BACKGROUND:Ossification of the ligamentum flavum was previously considered to be rare in the population.As research has progressed,its incidence rate is increasing gradually,which has aroused the interest of a large number of researchers. OBJECTIVE:To visualize and analyze the research results on ossification of the ligamentum flavum from the Web of Science Core Collection since 1999 using bibliometric methods,and to review the research history of ossification of the ligamentum flavum,highlighting important literature,summarizing research hotspots,and providing ideas for researchers to find research directions. METHODS:Using the Web of Science Core Collection as the data source,relevant papers on ossification of the ligamentum flavum were searched and screened.VOSviewer 1.6.19 and CiteSpace 6.2.R6 were used to conduct the visual analysis of annual publication volume,research countries,institutions,citations,journals,authors,and keywords. RESULTS AND CONCLUSION:(1)A total of 347 papers were included.Since 1999,the number of published papers has increased in a spiral pattern.China's research started later than Japan's,but the number of publications has come up later,with Peking University being the institution with the most publications,and Prof.Chen Zhongqiang from Peking University being the scholar with the most publications.(2)Five of the 10 most frequently cited publications were related to the surgical treatment of the disease.(3)Excluding keywords directly related to the research topic and synthetically analyzing frequencies and betweenness centralities of key words,terms such as"thoracic myelopathy,""dural ossification,""minimally invasive surgery,"and"ossification of the posterior longitudinal ligament"occupied a central position in this field.(4)Keywords clustering analysis showed that clinical manifestations and surgical treatment of ossification of the ligamentum flavum accounted for a large proportion of study.(5)The timeline and burst analysis of keywords revealed that"minimally invasive surgery"appeared as a keyword around 2015,with the highest burst strength and the latest burst start time,and began to receive extensive attention from researchers in 2019.The burst of the keyword"dural ossification"has not yet ended.(6)Surgical treatment for ossification of the ligamentum flavum has been at the forefront of research.Development and research of minimally invasive surgery and research on dural ossification secondary to ossification of the ligamentum flavum are both current research hotspots and possible future research trends.

Objective: To analyze the infection characteristics of newly reported HIV/AIDS cases in Hangzhou City, so as to provide the reference for effective AIDS intervention. Methods: Newly reported HIV/AIDS cases in Hangzhou City in 2022 were recruited. Demographic information, HIV testing status, infection routes and sexual behaviors were collected using questionnaire surveys. Blood samples were collected before antiviral treatment, and HIV-1 pol gene sequences were detected to construct molecular transmission networks. The characteristics of HIV/AIDS cases, including infection routes, time, and location were analyzed. Factors affecting infection time and location among HIV/AIDS cases were analyzed using a multivariable logistic regression model. Results: A total of 1 007 HIV/AIDS cases were reported in Hangzhou City in 2022, with 907 cases (90.07%) completing questionnaire surveys. Among them, 833 were males (91.84%), and 532 had out-of-province household registrations (58.65%). Ninety-one molecular transmission networks were established, and 276 cases were involved, with homosexual contact as the main infection route (199 cases, 72.10%). There were 311 recently infected cases (35.34%) and 569 previously infected cases (64.66%) among 880 cases whose infection time could be determined. There were 531 locally infected. cases (70.24%) and 225 imported cases (29.76%) among 756 cases whose infection location could be determined. Multivariable logistic regression analysis showed that the HIV/AIDS cases who were identified through voluntary counseling and testing (OR=1.826, 95%CI: 1.055-3.175) and sought sexual partners through homosexual dating apps (OR=2.461, 95%CI: 1.193-5.234) were more likely to be recently infected; the cases who lived in Hangzhou City for more than one year (>1 to 5 years, OR=2.853, 95%CI: 1.552-5.358; >5 years, OR=3.534, 95%CI: 1.382-9.804), sought sexual partners through entertainment venues (OR=3.449, 95%CI: 1.390-8.935), online/social apps (OR=2.416, 95%CI: 1.084-5.488) and homosexual dating apps (OR=3.734, 95%CI: 1.677-8.493) were more likely to be locally infected; student cases were more likely to be infected outside Hangzhou City (OR=0.115, 95%CI: 0.019-0.525). Conclusions The newly reported HIV/AIDS cases in Hangzhou City in 2022 were primarily infected through homosexual contact, previously and locally. Seeking sexual partners through homosexual dating apps is an important influencing factor for recent and local infections, highlighting the need for strengthening traceback investigations of related cases.

Objective To investigate the relationship between tooth loss and the occurrence of esophageal cancer in a natural village in Wenfeng District, Anyang City, Henan Province. Methods A prospective cohort study was conducted to observe the occurrence of tooth loss and esophageal cancer among the asymptomatic residents of the natural village for 16 years from January 2008 to July 2024. Data were analyzed by chi-square test, binary logistic regression, and restricted cubic spline. Results Among the total population of 711 cases, 136 cases were lost to follow-up and 575 cases were included in the final statistics, including 45 cases with esophageal cancer. Significant statistical difference was found between esophageal cancer patients with and without tooth loss (P<0.05). Logistic regression analysis showed that tooth loss was associated with the occurrence of esophageal cancer (OR=3.977, 95%CI: 1.543-10.255). After the adjustment for confounders, tooth loss remained significantly associated with the occurrence of esophageal cancer (OR=3.038, 95%CI: 1.035-8.914). A nonlinear dose-response relationship was observed between the number of teeth lost and the incidence of esophageal cancer. When the number of teeth lost was less than 12, the risk of esophageal cancer increased with the number of teeth lost. When more than 12 teeth were lost, the risk of esophageal cancer decreased as the number of teeth lost increased. Conclusion Tooth loss is a risk factor for the occurrence of esophageal cancer in this natural village. When the number of teeth lost is less than 12, the risk of esophageal cancer increases with the number of teeth lost.

Objective To study the prognostic factors of progressive hearing loss among children with large vestibular aqueduct syndrome(LVAS).Methods The clinical data of 49 children(95 ears)with LVAS who re-ceived at least two hearing tests from January 2017 to January 2023 in our hospital were retrospectively analyzed,and they were divided into two groups according to the progression of hearing loss:the stable group(55 ears)and the progressive group(40 ears).The effects for progressive hearing loss of initial age,gender,laterality,imaging features,audiometric data,and incomplete partition type Ⅱ(IP-Ⅱ)and SLC26A4(type A,B,C,D)genotypes were analyzed by univariate and multivariate Cox regression analysis.The potential prognostic factors were further verified by Kaplan-Meier survival analysis.Results Each dB decrease in the initial average hearing threshold in-creased the expected hazard by 7.03％(P=0.02).Incomplete partition type Ⅱ(IP-Ⅱ)was associated with 5.11 hazard ratio(95％CI,1.81 to 14.45,P=0.002).Genotype C was associated with 6.13 hazard ratio for progressive hearing loss(95％CI,2.07 to 18.13,P=0.001).Conclusion The initial average hearing threshold,IP-Ⅱ,and SLC26A4 genotype C were significant effect factors of progressive hearing loss in patients with LVAS.This could predict the progression of hearing loss in children with LVAS and help identify patients at high risk for progressive hearing loss.

Objective To explore the effects of permissive hypercapnia on postoperative cognitive function in elderly patients with diabetes mellitus.Methods Sixty elderly patients with diabetes mellitus scheduled for laparoscopic upper abdominal surgery under general anesthesia,were randomly divided into two groups:the permissive hypercapnia ventilation diabetes mellitus group(group DH)and the routine ven-tilation diabetes mellitus group(group DR),30 patients in each group.Another sixty elderly patients with non-diabetes mellitus scheduled for laparoscopic upper abdominal surgery under general anesthesia,were randomly divided into two groups:the permissive hypercapnia ventilation non-diabetes mellitus group(group NH)and the routine ventilation group(group NR),30 patients in each group.All patients in four groups were performed with tracheal intubation and mechanical ventilation after anesthesia induction.The respiratory parameters were adjusted to maintain PaCO2 in a range of 45-65 mmHg in groups DH and NH,and PaCO2 in a range of 35-45 mmHg in groups DR and NR.PETCO2 was recorded 5 minutes before pneu-moperitoneum,5,15,and 30 minutes after pneumoperitoneum.Blood samples were taken from the radial artery and jugular bulb for blood gas analysis 5 minutes before pneumoperitoneum,5,15,and 30 minutes after pneumoperitoneum.pH value and PaCO2 were recorded and arterial internal jugular vein bulbar oxygen difference(Da-jvO2)and cerebral oxygen extraction rate(CERO2)were calculated at the same time.The serum S100β protein concentration were detected before anesthesia induction and 3 days after operation.Montreal cognitive assessment(MoCA)scores and occurrence of postoperative cognitive dysfunction were recorded 1 day before operation,and 1 day,3 days and 7 days after operation.Results Compared with the baseline value 5 minutes before pneumoperitoneum,PETCO2 and PaCO2 were significantly increased,pH value,Da-jvO2 and CERO2 were significantly decreased 5,15,and 30 minutes after pneumoperitoneum in the four groups(P＜0.05).Compared with before anesthesia induction,the serum S100β protein concen-tration were significantly increased 3 days after operation in the four groups(P＜0.05).Compared with the last day before operation,MoCA scores were significantly decreased 1 day and 3 days after operation in the four groups(P＜0.05).Compared with group DR,PETCO2 was significantly increased,pH value,Da-jvO2,and CERO2 were significantly decreased 5 minutes before pneumoperitoneum,5,15,and 30 mi-nutes after pneumoperitoneum,the serum S100β protein concentration was significantly decreased 3 days af-ter operation,MoCA scores were significantly increased 1 day and 3 days after operation,the incidence rate of POCD was significantly decreased in group DH(P＜0.05).Compared with group NR,PETCO2 was sig-nificantly increased,pH value,Da-jvO2,and CERO2 were significantly decreased 5 minutes before pneu-moperitoneum,5,15,and 30 minutes after pneumoperitoneum,the serum S100β protein concentration was significantly decreased 3 days after operation,MoCA scores were significantly increased 1 day and 3 days af-ter operation,the incidence rate of POCD was significantly decreased in group NH(P＜0.05).Compared with group NH,Da-jvO2 and CERO2 were significantly increased 5 minutes before pneumoperitoneum,5,15,and 30 minutes after pneumoperitoneum,the serum S100β protein concentration was significantly in-creased 3 days after operation,MoCA scores were significantly decreased 1 day and 3 days after operation in group DH(P＜0.05).Conclusion Permissive hypercapnia can improve the cerebral oxygen metabolism during operation,reduce postoperative serum S100β protein concentration and reduce the incidence rate of POCD in the elderly patients with diabetes mellitus.

Objective To investigate the impact of total parathyroidectomy with autotransplantation (tPTx+AT)on bone mineral density and serum soluble Klotho (sKlotho)level in patients with secondary hyperparathyroidism (SHPT).Methods A total of 86 patients undergoing tPTx+AT in the Second Affiliated Hospital of Anhui Medical University from June 2019 to May 2022 were recruited in this study.Their demographic characteristics were collected before surgery,along with serum levels of corrected calcium,phosphorus,intact parathyroid hormone (iPTH),alkaline phosphatase (ALP),fibroblast growth factor 23 (FGF23),and sKlotho before and at 5 d,and 1,3,6,12 and 24 months after surgery.Dual energy X-ray absorptiometry was used to determine the BMD values of the lumbar spine L1-L4 before surgery and at 3,6,12 and 24 months after surgery.The changes in BMD and serum FGF23 and sKlotho levels before and after tPTx+AT were observed.Results Surgical treatment was successfully completed in all 86 patients,with their clinical symptoms such as bone pain and skin itching significantly improved postoperatively,and markedly decreased serum calcium,phosphorus,iPTH,ALP and FGF23 levels.The sKlotho level was significantly lower at 5 d postoperatively than that preoperatively,with that at 1 month after surgery increased by approximately 24.5％ than the preoperative level,and then the level was in a stable trend.The BMD values at the lumbar spine L1-L4 were increased postoperatively,and reached the highest levels at 12 months postoperatively.Further analyses showed that dialysis vintage,duration of SHPT,and ALP,iPTH and FGF23 levels were negatively correlated with the Z-scores of the lumbar spine L1-L4,while sKlotho level was positively correlated with the Z-scores.Conclusion tPTx+Atcan significantly improve the clinical symptoms of SHPT patients,regulate the balance of calcium and phosphorus metabolism,increase sKlotho level and reduce FGF23 level.It is an effective method to improve BMD.

OBJECTIVE To Analysis of CT and MRI imaging features of arrested pneumatisation of the sphenoid sinus and differentiate from osteogenic and chondrogenic tumours of the region.METHODS Retrospective analysis of CT and MRI findings was performed of 13 patients with sphenoid sinus arrested pneumatisation and 20 patients with osteogenic and chondrogenic tumours and tumor like lesions in the same period.Evaluation indicators included location,size,density,presence of expansive changes,calcification,cortical bone changes,MRI signal characteristics,signal changes after fat suppression,degree of enhancement,and statistical analysis was conducted.RESULTS Finally,the location includes the sphenoid body(4 cases),pterygoid process(3 cases)and multiple involved areas(6 cases).The arrested pneumatisation area is mainly characterized by fat density or mixed density of adipose and soft tissue.The longest diameter of the arrested pneumatisation zone is 0.8-4.1 cm.There is internal calcification(7 cases)and without bone expansive changes(13 cases).Cases with intact bone cortex(13 cases);On MRI T1WI,high signal(11 cases),equal signal(2 cases),on T2WI,high signal(10 cases),equal signal(3 cases).Decreased signal after fat suppression(13 cases),no significant enhancement(10 cases),and slight enhancement(3 cases).CONCLUSION The arrested pneumatisation of sphenoid sinus is a rare anatomical variation characterized by a mixed density of fat or soft tissue,intact bone cortex,without bone expansive changes,decreased signal of MRI fat suppression,and no obvious enhancement,which will help to differentiate from osteogenic and chondrogenic tumours of the region.

Objective:To evaluate the feasibility of measurement and characteristics of intraocular lens (IOL) tilt using the swept-source optical coherence tomography (SS-OCT) biometer (IOLMaster 700) and to explore its potentially relevant parameters.Methods:A cross-sectional study was conducted.Two hundred and forty-two eyes (119 right eyes, 123 left eyes) of 185 patients after phacoemulsification and IOL implantation were included in Beijing Tongren Hospital from July to September 2018.The IOL position, angle κ, angle α, corneal curvature, anterior chamber depth (ACD), pupil diameter (PD), and axial length (AL) were obtained by IOLMaster 700, and the IOL tilt direction and magnitude were calculated.The within-subject standard deviation and intraclass correlation coefficient were used to evaluate the repeatability of three IOL tilt measurements.Binocular symmetry of IOL tilt and the correlation between IOL tilt and different influencing factors were evaluated by Pearson linear correlation analysis or Spearman rank correlation analysis.Influencing factors for IOL tilt were assessed by multiple linear regression analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2018-049). Patients were informed of the purpose and methods of this study and signed the written informed consent.Results:The repeatability of IOL tilt measurements was excellent with a within-subject standard deviation of 5.16° for IOL tilt direction and 0.13° for IOL tilt magnitude.IOL tilt was mirror symmetric in both eyes.The IOL tilt direction in right eyes ranged from -89.60° to 87.53° with a mean of (18.85±29.65)°, and the tilt magnitude ranged from 1.32° to 7.05° with a mean of (4.16±1.26)°.The IOL tilt direction in left eyes ranged from -84.30° to 89.44° with a mean of (21.17±32.38)°, and the tilt magnitude ranged from 0.58° to 7.40° with a mean of (3.80±1.31)°.There were moderate and weak positive correlations of IOL tilt direction and tilt magnitude between both eyes ( r=0.473, P<0.001; r=0.335, P=0.011). IOL tilt magnitude was weakly positively correlated with angle α and IOL diopter ( rs=0.272, P=0.003; r=0.285, P=0.002), and was weakly negatively correlated with ACD, PD and AL ( r=-0.303, P=0.001; r=-0.233, P=0.011; rs=-0.331, P<0.001). In backward stepwise regression analysis, the regression equation of IOL tilt magnitude, angle α, ACD, PD, AL and IOL diopter in multiple linear regression analysis was as follows: IOL tilt magnitude=10.503+ 1.456×angle α-0.532×ACD-0.196×AL ( R2=0.400; F=8.588, P<0.001). Conclusions:The SS-OCT biometer can be an effective method to assess IOL tilt.IOL tilt is mirror symmetric between the right eyes and left eyes.

Objective:To assess the clinical and imaging features of SMARCB1-deficient sinonasal carcinoma.Methods:Form January 2016 to November 2021, the clinical data and pretreatment imaging findings of 16 cases with pathologically proven SMARCB1-de?cient sinonasal carcinomas were analyzed retrospectively in Beijing Tongren Hospital, Capital Medical University. Immunohistochemistry for SMARCB1 showed loss of the protein in the tumor nuclie. Clinical and imaging features, including tumor location, TNM stage, size, density of CT, bone change, MRI signal intensity, enhancement pattern, type of time-intensity curve (TIC) of dynamic contrast enhanced MRI (DCE-MRI), apparent diffusion coefficient (ADC) value and diffusion weighted imaging (DWI) were evaluated. For 14 cases, correlation of the ADC value and Ki-67 index was subsequently evaluated with Pearson correlation analysis.Results:For the 16 cases SMARCB1-deficient sinonasal carcinomas, clinical stage of T4 was 12 cases and T3 was 4 cases. The location included ethmoid sinus ( n=4), nasal cavity only ( n=1), both nasal cavity and ethmoid ( n=8), ethmoid and maxillary sinus ( n=1), ethmoid and frontal sinus ( n=1), ethmoid and sphenoid sinus ( n=1). The tumor size was (4.5±1.2) cm. Iso-attenuated of CT images was showed in 13 cases and heterogeneous with necrosis was showed in 3 cases. Focal bone erosion was found in 13 cases and extensive bone destruction was found in 3 cases. Compared with adjacent muscles, T 1WI of all 16 cases showed isointense, with focal hypointense in 3 cases. On T 2WI, the tumor was graded as isointense in 9 cases, hyperintense in 7 cases, with lower inner septal in 6 cases. Enhancement was graded as mild in 11 cases, moderate in 5 cases.MRI Enhancement images showed mild enhancement in 11 cases, moderate enhancement in 5 cases, heterogeneous enhancement in 6 cases, and homogeneous enhancement in 10 cases. For DCE-MRI of 14 cases, there were 10 cases of Ⅲ type and 4 cases of Ⅱ type of the TIC. The ADC value of 14 cases was (1.02±0.27)×10 -3 mm 2/s. The Ki-67 index was 48%±21%. No correlation was observed between Ki-67 index and ADC value ( r=-0.38, P=0.183). Conclusions:SMARCB1-deficient carcinomas are mostly centered in the nasal and ethmoid region of anatomic distribution. Tendency to be infiltrative the adjacent bone structure with invasive bone reaction, mild to moderate heterogeneous enhancement, T 2WI with lower inner septal, and Ⅲ types of TIC are certain suggestive imaging features of the entity.

Objective:To evaluate the clinical application of online adaptive radiotherapy based on iterative cone-beam computed tomography (iCBCT) for the pelvic malignancies.Methods:This was a prospective clinical trial of iCBCT guided online adaptive radiotherapy for pelvic malignancies in Department of Radiation Oncology, Peking Union Medical College Hospital. Clinical data of 13 patients with pelvic malignancies who received online adaptive radiotherapy from August to November, 2022 were preliminarily analyzed (2 cases of cervical cancer, 4 postoperative cervical cancer, 3 postoperative endometrial cancer, 3 bladder cancer and 1 prostate cancer). The feasibility of online adaptive radiotherapy, adaptive radiotherapy time, the frequency and magnitude of edits for organs at risk and target volume, target volume coverage and organs at risk doses were analyzed. Statistical analysis was performed by SPSS software. Data conforming to normal distribution were described by Mean±SD, and data with non-normal distribution were expressed by M ( Q1, Q3). Data with homogeneous variances were analyzed by t-test, and data with non-normal distribution or heterogeneous variances were analyzed by nonparametric test. Results:The average adaptive time was 15 min and 38 s (from acceptance of acquired CBCT scan to completion of the final plan selection). 85.4% (830/972 fractions) of influencer structures (system-defined organs adjacent to and with high impact on the generation of clinical target volume and planning target volume, primarily bladder, rectum and small intestine in pelvic neoplasms) automatically generated by artificial intelligence required no edits or minor editors, and 89.8% (491/547 fractions) of clinical target volume automatically generated by artificial intelligence required no edits or minor editors. The adapted plan was adopted in 98.5% (319/324 fractions) of radiotherapy fractions. Compared with the scheduled plan, the adapted plan showed better target volume coverage and reduced the dose of organs at risk.Conclusions:iCBCT guided online adaptive radiotherapy for the pelvic malignancies can be achieved within clinically acceptable timeslots. In addtion, better dose coverage of target volume shows the advantages of online adaptive radiotherapy.