Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Objective To study the correlation between the middle ear transfer function and the tympanoscle-rosis locations and severities,via idealized finite element simulations of the fixation effects of different parts of the middle ear.Methods A finite element model was developed based on human middle ear histological data,and the air-conduction sound transmission was simulated for verification.Mimicking tympanosclerosis with different loca-tions by increasing the Young's modulus of related tissues,the changes in the middle ear transfer function under tympanic membrane,ligaments,and joint fixations were calculated.Results Limited hardening of eardrum did not influence the sound transmission(＜5 dB).Ligaments hardening(including the superior mallear ligament,superior incudal ligament,and the posterior incudal ligament)induced fixations of the ossicular chain and caused low-to-mid velocity drop down of the tympanic membrane umbo and the stapes footplate.The results indicated low-to-mid fre-quency hearing loss,about 40 dB when the ligaments were fully fixed.The sound transmission was not affected by incudomalleolar joint,a slightly high frequency improvement(0～6 dB)occurred when the incudostapedial joint got hardened.Significant low-to-mid frequency drop was found for the stapes footplate velocity in the case of otosclero-sis,while the velocity of tympanic membrane umbo was not significantly affected.Conclusion Tympanosclerosis in-fluences middle ear sound transferring by increasing the stiffness of the system,the effects are sensitive to tympano-sclerosis locations and severity.Moreover,as the hardened location approaches the stapes,the variations of tympan-ic membrane and stapes footplate movement can be quite different.

Objective:To evaluate the efficacy of 3D printing technology combined with computer navigation-assisted screw implantation in the treatment of atlantoaxial instability (AAI) complicated by vertebral artery anomalies.Methods:A retrospective case series study was conducted to analyze the clinical data of 23 patients with AAI complicated by vertebral artery anomalies who were admitted to Honghui Hospital of Xi′an Jiaotong University between January 2019 and January 2023, including 10 males and 13 females, aged 19-70 years [(51.0±13.3)years]. Vertebral artery anomalies were categorized into unilateral high-riding vertebral artery with unilateral dominance ( n=14), bilateral high-riding vertebral arteries with unilateral dominance ( n=6), and ponticulus posticus ( n=3). All the patients underwent preoperative planning using a 3D-printed model of the atlantoaxial complex with the vertebral artery, followed by posterior atlantoaxial pedicle screw fixation with computer-assisted navigation. Operative duration and intraoperative blood loss were recorded. The accuracy of pedicle screw placement was assessed at 3 days postoperatively using the Gertzbein-Robbins classification. Visual analogue scale (VAS) scores and Japanese Orthopedic Association (JOA) scores were evaluated preoperatively, at 3 days, 3 months postoperatively, and at the last follow-up. Bony fusion was assessed using cervical CT with 3D reconstruction at the last follow-up. Complications were also observed. Results:All the patients were followed up for 12-19 months [(15.1±1.9)months]. The operative duration was 125-167 minutes [(140.6±10.9)minutes] and intraoperative blood loss was 200-600 ml [(295.7±77.8)ml]. At 3 days postoperatively, all the 66 pedicle screws were safely placed, with 60 screws (91%) rated as Gertzbein-Robbins Grade 0 and 6 screws (9%) as Grade 1. At 3 days and 3 months postoperatively, and at the last follow-up, the VAS scores were (4.0±1.0)points, (2.0±0.6)points, and (1.3±0.5)points, and the JOA scores were (14.2±1.2)points, (16.0±0.8)points, and (16.6±0.5)points, both of which were not only significantly improved compared with preoperative (5.6±1.3)points and (12.8±1.5)points, but also further improved over time ( P<0.05). At the last follow-up, 22 patients (96%) achieved satisfactory atlantoaxial bony fusion. No vertebral artery injury, spinal cord or nerve injury, cerebrospinal fluid leakage, or screw loosening were observed in any patients. Conclusion:For patients with AAI complicated by vertebral artery anomalies, 3D printing combined with computer navigation-assisted navigation for atlantoaxial pedicle screw implantation offers multiple advantages, including minimal surgical trauma, high screw placement accuracy, pain relief, neurological function improvement, high fusion rate, and lowered incidence of complications.

Objective To study the correlation between the middle ear transfer function and the tympanoscle-rosis locations and severities,via idealized finite element simulations of the fixation effects of different parts of the middle ear.Methods A finite element model was developed based on human middle ear histological data,and the air-conduction sound transmission was simulated for verification.Mimicking tympanosclerosis with different loca-tions by increasing the Young's modulus of related tissues,the changes in the middle ear transfer function under tympanic membrane,ligaments,and joint fixations were calculated.Results Limited hardening of eardrum did not influence the sound transmission(＜5 dB).Ligaments hardening(including the superior mallear ligament,superior incudal ligament,and the posterior incudal ligament)induced fixations of the ossicular chain and caused low-to-mid velocity drop down of the tympanic membrane umbo and the stapes footplate.The results indicated low-to-mid fre-quency hearing loss,about 40 dB when the ligaments were fully fixed.The sound transmission was not affected by incudomalleolar joint,a slightly high frequency improvement(0～6 dB)occurred when the incudostapedial joint got hardened.Significant low-to-mid frequency drop was found for the stapes footplate velocity in the case of otosclero-sis,while the velocity of tympanic membrane umbo was not significantly affected.Conclusion Tympanosclerosis in-fluences middle ear sound transferring by increasing the stiffness of the system,the effects are sensitive to tympano-sclerosis locations and severity.Moreover,as the hardened location approaches the stapes,the variations of tympan-ic membrane and stapes footplate movement can be quite different.

AIM:To analyze the expression changes of O-linked N-acetylglucosamine(O-GlcNAc)glycoprotein in the lens capsule of age-related cataract and diabetic cataract and investigate the role of O-GlcNAc glycoprotein in diabetic cataract.METHODS: The lens capsules of 54 patients(56 eyes)with diabetic cataract and 115 patients(120 eyes )with age-related cataract were studied. Immunoblotting was used to detect the expression level of O-GlcNAc protein in the lens capsules of age-related and diabetic cataracts, and mass spectrometry was used to identify the O-GlcNAc glycoproteins in lens capsules.RESULTS: Immunoblotting results showed that the expression level of O-GlcNAc protein in the lens capsule of diabetic cataracts was significantly higher than in the age-related cataracts(P<0.01). With the level of glycosylated hemoglobin increasing, the expression level of O-GlcNAc protein also increased(P<0.01). Totally 5 O-GlcNAc proteins with up-regulated expression(FABP5, KRT16, PGK1, CTSD and S100A7), and 18 O-GlcNAc proteins with down-regulated expression(CRYβB1, etc.)were identified in the lens capsule of patients with diabetic cataract by mass spectrometry. Three new O-GlcNAc glycosylation sites were identified in this study. They were O-GlcNAcylation at T1730 position and S1738 position of PTPRQ and O-GlcNAcylation at T61 position of ATP5MC2.CONCLUSION:O-GlcNAc glycosylation may be involved in the formation and development of diabetic cataract. The differential O-GlcNAc glycoprotein identified by mass spectrometry provided the data for further study about pathogenesis of diabetic cataract.

By organizing and studying on the original works of LI Wenrong， this paper aimed to explore his theories and methods for treating liver diseases. LI Wenrong believes that the liver is easily prone to physiological disturbances， difficult to pacify， and can be compared to a “chariot” that moves horizontally and vertically， acting as a “general” for both civil and military affairs. Pathologically， liver diseases tend to spread to other organs， resulting in ever-changing pathological changes， often affecting emotional health. In terms of therapeutic methods， LI Wenrong proposes ten methods including draining fire to calm the liver， nourishing water to moisten wood， clearing metal to calm the liver， calming gallbladder and harmonizing liver， subduing yang with shell-drug， treating liver diseases by supplementing spleen， soothing the liver with sweetness， astringing the liver with sourness， relieving the liver with spiciness， and draining the liver with excess-fire. These methods have great guidance and reference value for contemporary clinical practice in traditional Chinese medicine.

【Objective】 To analyze the risk factors related to the number of RBCs transfusion in neonates with neonatal respiratory distress syndrome (NRDS), and to explore the complications and the predictive indicators related to the increase of RBCs transfusion frequency. 【Methods】 NRDS newborns admitted to our hospital from January 2017 to January 2019 were selected and divided into three groups according to the number of RBCs transfusion, namely, non-transfusion group, 1~ 2 times group, and ≥3 times group. The clinical data and complications of the three groups were compared, and the risk factors leading to the increase of the number of blood transfusion were analyzed. 【Results】 Such factors as maternal age ≥35 years old, gestational age, birth weight, hemoglobin(Hb) at admission, non-invasive ventilation time, hospitalization time in neonatal intensive care unit(NICU), total enteral feeding time affected the blood transfusion frequency of the three groups(χ²=14.24, F=28.44, 41.70, 60.05, 3.83, 5.97, 4.40, P<0.05). The incidence of necrotizing enterocolitis (NEC), septicemia and feeding intolerance in blood transfusion ≥3 times group was significantly higher than that in 1~2 times group and non-transfusion group (χ²=19.30, 18.68, 6.98, P<0.05). Multivariate logistic regression analysis showed that birth weight, Hb at admission, length of stay in NICU and time of reaching total enteral feeding were independent risk factors for≥ 3 times of blood transfusion (OR=-3.942, -0.186, 0.530, 0.324, P<0.05). The ROC curve showed that birth weight and Hb at admission were effective in predicting blood transfusion ≥3 times, and the area under the ROC curve were 0.846 and 0.802, respectively, and the truncation values were 2.315 kg and 157.5 g/L. 【Conclusion】 Feeding intolerance, NEC and septicemia are the complications of the increased transfusion frequency in children with NRDS, and birth weight and hemoglobin at admission are effective in predicting blood transfusion ≥ 3 times.

Objective:To express and purify the fusion protein of GST-FILIP-1L and prepare its polyclonal antibody. Methods:The constructed recombinant expression vectors pGEX-4T3-FILIP-1L were transformed into Escherichia Coli BL21. FILIP-1L fusion protein was induced by IPTG and purified by Glutathion Sepharse 4B . The rabbit was immunized by the purified fusion protein,and pro-duced serum with anti-FILIP-1L antibody. The titer of polyclonal antibody was detected by ELISA, the anti-FILIP-1L polyclonal antibody was purified by Active and its combining specificity with FILIP-1L protein was further identified by Western blot. Results:The GST-FILIP-1L fusion protein was highly expressed in E. coli, and its specific polyclonal antibody was obtained after the immunization. The polyclonal antibody purified by Active Ester Agrose was able to combine specially with FILIP-1L protein and transformed FILIP-1L protein in 293 cells and FILIP-1L protein of liver cancer cells, respectively. Conclusion: The GST-FILIP-1L fusion protein was expressed successfully,the anti-GST-FILIP-1L polyclonal antibodies with high titer and specificity are successfully prepared,these antibodies provide an useful experimental tool to research the biological function of the FILIP-1L protein.

Objective To investigate the factors relating to oral infection in elderly patients treated with head and neck radiotherapy for malignant lymphoma and to provide the clinical basis for the prevention and treatment of oral infections.Methods A total of 97 patients treated with head and neck radiotherapy for malignant lymphoma from March 2007 to March 2012 were enrolled.The factors relating to oral infection after head and neck radiation therapy were analyzed.Results Totally 25 patients (25.77％,25/97) had oral infections.The single-factor analysis showed that education degree,occupation,cancer staging,oral self-cleaning,oral environment,chemotherapy were the important factors relating to oral infection (x2 =8.634,6.863,9.237,11.870,7.563,8.012,P＜0.01).The incidence of oral infection had no significant differences between male and female patients.Conclusions There are many factors relating to oral infection in elderly patients treated with head and neck radiotherapy for malignant lymphoma,and poor oral self-cleaning,history of gum disease and chemotherapy are the important related factors.