Objective To investigate the molecular mechanism by which HMGA2 participates in the TGF-β/Smad pathway in the regulation of the proliferation, aggression, and metastasis of laryngeal cancer. Methods shRNA transfection was used to construct the HMGA2 knockdown laryngeal cancer TU686 cell model, and subcutaneous transplantation tumor model and tail vein metastasis tumor model were established in nude mice. Western blot was conducted to detect the expression of HMGA2 and TGF-β/Smad pathway-related molecules in cells and tumor tissues. Results The proliferation, invasion, and metastasis of TU686 cells with HMGA2 knockdown decreased. The expression of TGF-β, Smad2, Smad3, and phosphorylated Smad2/3 protein also decreased. TGF-β1 stimulation of the TGF-β/Smad pathway could partially offset the antitumor effect caused by HMGA2 knockdown. Through in vitro experiments, we determined that low expression of HMGA2 significantly inhibited the growth of subcutaneously transplanted tumors, and TGF-β1 stimulation of the TGF-β/Smad pathway reduced the tumor-inhibitory effect resulting from the low expression of HMGA2. In tail vein metastases of nude mice, E-cadherin expression was elevated but N-cadherin expression was reduced in the HMGA2 knockdown group, suggesting that HMGA2 could inhibit the progression of EMT. After TGF-β1 stimulated the TGF-β/Smad pathway, the EMT effect due to HMGA2 knockdown was lessened. Conclusion HMGA2 may promote the proliferation, invasion, and metastasis of laryngeal cancer by upregulating the TGF-β/Smad signaling pathway.

Objective:To compare the biomechanical properties of posterolateral distal humeral plate, inverted anterior proximal humerus internal locking system (PHILOS), and anterior reconstruction plate in the treatment of distal humeral shaft fractures by a finite element analysis.Methods:One healthy adult male volunteer, aged 27 years, with a height of 171 cm and a weight of 70 kg, was recruited for this study. The finite element method was used to establish a simulation model of distal humeral shaft fracture. The maximum displacement and maximum stress were compared between fixation with posterolateral distal humeral plate (group A), fixation with inverted anterior PHILOS (group B), and fixation with anterior reconstruction plate (group C).Results:In groups A, B, and C, respectively, the overall stress peak values were 409.07 MPa, 217.04 MPa, and 370.64 MPa; the peak stresses under torsional load were 234.55 MPa, 348.80 MPa and 458.17 MPa; the overall stress peaks under bending load were 250.22 MPa, 466.76 MPa, and 582.32 MPa. The smaller the stress, the smaller the risk of fatigue fracture. In groups A, B, and C, respectively, the overall displacement peak values were 5.18 mm, 3.04 mm and 3.75 mm; the peak displacements under torsional load were 1.20 mm, 1.02 mm and 2.05 mm; the peak displacements under bending load were 3.85 mm, 5.28 mm and 9.04 mm. The smaller the displacement, the better the fixation stability.Conclusions:In the treatment of distal humeral shaft fractures, fixation with inverted anterior PHILOS leads to the best mechanical stability under axial compression and torsional stress, while fixation with the posterolateral distal humeral plate leads to the best mechanical stability under bending stress.

Objective:To compare the clinical effects between proximal humerus internal locking system (PHILOS) inverted and a posterior single plate in the anterior percutaneous minimally invasive internal fixation for distal humeral shaft fractures.Methods:A retrospective study was conducted to analyze the data of 65 patients with distal humeral shaft fracture who had been treated from January 2018 to May 2021 at Department of Orthopaedics, The Second Hospital of Fuzhou. The patients were assigned into 2 groups according to different treatment methods. In the observation group of 30 cases subjected to anterior percutaneous minimally invasive internal fixation with PHILOS inverted: 20 males and 10 females with an age of (41.5±11.6) years; type A in 5 cases, type B in 14 cases, and type C in 11 cases by AO fracture classification. In the control group of 35 cases subjected to anterior percutaneous minimally invasive internal fixation with a posterior single plate: 23 males and 12 females with an age of (39.9±11.2) years; type A in 7 cases, type B in 17 cases, and type C in 11 cases by AO fracture classification. The preoperative general data, operation time, intraoperative blood loss, total incision length, fracture healing time, and shoulder and elbow VAS scores, Constant-Murley shoulder function score, Mayo elbow performance score (MEPS), and complications at the last follow-up were recorded and compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There were no significant differences either in operation time, fracture healing time, or shoulder or elbow VAS pain score, Constant-Murley shoulder function score, or MEPS at the last follow-up between the 2 groups ( P>0.05). The intraoperative blood loss was (59.7±26.6) mL in the observation group and (165.7±86.4) mL in the control group, and the total incision length was (10.7±2.1) cm in the observation group and (18.6±2.7) cm in the control group, showing statistically significant differences between the 2 groups ( P<0.01). There was no injury to the radial nerve or musculocutaneous nerves, incision infection or fracture nonunion in the observation group. There were 4 cases of iatrogenic radial nerve injury, 2 cases of incision infection and 1 case of fracture nonunion in the control group, yielding a complication rate of 20.0% (7/35). The difference in the incidence of complications was significant between the 2 groups ( P<0.01). Conclusion:In the treatment of distal humeral shaft fracture with anterior percutaneous minimally invasive internal fixation, PHILOS inverted has advantages of less soft tissue damage, less intraoperative bleeding, and a lower risk of iatrogenic radial nerve injury than the posterior single plate.

Objective:To investigate the phenotypic heterogeneity and gene penetrance of a dopa-responsive dystonia (DRD) family.Methods:The clinical data of a four-generation DRD family (including 3 patients) admitted to Department of Neurology, China-Japan Friendship Hospital in November 2015 were retrospectively analyzed. The proband underwent whole exon sequence, and the genetic result was verified by Sanger sequencing. Sanger sequencing was performed in the other 14 subjects in the family; the genotypes and clinical manifestations were analyzed.Results:In 15 subjects underwent genetic testing, 7 had heterozygous mutations c.284G>A (p.P95L) in GCH1 gene; the penetrance of GCH1 gene mutation in this family was 0.43 (3/7), the gene penetrance in male was 0.25 (1/4), and the gene penetrance in female was 0.67 (2/3). Three subjects in the DRD family had clinical symptoms; the clinical symptoms of the two female patients were more severe than those of the male patient; the severity of clinical symptoms differed greatly between the 2 female patients. Conclusion:There is a wide intrafamilial phenotypic heterogeneity in DRD family members carrying the same gene mutation, and the phenotype is gender-related; the gene penetrance in male is lower than that in female, and the clinical phenotype is often milder.

Objective:To investigate the significance of Th1/Th2 cytokines in prognostic stratification of acute myeloid leukemia (AML).Methods:A total of 83 patients with newly diagnosed AML from June 2017 to April 2019 in the First People's Hospital of Yunnan Province were collected. According to the Chinese guidelines for diagnosis and treatment of adult acute myeloid leukemia (non-acute promyelocytic leukemia) (2017 edition), AML patients were divided into poor prognosis group (45 cases), moderate prognosis group (19 cases), and good prognosis group (19 cases); moderate prognosis plus poor prognosis was treated as the not good prognosis. Mann-Whitney U test and Kruskal-Wallis H test were used to compare the expression differences of Th1/Th2 cytokines in peripheral blood of different prognosis groups; cytokines with statistical differences among different prognosis groups were selected, and the cut-off value of AML patients with different prognostic stratification distinguished by cytokines was determined by using receiver operating characteristic (ROC) curve. Finally, patients were divided into ≥ cut-off value group and 0.05).The cut-off value of TNF-β was 3.23 pg/ml in good prognosis group and moderate prognosis group, the area under the ROC curve was 0.866 (95% CI 0.753-0.978, P < 0.05); among 26 patients with TNF-β≥ 3.23 pg/ml, 25 (96.2%) patients had not good prognosis. The cut-off value was 3.62 pg/ml for distinguishing between moderate prognosis group and poor prognosis group, the area under the ROC curve was 0.747 (95% CI 0.610-0.884, P = 0.02); 18 (100%) patients with TNF-β≥ 3.62 pg/ml had not good prognosis. The cut-off value was 2.19 pg/ml for distinguishing between good prognosis group and not good prognosis group, the area under the ROC curve was 0.719 (95% CI 0.595-0.842, P = 0.04); among 53 patients with TNF-β≥2.19 pg/ml, 46 (86.8%) patients had not good prognosis. Conclusions:The high expression of TNF-β may indicate that the prognosis of AML patients is not good. When the level of TNF-β was equal or greater than 3.62 pg/ml, it may contribute to the prognostic stratification of AML patients.

Objective:To observe the therapeutic efficacy and prognosis of daratumumab combined with chemotherapy bridging to allogeneic hematopoietic stem cell transplantation (allo-HSCT) followed by daratumumab and lenalidomide maintenance treatment for primary plasma cell leukemia (PCL).Methods:The clinical data of a patient with primary PCL admitted to the First People's Hospital of Yunnan Province in January 2020 were retrospectively analyzed, and relevant literatures were reviewed.Results:The patient was diagnosed with primary PCL and treated with daratumumab combined with BD (bortezomib + dexamethasone) for 1 course and BCDD (bortezomib + cyclophosphamide + liposomaldoxorubicin + dexamethasone) for two courses. The patient was treated with daratumumab combined with allo-HSCT after complete remission. The donor cells were successfully implanted and the chimerism rate of donor cells was 94.36% without acute graft-versus-host disease reaction. And then the patient received intermittent maintenance therapy of daratumumab combined with low dose lenalidomide after transplantation, and the current remission period after transplantation reached 4 months.Conclusions:Daratumumab combined with chemotherapy bridging to allo-HSCT followed by daratumumab and lenalidomide may improve the prognosis of primary PCL and prolong survival time.

Objective:To explore the changes of cerebral blood flow (CBF) perfusion caused by N 2O (laughing gas) abuse. Methods:From December 2017 to October 2018, the CBF perfusion images of 24 patients with laughing gas abuse (9 males, 15 females; age: 18-32(24.0±8.9) years) from China-Japan Friendship Hospital were analyzed retrospectively. The region uptake statistics of different brain regions of interest (ROI) (basal ganglia, central region, cerebellum, cingulate gyrus, frontal lobe, medial temporal lobe, occipital lobe, parietal lobe, temporal lobe) between patients with laughing gas abuse and normal people of the same age group from background software database were calculated automatically. Statistic>1.68 indicated the increase of local CBF perfusion, while statistic < -1.68 indicated the decrease of local CBF perfusion. The correlation between the statistics of bilateral brain regions and the correlation between statistical values and clinical indicators were analyzed by Pearson and Spearman correlation analyses.Results:The correlation of the statistics between bilateral regions of each brain area was significant( r values: 0.503-0.892, all P<0.05). The decreased CBF proportions of frontal and temporal lobes were 62.5%(15/24) and 70.8%(17/24), respectively. The highest proportion of increased CBF was cingulate gyrus (33.3%, 8/24). There were significant correlations between frontal lobe, central brain area and duration of laughing gas abuse ( rs values: 0.375, 0.305, both P<0.05). Conclusion:CBF perfusion imaging is helpful for understanding the changes of CBF in patients with laughing gas abuse.

Objective:To explore the changes in the expression of Tau protein and phosphorylated Tau (p-Tau) protein in neurons after spinal cord ischemia-reperfusion injury (SCII).Methods:Ninety-six healthy adult SD rats were randomly divided into a sham operation group ( n=48) and a SCII group ( n=48). Based on the reperfusion time of 3 h, 6 h, 12 h, 24 h, 48 h and 72 h, the SCII group was divided into 6 subgroups ( n=8 per subgroup). Immunohistochemical staining was used to observe the apoptosis of spinal cord neurons in the L 4-L 5 segments and the expression of Tau protein and p-Tau protein. Results:In the sham operation group, the neuron cells were intact, mainly concentrated in the gray matter. Tau protein was seen in a small number of neuron cells, and a small amount of filamentous p-Tau protein in the pernucleus and cytoplasm. There was no significant difference between Tau protein and p-Tau protein expression in neurons at each time point ( P>0.05). In the SCII group, scattered Tau protein was seen in the apoptotic cells while there was a strong positive expression of Tau protein in the non-apoptotic cells. The expression of Tau protein in the SCII group gradually increased after injury, reaching a peak at 48h and plateauing at 72 h, and was significantly different between any 2 time points (except for 72 h) ( P<0.05). In the SCII group, the positive expression of p-Tau protein was observed in the cytoplasm of the apoptotic cells in strips and sheets. It increased rapidly within 6 h but did not change significantly after 6 h, showing no significant difference between any 2 time points afterwards ( P>0.05). There was a statistically significant difference in the expression of Tau protein and p-Tau protein between the SCII group and the sham operation group at each time point ( P<0.05). Conclusion:It is hopeful to reduce the severity of spinal cord injury by regulating the expression of Tau protein and p-Tau protein within 6 to 48 hours after SCII.

Objective:To identify the essential quality, expected quality and charm quality of outpatient doctors based on Kano model.Methods:The Kano model quality attribute questionnaire for outpatient doctors was designed from 4 dimensions and 18 indicators of service, quality, safety and cost. 220 outpatients were investigated in a tertiary hospital. The reliability and validity of 212 valid questionnaires were tested and the questionnaire data were analyzed.Results:Both the Cronbach α coefficient and the KMO value were higher than 0.7, which indicated that the reliability and validity were good. Nine of the 18 survey indicators were essential quality, focusing on the quality dimension and service dimension; 4 items were expected quality; 4 items were charm quality, focusing on disease cognition, prevention and drug safety; 1 item was indifferent quality.Conclusions:The essential quality of outpatient doctors is to provide basic and standardized medical services to patients. Studying the quality attribute can provide behavior guidance for outpatient doctors, improve patient satisfaction and quality of outpatient medical services.

Objective:To investigate the clinical, neuropsychological and regional cerebral blood flow (rCBF) characteristics in patients with psychiatric symptoms caused by nitrous oxide abuse.Methods:Twelve patients with psychiatric symptoms caused by nitrous oxide abuse were enrolled from February 2018 to February 2020 in the Department of Neurology, China-Japan Friendship Hospital and the First Hospital of Tsinghua University.All patients were scored with the brief psychiatric rating scale (BPRS), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). The SPECT/CT images were collected with low-energy and high-resolution collimator.After the pictures were reconstructed, 18 brain regions were automatically sketched and calculated by Database Comparison software.The statistical value of the difference between the general mean value of each brain region and that of the corresponding region of interest in the same age group was estimated.Results:(1)The clinical manifestations of 12 patients were anxiety, depression, hallucination, delusion, and 7 patients were accompanied by cognitive decline.(2)Neuropsychological examination: BPRS score was 57.83±11.15 (anxiety depression factor was 3.94±0.47; lacking active factor was 3.25±0.85; thinking disturbance factor was 3.21±1.27; activity factor was 2.28±0.56; hostility factor was 3.14±1.24). The score of self-knowledge impairment was 2.92±1.08, the score of inability to work was 4.50±1.17, the score of HAMD was 32.75±10.13, the score of HAMA was 18.67±5.80, the score of MMSE was 27.67±2.50, and the score of MoCA was 24.58±3.78.(3)SPECT showed that compared with the general mean value of the corresponding regions of interest of normal people, the patients showed hypoperfusion in the frontal lobe (7 patients, 58.30%) and the temporal lobe (8 patients, 66.70%).Conclusion:Nitrous oxide abuse has an obvious effect on rCBF.The psychiatric symptoms include anxiety, depression, hallucination, delusion and so on, which affect the ability to work and learn.SPECT has important value in the diagnosis of nitrous oxide abuse, and indicates changes in local brain functional activity.