Purpose:To explore the in vitro effects of apoptosis induction of 2-methoxyestradiol(2ME2),an estrogen derivative on primary myeloma cells and hematopoietic precursors from multiple myeloma patients. Methods:The primary myeloma cells and hematopoietic precursors from 14 multiple myeloma patients were examined determine apoptosis cells in situ by terminal-deoxynucleotidyl transferase mediated dUTP nick end labeling(TUNEL)assay. Results:After co-cultured with different concentrations (1,4,16?mol/L) 2 ME2 for 48h respectively,apoptotic ratios of myeloma cells were 10.5? 1.2%,21.2?2.3%,36.8?3.6% respectively ,which shows a concentration- dependence.In comparision with the control group,the difference is of statistical significance(P0.05). Conclusions:2ME2 could electively induce apoptosis of primary myeloma cells from myeloma patients and has little apoptotic effect on granulocytic,erythrocytic and lymphocytic cells in the bone marrow.

Objective:To investigate the long-term efficacy of oral appliance treating of obstructive sleep apnea and hypopnea syndrome (OSAHS) in different periods of treatment.Methods:A total of 55 patients were included in the study.Patients were all diagnosed with OSAHS by overnight polysomnography and all received oral appliance (OA) as the therapy.The OA positioned the mandible at 60％-70％ of the maximal mandible advancement position and created a 4-5 mm incisor separation.The patients were instructed to wear the appliance during sleep,6-8 hours per day,for 5-7 days per week.They were divided into four groups by the period of treatment,including less than 1 year group;1-2 years group;2-6 years group and 6-9 years group.The polysomnographic study was used to investigate the efficacy of the four groups.The outcome measures included the score on the apnea-hypopnea index (AHI),the longest apnea time and the lowest oxygen saturation (LSaO2) levels during an overnight sleep.Results:The AHI decreased significantly in all the four groups.The less than 1 year group decreased from 24.50 (14.65,54.05) to 7.40 (2.12,10.00) events/h (P ＜ 0.001);The 1-2 years group decreased from 19.50 (12.15,39.23) to 1.80 (0.70,6.58) events/h (P =0.001);The 2-6 years group decreased from 25.00 (11.41,42.60) to 4.50 (1.35,7.90) events/h (P =0.001);The 6-9 years group decreased from 26.2 (16.95,47.45) to 4.00 (1.90,26.70) events/h (P =0.043).The longest apnea decreased significantly in less than 1 year group,1-2 years group and 2-6 years group.The longest apnea decreased from 57.00 (37.70,61.50) to 25.00 (15.90,33.50)seconds (P＜0.001) in the less than 1 year group,from 41.00 (25.50,62.26) to 13.10 (0.00,22.10) seconds (P =0.001) in the 1-2 year group and from 42.50 (30.35,58.15) to 15.60 (0.00,28.10) seconds (P =0.003) in the 2-6 year group.The LSaO2 levels increased significantly in the less than 1 year group and 2-6 years group.The LSaO2 levels rose significantly in the less than 1 year group,from 74.18％ ±7.96％ to 84.06％ ±7.67％ (P =0.001),and in the 2-6 years group,from 76.71％ ± 10.98％ to 84.06％ ±4.64％ (P =0.006),The LSaO2 levels did not increase significantly in the 1-2 years and 6-9 years groups.Kruskal-Wallis test showed that there were no statistically significant differences in the AHI,longest apnea time and LSaO2 in 4 the groups.Conclusion:The oral appliance is an effective therapy for patients with OSAHS in the long-term treatment.However,it's recommended to make appointments with patients as a follow-up supervision whether there is any efficacy decrease.And the oral appliance should be replaced if necessary.

Objective To explore the clinical characteristics of pleural effusion caused byMycoplasma pneumoniae in children.MethodsThe clinical data from children with pleural effusion caused byMycoplasma pneumoniae were retrospectively analyzed. Differences of clinical characteristics in children with pleural effusion caused byMycoplasma pneumoniae infection and non-Mycoplasma pneumoniae infection were compared. Moreover, multiple logistic regression analysis was performed on the factors that were identified to have statistical differences in single factor analysis. Receiver operating characteristic (ROC) curve was performed and the diagnostic boundary value of each factor and the diagnostic accuracy of the regression model were calculated.ResultsThere were statistical differences between children with pleural effusion caused byMycoplasma pneumoniae infection and by non-Mycoplasma pneumoniae infection in age, white blood cell count, lactic dehydrogenase (LDH), levels of IgA and IgM, and the proportion of multiple nuclei, glucose and lactic acid (LAC) in pleural effusion, pleural thickening, and formation of ifbrous separation (allP??3.92 years, serum IgM?>?1.29 g/L, LDH?>?367 U/L and pleural effusion LAC?

Objective:To explore the effects of sulforaphane (SFN), an activator of Nrf2, on anxiety and fear memory in Alzheimer's disease(AD) model mice and mechanism.Methods:The AD mice and wild type (WT) mice with the same background were randomly divided into four groups ( n=12 for each group): wild type + normal saline group (WT+ NS), wild type + sulforaphane (WT+ SFN), AD model + normal saline group (AD+ NS) and AD model + sulforaphane group (AD+ SFN). SFN was dissolved in normal saline (0.9% NaCl) and prepared solution with concentration of 1 g/L.According to body weight, mice in WT+ SFN group and AD+ SFN group were intraperitoneally injected with SFN (10 mg/kg), and mice in WT+ NS group and AD+ NS group were intraperitoneally injected with the same volume of normal saline once a day for 30 days.The open field test was used to detect the autonomous exploration ability and anxious behavior of mice.The elevated cross maze was used to detect the anxiety of mice.Conditional fear test was used to test the fear memory behavior of mice.Finally, the expression of superoxide dismutase(SOD) and malondialdehyde(MDA) in the hippocampus and cerebral cortex were detected by ELISA.Two-way ANOVA analysis was performed using GraphPad Prism 8.0.2 software. Results:In the open field test, the percentage of time in central region in AD+ SFN group ((9.99+ 0.37)%) was higher than that of AD+ NS group ((8.47+ 0.42)%) ( q=3.842, P<0.05). In the elevated cross maze, the percentage of time in open arm of AD+ SFN group ((26.2±1.6)%) was higher than that in AD+ NS group ((15.8±1.0)%) ( q=7.452, P<0.01). In the conditional fear test, all the mice of the four groups developed the fear memory, but AD+ SFN group showed higher freezing time ratio ((64.5±3.8)%) than AD+ NS group ((51.0±4.3)%)( q=5.266, P<0.01) in the testing stage.After SFN intervention, the important indicator of oxidative stress, the expression levels of SOD in hippocampus ( q=6.370, P<0.01) and cortex ( q=7.858, P<0.01) of AD mice increased, while the level of MDA in hippocampus ( q=5.146, P<0.05) and cortex ( q=5.833, P<0.01) decreased. Conclusion:SFN may inhibit oxidative stress through Nrf2 pathway, thereby improving anxiety and fear memory in AD mice.

Objective Toexplorethevalueofmonochromaticenergyimaginggeneratedfrom RevolutionCTindetectingcoronary plaquesindifferentconcentrationsofcontrastagent.Methods Sixtesttubesnumbered3,4,5,6,8and9inthephantom wereselectedand filledupwithdifferentconcentrationsofiodinesolutions(20,10,5,2.5,0,13mgI/mL,respectively),fishbonesimulatingcalcified plaqueandstreakyporksimulatinglipid/fibrousplaque.EachtubeunderwentspectralCTscan(studygroup,70keV monochromatic energyimaging)and120kVpCTscan (controlgroup)respectivelyinRevolutionCT.Theabilityofplaquedetectionwasevaluated subjectively,andfurtheranalysis was madeontheimages withascoregreaterthanorequaltothreepoints.One-way ANOVA and Bonferroni m ethod w ere used to co m pare the C T values and C N R in different tubes in the intra-group co m parison ,w hile paired t test and M ann-W hitney U testwereusedfortheinter-groupcomparison.Results TheoverallimagequalityofNo.4,5and9testtubes inbothgroupsmettheclinicaldiagnosticlevel.Intheintra-groupcomparison,No.5testtubeshowedhigherCNRofcalcifiedplaque andNo.9testtubeshowedhigherCNRoflipidplaqueandfibrousplaquethantheothers(t=4.105-29.214,allP<0.001).Whilein theinter-groupcomparison,thestudygroupshowedsimilarCNRofcalcifiedplaqueinNo.9testtube(t=-1.576,P=0.130)tothecontrol group,andhigherCNRintheothersthanthecontrolgroup(Z=-4.074--3.815,t=-14.782--3.520,allP<0.05).Conclusion Comparedwith120kVpCTimages,monochromaticenergyimagingat70keVfrom RevolutionCTshowedbetteroverallimagequality andcoulddisplaycoronaryplaquesbetterwiththecontrastagent concentrationfrom5mgI/mLto13mgI/mL.

Objective To investigate the image quality and radiation dose of spectral CT with automatic spectral imaging mode selection (ASIS) and adaptive statistical iterative reconstruction (ASIR) at abdominal CT as compared with low-kVp CT with ASIR.Methods Two hundred patients underwent the plain and arterial-phase (AP) and portal venous-phase (PVP) contrast-enhanced abdominal CT scan were analyzed prospectively.The patients were randomly assigned to the control group (low-kVp CT scan) and study group (spectral CT scan),if BMI ≤ 23.9 kg/m2,patients were assigned into group A (80 kVp) or group B (spectral CT with ASIS);if 24.0 kg/m2 ≤ BMI＜28.9 kg/m2,patients were assigned into group C (100 kVp) or group D (spectral CT with ASIS)(n=50 each).Groups A and B,groups C and D were matched by gender,age,body mass index,cross sectional area and contrast agent dose respectively.Low-kVp images and monochromatic images (40 to 60 keV) were all reconstructed by using ASIR.Radiation dose and quantitative parameters (image noise in HU and contrast-to-noise ratio of the liver,aorta and portal vein) were compared by using t test while overall image quality was assessed by Mann-Whitney U test between the matched groups.Results Radiation dose in the group B was significantly higher than group A (increased by 10％,P＜0.05) but there was no significant differences between groups C and D (P＞0.05).Compared to the control group,image noises in the study group were higher at 40 keV and 50 keV (P＜0.05),but similar at 40 keV (P＞0.05).At the energy level of 40 keV,the study group showed higher CNRs,but lower overall image quality scores than the control group except for the similar image quality scores between groups A and B during AP (P＜0.05).At the energy level of 50 keV,the CNRs and overall image quality scores in the study group were higher than or similar to the control group.At the energy level of 60 keV,the study group showed lower or similar CNRs,but higher or similar overall image quality scores compared with the control group.Conclusions The radiation dose of spectral CT with ASIS technique was slightly higher than 80 kVp CT but similar to 100 kVp CT.By combining ASIR technique,monochromatic image at 50 keV can maintain or improve CNR and overall image quality as compared with low-kVp images.

Objective To investigate the value of wide-detector helical CT combined with adaptive statistical iterative reconstruction-V (ASIR-V) in the low radiation dose CT examination of upper abdomen in obese patients.Methods In the first phantom experiment part,the optimal percentage of pre-and post-ASIR-V of abdominal scanning (120 kVp,NI =10 HU) were explored.The second human experiment was performed based on the phantom study,and our institutional review board approved this prospective study,each participant provided written informed consent.87 obese patients (body mass index,BMI ≥30 kg/m2) underwent contrast-enhanced abdominal CT scan were randomly divided into two scan protocols [protocol A:n =43,120 kVp,detector coverage of 80 mm,40％ pre-ASIR-V (group A1)and combined with 60％ post-ASIR-V (group A2) respectively;protocol B,n =44,120 kVp,detector coverage of 40 mm,40％ ASIR (group B)].Quantitative parameters [image noise and contrast-to-noise ratio (CNR)] and qualitative visual parameters (overall image quality as graded on a 5-point scale) were compared.Weighted effective dose (E) were assessed.Results The optimal percentage of pre-and post-ASIR-V of abdominal scanning were 40％ and 60％,respectively.The effective radiation dose in protocol A [(4.55 ± 0.95) mSv] was decreased for 53％ as compared with protocol B [(9.58 ± 2.04) mSv](t =-14.773,P ＜ 0.001).During the arterial phase and portal venous phase,except for the CNRs of liver,Group A2 showed higher CNRs (q =2.160-3.209,P ＜ 0.05),lower image noise(q =-4.212--3.202,P＜0.05),and higher overall image quality scores(Z =-5.155--2.561,P ＜0.05) as compared with group A1 and group B.Group A1 showed similar CNRs,similar image noise(P ＞ 0.05),and lower overall image quality scores (Z =-3.298--3.030,P ＜ 0.05) than group B.The overall image quality scores in group A were all greater than 3 point and met the clinical diagnostic level.Conclusions Compared with stand-detector helical CT in obese patients,the wide-detector helical CT combined with 40％ pre-ASIR-V could reduce the radiation dose by 53％,and improve overall image quality by combining post-ASIR-V technique.

Objective:To analyze the postoperative paravertebral muscle degeneration and its correlations with health related quality of life (HRQL) in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).Methods:The clinical data of the 50 patients were retrospectively analyzed who had undergone single-segmental MIS-TLIF at Department of Spinal Cord Surgery, The People's Hospital of Henan Province from January 2019 to December 2021. The relative volumes of lumbar posterior muscle (LM), the relative volumes of the psoas major (PM), and the rates of fatty degeneration (FD) of the fused segment and its adjacent segments were compared respectively between preoperation, 6 and 12 months postoperation. The correlations were analyzed between the HRQL scores [visual analog scale (VAS) for pain and Oswestry disability index (ODI)] and the relative LM volumes, the relative PM volumes, and the FD rates of the fused segment and its adjacent segments at 12 months postoperation.Results:Compared with the preoperative values, the relative LM volumes and the relative PM volumes of the fused segment and its adjacent segments at 6 and 12 months postoperation were significantly reduced while the FD rates significantly increased. However, the FD rate of the fused segment at 12 months postoperation (20.6% ± 6.1%) was significantly lower than that at 6 months postoperation (29.7% ± 8.2%) ( P < 0.05). The VAS score was strongly negatively or positively correlated with the relative LM volume ( r = -0.819, P < 0.001) and the FD rate ( r = 0.86, P < 0.001) of the fused segment, and moderately negatively correlated with the relative PM volume ( r = -0.435, P = 0.016). The ODI index was moderately negatively correlated with the relative LM volume ( r = -0.512, P = 0.004) and the relative PM volume ( r = -0.402, P = 0.020) of the fused segment, but moderately positively correlated with the FD rate of the fused segment ( r = 0.565, P = 0.001). There was a moderate negative correlation between the ODI index and the relative LM volume of the adjacent segments ( r = -0.478, P = 0.012). Conclusions:After MIS-TLIF, the volume of the paravertebral muscles decreases and the dorsal muscles develop fatty degeneration. The improvement of LM fatty degeneration may be observed by 12-month follow-up in the fused segment, but not in the adjacent segments. The LM volume and the FD rate of the fused segment are the most closely related to the postoperative HRQL.

Objective:To investigate the clinical efficacy of satellite rod revision surgery via a combined anterior and posterior approach for rod fracture after posterior vertebral column resection (PVCR) in patients with severe thoracolumbar kyphosis.Methods:A retrospective case series study was conducted on the clinical data of 11 patients with rod fracture after PVCR for severe thoracolumbar kyphosis, who were treated in Henan Provincial People′s Hospital from January 2013 to January 2021. There were 6 males and 5 females, with the age range of 21-62 years [(35.4±13.0)years]. Among them, 4 patients had traumatic kyphosis, 4 presented congenital kyphosis and 3 showed tuberculous kyphosis. All the patients had obvious low back pain. According to the American Spinal Injury Association (ASIA) score, 2 patients were found with grade C, 2 with grade D and 7 with grade E. All the patients underwent revision surgery for internal fixation using satellite rod via a combined anterior and posterior approach. The operation time, intraoperative blood loss and postoperative hospital stay were recorded. The imaging parameters such as kyphosis Cobb angle, scoliosis Cobb angle, distance between C 7 plumb line and central sacral vertical line (C 7-CSVL), and distance between C 7 plumb line and sagittal vertical axis (SVA) were measured preoperatively, at 1 week postoperatively and at latest follow-up. At the same time, the visual analogue scale (VAS), Oswestry dysfunction index (ODI), and simplified Chinese version of the scoliosis research society-22 (SRS-22) questionnaire were used to evaluate the clinical efficacy. At the latest follow-up, the osteotomy fusion was evaluated by Suk criterion and ASIA score was used to evaluate the recovery of neurological function. The complications were also recorded for the patients. Results:All the patients were followed up for 24-84 months [(47.5±16.2)months]. The operation time was 100-220 minutes [(149.4±37.6)minutes], with the intraoperative blood loss of 150-350 ml [(246.3±64.6)ml] and the postoperative hospital stay of 5-8 days [(6.1±1.1)days]. The kyphosis Cobb angles [(18.5±3.2)° and (19.3±2.9)°] and the scoliosis Cobb angles [(11.8±2.2)°, (11.1±2.2)°] at 1 week post-operation and at the latest follow-up were all improved significantly compared with the preoperative ones [(60.4±6.3)°, (21.7±5.5)°] (all P<0.01), with the average correction rates being 69.4% and 45.6%, respectively, with no significant differences between 1 week post-operation and latest follow-up (all P>0.05). The C 7-CSVL was reduced from preoperative (21.2±4.3)mm to (15.7±2.4)mm at 1 week post-operation, and to (15.9±2.2)mm at the latest follow-up (all P<0.01). The SVA was improved from preoperative (51.0±6.8)mm to (16.6±3.6)mm at 1 week post-operation, and to (15.3±3.9)mm at the latest follow-up (all P<0.01). There were no significant differences in C 7-CSVL or SVA at 1 week post-operation or at the latest follow-up (all P>0.05). The VAS [(2.5±0.9)points, (1.9±0.9)points], ODI (20.1±5.4, 18.4±5.2) and SRS-22 [(83.4±5.8)points, (85.0±4.1)points] at 1 week post-operation and at the latest follow-up were significantly improved compared with the preoperative ones [(6.0±1.4)points, 57.2±8.7, (62.0±9.1)points] (all P<0.01), but no significant differences were found between 1 week post-operation and latest follow-up (all P>0.05). At the latest follow-up, the bone grafts achieved osseous fusion in all the patients, and the ASIA grade was improved from grade C to grade D in 2 patients and from grade D to grade E in 2 patients. No complications such as serious neurological or vascular injury occurred during perioperative period. No pseudoarthrosis formation, internal fixation loosening or fracture occurred during follow-up. Conclusion:Satellite rod revision surgery via a combined anterior and posterior approach for rod fracture after PVCR in patients with severe thoracolumbar kyphosis has the advantages of less trauma and faster convalescence, excellent results of deformity correction, significant pain relief, functional improvement, and fewer complications.

Objective:To explore the clinical effect of the 3D printing pre-installed screw channel model in assisting screw placement of single complete segmented congenital hemivertebrectomy.Methods:Clinical data of 13 children treated with single complete segmented congenital hemivertebrectomy in the Department of Spine and Spinal Surgery of Henan Provincial People′s Hospital from August 2016 to January 2019 were retrospectively analyzed.Among them, there were 5 males and 8 females with the mean age of 9.9 (5-14) years.Categorized by the lesion location, 3 cases were located at T 9, 2 cases at T 10, 5 cases at T 11, 1 case at T 12, and 2 cases at L 1.During the operation, the 3D printing pre-installed screw channel model was used to assist the placement of pedicle screws.The accuracy of screw placement was assessed by the postoperative CT.All children were routinely examined by full-length anterior and lateral X-ray of spine in the standing position before and after surgery to measure the Cobb angles at the coronal and sagittal view.Furthermore, the correction rate of scoliosis and kyphosis after surgery and during follow-up was also calculated.The One-Way repeated measures ANOVA was used to compare the Cobb angle of scoliosis and kyphosis before surgery, after surgery and during follow-up. Results:A total of 85 pedicle screws were placed in 13 children, with the accuracy rate of screw placement of 95.3%.The mean surgery time and intraoperative blood loss were (216.9±28.3) min, and (478.5±132.6) mL, respectively.Scoliosis Cobb was corrected from (57.1±12.7)° to (12.7±4.7)° with a correction rate of (78.4±5.9)%, which was (14.2±7.0)° at the last follow-up.Kyphosis angle was corrected from (46.2±8.4)° to (13.2±4.4)° with a correction rate of (72.6±7.0)%, which was (14.0±3.4)° at the last follow-up.None of the children had serious complications like vascular and nerve damage.The mean postoperative follow-up was 12.3 (6-18) months.No significant loss of angle was detected during the follow-up period.There were significant differences in the lateral and kyphotic angles after surgery and during follow-up compared with preoperative ones (all P<0.05). No significant difference was detected between the postoperative lateral and kyphotic angles and those at the last follow-up (all P>0.05). Conclusion:The 3D printing pre-installed screw channel model used to assist screw placement of single complete segmented congenital hemivertebrectomy can improve the precision of screw placement and the orthopedic effect on lateral kyphosis.