Objective:To establish a new method and platform for screening, identifying, and exploring a new strategy for anti-hepatitis B immunotherapy based on hepatitis B virus (HBV)-specific TCR.Methods:Peripheral blood mononuclear cells were isolated from patients with acute hepatitis B. CD3 +CD8 +CD137 +T single cells were sorted out after stimulation with the HBsAg peptide library. The α and β chains in TCRs of single cells were amplified by PCR. TCR double-chain pairing and lentiviral packaging were performed through high-throughput sequencing. Re-infected Jurkat-76-NFAT-GFP cells and the cell lines stably expressing TCR were screened. HBsAg peptide library and immortalized B lymphocytes co-cultured with J76N-TCR were used to screen HBsAg-specific TCRs. K562 cell lines stably expressing HLA-A*24:02 were established to determine epitope peptide by screening A*24:02-restricted TCR. The screened TCRs were replaced with mouse C regions and packaged with lentiviruses. Functional validation was performed on healthy human CD4 +T and CD8 +T lymphocytes following infection. Results:Stable TCR-expressing cell lines were successfully prepared based on single-cell TCRαβ double-chain amplification and pairing technology. Twenty-one TCRs were screened using immortalized B lymphocytes, resulting in nine possible HLA-A*24:02-restricted HBsAg-specific TCRs. Further screening with K562-A2402 resulted in six A*24:02-restricted HBsAg-specific TCRs with identically recognized epitope peptide. The functional determination of the two TCR clones revealed their specific recognition function for target cells expressing HBsAg.Conclusion:HLA-A*24:02-restricted HBsAg-specific TCR with recognition function for target cells expressing HBsAg was successfully obtained based on the new experimental technology system, laying an important foundation for further exploration of antiviral immunotherapy based on HBV-specific TCR.

Objective To investigate the efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF),minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and posterior lumbar interbody fusion(PLIF)in patients with lumbar disc degenerative change.Methods The medical records of 101 patients with lumbar disc degenerative change who underwent surgical treatment in our hospital from January 2019 to December 2022 were retrospectively collected,and they were divided into UBE-TLIF group(37 cases),MIS-TLIF group(33 cases)and PLIF group(31 cases)according to types of operation.The operation related indexes,visual analogue scale(VAS),dysfunction and postoperative complications of the three groups were compared.The height of the intervertebral space and the lumbar lordosis angle were measured before and after surgery.Interbody fusion 12 months after surgery were evaluated via Bridwell criteria.Results The duration of operation of UBE-TLIF group was significantly longer than that of MIS-TLIF group and PLIF group,and MIS-TLIF group was significantly longer than that of PLIF group,the differences were statistically significant(P＜0.05);The intraoperative blood loss and postoperative drainage volume in the UBE-TLIF group were significantly less than those in the MIS-TLIF group and PLIF group,and the MIS-TLIF group was significantly less than that in the PLIF group,the postoperative hospital stay in the UBE-TLIF group was significantly shorter than that in the MIS-TLIF group and PLIF group,and the MIS-TLIF group was significantly shorter than that in the PLIF group,the differences were statistically significant(P＜0.05);The VAS of low back pain and leg pain at 1,3,and 12 months after operation in the 3 groups were significantly lower than those before operation(P＜0.05);The VAS of low back pain and leg pain at 1 and 3 months after operation in the UBE-TLIF group was significantly lower than that in the MIS-TLIF group and the PLIF group,and the VAS of low back pain and leg pain in the MIS-TLIF group was significantly lower than that in the PLIF group(P＜0.05);The Oswestry disability index(ODI)at 1,3 and 12 months after operation in the 3 groups was significantly lower than that before operation,and the ODI in UBE-TLIF group was significantly lower than that in MIS-TLIF group and PLIF group at 1 month after operation,the differences were statistically significant(P＜0.05);The intervertebral space height and lumbar lordosis angle at 1,3,and 12 months after operation were significantly bigger than those before operation in 3 groups(P＜0.05);At 12 months after operation,the intervertebral fusion rates of UBE-TLIF group,MIS-TLIF group and PLIF group were 94.59%,93.94%and 93.55%,respectively,showing no significant difference among the 3 groups(P＞0.05);The interbody fusion time in UBE-TLIF group and MIS-TLIF group was significantly shorter than that in PLIF group(P＜0.05);There was no significant difference in the incidence of complications among the three groups(P＞0.05).Conclusion UBE-TLIF,MIS-TLIF and PLIF can all achieve a higher interbody fusion rate in treating lumbar disc degenerative change,and UBE-TLIF and MIS-TLIF cause less serious surgical trauma,while UBE-TLIF outperforms MIS-TLIF in respect of surgical trauma,and sees faster postoperative recovery.

Objective To investigate the efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion(UBE-TLIF),minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and posterior lumbar interbody fusion(PLIF)in patients with lumbar disc degenerative change.Methods The medical records of 101 patients with lumbar disc degenerative change who underwent surgical treatment in our hospital from January 2019 to December 2022 were retrospectively collected,and they were divided into UBE-TLIF group(37 cases),MIS-TLIF group(33 cases)and PLIF group(31 cases)according to types of operation.The operation related indexes,visual analogue scale(VAS),dysfunction and postoperative complications of the three groups were compared.The height of the intervertebral space and the lumbar lordosis angle were measured before and after surgery.Interbody fusion 12 months after surgery were evaluated via Bridwell criteria.Results The duration of operation of UBE-TLIF group was significantly longer than that of MIS-TLIF group and PLIF group,and MIS-TLIF group was significantly longer than that of PLIF group,the differences were statistically significant(P＜0.05);The intraoperative blood loss and postoperative drainage volume in the UBE-TLIF group were significantly less than those in the MIS-TLIF group and PLIF group,and the MIS-TLIF group was significantly less than that in the PLIF group,the postoperative hospital stay in the UBE-TLIF group was significantly shorter than that in the MIS-TLIF group and PLIF group,and the MIS-TLIF group was significantly shorter than that in the PLIF group,the differences were statistically significant(P＜0.05);The VAS of low back pain and leg pain at 1,3,and 12 months after operation in the 3 groups were significantly lower than those before operation(P＜0.05);The VAS of low back pain and leg pain at 1 and 3 months after operation in the UBE-TLIF group was significantly lower than that in the MIS-TLIF group and the PLIF group,and the VAS of low back pain and leg pain in the MIS-TLIF group was significantly lower than that in the PLIF group(P＜0.05);The Oswestry disability index(ODI)at 1,3 and 12 months after operation in the 3 groups was significantly lower than that before operation,and the ODI in UBE-TLIF group was significantly lower than that in MIS-TLIF group and PLIF group at 1 month after operation,the differences were statistically significant(P＜0.05);The intervertebral space height and lumbar lordosis angle at 1,3,and 12 months after operation were significantly bigger than those before operation in 3 groups(P＜0.05);At 12 months after operation,the intervertebral fusion rates of UBE-TLIF group,MIS-TLIF group and PLIF group were 94.59%,93.94%and 93.55%,respectively,showing no significant difference among the 3 groups(P＞0.05);The interbody fusion time in UBE-TLIF group and MIS-TLIF group was significantly shorter than that in PLIF group(P＜0.05);There was no significant difference in the incidence of complications among the three groups(P＞0.05).Conclusion UBE-TLIF,MIS-TLIF and PLIF can all achieve a higher interbody fusion rate in treating lumbar disc degenerative change,and UBE-TLIF and MIS-TLIF cause less serious surgical trauma,while UBE-TLIF outperforms MIS-TLIF in respect of surgical trauma,and sees faster postoperative recovery.

Objective:To establish a new method and platform for screening, identifying, and exploring a new strategy for anti-hepatitis B immunotherapy based on hepatitis B virus (HBV)-specific TCR.Methods:Peripheral blood mononuclear cells were isolated from patients with acute hepatitis B. CD3 +CD8 +CD137 +T single cells were sorted out after stimulation with the HBsAg peptide library. The α and β chains in TCRs of single cells were amplified by PCR. TCR double-chain pairing and lentiviral packaging were performed through high-throughput sequencing. Re-infected Jurkat-76-NFAT-GFP cells and the cell lines stably expressing TCR were screened. HBsAg peptide library and immortalized B lymphocytes co-cultured with J76N-TCR were used to screen HBsAg-specific TCRs. K562 cell lines stably expressing HLA-A*24:02 were established to determine epitope peptide by screening A*24:02-restricted TCR. The screened TCRs were replaced with mouse C regions and packaged with lentiviruses. Functional validation was performed on healthy human CD4 +T and CD8 +T lymphocytes following infection. Results:Stable TCR-expressing cell lines were successfully prepared based on single-cell TCRαβ double-chain amplification and pairing technology. Twenty-one TCRs were screened using immortalized B lymphocytes, resulting in nine possible HLA-A*24:02-restricted HBsAg-specific TCRs. Further screening with K562-A2402 resulted in six A*24:02-restricted HBsAg-specific TCRs with identically recognized epitope peptide. The functional determination of the two TCR clones revealed their specific recognition function for target cells expressing HBsAg.Conclusion:HLA-A*24:02-restricted HBsAg-specific TCR with recognition function for target cells expressing HBsAg was successfully obtained based on the new experimental technology system, laying an important foundation for further exploration of antiviral immunotherapy based on HBV-specific TCR.

Ictal asystole in epileptic seizure (IA) is one of the severe complications of epilepsy, which is associated with falls and traumatic injuries related to seizures. Epileptic patients with IA may require adjustment to their treatment, including antiseizure medications adjustment, evaluation for epilepsy surgery and consideration of cardiac pacemaker implantation. However, there is no consensus on treatment options for these patients. This review focuses on the mechanisms, clinical features, auxiliary examinations and the outcomes of different treatments in the IA patients. Machine learning has some application values in analyzing the long-term video electroencephalogram (EEG) results of such patients and exploring the correlated characteristics between EEG and heart rate variability, which may provide a new perspective for the research.

Objective:To translate the Illness Identity Questionnaire (IIQ) into Chinese and test its reliability and validity.Methods:The English version of IIQ was translated into Chinese and back-translated according to the Brislin model. The item of the Chinese version was determined after cross-cultural adaptation and pre-experiment. A total of 368 patients with IBD treated in the First Affiliated Hospital with Nanjing Medical University from September 2022 to March 2023 were selected for a questionnaire survey to evaluate the reliability and validity of the questionnaire.Results:The Chinese version of IIQ contained 24 items in four dimensions. Four common factors were extracted by exploratory factor analysis, and the cumulative variance contribution rate was 64.025%. Confirmatory factor analysis showed that each fitting index of the modified model was within the acceptable range. The Cronbach's α coefficients of rejection, acceptance, engulfing, and enrichment in Chinese IIQ were respectively 0.780, 0.800, 0.921, and 0.917. The split-half reliability coefficients were 0.824, 0.818, 0.943, and 0.929; the retest reliability coefficients were 0.695, 0.667, 0.725, and 0.572, respectively.Conclusions:The Chinese version of IIQ is reliable and valid and can be used to assess illness identity in patients with chronic diseases.

Objective To compare the efficacy of arthroscopic rotator cuff repair using single row,double row,and suture bridge techniques in treating rotator cuff injuries and analyze the influencing factors of postoperative chronic pain.Methods Clinical data of 106 patients with rotator cuff injury to receive arthroscopic rotator cuff repair from January 2021 to February 2023 were retrospectively collected,were divided into single row group(n=35),double row(n=32)and suture bridge group(n=39).All patients from the three groups were evaluated using the pain visual analogue scale(VAS)and the Constant-Murley shoulder score(CMS)before surgery and 3,6,and 12 months after surgery,and their external rotation and forward flexion range of motion were measured.The incidence of postoperative retearing and chronic pain after surgery were compared among the three groups.Patients were divided into chronic pain group(n=21)and non-chronic pain group(n=85)depending whether chronic pain was seen or not after surgery and the clinical data was compared.Risk factors for postoperative chronic pain in arthroscopic rotator cuff repair patients were assessed via binary Logistic regression analysis.Results The VAS in suture bridge group was significant lower than that in single row group and double row group at 3,6 months after surgery,the VAS at 3,6,12 months after surgery in three groups were lower than that before surgery,the differences were statistically significant(P<0.05).The CMS score in suture bridge group was significant higher than that in single row group,double row group at 3,6 months after surgery,and all groups at 3,6,12 months after surgery were higher than that before surgery.The external rotation range of motion,and forward bending range of motion in suture bridge group were larger than those in single row group,double row group at 3,6 months after surgery,and all groups at 3,6,12 months after surgery were larger than those before surgery,the differences was statistically significant(P<0.05).The incidence of postoperative retearing in suture bridge group was significant lower than that in single row group and double row group,the difference was statistically significant(P<0.0167),but there was no difference between single row group and double row group(P>0.0167).The chronic pain occurrence was no statistical difference among the three groups(P>0.05).The chronic pain group had higher proportions of women,tear diameter<1.0 cm,and severe postoperative pain than those of non-chronic pain group(P<0.05).Other clinical data[age,body mass index(BMI),course of disease,location of injury,cause of injury,smoking and drinking history]were comparable between the two groups,the differences were not statistically significant(P>0.05).According to binary Logistic regression analysis,after adjusting for confounding factors(age,BMI,disease course,location and cause of injury),female gender,tear diameter<1.0 cm,and severe postoperative pain were independent risk factors for chronic pain after arthroscopic rotator cuff repair surgery(P<0.05).Conclusion In treating patients with rotator cuff injury,arthroscopic suture bridge outperforms single row and double row techniques in alleviating shoulder joint pain,promoting functional recovery and increasing range of motion,and presents lower risk of retearing.However,all three have some risk of chronic pain after surgery.Female gender,tear diameter<1.0 cm,and severe postoperative pain are independent risk factors for postoperative chronic pain.

BACKGROUND:Due to natural degradation,excellent biocompatibility and good mechanical properties,magnesium alloy has become a very valuable implant material in the biomedical field.However,the rapid degradation rate of magnesium alloy limits its further development and application. OBJECTIVE:To review the principle of the degradation of magnesium and its alloys in a physiological environment.The current research status of alloying elements selection is mainly introduced from the aspects of the safety of elements and their influence on the properties of magnesium and its alloys. METHODS:The articles were searched by using the databases of CNKI,PubMed,Web of Science and Elsevier.The key words were"magnesium(alloy),metal name(such as:bismuth(Bi),aluminum(Al)),corrosion,biocompatibility,metal toxicity,scaffold(stent)/screw"in Chinese and English.The search period was from 2013 to 2023.As a result,70 articles were applied for analysis after reading the contents of the articles. RESULTS AND CONCLUSION:Magnesium alloy has been widely studied in the medical field.Although some products have been applied in clinical practice,the high degradation rate of magnesium alloy in the human environment is still the main limitation of large-scale clinical application.The focus of future development is to control its corrosion rate.Alloying is a kind of method to improve the corrosion resistance of magnesium alloys,and various properties can also be improved by adding different alloy components.However,simple alloying cannot satisfy the pursuit of diversified properties of magnesium alloys.To develop multifunctional magnesium alloy products with excellent performance,it is necessary to combine various optimization methods,such as alloying and surface modification,to make up for the shortcomings of their respective methods in the future.In addition,the alloy structure updating with preparation process improvement is combined to enhance the properties of magnesium alloy.

Objective To explore the potential categories and influencing factors of the fear of progression in patients with inflammatory bowel diseases(IBD).Methods IBD patients who received inpatient treatment in a tertiary hospital in Nanjing from July 2022 to July 2023 were selected as the study subjects by convenience sampling method.The General Demographic Information Questionnaire,the Chinese version of the Fear of Progression Questionnaire-Short Form(FoP-Q-SF),the Chinese version of Inflammatory Bowel Disease Self-efficacy Scale(IBD-SES),and Social Support Rating Scale(SSRS)were administered to the participants.We applied one-way ANOVA and Logistic regression analysis to identify the factors associated with the potential categories of the fear of progression.Results A total of 303 retumed questionnaires(out of the 310)were valid,resulting an effective response rate of 97.74％.According to the results of latent profile analysis,we classified the respondents into 3 categories by the fear of progression,namely"low risk fear of disease adaptation group"(n=127,41.91％),"medium risk fear of illness distress group"(n=139,45.88％),"high risk fear of dysfunction group"(n=37,12.21％).3 groups showed statistically significant differences in permanent address,self-rated financial pressure,current disease status and self-efficacy(P＜0.05).Conclusion Patients with IBD had obvious differences in characteristics on the fear of progression.Nursing personnel should formulate personalized intervention strategies based on the classification characteristics of the fear of progression of IBD patients.Moreover,nurses should focus on improving patients'self-efficacy and promoting patients to treat medical care,stress and emotion management correctly.

Objective:To investigate the clinical, genetic, and pathological features of nemaline myopathy type 8 (NEM8) caused by KLHL40 gene variation. Methods:The clinical data, gene sequencing results, and musculoskeletal pathophysiology of two cases (a pair of twins) with NEM8 admitted to our hospital in July 2022 were collected. CNKI, VIP, Wanfang, Yiigle, PubMed, Embase, and Web of Science Database were searched with the English and Chinese terms "nemaline myopathy type 8", "nemaline body myopathy type 8", and " KLHL40" from January 2007 to February 2023. The clinical, genetic, and musculoskeletal characteristics of the NEM8 cases were summarized using the descriptive statistical analysis method. Results:(1) Case report: The mother (G2P2) of the twins (Ⅳ-2 and Ⅳ-3) was conceived by IVF-embryo transfer and delivered at 37 +1 gestational weeks. The two cases were dizygotic twins whose maternal grandmother had lip and palate cleft. The first baby (Ⅳ-1) of the woman exhibited absent left pinna, contracture at the end of both fingers, talipes equinovarus in both feet and died of respiratory failure two hours after birth. Fetal edema and fetal movement delay in the twins and varus right foot in one twin were found during pregnancy. Both cases developed intrapartum asphyxia with the clinical manifestations of generalized muscle weakness, respiratory failure, dysphagia, multiple joint contractures, and fractures. The families withdrew the treatment and the twins died after maintaining life with ventilators for 53 days after birth. Whole exome sequencing of the pedigree found c.1779G>T (p.W593C) homozygous variants of the KLHL40 gene in the twins and c.1779G>T (p.W593C) heterozygous variants of the KLHL40 gene in the parents, both were de novo. Musculoskeletal pathophysiology indicated that muscle fibers are thin and round with a fetal shape and absent rod. (2) Literature review: Among the 29 cases of NEM8, including two current cases and 27 cases retrieved from 15 papers, eight cases terminated the pregnancies, and 21 were live births; seven cases (24.1%) with positive family history; 19 cases (65.5%) were found with abnormalities during pregnancy, including abnormal fetal movements, polyhydramnios, joint contracture, and fetal edema. Of the 21 live births, 20 cases had intrapartum asphyxia, 21 had postnatal respiratory failure, 20 had generalized muscle weakness, and 19 had dysphagia. Among the 29 cases, 17 cases (58.6%) were homozygous variants of the KLHL40 gene, and 12 cases (41.4%) were compound heterozygous variants. The detection rate of c.1516A>C(p.Thr506Pro) was the highest [72.4% (21/29)], followed by c.602G>A(p.Trp201*) [17.2% (5/29)]. Out of the 15 cases who underwent musculoskeletal pathological examination, all had abnormal muscle fiber size and morphology; 10 cases had rods. Conclusions:NEM8 should be considered for those with abnormal fetal movements, polyhydramnios, joint malformation, fetal edema during the fetal period and failure to establish respiration at birth as well as postnatal generalized muscle weakness, respiratory failure, dysphagia, multiple joint contractures, and fracture. Moreover, genetic detection should be performed as soon as possible. NEM8 can be diagnosed in ones with KLHL40 gene homozygous or compound heterozygous variants and musculoskeletal pathological results of abnormal size and shape of muscle fibers, regardless of the presence of rods.