Objective To investigate the changes of blood lipid and glycosylated hemoglobin (HbA1c) levels in obese type 2 diabetes (T2DM) patients and their relationship with insulin resistance (Homa-IR). Methods A total of 120 cases of T2DM newly diagnosed in Motuo County, Tibet from February to October 2022 were selected as the observation group. According to BMI, the patients were divided into diabetes normal weight group (46 cases), overweight group (43 cases) and obesity group (31 cases); 145 healthy subjects were selected as the control group. The levels of HbA1c, fasting blood glucose (FPG), fasting insulin (FINS), serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) were detected in the study subjects, and Homa-IR and Homa-β indices were calculated. The height, weight, and abdominal circumference were measured. The differences in the levels of the above indicators between the observation group patients and the control group, as well as among various subgroups within the observation group were compared. The influencing factors of Homa-IR in obese T2DM patients were analyzed. Results Compared with the control group, a significant increase in BMI, abdominal circumference, blood pressure, HbA1c, FBG, FINS, TC, TG, LDL-C, UA, visceral fat area, and the levels of Home-IR and Home-β was found in the observation group (all P<0.05). There were significant differences in BMI, abdominal circumference, and the levels of FINS, Homa IR, Homa-β, and HbA1c in diabetes patients with different BMI (all P<0.05). Correlation analysis showed that TG levels in obese T2DM patients in the observation group were significantly correlated with HbA1c (r=0.396, P=0.027), Homa-IR (r=0.405, P=0.024), and Home-β (r=-0.401, P=0.025); LDL-C was significantly correlated with Homa-IR (r=0.411, P=0.022) and Homa-β (r=-0.412, P=0.021); HbA1c was significantly positively correlated with BMI (r=0.371, P=0.040). Conclusion Insulin resistance is closely related to TG, LDL-C, and BMI in obese T2DM patients from the Motuo ethnic minority of Tibet, suggesting that these factors may play a role in the occurrence of T2DM.

Objectives:This study aimed to assess the efficacy and safety of bendamustine in combination with rituximab (BR regimen) for the treatment of newly diagnosed indolent B-cell non-Hodgkin's lymphoma (B-iNHL) and elderly mantle cell lymphoma (eMCL) .Methods:From December 1, 2020 to September 10, 2022, a multi-center prospective study was conducted across ten Grade A tertiary hospitals in Shandong Province, China. The BR regimen was administered to evaluate its efficacy and safety in newly diagnosed B-iNHL and eMCL patients, and all completed at least four cycles of induction therapy.Results:The 72 enrolled patients with B-iNHL or MCL were aged 24-74 years, with a median age of 55 years. Eastern Cooperative Oncology Group (ECOG) performance status scores of 0-1 were observed in 76.4% of patients, while 23.6% had scores of 2. Disease distribution included follicular lymphoma (FL) (51.4% ), marginal zone lymphoma (MZL) (33.3% ), eMCL (11.1% ), and the unknown subtype (4.2% ). According to the Ann Arbor staging system, 16.7% and 65.3% of patients were diagnosed with stage Ⅲ and stage Ⅳ lymphomas, respectively. Following four cycles of BR induction therapy, the overall response rate was 98.6%, with a complete response (CR) rate of 83.3% and a partial response (PR) rate of 15.3%. Only one eMCL patient experienced disease progression during treatment, and only one FL patient experienced a relapse. Even when evaluated using CT alone, the CR rate was 63.9%, considering the differences between PET/CT and CT assessments. The median follow-up duration was 11 months (range: 4-22), with a PFS rate of 96.8% and an OS rate of 100.0%. The main hematologic adverse reactions included grade 3-4 leukopenia (27.8%, with febrile neutropenia observed in 8.3% of patients), grade 3-4 lymphopenia (23.6% ), grade 3-4 anemia (5.6% ), and grade 3-4 thrombocytopenia (4.2% ). The main non-hematologic adverse reactions such as fatigue, nausea/vomiting, rash, and infections occurred in less than 20.0% of patients.Conclusion:Within the scope of this clinical trial conducted in China, the BR regimen demonstrated efficacy and safety in treating newly diagnosed B-iNHL and eMCL patients.

【Objective】 To investigate the feasibility of full-endoscopic posterolateral odontoidectomy through morphological analysis and cadaver specimen surgery. 【Methods】 We collected the DICOM data of 20 normal cervical CT patients （10 males and 10 females） from the PACS Image Library of our hospital. The Mimics software was used for cervical CT reconstruction and anatomical measurements were made to measure the maximum sagittal diameter， coronal diameter and height of the odontoid process. The C1 lateral mass could provide the maximum working height and width of endoscopic operation with a diameter of 7 mm， as well as the angle between the anchor point of C1 lateral mass and the notch on both sides of the odontoid process. The feasibility of endoscopic surgery was analyzed based on the measured data. The fresh frozen corpse was used for the operation in prone position under the guidance of C-arm. Kirschner wire was anchored at the midpoint of the lower surface of the C1 lateral mass. Part of the C1 lateral mass was removed by the grinding drill and endoscopic tools， and then the odontoid process and adjacent ligaments were removed. 【Results】 The maximum sagittal diameter， coronal diameter and height of the odontoid process were （11.73±0.74）mm， （10.97±0.71）mm and （14.51±0.91）mm， respectively. The working height and width of the C1 lateral mass were （13.53±0.57）mm and （10.00±1.27）mm， respectively. The angle between the anchor point and the double-edge notch of the odontoid process was （28.3±3.1）°， with no statistical difference between the male and female patients （P>0.05）. All the measurements met the requirements of 7 mm endoscopic implantation and surgical operation， and the space for swing could be provided for complete or partial removal of the odontoid process to meet the requirements of ventral spinal decompression. In cadaver surgery， a fully endoscopic posterolateral approach enabled complete removal of the odontoid process by grinding part of the C1 lateral mass. Postoperative cervical CT confirmed that the odontoid process had been completely resected， and there were no signs of dural sac or vertebral artery injury. 【Conclusion】 The odontoid process can be completely resected through a posterolateral endoscopic approach via the lateral mass approach of C1， providing a new surgical method for clinical odontoidectomy to decompress the spinal cord in craniovertebral junction.

With further mastery of endoscopic technology， our team has gradually explored a series of endoscopic procedures to treat various types of cervical spondylosis by combining basic research and clinical needs. The procedures， including anterior， posterior and lateral approaches through the cervical spine， have been able to treat most of the common clinical cervical spine diseases. For cervical spondylosis combined with cervical spine sequence abnormalities and poor stability， endoscopic reconstructive surgery is the direction of our efforts. We will continue to learn from advanced experience， explore unfamiliar areas and promote the technology so that we will be able to finally fulfil the wish of Chinese people to receive minimally invasive surgical treatment for cervical spondylosis in China.

Objective:To compare the clinical efficacy between puncture assisted by a "TINAVI" orthopaedic robot versus freehand puncture in vertebroplaty for osteoporotic vertebral compression fracture(OVCF) of the upper thoracic vertebra.Methods:A retrospective study was conducted of the 19 patients (20 vertebral bodies) with OVCF of the upper thoracic vertebra who had been treated at Department of Spine Surgery, Honghui Hospital from January 2018 to March 2019 by robotic vertebroplasty (robot group) and of another 21 counterpart patients (21 vertebral bodies) who had been treated by conventional vertebroplasty from January 2016 to December 2017 (freehand group). Puncture was conducted by a "TINAVI" orthopaedic robot in the robotic vertebroplasty but freehand in the conventional vertebroplasty. The robot group had 5 males and 14 females, aged from 62 to 88 years; the freehand group had 6 males and 15 females, aged from 64 to 83 years. The 2 groups were compared in terms of operation time, bone cement volume, postoperative complications (cement leakage, infection and embolism), visual analogue scale (VAS), Oswestry disability index (ODI), anterior height (AH) and kyphosis angulation (KA) of the injured vertebra at day 1 and last follow-up after surgery.Results:The 2 groups were comparable because there were no significant differences between them in the preoperative general data ( P>0.05). Vertebroplasty via unilateral puncture approach was completed uneventfully in the 19 patients (20 vertebral bodies) in the robot group and in the 21 patients (21 vertebral bodies) in the freehand group. The 40 patients were followed up for 6 to 12 months (mean, 8.3 month). The operation time [(37.9±8.2) min], bone cement volume [(2.3±0.9) mL] and rate of cement leakage (10.0%, 2/20) in the robot group were all significantly less or lower than those in the freehand group [(46.2±9.4) min, (4.2±1.3) mL and 42.9% (9/21)] ( P<0.05). No infection or embolism was observed in either group. There were no significant differences between the 2 groups in VAS, ODI, AH or KA of the injured vertebra at day 1 or last follow-up after surgery ( P>0.05). Conclusion:In vertebroplaty for OVCF of the upper thoracic vertebra, compared with conventional freehand puncture, puncture assisted by a "TINAVI" orthopaedic robot can lead to satisfactory clinical efficacy because it reduces operation time, volume of bone cement injection, and thus incidence of bone cement leakage.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Objective:To investigate the early outcome of endoscopy-assisted percutaneous non-fusion fixation of unilateral C 1 lateral mass screw and C 2 pedicle screw in treatment of type II odontoid fracture in elderly patients. Methods:A retrospective case series study was conducted to analyze clinical data of 12 elderly patients with type II odontoid fracture admitted to Second Affiliated Hospital of Chongqing Medical University from July 2016 to September 2018. There were 5 males and 7 females, aged 66-89 years [(75.2±6.7)years]. American Society of Anesthesiologists (ASA) scores for all patients were greater than 2 points. Ten patients were classified to Grade E and the other two were classified to Grade D by American Spinal Injury Association (ASIA) scale scores. All patients underwent endoscopy-assisted percutaneous non-fusion fixation of unilateral C 1 lateral mass screw and C 2 pedicle screw. The operation time, intraoperative blood loss, hospital stays, intraoperative and postoperative complications were collected. The Neck Disability Index (NDI) scores and ASIA scale scores were compared preoperatively and 6 weeks postoperatively. The visual analogue scales (VAS) were recorded preoperatively, 6 weeks, 3, 6, 9 and 12 months postoperatively. Fracture healing was followed up postoperatively. Results:Operation time was 98-169 minutes [(123.2±17.7)minutes]. Intraoperative blood loss was 20-40 ml [(30.0±7.1)ml]. Hospital stays were 6-9 days [(7.3±0.7)days]. No neurovascular injury was observed intraoperatively and postoperatively. The NDI were 8%-30%[(19.3±6.3)%] 6 weeks postoperatively, significantly lower than 19%-45%[(33.1±9.9)%] preoperatively( P<0.05). All patients' ASIA scale scores reached grade E postoperatively. The VAS constantly decreased from 6-9 points [(7.8±0.9)points] preoperatively to 1-3 points [(1.8±0.6)points] 12 months postoperatively ( P<0.05). All the patients achieved bone healing after 4-11 months [(7.3±2.1)months]. Conclusion:For type II odontoid fracture in elderly patients, endoscopy-assisted percutaneous unilateral atlantoaxial screw non-fusion fixation can relieve pain and achieve rapid recovery of neck function and bone healing.

Objective:To compare the effect of robot navigation system (Tian Ji robot system) plus 3D printing and traditional C-arm X-ray fluoroscopy in assisting percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) for treatment of Kümmell disease.Methods:A retrospective case-control study was conducted to analyze the clinical data of 40 patients with Kümmell disease treated at Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine from December 2017 to February 2019, including 12 males and 28 females, with an average age of 56.4 years (range, 42-71 years). In observation group, 20 patients underwent PKP or PVP assisted by the robot navigation system and 3D printing. In control group, 20 patients underwent PKP or PVP assisted by the traditional C-arm X-ray fluoroscopy. The operation time and incidence of complications were observed. The visual analogue scale (VAS), Oswestry disability index (ODI), Cobb angle and anterior vertebral height were compared before operation, 1 day and 3 months after operation.Results:All patients were followed up for 3.5-8.6 months (mean, 6.7 months). The operation time in control group was (32.2±5.8)minutes, compared with (26.7±3.6)minutes in observation group ( P<0.05). The incidence of cement leakage was 0% (0/20) in the observation group and 5% (1/20) in control group ( P>0.05). One day after operation, in observation group and control group, the VAS was (2.1±0.3)points and (3.7±0.8)points, the ODI was 14.3±1.8 and 25.5±5.7, the Cobb angle was (20.6±1.2)° and (22.4±0.6)°, and the anterior height of vertebral body was (21.2±0.8)mm and (17.6±0.7)mm, respectively, showing significant improvement compared with those before operation ( P<0.01). Three months after operation, in observation group and control group, the VAS was (1.8±0.4)points and (2.8±0.8)points, the ODI was 12.3±1.5 and 21.6±2.3, the Cobb angle was (18.1±0.8) ° and (20.5±1.6)°, and the anterior height of vertebral body was (20.1±1.8)mm and (16.8±1.3)mm, showing no significant difference compared with those at day 1 after operation ( P>0.05). There were significant differences in the VAS, ODI, Cobb angle and anterior vertebral height between the two groups 1 day and 3 months after operation ( P<0.01). Conclusion:For Kümmell disease, with assistance with the robot navigation system combined with 3D printing, PKP or PVP can more effectively reduce the pain of patients, improve the quality of life, restore the anterior height of vertebral body, and realize the individualized treatment in comparison with the traditional C-arm X-ray fluoroscopy.

BACKGROUND: The blocking of the programmed cell death protein (PD-1)/programmed death-ligand 1 (PD-L1) axis has been found to have an anticancer activity against various types of cancer by enhancing T cell immunity, while there are no studies linking the PD-1/PD-L1 axis to chemotherapy drugs in osteosarcoma (OS). The present study aimed to investigate the effects of blocking PD-1/PD-L1 axis on the cisplatin chemotherapy in OS in vitro and in vivo. METHODS: Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was applied to detect PD-L1 mRNA in OS tissues. Cell proliferation and apoptosis were measured by Cell Counting Kit-8 (CCK-8) and flow cytometry assays, respectively. In vivo, the syngeneic mice were treated with cisplatin and anti-PD-1 antibody alone or jointly. RESULTS: In this study, it revealed that PD-L1 mRNA was highly expressed in OS tissues. Further inhibitory evaluation showed that the K7M2-LV cells (PD-L1 overexpression) co-cultured with PD-1 lymphocytes could promote K7M2 cell proliferation. Meanwhile, the combination of anti-PD-1 antibody and cisplatin significantly decreased the proliferation and increased the apoptosis of K7M2 cells in a co-culture system. In vivo, the combination of anti-PD-1 antibody and cisplatin significantly inhibited tumor growth, while the mechanisms did not involve regulatory T cells. CONCLUSION The present data suggested that the blocking of PD-1/PD-L1 axis had a positive prognostic value, which can enhance the chemotherapeutic effect of cisplatin in OS. These findings provide a rationale for utilizing PD1/PD-L1 blocking antibodies as a single agent to cure refractory OS in patients receiving cisplatin treatment.

BACKGROUND: Nerve growth factor (NGF) and myelin-associated glycoprotein (MAG) can promote the repair of peripheral nerve. However, increasing the expression of NGF and MAG in the injured peripheral nerve by transgene technology has not been reported.OBJECTIVE: To investigate the expression of NGF and MAG after adenovirus (Ad) mediated transfection in the injured sciatic nerve in rats.METHODS: Forty Sprague-Dawley rats were randomly divided into normal, model, Ad, NGF and NGF-MAG groups. Sciatic nerve injury models were established in the latter four groups by cutting and suturing the right sciatic nerve. Afterwards, the rats in each group were subject to the intramuscular injection of normal saline, normal saline, Ad (1×108 PFU), Ad-NGF (1×108 PFU), and Ad-NGF-MAG (1×108 PFU), respectively, once every 2 days, for consecutive three times.RESULTS AND CONCLUSION: The expression level of NGF in the rat sciatic nerve in the Ad and normal groups was significantly higher than that in the NGF and NGF-MAG groups (P < 0.05). Compared with the Ad, NGF and normal groups, the expression level of MAG in the NGF-MAG group was significantly increased (P < 0.05). To conclude, the Ad-mediated NGF and MAG after double gene transfection were expressed effectively in the injured sciatic nerve in rats.