Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To measure and analyse maxillofacial skeletal morphology based on the 3D model by Mimics and Matlab soft-ware.Methods:140 male volunteers aged 18-37 years,99 of Han,32 of Uygur and 9 of other natinalities were included.The values of maxillofacial skeletal morphology were measured by Mimics software combined with Matlab software after CT scanning.The data of skeletal morphologic features among skeletal classⅠ,Ⅱ and Ⅲ and among the ethnic groups were analysed with SPSS 26.0 software.Results:The distribution of skeletal class showed that there were 83 cases(59.3％)of class Ⅰ,41(29.3％)of class Ⅱ and 16(11％)of class Ⅲ.There were no significant differences on the age,height,nasal bone length,nasal bone depth,maxillary width,maxillary height,mandibular symphysis height,condylion distance and gonion distance among the 3 skeletal groups(P＞0.05).Skeletal class Ⅱshowed a significant shorter mandibular ramus,mandibular body and entire mandibular length compared with class Ⅰ and class Ⅲ,while class Ⅱ had a significant longer palatal length and larger Me angle compared with class Ⅲ(P＜0.05).Skeletal class Ⅲ showed no significance differences of all dimensions compared with class Ⅰ(P＞0.05).The nasal bone depth of Han subjects was smaller than that of Uygur,while the length of the mandibular symphysis and the entire mandible of Han group were greater than that of Uygur group(P＜0.05).No correlation was observed between age and all facial skeletal dimensions respectively(P＞0.05).The ANB an-gle is negatively correlated with the mandibular body(r=-0.327)and mandibular length(r=-0.322)respectively.Conclusion:There was no significant difference in nasal bone,facial bone width and facial bone height among the 3 skeletal patterns.Class Ⅱhas a significant shorter mandibular ramus,mandibular body and entire mandibular length.Uygur young males have significantly greater nasal bone depth than Han.

Objective:To measure and analyse maxillofacial skeletal morphology based on the 3D model by Mimics and Matlab soft-ware.Methods:140 male volunteers aged 18-37 years,99 of Han,32 of Uygur and 9 of other natinalities were included.The values of maxillofacial skeletal morphology were measured by Mimics software combined with Matlab software after CT scanning.The data of skeletal morphologic features among skeletal classⅠ,Ⅱ and Ⅲ and among the ethnic groups were analysed with SPSS 26.0 software.Results:The distribution of skeletal class showed that there were 83 cases(59.3％)of class Ⅰ,41(29.3％)of class Ⅱ and 16(11％)of class Ⅲ.There were no significant differences on the age,height,nasal bone length,nasal bone depth,maxillary width,maxillary height,mandibular symphysis height,condylion distance and gonion distance among the 3 skeletal groups(P＞0.05).Skeletal class Ⅱshowed a significant shorter mandibular ramus,mandibular body and entire mandibular length compared with class Ⅰ and class Ⅲ,while class Ⅱ had a significant longer palatal length and larger Me angle compared with class Ⅲ(P＜0.05).Skeletal class Ⅲ showed no significance differences of all dimensions compared with class Ⅰ(P＞0.05).The nasal bone depth of Han subjects was smaller than that of Uygur,while the length of the mandibular symphysis and the entire mandible of Han group were greater than that of Uygur group(P＜0.05).No correlation was observed between age and all facial skeletal dimensions respectively(P＞0.05).The ANB an-gle is negatively correlated with the mandibular body(r=-0.327)and mandibular length(r=-0.322)respectively.Conclusion:There was no significant difference in nasal bone,facial bone width and facial bone height among the 3 skeletal patterns.Class Ⅱhas a significant shorter mandibular ramus,mandibular body and entire mandibular length.Uygur young males have significantly greater nasal bone depth than Han.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Oral and maxillofacial malignant tumors threaten the life and health of patients, and seriously affect their swallowing, language function and face. 125I seeds brachytherapy for oral and maxillofacial malignant tumors has been widely concerned and studied because of its advantages such as less surgical trauma, large and uniform dose distribution in the target tissue, little damage to the surrounding normal tissue, and reducing radiation exposure of medical staff. Low-dose brachytherapy with 125I seeds can effectively reduce the tumor volume and prolong the survival time of patients. This article reviews the clinical application of 125I seeds brachytherapy in oral and maxillofacial malignant tumors.

Objective: To explore physical health status and influencing factors of preschool children in Tibet, so as to provide a scientific reference and theoretical basis for the healthy development of physical fitness. Methods: Data were collected from children (3-6 years old) of Xizang national physical fitness monitoring, and a total of 1 521 preschool children were recruited who received questionnaire survey and physical fitness test. Independent sample t-test and one-way ANOVA were used to compare the differences in physical fitness indexes of preschool children in different groups. Chi square test and binary Logistic regression model were used to analyze the factors affecting physical health of preschool children. Results: The total qualified rate of physical fitness was 79.75%, among which the excellent rate was 3.16%, the good rate was 15.12%, the qualified rate was 61.47% and the unqualified was 20.25%. From the perspective of BMI, the excellent physical fitness rate (3.74%) and good physical fitness rate ( 17.47% ) were highest in healthy weight preschool children, and the qualified physical fitness rate of overweight preschool children (69.03%) was higher than that of obese (55.88%) and healthy weight preschool children (60.68%)( χ 2=53.56, P <0.01). From the perspective of ethnic, Tibetan children s physique proficiency (3.69%), good rate ( 17.13% ) than with the elevation of the Han nationality (0.74%, 5.88%), fraction defective (16.97%), lower than that of Han nationality (35.29%) ( χ 2=53.71, P <0.01); The results of chest circumference, skinfold thickness, body fat percentage, tennis throw distance, continuous jump of both feet, sitting forward bend and balance beam walking of Tibetan children were higher than those of Han children, and the results of quiet heart rate and standing long jump were lower than those of Han children ( t = 2.72 , 10.95, 9.66, 3.68, 3.88, 8.04, 3.56, 8.70, -4.39 , -4.40, P <0.01). Binary Logistic regression analysis showed that Tibetans ( OR =2.29), breastfeeding ( OR =1.51), body dynamics outdoor daily exercise duration 30-90 min (30-<60 min ;OR = 2.03 ; 60-90 min: OR =2.22) were positively correlated with physical health of preschool children ( P <0.05). Conclusions The total physical qualification rate of preschool children aged 3-6 years old in Tibet is lower than the national average. Ethnic group, feeding pattern during infancy, and physical activity are all factors that affected the physical fitness of preschool children in Tibet. It is of great significance to improve the physique of preschool children in Tibet to promote their sustainable and healthy development.

Objective:To examine the physical health status and factors affecting individuals aged 60-69 years in certain regions of Tibet.Methods:The study analyzed data collected from 824 individuals aged 60-69 from the Xizang national physique monitoring.Chi-square test and binary logistic regression were used to identify factors that affect the physical health of this age group.Results:The study evaluated the physical fitness of elderly individuals aged 60 to 69 years old in three regions of Tibet.The results indicated that only 11 cases(1.3%)of participants had excellent physical fitness, while 47 cases(5.7%) had good physical fitness, 394 cases(47.8%)were qualified, and 372 cases(45.1%)were unqualified.The study also found significant differences in physical fitness based on age( χ2=8.367, P=0.039), sex( χ2=22.168, P<0.001), urban/rural location( χ2=12.282, P=0.006), region( χ2=60.358, P<0.001), and body mass index(BMI)( χ2=105.134, P<0.001). Specifically, individuals aged 60-64 years old had a higher proportion of qualified physique than those aged 65-69 years old.Women had better physical fitness than men, and individuals living in urban areas had better physical fitness than those in rural areas.Moreover, participants from Lhasa and Nagqu regions had better physical fitness than those from Nyingchi.Obese elderly individuals had worse physical fitness than those with normal weight(all P<0.05 for all). The study found that female gender( OR=1.765, 95% CI: 1.284-2.425), being a Lhasa( OR=2.799, 95% CI: 1.677-4.672)or Naqu resident( OR=2.730, 95% CI: 1.677-4.445), and engaging in regular exercise( OR=1.845, 95% CI: 1.078-3.160)were protective factors for physical health among individuals aged 60-69 years old.However, not working( OR=0.503, 95% CI: 0.289~0.876)and obesity( OR=0.108, 95% CI: 0.066-0.177)were identified as risk factors for physical health in this age group.Additionally, the analysis revealed significant differences in fitness ratios based on exercise frequency( χ2=18.760, P<0.001)and exercise time( χ2=15.485, P<0.001). Specifically, the fitness ratio of individuals who exercised 1-2 times and 3-4 times a week was significantly higher than that of non-exercisers.The fitness ratio of elderly individuals who exercised for 30 to 60 minutes per session was significantly higher than those who exercised for less than 30 minutes.Furthermore, those who exercised 3-4 times per week had a fitness ratio 2.58 times higher than those who did not exercise at all( P<0.05). Conclusions:This study conducted in Nyingchi, Lhasa, and Nagqu of Tibet found that 45.1% of individuals aged 60-69 years had an unqualified physique.There was a negative correlation between non-employment and BMI≥28 kg/m 2 with physical health, whereas female gender, residing in Lhasa or Nagqu, and engaging in regular physical exercise showed a positive correlation.The study suggests that physical exercise for 30-60 minutes, 3-4 times a week, can significantly improve the proportion of qualified physical fitness among the elderly.

Objective:To introduce our experience on dealing with the internal carotid artery (ICA) during the resection of lateral skull base tumors, and to explore the reference values for using radiological findings to make a rational surgical plan.Methods:A retrospective study of patients who underwent resection of lateral skull base tumors involving ICA at Peking Union Medical College Hospital from May 2015 to May 2021 was conducted. The demographic information, preoperative examinations, diagnosis, surgical details and follow-ups were collected. A total of 41 patients were enrolled [24 (58.5%] females, 17 (41.5%) males], with an average age of 47.9 years. According to the preoperative imaging findings, the relationships between the tumors and ICA were divided into four types: adjacency, compression, invasion and ICA aneurysm.Results:The ICA was preserved in 32 (78.0%, 32/41) cases and was reconstructed in nine (22.0%, 9/41) cases. All the 27 (65.9%, 27/41) tumors adjacent to ICA were successfully separated from the artery. Among the 11 tumors compressing the ICA, six were resected with the involved ICA segment and vascular reconstruction was conducted. One (2.4%, 1/41) tumor invading ICA and two (4.9%, 2/41) ICA aneurysms required revascularization. The mean follow-up time was (26.1±2.9) months. There was no recurrence, except one case of adenoid cystic carcinoma which had brain metastases one year after surgery.Conclusions:According to the preoperative imaging, lateral skull base tumors adjacent to ICA can be detached from the vascular surface. Separation should be attempted first for tumors compressing ICA, and revascularization should be followed if separation failed. Vascular reconstruction is usually needed in the removal of tumors invading ICA and ICA aneurysms. Preoperative radiology can provide good references for planning a surgery for lateral skull base tumors.

Cardiomyopathy, Dilated/metabolism* ; Humans ; Microfilament Proteins/metabolism* ; Models, Cardiovascular ; Mutation ; Myocytes, Cardiac ; Pluripotent Stem Cells/metabolism* ; Transcription Factors/metabolism* ; Troponin T/metabolism*

Dysregulation of circadian rhythms associates with cardiovascular disorders. It is known that deletion of the core circadian gene Bmal1 in mice causes dilated cardiomyopathy. However, the biological rhythm regulation system in mouse is very different from that of humans. Whether BMAL1 plays a role in regulating human heart function remains unclear. Here we generated a BMAL1 knockout human embryonic stem cell (hESC) model and further derived human BMAL1 deficient cardiomyocytes. We show that BMAL1 deficient hESC-derived cardiomyocytes exhibited typical phenotypes of dilated cardiomyopathy including attenuated contractility, calcium dysregulation, and disorganized myofilaments. In addition, mitochondrial fission and mitophagy were suppressed in BMAL1 deficient hESC-cardiomyocytes, which resulted in significantly attenuated mitochondrial oxidative phosphorylation and compromised cardiomyocyte function. We also found that BMAL1 binds to the E-box element in the promoter region of BNIP3 gene and specifically controls BNIP3 protein expression. BMAL1 knockout directly reduced BNIP3 protein level, causing compromised mitophagy and mitochondria dysfunction and thereby leading to compromised cardiomyocyte function. Our data indicated that the core circadian gene BMAL1 is critical for normal mitochondria activities and cardiac function. Circadian rhythm disruption may directly link to compromised heart function and dilated cardiomyopathy in humans.