OBJECTIVE: To compare the effectiveness of a zero-profile three-dimensiaonal (3D)-printed microporous titanium alloy Cage and a conventional titanium plate combined with a polyether-ether-ketone (PEEK)-Cage in the treatment of single-segment cervical spondylotic myelopathy (CSM) by anterior cervical discectomy and fusion (ACDF). METHODS: The clinical data of 83 patients with single-segment CSM treated with ACDF between January 2022 and January 2023 were retrospectively analyzed, and they were divided into 3D-ZP group (35 cases, using zero-profile 3D-printed microporous titanium alloy Cage) and CP group (48 cases, using titanium plate in combination with PEEK-Cage). There was no significant difference in gender, age, disease duration, surgical intervertebral space, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), vertebral height at the fusion segment, Cobb angle, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, complications, interbody fusion, and prosthesis subsidence were recorded and compared between the two groups. VAS score, NDI, and JOA score were used to evaluate the improvement of pain and function before operation, at 3 months after operation, and at last follow-up, and the vertebral height at the fusion segment and Cobb angle were measured by imaging. The degree of dysphagia was assessed by the Bazaz dysphagia scale at 1 week and at last follow-up. RESULTS: The operation was successfully completed in all the 83 patients. There was no significant difference in intraoperative blood loss and hospital stay between the two groups (P>0.05), but the operation time in the 3D-ZP group was significantly shorter than that in the CP group (P<0.05). Patients in both groups were followed up 24-35 months, with an average of 25.3 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). The incidence and grade of dysphagia in CP group were significantly higher than those in 3D-ZP group at 1 week after operation and at last follow-up (P<0.05). There was no dysphagia in 3D-ZP group at last follow-up. There was no complication such as implant breakage or displacement in both groups. The intervertebral fusion rates of 3D-ZP group and CP group were 65.71% (23/35) and 60.42% (29/48) respectively at 3 months after operation, and there was no significant difference between the two groups [OR (95%CI)=1.256 (0.507, 3.109), P=0.622]. The JOA score, VAS score, and NDI significantly improved in the 3D-ZP group at 3 months and at last follow-up when compared with preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in the improvement rate of JOA between the two groups at last follow-up (P>0.05). At 3 months after operation and at last follow-up, the vertebral height at the fusion segment and Cobb angle significantly improved in both groups, and the two indexes in 3D-ZP group were significantly better than those in CP group (P<0.05). At last follow-up, the incidence of prosthesis subsidence in 3D-ZP group (8.57%) was significantly lower than that in CP group (29.16%) (P<0.05). CONCLUSION The application of zero-profile 3D-printed Cage and titanium plate combined with PEEK-Cage in single-segment ACDF can both reconstruct the stability of cervical spine and achieve good effectiveness. Compared with the latter, the application of the former in ACDF can shorten the operation time, reduce the incidence of prosthesis subsidence, and reduce the incidence of dysphagia.
Humans ; Spinal Fusion/instrumentation* ; Titanium ; Cervical Vertebrae/surgery* ; Diskectomy/instrumentation* ; Bone Plates ; Male ; Printing, Three-Dimensional ; Female ; Retrospective Studies ; Middle Aged ; Treatment Outcome ; Benzophenones ; Adult ; Spondylosis/surgery* ; Aged ; Polymers ; Ketones ; Polyethylene Glycols

Objective:To document any effect of a pulsed electromagnetic field (PEMF) on the regulation of neuropeptide Y (NPY) in nucleus pulposus (NP) tissue, NP cell apoptosis and matrix degradation using rats with intervertebral disc degeneration (IDD).Methods:Eighteen Sprague-Dawley rats were randomly divided into a control group, an IDD model group (the model group), and a PEMF group. IDD was induced in both the model and PEMF groups. Right after the modeling, the PEMF group received 14 days of PEMF treatment, while the control group and model group were given no special treatment. Meanwhile, the primary rat nucleus pulposus cells (NPCs) were cultured using Dulbecco′s Modified Eagle Medium at 37℃ and 5% CO 2. When the fusion rate reached 90% after passage, the NPCs were divided into a control group, a TNF-α model group (referred to as model group) and TNF-α + PEMF group (referred to as PEMF group) and treated accordingly. Eight weeks after the modeling, safranin-o/fast green staining was used to assess any pathological morphology changes. The expression of NPY, neuropeptide Y receptor Y2 (NPY2R), bcl-2-associated X protein (Bax), B-cell lymphoma 2 (Bcl-2), collagen type II (Col-II) and matrix metalloproteinase-3 (MMP3) in the intervertebral disc and the cultivated nucleus pulposus cells of the 3 groups were determined. Results:The intervertebral disc cells in the model group were ruptured and folded, with significantly increased polysaccharide and protein components, and significantly increased bone fibers. In the PEMF group the cell boundaries were clearer, with less fibrin fracture and increased cartilage tissue. NPY was expressed in the fibrous annulus and the nucleus pulposus of the intervertebral disc in the model group. The average expression levels of NPY and NPY2R were significantly higher than in the control group and the model group. Compared with the control group, there was a significant increase in the level of Bax and a significant decrease in the expression of Bcl-2 in the model group, and there was a significant decrease in the level of Bax in the PEMF group. Compared with the control group, there was a significant decrease in the Col-II level but a significant increase in the MMP3 protein expression in the model group. The average Col-II mRNA expression was significantly higher in the PEMF group compared with the model group, but the average MMP3 protein expression was significantly less. Those results are consistent with observations in vivo.Conclusion:PEMF may reverse the imbalance of ECM metabolism and delay IDD degeneration by up-regulating the expression of NPY and Bcl-2, as well as blocking the Bax/Bcl-2 signaling pathway to inhibit apoptosis of nucleus pulposus cells.

Humans ; Thyrotoxicosis/chemically induced* ; Amiodarone

Objective:To investigate the application value of the diagnostic and surgical method for asymmetric prominent mandibular angle assisted by digital surgical design.Methods:The data of the females in Han nationality with prominent mandibular angle from December 2010 to December 2020 in the Department of Digital Plastic Surgery of Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. ProPlan CMF 3.0 software was used to preoperatively mirror the patient’s three-dimensional(3D) model to obtain a diagnosis. The characteristics of bilateral differences of asymmetry of mandible were evaluated, and the surgical method were analyzed. The effect of surgery was objectively evaluated by indicators such as gonion point width (Go-W), condyle apex height (Co-H), and mandibular angle(Ag). SPSS 18.0 was used for statistical analysis, and the data were tested by Kolmogorov-Smirnov test, and the result were in line with the normal distribution. The data were expressed in Mean±SD, and the paired t-test was used to compare the measurement result of the indicators on both sides of the mandible, and P<0.05 was a statistically significant difference. Results:A total of 30 female patients, aged from 18 to 39 years, were included. Preoperative 3D model measurements showed a longer mandibular ascending branch on one side of the mandible (long side) and a more extrusion of the mandibular angle on the other side (prominent side), which was treated with a modified surgical method of mandibular angle osteotomy. The height of the osteotomy line on the long side was the height of the exuberant osteotomy line + the height difference between the two sides, and the thickness of the outer plate grinding on the protrusion side was the thickness of the outer plate grinding on the long side + the width difference between the two sides. Both the preoperative pogonion and menton points were far from the long side of the mandible and biased towards the prominent side. The height, width and mandibular angle of the marker points on both sides of the mandible were compared, and the differences were statistically significant ( P<0.01). Among them, the asymmetrical difference between Go-W, Co-H and Ag was the largest, which could be used to evaluate the effect of surgery. The differences between Go-W, Co-H and Ag before and after surgery on the long side of the mandible were (1.10±2.05) mm, (12.84±2.96) mm, (-17.75±5.16)°, and the differences between the three indicators on the prominent side were (4.24±1.64) mm, (10.95±3.25) mm, (-14.87±5.14)°, respectively, and the differences between preoperative and postoperative comparisons were statistically significant ( P<0.01). The asymmetric differences between the three indicators on both sides of the mandible after surgery were (-0.32±2.30) mm, (-0.02±0.37) mm, (-0.01±1.87)°, respectively, and the differences were not statistically significant ( P>0.05). All patients had no complications such as hematoma and infection after surgery, and the patients were satisfied with the result of the operation. Conclusions:Asymmetric hypertrophy mandibular angle can be reconstructed by the patient’s preoperative 3D model to accurately measure the differences between the two sides of the mandible. This design can effectively guide the surgical method, improve the symmetry of the patient’s bilateral mandible, and achieve better aesthetic effects on the face.

Objective:To investigate the application value of the diagnostic and surgical method for asymmetric prominent mandibular angle assisted by digital surgical design.Methods:The data of the females in Han nationality with prominent mandibular angle from December 2010 to December 2020 in the Department of Digital Plastic Surgery of Plastic Surgery Hospital, Chinese Academy of Medical Sciences were analyzed retrospectively. ProPlan CMF 3.0 software was used to preoperatively mirror the patient’s three-dimensional(3D) model to obtain a diagnosis. The characteristics of bilateral differences of asymmetry of mandible were evaluated, and the surgical method were analyzed. The effect of surgery was objectively evaluated by indicators such as gonion point width (Go-W), condyle apex height (Co-H), and mandibular angle(Ag). SPSS 18.0 was used for statistical analysis, and the data were tested by Kolmogorov-Smirnov test, and the result were in line with the normal distribution. The data were expressed in Mean±SD, and the paired t-test was used to compare the measurement result of the indicators on both sides of the mandible, and P<0.05 was a statistically significant difference. Results:A total of 30 female patients, aged from 18 to 39 years, were included. Preoperative 3D model measurements showed a longer mandibular ascending branch on one side of the mandible (long side) and a more extrusion of the mandibular angle on the other side (prominent side), which was treated with a modified surgical method of mandibular angle osteotomy. The height of the osteotomy line on the long side was the height of the exuberant osteotomy line + the height difference between the two sides, and the thickness of the outer plate grinding on the protrusion side was the thickness of the outer plate grinding on the long side + the width difference between the two sides. Both the preoperative pogonion and menton points were far from the long side of the mandible and biased towards the prominent side. The height, width and mandibular angle of the marker points on both sides of the mandible were compared, and the differences were statistically significant ( P<0.01). Among them, the asymmetrical difference between Go-W, Co-H and Ag was the largest, which could be used to evaluate the effect of surgery. The differences between Go-W, Co-H and Ag before and after surgery on the long side of the mandible were (1.10±2.05) mm, (12.84±2.96) mm, (-17.75±5.16)°, and the differences between the three indicators on the prominent side were (4.24±1.64) mm, (10.95±3.25) mm, (-14.87±5.14)°, respectively, and the differences between preoperative and postoperative comparisons were statistically significant ( P<0.01). The asymmetric differences between the three indicators on both sides of the mandible after surgery were (-0.32±2.30) mm, (-0.02±0.37) mm, (-0.01±1.87)°, respectively, and the differences were not statistically significant ( P>0.05). All patients had no complications such as hematoma and infection after surgery, and the patients were satisfied with the result of the operation. Conclusions:Asymmetric hypertrophy mandibular angle can be reconstructed by the patient’s preoperative 3D model to accurately measure the differences between the two sides of the mandible. This design can effectively guide the surgical method, improve the symmetry of the patient’s bilateral mandible, and achieve better aesthetic effects on the face.

Extracellular vesicles are spherical membrane vesicles formed by bimolecular lipid layers and are secreted and released into the extracellular environment by many kinds of cells.Extracellular vesicles include exosomes, microparticles and apoptotic bodies, which represent newly discovered ways of intercellular communication and can be used as biomarkers to distinguish a variety of diseases.However, how extracellular vesicles change with age and the underlying mechanisms for these changes are not clear.This article reviews current research on extracellular vesicles, with a focus on the relationship between extracellular vesicles and aging and its role in aging-related diseases.Furthermore, its practical application in aging is also discussed, in order to provide new ideas for the intervention of the aging process and the treatment of aging-related diseases.

Objective:To study the clinical and cytogenetic characteristics of patients with multiple myeloma harboring 6q deletion, with the aim to determine the impact of 6q deletion on survival.Methods:This study included the retrospective analysis of 382 newly diagnosed patients with multiple myeloma in our hospital from 2014 to 2017 and compared the clinical and cytogenetic characteristics between patients with and without 6q deletion. The log-rank test and the Cox proportional hazards regression model were used to analyze prognostic factors for progression-free survival (PFS) and overall survival (OS) .Results:Compared to those without 6q, the patients with 6q deletion were older (median age, 63 vs 58 years, P=0.039) , had higher incidence of t (4; 14) (30.4% vs 16.4% , P=0.020) , and higher proportion of complex karyotypes (22.2% vs 5.3% , P=0.001) . Univariate survival analysis using the log-rank test revealed that 6q deletion was associated with shorter PFS. However, by the Cox multivariate proportional hazards regression model, 6q deletion was not an independent prognostic factor and its effect on survival was affected by age, t (4; 14) , and other risk factors. Conclusions:6q deletion was common in elderly patients with multiple myeloma and was often accompanied by t (4;14) and complex karyotypes. However, 6q deletion was not an independent prognostic factor for multiple myeloma.

OBJECTIVE：To establish HPLC fingerprint of Coptis chinensis inflorescence，and study its spectrum-effect relationship with antioxidant and antibacterial effects. METHODS ：Taking 14 batches of C. chinensis inflorescence from different producing areas as the object ，HPLC method was adopted. The determination was performed on Supersil C 18 column with mobile phase consisted of acetonitrile- 0.1％ phosphoric acid solution（gradient elution ）at the flow rate of 1.0 mL/min. The column temperature was set at 25 ℃. The detection wavelength was set at 329 nm，and sample size was 10 μL. The fingerprints of 14 batches of C. chinensis inflorescence were established by Similarity Evaluation System of TCM Fingerprint （2012 A edition ），and the similarity evaluation and common peak identification were carried out. Taking DPPH free radical scavenging rate and hydroxyl radical scavenging rate as antioxidant effects index ，relative antibacterial activity （Escherichia coli ）as antibacterial effect index ， SPSS 21.0 software was adopted to analyze the Pearson correlation between common peaks of C. chinensis inflorescence and above efficacy indexes ；their spectrum-effect relationship was established and validated. RESULTS ：A total of 7 common peaks were obtained in HPLC fingerprint of C. chinensis inflorescence，and the similarity was no less than 0.916. No. 5 peak was identified as berberine hydrochloride. Seven common peaks were positively correlated with DPPH free radical scavenging rate ；No. 1-3，4，6，7 peaks were positively correlated with hydroxyl radical scavenging rate ，while No. 5 peak was negatively correlated with hydroxyl radical scavenging rate. There was a positive correlation between No. 5 peak and antibacterial activity in vitro . After validation ， relative error between the predicted values and the measured values of DPPH free radical scavenging rate ，hydroxyl radical scavenging rate and relative antibacterial activity was 0.92％- 14.5％ . CONLUSIONS ：The established spectrum-effect relationship model can be used to evaluate antioxidant andantibacterial effects of C. chinensis inflorescence. The chemical components represented by No. 1，2，3，4，6，7 peaks are the material basis of antioxidant effect of C. chinensis inflorescence， and berberine hydrochloride is the material basis of antibacterial effect.

OBJECTIVE：To optimi ze the ratio of four comp onents of Compound renshen jianti formulation （Panax ginseng ， Dioscorea oppositifolia ，Lycium barbarum fruit，Alpinia oxyphylla ），and to investigate its anti-fatigue activity and acute toxicity. METHODS：The water extract of Compound renshen jianti formulation was prepared by water extraction ，concentration and decompression drying. By single factor tests ，using weight-bearing swimming time as index ，the effects of four factors were investigated，such as the amount of P. ginseng ，D. oppositifolia ，L. barbarum fruit，A. oxyphylla . On the basis of single factor tests，using comprehensive score of weight-bearing swimming time ，serum urea nitrogen content ，liver glycogen content and AUC of blood lactate after exercise as index ，the formulation was optimized by Box-Behnken response surface method. The mice was divided into blank control group （water），positive control group （Renshen hongjingtian capsules ，0.135 g/kg）and compound low-dose，medium-dose and high-dose groups [the optimal ratio of Compound renshen jianti formulation extract （called“optimal compound formulation ”for short ）4.08，8.16，12.24 g/kg，by crude drug] ，intragastric administration of drug or distilled water 20 mL/kg，once a day ，for consecutive 30 d. The weight-bearing swimming time ，the contents of serum urea nitrogen ，liver glycogen and blood lactate AUC after exercise were used to optimize its anti-fatigue activity of optimal compound formulation. The comprehensive score was calculated based on the measured data of mice in the compound formulation middle-dose group ， and the difference between it and the theoretical prediction value was compared. The mice were given optimal compound formulation intragastrically （total dose 16.00 g/kg， by extract）. The general state ， body mass change ， toxic characteristics and death of mice were observed and recorded for 14 days. Median lethal dose （LD50）and maximum tolerated dose （MTD）were measured. RESULTS ：The optimal formulation ratio of Compound renshen jianti formulation included that P. ginseng 1.5 g，D. oppositifolia 10 g，L. barbarum fruit 10 g，A. oxyphylla 3 g. Results of anti-fatigue activity validation test showed that the optimal compound formulation could significantly prolonged weight-bearing swimming time ，reduced serum content of urea nitrogen ，blood lactate content and its AUC （except for low-dose group ），while significantly increased the content of liver glycogen （P＜0.05 or P＜0.01）. Average comprehensive score of medium-dose group was 96.95，which was only 0.06％ different from the theoretical prediction value of 97.01. The results of acute toxicity test showed that there was no death in mice. The oral MTD of the optimal compound formulation was more than 15 g/kg，which was non-toxic. CONCLUSIONS ：The optimal Compound renshen jianti formulation has effective anti-fatigue activity of mice ，and has no significant toxic effect.