Objective:To explore the gene microarray of patients with ankylosing spondylitis in GEO database by using various bioinformatics methods, and to explore the possible targets and mechanisms of action.Methods:The GEO database was searched with "ankylosing spondylitis" the keyword, and the expression profile of genes related to AS was selected as the research object. Standard difference analysis, weighted co-expression analysis and gene set enrichment analysis were conducted to construct the disease set. GO and KEGG enrichment analysis were performed on the disease sets. The NCC algorithm identifies the first five key genes. THP-1 cells were implanted into RPMI-1640 culture medium containing 10% fetal bovine serum to multiply and construct the cell model of AS in vitro. The expression levels of 5 key genes were detected by qRT-PCR and Western blot. The experimental measurement data were expressed as mean± standard deviation, and the t test was used in comparison between the two groups. Results:One thousand six hundred and sixty seven disease genes were analyzed, functional annotation was mainly concentrated in 689 molecular components of cytoplasmic ribosomes, ribosomal subunits, ribosomes, cytoplasmic large ribosomal subunits, the structural composition of ribosomal REDOX enzyme activity, 1 002 molecular functions of NADH dehydrogenase activity, NADH dehydrogenase activity, and 5 764 molecular processes of mRNA catabolism and RNA catabolism The physical process involved 1 002 signaling pathways involved in Alzheimer′s disease, Prion disease, Parkinson′s disease, and the first 5 key genes were identified as RPS11, RPL4, RPL37A, RPS23, and RPS9. The experimental results were obtained by t test. The results showed that TNF-α mRNA ( t=5.59, P=0.001) and protein ( t=20.14, P<0.001) were significantly increased, indicating that LPS had induced inflammatory response in THP-1 cells, while RPL37AmRNA ( t=5.87, P=0.001), RPS11 mRNA ( t=3.88, P=0.008), RPS23 mRNA ( t=2.64, P=0.038), RPL37A protein ( t=3.18, P=0.030), RPS11 protein ( t=11.26, P<0.001), RPS23 protein ( t=5.64, P<0.001), increased, while RPS9 mRNA ( t=3.16, P=0.020), RPL4 mRNA ( t=2.54, P=0.044), RPS9 protein ( t=5.85, P<0.001) and RPL4 ( t=2.93, P=0.040) protein expressions decreased. RPL23 stimulated the joint synovial tissue to produce effect-T lymphocytes and release a large number of IL-2 and other inflammatory cytokines. RPS9 acts on the early stages of ribosomogenesis, and knocking down RPS9 reduced overall protein synthesis. RPL4 interacted with TTC22 protein to enhance the binding of WTAP mRNA to RPL4, which was associated with immune diseases. The nucleoprotein OGFOD1 catalyzed the hydroxylation of RPS23 and participated in the inflammatory process. The chromosome conformation confirmed the single nucleotide polymorphism function of IL23R genomic locus in AS disease. Conclusion:Ribosomal protein may be an important target for exploring the mechanism of AS inflammation.

BACKGROUND:The calcaneus is located in the lower posterior part of the foot and is heavily stressed.Calcaneus is complex and irregular in shape,surrounded by thin cortical bone and filled with a large number of trabeculae.The study of the microstructure,movement,and distribution of trabeculae is helpful to improve the understanding of calcaneus fracture. OBJECTIVE:The image data of calcaneus were obtained by scanning the calcaneus specimens with micro-computed tomography,and the structure of trabecular bone in calcaneus was analyzed to explore the morphology,distribution and structural characteristics of trabecular bone in calcaneus. METHODS:Dry adult calcaneus specimens were continuously scanned by micro-computed tomography,and the images were obtained after scanning and stored in DICOM format.Image data were imported into Hiscan Analyzer software to display clear and complete images of the sagittal plane,coronal plane,and the horizontal plane of the adult calcaneus.The trabecular movement of bone was observed layer by layer.According to the trabecular movement characteristics,the sagittal plane of the calcaneus was divided into six parts.A 49-mm2 region of interest was selected for each part at the same thickness as 7 mm.The three-dimensional microstructure of calcaneus and trabecular bone was obtained after three-dimensional reconstruction.After binarization,the volume fraction,surface density,trabecular thickness,trabecular space,and trabecular number parameters of the trabecular bone in the region of interest were calculated by software. RESULTS AND CONCLUSION:(1)The cortical layer of the calcaneus was very thin and filled with a large amount of cancellous bone,and the cortical layer of the horn of Gissane was obviously thickened.(2)The trabecular volume fraction in the upper part of the calcaneus was greater than that in the anterior part of the lower part of the calcaneus,the central triangle,the posterior part of the lower part of the calcaneus,and the base of the calcaneus,and the trabecular volume fraction in the tubercle of the calcaneus was greater than that in the anterior part of the lower part of the calcaneus,the central triangle,the posterior part of the lower part of the calcaneus,and the base of the calcaneus.The surface density of the trabecular bone in the tubercle of the calcaneus was higher than that in the front of the lower calcaneus,the middle triangle area,and the bottom of calcaneus,and the surface density of the trabecular bone in the upper part of calcaneal bone,and the lower part of the calcaneus was higher than that in the middle triangle area.The thickness of the trabecular bone in the upper part of the calcaneus was greater than that in the tubercle of the calcaneal bone.The bone trabecular space in the middle triangle was larger than that in the upper part of the calcaneus and calcaneal tubercles.The number of bone trabeculae in the calcaneal tubercles was greater than that in the middle triangle area.(3)These results indicate that the trabeculae of rod bone were mainly distributed in the middle triangle area.The surface density of trabeculae was the smallest,the volume fraction was smaller,and the space between trabeculae was the largest.This part of the bone is relatively loose.The compression resistance is poor when subjected to high impact.The trabecular bone fractures first occur,which is a prone site for fractures.

Objective:To investigate the pathogenesis, clinical signs and diagnosing procedures of relapsing polychondritis(RP) in children with airway involvement.Methods:The medical history, clinical symptoms, physical examination, electronic laryngoscopy and imaging findings of six patients were retrospectively analyzed. The patients diagnosed as relapsing polychondritis with involving the airway from January 2018 to December 2021 were in our hospital. The clinical features of the 6 cases were summarized.Results:All 6 patients were male, ranging in age from 8 years 1 month to 14 years 1 month, with a median age of 12.04 years. Stridor and dyspnea were observed in all patients, with hoarseness in 2 patients and frequently nocturnal dyspnea during sleep in 2 patients. Initially, all children were diagnosed as laryngitis or laryngotracheitis, and were treated symptomatically with glucocorticoids and aerosol inhalation. Immunosuppressants and targeted therapy with biologics were given after patients diagnosed as RP. All patients were ultimately required tracheostomy. The time from the onset of airway symptoms to tracheostomy ranged from 1 month to 27 months. Two children had a history of endotracheal intubation prior to tracheostomy. All 6 patients underwent electronic laryngoscopy, revealing involvement of the laryngeal and subglottic mucosa and cartilage structures, which showed gradual improvement with medical therapy. Computed tomography (CT) of the trachea with three-dimensional reconstruction was performed in all patients, demonstrating moderate to severe subglottic stenosis. Two patients exhibited complete airway obstruction at the C4-C6 cervical level. Three children underwent suspension laryngoscopy under general anesthesia and endotracheal mucosal biopsy.Of the 6 children, 3 presented with nasal tip collapse or saddle nose, 2 had auricular cartilage changed, and 1 had scleralinvolvement. One patient underwent PET-CT scanning, which revealed tracheal collapse, diffuse increase in FDG(Flurodeoxyglucose)metabolism with increased FDG uptake in the nasal alar regions. All children were followed up for 2-3 years, 1 child died, while the remaining five continued to receive medical treatment.Conclusions:Relapsing polychondritis with airway involvement has an insidious onset and is difficult to diagnose. The airway stenosisresulting from RP is always severe and necessitating tracheotomy to maintain airway patency in the majority of cases.The treatment coursef or RP is prolonged, requiring long-term tracheostomy tube placement.

Objective To evaluate the apparent diffusion coefficient(ADC)values of different bone marrow infiltration patterns in multiple myeloma(MM)patients with MR whole-body diffusion weighted imaging(WB-DWI)and to determine the ADC thresholds for different bone marrow infiltration patterns.Methods Nineteen MM patients diagnosed for the first time were selected.The lesions types of each site(cervical spine,ribs,sternum,humerus,scapula,sacral spine,ilium,femur,thoracic spine,and lumbar spine)after the WB-DWI images were visually evaluated,which were divided into focal group(including focal lesion in combined focal and diffuse infiltration)[region of interest(ROI)=141],pure diffuse infiltration group(ROI=150),diffuse lesion in combined focal and diffuse infiltration group(ROI=127),"salt-and-pepper"group(ROI=54),and normal appearance group(ROI=68).ADC values were measured and compared between each group and the receiver operating characteristic(ROC)curve was drawn to distinguish different patterns of bone marrow infiltration.Results There was no statistically significant difference in ADC values between the diffuse lesion in combined focal and diffuse infiltration group and the"salt-and-pepper"group(P＞0.99),and there was statistically significant difference in ADC values between the other groups(P＜0.05).The ROC curve showed that the area under the curve(AUC)for identifying focal group and the"salt-and-pepper"group was 0.889[95％confidence interval(CI)0.844-0.934],the AUC for identifying pure diffuse infiltration group and the normal appearance group was 0.968(95％CI 0.949-0.987).ADC values were able to accurately and visually differentiate between the different patterns of bone marrow infiltration.Conclusion The ADC values can be used as a quantitative tool to objectively distinguish different bone marrow infiltration patterns in MM patients.

OBJECTIVE To investigate the therapeutic effect of autologous costal cartilage transplantation with anterior/posterior split of cricoid cartilage on laryngotracheal stenosis in children.METHODS A retrospective analysis of 12 cases of laryngotracheal stenosis in children treated with anterior/posterior split of cricoid cartilage combined with T-tube implantation in Beijing Children's Hospital Affiliated to Capital Medical University in recent years.There were 5 males and 7 females,aged from 2 years and 6 months to 16 years and 9 months,with an average age of 8 years and 9 months.There were 2 cases of grade Ⅱ stenosis,9 cases of grade Ⅲ stenosis and 1 case of grade Ⅳ stenosis.All cases underwent tracheotomy before operation.The course of disease ranged from 4 months to 6 years,with an average of 3 years.RESULTS Of the 12 patients,10(83.3％)were cured,and the tracheotomy cannula was successfully removed to restore normal breathing and pronunciation function.There were 2 cases of extubation failure,including 1 case of grade Ⅲ stenosis and 1 case of grade Ⅳ stenosis.CONCLUSION The etiology of laryngotracheal stenosis in children is complex and difficult to treat.Anterior/posterior split costal cartilage transplantation combined with T-tube implantation through internal/external cervical approach can achieve good therapeutic effect in the treatment of laryngotracheal stenosis in children.

OBJECTIVE To investigate the anti-inflammatory effects and mechanism of Zhuang medicine Tongfeng li’an capsules on gouty arthritis in combination with in vivo and in vitro experiments. METHODS Sixty rats were randomly divided into normal group， model group， positive control group （27 mg/kg allopurinol+0.27 mg/kg colchicine）， Tongfeng li’an capsules low- dose， medium-dose and high-dose groups （2.2， 4.5， 9.0 g/kg）， with 10 rats in each group. Except for normal group， gouty arthritis model of rats was induced in other groups. Rats in each administration group were given corresponding drugs intragastrically， and rats in the normal group and model group were given equal volume of water intragastrically for 14 consecutive days. The degree of ankle joint swelling， serum level of interleukin-1β （IL-1β） and protein expressions of nuclear factor kappa-B （NF-κB） in synovial tissue were detected， and the histopathological changes of synovium tissue in the ankle joint of rats were observed. The inflammation model was established by stimulating RAW264.7 cells with lipopolysaccharide. After Tongfeng li’an capsules （62.5， 125， 250 μg/mL） were given， the levels of nitric oxide （NO）， reactive oxygen species （ROS） and IL-1β in the cells and protein expression of NF-κB were detected， and NF-κB localization in the cells was also determined. RESULTS Results of in vivo experiment showed that compared with normal group， the swelling degree of the ankle joint， serum IL-1β level and protein expression of NF-κB in synovium tissue were all increased significantly in model group （P＜0.05）； pathological changes such as synovial hyperplasia， edema， vascular congestion， capillary hyperplasia， and increased inflammatory cells were observed. Compared with model group， the levels of above indexes were all decreased significantly in Tongfeng li’an capsules high-dose group （P＜0.05）， and most of the above indexes were significantly reduced in Tongfeng li’an capsules medium-dose and low-dose groups （P＜0.05）； synovial hyperplasia of the ankle joint improved， and the infiltration of inflammatory cells 2019BS044） decreased. Results of in vitro experiment showed that Tongfeng li’an capsule could significantly reduce the levels of NO， ROS and IL-1β and protein expression of NF-κB（P＜0.01）， and inhibit NF- κB nucleation. CONCLUSIONS Tongfeng li’ancapsules have good anti-inflammatory effect on gouty arthritis， and its mechanism may be related to the inhibition of NF-κB signaling pathway activity.

Objectives: Two cases who underwent fetal pulmonary valvuloplasty (FPV) for pulmonary atresia with intact ventricular septum (PA-IVS) or critical pulmonary stenosis with intact ventricular septum (CPS-IVS) successfully were reported. The aim of the report was to explore the criteria for case selection, the technical essentials of FPV, and the postpartum outcome of the fetus. Methods: One case with PA-IVS and the other with CPS-IVS were enrolled in September 2016 and February 2017 in Guangdong General Hospital, and both cases were diagnosed with severe right ventricular dysplasia and tricuspid regurgitation by fetal echocardiogram. Parameters of right ventricle development and hemodynamics from echocardiography included tricuspid/mitral annulus (TV/MV), right ventricle/left ventricle long-axis (RV/LV), pulmonary/aortic annulus (PV/AV), tricuspid inflow duration/cardiac cycle, degree of tricuspid regurgitation (TR), blood flow direction of arterial duct and ductus venosus. Multidisciplinary team including the maternal-fetal cardiology, pediatric cardiology, cardiac surgery, obstetrics, neonatology and anesthesiology was summoned to discuss the indications and timing of PFV. Two cases underwent ultrasound-guiding trans-abdominal PFV at the 28 weeks of gestational age. Echocardiography was performed to observe the opening and closing of the pulmonary valve, and to evaluate the development of right ventricle and improvement in hemodynamics every 2-4 weeks until delivery. Results: From the technical perspective, pulmonary balloon valvuloplasty was successfully performed in these two cases. The opening of pulmonary valve improved in these two cases at 2-4 weeks after FPV. However, an obvious restenosis was detected in the first case at 5-8 weeks after FPV. In the first case, the echocardiography parameters including TV/MV, RV/LV, PV/AV and tricuspid inflow duration/cardiac cycle increased from 0.56, 0.42, 0.85,0.26 to 0.59, 0.51, 0.87, 0.32 at 5-8 weeks after FPV, respectively. However, the direction of blood flow through the arterial duct was still reverse. In the second case, TV/MV, RV/LV, PV/AV and tricuspid inflow duration/cardiac cycle ratio increased from 0.70, 0.63, 0.91,0.35 to 0.80, 0.80, 0.97, 0.42 at 5-8 weeks after FPV, respectively. The direction of blood flow through the arterial duct changed to bidirectional. Both fetuses were born alive. The first case underwent pulmonary valve commissurotomy and modified Blalock-Taussig shunt on the 8^th day after delivery and received follow-up for 6 months. The strategy for the next-step therapy was still pending. The second case underwent transcutaneous pulmonary balloon valvuloplasty on the 19^th day after delivery and received follow-up for 3 months. The opening of pulmonary valve improved obviously and the cardiac function was normal in the second case. Conclusions FPV is safe and effective for fetus during the second and third trimester of pregnancy, and FPV is beneficial for the development of fetal ventricle, valve and large artery. In addition, FPV may help to avoid the postnatal surgery for isolated single ventricle, improve fetal heart failure and prevent fetal death.

Objective To compare the particle pollution to the solution in the ampoule wrapped and broken by non-woven fabrics and medical gauze.Methods Totally 200 pcs of sterile water for injection(2 ml/pc) were randomly divided into the experimental group and the control group,with 100 pcs for each.For the experimental group,the ampoules were wrapped and broken by disinfected non-woven fabrics.For the control group,the ampoules were wrapped and broken by medical gauze.The solution was sucked from the ampoule with a 10 ml syringe and injected into a measuring cup for testing.Results The quantity of particles in the solution in the experimental group was less than that in the control group,and the difference was statistically significant (P＜0.05).Conclusion Wrapping and breaking the ampoule by disinfected non-woven fabrics can reduce particle pollution to the solution,and this method is easy to practice.

Objective To observe the clinical curative effect of modified Qiwei Baizhu Powder for mesenteric lymphadenitis in children with spleen deficiency and dampness retention. Methods A multi-center randomized and controlled trial was carried out in 150 cases of mesenteric lymphadenitis in children with spleen deficiency and dampness retention. The patients were randomized into Chinese medicine group, western medicine group and combination group, 50 cases in each group. Chinese medicine group was treated with modified Qiwei Baizhu Powder, western medicine group was treated with Cefaclor for Oral Suspension, and the combination group was treated with modified Qiwei Baizhu Powder plus Cefaclor for Oral Suspension. Before treatment and after treatment for 7 days, one month and 3 months, changes in syndrome manifestations and the size of abdominal mesenteric lymph nodes were monitored. The total effective rate and cure rate of the three groups were compared, and the safety of the regimen was also evaluated. Results (1) In Chinese medicine group, 5 patients dropped out, and a total of 45 cases completed the trial; in western medicine group, 3 patients dropped out, and a total of 47 cases completed the trial; in the combination group, 7 patients dropped out, and a total of 43 casescompleted the trial.(2) The total effective rate of Chinese medicine group and combination group after treatment for 7 days, one month and 3 months was significantly higher than that of western medicine group (P < 0.05), and the cure rate after treatment for one month and 3 months was also significantly higher than that of western medicine group (P<0.01). The differences of total effective rate and cure rate were insignificant between Chinese medicine group and combination group(P>0.05) at various time points.(3) After treatment for 7 days, one month and 3 months, the transverse and longitudinal diameters of mesenteric lymph nodes in Chinese medicine group and combination group were shorter than those of western medicine group (P < 0.05) , but the difference was insignificant between Chinese medicine group and combination group (P>0.05). (4) Except for the drop-out cases, all of the children finished the trial. During the treatment, no obvious adverse reaction was found. Conclusion Modified Qiwei Baizhu Powder exerts certain efficacy for the treatment of mesenteric lymphadenitis in children with spleen deficiency and dampness retention.

Objective To evaluate the clinical efficacy of the over-the-scope-clip (OTSC) for endoscopic closure of acute refractory non-variceal upper gastrointestinal bleeding. Methods This retrospective study selected 16 refractory patients, including 2 cases with Mallory-Weiss syndrome, 7 cases with gastric ulcer, 1 case with gastric carcinoma and 6 cases with duodenal ulcer, underwent OTSC treatment of acute non-variceal upper gastrointestinal bleeding from January 2015 to June 2016 as study subjects. Results All of the 16 patients with bleeding lesions were successfully controlled. The successful rate is 100.0%. The mean procedure of OTSC for endoscopic bleeding closure was between 5.0 and 6.0 min. Conclusion The Over-the-Scope-Clip system is safe and effective for closure of acute non-variceal upper gastrointestinal bleeding in refractory patients, and deserves further clinical applications.