BACKGROUND:Intervertebral disc degeneration is clinically considered to be the main cause of low back pain,but due to the unclear pathogenesis of intervertebral disc degeneration,there is still a lack of effective means to delay the progression of the disease.Single-cell RNA sequencing technology can amplify and sequence mRNA at the single-cell level,reveal the gene expression intensity of a single cell,discover different cell subsets in tissues according to the heterogeneity of cells,study the pathogenesis of intervertebral disc degeneration at the molecular level,and provide a new theoretical basis for its early diagnosis and treatment. OBJECTIVE:To introduce the basic principles of single-cell RNA sequencing technology and review the research progress of single-cell RNA sequencing technology in intervertebral disc degeneration in recent years. METHODS:A computer was used to search PubMed,Web of Science,CNKI and WanFang databases for the literature published from 2012 to 2022.Key words were"single-cell RNA sequencing,intervertebral disc degeneration,sequencing Technology"in Chinese and English.Duplicate,poor-quality and irrelevant articles were excluded;a total of 70 articles were eventually included. RESULTS AND CONCLUSION:(1)We identified new cell subsets such as homeostatic chondrocytes,hypertrophy chondrocyte-like nucleus pulposus cells and fibrous nucleus pulposus cells,identified the marker genes and transcription factors of these cell subsets,and described the functions,differentiation paths and cell fate of these cell subsets during the development and progression of intervertebral disc degeneration,and proposed the concept of progenitor nucleus pulposus cells.A cell subpopulation with progenitor nucleus pulposus cells properties was identified and its effectiveness in treating intervertebral disc degeneration was verified in mice.(2)Fibro chondrocyte-like annulus fibrosus cells and annulus fibrosus stem cells with both cartilage and fiber properties were identified,and a new type of composite hydrogel was prepared by combining fibrous cartilage inducers silk fibroin and hyaluronic acid in vitro.Experiments in mice demonstrated that this hydrogel could repair both annulus fibrosus tissue and cartilage matrix,and was remarkably effective in the treatment of intervertebral disc degeneration.(3)Regulatory chondrocytes were found in endplate cartilage.Two distinct fates in the progression of intervertebral disc degeneration were analyzed and the differential genes in the two fates were identified.Intercellular communication analysis indicated that regulatory chondrocytes interact with endothelial cells to promote angiogenesis.(4)Immune cells such as macrophages,T cells,myeloid progenitor cells and neutrophils were identified in the degenerated intervertebral disc tissues,demonstrating the existence of immune response during intervertebral disc degeneration.It was found that apolipoprotein induced the polarization of macrophages M1 and M2 subtypes,and this polarization process affected the activity of progenitor nucleus pulposus cells by amplifying the inflammatory response through the MIF signaling pathway.

Objective:To investigate the grade of varicocele and its impact on semen quality of officers and soldiers stationed in coastal areas.Methods:The research subjects were 146 patients with left-sided varicocele and 32 healthy men selected from the male officers and soldiers who had visited the Beidaihe Sanatorium of PLA Joint Logistics Support Force. They were given physical and ultrasonic examination of spermatic vein and were divided into different groups by ultrasonic grading according to the inner diameter of their spermatic vein. Their semen quality was routinely analyzed.Results:There was no significant difference in semen volume or sperm deformity rate among the groups（ P > 0.05）. As varicocele aggravated，the sperm survival rate，sperm density，and the proportion of Grade A + B sperm all decreased significantly in the groups of clinical type II and III compared with those in the groups of normal type，subclinical type，and clinical type I（ P < 0.05）. Conclusion:The incidence of varicocele in officers and soldiers of coastal garrisons is significantly higher than that in the general population. The varicocele grade is closely related to the semen quality. Varicocele of clinical type I and below has less impact on the semen quality.

Objective:To observe the changes in semen quality before and after operation in the officers and soldiers stationed at coastal areas with clinical varicocele，and to evaluate the outcome of operation.Methods:According to the results of the color Doppler ultrasound，a total of 113 patients with clinical left varicocele who underwent high ligation of the spermatic vein in the Department of Urology of the Beidaihe Rehabilitation and Recuperation Center of PLA Joint Logistics Support Force were divided into three groups：clinical grade Ⅰ（ n=31），clinical grade Ⅱ（ n=36），and clinical grade Ⅲ（ n=46）. The semen qualities of all patients were analyzed before and after operation. Results:There was no significant change in semen quality before and after operation in the clinical grade Ⅰ group（ P>0.05）；the semen quality in the clinical grade Ⅱ group was significantly improved after operation（ P<0.05）；the semen quality in the clinical grade Ⅲ group after operation was generally improved（ P<0.05）. There was no significant difference in semen volumes or sperm deformity rates before and after operation among the three groups（ P>0.05）. Conclusion:The incidence of clinical varicocele in officers and soldiers stationed at coastal areas is significantly higher than that in the general population. The improvement of postoperative semen quality is closely related to the severity of preoperative varicocele. Ultrasound combined with routine semen examination can effectively evaluate the improvement of postoperative semen quality.

Background::Cancer immunotherapy has emerged as a promising strategy against triple-negative breast cancer (TNBC). One of the immunosuppressive pathways involves programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1), but many patients derived little benefit from PD-1/PD-L1 checkpoint blockades treatment. Prior research has shown that MYC, a master transcription amplifier highly expressed in TNBC cells, can regulate the tumor immune microenvironment and constrain the efficacy of immunotherapy. This study aims to investigate the regulatory relationship between MYC and PD-L1, and whether a cyclin-dependent kinase (CDK) inhibitor that inhibits MYC expression in combination with anti-PD-L1 antibodies can enhance the response to immunotherapy. Methods::Public databases and TNBC tissue microarrays were used to study the correlation between MYC and PD-L1. The expression of MYC and PD-L1 in TNBCs was examined by quantitative real-time polymerase chain reaction and Western blotting. A patient-derived tumor xenograft (PDTX) model was used to evaluate the influence of a CDK7 inhibitor THZ1 on PD-L1 expression. Cell proliferation and migration were detected by 5-ethynyl-2′-deoxyuridine (EdU) cell proliferation and cell migration assays. Tumor xenograft models were established for in vivo verification. Results::A high MYC expression level was associated with a poor prognosis and could alter the proportion of tumor-infiltrating immune cells (TIICs). The positive correlation between MYC and PD-L1 was confirmed by immunostaining samples from 165 TNBC patients. Suppression of MYC in TNBC caused a reduction in the levels of both PD-L1 messenger RNA and protein. In addition, antitumor immune response was enhanced in the TNBC cancer xenograft mouse model with suppression of MYC by CDK7 inhibitor THZ1. Conclusions::The combined therapy of CDK7 inhibitor THZ1 and anti-PD-L1 antibody appeared to have a synergistic effect, which might offer new insight for enhancing immunotherapy in TNBC.

Objective:To investigate the long-term efficacy and complications of augmentation uretero-enterocystoplasty (AUEC).Methods:The clinical data of 262 patients with lower urinary tract dysfunction who underwent AUEC at our center from January 2003 to June 2022 were analyzed retrospectively. There were 193 males and 69 females, the median age was 24 (4, 67) years, the median disease duration was 12.0 (0.2, 56.0) years and the preoperative creatinine was 91.5 (68.1, 140.0) μmol/L. 320 ureters had high-grade UUTD, 216 ureters had VUR, 14 of which had low-pressure reflux.The number of low-grade VUR ureter was 22 (10.2%) and the number of high-grade VUR ureter was 194 (89.8%). Video-urodynamics showed that the maximum bladder capacity was 102 (47, 209) ml, the maximum detrusor pressure was 33.0 (15.5, 50.5) cmH 2O, and the bladder compliance was 6.4 (3.0, 12.3) ml/cmH 2O. All patients underwent AUEC. The surgical method is to cut a segment of sigmoid colon, open the sigmoid colon along the mesenteric margin, fold and suture it into " U" or " S" shaped intestinal mesh according to the principle of " detubulization" . At the same time, perform ureteroplasty and replanting, and then anastomosis the intestinal mesh with the opened bladder flap to form an expanded new bladder. Follow-up was performed via outpatient clinic or telephone. The creatinine, maximum bladder capacity, maximum detrusor pressure, bladder compliance, ureteral reflux and upper urinary tract dilatation were compared preoperatively and postoperatively. The postoperative complications were also evaluated. Results:The median follow-up time was 57.4 (4, 151) months after surgery. At 1-3 months after surgery, the maximum bladder capacity and bladder compliance increased to 303.9% and 189.9% of the preoperative level, and the maximum detrusor pressure decreased to 63.6% of the preoperative level. At 6-10 years after surgery, the maximum bladder capacity and bladder compliance increased to 490.2% and 627.9% and the maximum detrusor pressure decreased to 25.8% of the preoperative level. The UUTD of the patients was significantly reduced after surgery. The number of the high grade UUTD decreased to 116 (116/398, 29.2%) at 1-3 months and 51 (51/274, 18.6%) at 4-6 months. At 6-10 years, the number of the high-grade UUTD decreased to 4 (4/76, 5.3%) ( P<0.001), which was significantly lower than that before operation. The VUR was significantly relieved after operation, and 393 ureters had no VUR at 1-3 months, accounting for 97.8% (393/402) of the total ureters. Sustained remission of VUR was observed during follow-up. 73 ureters had no VUR at 6-10 years, accounting for 96.1% (73/76) of total ureters ( P<0.001). Patients' creatinine decreased to 79.0 (65.0-128.2) μmol/L at 1-3 months postoperatively, with a downward trend but no statistical difference, and creatinine levels were not significantly elevated at any postoperative time point compared with preoperative levels ( P>0.05). Postoperative complications included metabolic acidosis in 26 cases (9.9%), vesicoureteral anastomosis stenosis in 15 cases (5.7%), recurrent urinary tract infection in 16 cases (6.1%), and urinary calculi in 20 cases (7.6%), and intestinal obstruction requiring laparotomy in 8 cases (3.1%), all of them could be improved after treatments. Conclusions:AUEC is a safe and effective method for treating high-grade VUR or VUR with impaired anti-reflux mechanism, high-grade UUTD or UUTD with ureteral or vesicoureteral junction obstruction, and all of the complications can be improved after treatment. This technique can increase the bladder capacity and compliance, reconstruct the anti-reflux mechanism, and release upper urinary tract obstruction. It may play an important role in stabilizing and protecting the residual renal function from further deterioration.

Objective:To investigate the grade of varicocele and its impact on semen quality of officers and soldiers stationed in coastal areas.Methods:The research subjects were 146 patients with left-sided varicocele and 32 healthy men selected from the male officers and soldiers who had visited the Beidaihe Sanatorium of PLA Joint Logistics Support Force. They were given physical and ultrasonic examination of spermatic vein and were divided into different groups by ultrasonic grading according to the inner diameter of their spermatic vein. Their semen quality was routinely analyzed.Results:There was no significant difference in semen volume or sperm deformity rate among the groups（ P > 0.05）. As varicocele aggravated，the sperm survival rate，sperm density，and the proportion of Grade A + B sperm all decreased significantly in the groups of clinical type II and III compared with those in the groups of normal type，subclinical type，and clinical type I（ P < 0.05）. Conclusion:The incidence of varicocele in officers and soldiers of coastal garrisons is significantly higher than that in the general population. The varicocele grade is closely related to the semen quality. Varicocele of clinical type I and below has less impact on the semen quality.

Objective:To observe the changes in semen quality before and after operation in the officers and soldiers stationed at coastal areas with clinical varicocele，and to evaluate the outcome of operation.Methods:According to the results of the color Doppler ultrasound，a total of 113 patients with clinical left varicocele who underwent high ligation of the spermatic vein in the Department of Urology of the Beidaihe Rehabilitation and Recuperation Center of PLA Joint Logistics Support Force were divided into three groups：clinical grade Ⅰ（ n=31），clinical grade Ⅱ（ n=36），and clinical grade Ⅲ（ n=46）. The semen qualities of all patients were analyzed before and after operation. Results:There was no significant change in semen quality before and after operation in the clinical grade Ⅰ group（ P>0.05）；the semen quality in the clinical grade Ⅱ group was significantly improved after operation（ P<0.05）；the semen quality in the clinical grade Ⅲ group after operation was generally improved（ P<0.05）. There was no significant difference in semen volumes or sperm deformity rates before and after operation among the three groups（ P>0.05）. Conclusion:The incidence of clinical varicocele in officers and soldiers stationed at coastal areas is significantly higher than that in the general population. The improvement of postoperative semen quality is closely related to the severity of preoperative varicocele. Ultrasound combined with routine semen examination can effectively evaluate the improvement of postoperative semen quality.

Objective:To investigate the feasibility and early clinical effect of lumbar lateral anterior interbody fusion in the treatment of degenerative lumbar scoliosis.Methods:Forty patients with degenerative lumbar scoliosis who underwent lumbar lateral anterior interbody fusion combined with posterior percutaneous pedicle screw and rod internal fixation from January 2018 to January 2020 were selected. There were 17 males and 23 females; The age was 65.4±7.2 years (range 51-84 years). All patients had obvious low back pain, of which 22 patients (55.0%) had lower limb pain, numbness or intermittent claudication. 16 patients (40.0%) had scoliosis and the main curve protruded to the right, and 24 patients (60.0%) had scoliosis and the main curve protruded to the left. The operation time and intraoperative bleeding were recorded. The main outcome measures were visual analogue scale (VAS), Oswestry disability index (ODI), the MOS item short from health survey (SF-36), deformity correction, bone graft fusion time and complications.Results:The left approach was used in 16 cases of scoliosis with the main curve protruding to the right; In 24 cases, the main curve of scoliosis protruded to the left, of which 6 cases showed osteophyte on the concave side (right side) of coronal CT and the right approach was adopted, while the rest were adopted the left approach. Single segment fusion was performed in 8 cases (20.0%), double segment fusion in 12 cases (30.0%), three segment fusion in 16 cases (40.0%), and four segment fusion in 4 cases (10%). Among the 22 patients with symptoms of lower limb nerve damage, 6 needed secondary unilateral laminectomy. All 40 patients completed the operation successfully, the operation time was 255±37 min (range 130-345 min) and the amount of intraoperative bleeding was 100±16.2 ml (range 10-505 ml). All patients were followed up for 12.8±4.5 months (range 6-24 months). The preoperative VAS score was 5.7±1.0, improved to 3.5±0.7 on the first day after operation, and 1.4±0.3 at the last follow-up. The difference was statistically significant ( F=2322.229, P <0.001). The preoperative ODI was 79.9%±9.3%, the first day after operation was 51.6%±8.9%, and the last follow-up was 11.7%±2.2%. The difference was statistically significant ( F=3770.411, P <0.001). SF-36 was 68.6±5.3 before operation and 78.4±5.5 on the first day after operation, which increased to 109.9 ± 4.9 at the last follow-up. The difference was statistically significant ( F=21736.486, P <0.001). The Cobb angle of lumbar scoliosis was 27.8°±14.1° before operation and 7.5°±3.5° on the first day after operation, the difference was statistically significant ( t=3.551, P <0.001); The height of intervertebral space was 10.9±2.1 mm before operation and 15.3±3.4 mm on the first day after operation, the difference was statistically significant ( t=2.106, P <0.001). 24 patients (60.0%) had pain or numbness in the front of the thigh, and 4 patients (10.0%) had quadriceps femoris weakness; These symptoms disappeared within 3 months after operation in 26 patients, except that the numbness in the front of the thigh was only reduced in 2 patients 3 months after operation. All patients achieved satisfactory fusion in all segments at the last follow-up, and there was no non-fusion. Conclusion:Lumbar lateral anterior interbody fusion is a safe and feasible method for the treatment of degenerative lumbar scoliosis.

Objective:To summarize the technical points of laparoscopic pancreaticoduodenectomy (LPD) carried out in a single center.Methods:The clinical data of 102 patients who underwent laparoscopic pancreaticoduodenectomy in 2018 at the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University were retrospectively analyzed, and the general conditions, operation time, intraoperative blood loss, and surgical operation were analyzed. Post-operative complications, hospital stay and other indicators were studied.Results:Of the 102 patients who were included, there were 57 males and 45 females, aged 15.0 to 79.0 (59.9±11.8) years old, with a body mass index (23.6±3.6) kg/m 2. For the 102 patients who underwent LPD, 6 were total pancreatic resection. Three were combined with vascular resection in the form of portal vein-superior mesentery vein segmental resection. The operation time was (376.6±87.2) min, the intraoperative blood loss was 350 (100, 800) ml, and the postoperative hospital stay was (17.0±5.9) days. Postoperative complications occurred in 26 of the 102 patients (25.5%), and more than two complications occurred in 17 patients. B/C grade pancreatic fistula occurred in 9 patients (9.4%), abdominal bleeding in 8 patients (7.8%), gastrointestinal bleeding in 2 patients (2.0%), biliary fistula in 4 patients (3.9%), and gastric emptying disorder in 5 patients (4.9%), 8 patients had pulmonary infection (7.8%). Five patients (4.9%) died during the perioperative period. Conclusion:The main technical points of LPD included en bloc resection, pancreaticojejunostomy, and vascular reconstruction. The basis of LPD is en bloc resection. Combined resection and reconstruction of vascular segments is a sign of maturity of LPD technology and a prerequisite for further development as a routine procedure.

Objective: To explore the relationship between the compression depth and compressive stress of the anterior and posterior cervical spinal cord in different sports positions. Methods: Specimens of ten intact fresh cervical spine (C₁-T₁) from adult cadaver were collected. In order to simulate cervical disc degeneration and abnormal ligamentum flavum, we placed two hemispherical steel balls into the anterior and posterior side of the cervical spinal cord through the bone window of the C_{4, 5}. The measurement was conducted in 10%, 20%, 30%, 40%, 50%, and 60% of the sagittal diameter for the compressive stress of the anterior and posterior cervical spinal cord under different compression depths of flexion, neutral, and posterior extension. Results: The anterior depth of a certain pressure with the posterior pressure depth was increasing in neutral position, the stress on the anterior of the cervical cord-meningeal complex (CCMC) had no significant change, while the stress on the posterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the posterior of the CCMC varied insignificantly between 10% and 20% depth of canal occlusion (P>0.05). However, there was remarkable significance among 30% and 60% (P<0.05). In extension or flexion position, the stress on the anterior of the CCMC had no significant change, while the stress on the posterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the posterior of the CCMC varied insignificantly between neighboring depths of canal occlusion from 10% (P>0.05). However, there was remarkable significance among 20% and 60% (P<0.05). The posterior depth of a certain pressure with the anterior pressure depth was increasing in neutral position. The stress on the anterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the anterior of the CCMC varied insignificantly between 10% and 20% depth of canal occlusion(P>0.05). However, there was remarkable significance among 30% and 60% (P<0.05). The stress on the posterior of the CCMC had no significant change. In extension or flexion position, the stress on the anterior of the CCMC increased greatly with the increasing of the degree of canal occlusion. The stress on the anterior of the CCMC varied insignificantly between neighboring depths of canal occlusion from 10% (P>0.05). However, there was remarkable significance among 20% and 60% (P<0.05). The stress on the posterior of the CCMC had no significant change. Compared with the neutral position, the anterior flexion position and the posterior extension position had different trends in the compressive stress in the anterior and posterior aspect of the cervical spinal cord. Conclusion The stress on the anterior and the posterior of the CCMC has a closely nonlinear relationship with the depth of canal occlusion. With the increase of the depth of canal occlusion, the stress is increasing, especially running over the 30% depress of canal occlusion under neutral position. However, the stress is increased, especially running over the 20% depress of canal occlusion under the flexion and extension position.