Background Metals and metalloids in fine particulate matter (PM_2.5) may cause damage to the respiratory and circulatory systems of the human body, and long-term exposure is prone to causing chronic poisoning, cancer, and other adverse effects. Objective To assess the distribution characteristics of metals and metalloids in outdoor PM_2.5 in a southern city of China, conduct source apportionment, and evaluate the associated health risks, thereby providing theoretical support for further pollution control measures. Methods PM_2.5 samples were collected in districts A, B, and C of a southern China city, and the concentrations of 17 metals and metalloids were detected by inductively coupled plasma-mass spectrometry (ICP-MS). Pollution sources were assessed through enrichment factor and principal components analysis, and the main pollution sources were quantified using absolute principal component scores-multivariate linear regression (APCS-MLR). Health risks were evaluated based on the Technical guide for environmental health risk assessment of chemical exposure (WS/T777—2021). Results The ambient air PM_2.5 concentrations in the city were higher in winter and spring, and lower in summer and autumn. The annual average concentrations of ambient PM_2.5 in districts A, B, and C were 36.7, 31.9, and 24.4 μg·m⁻³, respectively. The ambient PM_2.5 levels in districts B and C were below the second-grade limit set by the Ambient air quality standards (GB 3095—2012). The enrichment factors of cadmium (Cd), aluminum (Al), and antimony (Sb) were greater than 10, those of copper (Cu), lead (Pb), arsenic (As), nickel (Ni), mercury (Hg), and molybdenum (Mo) fell between 1 and 10, and those of manganese (Mn), vanadium (V), chromium (Cr), cobalt (Co), barium (Ba), beryllium (Be), and uranium (U) were below or equal to 1. The comprehensive evaluation of source analysis showed that the main pollution sources in districts A and C and the whole city were coal-burning. In district B, the main pollution source was also coal combustion, followed by industrial process sources and dust sources. The carcinogenic risks of As and Cr were between 1×10⁻⁶ and 1×10⁻⁴. However, the hazard quotients for 15 metals and metalloids in terms of non-carcinogenic risk were below 1. Conclusion Cr and As in the atmospheric PM_2.5 of the city present a certain risk of cancer and should be paid attention to. In addition, preventive control measures should be taken against relevant pollution sources such as industrial emission, dust, and coal burning.

BACKGROUND:Traditional surgery for lumbar disc herniation involves extensive excision of tissue surrounding the nerve for decompression and removal of protruding lumbar intervertebral discs,which poses various risks and complications such as nerve damage causing paralysis,lumbar instability,herniation recurrence,intervertebral space infection,and adjacent vertebral diseases. OBJECTIVE:To propose the symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous technique for lumbar spine symmetrically decompression,showing the induced resorption of herniated nucleus pulpous phenomenon and early clinical efficacy,and then analyze its decompression mechanism. METHODS:214 patients with lumbar disc herniation at Department of Orthopedics,First Affiliated Hospital of Zhengzhou University from March 2021 to May 2023 were enrolled in this study.Among them,81 patients received conservative treatment as the control group,and 133 patients received symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous treatment as the trial group.Before surgery,immediately after surgery(7-14 days),and early after surgery(over 1 year),MRI images were used to measure the volume changes of lumbar disc herniation.CT images were used to measure the posterior displacement distance of the lumbar spinous process ligament complex,as well as the width and height of the lateral recess.Japanese Orthopaedic Association scores were used to evaluate the patient's neurological function recovery. RESULTS AND CONCLUSION:(1)Control group:81 patients with lumbar disc herniation were treated conservatively,with a total of 171 herniated lumbar discs.The average follow-up time was(22.7±23.1)months.The first and second MRI measurements of 171 herniated lumbar discs showed herniated lumbar disc volumes of(551.6±257.9)mm3 and(792.2±330.4)mm3,respectively,with an average volume increase rate of(53.2±44.4)%,showing statistically significant differences(P<0.001).Out of 171 herniated lumbar discs,4 experienced natural shrinkage,with an absorption ratio of 2.3%(4/171)and an absorption rate of(24.5±9.9)%.(2)Trial group:133 patients with lumbar disc herniation had a total of 285 herniated lumbar discs.(1)Immediately after surgery:All patients were followed up immediately after surgery.229 out of 285 herniated lumbar discs experienced retraction,with an absorption ratio of 80.3%(229/285)and an average absorption rate of(21.5±20.9)%,with significant and complete absorption accounting for 6.5%.There were a total of 70 herniated lumbar discs in the upper lumbar spine,with an absorption ratio of 85.7%(60/70),an average absorption rate of(23.1±19.5)%,and a maximum absorption rate of 86.6%.There were 215 herniated lumbar discs in the lower lumbar spine,with an absorption ratio of 78.6%(169/215),an average absorption rate of(21.0±21.3)%,and a maximum absorption rate of 83.2%.Significant and complete absorption of the upper and lower lumbar vertebrae accounted for 5.7%and 6.5%,respectively,with no statistically significant difference(P>0.05).The average distance of posterior displacement of the spinous process ligament complex immediately after surgery was(5.2±2.8)mm.There were no significant differences in the width and height of the left and right lateral recess before and immediately after surgery(P>0.05).The Japanese Orthopaedic Association score immediately after surgery increased from(10.1±3.4)before surgery to(17.0±4.8),and the immediate effective rate after surgery reached 95.6%.(2)Early postoperative period:Among them,46 patients completed the early postoperative follow-up.There were 101 herniated lumbar discs,with an absorption ratio of 94%(95/101)and an average absorption rate of(36.9±23.7)%.Significant and complete absorption accounted for 30.6%,with a maximum absorption rate of 100%.Out of 101 herniated lumbar discs,3 remained unchanged in volume,with a volume invariance rate of 2.97%(3/101).Out of 101 herniated lumbar discs,3 had an increased volume of herniated lumbar discs,with an increase ratio of 2.97%(3/101)and an increase rate of(18.5±18.4)%.The Japanese Orthopaedic Association score increased from preoperative(9.3±5.1)to(23.5±4.0),with an excellent and good rate of 93.4%.(3)The early postoperative lumbar disc herniation absorption ratios of the control group and trial group were 2.3%and 85.9%,respectively,with statistically significant differences(P<0.001).(4)Complications:There were two cases of incision exudation and delayed healing in the trial group.After conservative treatment such as dressing change,no nerve injury or death occurred in the incision healing,and no cases underwent a second surgery.(5)It is concluded that symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous is a new method for treating lumbar disc herniation that can avoid extensive excision of the"ring"nerve and achieve satisfactory early clinical efficacy.It does not damage the lumbar facet joints or alter the basic anatomical structure of the lateral recess,fully preserves the herniated lumbar discs,and can induce significant or even complete induced resorption of herniated nucleus pulpous.Symmetrically adduction of lumbar decompression induced resorption of herniated nucleus pulpous provides a new basis and method for the clinical treatment of lumbar disc herniation.

Objective To analyze the value of abdominal CT images combined with serological indicators in predicting the ureteral involvement in idiopathic retroperitoneal fibrosis(IRF). Methods The CT images of 79 IRF patients were analyzed retrospectively,including the involved sites and enhancement characteristics of the lesions.According to the inclusion and exclusion criteria,43 patients with complete serological data were selected and assigned into a ureteral involvement group(n=29)and a non-ureteral involvement group(n=14) according to whether ureters were involved in IRF.Logistic regression analysis was performed to select independent risk factors for ureteral involvement in IRF.The receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of the CT arterial phase enhancement magnitude and serum cystatin C(CysC)for ureteral involvement in IRF. Results The CT images of IRF usually showed a soft tissue density lesion encompassing the abdominal aorta,iliac arteries,ureters,and retroperitoneal tissue,with a wide range of distribution.The ureteral involvement group and the non-ureteral involvement group showed differences in gender(P=0.031),CT arterial phase enhancement amplitude(P=0.014),CT venous phase enhancement amplitude(P=0.032),and serum CysC(P=0.036).Logistic regression analysis showed that gender(P=0.034),CT arterial phase enhancement amplitude(P=0.046),and serum CysC(P=0.041)were independent risk factors for ureteral involvement in IRF.The area under the curve for CT arterial phase enhancement combined with serum CysC to predict ureteral involvement in IRF was 0.776.Ten patients had lower levels of erythrocyte sedimentation rate(P<0.001),C-reactive protein(P=0.021),and IgG4(P<0.001)in the follow-up period than before treatment. Conclusion The combination of abdominal CT images with serological indicators demonstrates high accuracy in predicting the ureteral involvement in IRF,providing reference for early clinical diagnosis.
Humans ; Male ; Female ; Retroperitoneal Fibrosis/pathology* ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed ; Aged ; Adult ; Ureter/diagnostic imaging* ; Predictive Value of Tests ; Cystatin C/blood*

Objective:To investigate the clinical efficacy of minimally invasive double anchoring combined with percutaneous kyphoplasty (PKP) for Kümmell disease.Methods:The clinical data of 24 patients with Kümmell disease who were treated with minimally invasive double anchoring combined with PKP in Cangzhou People's Hospital from October 2022 to March 2024 were retrospectively analyzed. Among them, there were 2 T 10 vertebrae, 5 T 11 vertebrae, 7 T 12 vertebrae, 6 L 1 vertebrae, and 4 L 2 vertebrae. There were 6 males and 18 females. The average age was 72.05±4.52 years (range, 66-80 years). The bone mineral density T value was -3.41±0.77 (range, -2.5-4.5). The stages of Li's Kümmell disease included 13 cases of stage II and 11 cases of stage III. The operation time, intraoperative blood loss, and volume of bone cement injected were recorded. The vertebral index, vertebral angle and Cobb angle of diseased segment were measured before and after operation. The visual analogue scale (VAS) was used to assess the degree of pain, the Oswestry disability index (ODI) and the Japanese Orthopaedic Association (JOA) low back pain scale were used to assess spinal function. The Medical Outcome Study short form 36 item health survey (SF-36) was used to assess the general health status of the patients. The postoperative symptom recovery was evaluated by Odom criteria. Results:The mean operative time of the 24 patients was 35.32±6.86 min, the injected volume of bone cement was 4.39±1.72 ml, and the intraoperative blood loss was 16.56±5.21 ml. All patients were followed up for 10 to 14 months, with an average of 11.7 months. Postoperative CT examination showed that the screw positions were satisfactory, and no loosening or displacement of bone cement mass occurred. On the first day after surgery, the vertebral body index, vertebral body angle and Cobb angle of diseased segment were 77.71%±2.75%, 12.40°±1.53° and 25.77°±4.49°, respectively, which represented significant improvements from the preoperative values of 43.09%±5.66%, 22.12°±2.92° and 46.98°±5.68° before surgery ( P<0.05). At the last follow-up, the values were 76.18%±2.32%, 12.41°±2.53°, 26.14°±4.87°, respectively, which were significantly improved compared with those before surgery ( P<0.05), but there was no statistical significance compared with the first day after surgery ( P>0.05). The VAS, ODI and JOA scores on the first day after surgery were 2.11±0.87 points, 22.46±5.49 points and 27.68±2.45 points, respectively, which were significantly improved compared with those before surgery 7.50±0.98 points, 76.25±8.56 points and 14.96±4.91 points ( P<0.05). At the last follow-up, the values were 2.26±0.88, 23.87±3.25 and 26.58±2.77, respectively, which were significantly improved compared with those before surgery ( P<0.05), and there was no statistical significance compared with the first day after surgery ( P>0.05). All 24 patients completed SF-36 scale assessment, and the results showed that there were statistically significant differences in physiological function, physiological role, physical pain, general health status, social function scores and mental health between the patients before surgery and the last follow-up ( P<0.05), while there were no statistically significant differences in vitality and emotional function ( P>0.05). At the last follow-up, the Odom criteria showed excellent results in 18 cases, good in 4 cases, and fair in 2 cases. Conclusions:The application of minimally invasive double anchoring (single nail fixation) combined with PKP in the treatment of Kümmell disease can effectively prevent the loosening and displacement of bone cement masses, and the fixation effect is satisfactory, which can restore the height of the injured vertebrum, reduce kyphosis and improve spinal function. The clinical symptoms of the patients were significantly improved, and the quality of life was enhanced.

Objective:To investigate the causes and management strategies of anesthetic complications during percutaneous spinal endoscopic surgery under local anesthesia.Methods:A total of 16 800 patients (8 625 males and 8 175 females) who underwent percutaneous spinal endoscopic surgery under local anesthesia (including intravenous basic anesthesia) in Tianjin Hospital, Shandong Public Health Clinical Center and Hebei General Hospital from February 2012 to February 2023 were retrospectively analyzed. The average age was 45.3±21.6 years (range, 12-84 years). There were 220 cases of posterior cervical keyhole endoscopic surgery, 50 cases of thoracic transforaminal endoscopic surgery, 70 cases of thoracic posterior interlaminar endoscopic surgery, 11 670 cases of lumbar transforaminal endoscopic surgery, and 4 790 cases of lumbar posterior interlaminar endoscopic surgery. The occurrence time, clinical manifestations, management of intraoperative anesthesia complications were recorded, as well as surgical segments, puncture sites, complication symptoms, signs, outcome and prognosis.Results:All patients received percutaneous water-mediated uniaxial spinal endoscopic surgery under local anesthesia. There were 9 patients experienced anesthesia complications, including 6 cases of epidural diffusion of anesthetics and 3 cases of anesthetics mistakenly entering the subarachnoid space. There were 4 males and 5 females, aged 48.4±18.2 years (range, 28-84 years). There were 1 case of T 12L 1 disc herniation, 1 case of C 5-6 disc herniation, 3 cases of L 4-5 disc herniation and 4 cases of L 5S 1 disc herniation. Surgical segments and procedures: 1 case of C 5-6 posterior Keyhole endoscopic surgery, 1 case of T 12L 1 transforaminal endoscopic surgery, 2 cases of L 4-5 transforaminal endoscopic surgery, 1 case of L 4-5 interlaminar endoscopic surgery, and 4 cases of L 5S 1 interlaminar endoscopic surgery. Anesthesia complications all appeared 5-10 min after injection of local anesthetics, with symptoms of decreased oxygen saturation, decreased blood pressure, altered consciousness, and sensory and motor dysfunction of limbs. 6 patients with epidural diffusion of anesthetics recovered completely after symptomatic treatment in 5 cases, and 1 case was left with foot drop. Three patients with anesthetics mistakenly entering the subarachnoid space were immediately converted to the supine position, of which one recovered by mask oxygenation; 1 patient improved after emergency tracheal intubation, rehydration, and application of vasoconstrictive medications; and 1 patient developed multiple complications such as multiorgan failure, rhabdomyolysis, and sepsis after tracheal intubation, and recovered at 3 months after surgery with symptomatic treatment. Conclusions:Epidural diffusion and entering into subarachnoid space of anesthetics are serious complications of local anesthesia in percutaneous spinal endoscopic surgery. In addition to sensory and motor dysfunction of the limbs, the functions of the respiratory and circulatory systems can also be affected. It is necessary to be alert to the occurrence of anesthesia-related complications during operation and early identification and treatment.

Objective:To investigate the safety and feasibility of the domestic single-port serpentine-arm robotic surgical system for pyeloplasty in children with congenital ureteropelvic junction obstruction(UPJO).Methods:Data of UPJO patients who underwent pyeloplasty using a domestic single-port ser-pentine-arm robotic surgical system(Beijing Surgerii Robotics Co.,Ltd.)in Beijing Children's Hospital from November 2023 to February 2024 were retrospectively collected.The patients who were not receiving surgical treatment for the first time,had hydronephrosis caused by other reasons(such as ureterovesical junction obstruction,posterior urethral valve,urinary tract stones,vesicoureteral reflux,ureterocele,etc.),had other urinary tract malformations(such as duplicated kidneys,congenital renal dysplasia,etc.),had severe atrophy of the affected kidney,severe urinary tract infection or severe renal insufficien-cy were excluded.All the surgeries were performed through the umbilicus and abdominal cavity,and the operation time,number of intraoperative incisions,incision size,intraoperative blood loss,and peri-operative complications were recorded.Statistical analysis was performed to compare changes in the an-teroposterior pelvic diameter(APD)and renal cortical thickness before surgery and 6 months postopera-tively.Results:A total of 10 patients were included(8 males and 2 females),with an average age of(10.20±3.12)years.Nine patients were on the left side and one patient was on the right side.The average height was(142.0±17.8)cm and the average weight was(37.6±17.9)kg.All the patients underwent surgery using the domestic single-port robotic surgery system,and no patient was converted to open pyeloplasty.The total operation time was(237±96)min,and the operation time on the operating table was(162.0±69.3)min.The intraoperative blood loss was 5.00(2.25,5.00)mL.No compli-cations,such as bleeding,urine extravasation,fever,and poor wound healing occurred during the perioperative period.Compared with the preoperative measurements,the APD was significantly shortened postoperatively(P=0.005),and the renal cortical thickness significantly increased(P=0.011).Con-clusion:The domestic single-port serpentine arm robotic surgical system is safe and feasible for UPJO pyeloplasty in children,with good surgical results,and can be promoted and applied in most domestic medical centers.

Objective:To explore the feasibility of using low-dose computed tomography(LDCT)with deep learning reconstruction(DLR)on the chest for the screening of lung nodules,and to compare the image quality and detection rate of nodules between LDCT and routine dose CT(RDCT)-DLR.Methods:A total of 104 overweight or obese patients[body mass index(BMI)≥25 kg/m2]who received CT examination on chest due to pulmonary nodule screening from September to December 2023 were included to conduct prospective study.All patients underwent respectively RDCT(120 kV)and LDCT(100 kV)scans,all of the two scans used the modulation of automatic tube current,and adopted deep learning AI algorithm ClearInfinity to conduct reconstruction(RDCT:CI 40%,LDCT:CI 50%).Radiation dose and nodules number of them were recorded.At the T8 vertebral level,CT values(Hounsfield Units,HU)of mediastinal fat and lung parenchyma in the right lower lobe were measured,along with image noise(standard deviation,SD).The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were subsequently calculated.Two radiologists independently performed subjective evaluations of image quality and pulmonary nodules using a Likert 4-point scale.Paired t-tests or Wilcoxon rank-sum test were employed to compare differences in radiation dose,objective image noise,and subjective scores between LDCT and RDCT.Results:A total of 104 patients were enrolled,including 54 males and 50 females,with a mean age of 52±13 years and a BMI of(27.77±2.64)kg/m2.The effective radiation dose of LDCT demonstrated a statistically significant reduction compared to RDCT(Z=-8.853,P<0.001),with a mean effective radiation dose reduction of 77.86%.The differences in lung CT value,lung noise,fat noise,lung parenchyma SNR,fat SNR and CNR of images between two groups were significant(Z=-3.022,-2.327,-4.785,-2.059,-3.765,-4.013,P<0.05),while there were not significant differences in the comparisons for fat CT value and lung parenchyma SNR(P>0.05).The image contrast,image noise,and subjective score for image quality of lung nodule of LDCT were lower than those of RDCT(t=2.877,2.387,5.096,P<0.05),but all subjective scores of that were>3,which can meet the requirements of clinical diagnosis.In terms of nodule detection,RDCT found out about 418 nodules,while LDCT found out about 421,the false positive rate of LDCT only was 0.72%.Conclusion:In overweight or obese patients,LDCT that combined with DLR algorithm on chest is equivalent to RDCT on image quality and the detection rate of lung nodule,and it significantly reduce radiation exposure on patients at the same time.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Venetoclax (Ven) is now widely used for both acute myeloid leukaemia (AML) and high-risk myelodysplastic syndrome (MDS), yet there is no consensus on salvage regimens after Ven failure. This study retrospectively evaluated the efficacy and safety of selinexor combined with subcutaneous decitabine (DAC) in 10 patients with AML or MDS with excess blasts (MDS-EB1/2) who had experienced prior Ven treatment failure. A literature review was also performed. Among the 7 patients with AML, 1 achieved complete remission (CR), 2 achieved CR with incomplete hematologic recovery (CRi), 1 achieved partial remission (PR), 2 had no remission, and 1 experienced disease progression (PD). Among the 3 patients with MDS, 2 achieved marrow CR and 1 had stable disease (SD). The median duration of response among the 6 responding patients was 2 months (range, 0.5-6 months). All 10 patients experienced varying degrees of myelosuppression. Five patients had mild gastrointestinal reactions, all of which were manageable. The overall tolerability was good, and no treatment-related deaths occurred. These findings suggest that selinexor combined with subcutaneous decitabine offers a novel and well-tolerated therapeutic option for patients with myeloid malignancies who have previously failed venetoclax-based therapy.

Objective To explore the predictive factors of recurrence of chronic suppurative otitis media(CSOM)after otoendoscopic surgery,and construct a risk quantified nomogram model.Methods The clinical data of 485 patients with CSOM who underwent otoendoscopic surgery in our hospital from February 2021 to February 2023 were retrospectively analyzed.The patients were divided into the recurrence group and the non-recurrence group according to the recurrence situation during the follow-up period.The clinical data of patients between the two groups were compared,and the predictive factors of postoperative recurrence were analyzed by Cox regression method.A risk quantified nomogram model was constructed based on these predictive factors.The predictive efficiency of the model was verified by receiver operating characteristic(ROC)curve,and the calibration degree of the model was verified by Hosmer-Lemeshow goodness of fit analysis,and the clinical net benefit of the model was evaluated by decision curve analysis(DCA)method.Results Follow-up ranged from 6 to 39 months,with a median of 21(11,32)months,the postoperative recurrence rate was 14.64%(71/485).Combined with recurrent upper respiratory tract infections(HR=3.019,95%CI:1.609 to 5.664),combined with chronic rhinosinusitis(HR=2.428,95%CI:1.529 to 3.856),combined with adenoid hypertrophy(HR=2.214,95%CI:1.381 to 3.551),middle ear risk index(MERI)score(HR=2.863,95%CI:1.445 to 5.675),the seven-item eustachian tube dysfunction questionnaire(ETDQ-7)score(HR=2.679,95%CI:1.505 to 4.765)and inadequate drainage of the surgical cavity(HR=2.373,95%CI:1.503 to 3.746)were the risk factors for postoperative recurrence(P<0.05).A risk quantified nomogram model of recurrence after otoendoscopic surgery in CSOM patients was constructed based on the predictive factors of Cox regression analysis,among them the risk value ranges of patients who combined with recurrent upper respiratory tract infections,combined with chronic rhinosinusitis,combined with adenoid hypertrophy,MERI score,ETDQ-7 score,and inadequate drainage of the surgical cavity were 0 to 65 points,0 to 56 points,0 to 52 points,0 to 76 points,0 to 64 points,and 0 to 76 points,respectively.The area under the curve of ROC,sensitivity and specificity of the model for predicting postoperative recurrence were 0.928(95%CI:0.875 to 0.948),85.92%and 88.89%,respectively.There was no significant difference between the predicted probability of postoperative recurrence and the actual probability(P>0.05).The threshold probability of postoperative recurrence predicted by the model in the range of 4%to 92%could obtain clinical net benefit.Conclusion The predictive factors of recurrence after otoendoscopic surgery in CSOM patients include combined with recurrent upper respiratory tract infections,combined with chronic rhinosinusitis,combined with adenoid hypertrophy,MERI score,ETDQ-7 score and inadequate drainage of the surgical cavity,the risk quantified nomogram model based on these factors is highly effective in predicting postoperative recurrence.