BACKGROUND: Thoracolumbar segments (T11-L2) prone to damage due to its special anatomical and biomechanical characteristics. Therefore, fully understanding the shape of pedicle of vertebral arch and finding the visible, constant, and the point of insertion of the pedicle axis is very important to the safety of pedicle screw placement.OBJECTIVE: To measure the surgically relevant parameters of thoracolumbar pedicles between Han and Uygur males using computed tomography (CT) scan to provide some anatomic reference data for pedicle screw fixation.METHODS: The vertebral bodies and pedicles of adult males were scanned (60 cases of Han people and 60 cases of Uygur people) from T10-L3 with CT. The parameters were processed by three-dimensional reconstruction. Transverse pedicle width, pedicle axis length, transverse pedicle angle, and sagittal pedicle angle were measured by using length and angle measurement tool of browser in bone-window CT images. The age and stature information were recorded. All the data above were processed by SPSS 13.0 software.RESULTS AND CONCLUSION: (1) The mean transverse pedicle width of T12 and L1 in Han was bigger than that in the Uygur. (2) The mean transverse pedicle angle of T12 and L2 in Han was bigger than that in the Uygur. (3) The mean pedicle axis length and sagittal pedicle angle of T11 and L1 in Han were bigger than that in the Uygur (P < 0.05). (4) There were some differences among some parameters of the thoracolumbar pedicles between the Han and Uygur people.Data from any study only can be used as a guide for pedicle screw fixation. Preoperative CT evaluation may provide an individualized strategy to reduce the incidence of postoperative complications caused by misplacement.

Objective To investigate the effects of mefformin on the differentiation of osteoclastas well as relative mechanism.Methods Raw264.7 cells from the murine macrophage cell line was used.Receptor activator of NF-κB ligand (RANKL) was used to stimulate osteoclast differentiation from Raw264.7 cells.Osteoclast differentiation was assessed by tartrate-resistant acid phosphatase (TRAP) and actin fluorescence staining and counting the TRAP-positive cells after exposure to different concentrations of mefformin (0 μmol/L,400 μmol/L,800 μmol/L and 1000 μmol/L) or rapamicin (100 nmol/L) in the presence of 50 ng/ml RANKL for 5 days.Bone-resorbing activity was evaluated by BD BioCoatTM OsteologicTM Bone Cell Culture System.The expression of osteoclast-specific genes like TRAP,capthesin K,calcitonin receptor (CTR) and matrix metalloproteinase (MMP-9) was evaluated by RT-PCR.The expression of tumor necrosis factor-α(TNF-ct) S6K1Thr389,S6 Ser235/236,4E-BP1Thr37/46 and c-Fos protein was evaluated by ELISA kit and Western blot analysis,respectively.Results Mefformin dose-dependently inhibited RANKL-stimulated osteoclasts differentiation in Raw264.7 cell culture,as manifested by decrease of TRAP-positive multinucleated cells and pit erosion area,down-regulation of TRAP,cathepsin K,CTR and MMP-9 mRNA and reduction of TNF-α and c-Fos protein expression.Further study revealed that RANKL activated mTOR complex 1(mTORC1) signaling,while mefformin impaired RANKL-stimulated mTORC1 signaling.Rapamycin,an mTORCl-specific inhibitor and immunosuppressive macrolides could also prevent RANKL-induced osteoclast differentiation and bone resorption in vitro.Conclusion Mefformin inhibits osteoclastogenesis in vitro,which may due to reduction of TNF-α and c-Fos protein expression,and mTORC1 signaling is involved in this process.

Objective To compare the postoperative extubation time and length of PACU retention between patients who had undergone retroperitoneal laparoscopic unilateral adrenal pheochromocytoma resection and other adrenal tumor resection.Methods A retrospective study of 57 hypertensive patients who had undergone retroperitoneal laparoscopic unilateral adrenal tumor resection under the general anesthesia was conducted.Nineteen patients with adrenal pheochromocytoma were assigned to group S,and other 38 patients were assigned to group D.We recorded and compared the gender ratio,ASA grade,age,weight,height,duration of operation and anesthesia,dosage of anes thetics,extubation time,and length of PACU retention between the two groups.Results There were no significant differences in gender ratio,ASA grade,age,weight,height,duration operation and anesthesia,as well as doses of propofol,midazolam,fentanyl and muscle relaxants between the two groups.As to extubation time and length of PACU retention,those of group S were both significantly longer than those of group D [30.0(25.0-42.5)min vs 20.0(15.0-20.0)min;70.0(57.5-82.5)min vs 45.0(33.5-55.0) min,P＜0.05,respectively].Conclusion Retroperitoneal laparoscopic unilateral adrenal pheochromocytoma resection might lead to postoperatively longer extubation time and length of PACU retention.It does not relate to the dosage of anesthetics used perioperatively.

Objective To investigate the efficacy of precise ultrasound-guided stellate ganglion block(UG-SGB)combined with ozonated autohemotherapy in the treatment of sudden hearing loss.Methods Fifty-seven patients with sudden hearing loss,27 males and 30 females,aged 19-82 years,BMI 20-29 kg/m2,ASA physical status Ⅰ or Ⅱ,were randomly divided into drugs combined with UG-SGB and ozonated autohemotherapy treatment group(group U,n=29)and drugs group(group D,n=28)accord-ing to the random number table.All patients were given drug therapy.In addition to the treatment above,pa-tients in group U also received precise ultrasound-guided stellate ganglion block once on affected side com-bined with ozonated autohemotherapy once daily for 10 consecutive days.Patients in group D received drug therapy only.The average hearing threshold of the two groups was compared before treatment(T0),at dis-charge(T1),1 month(T2),3 months(T3),and 6 months after discharge(T4).The hearing improve-ment of the two groups was also compared at T1-T4 on the basis of T0.Moreover,tinnitus rate of the two groups was recorded T0-T4.In addition,adverse reactions such as toxicosis of local anaesthetics,pneumo-thorax were recorded.Results Compared with T0,the average hearing threshold was reduced significantly in both groups at T1-T4(P＜0.05),the incidence of tinnitus was reduced significantly at T1-T4 in both groups(P＜0.05).Compared with T,,the average hearing threshold was reduced significantly in group U at T2-T4(P＜0.05).The average hearing threshold of group U was lower than that in group D at T1-T4(P＜0.05).The hearing improvement in group U was better than that in group D at T2-T4(P＜0.05).The proportion of complete hearing recovery in group U was increased significantly than that in group D at T2-T4(P＜0.05)The proportion of effective hearing improvement in group U was decreased than that in group D at T3-T4(P＜0.05).No obvious adverse reaction was recorded,such as toxicosis of local anaesthetics,pneumothorax.Conclusion Precise ultrasound-guided stellate ganglion block combined with ozonated auto-hemotherapy based on drug treatment significantly improves the average hearing threshold of patients with sudden hearing loss in acute stage and improve their hearing.

Sarcomatoid carcinoma of the renal pelvis accounts for a very low percentage of malignant tumors in the renal pelvis and has a poor prognosis. This article reported a patient with sarcomatoid carcinoma of the renal pelvis. The patient presented with macroscopic hematuria as the first symptom, and CT suggested left renal occupancy, unilateral nephrectomy was performed, and pathology suggested sarcomatoid carcinoma of the renal pelvis. Three weeks after surgery, a follow-up CT showed tumor recurrence. Programmed death 1(PD-1)inhibitor was given once every 3 weeks. Repeated CT examination after 24 weeks of continuous treatment suggested that the recurrent tumor disappeared. The patients was followed-up for 42 months without tumor recurrence or metastasis.

Objective: To investigate the clinico-pathological characteristics, outcomes and their predictors in malignant hypertension related kidney injury with and without primary glomerular diseases. Methods: Patients with clinical diagnosis of malignant hypertension, biopsy-proven kidney injury caused by malignant hypertension and complete clinical data from January 2010 to December 2018 were retrospectively analyzed. According to clinical and renal pathology, patients were divided into malignant hypertension related kidney injury without primary nephropathy group and with primary nephropathy group. Clinico-pathological characteristics and outcomes were evaluated and compared between malignant hypertension related kidney injury with and without primary glomerular diseases. Results: Totally 31 biopsy-proven kidney injury patients were analyzed. Among them, there were 18 cases with primary glomerular diseases and 13 cases without primary glomerular diseases, with age of (32.5±6.5) years old and (34.7±8.1) years old, respectively. There were 12 males in both group. The proportion of primary IgA nephropathy was higher (16/18) in the group of malignant hypertension related kidney injury with primary glomerular diseases. Malignant hypertension with primary glomerular diseases patients had lower plasma albunin level [(32.7±6.4) g/L vs (38.5±7.3) g/L, P=0.027], higher 24-hour proteinuria level [(4.03±2.71) g vs (1.45±0.98) g, P=0.002] and higher incidence rates of dysmorphic hematuria (14/18 vs 0, P=0.001) than those without primary glomerular diseases patients. Glomerular sclerosis, mesangial proliferation, tubular atrophy and interstitial fibrosis were more severe in malignant hypertension with primary glomerular diseases patients (all P<0.05), but the ischemic wrinkling of glomerular capillary was more severe in malignant hypertension without primary glomerular diseases (P<0.01). There were no differences of acute or chronic malignant hypertensive injury in small artery and in afferent arterioles between the two groups. Cox regression analysis showed that loss of brush-border with flattening of tubular epithelium was the predictor for renal partial recovery (HR=5.956, 95% CI 1.198-29.614, P=0.029). Kaplan-Meier analysis showed that malignant hypertension patients with primary glomerular diseases had shorter renal survival time than those without primary glomerular diseases [(24.1±9.3) months vs (56.6±12.4) months], and accumulative renal survival rate of malignant hypertension patients with primary glomerular diseases was lower than that without primary glomerular diseases (11.6% vs 53.3%, Log-rank χ²=5.022, P=0.025). Multivariate Cox regression analysis showed that severe tubular atrophy and interstitial fibrosis were independent risk factors for end-stage renal disease in malignant hypertension patients (HR=5.870, 95% CI 1.372-25.112, P=0.017). Conclusions Malignant hypertension with primary glomerular diseases patients have more severe clinico-pathological renal impairment and poorer prognosis of long-term renal survival than those without primary glomerular diseases. Acute renal tubular injury (loss of brush-border with flattening of tubular epithelium) is the only predictor of renal function improvement in patients with malignant hypertension and renal impairment within one year. Tubular atrophy/interstitial fibrosis is a risk factor for end-stage renal disease in patients with malignant hypertension. Renal biopsy is an indispensable tool for predicting short-term and long-term renal outcomes.