Objective To compare the differences in intraoperative radiation exposure between leadless and transvenous pacemaker implantation. Methods Cumulative dose (CD), dose area product (DAP), and fluoroscopy time during procedure were recorded and analyzed in 21 patients with leadless pacemaker implantation (Micra group), 55 patients with transvenous single-chamber pacemaker implantation (VVI group), and 216 patients with transvenous dual-chamber pacemaker implantation (DDD group). Results The fluoroscopy times of the Micra group, VVI group, and DDD group were 5.0 ± 1.9, 4.8 ± 1.4, and 7.6 ± 1.9 min, respectively (P < 0.001). Their CD values were 203.5 ± 76.1, 147.0 ± 41.0, and 249.6 ± 58.2 mGy, respectively (P < 0.001). Their DAP values were 18.6 ± 7.1, 13.4 ± 3.9, and 22.6 ± 5.6 Gy·cm², respectively (P < 0.001). Compared with the VVI group, the Micra group had similar fluoroscopy time (P=0.813) but higher CD (P=0.010) and DAP values (P = 0.012). Compared with the DDD group, the Micra group had reduced fluoroscopy time (P < 0.001), CD value (P = 0.033), and DAP value (P = 0.047). Conclusion Leadless pacemaker implantation is associated with increased radiation exposure compared to transvenous single-chamber pacemaker implantation. However, it offers a significant advantage in reducing radiation exposure for both medical staff and patients compared to transvenous dual-chamber pacemaker implantation.

OBJECTIVE: To evaluate early effectiveness of posterior 180-degree decompression via unilateral biportal endoscopy (UBE) in the treatment of lumbar spinal stenosis (LSS) combined with Michigan State University (MSU)-1 lumbar disc herniation (LDH). METHODS: A retrospective analysis was conducted on clinical data from 33 patients with LSS combined with MSU-1 LDH, who met selection criteria and were treated between March 2022 and January 2024. All patients underwent UBE-assisted 180-degree spinal canal decompression. The cohort comprised 17 males and 16 females, aged 37-82 years (mean, 67.1 years). Preoperative presentations included bilateral lower limbs intermittent claudication and radiating pain, with disease duration ranging from 5 to 13 months (mean, 8.5 months). Affected segments included L _{3, 4} in 4 cases, L _{4, 5} in 28 cases, and L ₅, S ₁ in 1 case. LSS was rated as Schizas grade A in 4 cases, grade B in 5 cases, grade C in 13 cases, and grade D in 11 cases. LDH was categorized as MSU-1A in 24 cases, MSU-1B in 2 cases, and MSU-1AB in 7 cases. Intraoperative parameters (operation time, blood loss) and postoperative hospitalization length were recorded. The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to assess the lower limb pain and functional outcomes after operation. Clinical efficacy was evaluated at last follow-up via modified MacNab criteria. Quantitative radiological assessments included dural sac cross-sectional area (DSCA) measurements and spinal stenosis grading on lumbar MRI. Morphological classification of lumbar canal stenosis was determined according to the Schizas grading, categorized into four grades. RESULTS: The operation time was 60.4-90.8 minutes (mean, 80.3 minutes) and intraoperative blood loss was 13-47 mL (mean, 29.9 mL). The postoperative hospitalization length was 3-5 days (mean, 3.8 days). All patients were followed up 12-16 months (mean, 13.8 months). The VAS score and ODI improved at immediate and 3, 6, and 12 months after operation compared to before operation, and the differences between different time points were significant ( P<0.05). At last follow-up, the clinical efficacy assessed by the modified MacNab criteria were graded as excellent in 23 cases, good in 9 cases, and poor in 1 case, with an excellent and good rate of 96.97%. Postoperative lumbar MRI revealed the significant decompression of the dural sac in 32 cases, with 1 case showing inadequate dural expansion. DSCA measurements confirmed progressive enlargement and stenosis reduction over time. The differences were significant ( P<0.05) before operation, immediately after operation, and at 6 months after operation. At 6 months after operation, Schizas grading of spinal stenosis improved to grade A in 27 cases and grade B in 6 cases. CONCLUSION Posterior 180-degree decompression via UBE is a safe and feasible strategy for treating LSS combined with MSU-1 LDH, achieving effective neural decompression while preserving intervertebral disc integrity.
Humans ; Spinal Stenosis/diagnostic imaging* ; Male ; Female ; Aged ; Lumbar Vertebrae/surgery* ; Middle Aged ; Intervertebral Disc Displacement/complications* ; Decompression, Surgical/methods* ; Retrospective Studies ; Endoscopy/methods* ; Adult ; Aged, 80 and over ; Treatment Outcome

OBJECTIVE To prepare tetrandrine （TET）-loaded chitosan（CS）-stearic acid （SA） nano micelles modified with folic acid （FA）（ FA-CS-SA/TET nano micelles）， characterize them and study the anti-inflammatory effect in vitro. METHODS FA- CS-SA/TET nano micelles were prepared by ultrasonic method； the preparation technology was optimized by orthogonal test and validation test was also performed with the mass ratio of FA-CS-SA to TET， ultrasound power and ultrasound times as the factors， using the comprehensive score of entrapment efficiency （EE）， drug loading （DL） and particle size as evaluation index. FA-CS-SA/ TET nano micelles prepared by the optimal technology were characterized， and their release performance in vitro was investigated. RAW264.7 cells were used as subjects to investigate their anti-inflammatory activity in vitro. RESULTS The optimal preparation technology included that the mass ratio of FA-CS-SA to TET was 2∶1， ultrasonic power was 200 W， and the ultrasonic frequency was 200 times. The parameters of FA-CS-SA/TET nano micelles prepared by optimized technology included that EE was （98.86± 0.30）%， DL was （28.57±0.34）%， the average particle size was （227.0±9.4） nm， polydispersity index was 0.42±0.04， and the Zeta potential was（12.6±2.3）mV， respectively. The nano micelles were uniform in appearance and round in shape. The nano micelles were released quickly in 0.5% sodium dodecyl sulfate solution， with a cumulative release rate of （79.49±3.43）% within 72 hours， and its anti-inflammatory effect was stronger than that of TET raw materials. CONCLUSIONS FA-CS-SA/TET nano micelles are prepared successfully in the study， with good drug loading performance， uniform particle size， and good in vitro anti-inflammatory activity.

OBJECTIVE To explore in vitro dissolution and in vivo pharmacokinetics of Luteolin solid dispersion in Beagle dogs. METHODS The dissolution of Luteolin solid dispersion was investigated according to the second method （paddle method） of the “dissolution determination method” in the 2020 edition of Chinese Pharmacopoeia （Part Ⅳ）. UPLC-MS/MS method was established to determine the concentration of luteolin in the plasma of Beagle dogs. Twelve Beagle dogs were randomly divided into luteolin group and Luteolin solid dispersion group， with 6 dogs in each group. They were given relevant medicine orally at the dose of 10 mg/kg luteolin. Blood was collected before medication （0 h）， at 5， 10， 15， 30， 45 min and 1， 2， 4， 6， 8， 10， 12， 24， 48 h after administration. After protein precipitation with acetonitrile， the blood concentration of luteolin in Beagle dogs was determined by UPLC-MS/MS and the major pharmacokinetic parameters were calculated with non-compartmental models by using DAS 3.2.8 pharmacokinetic software. RESULTS The dissolutions of Luteolin solid dispersion in purified water and 0.1% sodium dodecyl sulfate solution was significantly higher than those of luteolin； the dissolution rate reached 95% in 0.1% sodium dodecyl sulfate solution for 120 minutes. The peak concentration （cmax） of luteolin in the Luteolin solid dispersion group of Beagle dogs was 5.62 times higher than the luteolin group， and the relative bioavailability was 348%. Compared with luteolin group， cmax and the area under the drug time curve of luteolin in the Luteolin solid dispersion group of Beagle dogs were significantly increased， while the apparent distribution volume was significantly reduced （P＜0.05）. CONCLUSIONS Luteolin solid dispersion can improve in vitro dissolution and bioavailability of luteolin in Beagle dogs.

Thyroid hormone resistance syndrome complicated with papillary thyroid cancer is clinically rare.Madelung's disease is a rare disorder of lipid metabolism.We analyzed the clinical data of a case of thyroid hormone resistance syndrome complicated with papillary thyroid carcinoma and Madelung's disease,performed whole-exon sequencing for the patient's peripheral blood samples,and retrospectively analyzed the relevant liter-ature.This review is expected to provide experience for clinical diagnosis and treatment.

Objectives:To visualize and analyze the research on the application of 3D printing technology in the field of spinal surgery at home and abroad,construct visualization maps,and provide reference for future research by comparing the research hotspots at home and abroad.Methods:The China National Knowledge Infrastructure(CNKI)database was searched using the keywords of"3D printing"and"spine"for literature published in 2013-2023 in Chinese;The Web of Science Core Collection database was used as English database,literature published in 2013-2023 with topics including"3D printing"and"Spine"were searched with"TS=(3D printing)AND TS=(Spine)".A total of 256 Chinese literature and 250 English literature were included and imported into CiteSpace software after excluding the duplicate and low relevance articles.The annual publication quantity,authors,keywords,countries,institutions,keyword clustering,and keyword promi-nence in both Chinese and English literature were visualized and analyzed.Results:The annual publication numbers of domestic and foreign publications from 2013 to 2023 were similar.The top three authors pub-lished the most Chinese literature were Li Chao,Niu Guoqi,and Sun He;The top three authors published the most English literature were Clifton William,Damon Aaron,and Nottmeier Eric.In the visualization map of Chinese literature keywords,there were 215 nodes and 617 lines with a density of 0.0273;The most fre-quently appeared keywords were 3D printing(148 times,1.09),spinal surgery(47 times,0.26),and scoliosis(30 times,0.10).In the English literature keyword visualization graph,there were 282 nodes and 1359 lines with a density of 0.0367;The most frequently appeared keywords were 3D printing(116 times,0.07),surgery(54 times,0.12),and accurate(42 times,0.18).A total of 206 nodes and 100 lines with a density of 0.0047 ap-peared in the visualization graph of the institutions of CNKI database,and 216 nodes and 147 lines appeared in the visualization graph of the institutions of Web of Science with a density of 0.0063.China published the most articles,followed by the United States and Australia.The top three institutions published the most Chi-nese literature were Peking University Third Hospital,Yan'an University Affiliated Hospital,and Bengbu Med-ical College Second Affiliated Hospital.The top three institutions published the most literature abroad were Mayo Clin,Southern Med Univ,and Capital Med Univ.After clustering the keywords of Chinese and English literature,6 meaningful clusters were obtained respectively.The most prominent keywords in Chinese and Eng-lish literature were tissue engineering and patient specific,respectively.Conclusions:The hot topics of 3D printing technology in spinal surgery research vary in countries.The connections between foreign institutions are relatively dense,while those in China are relatively scattered.

Objective:To identify the method to reduce X-ray exposure during ablation of atrial fibrillation (AF) by comparing the cryoballoon (CRYO) ablation and remote magnetic navigation (RMN) ablation.Methods:A retrospective analysis was conducted on 144 patients undergoing CRYO ablation (CRYO group) and 121 patients undergoing RMN ablation (RMN group) in our hospital. Entrance surface doses at reference points online, exposure time during procedure and outcomes were analyzed for different types of patients.Results:Compared with the RMN group, the procedure time for the CRYO group significantly decreased [(165.0±23.6), (97.8±18.4) min, t=26.05, P<0.001]. However, the entrance surface dose value [(232.3±130.7), (669.0±387.5) mGy, Z=-12.29, P<0.001] and X-ray exposure time [(8.1±3.1), (23.4±6.2) min, t=-24.57, P<0.001] increased significantly for the CRYO group. No significant difference was found between the two groups in the proportion of maintaining sinus rhythm during follow-up of patients (71.9%, 75.7%, P=0.618). Multiple regression analysis showed that obese patients, patients with non-paroxysmal AF and patients with variant pulmonary veins were associated with an increase in entrance surface dose values in the CRYO group ( t=5.47, 2.23, 3.39, P<0.05). The X-ray exposure time for the three types patients above in the CRYO group also increased ( t=2.87, 3.86, 3.25, P<0.05) in the CRYO group. However, only obese patients in the RMN group had an increase in entrance surface dose value ( Z=-4.15, P<0.001) and no increase in exposure time. For the three types of patients above, there was no significant difference in proportion of maintaining sinus rhythm between the CRYO group and the RMN group during follow-up ( P>0.05). Conclusions:Compared with RMN ablation, the radiation exposure of CRYO AF ablation significantly increased, especially in obese patients, patients with non-paroxysmal AF and patients with pulmonary veins variation. The use of RMN for these types of patients may reduce the radiation exposure without affecting the procedure outcomes.

Animals ; Coronary Vessels ; Diabetes Mellitus ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle ; Rats

Objective:To compare the differences of fluoroscopy time and dose between HIS bundle pacing and right ventricle apex pacing.Methods:This study includes thirty patients undergoing HIS bundle pacing (HIS group) and 32 patients undergoing right ventricular apex pacing (RVA group). The fluoroscopy time and cumulative dose (CD) to patients during surgery were recorded and analyzed.Results:The operation time for patients in HIS group and RVA group were (76.8±13.1) and (66.0±10.8) min ( t=3.386, P<0.001), respectively. The fluoroscopy time was (698.2±113.7) and (293.3±63.9) s ( t=14.709, P<0.001) and the CD were (391.3±70.0) and (162.3±40.5) mGy ( t=13.694, P<0.001) in HBP group and RVA group, respectively. In comparison, the fluoroscopy time and CD for HIS bundle electrode implantation were (501.2±112.3) s and (279.9±65.0) mGy, respectively, significantly higher than in the case of RVA, where the values were (103.4±30.6) s and (57.3±13.8) mGy ( t=15.864, Z=-6.524, P<0.001). Conclusions:Compared with right ventricular apical pacing, the HIS bundle pacing takes longer operation time, leading to higher radiation dose, which should be prudently selected.

Objective: To investigate the impact of n-3 polyunsaturated fatty acid (n-3 PUFA) on function and expression of store-operated calcium channels (SOCC) in coronary artery smooth muscle cells (SMC) derived from diabetic rat. Methods: A total of 180 healthy male Sprague-Dawley (SD) rats were randomly divided into normal group (N, n=45), placebo-treated diabetic group (D, n=45), lose dose n-3 PUFA treated diabetic group (DL, n=45) and high dose n-3 PUFAs treated diabetic group (DH, n=45). Streptozotocin-induced diabetic rat animal model was established by two consecutive intraperitoneal injections. After modeling, rats in group DL and DH were treated with 10 mg·kg^-1·d^-1 and 50 mg·kg^-1·d^-1 n-3 PUFAs respectively per gavage for eight weeks. After eight weeks, rat coronary artery SMC was isolated by enzyme digestion. Changes of cytosolic calcium concentration in coronary artery SMC were examined by calcium fluorescence imaging technique, coronary artery tension was detected by myograph system, and protein expressions of SOCC on coronary artery SMC were measured by Western blot. Results: SOCC induced ΔF340/F380 of group N, D, DL and DH were 0.425±0.023, 0.838±0.037, 0.342±0.052 and 0.364±0.045 respectively, which was significantly lower in group N, DL, DH than in group D (P<0.05). SOCC induced changes of tensions were 0.94±0.09, 1.95±0.18, 1.35±0.24 and 1.01±0.18 in the group N, D, DL and DH, respectively, which was significantly lower in group N and DH than in group D (P<0.05). Protein expressions of STIM1, Orai1 and TRPC1 were significantly higher in diabetic rat coronary SMC than in group N (P<0.05). STIM1 protein expressions were significantly lower in group DL and DH than in group D, and Orai1 and TRPC1 protein expressions were similar among group. Conclusions Coronary artery tension, cytosolic calcium concentration and protein expressions of SOCC are higher in diabetic rat coronary artery SMC when compared with normal rats. n-3 PUFA intervention could downregulate the protein expression of SOCC, reduce cytosolic calcium concentration and coronary artery tension, and is protective to the diabetic injury in coronary artery.