Objective To explore the gene expression profile in paraspinal muscle degeneration(PMD)and identify key ferroptosis genes.Methods RNA sequencing was performed on paraspinal muscle tissue of 3 normal and 3 PMD patients respectively to obtain differentially expressed genes.Through protein-protein interaction(PPI)and gene functional enrichment analysis,the intersection of ferroptosis genes was identified to identify key hub genes associated with ferroptosis.The diagnostic value for PMD disease was analyzed by receiver operating characteristic(ROC)curves.Results A total of 292 differentially expressed genes were identified in PMD.Among them,125 genes were significantly downregulated and 167 genes were significantly upregulated.Bioinformatics analysis revealed that 14 differentially expressed genes were associated with ferroptosis.Among them,ferroptosis genes MUC1,ATF3 and CDKN1A were key hub genes with good specificity and sensitivity for diagnosing PMD.Functional enrichment analysis revealed that they may mediate the occurrence and progression of PMD by regulating cell apoptosis,ferroptosis and skeletal muscle tissue development and differentiation.Conclusion Ferroptosis genes MUC1,ATF3 and CDKN1A can serve as biomarkers for diagnosing PMD,providing theoretical basis for decoding the pathological mechanism of PMD and developing new drugs.

Objective:To established a rapid method for the determination of lactose(C12 H22 O11)content.Methods:The specific rotation([α]20D)of pure lactose was measured with lactose extract product,and the correc-tion coefficient was calculated.The measured rotatory value of the sample was multiplied by the correction coeffi-cient to obtain the mass(g)of lactose in the test product,and the lactose content was calculated.The equivalence of the newly established polarimetric method and the legal test method(HPLC-RID method)for the determination of lactose content was studied.Results:The linear relation of established method was excellent with the range of 0.05-0.20 g·mL-1(r=1.000 0)and the method also had good reproducibility(RSD=0.07％(n=6)).The lactose content of 141 batches samples measured by polarimetry was compared with the results determined by official analytical procedure,and the results showed the relative deviation between the same batches was less than 1.0％.The results of one-way ANOVA also showed that there was no significant difference between two groups(Sig.＞0.05).Conclusion:The performance of polarimetry is comparable to HPLC-RID in the Chinese Pharma-copoeia 2020 Vol Ⅳ.Meanwhile,the polarimetry can reduce the test cost,shorten the test time and meet the requirements of the quality control.

Dizziness or vertigo is a common clinical symptom, and its underlying etiology is complex. Many clinicians are confused about its diagnosis and treatment. This article presents a case about chronic vestibular syndrome. And case appreciation and academic discussion are conducted by well-known domestic neurologists and otologists, so as to provide a good thinking model and basic ideas for the diagnosis and treatment of dizziness or vertigo, hoping to further improve the diagnosis and treatment level among clinicians.
Humans ; Dizziness/therapy* ; Vertigo/etiology* ; Vestibular Diseases/complications* ; Otolaryngologists

Objective:To explore the effects of conditioned medium of human bone marrow mesenchymal stem cells (BMSCs) on the proliferation, adhesion and differentiation of immortalized human Müller cell line (MIO-M1).Methods:The differentiation was induced in the third-passage BMSCs with osteogenic, chondrogenic and adipogenic medium and identified by alizarin red, alcian blue and oil red O staining, respectively.The expression levels of mesenchymal stem cell markers CD73, CD90 and CD105 and hematopoietic cell markers CD34, CD45 and human leukocyte antigen-DR (HLA-DR) were assayed by flow cytometry.The expressions levels of Müller cell markers SOX9, glutamine synthetase (GS), vimentin and cellular retinaldehyde-binding protein (CRALBP), retinal stem cell markers SOX2, nestin and CHX10, and cell proliferation marker cyclin D3 (CCND3) in MIO-M1 cells were detected by immunofluorescence staining.The MIO-M1 cells were divided into standard medium group, 293T conditioned medium group, and BMSC conditioned medium group and were incubated in the medium according to grouping.The cellular area, circularity, elongation factor and perimeter were analyzed quantitatively.The cell cycle was detected by flow cytometry, and the cell proliferation was determined by neurospora experiment and 5-ethynyl-2'-deoxyuridine (EdU) staining.The expression of vascular cell adhesion molecule 1 (VCAM-1) at protein and mRNA levels in the culture supernatant was detected by enzyme linked immunosorbent assay (ELISA) and quantitative real-time PCR (qRT-PCR), respectively.The expression of retinal neuron markers protein kinase C (PKCα), Rhodopsin, microtubule-associated protein 2 (MAP2) and β-tubulin (Tuj1) was detected by immunofluorescence staining and qRT-PCR.Results:CD73, CD90, CD105 showed an enhanced expression, and CD34, CD45 and HLA-DR showed weakened expression in the BMSCs.The BMSCs differentiated into osteoblasts, chondrocytes and adipocytes.Expression of SOX9, GS, vimentin and CRALBP, SOX2, CHX10, nestin and CCND3 was found in the MIO-M1 cells.Compared with standard medium group and 293T conditioned medium group, MIO-M1 cells cultured in BMSC conditioned medium group changed into an elongated spindle-shaped or multipolar morphology with reduced cell area, increased elongation index and decreased circularity, showing statistically significant differences among them ( F=6.973, 12.370, 6.311; all at P<0.01). There were increased neurospheres formed by MIO-M1 cells in BMSC conditioned medium group compared with standard medium group and 293T conditioned medium group at different time points ( Fgroup=134.300, P<0.001; Ftime=82.910, P<0.001). Compared with the standard medium group and 293T conditioned medium group, the EdU-positive rate and proliferation index of MIO-M1 cells in BMSC conditioned medium group were significantly increased, with statistically significant differences ( F=6.973, 74.110; all at P<0.05); the VCAM-1 protein expression in cell supernatant and the relative expression level of VCAM-1 mRNA in BMSC conditioed medium group were significantly increased ( F=13.720, 7.896; all at P<0.05); the mRNA expression levels of PKCα, Rhodopsin, Tuj1 and MAP2 were higher in MIO-M1 cells of BMSC conditioned medium group under the condition of differentiation ( F=14.490, 5.424, 14.330, 7.405; all at P<0.05). Conclusions:BMSCs conditioned medium can change the morphology of MIO-M1 cells and promote their proliferation, adhesion and differentiation into retinal neurons.

Objective:To conduct a retrospective analysis of efficacy and safety of different conversion schemes of tacrolimus to slow-release dosage forms for recipients in stable phase after renal transplantation to provide rationales for the conversion strategy of tacrolimus.Methods:From January 2020 to June 2020, clinical data were reviewed for 101 kidney transplant recipients converting from common tacrolimus dosage form to tacrolimus sustained-release dosage form during postoperative stable period.There were 62 males and 49 females with an age range of 19 to 69 years.They were divided into two groups according to iso-dose and incremental-dose switching schemes.The common dosage form of tacrolimus was converted into a sustained-release dosage form with different conversion doses, They were divided into two groups of 1∶1 conversion( n=55)and >1∶1 conversion( n=46). The clinical parameters of serum creatinine(Scr), blood urea nitrogen(BUN), alanine aminotransferase(ALT)and aspartate aminotransferase(AST), alkaline phosphatase(ALP), serum albumin(ALB), white blood cell count(WBC), urinary white blood cell(UWBC), hemoglobin(Hb)and fasting blood glucose(Glu)were compared between two groups after conversion. Results:Regarding numerical change trend after switching to tacrolimus sustained-release dosage form, drug dose/variation trend was smaller and blood drug concentration more stabilized.In two subgroups converted by 1∶1 and 1>1 initial dose, change trend of dose/blood concentration in 1∶1 conversion group appeared to be more stable.However, no inter-group difference existed in long-term parameters.Scr was lower at 1 week and 3 months after switching to extended-release dosage form( P<0.05)and BUN was lower at 2 weeks( P<0.05). In addition, at 5 months after conversion, ALT and AST significantly improved as compared with common dosage form( P<0.05). Significant differences existed in urinary WBC(UWBC)at 2/3 weeks( P<0.05). After switching for 2 weeks, hemoglobin significantly improved compared with common dosage form( P<0.05). No significant differences existed in ALP, ALB or Glu at other timepoints and pre-conversion( P>0.05). In 1∶1 switch group, renal function tended to improve.At 2 weeks, BUN was lower than pre-conversion; at 1/3 weeks, Scr was lower than pre-conversion( P<0.05). In addition, there was also a trend of improvement in liver function in 1∶1 conversion group.At 1 week and 5 months, ALT was lower than pre-conversion( P<0.05). However, no significant differences existed in AST, ALB, ALP, Glu, UWBC and serum WBC count at each timepoint between two different dose conversion groups( P>0.05). After conversion, intra-individual variability of tacrolimus trough concentration significantly improved( P<0.05). Conclusions:With the same safety and efficacy as common dosage form, sustained-release dosage form of tacrolimus may improve drug variability of individuals.When converting common dosage form into sustained-release dosage form, individual differences should be considered.While monitoring trough concentrations, proper doses should be adjusted on the basis of various clinical parameters.

Objective:To explore the long-term preservation value and repair effect of normothermic machine perfusion (NMP) on clinically discarded kidneys.Methods:A case of clinical discarded donor kidney was collected, and NMP was carried out in vitro for 9 hours with recovered blood. The dynamic changes of renal appearance, blood gas and biochemistry analysis of perfusate and renal pathology were recorded. Results:In the second to fifth hour of NMP, the appearance of renal was pink and ex vivo normothermic perfusion assessment score (EVNP) was grade Ⅰ. While, the sixth hour and beyond of NMP, the appearance of kidney turned to dark red and EVNP was grade Ⅲ. The renal perfusion blood flow maintained above 150 ml/min in the first 6 hours and decreased significantly after that, and at the end, was only 50 ml/min. During the whole process of perfusion, urine output was maintained at about 100 ml/h. PO 2 remained above 100 mmHg in the first 5 hours of perfusion and from the 6th hour, was lower than 80 mmHg and continued to decline, and was close to 0 at the end of perfusion. The results showed that although the K + concentration changes in blood and urine in the first 5 hours of NMP had a good consistency, the lactic acid level had been rising. In addition, there was no significant change in the histopathology at the fourth hour of perfusion compared with that before zero-point puncture, and the fibrinous thrombus in glomeruli was improved compared with that before perfusion. However, at the sixth hour after perfusion and before the end of perfusion, the pathological changes of renal tissue were significantly worse. There were a large of thrombosis in glomerular blood vessels, renal tubular atrophy and acute tubular necrosis. Conclusions:NMP can realize the evaluation of extended criteria donors before transplantation, and it proves the feasibility and repair potential of NMP in kidney to a certain extent. At the same time, NMP also provides a new way to expand the source of donor kidney and to pre-treat organ in vitro.

Objective:To investigate the feasibility and clinical effects of thoracic endoscopic-assisted anterior-lateral decompression and fusion for thoracolumbar or upper lumbar disc herniation (LDH) associated with vertebral osteochondrosis (VO).Methods:From December 2017 to December 2019, 10 patients of thoracolumbar or upper LDH associated with VO were treated with thoracic endoscopic-assisted anterior-lateral decompression and fusion, including 6 men and 4 women, with an average 49.2 years old (range, 37 to 65 years old). The involved levels included T 12L 1 in 5 cases, L 1, 2 in 2 cases and L 2, 3 in 3 cases. There were 4 cases of simple thoracolumbar or upper LDH associated with VO and 6 cases of thoracolumbar or upper LDH associated with VO combined with ligamentum flavum hyperplasia and ossification or kyphosis (combined with posterior decompression and internal fixation or posterior correction surgery). The visual analogue scale (VAS), Oswestry disability index (ODI) and anterior and posterior height of intervertebral space were evaluated at follow-up. The clinical effects were evaluated according to the modified MacNab criteria. Results:The operation was performed successfully in all the patients. During the operation, the herniated disc and ossification were clearly exposed and completely removed, with the sufficient decompression of spinal cord, nerve root and dural sac. The operation duration was 115.4±23.8 minutes (range, 70 to 180 mins). Intraoperative bleed loss was 122.6±21.3 ml (range, 40 to 310 ml). The patients were followed up for averagely 21.6 months (range, 12 to 36 months). At the final follow-up, VAS score decreased from preoperative 7.2±1.9 to 1.8±1.1, and ODI decreased from preoperative 64.3%±13.9% to 16.3%±5.1% ( P<0.05). The anterior height of intervertebral space recovered from preoperative 7.8±1.5 mm to 11.9±2.3 mm, and the posterior height of intervertebral space recovered from preoperative 4.5±1.1 mm to 7.4±1.6 mm ( P<0.05). According to modified MacNab criteria, the results were excellent in 9 cases and good in 1 case. Conclusion:For thoracolumbar or upper LDH associated with VO, thoracic endoscopic-assisted anterior-lateral decompression and fusion provided clear vision of the surgical field, fully exposed and completely removed the herniated disc and ossification, which achieved satisfactory short-term results.

Objective: To investigate the feasibility and short term clinical efficacy of early minimally invasive treatment of complex pelvic trauma with Starr reduction frame combined with O-arm navigation system. Methods: From June 2017 to December 2018, thirty two patients with Tile C complex pelvic fractures were prospectively divided into two groups according to the random number table. The open treatment group included 17 cases (open reduction and internal fixation group; 10 males and 7 females, age 24-60 years, average 37±6.5 years; according to Tile classification, 8 cases of C1 type, 8 cases of C2 type and 1 case of C3 type; according to the Denis classification of sacral fractures, 9 cases in zone I, 6 cases in zone II and 2 cases in zone III). The combined treatment group included 15 cases (Starr reduction frame group combined with O-arm navigation system, 8 males and 7 females, age 32-57 years, average 40±5.2 years; according to Tile classification, 8 cases of C1 type, 6 cases of C2 type and 1 case of C3 type; according to the Denis classification of sacral fractures, 8 cases in zone I, 5 cases in zone II and 2 cases in zone III). The ilioinguinal and Stoppa approaches were used in the open treatment group, and the anterior and posterior ring injuries were fixed with reconstruction plate screws and hollow screws, respectively. In the combined treatment group, starr frame was used to assist reduction, combined with "O" arm navigation technique, infix internal fixation frame, superior pubic branch screw, sacroilium screw were used to fix the anterior and posterior ring injury. The quality of pelvic fracture reduction was evaluated by the Matta scoring system, and the Majeed score was used to evaluate the clinical efficacy. Results: All patients were followed up for 6 to 12 months. The hospitalization time (45±11 d), operation time (220.0±49.4 min) and fracture healing time (24.0±5.6 weeks) in the open treatment group were longer than those in the combined treatment group (21±9 d, 180.0±24.2 min, 16.1±3.8 weeks), and the intraoperative blood loss (820.0±140.4 ml) was significantly higher than that in the combined treatment group (24.0±10.4 ml)(t=6.651, 2.772, 6.128, 22.874; all P< 0.05). According to Matta scoring system, in the open treatment group, there are 8 excellent cases, 6 good cases, 2 fair cases, 1 poor case, thus the excellent and good rate was 82.4%(14/17). While 9 cases were excellent, 5 good, 1 fair, and the excellent and good rate was 93.3% (14/15) in the combined treatment group. At the latest follow-up, Majeed score was 51-85 points in the open treatment group, including excellent in 8 cases, good in 6 cases, fair in 2 cases, poor in 1 case, thus the excellent and good rate 82.4% (14/17), and the Majeed score was 75-95 points in the combined treatment group, including excellent in 9 cases, good in 5 cases, fair in 1 case, thus excellent and good rate 93.3% (14/15). There was a statistically significant difference between the two groups of Matta score and Majeed score (χ²=0.034, 0.040; P< 0.05). Surgical infection occurred in 4 cases in the open treatment group and healed after debridement and treatment with sensitive antibiotics. The incidence of complications was 23.5% (4/17). In the combined treatment group, 2 cases had anterolateral thigh skin sensory loss after operation, and the symptoms were relieved after mannitol, mecobalamine treatment and removal of internal fixations. One patient had hematoma of the gluteus maximus muscle after operation. The result of angiography showed that the INFIX screw was too long and perforated near the foramen of the ischium, resulting from the injury of the superior gluteal artery. After stopping the use of anticoagulant, intravenous infusion of tranexamic acid, blood transfusion, etc., the patient was cured and discharged from hospital. The incidence of complications was 20.0% (3/15). There was no significant difference in the incidence of complications between the two groups. Conclusion With the help of starr reduction frame, the early reduction and minimally invasive treatment of pelvic fracture can be realized, and the amount of intraoperative bleeding can be reduced. The combined application of "o" arm navigation can improve the accuracy and safety of sacroiliac screw and anterior column screw placement, reduce the radiation dose and frequency of operators and patients, shorten the operation time and improve the curative effect.

Objective: To investigate the incidence of complications following minimal invasive subcutaneous internal fixator (INFIX) for the treatment of anterior pelvic ring instability, and to analyze control measures. Methods: Data of 42 patients with anterior pelvic ring instability who were treated by anterior subcutaneous internal fixation in our hospital from January 2016 to December 2017 were retrospectively analyzed. There were 15 females and 27 males with an average age of 45.4 years (range, 18-67 years). There were 26 traffic injuries, 10 falling injuries, 3 crush injuries and 3 low energy injuries. According to Tile classification, 24 cases of B2 type, 16 cases of B3 type, 1 case of C1 type and 1 case of C2 type. According to Young-Burgess classification, there were 20 cases of LCI, 18 cases of LCII, 1 case of LCIII, 1 case of APCI, 1 case of APCII, and 1 case of VS. Fourteen cases were combined with limb fractures, and 11 cases were combined with thoracic or abdominal injuries requiring surgical treatment, while 16 cases were with brain injuries. For type APC2, LC1, and some LC2 fractures, fixation for the anterior pelvic ring is enough with INFIX technique alone. For some LC2, LC3, or VS fractures, the anterior and posterior ring were both fixed. Postoperative reduction was evaluated by Matta radiological criteria. Lateral thigh numbness and pain, quadriceps muscle power were recorded during follow-up, and clinical efficacy was evaluated by Majeed score at 6 months after operation. Results: All the 42 patients were followed up for 6 to 12 months, with an average of 9.3 months. Matta standard evaluation for fracture reduction showed that 28 cases were excellent, 14 cases good, and the excellent and good rate was 100%. The early complication rate (within 3 month after operation) was 23.8% (10/42) including 6 cases of lateral femoral cutaneous nerve injury and 2 cases of femoral nerve injury. The symptoms were obviously relieved after the treatment of nutrient nerve and hyperbaric oxygen; 1 case had incision infection which was healed after anti-infection therapy and internal plant removal; 1 case suffered from superior gluteal artery injury which was controlled by pressure hemostasis. Six months after surgery, no case had lost reduction. At 6 months follow-up, the Majeed score was 72-96, with an average of 84.96, of which 32 were excellent and 10 were good, thus the excellent and good rate was 100% (42/42). Conclusion INFIX is an effective internal fixation method for the treatment of unstable anterior pelvic ring injury. However, it has a high rate of early complications, among which nerve injury has the highest incidence.

To provide anatomy information for harvesting the posterior tibial artery cutaneous branches-chain flaps. Methods The research was performed from January, 2017 to January, 2018. Anatomic ob-servation on 10 legs from fresh human cadaver were performed. The location of cutaneous branches of the posterior tibial artery was observed and its diameter and length was measured. Five legs were prepared to investigate the cuta-neous branches of posterior tibial artery.The anastomosis of cutaneous branches of posterior tibial artery was observed by PVA-bismuth oxide perfusion for molybdenum target X-ray arteriography in 5 perfused legs. The cutaneous branches with diameter over 0.2 mm in 10 legs of latex perfusion microdissection were included in the statistical analysis.The data were clustered and analyzed to find the location of distant and near cutaneous branches, which was called the gathering point of cutaneous branch vascular plexus. Secondly, the measured data of distal and near seg-ments containing cutaneous branches were compared by t-test.Then the distribution of cutaneous branches of posteri-or tibial artery on the tibiofibular side was compared by Chi-square test.It was considered to be significant if P value was under 0.05. Results ①There were 4.3 cutaneous branches raised from the posterior tibial artery.There was no significant difference on the tibial and ribula side distribution of the cutaneous branches from the posterior tibial artery (P＞0.05).②The distal cutaneous branch clusters was located at about 1/5 of the distal leg and there were 3.6 cutaneous branches raised from the posterior tibial artery. While the proximal clusters was located at 1/3 of the proximal leg and there were 0.7 cutaneous branches raised from the posterior tibial artery.There were no significant differences in the di-ameters (P=0.28) and pedicle length (P=0.14) between distal and proximal cutaneous branches. ③There were the large cutaneous perforators (≥1.0) mm from the posterior tibial artery at (6.37±1.22) cm proximal to the medial malleolus.The diameter and pedicle length of the distal perforators were (1.11±0.09) mm and (6.53±1.51) mm respectively.④The vas-cular chains parallel to the posterior tibial artery were formed via anastomosis of the adjacent cutaneous perforators. Conclusion The cutaneous expenditure of posterior tibial artery is constant, with a certain pedicle length and diameter. There are 2 relatively dense vascular plexus of cutaneous branches. The proximal and distal vascular flaps can be de-signed with these 2 vascular dense points as rotation points.