Objective: To determine 17 types of phthalic acid esters (PAEs) in drinking water using solid-phase extraction coupled with gas chromatography-mass spectrometry (GC-MS) in multiple reaction monitoring (MRM) mode. Methods: One litre of commercially available bottled water was purified using an HLB solid-phase extraction column, and was eluted with ethyl acetate, dichloromethane and average methanol. Seventeen types of PAEs were detected using a triple quadrupole gas chromatography-mass spectrometer in MRM mode. By optimizing the temperature programming and adjusting the mass spectrometry collision energy, collection efficiency was improved and matrix interference was reduced. The precision and accuracy of this method were assessed by determining the standard curves, detection limits, quantification limits, relative standard deviations (RSD) and average spiked recovery rates for the 17 types of PAEs. Results: The 17 types of PAEs showed good linear relationships between mass concentration and chromatographic peak areas in the range of 0.02 to 1.0 mg/L, with correlation coefficients all greater than 0.999 1. The detection limits ranged from 0.002 9 to 0.009 7 mg/kg, the quantification limits ranged from 0.008 7 to 0.029 1 mg/kg, the RSD ranged from 0.8% to 3.0%, and the average spiked recovery rates ranged from 88.8% to 111.8%. Conclusion Solid-phase extraction coupled with MRM of GC-MS can better determine low concentrations of PAEs in drinking water.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

BACKGROUND:Osteonecrosis due to drugs is a serious adverse reaction occurring after the application of such drugs.Increasing evidence suggests that the gut microbiota composition is associated with osteonecrosis due to drugs.However,the causal relationship of the gut microbiota to osteonecrosis due to drugs is still unclear. OBJECTIVE:To evaluate the potential causal relationship between the gut microbiota and the risk of osteonecrosis due to drugs using the Mendelian randomization method. METHODS:A two-sample Mendelian randomization study was performed using the summary statistics of gut microbiota from the largest available genome-wide association study meta-analysis(n=13 266)conducted by the MiBioGen consortium as well as the summary statistics of osteonecrosis due to drugs obtained from the FinnGen consortium R9 release data(264 cases and 377 013 controls).Inverse variance weighted,MR-Egger,weighted median,weighted model and simple model were used to examine the causal association between gut microbiota and osteonecrosis due to drugs.Sensitivity analysis was used to test whether the results of the Mendelian randomization analysis were reliable.Reverse Mendelian randomization analysis was performed on all the bacteria as an outcome for effect analysis and sensitivity analysis. RESULTS AND CONCLUSION:Inverse variance weighted estimates suggested that Lentisphaerae(phylum),Lentisphaeria(class),Melainabacteria(class),Gastranaerophilales(order),Rhodospirillales(order),Victivallales(order)and Bifidobacterium(genus)had protective causal effects on osteonecrosis due to drugs.Methanobacteria(class),Bacillales(order),Methanobacteriaceae(family),Lachnospiraceae(family),Methanobacteriales(order),Holdemania(genus),Holdemania(UCG010 group)(genus),Odoribacter(genus)and Tyzzerella3(genus)had negative causal effects on osteonecrosis due to drugs.According to the results of reverse Mendelian randomization analysis,Clostridiaceae1(family),Peptostreptococcaceae(family),Streptococcaceae(family),Clostridiumsensustricto1(genus)and Streptococcus(genus)showed negative causal effects on osteonecrosis due to drugs.However,Eisenbergiella(genus)showed protective causal effects on osteonecrosis due to drugs.None of the bidirectional sensitivity analysis revealed heterogeneity or horizontal pleiotropy.When gut microbiota were used as exposure and osteonecrosis due to drugs as the outcome,Mendelian randomization analysis found that seven bacterial traits were positively correlated to osteonecrosis due to drugs,nine bacterial traits were negatively related to osteonecrosis due to drugs.When osteonecrosis due to drugs were used as exposure and gut microbiota as the outcome,reverse Mendelian randomization analysis found a negative correlated relationship with five bacterial traits and a positive causal relationship with one bacterial trait.By changing the diversity and composition of gut microbiota,it is expected to improve the incidence and prognosis of osteonecrosis due to drugs,providing new ideas for the study of orthopedic diseases.

BACKGROUND:Our previous studies found that the polypeptide of Cornus cervi Colla can promote bone growth,which has a good application prospect in the treatment of bone diseases.However,how Cornus cervi Colla works in the body and the principle are not clear. OBJECTIVE:To study the in vivo distribution and tracing of Cornus cervi Colla using fluorescence labeling and tracer technique. METHODS:Cornus cervi Colla was fluorescently labeled using fluorescein isothiocyanate,and the labeling results were detected by fluorescence imaging and UV spectral scanning.Successfully labeled Cornus cervi Colla was injected into mice by gavage,and the absorption of Cornus cervi Colla into blood was detected by laser confocal microscopy,and the distribution of Cornus cervi Colla in mice was detected by small animal in vivo imager.The distribution of Cornus cervi Colla in the mice was detected by laser confocal microscopy.Samples were taken from serum and bone at the time of the strongest fluorescence,and gel electrophoresis was carried out on serum and bone tissue protein solutions,and the components of Cornus cervi Colla absorbed into target organs were determined by secondary mass spectrometry. RESULTS AND CONCLUSION:The fluorescent markers were successfully separated by dextran gel chromatography,and the fluorescence imaging and ultraviolet spectrum scanning proved that the labeling was successful,and the fluorescence substitution degree of FITC-labeled Cornus cervi Colla was 0.953%.The fluorescence intensity of the components of Cornus cervi Colla in the blood showed that Cornus cervi Colla was most distributed in serum after oral administration for 2 hours.The fluorescence images of mice at different times were the same as those of bilateral femur and tibia,indicating that Cornus cervi Colla could play a role by entering the bone.Compared with UniProt database,secondary mass spectrometry showed that the peptide was a characteristic fragment of decorin.It is proved that decorin in Cornus cervi Colla can enter the bone to play a therapeutic role.

Objective To analyze the relationships between pulmonary ground-glass nodules(GGN)and bronchi and blood vessels and their diagnostic values for infiltrative lesions based on high-resolution computed tomography(HRCT)target scanning technology.Methods Patients with GGN detected by HRCT target scanning and complete pathological results were retrospectively selected as the research subjects.The relationships between GGN and bronchi and blood vessels in patients with different pathological types were analyzed,and the relationships for detecting infiltrative lesions were further analyzed,using pathological results as the gold standard.Results Three hundred patients were divided into 237 cases of pre-invasive lesions and 63 cases of infiltrative lesions according to pathological results.There were statistically significant differences in lesion properties and lesion morphology in patients with different types of GGN(P＜0.05).There were statistically significant differences in the relationships between GGN and bronchi and blood vessels in the pre-invasive lesions and the infiltrative lesions(P＜0.05).Based on the pathological results as the gold standard,the sensitivity of HRCT bronchial classification,vascular classification,and their combined detection of infiltrative lesions were 84.13％(53/63),95.24％(60/63),and 95.24％(60/63);specificity were 83.12％(197/237),87.34％(207/237),and 87.34％(207/237);accuracy were 83.33％(250/300),89.00％(267/300),and 89.00％(267/300).Conclusion Evaluating the classification of pulmonary GGN and bronchi and blood vessels by HRCT target scanning technology has good value in identifying infiltrative lesions.The combined diagnosis of the two signs can further improve the accuracy of detection.

Methods: The study included patients who underwent LIF. The demographic characteristics and radiographic and surgical data were collected and evaluated. The included patients were divided into control group and FJOA group based on the preoperative adjacent facet joint Pathria grade. Preoperative and last follow-up LBP Visual Analog Scale (VAS) score, leg pain (LP) VAS, Oswestry Disability Index (ODI) and RASD were evaluated and compared. The improvement rates in VAS and ODI were calculated and compared between the two groups. Logistic regression was used to analyze the risk factors of LBP relief and incidence of RASD. Results: In total, 197 patients (control group, 86; FJOA group, 111) were included, and the median follow-up was 46 months. The VAS and ODI in both groups significantly improved after surgery. At the last follow-up, the FJOA group had higher VAS and lower VAS improvement rates of LBP than the control group (p<0.05). However, no significant difference in the LP VAS and ODI was found between the two groups. The incidence of RASD in the FJOA group was significantly higher than that in the control group (48.6% vs. 30.2%, p=0.034). Multivariate logistic regression analysis showed that preoperative adjacent FJOA was significantly associated with LBP relief (odds ratio [OR], 0.691; 95% confidence interval [CI], 0.498–0.958) and the postoperative incidence of RASD (OR, 1.406; 95% CI, 1.020–1.939). Conclusions The preoperative FJOA in the adjacent segments was significantly associated with LBP following LIF. Patients with preoperative FJOA were more likely to have RASD following lumbar fusion surgery.

Objective To investigate the diagnostic value of combining carotid intima-media thickness (cIMT) with serum Galectin-3 (Gal-3) and Pentraxin 3 (PTX3) in patients with psoriasis complicated with cardiovascular disease (CVD). Methods Thirty-eight patients with psoriasis complicated with CVD were included in CVD group, 51 patients with psoriasis alone were included in psoriasis group, and 60 healthy subjects were selected as control group. Clinical data were collected from each group. The cIMT was measured using carotid ultrasound, and serum Gal-3, PTX3, and inflammatory markers[high sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), tumor necrosis factor-α (TNF-α)]were detected using enzyme-linked immunosorbent assay. Multivariate Logistic regression analysis was used to identify the influencing factors of CVD in patients with psoriasis. The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of serum Gal-3, PTX3, and cIMT for CVD. Results The cIMT was greater in the CVD group and the psoriasis group than in the control group, and the CVD group was greater than the psoriasis group (P < 0.05). The serum levels of Gal-3, PTX3, hs-CRP, PCT, and TNF-α were higher in the CVD group and the psoriasis group than in the control group, and their levels were higher in the CVD group than in the psoriasis group (P < 0.05). The psoriasis area and severity index (PASI) score was higher in the CVD group than in the psoriasis group (P < 0.05). Pearson's correlation analysis showed that cIMT, Gal-3, and PTX3 were separately positively correlated with hs-CRP, PCT, and TNF-α (P < 0.05). Multivariate Logistic regression analysis showed that PASI score, cIMT, Gal-3, PTX3, hs-CRP, and TNF-α were independent influencing factors for CVD in patients with psoriasis (OR=1.250, 1.451, 1.432, 1.365, 1.413, 1.465; P < 0.05). The diagnostic model based on cIMT combined with serum Gal-3 and PTX3 had higher diagnostic value for CVD in patients with psoriasis than single diagnosis. The area under the curve was 0.922, with sensitivity and specificity of 0.91 and 0.85, respectively. Conclusion The cIMT, serum Gal-3, and serum PTX3 are independent influencing factors for CVD in patients with psoriasis. The combination of the three indicators has higher diagnostic value for CVD in patients with psoriasis.

OBJECTIVE: To measure the concentration of bone morphogenetic protein 2 (BMP-2) in demineralized bone matrix (DBM) prepared from different long bones and to evaluate the osteoinductivity of different DBM on MC3T3-E1 cells. METHODS: Different bones from the same cadaver donor were used as the initial materials for making DBM, which were divided into ulna group (uDBM), humerus group (hDBM), tibia group (tDBM), and femur group (fDBM) according to the origins, and boiled DBM (cDBM) was taken as the control group. The proteins of DBM were extracted by guanidine hydrochloride, and the concentrations of BMP-2 were determined by ELISA assay. Then the DBM were co-cultured with MC3T3-E1 cells, the proliferation of MC3T3-E1 cells was observed by cell counting kit 8 (CCK-8) assay. The osteogenic differentiation ability of MC3T3-E1 cells was qualitatively observed by alizarin red, alkaline phosphatase (ALP), and Van Gieson staining, and the osteogenic differentiation ability of MC3T3-E1 cells was quantitatively analyzed by ALP content. Linear regression was used to analyze the effect of BMP-2 concentration in DBM on ALP synthesis. RESULTS: There were significant differences in the concentration of BMP-2 among the DBM groups (P<0.05). The concentrations of BMP-2 in the lower limb long bone were higher than those in the upper limb long bone, and the concentration of BMP-2 in the fDBM group was about 35.5 times that in the uDBM group. CCK-8 assay showed that the cells in each group continued to proliferate within 5 days of co-culture, and the absorbance (A) values at different time points were in the order of cDBM groupP<0.05). Linear regression analysis showed that y^=0.361+0.017x, the effect of BMP-2 concentration in DBM on cellular ALP content was significant (t=3.552, P=0.005); for every 1 ng/g increase in BMP-2 concentration, ALP content would increase by 0.017 [95%CI (0.006, 0.027)] U/100 mL. CONCLUSION The concentration of natural BMP-2 in different long bones varies greatly, and the lower limb long bone is higher than the upper limb long bone. The harvested location of bone material was an important factor affecting the osteoinductivity of DBM.
Alkaline Phosphatase ; Bone Matrix ; Bone Morphogenetic Protein 2 ; Cell Count ; Coloring Agents ; Osteogenesis ; Animals ; Mice

Objective:To explore the application value of 3D-slicer software in measuring renal volume parameters of renal transplant donors in evaluating renal function.Methods:The data of 31 renal donors admitted to Beijing Friendship Hospital, Capital Medical University from October 2019 to September 2022 were retrospectively analyzed. Glomerular filtration rate (GFR) were measured by SPECT radioactive dynamic imaging, and renal cortex volume (RCV), renal parenchymal volume (RPV) were measured after 3D reconstruction of urinary enhanced CT based on 3D slicer software. The estimated GFR(eGFR) predicted by creatinine-based GFR estimation equations (C-G equation, modified and simplified MDRD equation) and volume-based GFR estimation equations (Herts equation, Choi equation). Different eGFR were calculated, and the correlation between kidney volume parameters, eGFR equations and measured GFR was analyzed. The deviation, accuracy and consistency between different equations eGFR and measured GFR were analyzed and compared. The measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for inter-group comparison. Measurement data with non-normal distribution were represented by M( Q1, Q3), and non-parametric test was used for comparison between groups. Results:The correlation between different eGFR and measured GFR is poor, and the deviation is small, and with good accuracy and consistency. Except for the weak correlation between the Choi equation eGFR and measured GFR ( r=0.382, P=0.034), there was no significant correlation between eGFR by other equations and measured GFR ( P>0.05). Among them, the deviation between the Herts equation-eGFR and measured GFR was the smallest (0.30 mL·min -1·1.73 m -2), with a 10% coincidence rate (61.29%) and a 30% coincidence rate (96.77%), and the best consistency with measured GFR, with a consistency limit of -28.75 to 29.34 mL·min -1·1.73 m -2. Conclusion:Compared with the laboratory index formula method, the Herts equation has better prediction efficiency in estimating GFR, The measurement of renal volume parameters by 3D slicer software has a certain clinical value in evaluating the renal function of renal donors, which is worthy of further application.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.