BACKGROUND:Paraspinal muscle degeneration is one of the main causative factors of low back pain,and the changes in the paraspinal muscles are closely related to its occurrence and development.At present,clinical practitioners focus on the changes of paraspinal muscles in degenerative lumbar diseases to prevent and treat lumbar diseases,but ignore the connection and related mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles.OBJECTIVE:To comprehensively summarize the interaction between paraspinal muscles and lumbar intervertebral discs,and to review the relationship and mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles,in order to provide a reference for clinical prevention and treatment.METHODS:Chinese keywords"lumbar intervertebral disc,paraspinal muscle,multifidus muscle,low back pain,degeneration,imaging,magnetic resonance imaging"were used to search the relevant literature in Chinese databases such as CNKI,VIP,and WanFang.English keywords"lumbar disc,paraspinal muscle,multifidus muscle,low back pain,degeneration,imaging,MRI"were used to search the relevant literature in databases such as Medline,PubMed,and Web of Science.After preliminary screening of titles and abstracts,68 articles were finally selected for result analysis according to the inclusion and exclusion criteria.RESULTS AND CONCLUSION:(1)Researchers have used various methods to evaluate the degree of paraspinal muscle degeneration,and at the same time evaluated the degree of lumbar intervertebral disc degeneration according to the Pfirrmann grading system.It is found that clinical diagnosis and treatment should pay attention to gender differences,and the influence of factors such as obesity on the degeneration of intervertebral discs and muscles,in order to develop more individualized treatment plans.(2)There is a certain correlation between lumbar intervertebral disc degeneration and paraspinal muscle fat infiltration,but the research results are controversial.Most studies have found that fat infiltration of the paraspinal muscles(especially the multifidus muscle)is positively correlated with the degree of lumbar intervertebral disc degeneration.(3)It is currently believed that the three mechanisms of disuse atrophy,denervation,and inflammatory factors may interact with each other to jointly lead to structural and functional changes in the paraspinal muscles,which are closely related to the occurrence of lumbar intervertebral disc degeneration and low back pain.(4)Clinically,attention should be paid to the changes of the muscles at the level below the affected nerve root segment,which is helpful for the diagnosis and localization of lumbar radiculopathy.At the same time,inhibition of inflammatory factors may become a potential target for treatment.(5)Clinically,the first step is to correct nerve root compression through appropriate medication or surgery to control inflammatory reactions and nerve root pain,and then carry out targeted muscle rehabilitation training.If necessary,consider using new treatment methods such as interferential current electrical stimulation to improve the patient's symptoms and prognosis.

Objective:To investigate the gene expression level of fructose-bisphosphate aldolase A (ALDOA) in non-small cell lung cancer (NSCLC) tissues and the effect of ALDOA on NSCLC prognosis and immune cell infiltration in tumor microenvironment (TME).Methods:The clinical data of patients with lung adenocarcinoma and squamous cell carcinoma, the data of corresponding gene in tumor tissues and corresponding normal lung tissues in The Cancer Genome Atlas (TCGA) database, and the data of healthy population in the Genotype Tissue Expression (GTEx) database were collected in June 2023. Gene Expression Profile Interaction Analysis (GEPIA) 2.0 online tool was used to explore the expression differences of ALDOA at transcription level in NSCLC tissues and normal lung tissues, as well as NSCLC tissues of different stages; the expression of ALDOA was obtained through immunohistochemical staining in different pathological types of NSCLC and normal lung tissues from the Human Protein Atlas (HPA) database; the survival of patients with high and low expression of ALDOA in NSCLC tissues in TCGA database was evaluated by plotting Kaplan-Meier survival curves (differentiated by the median expression of ALDOA at transcription level in NSCLC samples), and log-rank test was used for comparing survival between groups. Using the Tumor Immune Estimation Resource (TIMER) 2.0 database, the CIBERSORT algorithm was applied to evaluate the correlation between ALDOA expression and immune cell infiltration levels in NSCLC tissues from the TCGA database. Further analysis of the correlation between ALDOA expression levels and programmed death receptor ligand 1 (PD-L1), matrix metalloproteinase 9 (MMP-9), vascular endothelial growth factor (VEGF), and various inflammatory factors in NSCLC tissues was conducted using the GEPIA 2.0 online tool to evaluate the impact of ALDOA expression levels on the tumor immune microenvironment.Results:The expression of ALDOA at transcription level in lung adenocarcinoma (483 cases) and lung squamous cell carcinoma (486 cases) tissues were higher than those in corresponding normal lung tissues (347 and 338 cases, respectively), and the differences were statistically significant (all P < 0.01). There was a statistically significant difference in the expression of ALDOA at transcription level among TNM stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ NSCLC tissues ( F = 4.55, P = 0.004), and the expression level of ALDOA gradually increased with the increase of stage. In the HPA database, ALDOA protein stained by immunohistochemistry showed mild to moderate staining in normal lung tissues, while it showed severe staining in lung adenocarcinoma and squamous cell carcinoma tissue samples. Kaplan-Meier survival analysis showed that the overall survival of lung adenocarcinoma patients (239 cases) with high ALDOA expression was worse than that of patients with low ALDOA expression (239 cases) ( P < 0.001), and there was no statistically significant difference in disease-free survival between the two groups ( P = 0.140). There was no statistically significant difference in overall survival and disease-free survival between patients with high expression (241 cases) and low expression (241 cases) of ALDOA in lung squamous cell carcinoma (both P > 0.05). TIMER 2.0 database analysis shows that in lung adenocarcinoma, the expression of ALDOA at transcription level was negatively correlated with the levels of activated mast cells ( Rho = -0.209) and memory B cells ( Rho = -0.133), and positively correlated with the levels of resting mast cells ( Rho = 0.210) and resting natural killer cells ( Rho = 0.110), with statistically significant differences (all P < 0.05). In lung squamous cell carcinoma, the expression of ALDOA at transcription level was negatively correlated with the levels of activated mast cells ( Rho = -0.105), memory B cells ( Rho = -0.213) and CD8 + T cells ( Rho = -0.148), and positively correlated with the levels of resting mast cells ( Rho = 0.173), plasma B cells ( Rho = 0.174) and resting natural killer cells ( Rho = 0.136), with statistically significant differences (all P < 0.05). In NSCLC tissues, the expression of ALDOA at transcription level was negatively correlated with PD-L1 ( R = -0.11), interleukin (IL)-2 ( R = -0.31), IL-4 ( R = -0.14), IL-5 ( R = -0.10), IL-6 ( R = -0.12), and IL-10 ( R = -0.24) levels (all P < 0.001), positively correlated with MMP-9 ( R = 0.11) and VEGF ( R = 0.18) levels (both P < 0.001), and positively correlated with IL-9 ( R = 0.11) and VEGF ( R = 0.18) levels (both P < 0.001), but it was not correlated with IL-17 level ( R = -0.02, P = 0.540). Conclusions:The expression level of ALDOA is elevated in NSCLC tissues, and high ALDOA level in lung adenocarcinoma may indicate poor survival of patients. ALDOA may affect the levels of immune cell infiltration, tumor markers and inflammatory factors in TME, and it may be a potential biomarker for prognosis.

BACKGROUND:Paraspinal muscle degeneration is one of the main causative factors of low back pain,and the changes in the paraspinal muscles are closely related to its occurrence and development.At present,clinical practitioners focus on the changes of paraspinal muscles in degenerative lumbar diseases to prevent and treat lumbar diseases,but ignore the connection and related mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles.OBJECTIVE:To comprehensively summarize the interaction between paraspinal muscles and lumbar intervertebral discs,and to review the relationship and mechanisms between lumbar intervertebral disc degeneration and paraspinal muscles,in order to provide a reference for clinical prevention and treatment.METHODS:Chinese keywords"lumbar intervertebral disc,paraspinal muscle,multifidus muscle,low back pain,degeneration,imaging,magnetic resonance imaging"were used to search the relevant literature in Chinese databases such as CNKI,VIP,and WanFang.English keywords"lumbar disc,paraspinal muscle,multifidus muscle,low back pain,degeneration,imaging,MRI"were used to search the relevant literature in databases such as Medline,PubMed,and Web of Science.After preliminary screening of titles and abstracts,68 articles were finally selected for result analysis according to the inclusion and exclusion criteria.RESULTS AND CONCLUSION:(1)Researchers have used various methods to evaluate the degree of paraspinal muscle degeneration,and at the same time evaluated the degree of lumbar intervertebral disc degeneration according to the Pfirrmann grading system.It is found that clinical diagnosis and treatment should pay attention to gender differences,and the influence of factors such as obesity on the degeneration of intervertebral discs and muscles,in order to develop more individualized treatment plans.(2)There is a certain correlation between lumbar intervertebral disc degeneration and paraspinal muscle fat infiltration,but the research results are controversial.Most studies have found that fat infiltration of the paraspinal muscles(especially the multifidus muscle)is positively correlated with the degree of lumbar intervertebral disc degeneration.(3)It is currently believed that the three mechanisms of disuse atrophy,denervation,and inflammatory factors may interact with each other to jointly lead to structural and functional changes in the paraspinal muscles,which are closely related to the occurrence of lumbar intervertebral disc degeneration and low back pain.(4)Clinically,attention should be paid to the changes of the muscles at the level below the affected nerve root segment,which is helpful for the diagnosis and localization of lumbar radiculopathy.At the same time,inhibition of inflammatory factors may become a potential target for treatment.(5)Clinically,the first step is to correct nerve root compression through appropriate medication or surgery to control inflammatory reactions and nerve root pain,and then carry out targeted muscle rehabilitation training.If necessary,consider using new treatment methods such as interferential current electrical stimulation to improve the patient's symptoms and prognosis.

Objective:To investigate the gene expression level of fructose-bisphosphate aldolase A (ALDOA) in non-small cell lung cancer (NSCLC) tissues and the effect of ALDOA on NSCLC prognosis and immune cell infiltration in tumor microenvironment (TME).Methods:The clinical data of patients with lung adenocarcinoma and squamous cell carcinoma, the data of corresponding gene in tumor tissues and corresponding normal lung tissues in The Cancer Genome Atlas (TCGA) database, and the data of healthy population in the Genotype Tissue Expression (GTEx) database were collected in June 2023. Gene Expression Profile Interaction Analysis (GEPIA) 2.0 online tool was used to explore the expression differences of ALDOA at transcription level in NSCLC tissues and normal lung tissues, as well as NSCLC tissues of different stages; the expression of ALDOA was obtained through immunohistochemical staining in different pathological types of NSCLC and normal lung tissues from the Human Protein Atlas (HPA) database; the survival of patients with high and low expression of ALDOA in NSCLC tissues in TCGA database was evaluated by plotting Kaplan-Meier survival curves (differentiated by the median expression of ALDOA at transcription level in NSCLC samples), and log-rank test was used for comparing survival between groups. Using the Tumor Immune Estimation Resource (TIMER) 2.0 database, the CIBERSORT algorithm was applied to evaluate the correlation between ALDOA expression and immune cell infiltration levels in NSCLC tissues from the TCGA database. Further analysis of the correlation between ALDOA expression levels and programmed death receptor ligand 1 (PD-L1), matrix metalloproteinase 9 (MMP-9), vascular endothelial growth factor (VEGF), and various inflammatory factors in NSCLC tissues was conducted using the GEPIA 2.0 online tool to evaluate the impact of ALDOA expression levels on the tumor immune microenvironment.Results:The expression of ALDOA at transcription level in lung adenocarcinoma (483 cases) and lung squamous cell carcinoma (486 cases) tissues were higher than those in corresponding normal lung tissues (347 and 338 cases, respectively), and the differences were statistically significant (all P < 0.01). There was a statistically significant difference in the expression of ALDOA at transcription level among TNM stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ NSCLC tissues ( F = 4.55, P = 0.004), and the expression level of ALDOA gradually increased with the increase of stage. In the HPA database, ALDOA protein stained by immunohistochemistry showed mild to moderate staining in normal lung tissues, while it showed severe staining in lung adenocarcinoma and squamous cell carcinoma tissue samples. Kaplan-Meier survival analysis showed that the overall survival of lung adenocarcinoma patients (239 cases) with high ALDOA expression was worse than that of patients with low ALDOA expression (239 cases) ( P < 0.001), and there was no statistically significant difference in disease-free survival between the two groups ( P = 0.140). There was no statistically significant difference in overall survival and disease-free survival between patients with high expression (241 cases) and low expression (241 cases) of ALDOA in lung squamous cell carcinoma (both P > 0.05). TIMER 2.0 database analysis shows that in lung adenocarcinoma, the expression of ALDOA at transcription level was negatively correlated with the levels of activated mast cells ( Rho = -0.209) and memory B cells ( Rho = -0.133), and positively correlated with the levels of resting mast cells ( Rho = 0.210) and resting natural killer cells ( Rho = 0.110), with statistically significant differences (all P < 0.05). In lung squamous cell carcinoma, the expression of ALDOA at transcription level was negatively correlated with the levels of activated mast cells ( Rho = -0.105), memory B cells ( Rho = -0.213) and CD8 + T cells ( Rho = -0.148), and positively correlated with the levels of resting mast cells ( Rho = 0.173), plasma B cells ( Rho = 0.174) and resting natural killer cells ( Rho = 0.136), with statistically significant differences (all P < 0.05). In NSCLC tissues, the expression of ALDOA at transcription level was negatively correlated with PD-L1 ( R = -0.11), interleukin (IL)-2 ( R = -0.31), IL-4 ( R = -0.14), IL-5 ( R = -0.10), IL-6 ( R = -0.12), and IL-10 ( R = -0.24) levels (all P < 0.001), positively correlated with MMP-9 ( R = 0.11) and VEGF ( R = 0.18) levels (both P < 0.001), and positively correlated with IL-9 ( R = 0.11) and VEGF ( R = 0.18) levels (both P < 0.001), but it was not correlated with IL-17 level ( R = -0.02, P = 0.540). Conclusions:The expression level of ALDOA is elevated in NSCLC tissues, and high ALDOA level in lung adenocarcinoma may indicate poor survival of patients. ALDOA may affect the levels of immune cell infiltration, tumor markers and inflammatory factors in TME, and it may be a potential biomarker for prognosis.

BACKGROUND:Intervertebral disc degeneration is an important cause of low back pain.At present,there are many modeling methods for disc degeneration in China and abroad,but there is not a model for low back pain due to disc degeneration. OBJECTIVE:To compare the effect of mechanical puncture combined with tumor necrosis factor α and complete Freund's adjuvant with a conventional disc mechanical puncture alone. METHODS:A total of 18 male adult Sprague-Dawley rats were randomly divided into 3 groups,with 6 animals in each group.No treatment was given in the blank group.Animal models of intervertebral disc degeneration were made in the L4-5 segments of rats in the control using conventional mechanical puncture.In the experimental group,on the basis of mechanical puncture,tumor necrosis factor α+complete Freund's adjuvant was injected into the L4-5 intervertebral discs using a microinjector to establish a model of disc degeneration induced by mechanical puncture combined with inflammatory factors.Four weeks after surgery,the pain threshold of rats was measured by the hot plate method for assessing the perception of heat injury in rats with intervertebral disc degeneration.MRI examination was performed to observe the disc degeneration in each group.ELISA was used to detect the levels of serum tumor necrosis factor α,interleukin 1β,interleukin 6 and prostaglandin E2.Hematoxylin-eosin and Safranin O-fast green staining were used to observe the morphological changes of the disc. RESULTS AND CONCLUSION:In terms of pain,the behavioral pain threshold of the experimental group was continuously decreased,and the levels of serum inflammatory factors were significantly higher compared with the control group.In terms of morphology,the MRI results showed that the L4-5 nucleus pulposus signal completely disappeared in the experimental group.Histopathological results showed that in the control group,the nucleus pulposus was intact,more notochord cells were visible,and some fiber rings were ruptured,while in the experimental group,there are fewer notochord cells and the structure of the nucleus pulposus and fibrous ring is disturbed,with the boundary disappearing.To conclude,mechanical puncture combined with tumor necrosis factor alpha and complete Freund's adjuvant can successfully establish a discogenic low back pain model in rats.This operation is simple and economical to achieve obvious disc degeneration and low back pain,with greatly shortened molding cycle.This model can be used as a reference for studying discogenic low back pain models.

Objective:Immune checkpoint inhibitors have a high remission rate in the preoperative application of resectable and potentially resectable non-small cell lung cancer when combined with chemotherapy. For the unresectable stage Ⅲ non-small cell lung cancer, whether the transformation can be achieved through this regimen to provide opportunities for surgical resection is controversial. In this study, we evaluated the pattern of transformation therapy by reviewing the efficacy and safety of preoperative therapy and surgery of this group.Methods:A review of 23 patients undergoing surgical resection after transformation therapy by preoperative immunotherapy combined chemotherapy between November 2019 and November 2021 was performed. All patients must clarify the pathological diagnosis of non-small cell lung cancer by biopsy. After the multi-disciplinary treatment team and preoperative imaging assessment, the diagnosis should be consistent with unresectable stage III as described in the Expert Consensus on Multidisciplinary Management of Stage Ⅲ Non-Small Cell Lung Cancer, 2019 Edition. After 2 to 4 cycles of preoperative anti-PD-1 monoclonal antibody combined with chemotherapy, the surgical team assessed the chance of resection and performed surgery. Important indicators such as surgical resection rate, R0 resection rate, MPR, pCR, incidence of grade 3-5 adverse reactions and various other perioperative data were counted.Results:In the whole group, initial imaging evaluation was 10 of stage cⅢA and 13 of stage cⅢB.15 cases had multiple stations N2 lymph nodes metastasis, 9 had enlarged fused N2 lymph nodes metastasis, 6 had large vessel invasion(T4), and 1 had contralateral mediastinal lymph node metastasis(N3). After preoperative neoadjuvant therapy, 17 cases achieved PR, 3 achieved SD and 3 achieved PD. The surgical resection rate of the whole group was 91.3%(21/23, 1 lobectomy combined with superior vena cava reconstruction, 2 sleeve lobectomy, 5 pneumonectomy, 12 lobectomy/combined lobectomy, 1 wedge resection and 2 unresectable cases), R0 resection rate was 95.2%(20/21). MPR was achieved in 13 cases, 8 of them reached pCR. There were no perioperative deaths, median surgical time was 260(190-460) min, median bleeding volume was 100(50-750) ml, median drainage time was 5(3-9) days, and median hospitalization was 7(5-11) days. Two cases got immunotherapy-related grade 3 adverse reactions, one was interstitial pneumonia and the other was immune-related injury involving the eye, oral and genital mucosa. Two cases got surgical complications and one was persistent lung leakage, which stopped after 46 days of conservative treatment; The other was pleural effusion, which was relieved after drainage.Conclusion:For the unresectable stage Ⅲ NSCLC, immunotherapy combined chemotherapy is an effective preoperative downstage method. It can convert 91.3% cases to resectable ones while achieving a good degree of pathological remission. Its side reactions are generally controllable and safety.

AIM: To observe the effect ofacacia honey (AH) on serum uric acid level and renal function in potassium oxonate modelrats after drinking AH aqueous solution. METHODS: Sixty male SD rats were selected and randomly divided into control group (CON group), potassium oxonate model group (OA model group), 10% fructose group (10% F group) and different concentration honey groups (25%, 12.5% and 6.25% AH groups). All rats were fed with normal diet.The rats in CON group were subcutaneously injected with 5% sodium carboxymethyl cellulose (CMC-Na) solution and drunk sterile water every day, while rats in other groups were injected with 100 mg / kg OA solution suspended with 5% CMC-Na subcutaneouslyand drunksterile water orfructose solution or AH solution of different concentrations every day. Before and during the 4-week test, rats were weighed and blood was taken once a week. At the end of test, urine and feces specimens or kidney tissues were collected and blood was taken from the abdominal aorta. The uric acid content in blood, urine, and feces and the levels of serum creatinine (Cre) and blood urea nitrogen (BUN) or inflammatory factors in kidney tissues were measured. Renal function and histology were evaluated. RESULTS: Compared with CON group, AH could significantly reduce the body weight of rats (P<0.05), increase the kidney organ coefficient, the levels of serum uric acid, and uric acid in urine or feces, and reduce the level of fecal uric acid (FUA) in rats. AH can down regulate the level of tumor necrosis factor alpha (TNF-a) (P< 0.05) and up regulate the expression of monocyte chemoattractant protein 1 (MCP-1) and transforming growth factor β - 1 (TGF - β1) in rats kidneys; AH can cause slight to mild dilatation of renal tubules and mild to moderate basophilic lesions of renal rubules in rat kidney in a dose dependent manner. CONCLUSION: In the doses rang of present study, AH can cause hyperuricemia, renal tubular dilatation and basophilic lesions, and lead to renal function damage in rats.

The morbidity and mortality of lung cancer are always at the forefront of malignant tumors. To improve the therapeutic effects and overall survival of lung cancer patients is one of the key areas both in clinical medicine and basic research. With the development of precision medicine, targeted treatment based on the characteristics of DNA mutation and immunotherapy targeting PD-1/PD-L1, CTLA-4 and other pathways have promoted the progress of the overall diagnosis and treatment level of lung cancer, which has been widely used in clinical practice. While making the continuous achievements in the above fields, the researchers committed to lung cancer research are gradually shifting their attention to the exploration of RNA level. Some results have been accumulated in the effects of RNA epigenetic modifications on the biological behavior of lung cancer. N6-methyladenosine(m6A) is the most abundant form of mRNA methylation. The dysfunction of m6A modification mediated by related regulatory proteins has been reported to play an important role in the development and progression of lung cancer. This paper focuses on the detection methods of m6A modification, related regulatory proteins and their mode of action, and reviews the effects on the onset, diagnosis, treatment and prognosis of lung cancer. The aim is not only to summarize the researchers' latest understanding of the epigenetic regulatory mechanism, but also to provide new perspectives for the early diagnosis, effective drug use and prognosis judgment of lung cancer.

Objective:To investigate the relationship between sarcopenia and early renal dysfunction in elderly patients with type 2 diabetes mellitus(T2DM).Methods:A total of 198 elderly patients with T2DM aged over 60 years undergoing treatment in the Geriatric Department of Beijing Hospital from July 2018 to July 2019 were enrolled in this retrospective case-control study.The estimated glomerular filtration rate(eGFR)is calculated according to the CKD-EPI Cr-Cys formula.Based on the eGFR, the patients were divided into normal renal function group(n=63, in CKD 1 stage)and mild renal dysfunction group(n=135, in CKD 2-3a stage). All subjects underwent physical examination, laboratory examination and dual energy X-ray bone density examination. Results:The age, weight, body mass index, abdominal circumference, serum creatinine, cystatin C, uric acid, diastolic pressure, the proportions of diabetes and hypertension were lower, and the high-density lipoprotein cholesterol, appendicular skeletal muscle mass(ASM)and skeletal muscle mass index(SMI)were higher, in the normal renal function group than in the mild renal dysfunction group( P<0.05 or 0.01). Spearman correlation analysis showed that eGFR was positively correlated with SMI( r=0.343, P<0.01). Logistic regression analysis showed that body weight( OR=1.318, 95% CI: 1.091-1.594), uric acid( OR=1.007, 95% CI: 1.001-1.012), diastolic blood pressure( OR=1.072, 95% CI: 1.033-1.112), years of diabetes( OR=1.075, 95% CI: 1.013-1.142)were risk factors, and the LSM( OR=0.136, 95% CI: 0.047-0.392)and SMI( OR=0.778, 95% CI: 0.703-0.860)were protective factors for the early renal dysfunction in elderly patients with T2DM. Conclusions:Elderly patients with T2DM are often co-existed with sarcopenia.Sarcopenia is associated with early renal dysfunction in elderly patients with T2DM.

With the acceleration of the aging process in China, the incidence rates of coronary heart disease and cerebral infarction have significantly increased.And iodine contrast agent is often used in imaging diagnosis and percutaneous intervention therapy.The contrast medium is filtered from the glomerulus in its original form and is not absorbed by renal tubules.However, the accumulation of iodine contrast medium in the kidney can lead to acute kidney injury.Kidney is one of the most important excretory and endocrine organs in human body.The prevention and treatment of contrast-induced nephropathy(CIN)have been widely concerned.The incidence rate of contrast-induced renal damage is higher and the prognosis is poorer in the elderly than in the non-elderly due to the decline of organ function in the elderly.At present, the mechanism of action for oxygen free radicals in CIN of the elderly is still unclear.This article reviews the researches on the role of oxygen free radical in CIN of the elderly studied by domestic and foreign scholars in recent years.