Objective To investigate the efficacy and safety of spinal endoscopic decompression through 45° puncture foraminal approach in treatment of L5/S1 lumbar disc herniation(LDH).Methods Clinical data of 130 patients with L5/S1 level LDH from January 2021 to January 2023 were retrospectively analyzed.These patients were divided into two groups based on the spinal endoscopic surgery approach.Observation group(67 patients)underwent spinal endoscopic decompression via 45° puncture,while the control group(63 patients)underwent spinal endoscopic decompression using the traditional transforaminal endoscopic spinal system(TESSYS)technique.Perioperative indicators such as operation time,X-ray fluoroscopy time,and hospital stay were recorded for both groups.Visual analogue scale(VAS)scores for low back pain and lower limb pain,as well as the Oswestry disability index(ODI)were assessed before surgery and at 1 day,3 months,6 months,and 12 months after operation.The overall efficacy was evaluated using the modified MacNab criterion at 12 months postoperatively.Results All the patients in both groups successfully underwent spinal endoscopic decompression.The observation group had significantly shorter average operation time and intraoperative X-ray fluoroscopy time compared to the control group,the differences were statistically significant(P＜0.05).There was no significant difference in hospital stay between the two groups(P=0.505).Compared to preoperative values,both groups showed a significant decreasing trend in VAS scores for low back pain,lower limb pain,and ODI at 1 day,3 months,6 months,and 12 months after operation,the differences were statistically significant(P＜0.05).The observation group had significantly low back pain VAS score,lower limb pain VAS score and ODI at 1 day and 3 months after operation compared to the control group(P＜0.05).There were no statistically significant differences in low back pain VAS score,lower limb pain VAS score and ODI between the two groups 6 and 12 months after operation(P＞0.05).At 12 months after operation,the excellent and good rate was 95.5％ in observation group and 85.7％ in control group,with no significant difference between the two groups(P=0.054).No surgery-related complications occurred in either group.During postoperative follow-up,6 patients(9.5％)in control group experienced recurrence of low back pain and lower limb pain due to recompression of nerve roots by residual herniated material,while no recurrence was observed in observation group,the difference was statistically significant(P=0.035).Conclusion Both the 45° puncture technique and the traditional TESSYS technique can achieve satisfactory decompression effects in patients with LDH at the L5/S1 segment undergoing transforaminal spinal endoscopic decompression surgery.However,the 45° puncture technique can shorten the operation time and X-ray fluoroscopy time,resulting in more pronounced early postoperative improvement and a lower recurrence rate.It is worthy clinical application.

Most cancers are currently incurable, partly due to abnormal post-translational modifications (PTMs). In this study, we initially used multiple myeloma (MM) as a working model and found that SUMOylation activating enzyme subunit 1 (SAE1) promotes the malignancy of MM. Through proteome microarray analysis, SAE1 was identified as a potential target for bioactive colcemid or its derivative colchicine. Elevated levels of SAE1 were associated with poor clinical survival and increased MM proliferation in vitro and in vivo. Additionally, SAE1 directly SUMOylated and upregulated the total protein expression of p27, leading to LLPS-mediated nuclear export of p27. Our study also demonstrated the involvement of SAE1 in other types of cancer cells, and provided the first monomer crystal structure of SAE1 and its key binding model with colchicine. Colchicine also showed promising results in the Patient-Derived Tumor Xenograft (PDX) model. Furthermore, a controlled clinical trial with 56 MM patients demonstrated the clinical efficacy of colchicine. Our findings reveal a novel mechanism by which tumor cells evade p27-induced cellular growth arrest through p27 SUMOylation-mediated nuclear export. SAE1 may serve as a promising therapeutic target, and colchicine may be a potential treatment option for multiple types of cancer in clinical settings.

Objective To explore the clinical characteristics of children with bloodstream infections caused by Klebsiella pneumoniae(KP),analyze the high-risk factors for developing carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection and poor prognosis.We hope to provide clinical evidence for reducing carbapenem-resistant strains and improving prog-nosis.Methods Clinical data of children with blood cultures confirmed KP infection admitted to the Department of Pediatrics,Pediatric Surgery,PICU,and NICU of Shanghai Jiao Tong University School of Medicine Affiliated Xinhua Hospital from 2016 to 2022 were collected.Based on antibiotics sensitivity results and prognosis,the patients were divided into CRKP and non-CRKP infection groups,good prognosis(recovered or improved)and bad prognosis(death or withdrawing treatment)groups.Clinical characteristics,laboratory tests,and risk factors were compared between these groups.Results Among 177 blood culture samples positive for KP,97 strains(54.8％)were found to be CRKP.Logistic regression analysis suggests a histo-ry of surgery during hospitalization(OR=2.678,95％CI:1.248-5.746,P=0.011),mechanical assisted ventilation(OR=2.774,95％CI:1.235-6.229,P=0.017),hospital stay≥25 days(OR=3.467,95％CI:1.431-8.401,P=0.006),platelet count≥237 × 109/L(OR=3.005,95％CI:1.268-7.124,P=0.012),and mean platelet volume(MPV)≥12fL(OR=3.011,95％CI:1.140-7.955,P=0.026)were possible risk factors for CRKP bloodstream infection.Mechanical assisted venti-lation(OR=2.819,95％CI:1.138-6.985,P=0.025),platelet count＜149 × 109/L(OR=0.238,95％CI:0.079-0.717,P=0.011)were possible risk factors for poor prognosis in pediatric patients.Conclusion The antibiotic resistance rate of KP blood-stream infection is high and shows an increasing trend.In KP blood stream infection children,hospital stay longer than 25 days,surgery history,mechanical assisted ventilation,platelet count≥237 × 109/L and MPV≥12 fL are at high risk for CRKP in-fection.CRKP infection is not a risk factor for bad prognosis,however,KP blood stream infection children with platelet count＜149 × 109/L and mechanical assisted ventilation high-risk factors for CRKP bloodstream infection are at risk for bad progno-sis.Special attention and timely intervention should be paid to these patients.

Objective To explore the clinical characteristics of children with bloodstream infections caused by Klebsiella pneumoniae(KP),analyze the high-risk factors for developing carbapenem-resistant Klebsiella pneumoniae(CRKP)bloodstream infection and poor prognosis.We hope to provide clinical evidence for reducing carbapenem-resistant strains and improving prog-nosis.Methods Clinical data of children with blood cultures confirmed KP infection admitted to the Department of Pediatrics,Pediatric Surgery,PICU,and NICU of Shanghai Jiao Tong University School of Medicine Affiliated Xinhua Hospital from 2016 to 2022 were collected.Based on antibiotics sensitivity results and prognosis,the patients were divided into CRKP and non-CRKP infection groups,good prognosis(recovered or improved)and bad prognosis(death or withdrawing treatment)groups.Clinical characteristics,laboratory tests,and risk factors were compared between these groups.Results Among 177 blood culture samples positive for KP,97 strains(54.8％)were found to be CRKP.Logistic regression analysis suggests a histo-ry of surgery during hospitalization(OR=2.678,95％CI:1.248-5.746,P=0.011),mechanical assisted ventilation(OR=2.774,95％CI:1.235-6.229,P=0.017),hospital stay≥25 days(OR=3.467,95％CI:1.431-8.401,P=0.006),platelet count≥237 × 109/L(OR=3.005,95％CI:1.268-7.124,P=0.012),and mean platelet volume(MPV)≥12fL(OR=3.011,95％CI:1.140-7.955,P=0.026)were possible risk factors for CRKP bloodstream infection.Mechanical assisted venti-lation(OR=2.819,95％CI:1.138-6.985,P=0.025),platelet count＜149 × 109/L(OR=0.238,95％CI:0.079-0.717,P=0.011)were possible risk factors for poor prognosis in pediatric patients.Conclusion The antibiotic resistance rate of KP blood-stream infection is high and shows an increasing trend.In KP blood stream infection children,hospital stay longer than 25 days,surgery history,mechanical assisted ventilation,platelet count≥237 × 109/L and MPV≥12 fL are at high risk for CRKP in-fection.CRKP infection is not a risk factor for bad prognosis,however,KP blood stream infection children with platelet count＜149 × 109/L and mechanical assisted ventilation high-risk factors for CRKP bloodstream infection are at risk for bad progno-sis.Special attention and timely intervention should be paid to these patients.

Objective To investigate the efficacy and safety of spinal endoscopic decompression through 45° puncture foraminal approach in treatment of L5/S1 lumbar disc herniation(LDH).Methods Clinical data of 130 patients with L5/S1 level LDH from January 2021 to January 2023 were retrospectively analyzed.These patients were divided into two groups based on the spinal endoscopic surgery approach.Observation group(67 patients)underwent spinal endoscopic decompression via 45° puncture,while the control group(63 patients)underwent spinal endoscopic decompression using the traditional transforaminal endoscopic spinal system(TESSYS)technique.Perioperative indicators such as operation time,X-ray fluoroscopy time,and hospital stay were recorded for both groups.Visual analogue scale(VAS)scores for low back pain and lower limb pain,as well as the Oswestry disability index(ODI)were assessed before surgery and at 1 day,3 months,6 months,and 12 months after operation.The overall efficacy was evaluated using the modified MacNab criterion at 12 months postoperatively.Results All the patients in both groups successfully underwent spinal endoscopic decompression.The observation group had significantly shorter average operation time and intraoperative X-ray fluoroscopy time compared to the control group,the differences were statistically significant(P＜0.05).There was no significant difference in hospital stay between the two groups(P=0.505).Compared to preoperative values,both groups showed a significant decreasing trend in VAS scores for low back pain,lower limb pain,and ODI at 1 day,3 months,6 months,and 12 months after operation,the differences were statistically significant(P＜0.05).The observation group had significantly low back pain VAS score,lower limb pain VAS score and ODI at 1 day and 3 months after operation compared to the control group(P＜0.05).There were no statistically significant differences in low back pain VAS score,lower limb pain VAS score and ODI between the two groups 6 and 12 months after operation(P＞0.05).At 12 months after operation,the excellent and good rate was 95.5％ in observation group and 85.7％ in control group,with no significant difference between the two groups(P=0.054).No surgery-related complications occurred in either group.During postoperative follow-up,6 patients(9.5％)in control group experienced recurrence of low back pain and lower limb pain due to recompression of nerve roots by residual herniated material,while no recurrence was observed in observation group,the difference was statistically significant(P=0.035).Conclusion Both the 45° puncture technique and the traditional TESSYS technique can achieve satisfactory decompression effects in patients with LDH at the L5/S1 segment undergoing transforaminal spinal endoscopic decompression surgery.However,the 45° puncture technique can shorten the operation time and X-ray fluoroscopy time,resulting in more pronounced early postoperative improvement and a lower recurrence rate.It is worthy clinical application.

Objective To investigate the efficacy of transjugular intrahepatic portosystemic shunt(TIPS)in preventing rebleeding in patients with hepatocellular carcinoma(HCC)comorbid with esophagogastric variceal bleeding and the influencing factors for prognosis.Methods A retrospective analysis was performed for the clinical data of 35 HCC patients comorbid with esophagogastric variceal bleeding who were admitted to Zengcheng Branch of Nanfang Hospital,Southern Medical University,and were treated with TIPS from July 2019 to April 2023.The Kaplan-Meier curve was used to assess rebleeding rate and survival rate after TIPS,and the Cox regression model was used to investigate the influencing factors for postoperative rebleeding and survival.Results The TIPS procedure was technically successful in all patients,with a median follow-up time of 16.4 months.During follow-up,11 patients(31.4%)experienced esophagogastric variceal rebleeding,with the 1-month,3-month,and 1-year rebleeding rates of 5.7%,17.1%,and 28.6%,respectively.White blood cell count(WBC)(risk ratio[HR]=1.31,95%confidence interval[CI]:1.04-1.64,P=0.021),number of tumors≥3(HR=35.68,95%CI:1.74-733.79,P=0.021),and portal pressure gradient before TIPS(HR=0.85,95%CI:0.73-0.99,P=0.032)were independent predictive factors for rebleeding after TIPS.Shunt dysfunction was observed in 5 patients after surgery.A total of 19 patients died during follow-up,with a median survival time of 9.6 months.Portal vein tumor thrombosis(PVTT)(HR=7.04,95%CI:1.31-37.78,P=0.023),total bilirubin(TBil)(HR=1.02,95%CI:1.00-1.03,P=0.042),and serum albumin(HR=0.82,95%CI:0.72-0.94,P=0.004)were independent predictive factors for survival after TIPS.Conclusion TIPS procedure can be used as a therapeutic option to prevent esophagogastric variceal rebleeding in patients with HCC.Patients with a relatively high level of WBC or TBil or those with PVTT tend to have a poorer prognosis,and the application of TIPS treatment in such patients should be determined with caution.

Objective:To investigate the effect of lateral tibial periosteum distraction on diabetic foot and vasculitis foot.Methods:A retrospective analysis of 13 patients (16 feet) who received lateral tibial periosteal distraction between June 2019 and May 2020 were included in the study. 9 males and 4 females; aged 39-77 years (average 66 years); left foot 7 cases, right foot 9 cases. 5 cases were patients with diabetic foot, 1 case was diabetic foot with arteriosclerosis obliterans, 2 cases were thromboembolic vasculitis, and 5 cases were arteriosclerosis obliterans. The tibial periosteum was dissected and a distraction device was placed. In the 3 patients with foot ulcers, tibial periosteum distraction devices were placed on the severer side. The periosteal distraction began on the third day after surgery, about 0.75 mm/d, the adjustment was done usually in two weeks. Two weeks later, the stretch plate was removed surgically. The followings were evaluated: visual analogue scale (VAS) pain score, foot peripheral oxygen saturation, foot capillary filling test, lower extremity arterial CT angiography (CTA), etc.Results:All 13 patients were followed up for 2-12 weeks, with an average of 3.85 weeks. VAS pain score: the average pain score of 13 patients with preoperative foot pain was 5.31±1.84 (range, 2-9) points, and 2 weeks after surgery, the average value was 2.46±1.39 (range, 1-6) points with statistical significance ( t=6.124, P<0.001) ; peripheral foot oxygen saturation: the average preoperative blood oxygen saturation of 12 patients was 87.83%±14.83% (range, 50%-98%), 1 patient was not detected before surgery, and 2 weeks after operation, the average blood oxygen saturation was 92.33%±7.91% (range, 75%-99%). There was no significant difference between them ( t=1.124, P=0.285). The foot skin temperature of 10 patients was 35.68±0.85 ℃ (range, 34.00-36.60 ℃) before surgery and 36.23±0.46 ℃ (range, 35.50-36.90 ℃) after surgery, and the difference was statistically significant ( t=3.197, P=0.008) . Capillary filling test: 2 weeks after operation, the capillary filling response was significantly improved. All 13 patients had improved CTA of both lower extremity arteries before operation, and 11 patients had CTA taken back after two weeks of operation. Compared with preoperative CTA, new vascular network was found in the operation limb. In addition to 1 patient with thromboangiitis obliterans (mainly suffering from foot pain, no wound symptoms), 2 of 12 patients with heart failure, renal failure and other basic diseases did not heal, and the wounds of the other 10 patients had improved significantly 1 month later. Conclusion:Lateral tibia periosteum distraction can be used to treat chronic ischemic diseases of lower extremities with satisfactory postoperative results.

According to the practical problems including uneven distribution of medical resources in border areas , the difficulty of medical treatment for grass-roots unit, the low efficiency of referral between hospitals , and untimely mastery of health conditions of offi-ciers and soldiers , we constructed and developed a telemedicine information system based on hospital medical database with the backig of military integrated information network platform .A joint regional service platform among hospitals was constructed to realize high efficien -cy of medical referrals for officers and soldiers , computerization of personal medical information transmission , digitalization of health re-cords management , and paperless medical audit .The system provides convenient and high quality health care services , improves the level and efficiency of medical service , and enhances the ability of medical support to the troops by informationization .

OBJECTIVETo investigate the clinical and laboratory features of very long chain acyl-CoA dehydrogenase deficiency ( VLCADD ) and the correlations between its genotype and phenotype.

METHODEleven patients diagnosed as VLCADD of Shanghai Jiaotong University School of Medicine seen from September 2006 to May 2014 were included. There were 9 boys and 2 girls, whose age was 2 d-17 years. Analysis was performed on clinical features, routine laboratory examination, and tandem mass spectrometry (MS-MS) , gas chromatography mass spectrometry (GC-MS) and genetic analysis were conducted.

RESULTAll cases had elevated levels of blood tetradecanoylcarnitine (C14:1) recognized as the characteristic biomarker for VLCADD. The eleven patients were classified into three groups: six cases in neonatal onset group, three in infancy onset group form patients and two in late onset group. Neonatal onset patients were characterized by hypoactivity, hypoglycemia shortly after birth. Infancy onset patients presented hepatomegaly and hypoglycemia in infancy. The two adolescent patients showed initial manifestations of exercise intolerance or rhabdomyolysis. Six of the eleven patients died at the age of 2-8 months, including four neonatal onset and two infant onset patients, with one or two null mutations. The other two neonatal onset patients were diagnosed since early birth through neonatal screening and their clinical manifestation are almost normal after treatments. Among 11 patients, seventeen different mutations in the ACADVL gene were identified, with a total mutation detection rate of 95.45% (21/22 alleles), including eleven reported mutations ( p. S22X, p. G43D, p. R511Q, p. W427X, p. A213T, p. C215R, p. G222R, p. R450H, p. R456H, c. 296-297delCA, c. 1605 + 1G > T) and six novel mutations (p. S72F, p. Q100X, p. M437T, p. D466Y, c. 1315delG insAC, IVS7 + 4 A > G). The p. R450H was the most frequent mutation identified in three alleles (13.63%, 3/22 alleles), followed by p. S22X and p. D466Y mutations which were detected in two alleles (9.09%, 2/22 alleles).

CONCLUSIONThe ACADVL gene mutations were heterozygous in our patients. The mortality of neonatal onset form and infant onset form is much higher than the late onset form patients, suggesting a certain correlation between the genotype and phenotype was found. The earlier diagnosis and treatment of VLCADD are of vital importance for the improvement of the prognosis of the patients.

Acyl-CoA Dehydrogenase, Long-Chain ; deficiency ; genetics ; Adolescent ; Age of Onset ; Alleles ; Asian Continental Ancestry Group ; Child ; Child, Preschool ; China ; Female ; Genetic Testing ; Genotype ; Heterozygote ; Humans ; Infant ; Infant, Newborn ; Lipid Metabolism, Inborn Errors ; complications ; genetics ; Male ; Mitochondrial Diseases ; complications ; genetics ; Muscular Diseases ; complications ; genetics ; Mutation ; Neonatal Screening ; Phenotype ; Prognosis ; Rhabdomyolysis ; etiology ; Spectrum Analysis ; Tandem Mass Spectrometry

Objective To study the effects of High frequency two -way jet ventilation on the function respiratory and circulation of patients with Trachea and Carinal reconstruction.Methods Fifty patients with lung cancer,who were scheduled for elective trachea and carinal reconstruction,were intubated with double lumen tube following anesthesia induction and general anesthesia.High frequency ventilation was used on the healthful main bronchus during carinal reconstruction,a Hunsaker tube was inserted 3cm into the healthful main bronchus.HFTJV was applied with the respiratory rate of 120 /min,the ratio of inspiration and expiration E =1:1 and drive pressure of 0.2 -0.25Mpa.Blood gas analysis was made before the anesthesia,15 min following one -lung ventilation,10,20, 30 min following HFTJV and 15min following one -lung ventilation,respectively and monitor MAP,HR,SpO2 , PetCO2 .Results PaO2 in high frequency ventilation increased significantly compared with preoperative (78.0 ± 10.5)mmHg,was respectively (161.4 ±10.2)mmHg,(156.0 ±15.7)mmHg,(153.0 ±15.1)mmHg (P <0.01);PaO2 in high frequency ventilation 30min was (153.0 ±15.1)mmHg (P <0.05).It was lower than single lung venti-lation (front 165.50 ±11.3mmHg)and higher than 100mmHg equally;PaCO2 in the high frequency ventilation was slightly increased compared with OLV 30min (front),and the difference was not statistically significant (P >0.05). Conclusion HFTJV is safe and reliable for Trachea and carinal reconstruction.