Objective To explore the differences in therapeutic efficacy and possible mechanism of different routes of administration of fullerene nanoparticles in the treatment of radiation retinopathy.Methods Eight-week-old adult male SD rats were randomly divided into blank group(Control),irradiation group(X-Ray),irradiation+vitreous cavity administration group[X+F(IVT)],irradiation+ocular surface administration group[X+F(OS)],and irradiation+intravenous administration group[X+F(IV)],with 5 rats in each group.The blank group was not treated,the irradiation groups exposed to X-ray irradiation to establish the model,and fullerenol nanoparticles were given to the treatment groups through different routes after irradiation.At 7,14,and 28 d after modeling,body weight and fundus changes were measured to evaluate drug safety,retinal optical coherence tomography(OCT)was used to observe the change in retinal tissue structure,and electroretinography(ERG)was applied for oscillatory potentials(OPs)to evaluate visual function.CD31 immunofluorescence staining was carried out to evaluate retinal endothelial vascular status,and in vivo imaging was utilized to evaluate the accumulation of fullerenol nanoparticles in the eyes.Results The growth curves of body weight demonstrated that fullerenol nanoparticles did not affect the growth and development of rats,with no statistical difference between the treatment groups and the control group.Irradiation resulted in a significant reduction in visual function,decreased amplitudes of a-wave and b-wave,and declined OPs(P<0.01),and significantly increased thicknesses of the ganglion cell layer(GCL)and the inner nuclear layer(INL)in the retinas,as evidenced by OCT(P<0.01),along with a notably absent presence of CD31-positive cells(P<0.01).Notably,the X+F(IVT)group obtained significantly improved visual function after intravitreal administration,effectively maintained thickness of the GCL and INL,and prevention against the loss of CD31-positive cells(P<0.01).However,no such effective results were observed in the irradiated groups receiving intravenous either ocular surface administration.In vivo imaging revealed that intravitreal administration maintained high ocular accumulation of fullerene for 96 h,while ocular surface administration sustained these concentrations for only 12 h.Intravenous administration,in contrast,only led to a predominant drug distribution in vascular-rich areas,but reduced ocular accumulation.Conclusion Fullerene nanoparticles possess a therapeutic effect on radiation retinopathy,and the intravitreal administration route demonstrates better efficacy than ocular surface and intravenous administration.

Objective To analyze the influencing factors of feeding intolerance in the patients with se-vere traumatic brain injury(STBI).Methods The clinical data in 96 patients with STBI in this hospital from January 2023 to December 2023 were retrospectively analyzed.The patients were divided into the tolerance group and non-tolerance group according to whether the intolerance developed during the feeding process.The general condiction,laboratory detection,treatment measures and enteral nutrition implementation condition were recorded.The multivariate logistic regression was used to analyze the influencing factors of feeding intol-erance in STBI patients.Results Among 96 patients,43 cases(44.79％)developed the feeding intolerance.The results of univariate analysis showed that GCS score,blood glucose,serum albumin,starting time of en-teral nutrition,sedative drugs use,mechanical ventilation,antacids use,combined use of antibiotics,vasoactive drugs use,mild hypothermia therapy and prone position ventilation were related with the feeding intolerance in STBI patients.The multivariate logistic regression analysis showed that combined use of antibiotics(OR=43.628,P=0.002),use of vasoactive drugs(OR=140.211,P=0.004),delayed initiation of enteral nutrition(OR=44.529,P=0.009),mild hypothermia treatment(OR=439.599,P=0.001)and prone position venti-lation(OR=288.702,P=0.014)were the independent influencing factors of feeding intolerance in STBI pa-tients.Conclusion STBI patients are prone to develop the feeding intolerance.If there is no contraindication,the enteral nutrition should be initiated as early as possible,and the personalized prevention and treatment measures aiming at various influencing factors should be formulated.

Objective:To analyze the revision strategies for failed atlantoaxial dislocation (AAD) surgery.Methods:A retrospective analysis was conducted on 145 patients who underwent revision surgery for AAD at the General Hospital of Southern Theatre Command of PLA between September 2009 and December 2023. The cohort included 74 males and 71 females, with a mean age of 43±16 years (range, 6-72 years). The initial surgical approaches were: anterior 31 cases, posterior 114 cases. Based on imaging assessments of immediate postoperative reduction and fusion status prior to revision, the cases of failure were classified into reduction-nonfusion type (22 cases), nonreduction-fusion type (31 cases), and nonreduction-nonfusion type (92 cases). Among the nonreduction-nonfusion cases, 39 had initial surgery with internal fixation for reduction, while 53 had initial surgery with simple decompression (posterior arch resection, foramen magnum decompression) without reduction. In the nonreduction-fusion cases, 8 cases had spot fusion and 23 had extensive fusion. Japanese Orthopaedic Association (JOA) scores were compared before and after revision, and complication rates were observed.Results:All patients successfully underwent surgery. The revision approaches included: anterior (anterior fixation and fusion 52 cases, anterior implant removal combined anterior fixation and fusion 4 cases, transoral odontoidectomies 16 cases, anterior implant removal combined transoral odontoidectomy 2 cases), posterior (posterior fixation and fusion 2 cases, posterior implant removal combined posterior fixation and fusion 22 cases), and combined anterior-posterior (posterior implant removal combined anterior fixation and fusion 18 cases, anterior implant removal combined posterior fixation and fusion 25 cases, posterior implant removal combined transoral odontoidectomy 5 cases). Operative time was 254.20±107.63 min (range, 90-660 min), and blood loss was 218.83±172.17 ml (range, 20-800 ml). Except for 3 patients who died due to postoperative complications, all patients were followed up for a duration of 12±11 months (range, 3-60 months). Six patients who failed to achieve bony fusion after the initial revision surgery underwent a second revision due to poor reduction (1 case), infection (1 case), suboptimal implant position (3 cases), and graft nonunion (1 case). All three patients with bony fusion after the initial revision surgery underwent a second revision due to poor reduction. Following the second revision surgery, none of the 9 patients exhibited graft nonunion or spinal cord compression. The 136 successful initial revision cases had a final follow-up JOA score of 14.75±2.00, significantly higher than the preoperative score of 11.93±2.92 ( t=-18.869, P<0.001). Conclusions:Revision surgery for AAD should take into account the immediate postoperative reduction status and fusion status prior to revision. An appropriate revision strategy should be selected to achieve satisfactory reduction and bony fusion.

BACKGROUND: Approximately 40% of individuals with diabetes worldwide are at risk of developing diabetic kidney disease (DKD), which is not only the leading cause of kidney failure, but also significantly increases the risk of cardiovascular disease, causing significant societal health and financial burdens. This study aimed to describe the burden of DKD and explore its cross-country epidemiological status, predict development trends, and assess its risk factors and sociodemographic transitions. METHODS: Based on the Global Burden of Diseases (GBD) Study 2021, data on DKD due to type 1 diabetes (DKD-T1DM) and type 2 diabetes (DKD-T2DM) were analyzed by sex, age, year, and location. Numbers and age-standardized rates were used to compare the disease burden between DKD-T1DM and DKD-T2DM among locations. Decomposition analysis was used to assess the potential drivers. Locally weighted scatter plot smoothing and Frontier analysis were used to estimate sociodemographic transitions of DKD disability-adjusted life years (DALYs). RESULTS: The DALYs due to DKD increased markedly from 1990 to 2021, with a 74.0% (from 2,227,518 to 3,875,628) and 173.6% (from 4,122,919 to 11,278,935) increase for DKD-T1DM and DKD-T2DM, respectively. In 2030, the estimated DALYs for DKD-T1DM surpassed 4.4 million, with that of DKD-T2DM exceeding 14.6 million. Notably, middle-sociodemographic index (SDI) quintile was responsible for the most significant DALYs. Decomposition analysis revealed that population growth and aging were major drivers for the increased DKD DALYs in most regions. Interestingly, the most pronounced effect of positive DALYs change from 1990 to 2021 was presented in high-SDI quintile, while in low-SDI quintile, DALYs for DKD-T1DM and DKD-T2DM presented a decreasing trend over the past years. Frontiers analysis revealed that there was a negative association between SDI quintiles and age-standardized DALY rates (ASDRs) in DKD-T1DM and DKD-T2DM. Countries with middle-SDI shouldered disproportionately high DKD burden. Kidney dysfunction (nearly 100.0% for DKD-T1DM and DKD-T2DM), high fasting plasma glucose (70.8% for DKD-T1DM and 87.4% for DKD-T2DM), and non-optimal temperatures (low and high, 5.0% for DKD-T1DM and 5.1% for DKD-T2DM) were common risk factors for age-standardized DALYs in T1DM-DKD and T2DM-DKD. There were other specific risk factors for DKD-T2DM such as high body mass index (38.2%), high systolic blood pressure (10.2%), dietary risks (17.8%), low physical activity (6.2%), lead exposure (1.2%), and other environmental risks. CONCLUSIONS DKD markedly increased and varied significantly across regions, contributing to a substantial disease burden, especially in middle-SDI countries. The rise in DKD is primarily driven by population growth, aging, and key risk factors such as high fasting plasma glucose and kidney dysfunction, with projections suggesting continued escalation of the burden by 2030.
Humans ; Global Burden of Disease ; Risk Factors ; Male ; Female ; Disability-Adjusted Life Years ; Diabetic Nephropathies/epidemiology* ; Middle Aged ; Diabetes Mellitus, Type 2/epidemiology* ; Adult ; Diabetes Mellitus, Type 1/complications* ; Aged ; Adolescent ; Young Adult ; Quality-Adjusted Life Years

Objective:To analyze the revision strategies for failed atlantoaxial dislocation (AAD) surgery.Methods:A retrospective analysis was conducted on 145 patients who underwent revision surgery for AAD at the General Hospital of Southern Theatre Command of PLA between September 2009 and December 2023. The cohort included 74 males and 71 females, with a mean age of 43±16 years (range, 6-72 years). The initial surgical approaches were: anterior 31 cases, posterior 114 cases. Based on imaging assessments of immediate postoperative reduction and fusion status prior to revision, the cases of failure were classified into reduction-nonfusion type (22 cases), nonreduction-fusion type (31 cases), and nonreduction-nonfusion type (92 cases). Among the nonreduction-nonfusion cases, 39 had initial surgery with internal fixation for reduction, while 53 had initial surgery with simple decompression (posterior arch resection, foramen magnum decompression) without reduction. In the nonreduction-fusion cases, 8 cases had spot fusion and 23 had extensive fusion. Japanese Orthopaedic Association (JOA) scores were compared before and after revision, and complication rates were observed.Results:All patients successfully underwent surgery. The revision approaches included: anterior (anterior fixation and fusion 52 cases, anterior implant removal combined anterior fixation and fusion 4 cases, transoral odontoidectomies 16 cases, anterior implant removal combined transoral odontoidectomy 2 cases), posterior (posterior fixation and fusion 2 cases, posterior implant removal combined posterior fixation and fusion 22 cases), and combined anterior-posterior (posterior implant removal combined anterior fixation and fusion 18 cases, anterior implant removal combined posterior fixation and fusion 25 cases, posterior implant removal combined transoral odontoidectomy 5 cases). Operative time was 254.20±107.63 min (range, 90-660 min), and blood loss was 218.83±172.17 ml (range, 20-800 ml). Except for 3 patients who died due to postoperative complications, all patients were followed up for a duration of 12±11 months (range, 3-60 months). Six patients who failed to achieve bony fusion after the initial revision surgery underwent a second revision due to poor reduction (1 case), infection (1 case), suboptimal implant position (3 cases), and graft nonunion (1 case). All three patients with bony fusion after the initial revision surgery underwent a second revision due to poor reduction. Following the second revision surgery, none of the 9 patients exhibited graft nonunion or spinal cord compression. The 136 successful initial revision cases had a final follow-up JOA score of 14.75±2.00, significantly higher than the preoperative score of 11.93±2.92 ( t=-18.869, P<0.001). Conclusions:Revision surgery for AAD should take into account the immediate postoperative reduction status and fusion status prior to revision. An appropriate revision strategy should be selected to achieve satisfactory reduction and bony fusion.

OBJECTIVES: Programmed death 1 (PD-1) associated fulminant type 1 diabetes (PFD) is a rare acute and critical in internal medicine, and its clinical characteristics are still unclear. This study aims to analyze the clinical characteristics of PFD patients to improve clinical diagnosis and treatment. METHODS: We retrospectively analyzed the clinical data of 10 patients with PFD admitted to the Second Xiangya Hospital of Central South University, combined with the data of 66 patients reported in the relevant literature, analyzed and summarized their clinical and immunological characteristics, and compared the patients with PFD with different islet autoantibody status. RESULTS: Combined with our hospital and literature data, a total of 76 patients with PFD were reported, with the age of (60.9±12.1) years old, 60.0% male and body mass index of (22.1±5.2) kg/m2. In 76 patients, the most common tumors were lung cancer (43.4%) and melanoma (22.4%). Among PD-1 inhibitors, the most common drugs are nivolumab (37.5%) and pembrolizumab (38.9%). 82.2% of PFD patients developed diabetes ketoacidosis. The median onset time from PD-1 related inhibitor treatment to hyperglycemia was 95 (36.0, 164.5) d, and the median treatment cycle before the onset of diabetes was 6 (2.3, 8.0) cycles. 26% (19/73) of PFD patients had positive islet autoantibodies, and the proportion of ketoacidosis in the positive group was significantly higher than that in the negative group (100.0% vs 75.0%, P<0.05). The onset time and infusion times of diabetes after PD-1 inhibitor treatment in the autoantibody positive group were significantly lower than those in the autoantibody negative group (28.5 d vs 120.0 d; 2 cycles vs 7 cycles, both P<0.001). CONCLUSIONS After initiation of tumor immunotherapy, it is necessary to be alert to the occurrence of adverse reactions of PFD, and the onset of PFD with islet autoantibody positive is faster and more serious than that of patients with autoantibodies negative. Detection of islet autoantibodies and blood glucose before and after treatment with PD-1 inhibitors is of great value for early warning and prediction of PFD.
Humans ; Male ; Middle Aged ; Aged ; Female ; Diabetes Mellitus, Type 1 ; Programmed Cell Death 1 Receptor ; Immune Checkpoint Inhibitors/therapeutic use* ; Retrospective Studies ; Ketosis ; Autoantibodies

Objective:To evaluate the preliminary clinical application of our self-designed posterior reduction forceps for atlantoaxial dislocation in the reduction and fixation of irreducible atlantoaxial dislocation with simple posterior screw-rod system.Methods:Our posterior reduction forceps was self-designed and developed to assist simple posterior screw-rod system in the treatment of irreducible atlantoaxial dislocation based on the posterior atlantoaxial screw-rod system. A retrospective study was conducted to analyze the clinical data of 5 patients with irreducible atlantoaxial dislocation who had been treated from January 2021 to October 2022 at Department of Spine Surgery, General Hospital of Southern Theatre Command of PLA with our self-designed posterior reduction forceps. There were 2 males and 3 females, aged 53, 62, 45, 32 and 48 years, respectively. Diagnosis: 1 case of free odontoid process combined with atlantoaxial dislocation, 2 cases of atlantoaxial dislocation, and 2 cases of old odontoid process fracture combined with atlantoaxial dislocation. Respectively, their preoperative Japanese Orthopaedic Association (JOA) scores were 9, 11, 12, 13 and 10 points and their atlanto-dental intervals (ADI) 9.8, 7.4, 6.6, 6.4 and 8.5 mm. Postoperatively, atlantoaxial reduction and spinal cord compression were evaluated by X-ray, CT, and MRI examinations, and internal fixation, atlanto-axial sequence, and bone graft fusion by X-ray and CT examinations. One week after surgery, the JOA scores were used to evaluate the patients' neurological function and the ADI was measured to evaluate the atlantoaxial reduction.Results:The surgery was successfully performed in the 5 patients, with no intraoperative complications like neurovascular injuries to the spinal cord. The postoperative atlantoaxial reduction was satisfactory, the position of internal fixation was good, the compression to the spinal cord was relieved, and the clinical symptoms were significantly improved. At 1 week after surgery, respectively, the JOA score: 13, 14, 14, 15 and 13; the ADI: 2.6, 2.1, 1.8, 1.5 and 2.2 mm; the follow-up time: 3, 6, 12, 9 and 6 months; the bone fusion time: 3, 3, 6, 6 and 3 months. Follow-ups revealed no loosening or fracture of internal fixation, good atlanto-axial sequence, and no recurrence of dislocation.Conclusion:Our self-designed posterior reduction forceps for atlantoaxial dislocation can assist the simple posterior screw-rod system to treat irreducible atlantoaxial dislocation, leading to good preliminary clinical outcomes.

Objective:To investigate and understand current status of radiotherapy resources in the Association of Southeast Asian Nations (ASEAN) and analyze the radiotherapy needs of ASEAN countries, aiming to provide suggestions for China's radiotherapy technology international assistance work.Methods:We created a database of 10 ASEAN countries using open-source data, including data on population size, per capita gross national income, new cancer cases, and radiotherapy equipment (megavolt units). We also estimated the number of cases requiring radiotherapy and the demand for radiotherapy equipment. Descriptive statistics were used to present aggregate data and national data.Results:In 2020, the number of new cancer cases in ASEAN countries was 1.0992 million, and the estimated total number of cancer patients requiring radiotherapy was 700 300. The number of radiotherapy equipment required was 1 406. At present, the actual number of radiotherapy equipment in ASEAN countries is 564, and there is a certain gap between the existing radiotherapy resources in some ASEAN countries and the actual needs of cancer patients in their own countries. In 2040, the estimated number of new cancer cases in ASEAN countries will be 1.803 million, and the estimated total number of cancer patients who need radiotherapy in ASEAN countries will be 1.141 2 million. The number of required radiotherapy equipment will be 2 287. By 2040, the growth rate of radiation therapy equipment demand in ASEAN countries will be 305%, and all ASEAN countries need to allocate more radiotherapy resources to cope with the increase in the number of cancer patients and radiotherapy demand.Conclusions:ASEAN countries have a huge demand for radiotherapy in the next two decades, while there are significant differences among different countries. China's precision radiotherapy science and technology have huge potential for ASEAN countries. Radiotherapy science and technology international assistance work based on the needs of ASEAN countries will help China's radiotherapy continue to exert influence and promote the health and well-being of people in ASEAN countries.

OBJECTIVE: To explore the genetic basis for a Chinese pedigree affected with genetic epilepsy with febrile seizures plus (GEFS+). METHODS: Clinical data of the proband and his family members were collected. Following extraction of genomic DNA, the proband was subjected to high-throughput sequencing. Candidate variant was verified by Sanger sequencing of the proband and other family members. RESULTS: The pedigree, including 6 patients with febrile seizures from 3 generations, was diagnosed with typical GEFS+. Among them, 2 had febrile seizures (FS), 1 had febrile seizures plus (FS+), and 3 had febrile seizures with focal seizures. High-throughput sequencing revealed that the proband has carried a heterozygous missense variant of c.4522T>A (p.Tyr1508Asn) of the SCN1A gene. Sanger sequencing confirmed that other five patients and one normal member from the pedigree have also carried the same variant, which yielded a penetrance of 85.7%. CONCLUSION The c.4522T>A (p.Tyr1508Asn) of the SCN1A gene probably underlay the disease in this pedigree. The pattern of inheritance was consistent with autosomal dominant inheritance with incomplete penetrance. Above finding has enriched the variant spectrum of the SCN1A gene.
Epilepsy/genetics* ; Humans ; NAV1.1 Voltage-Gated Sodium Channel/genetics* ; Pedigree ; Phenotype ; Seizures, Febrile/genetics*

Objective:To explore the occupational stress status and influencing factors of workers in a textile factory in Zhejiang Provice.Methods:In October 2018, 505 workers from a textile factory in Zhejiang Province were selected as research objects by convenient sampling method. A total of 505 questionnaires were distributed, 495 of which were effective and the effective recovery rate was 98.0%. Job Content Questionnaire (JCQ) and Effort Reward Imbalance Questionnaire (REI) were used to investigate textile workers' occupational stress and analyze its influencing factors. The differences of the composition ratio of different groups were tested by χ 2 test. The influencing factors such as age, gender and occupation on occupational stress were analyzed by multivariate logistic regression. Results:ERI analysis results showed that the high and low occupational stress accounted for 30.1% and 69.9%, respectively. The differences of occupational stress among workers of different job types and working ages were statistically significant ( P<0.05) . The detection rates of high occupational stress of paper workers and spinners were 47.8% (11/23) and 44.8% (30/67) , respectively, higher than other jobs. The detection rate of high occupational stress for workers with more than 5 years of service was 46.4% (13/28) . The results of JCQ analysis showed that there was no statistical significance in the differences of daily working hours and length of service between different gender, education levels, types of work patterns, and occupational stress ( P>0.05) . Job types had significant effects on the occupational stress defined by ERI ( P<0.05) , the risk of occupational stress was 2.151 times than that of the coiler. Conclusion:There are significant differences in occupational stress risk among workers of different types of work in textile industry, so different measures should be taken to prevent and control occupational stress in different jobs.