Approximately 30%-40% of epilepsy patients do not respond well to adequate anti-seizure medications (ASMs), a condition known as pharmacoresistant epilepsy. The management of pharmacoresistant epilepsy remains an intractable issue in the clinic. Its early prediction is important for prevention and diagnosis. However, it still lacks effective predictors and approaches. Here, a classical model of pharmacoresistant temporal lobe epilepsy (TLE) was established to screen pharmacoresistant and pharmaco-responsive individuals by applying phenytoin to amygdaloid-kindled rats. Ictal electroencephalograms (EEGs) recorded before phenytoin treatment were analyzed. Based on ictal EEGs from pharmacoresistant and pharmaco-responsive rats, a convolutional neural network predictive model was constructed to predict pharmacoresistance, and achieved 78% prediction accuracy. We further found the ictal EEGs from pharmacoresistant rats have a lower gamma-band power, which was verified in seizure EEGs from pharmacoresistant TLE patients. Prospectively, therapies targeting the subiculum in those predicted as "pharmacoresistant" individual rats significantly reduced the subsequent occurrence of pharmacoresistance. These results demonstrate a new methodology to predict whether TLE individuals become resistant to ASMs in a classic pharmacoresistant TLE model. This may be of translational importance for the precise management of pharmacoresistant TLE.
Epilepsy, Temporal Lobe/diagnosis* ; Animals ; Drug Resistant Epilepsy/drug therapy* ; Electroencephalography/methods* ; Rats ; Anticonvulsants/pharmacology* ; Neural Networks, Computer ; Male ; Humans ; Phenytoin/pharmacology* ; Adult ; Disease Models, Animal ; Female ; Rats, Sprague-Dawley ; Young Adult ; Convolutional Neural Networks

Objective:To investigate the efficacy of percutaneous vertebroplasty through unilateral transverse process-pedicular for postmenopausal lumbar osteoporotic fractures.Methods:Retrospective analysis included 102 patients with postmenopausal lumbar osteoporotic fracture admitted to Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine from Jan. 2023 to Jan. 2024, who were divided into unilateral transverse process-pedicular group (UTPP group, n=48) and unilateral transverse pedicular group (UTP group, n=54) by means of approach. The changes of surgery-related indexes, imaging indexes and postoperative lumbar function recovery of the two groups were observed, and the patients were followed up for 1 year to record the incidence of secondary fracture of injured vertebra, fracture of adjacent vertebra and diffusion of bone cement. Results:The bone cement leakage rate in UTPP group was lower than that in UTP group ( P < 0.05), and there was no statsistically significant difference in operation time, fluoroscopy times, intraoperative blood loss, bone cement injection amount and hospital stay between the two groups ( P > 0.05). Before surgery, 3 months and 6 months after surgery, vertebral anterior margin height, middle vertebral height and sagittal cobb Angle between the two groups showed no significant differences ( P > 0.05). Visual analogue score (VAS) and oswestry disability index (ODI) between the two groups before surgery and 3 months after surgery had no statistically significant differences ( P > 0.05) ; VAS and ODI scores in UTPP group were lower than those in UTP group 6 months after surgery ( P < 0.05). The incidence of secondary fracture in UTPP group was lower than that in UTP group, while the height diffusion rate of bone cement was higher (all P < 0.05). The incidence of adjacent vertebral fracture between the two groups showed no statistically significant difference ( P > 0.05) . Conclusions:In postmenopausal patients with lumbar osteoporotic fractures, percutaneous vertebroplasty through unilateral transverse process-pedicular can effectively reduce the rate of intraoperative bone cement leakage, and has certain advantages in improving postoperative pain, promoting the recovery of postoperative lumbar function and reducing the risk of secondary fractures.

Objective:To explore the applied value of three-dimensional(3D)image reconstruction in laparoscopic partial nephrectomy(LPN).Methods:A total of 80 patients who underwent LPN due to renal tumors at Linyi Central Hospital between May 2019 and December 2022 were retrospectively selected.The patients were divided into an observation group and a control group,with 40 cases in each group,according to different preoperative imaging examination methods.After computed tomography urography(CTU)examination,the obtained DICOM data of observation group were used to reconstruct 3D images by 3D image reconstruction system.The planning and intraoperative positioning were conducted through auxiliary surgery plan with 3D model,and patients'conditions were informed to their family members through 3D image model.The size and location of the tumor,and the relationship between the tumor,blood vessels and surrounding tissues and organs were observed.Then,the LPN was performed.The control group used CT images to assist LPN after CTU examination.The differences in variously perioperative clinical indicators between the two groups were compared.Blood creatinine levels of two groups were measured before,after,and during follow-up.Additionally,a questionnaire survey was used to score the understanding level of patients'families for the informed content items.Results:There were no significant differences between the two groups in gender,age,difference of tumor side,maximum tumor diameter,body mass index,the score of R.E.N.A.L score system of renal tumor[maximum diameter?,external convexity rate(E),the closest distance(N),difference of side(A)and longitudinal position(L)],preoperative serum creatinine,and other general data(P>0.05).The occlusion time(21.70±6.39)min of renal artery,the time(9.25±2.95)min of seeking target artery,the operation time(122.55±42.57)min,and the resection time(6.47±2.25)min of tumor in the observation group were all shorter than those in the control group,and the differences of them between two groups were statistically significant(t=-2.87,-4.49,-3.60,-3.41,P<0.05),respectively.The scores of understanding levels of patients'families in the observation group for renal structure,site and size of tumor,the relationship between tumor and their surrounding tissue,and surgical plan and purpose were higher than those in the control group,and the differences of them between the two groups were statistically significant(t=-10.07,-13.86,-2.97,-17.57,-17.12,P<0.05),respectively.There were no significant differences between the observation group and the control group in terms of the volume of intraoperative blood loss,hospital stay duration,positive rate of resection margin,incidence of complication,and levels of postoperative serum creatinine during follow-up(P>0.05).Conclusion:The application of 3D image reconstruction that assists LPN can shorten the time of surgical operation,occlusion time of renal artery,time of resecting tumor and time of seeking target artery,which can improve preoperative communication satisfaction between doctors and patients.

Objective:To investigate the efficacy of percutaneous vertebroplasty through unilateral transverse process-pedicular for postmenopausal lumbar osteoporotic fractures.Methods:Retrospective analysis included 102 patients with postmenopausal lumbar osteoporotic fracture admitted to Hangzhou Fuyang Hospital of Orthopedics of Traditional Chinese Medicine from Jan. 2023 to Jan. 2024, who were divided into unilateral transverse process-pedicular group (UTPP group, n=48) and unilateral transverse pedicular group (UTP group, n=54) by means of approach. The changes of surgery-related indexes, imaging indexes and postoperative lumbar function recovery of the two groups were observed, and the patients were followed up for 1 year to record the incidence of secondary fracture of injured vertebra, fracture of adjacent vertebra and diffusion of bone cement. Results:The bone cement leakage rate in UTPP group was lower than that in UTP group ( P < 0.05), and there was no statsistically significant difference in operation time, fluoroscopy times, intraoperative blood loss, bone cement injection amount and hospital stay between the two groups ( P > 0.05). Before surgery, 3 months and 6 months after surgery, vertebral anterior margin height, middle vertebral height and sagittal cobb Angle between the two groups showed no significant differences ( P > 0.05). Visual analogue score (VAS) and oswestry disability index (ODI) between the two groups before surgery and 3 months after surgery had no statistically significant differences ( P > 0.05) ; VAS and ODI scores in UTPP group were lower than those in UTP group 6 months after surgery ( P < 0.05). The incidence of secondary fracture in UTPP group was lower than that in UTP group, while the height diffusion rate of bone cement was higher (all P < 0.05). The incidence of adjacent vertebral fracture between the two groups showed no statistically significant difference ( P > 0.05) . Conclusions:In postmenopausal patients with lumbar osteoporotic fractures, percutaneous vertebroplasty through unilateral transverse process-pedicular can effectively reduce the rate of intraoperative bone cement leakage, and has certain advantages in improving postoperative pain, promoting the recovery of postoperative lumbar function and reducing the risk of secondary fractures.

Objective:To explore the applied value of three-dimensional(3D)image reconstruction in laparoscopic partial nephrectomy(LPN).Methods:A total of 80 patients who underwent LPN due to renal tumors at Linyi Central Hospital between May 2019 and December 2022 were retrospectively selected.The patients were divided into an observation group and a control group,with 40 cases in each group,according to different preoperative imaging examination methods.After computed tomography urography(CTU)examination,the obtained DICOM data of observation group were used to reconstruct 3D images by 3D image reconstruction system.The planning and intraoperative positioning were conducted through auxiliary surgery plan with 3D model,and patients'conditions were informed to their family members through 3D image model.The size and location of the tumor,and the relationship between the tumor,blood vessels and surrounding tissues and organs were observed.Then,the LPN was performed.The control group used CT images to assist LPN after CTU examination.The differences in variously perioperative clinical indicators between the two groups were compared.Blood creatinine levels of two groups were measured before,after,and during follow-up.Additionally,a questionnaire survey was used to score the understanding level of patients'families for the informed content items.Results:There were no significant differences between the two groups in gender,age,difference of tumor side,maximum tumor diameter,body mass index,the score of R.E.N.A.L score system of renal tumor[maximum diameter?,external convexity rate(E),the closest distance(N),difference of side(A)and longitudinal position(L)],preoperative serum creatinine,and other general data(P>0.05).The occlusion time(21.70±6.39)min of renal artery,the time(9.25±2.95)min of seeking target artery,the operation time(122.55±42.57)min,and the resection time(6.47±2.25)min of tumor in the observation group were all shorter than those in the control group,and the differences of them between two groups were statistically significant(t=-2.87,-4.49,-3.60,-3.41,P<0.05),respectively.The scores of understanding levels of patients'families in the observation group for renal structure,site and size of tumor,the relationship between tumor and their surrounding tissue,and surgical plan and purpose were higher than those in the control group,and the differences of them between the two groups were statistically significant(t=-10.07,-13.86,-2.97,-17.57,-17.12,P<0.05),respectively.There were no significant differences between the observation group and the control group in terms of the volume of intraoperative blood loss,hospital stay duration,positive rate of resection margin,incidence of complication,and levels of postoperative serum creatinine during follow-up(P>0.05).Conclusion:The application of 3D image reconstruction that assists LPN can shorten the time of surgical operation,occlusion time of renal artery,time of resecting tumor and time of seeking target artery,which can improve preoperative communication satisfaction between doctors and patients.

Objective:To investigate the feasibility of reducing the radiation dose on coronary artery calcium score (CS) of virtual non-contrast (VNC) scanning in dual-layer spectral coronary CT angiography(CCTA).Methods:One hundred and twenty-two patients were examined on a dual-layer spectral detector CT scanner from March 2019 to August 2020. Volume CT dose index (CTDI vol), dose length product (DLP), effective dose ( E) were all evaluated for each patient. CS was calculated from both true non-contrast (TNC) and VNC images for left anterior descending (LAD), left circumflex (LCx), right coronary artery (RCA), and the total coronary artery (Total) by two radiologists independently. Pearson′s correlation coefficient was calculated for measuring the association between variables. The correction coefficients of each branch (λ LAD, λ LCx, and λ RCA) and the average correction coefficient (λ AVG) of the total coronary artery were obtained. The calibrated calcium score (CCS_VNC) was equal to λ multiplied by CS_VNC. The CS_TNC and CCS_VNC were compared using repeated oneway analysis of variance test. Correlation analyses for CS_TNC and CCS_VNC and agreement evaluation with Bland-Altman-Plots were performed. Results:The average effective doses in TNC, CCTA and total group were 0.69, 6.47 and 7.16 mSv, respectively. The effective dose was reduced by 10.6% and the scan time was reduced by 39% while using VNC images. There were significant differences among the CS_TNC and CS_VNC of LAD, LCx, RCA and Total ( t=6.75, 5.33, 4.99, 6.60, P< 0.05). Excellent correlations were observed between CS_VNC and CS_TNC ( R2 values were 0.929, 0.896, 0.958, and 0.918; λ values were 2.18, 1.18, 2.15, and 2.07, respectively). There were no significant statistically difference among the CS_TNC, CCS_VNC AVG, and CCS_VNC LAD/RCA of the LAD and RCA (all P> 0.05). The difference was statistically significant among the CS_TNC, CCS_VNC AVG, and CCS_VNC LCx of the LCx ( F=10.94, P<0.05). The paired comparison were performed in groups and the differences were statistically significant between the CS_TNC versus CCS_VNC AVGand CCS_VNC AVG versus CCS_VNC LCx ( t=3.31, 3.43, all P<0.05). There was no significant statistically difference between the CCS_VNC LCx and CCS_VNC AVG( P>0.05). Conclusions:It was feasible to accurately evaluate the CS_VNC from spectral data in comparison to TNC imaging, and to reduce the patient radiation dose and acquisition time.

Objective:To explore the efficacy of small incision open reduction and internal fixation and arthroscopic high strength non-absorbable suture in the treatment of tibial avulsion fracture of anterior cruciate ligament (ACL).Methods:The clinical data of 72 patients with ACL tibial avulsion fracture treated in Shantou Central Hospital from April 2018 to April 2020 were analyzed retrospectively. The patients were randomly divided into control group ( n=36) and experimental group ( n=36). The control group was treated with small incision open reduction and internal fixation and the experimental group was treated with high intensity non-absorbable suture under arthroscopy. The general data, surgical indexes and postoperative adverse reactions of the two groups were compared, and the knee joint function indexes of the two groups before and after treatment were compared and evaluated by random walking model. The counting data were expressed by percentage, the comparison between groups was expressed by chi-square test, the measurement data was expressed by mean ±standard deviation, the independent t-test was used for inter-group comparison, and the paired t-test was used for intra-group comparison. Results:There was no significant difference in general information, intraoperative blood loss, preoperative Lysholm score, IKDC score, Tegner score, knee mobility, and bilateral tibial displacement distance between the two groups of patients ( P>0.05). In the experimental group, the operation time, hospitalization time, the first postoperative time to move to the ground, bone healing time, and the total incidence of adverse reactions were (68.41±7.65) min, (11.93±3.24) d, (6.37±1.85) d, (23.65± 2.28) weeks, 2.78% (1/36), the control group were (55.37±8.62) min, (13.45±2.96) d, (8.16±2.08) d, (25.79±2.46) weeks, 22.22% (8/36), the difference between the two groups was statistically significant ( P<0.05). The Lysholm score, IKDC score, Tegner score, range of motion of the knee joint, and the difference of bilateral tibial displacement distance after treatment in the experimental group were (85.27±5.28) points, (85.43±1.74) points, and (6.65±1.41) points, respectively. (108.45±5.79)°, (1.12±0.65) mm, the control group was (79.73±4.69) points, (80.37±1.59) points, (5.72±1.31) points, (97.58±5.42)°, (2.24±0.72) mm, the difference between the two groups was statistically significant ( P<0.05). Random walking model evaluation the improvement of knee joint function in the experimental group was significantly better than that in the control group. Conclusion:Arthroscopic treatment of ACL tibial avulsion fracture with high-intensity non-absorbable suture can significantly improve the knee joint function of patients with rapid recovery and high safety, so it has a broad prospect of clinical application.

The CRISPR/Cas9 gene editing system has been widely used in basic research, gene therapy and genetic engineering due to its high efficiency, fast speed and convenience. Meanwhile, the discovery of novel CRISPR/Cas systems in the microbial community also accelerated the emergence of novel gene editing tools. CRISPR/Cpf1 is the second type (V type) CRISPR system that can edit mammalian genome. Compared with the CRISPR/Cas9, CRISPR/Cpf1 can use 5'T-PAM rich region to increase the genome coverage, and has many advantages, such as sticky end of cleavage site and less homologous recombination repair. Here we constructed three CRISPR/Cpf1 (AsCpf1, FnCpf1 and LbCpf1) expression vectors in silkworm cells. We selected a highly conserved BmHSP60 gene and an ATPase family BmATAD3A gene to design the target gRNA, and constructed gHSP60-266 and gATAD3A-346 knockout vectors. The efficiency for editing the target genes BmATAD3A and BmHSP60 by AsCpf1, FnCpf1 and LbCpf1 were analyzed by T7E1 analysis and T-clone sequencing. Moreover, the effects of target gene knockout by different gene editing systems on the protein translation of BmHSP60 and BmATAD3A were analyzed by Western blotting. We demonstrate the CRISPR/Cpf1 gene editing system developed in this study could effectively edit the silkworm genome, thus providing a novel method for silkworm gene function research, genetic engineering and genetic breeding.
Animals ; Bombyx/metabolism* ; CRISPR-Cas Systems/genetics* ; Endonucleases/genetics* ; Gene Editing ; RNA, Guide/genetics*

Objective:To explore the sequence of reduction and fixation in the treatment of middle and lower tibiofibular fractures on the same plane using tibial intramedullary nailing plus fibular plating.Methods:A retrospective analysis was performed of the 58 patients with middle and lower tibiofibular fractures on the same plane from January 2016 to December 2017. They were 38 males and 20 females, aged from 20 to 65 years (average, 40 years). The left side was affected in 30 cases and the right in 28. By the AO classification, 27 cases were type 42-A, 18 ones type 42-B and 13 ones type 42-C. Of them, 33 had the fibula reduced and fixated first (the fibular group) while 25 had the tibia reduced and fixated first (the tibial group). The 2 groups were compared in terms of operation time, rate of tibial closed reduction, rate of dynamization of intramedullary nails, fracture healing time and postoperative complications.Results:All the patients were followed up for 12 to 24 months (average, 17.2 months). The operation time in the fibular group was 96 minutes ± 15 minutes, significantly shorter than that in the tibial group (116 minutes ± 19 minutes)( P<0.05). The rate of tibial closed reduction was 84.8% (28/33) in the fibular group and 60.0%(15/25) in the tibial group, presenting a significant difference ( P<0.05). There were no significant differences between the 2 groups in the rate of dynamization of intramedullary nails, fracture healing time or postoperative complications ( P>0.05). Conclusions:Tibial intramedullary nailing plus fibular plate osteosynthesis is an effective treatment for the middle and lower tibiofibular fractures on the same plane. When the fracture line is not located in the narrow segment of the tibia, reduction and fixation of the fibula first is advantageous over reduction and fixation of the tibia first, because it can facilitate tibial reduction and nail placement and improve surgical efficiency without increasing the fracture healing time.

Objective:To analyze and the smile line of Zhuang-Chinese youths.Methods:1 00 Zhuang volunteers aged 1 8-25 years were recruited for this study.The faces were individually registered by digital videography.The length and thickness of upper lips and mandibular incisor crown height appearance at rest,smile and laugh were recorded.Statistical analysis was performed using Mann-Whitney-U Test and non-parametric analysis.Results:The upper lip in men was longer than that in women at rest(P<0.05 ).The upper lip length increased and thickness decreased at smile and laugh in all subjects,in men was longer and thicker than in women(P<0.05),but there was no significant difference of upper lip thickness at rest between sexes(P<0.05).The mandibular anterior teeth,gingival papilla of all subjects were appeared at smile and laugh,there was no significant difference between sexes(P<0.05). Gingiva appearance at smile was in less than 1 0%of the subjects.39%subjects had high smile line,46%had average smile line and 1 5% had low smile line.Conclusion:Most of the Zhuang youths have moderate smile line,less high smile line and least low smile line.