ObjectiveTo sum up the clinical features of 5α-reductase type 2 deficiency （5α-RD2） complicated by central precocious puberty （CPP）， and provide experience for clinicians. MethodsA retrospective review was conducted of child patients with 5α-RD2 followed up to puberty at a single tertiary pediatric center， in whom 6 cases developed CRP. Clinical characteristics and treatment history of them were analyzed. A literature review was also performed to investigate possible mechanisms underlying the co-occurrence of 5α-RD2 and CPP. ResultsThe median age at initial presentation was 5.55 years （IQR 3.50-7.20）. Common clinical features included micropenis and hypospadias. Median stretched penile length （SPL） was 2.25 cm （IQR 1.8-2.8）， with an SPL-SDS of -4.5 （IQR -3.1 to -5.8）. Median external masculinization score （EMS） and Prader scores were 8.5 （IQR 5.0-9.0） and 4.5 （IQR 3.0-5.0）， respectively. Pubertal onset occurred at a median age of 8.70 years （IQR 7.80-9.00）. Three patients were overweight or obese. Five had received 2.5% dihydrotestosterone （DHT） gel prior to pubertal onset， with a median cumulative dose of 205.5 mg/kg （IQR 72.0-660.3 mg/kg） with DHT gel therapy. Notably， one patient with normal body mass index （BMI） and no history of androgen or gonadotropin therapy also exhibited early pubertal onset at 8.4 years. ConclusionCPP in children with 5α-RD2 may be associated with prior dihydrotestosterone （DHT） gel therapy and elevated BMI； however， a potential intrinsic link to the underlying disorder cannot be excluded. Further studies are needed to elucidate the pathophysiological mechanisms.

Objective:To investigate the protective effect of lycopene on rats with cognitive dysfunction (CD) induced by sevoflurane anesthesia through endoplasmic reticulum stress (ERS).Methods:A rat CD model was established using sevoflurane anesthesia induction. SD rats were randomly divided into a sham operation group, model group, low-, high-dose (5 and 10 mg/kg) lycopene groups, and a lycopene + tunicamycin (10 mg/kg + 100 μg/kg) group, with 12 rats in each group. 5 and 10 mg of lycopene was dissolved in 1 ml of sodium carboxymethylcellulose to form a suspension, and 10 μg of clindamycin was dissolved in 1 and 2 ml of 0.1% dimethyl sulfoxide. Rats in the low-, high-dose lycopene groups were gavaged with 1 ml of lycopene suspension, respectively, and the rats in the lycopene + tunicamycin group were gavaged with 1 ml of lycopene suspension and received 1 ml intraperitoneal injection of clindamycin. The sham operation group and the model group received an equal amount of saline by gavage or intraperitoneal injection, respectively. The low-, high-dose lycopene groups received an equal amount of saline by intraperitoneal injection, both 1 time/d for 6 weeks. The Morris water maze test was used to determine the cognitive function of rats. HE staining was used to observe the morphological changes of rat hippocampal tissue. TUNEL staining was used to observe the apoptosis of neurons in rat hippocampal tissue. The ELISA method was used to detect the levels of brain-derived neurotrophic factor (BDNF) and S100 calcifying protein β (S100β) in hippocampal tissue. Western Blot was used to detect the levels of apoptosis-related proteins in rat hippocampal tissues, including the levels of B-cell lymphoma-2 (Bcl-2), Bcl-2 associated X protein (Bax) with ERS marker glucose-regulated protein 78 (GRP78), C/EBP homologous protein (CHOP), and cysteinyl aspartate specific proteinase-12 (Caspase-12).Results:Compared with the model group, the escape latency, neuronal apoptosis rate, S100β level, GRP78, CHOP, Caspase-12, and Bax expression were decreased in the low-, high-dose lycopene groups on days 3, 4, and 5 (all P < 0.05), and the number of crossing platforms, BDNF level, and Bcl-2 expression were increased (all P < 0.05). With the increase of lycopene dose, the escape latency, neuronal apoptosis rate, S100β level, GRP78, CHOP, Caspase-12, and Bax expression were decreased in the high-dose lycopene group compared with the low-dose lycopene group on days 3, 4, and 5 (all P < 0.05), and the number of crossing platforms, BDNF level, and Bcl-2 expression were increased (all P < 0.05). Compared with the high-dose lycopene group, the escape latency, neuronal apoptosis rate, S100β level, GRP78, CHOP, Caspase-12, and Bax expression were increased in the lycopene + tunicamycin group on days 3, 4, and 5 (all P < 0.05), and the number of crossing platforms, BDNF level, and Bcl-2 expression were decreased (all P < 0.05). Hippocampal tissue neuronal loss and the inflammatory infiltration were both reduced in CD rats after lycopene intervention. The ERS activator tunicamycin attenuated the protective effect of lycopene on sevoflurane-induced CD rats. Conclusions:Lycopene may play a protective role against CD in rats anesthetized with sevoflurane by inhibiting ERS.

Objective To summarize the clinical characteristics of children with drug-induced hypersensitivity syndrome(DIHS)complicated with herpesvirus reactivation,and to promote the early and accurate identification,diagnosis,and treatment of DIHS in children.Methods The medication history,clinical manifestations,treatment,and prognosis of 12 children confirmed DIHS complicated with herpesvirus reactivation in Guangzhou Women and Children's Medical Center between January 2018 and March 2023 were retrospectively analyzed.The changes in hematological parameters,inflammatory indexes,and hepatic and renal function within 5 d before the eruption,5 d,and 6-10 d after eruption were compared.Results Of the 12 patients,the male-to-female ratio was 5∶1,with a median age of 27(interquartile range 20.50-34.75)months.Two or more antibiotics were used at least two to six weeks before onset,with a combination of 3 or more antibiotics in 7 children,and a combined or sequential application of 2 antibiotics in 5 children.The antibiotics included cephalosporins(n=12),semisynthetic penicillins(n=5),vancomycin(n=4)and azithromycins(n=7).All 12 patients presented fever,rashes,and multiple organ involvement.The rashes were red maculopapules in the early stage and then gradually developed into massive fusion exceeding 50%of the whole body.Among them,seven children were accompanied by facial edema,and two had purplish-red facial rashes.11 children suffered from exfoliative dermatitis in the later stage.12 children presented obviously enlarged lymph nodes.Liver involvement was the most common(100%,simple increase of transaminase in four children,cholestasis in six children,and hepatic failure in two children),and lung involvement was found in nine children.Laboratory examination showed no significant increase in leukocytes or eosinophils within 5 d before the eruption,but low levels of atypical lymphocytes.After the eruption,leukocytes,eosinophils,and atypical lymphocytes increased progressively.Inflammatory indexes of hypersensitive C-reactive protein(CRP),procalcitonin(PCT)increased dramatically before and after the eruption.All the children received intravenous immunoglobulin(IVIG)and methylprednisolone,two children were given antiviral therapy,and nine children were treated with multiple plasma exchanges.After treatment,nine children were cured,one developed immune reconstitution syndrome,and two died of hepatic failure.Conclusions Antibiotics are common allergenic drugs for DIHS in children.Its clinical manifestations include fever and rashes,accompanied by multiple organ involvement,such as the liver and lung.When leukocytes,eosinophils,and atypical lymphocytes are progressively elevated after the eruption,DIHS should be highly suspected,herpesvirus activation should be monitored,medication history should be traced,and early active immunotherapy and antiviral therapy should be conducted if necessary.

OBJECTIVE: To assess the clinical effects of percutaneous endoscopic surgery through two different approaches for stable degenerative lumbar spondylolisthesis. METHODS: Sixty-four patients with stable degenerative lumbar spondylolisthesis who underwent percutaneous endoscopic procedures between January 2016 and December 2019 were divided into transforaminal approach group and interlaminar approach group according to surgical approaches, 32 patients in each group. There were 16 males and 16 females in transforaminal approach group, aged from 52 to 84 years old with an average of (66.03±9.60) years, L₂ slippage in 4 cases, L₃ slippage in 5, and L₄ slippage in 23. There were 17 males and 15 females in interlaminar approach group, aged from 46 to 81 years old with an average of (61.38±9.88) years, L₃ slippage in 3 cases, L₄ slippage in 15, and L₅ slippage in 14. Operative time, intraoperative fluoroscopy times, and postoperative bedtime were compared between two groups. Anteroposterior displacement values, interbody opening angles, and the percentage of slippage were measured on preoperative and postoperative 12-month dynamic radiographs. Visual analogue scale (VAS) of low back pain and lower extremity pain, and the Japanese Orthopaedic Association (JOA) score before and after surgery were observed, and clinical effects were evaluated according to the modified MACNAB criteria. RESULTS: All operations were successfully completed, and patients in both groups were followed up for more than 1 year, and without complications during follow-up period. ①There was no significant difference in operation time between two groups(P>0.05). Intraoperative fluoroscopy times were longer in transforaminal approach group than that in intervertebral approach group(P<0.05). Postoperative bedtime was shorter in transforaminal approach group than that in intervertebral approach group (P<0.05).② No lumbar instability was found on dynamic radiography at 12 months postoperatively in both groups. There were no significant differences in anteroposterior displacement values, interbody opening angles, and the percentage of slippage between two groups postoperative 12 months and preoperative 1 day(P>0.05). ③There was no significant difference between two groups in VAS of low back pain at 3 days and 1, 12 months after the operation compared with the preoperative(P>0.05), but the VAS of the lower extremity pain was significantly improved compared with the preoperative(P<0.05). Both of groups showed significant improvement in JOA score at 12 months compared with preoperatively(P<0.05). There was no significant difference in VAS of low back pain, lower extremity pain and JOA scores between two groups during the same period after surgery(P>0.05). According to modified Macnab criteria, excellent, good, fair and poor outcomes were 21, 7, 3 and 1 in transforaminal approach group respectively, and which in intervertebral approach group were 20, 7, 5 and 0, there was no significant difference in clinical effect between the groups(P>0.05). CONCLUSION Intervertebral approach may reduce intraoperative fluoroscopy times and transforaminal approach can shorten postoperative bedtime, both approaches achieve satisfactory results in the treatment of stable degenerative lumbar spondylolisthesis with no progression of short-term slippage.
Male ; Female ; Humans ; Middle Aged ; Aged ; Aged, 80 and over ; Spondylolisthesis/surgery* ; Low Back Pain/surgery* ; Treatment Outcome ; Lumbar Vertebrae/surgery* ; Spinal Fusion/methods* ; Retrospective Studies

Objective:To investigate the dosimetric effects of prone immobilization devices combined with a belly board (PIDBBs) in the intensity-modulated radiotherapy (IMRT) for gynecologic cancers.Methods:A total of 20 patients with cervical or endometrial cancer treated with radiotherapy in the Third Affiliated Hospital of Sun Yat-sen University from August 2020 to June 2021 were retrospectively analyzed. Two sets of body contours were outlined for each patient. One set of body contours did not contain the immobilization devices, and the other contour set included the immobilization devices. For each patient, doses were calculated for the two sets of contours using the same 7-field IMRT plan and were recorded as Plan without and Plan with. The dosimetric difference caused by the immobilization devices was assessed by comparing the parameter values in the dose-volume histograms (DVHs) and by plan subtraction. The Gafchromic EBT3 film and anthropomorphic phantom were used to verify the calculated doses. Results:The target coverage and average dose of Plan with were lower than those of Plan without. Specifically, the V50 Gy, V49 Gy, and Dmean of planning target volume (PTV) decreased by 19.75%, 7.99%, and 2.54% ( t = 8.96, 10.49, 22.09, P < 0.01), respectively. The V40 Gy, V30 Gy, V20 Gy, V15 Gy, and Dmean of skins increased by 51.79%, 51.05%, 45.72%, 33.63% and 10.80% ( t = -2.54, -5.63, -15.57, -24.06, -13.88, P < 0.01), respectively. Doses to other organs at risk (OARs) showed no significant differences. As indicated by the EBT3 measurements, the doses to skins of the abdomen and pelvis on the anthropomorphic phantom increased by approximately 37.24% ( t = 10.86, P<0.01). Conclusions:Although PIDBBs can effectively reduce the low dose to the small intestine, the radiation attenuation caused by them can reduce the PTV coverage of radiotherapy plans and increase the doses to abdominal and pelvic skins sharply, especially for patients requiring irradiation of the groin and perineum.

There are still many unresolved problems in the treatment and prognosis of nondisplaced femoral neck fractures, such as nonunion and avascular necrosis of the caput femoris .In order to reduce the risk of various complications after non-displaced femoral neck fractures, the caput femoris posterior tilt of femoral neck fractures and its impact on prognosis have attracted more and more attention. A large number of scholars' studies have found that when the posterior tilt exceeds 20°, the risk of internal fixation failure increases significantly. Based on this concept, we can choose to use primary artificial joint replacement instead of three-screw internal fixation according to the different posterior tilt angles of patients to reduce the incidence of postoperative complications. At the same time, our analysis found that comminution of the posterior segment of the femoral neck would lead to an increase in the posterior inclination angles. The purpose of this review was to investigate the relationship between caput femoris posterior tilt of femoral neck fractures and surgical outcome, and to introduce a new method for measuring caput femoris posterior tilt of the femoral neck.
Humans ; Prognosis ; Postoperative Complications/epidemiology* ; Femoral Neck Fractures/complications* ; Femur Neck ; Reoperation ; Fracture Fixation, Internal/methods* ; Retrospective Studies

OBJECTIVE: To explore biomechanical characteristics of minimally invasive different screw fixations in treating Sanders typeⅡcalcaneal fractures. METHODS: Dicom data of calcaneus by CT scan were input into Mimics 21.0 software and Ansys15.0 software to construct three-dimensional finite element digital model of calcaneus;this model was input into UG NX 10.0 software, and calcaneus was cut according to Sanders classification to establish Sanders typeⅡ calcaneus model with posterior articular surface collapse;then simulated minimally invasive screw internal fixation after calcaneal fracture:a screw from posterior articular surface was used to outside-in fix sustentaculum tali, other 4 screws were used to fix calcaneus by different methods through calcaneal tuberosity, and 4 different calcaneal models were obtained. Under the same conditions, 4 types of internal fixation models were loaded respectively, and nonlinear finite element analysis was performed to calculate the stress distribution of different internal fixation models. RESULTS: Under the same condition of loading, the model 3 had smaller displacement value, maximum calcaneus displacement value and maximum equivalent stress value of the screw than other three internal fixation models, and the stress was more dispersed. CONCLUSION In minimally invasive screw internal fixation of calcaneus fracture, after 1 sustentaculum tali screw fixation, 2 screws crossed fix posterior articular surface from calcaneal tuberosity, 2 screws fix parallelly calcaneocuboid joint from calcaneal tuberosity are more suitable for biomechanical requirements, and could provide basic theory for clinical treatment.
Bone Screws ; Calcaneus/surgery* ; Finite Element Analysis ; Fracture Fixation, Internal ; Fractures, Bone/surgery* ; Humans ; Treatment Outcome

OBJECTIVE: To investigate the feasibility of a drill template for the placement of guided template of middle and upper thoracic percutaneous vertebroplasty in thoracic pedicle approach on digital design and 3D printing technology. METHODS: The preoperative CT images of 20 patients with thoracic fracture were collected retrospectively. With the 3D soft tissue printing technology, the data was reconstructed by 3D imaging reconstruction software to produce 1∶1 three dimensional soft tissue model. The pedicle screw channel and the digital template were designed by the 3-matic module of Mimics15.0 software. After guide template was printed by 3D printer and three dimensional template was fixed on the model, 2.0 mm Kirschner was placed and the accuracy of a drill template was observed by CT scans, bone cement was injected through the puncture tube and verified with images. The time of nail guide design, guide template production and cost were recorded. RESULTS: The effectiveness of three dimensional thoracic model and digital guided template of middle and upper thoracic percutaneous vertebroplasty of thoracic fractures in thoracic pedicle approach was confirmed. Kirschner was placed and the accuracy of screw placement was confirmed with CT scanning. Template and the corresponding anatomical landmark fitted well, bone cement had showed good filling. The average printing time of upper thoracic spine model with soft tissue, the mean time of nail guide design, guide template production and cost were (719.00±3.03) min, (12.30±1.01) min, (55.50±10.30) min and RMB 3 150 yuan on average respectively. CONCLUSION By means of individual design and 3D soft tissue printingtechnology, accurate placement of guided template of middle and upper thoracic percutaneous vertebroplasty could be realized.
Humans ; Pedicle Screws ; Printing, Three-Dimensional ; Retrospective Studies ; Surgery, Computer-Assisted ; Vertebroplasty

OBJECTIVE: In order to select the proper size of prosthesis ball head, the biomechanical changes of hip joint using different diameter prosthesis ball head was studied by three-dimensional finite element analysis. METHODS: The thin-layer CT data and related parameters of artificial femoral head prosthesis were used to establish the finite element model of hip joint after artificial femoral head replacement with different ball diameter of prosthesis(M0:preoperative model;M1:ball head diameter=original femoral head diameter;M2:ball head diameter=original femoral head diameter+1 mm;M3:Ball head diameter= Original femoral head diameter -1 mm;M4:ball head diameter =original femoral head diameter -2 mm). Loading the joint forces and related muscle loads were loaded, and the stress distribution and change of bone and cartilage around acetabulum were analyzed by simulating the standing state of one foot when walking slowly. RESULTS: (1) In M1 to M4, the stress concentration in pelvis was different. The peak value of Von Mises stress in the pelvis of M3 was 44.8 MPa, which was the closest to that before operation, with an increment of 13.4%. The displacement of the pelvis of M3 was the smallest in the four groups after operation, with an increment of 1.40 mm. The next was M1, with a peak value of 47.3 MPa, with an increment of 19.7%, and a pelvic displacement of 1.59 mm. (2) In acetabulum area, the peak value of Von Mises stress in M3 was 23.3 MPa, which was the closest to that before operation, with an increment of about 6.3%, followed by M1, with a peak value of 24.0 MPa and an increment of about 8.1%. (3) On the acetabulum cartilage, the stress distribution of M1 and M3 was similar to that before operation, and the peak value of Von Mises stress of M3 was 18.5 MPa, which was the closest to that before operation, followed by M1, which was 22.5 MPa. (4) M1 to M4 showed different degree of stress concentration in the outer upper quadrant of the artificial femoral head, but showed stress shielding under it;among them, the von Mises stress distribution of M3 was more uniform than that of other models, and its peak value (70.8 MPa) was the lowest in each group, followed by M1 (80.7 MPa). CONCLUSION When femoral head replacement is performed, it is suggested that the prosthesis ball head with the diameter less than 1 mm and the prosthesis ball head with the same diameter as the original femoral head should be used first, so as to obtain the closest natural mechanical characteristics of the hip joint before the replacement and reduce the risk of complications caused by size differences.
Femur Head ; Finite Element Analysis ; Hip Joint ; Hip Prosthesis ; Stress, Mechanical