Objective:To explore the causes and preventive measures of respiratory arrest following general anesthesia in children with obstructive sleep apnea （OSA）, in order to enhance the safety of OSA surgeries under general anesthesia. Methods:A retrospective analysis was conducted on the clinical and follow-up data of four pediatric cases that experienced respiratory arrest after general anesthesia for OSA at Shenzhen Hospital of Southern Medical University from March 2020 to March 2022. Results:All four children exhibited varying degrees of decreased blood oxygen saturation, cyanosis, and loss of consciousness after OSA surgery under general anesthesia, with one case experiencing respiratory and cardiac arrest. Through emergency rescue measures such as oxygen supplementation, suctioning, positive pressure ventilation, awakening, and cardiopulmonary resuscitation, all four children were stabilized. Follow-up after 2 to 6 months showed no complications. The main reasons for the occurrence are analyzed as: residual anesthetic drugs, characteristics of the OSA disease, and the unique aspects of the pediatric population. Conclusion:Children undergoing general anesthesia for OSA should be closely monitored for vital signs after surgery. If respiratory suppression occurs, active rescue measures should be taken to avoid serious consequences.
Humans ; Sleep Apnea, Obstructive/surgery* ; Anesthesia, General/adverse effects* ; Retrospective Studies ; Child ; Postoperative Complications/prevention & control* ; Male ; Female ; Child, Preschool

Background::Renal ischemia-reperfusion (R-I/R) injury is the most prevalent cause of acute kidney injury, with high mortality and poor prognosis. However, the underlying pathological mechanisms are not yet fully understood. Therefore, this study aimed to investigate the role of N-myc downstream-regulated gene 2 ( Ndrg2) in R-I/R injury. Methods::We examined the expression of Ndrg2 in the kidney under normal physiological conditions and after R-I/R injury by immunofluorescence staining, real-time polymerase chain reaction, and western blotting. We then detected R-I/R injury in Ndrg2-deficient ( Ndrg2-/-) mice and wild type ( Ndrg2+/+) littermates in vivo, and detected oxygen and glucose deprivation and reperfusion (OGD-R) injury in HK-2 cells. We further conducted transcriptomic sequencing to investigate the role of Ndrg2 in R-I/R injury and detected levels of oxidative stress and mitochondrial damage by dihydroethidium staining, biochemical assays, and western blot. Finally, we measured the levels of mitophagy in Ndrg2+/+ and Ndrg2-/- mice after R-I/R injury or HK-2 cells in OGD-R injury. Results::Ndrg2 was primarily expressed in renal proximal tubules and its expression was significantly decreased 24 h after R-I/R injury. Ndrg2-/- mice exhibited significantly attenuated R-I/R injury compared to Ndrg2+/+ mice. Transcriptomics profiling showed that Ndrg2 deficiency induced perturbations of multiple signaling pathways, downregulated inflammatory responses and oxidative stress, and increased autophagy following R-I/R injury. Further studies revealed that Ndrg2 deficiency reduced oxidative stress and mitochondrial damage. Notably, Ndrg2 deficiency significantly activated phosphatase and tensin homologue on chromosome ten-induced putative kinase 1 (PINK1)/Parkin-mediated mitophagy. The downregulation of NDRG2 expression significantly increased cell viability after OGD-R injury, increased the expression of heme oxygenase-1, decreased the expression of nicotinamide adenine dinucleotide phosphate oxidase 4, and increased the expression of the PINK1/Parkin pathway. Conclusion::Ndrg2 deficiency might become a therapy target for R-I/R injury by decreasing oxidative stress, maintaining mitochondrial homeostasis, and activating PINK1/Parkin-mediated mitophagy.

Objective To analyze the epidemiological characteristics of population-based cohort of patients with the comorbidity of cardiovascular and cerebrovascular diseases and type 2 diabetes in Lingnan area,and to study the related influencing factors in the onset and progression of the disease. Methods A retrospective cohort study was used to collect data from people who underwent physical examination in the Eleventh People's Hospital of Guangzhou from May 2022 to December 2023. Data mainly included questionnaire surveys,physical examinations,and laboratory testing indicators. The 2022 was defined as the baseline to statistically analyze the occurrence and development of the comorbidity of cardiovascular and cerebrovascular diseases and type 2 diabetes in this population,and to analyze the related influencing factors of comorbidity and distribution of traditional Chinese medicine constitution in comorbidity population. Results Finally,a total of 26498 subjects were included,from which there were 359 patients with the comorbidity of cardiovascular and cerebrovascular diseases and type 2 diabetes (comorbidity group),accounting for 1.4％ of the total. Among them,290 were male,accounting for 80.8％,which is much higher than female. The mean age was(61.6±9.5)years old,which was significantly higher than that of the non-comorbidity group. The cases of comorbidity group were mainly concentrated in the age group of 45-75 years old,and no cases were found in people under 35 years old. There were 293 patients with the comorbidity of ischemic cardiovascular disease and type 2 diabetes,whose proportion (81.6％) is much higher than that of other types. Significant differences between comorbidity group and non-comorbidity group were found in terms of gender,age,age distribution,height,body mass,body mass index (BMI),smoking,alcohol consumption,marital status,exercise,and dampness syndrome (P<0.05). About 1.0％ of population at the baselined converted from non-comorbidities or single disease to comorbidities. The proportion of newly diagnosed patients with the comorbidity of ischemic cardiovascular disease and type 2 diabetes is the highest,up to 68.9％. BMI overweight or obesity,large waist circumference,smoking,dampness syndrome and exercise were the risk factors affecting the comorbidity of cardiovascular and cerebrovascular diseases and type 2 diabetes. A total of 264 cases of comorbidity group had finished evaluation of traditional Chinese medicine body constitutions. The proportion of balanced constitution was the highest (31.1％),followed by dampness-heat constitution (18.2％),yang-deficiency constitution (13.3％) and phlegm-dampness constitution (11.7％). Conclusion The incidence of the comorbidity of cardiovascular and cerebrovascular diseases and type 2 diabetes is high in Lingnan area,which may be related to dampness constitution,BMI overweight or obesity,large waist circumference,smoking,dampness syndrome and lack of exercise.

Exosomes are nanoscale particles secreted by various cells,including immune,stem,and tumor cells.They are enriched with bio-active substances that transport tumor information,mediate intercellular communication,and regulate multiple physiological processes and tumor microenvironment(TME)remodeling.Exosomes secreted by different tumor cell types exhibit cell-specific characteristics,contain various factors involved in immune regulation,and can interact with all types of immune cells.Cancer immunoediting is a process in which the immune system can both constrain and promote tumor development,involving three phases:elimination,equilibrium,and escape.Tu-mor-derived exosomes play diverse roles during these stages,both promoting anti-tumor immunity and inhibiting the anti-tumor activity of immune cells.Collectively,understanding the immunoediting role of exhausted T cells(TEXs)in regulating the immune microenvironment in lung cancer provides novel insights into antitumor therapy.

Objectives:To compare the clinical efficacy and safety of uni-portal endoscopic lumbar interbody fusion by using larger-diameter endoscope for single-level lumbar disease via transforaminal approach versus transfacet approach.Methods:46 patients underwent single-level uni-portal endoscopic lumbar interbody fu-sion from June 2018 to February 2022 were enrolled.18 of the patients were male and 28 were female.The mean age was 60.9±10.5 years old(40-80 years).The follow-up time was 3-47 months.Patients were divided into two groups according to the surgical approach,18 of which were included in the transforaminal group,and the remaining 28 were included in the transfacet group,and a full spinal endoscope of 7.1mm inner-di-ameter working-channel was applied to all the patients.The clinical result was evaluated before surgery,at 3d after surgery and the final follow-up,by Oswestry disability index(ODI),visual analogue scale(VAS)for back pain and leg pain,and Japanese Orthopaedic Association(JO A)score.The decompression and implant were evaluated by anteroposterior and lateral X-ray plain film and lumbar CT at 3d after operation.Bridwell criteria were used to evaluate the fusion rate based on CT images for patients followed up for more than 6 months after surgery.Results:No significant differences were found in age,gender,diagnosis,preoperative in-tervertebral height,surgical segment,preoperative ODI,VAS and JOA score between the two groups(P＞0.05).72.2％of the patients in transforaminal group complained unilateral radicular symptom,while 64.3％of the patients in transfacet group suffered from bilateral radicular symptoms(P=0.020).The average operation time was 327.7±89.9min in the transforaminal group,significantly longer than the 385.9±96.7min in the transfacet group(P=0.047),and the mean length of hospital stay in the transforaminal group was 14.8±6.0d,shorter than that of 19.5±7.8d in the transfacet group(P=0.038).75％of the patients in transfacet group underwent unilater-al laminotomy with bilateral spinal canal decompression(ULBD).The ODI scores,back and leg pain VAS scores and JOA score were significantly improved postoperatively and at the final follow-up in both groups(P＜0.05),while no statistical differences between groups(P＞0.05).Postoperative intervertebral height significantly increased in both group(P＜0.001),but no statistical difference was found between groups(P＞0.05).The compli-cation rate was comparable between two groups,without severe intraoperative or postoperative complication.A-mong the 21 patients who were followed up for more than 6 months and received CT examinations,20(95.2％)presented bony fusion at surgical segment,and there was no statistical difference between the two groups in fusion rate.Conclusions:Both the transforaminal approach and the transarticular protrusion ap-proach are safe and effective for the single-level lumbar interbody fusion under single-hole coaxial large channel endoscopy,and the transforaminal approach results in shorter operation time and shorter hospital stay.

Objectives:To explore the clinical outcomes of single-level full-endoscopic lumbar interbody fu-sion for degenerative lumbar spine disorders combined with osteoporosis.Methods:24 consecutive patients with degenerative lumbar spine disorders who underwent single-level full-endoscopic lumbar interbody fusion and were detected by dual-energy X-ray absorptiometry(DXA)during hospitalization for bone mineral density(BMD)from June 2018 to February 2022 were enrolled,including 7 males and 17 females with an average age of 66.0±9.9 years old(range 44-80 years).The follow-up period was 21.6±12.6(3-47)months after oper-ation.And the patients were divided into two groups of osteoporosis group(containing 8 osteoporotic cases)and control group(containing 16 non-osteoporotic cases).Anti-osteoporosis therapy was initiated on the diagnosis of osteoporosis.The surgery was performed using a 7.1mm inner-diameter full-endoscope.The general data and perioperative parameters were compared between the two groups.Before operation,on 3d after operation and at final follow-up,visual analogue scale(VAS)score for back and leg pain,Japanese Orthopaedic Association(JOA)score and Oswestry disability index(ODI)were used for evaluating clinical outcomes.Digital radiography(DR)and computed tomography(CT)were performed on postoperative 3d for neural decompression and implant position assessment.For patients who received DR examination,cage subsidence and screw loosening were recorded at the final follow-up;For patients who were followed-up for 6 months and more and examined with CT,fusion rate was evaluated.The complications were recorded and compared between the two groups.Re-sults:No significant differences were found in age,gender,diagnosis,preoperative intervertebral height,surgi-cal segment,preoperative VAS scores,JOA scores and ODI between the two groups.The average of the low-est T value was-3.2±0.6 for osteoporosis group,lower than the-1.4±0.8 for control group(P=0.000).The mean operative time was 429.9±135.2min for osteoporosis group,more than the 327.4±68.2min for the controls(P=0.020).There was no significant difference in intraoperative imaging assistance,bleeding,number of cases received unilateral laminotomy for bilateral decompression(ULBD),postoperative intervertebral height and length of hospital stay between groups.The VAS scores for back and leg pain,JOA scores and ODI improved post-operatively and at the final follow-up in both groups comparing with those values before operation(P＜0.05),and there was no significant difference between groups,respectively.The postoperative 3d intervertebral height in both groups increased after surgery(P＜0.01),and none significant difference was found between groups.In the osteoporosis group,asymptomatic cage subsidence happened in 1 case with severe osteoporosis(T=-4.4)due to intraoperative endplate damage during cage implantation,but no symptoms were observed,therefore no spe-cial treatment was given;And dural tear and subsequent incomplete nerve root injury happened to another case in the osetoporosis group,whose symptoms were relieved after symptomatic treatment such as neurotro-phy.18 patients received lumbar DR at final follow-up,and 10 patients received CT evaluation at more than 6 months'follow-up,no significant difference was found in cage subsidence and screw loosening rate and fusion conditions between groups(P=1.000).Conclusions:Single-level full-endoscopic lumbar interbody fusion is safe and effective in the short-term for the treatment of degenerative lumbar spine disorder combined with osteoporosis.

Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

BACKGROUND:The Pilon fracture has a complex fracture line and a comminuted fracture fragment.It is often associated with bone loss and soft tissue damage and is one of the most difficult fractures to treat clinically. OBJECTIVE:To analyze the correlation between tibial and fibular fractures in Pilon fractures. METHODS:A retrospective analysis was conducted on 188 patients with Pilon fracture in the Department of Trauma Orthopedics,The Second People's Hospital of Lianyungang City from January 2014 to January 2022.Imaging data of these patients were collected.Fibular fracture level,fibular fracture type,number of fibular fracture blocks,tibial position status,main fracture blocks of the tibia,size of medial fracture blocks of the tibia,tibial fracture angle,Topliss classification(sagittal plane)and Topliss classification(coronal plane)were summarized into a database.SPSS 25.0 was used to analyze the data of tibia and fibula in Pilon fractures by Spearman correlation analysis.On the basis of the correlation,multiple disordered Logistic regression was used to further analyze the correlation. RESULTS AND CONCLUSION:(1)Spearman correlation analysis showed that tibial fracture angle was positively correlated with fibular fracture type,fibular fracture level and fibular fracture number.Tibial position status was positively correlated with tibial fracture angle and Topliss classification(coronal plane),but negatively correlated with major tibial fracture blocks and Topliss classification(sagittal plane).The level of fibular fracture was positively correlated with the type of fibular fracture and the number of fibular fractures.The main fracture blocks of the tibia were positively correlated with Topliss classification(coronal plane)and negatively correlated with Topliss classification(sagittal plane).(2)Multiple Logistic regression analysis showed that:the level of fibular fracture was correlated with the type of fibular fracture(P<0.05);the number of fibular fractures was correlated with the main fracture block of tibia(P<0.05).(3)It is indicated that the more inclined the ankle joint was to the valgus,the more likely it was to lead to fibular fracture,and the higher the fibular fracture level,the more serious the fibular fracture degree,the more complex the fibular fracture type,the larger the tibial fracture angle,the more the tibia presented Topliss classification(coronal plane)fracture.(4)When the ankle joint was more inclined to be in varus or varus + dorsiflexion,the fibula often did not fracture or simple fracture occurred,and the lower the fracture level,the smaller the tibial fracture angle,the more Topliss classification of the tibia(sagittal plane),the more main fracture blocks of the tibia,the larger the medial fracture block.When the ankle joint is in the dorsiflexion,it often results in a simple fibular fracture with a posterolateral tibial fracture.

BACKGROUND:Traumatic spinal cord injury primarily relies on scale assessment and imaging examinations in clinical practice.However,there are limitations in predicting the prognosis of the injury.Therefore,the use of metabolomics technology for biomarker screening is significant for estimating the extent of damage,injury and recovery,as well as developing new therapies. OBJECTIVE:To characterize the metabolic features of patients with traumatic spinal cord injury using metabolomics technology and explore potential biomarkers and disrupted metabolic pathways. METHODS:Serum and urine samples were collected from 20 patients with traumatic spinal cord injury(observation group)and 10 healthy subjects(control group).Metabolites were analyzed and multivariate statistical analysis was then performed for data processing to screen differential metabolites.Metabolic pathway enrichment was performed using MetaboAnalyst software.Logistic regression was applied to construct a biomarker combination model,and its relationship with the American Spinal Injury Association grading was analyzed. RESULTS AND CONCLUSION:Significant differences in 160 and 73 metabolites were detected in the serum and urine samples of the two groups,respectively.Pathway enrichment analysis showed evident disturbances in lipid metabolism after traumatic spinal cord injury,including sphingolipid,arachidonic acid,α-linolenic acid,and arachidonic acid metabolism,as well as glycerophospholipid and inositol phosphate biosynthesis.The combination of two identified biomarkers,telmisartan and quercetin glycoside,showed a correlation with the American Spinal Injury Association grading in both serum and urine levels.Thus,metabolomics technology provides assistance in further understanding the pathological mechanisms of traumatic spinal cord injury and screening therapeutic targets.The identified metabolic biomarker combination may serve as a reference for assessing the severity of traumatic spinal cord injury.

Objective:To investigate the effectiveness of the modified Bikini approach in the fixation of acetabular fracture with an integrated wing-shaped anatomical locking plate.Methods:A retrospective study was conducted to analyze the data of 54 patients with acetabular fracture who had been treated at Department of Trauma Orthopedics, Orthopedic Medical Center, The Third Hospital Affiliated to Southern Medical University from May 2017 to June 2021. The patients were divided into 2 groups based on different surgical approaches: an observation group [26 cases, 6 males, 20 females; aged 40.0 (29.8, 46.8) years] treated with fixation with an integrated wing-shaped anatomical locking plate through the modified Bikini approach, and a control group [28 cases, 10 males, 18 females; aged 34.5 (24.0, 43.5) years] treated with fixation with an integrated wing-shaped anatomical locking plate through the lateral-rectus approach. The incision length, operation time, intraoperative bleeding, length of hospital stay, quality of postoperative fracture reduction, visual analog scale (VAS) for pain, hip function, Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were compared between the 2 groups.Results:The differences in the preoperative general data between the 2 groups were not statistically significant, indicating comparability ( P>0.05). There were no statistically significant differences between the 2 groups either in terms of incision length, operation time, intraoperative bleeding, or hospital stay ( P>0.05). The 2 groups were not significantly different in the excellent/good rate of fracture reduction [100.0% (26/26) versus 92.9% (26/28)], VAS at 1 month postoperation [2.0(1.0, 3.0) versus 2.0(1.0, 3.0)], or the modified Merle d'Aubigné and Postel hip score at 12 months postoperation [13.5(12.3, 14.8) versus. 14.0(13.0, 15.0)] ( P>0.05). However, the VSS [4.50(4.00, 6.00)] and POSAS (29.85±10.05) at 12 months postoperation in the observation group were significantly lower than those in the control group [6.50(5.00, 8.25) and 37.11±11.75] ( P<0.05). Conclusion:In the fixation of acetabular fracture with an integrated wing-shaped anatomical locking plate, the modified Bikini approach can not only achieve as fine early clinical efficacy as the lateral-rectus approach, but also demonstrate the aesthetic advantages of smaller incision scar and more hidden incision.