE:To discuss the surgical effects of anchor fixation via posterior approach on cervical spinal canal stenosis combined with cerebral infarction.
METHODS:A total of 21 patients with cervical spinal canal stenosis combined with cerebral infarction who were admitted over the past 5 years accepted cervical posterior expensive open-door laminoplasty and fixation with wire anchors. Therapeutic effects were evaluated according to the Japanese Orthopaedic Association (JOA) scores.
RESULTS AND CONCLUSION:Al the patients were fol owed up 6 to 24 months, averagely 15 months. Al patients were smoothly through the perioperative period. There were no acute severe cerebral infarction cases. Preoperative JOA score was (7.6±2.0) points averagely, and postoperative JOA score was (13.3±1.8) points averagely, showing a significant difference (P<0.01). Of the 21 patients, excellent effects were in 11 cases and good in 7 cases. The effective rate was 95%(20/21), and the excellent-good rate was 86%(18/21). The risk of surgical treatment of patients with cerebral infarction is higher, but it is not the absolute contraindication. Choosing the proper operation way is highly important. Cervical posterior expensive open-door laminoplasty and fixation with wire anchors can be used to reduce the risk of cerebrovascular accidents to some extent, and obtain an excellent clinical effect.

In the past decades, people's work and life styles have dramatically changed during the rapid economic development and urbanization in China. A national survey reported that Chinese adults spend an average of 81% of daily time in indoor environment. Exposure to indoor air pollution plays key roles for human health but is likely to be neglected due on the relatively lower concentration levels and lower awareness among common people. Till now, published studies focus more on the pollution levels or the toxicological effects of indoor air pollutants but there is a lack of disease burden assessment attributable to indoor air pollution. In this review, several international studies were introduced on the disease burden estimation attributable to indoor air pollution, as well as the estimation methods. The current situation of national study was also reviewed. The strengths and limitations of the representative international studies were discussed. This review is helpful in providing data to guide the research on disease burden assessment attributable to indoor air pollution in China, and further helps to prioritize the indoor air pollution control based on disease burden ranking among pollutants and motivate public policies to protect the public health.

OBJECTIVE To investigate the effect of andrographolide （Andro） on the neuronal apoptosis in ischemic stroke （IS） rats by regulating the neuregulin-1 （Nrg-1）/epithelial growth factor receptor 4 （ErbB4） signaling pathway. METHODS The IS rat model was established using the suture method. Sixty successfully modeled rats were randomly divided into model group （physiological saline）， Andro low-dose group （Andro-L group， 50 mg/kg）， Andro high-dose group （Andro-H group， 100 mg/kg）， and Andro-H+Dacomitinib group （100 mg/kg of Andro+7.5 mg/kg of Nrg-1/ErbB4 signaling pathway inhibitor Dacomitinib）， with 15 rats in each group. Another 15 rats were chosen as the sham group （physiological saline）. The rats were intragastrically administered medication/physiological saline once a day for 7 consecutive days. After medication， the neurological function of the rats was assessed； the levels of lactate dehydrogenase （LDH）， tumor necrosis factor-α （TNF-α）， interleukin-1β （IL-1β）， IL-10， and nerve growth factor （NGF） in the rat serum were detected； the infarct area of the rat brain was measured， and the pathological changes in the hippocampal tissue of the rats were observed. Moreover， the apoptosis rate of hippocampal neurons and the levels of malondialdehyde （MDA）， superoxide dismutase （SOD）， catalase （CAT）， matrix metalloproteinase-9 （MMP-9）， cleaved-caspase- 3， Nrg-1 protein expressions and phosphorylated ErbB4 （p-ErbB4）/ErbB4 ratio in the hippocampal tissue were detected. RESULTS Compared with the model group， the Zea-Longa score， the escape latency， the serum LDH， TNF-α， IL-1β levels， the percentage of cerebral infarction area， the hippocampal neuron apoptosis rate， the MDA level and MMP-9， cleaved-caspase-3 protein expression levels in the hippocampal tissue in the Andro-L and Andro-H groups were significantly reduced/shortened （P＜0.05）. The dwelling time， the number of platform crossings， the serum IL-10， NGF levels， the CAT， SOD levels， the Nrg-1 protein expression level and p-ErbB4/ErbB4 ratio in the hippocampal tissue were significantly extended/increased （P＜0.05）； the degree of hippocampal neural tissue damage was significantly E-mail：lrxxl3@163.com reduced. Dacomitinib could significantly weaken the improvement effect of high-dose Andro on neuronal injury in IS rats （P＜0.05）. CONCLUSIONS Andro can reduce the inflammatory response， oxidative stress， and hippocampal tissue damage in IS rats， and promote neurological function. Its mechanism of action may be related to the activation of Nrg-1/ErbB4 signaling pathway.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.

Both natural ginsenoside F2 and unnatural ginsenoside 3β,20S-Di-O-Glc-DM were reported to exhibit anti-tumor activity. Traditional approaches for producing them rely on direct extraction from Panax ginseng, enzymatic catalysis or chemical synthesis, all of which result in low yield and high cost. Metabolic engineering of microbes has been recognized as a green and sustainable biotechnology to produce natural and unnatural products. Hence we engineered the complete biosynthetic pathways of F2 and 3β,20S-Di-O-Glc-DM in Saccharomyces cerevisiae via the CRISPR/Cas9 system. The titers of F2 and 3β,20S-Di-O-Glc-DM were increased from 1.2 to 21.0 mg/L and from 82.0 to 346.1 mg/L at shake flask level, respectively, by multistep metabolic engineering strategies. Additionally, pharmacological evaluation showed that both F2 and 3β,20S-Di-O-Glc-DM exhibited anti-pancreatic cancer activity and the activity of 3β,20S-Di-O-Glc-DM was even better. Furthermore, the titer of 3β,20S-Di-O-Glc-DM reached 2.6 g/L by fed-batch fermentation in a 3 L bioreactor. To our knowledge, this is the first report on demonstrating the anti-pancreatic cancer activity of F2 and 3β,20S-Di-O-Glc-DM, and achieving their de novo biosynthesis by the engineered yeasts. Our work presents an alternative approach to produce F2 and 3β,20S-Di-O-Glc-DM from renewable biomass, which lays a foundation for drug research and development.