Objective:To investigate the efficacy and safety of nerve decompression surgery through the lateral-rectus approach for sacral plexus nerve injury after sacral fracture fixation.Methods:A retrospective study was conducted to analyze the 10 patients with combined sacral plexus nerve injury after sacral fracture fixation who had been admitted to Department of Orthopedics, Xiangya Hospital between May 2022 and May 2023. There were 2 males and 8 females with an age of 16.5 (15.0, 26.3) years. At the time of injury, the patients had been clearly diagnosed as sacral fracture combined with sacral plexus nerve injury. By the Denis classification of sacral fractures: 7 cases of type Ⅱ and 3 cases of type Ⅲ; sacral plexus nerve injury sites: 1 case of L 4, 8 cases of L 5, 7 cases of S 1, and 2 cases of S 2. All of them were treated with reduction and internal fixation via the posterior approach within 2 weeks after injury, but after surgery their manifestations of sacral plexus nerve injury still persisted which were confirmed by CT, magnetic resonance imaging and neuromuscular electromyography. Therefore, at (4.0±2.3) months after internal fixation, all patients were treated with nerve decompression surgery through the lateral-rectus approach. The operative time, intraoperative bleeding, length of hospitalization, Gibbons nerve damage score and neurological recovery at the last follow-up were recorded. Results:In the 10 patients, the operative time was (112.0±21.5) min, intraoperative bleeding (215.0±91.3) mL, and length of hospitalization 7.0 (6.0, 8.5) d. Intraoperatively, sacral plexus nerve compression was found in 9 cases (6 cases of nerve compression and pulling due to fracture displacement, 3 cases of nerve entrapment due to soft tissue scar adhesion), and 1 case of nerve root avulsion injury. No other intraoperative complications occurred. The 10 patients were followed up for (9.2±2.3) months after surgery. At the last follow-up, the Gibbons score for the 10 patients improved from preoperative 3.0 (3.0, 3.3) points to 1.0 (1.0, 2.0) point, and their British Medical Research Council (BMRC) nerve injury grading was improved from the preoperative grade 0.0 (0.0, 1.3) to grade 3.5 (2.8, 4.0) (1 case of M5, 4 cases of M4, 4 cases of M3, and 1 case of M2).Conclusion:The lateral-rectus approach is effective and safe for exploration and decompression of the sacral plexus nerve in patients combined with sacral plexus nerve injury despite sacral fracture fixation.

Acute lymphoblastic leukemia（ALL）is the most common pediatric cancer and has good outcome.However，the prognosis of relapsed/refractory ALL in children is poor.Intensive reinduction chemotherapy and hematopoietic stem cell transplantation have become alternative treatments. Bortezomib，as the primary generation proteasome inhibitor，has been approved for the treatment of multiple myeloma and mantle cell lymphoma. In recent years，several clinical studies have confirmed promising responses and well tolerated of bortezomib combined with various chemotherapeutic drugs in treating children with relapsed/refractory ALL，to improve the complete remission rate and survival rate. This article reviews the mechanisms of bortezomib in ALL and the clinical study progress and safety of bortezomib combined with chemotherapy in children with relapsed/refractory ALL.

Objective:Type H blood vessels are a subtype of bone-specific microvessels(CD31hiEmcnhi)that play an important regulatory role in the coupling of angiogenesis and osteogenesis.Despite reports on the distinct roles of type H and L vessels under physiological and pathological bone conditions,their genetic differences remain to be elucidated.This study aims to construct a competitive endogenous RNA(ceRNA)network of key gene for differencial expression(DE)in type H and L vascular endothelial cells(ECs)through integrated bioinformatic methods. Methods:We downloaded relevant raw data from the ArrayExpress and the Gene Expression Omnibus(GEO)database and used the Limma R-Bioconductor package to screen for DE lncRNAs,DE miRNAs,and DE mRNAs between type H and L vascular ECs.A total ceRNA network was constructed based on their interactions,followed by refinement using protein-protein interaction(PPI)networks to select upregulated and downregulated key genes.Enrichment analysis was performed on these key genes.Random validation was conducted using flow cytometry and real-time RT-PCR. Results:A total of 1 761 DE mRNAs,187 DE lncRNAs,and 159 DE miRNAs were identified,and a comprehensive ceRNA network was constructed based on their interactions.Six upregulated(Itga5,Kdr,Tjp1,Pecam1,Cdh5,and Ptk2)and 2 downregulated(Csf1r and Il10)key genes were selected via PPI network to construct a subnetwork of ceRNAs related to these key genes.Upregulated key genes were mainly enriched in negative regulation of angiogenesis and vascular apoptosis.Results from flow cytometry and real-time RT-PCR were consistent with bioinformatics analysis. Conclusion:This study proposes a ceRNA network associated with upregulated and downregulated type H and L vascular ECs based on selected key genes,providing new insights into the regulatory mechanisms of type H and L vascular ECs in bone metabolism.

Objective:To compare the clinical efficacy of robot-assisted versus fluoroscopy-assisted sacroiliac screw internal fixation for posterior pelvic ring fractures.Methods:China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Medical Journal Full-text Database, PubMed, Web of Science and ScienceDirect were searched for literature on robot-assisted versus fluoroscopy-assisted sacroiliac screw internal fixation for posterior pelvic ring fractures. The search time was from the establishment of each database to March 2023. Meta-analysis was performed on the included literature. The random-effects model was used when the heterogeneity between groups was large, and the fixed-effects model was used when the heterogeneity between groups was small.Results:A total of 15 studies were included in the meta-analysis, including 465 patients in the robot-assisted group and 396 patients in the fluoroscopy-assisted group. Meta-analysis showed that the number of fluoroscopies [ SMD=-3.12, 95% CI (-4.34, -1.89), P<0.001], the number of guide pin adjustments [ SMD=-3.75, 95% CI (-6.77, -0.72), P=0.015], intraoperative blood loss [ SMD=-0.83, 95% CI (-1.18, -0.49), P<0.001], and operative time [ SMD=-2.59, 95% CI (-4.11, -1.08), P<0.001] were smaller than those in the fluoroscopy-assisted group. The rate of excellent screw implantation [ OR=10.13, 95% CI (3.67,27.98), P<0.001] of the robot-assisted was larger than the fluoroscopy-assisted group. There was no significant difference in Majeed functional score [ SMD=0.28, 95% CI (-0.0003, 0.55), P=0.050] and fracture healing time [ SMD=-0.14, 95% CI (-0.46, 0.17), P=0.367] between the two groups. Conclusion:Robot-assisted percutaneous sacroiliac screw fixation for posterior pelvic ring fractures has the advantages of less fluoroscopy, less guide pin adjustment, less intraoperative blood loss, shorter operation time, and higher rate of excellent screw position. However, there is no difference in Majeed score and fracture healing time between robot-assisted percutaneous sacroiliac screw fixation and fluoroscopy-assisted percutaneous sacroiliac screw fixation.

OBJECTIVE：To study the effec ts of Tibetan Codonopsis tralictrifolia extract （called“ZDS”for short ） on collagen-induced arthritis （CIA）model rats and its mechanism. METHODS ：Eight of 48 rats were randomly selected as normal control group （normal saline ），and the remaining 40 rats were used to establish CIA model. After successful modeling ，the rats were randomly divided into model group （normal saline ），ZDS low-dose ，medium-dose and high-dose groups （0.44，0.88，1.76 g/kg，by crude drug ），dexamethasone group （positive control ，0.002 5 g/kg），with 8 rats in each group. They were given relevant medicine intragastrically ，the volume of 400 μL，once a day ，for consecutive 28 days. The body weight of rats were weighed before medication （0 d），7，14，21 and 28 days after medication ；and arthritis indexes were scored. The pathological changes of the knee joint synoviual tissue were observed after last medication. The thymus index ，spleen index ，the levels of serum inflammatory factors （IL-1β，TNF-α，IL-6），protein expressions of NF-κB p65，p-NF-κB p65，IκB and p-IκB in synovial tissue were detected. RESULTS ：Compared with normal control group ，the body weight （14，21，28 days after administration ）of rats in model group was significantly reduced （P＜0.05）；the arthritis index score （before administration and different administration time）was significantly increased （P＜0.05）；the joint synovial tissue was pathologically damaged ；the thymus and spleen index ， inflammation factor level ，the protein expression of p-NF-κB p65 and p-IκB were increased significantly（P＜0.05），while the protein expression of IκB was decreased significantly（P＜0.05）. Compared with model group ，the level of IL- 1β was decreased significantly in ZDS low-dose group （P＜0.05）. Body weight of rats （21，28 days after administration ）were increased significantly in ZDS medium-dose and high-dose groups ，dexamethasone group （P＜0.05），while arthritis index score （14，21，28 days after administration ） was decreased significantly （P＜0.05）. The pathological damage of joint synovial tissue was significantly relieved ；thymus and spleen index ，inflammation factor level ，the protein expression of p-NF-κB p65 and p-IκB were significantly reduced，while the protein expression of IκB was significantly increased （P＜0.05）. CONCLUSIONS ：ZDS can improve CIA model rats to some extent ，and its mechanism may be related to the inhibition of NF-κB signaling pathway.

Objective:To evaluate the clinical efficacy and safety of modified chitosan eye drops on rabbit Candida albicans keratitis model.Methods:Ten healthy female New Zealand rabbits were used to establish the superficial Candida albicans keratitis model by the corneal surface lens method in the right eye.Slit lamp microscopy and corneal scraping and microscopic examination were performed to preliminarily determine whether the keratitis model has been successfully established, the rabbits were then randomly divided into a model group and a modified chitosan group by the random number table method.The successfully established rabbit models which were determined by fungal culture results were retained.Five normal rabbits receiving no intervention served as a normal control group.The experimental eyes in the normal control and modified chitosan groups were treated with modified chitosan eye drops, Six times a day for one week, and subsequently four times a day for one week.No treatment was administered to the model group.The changes of corneal lesions and ocular surfaces were examined by slit lamp microscopy every day.At 1, 7, 14, 21 and 28 days after modeling, the eye condition and corneal clinical scores was assessed by slit lamp microscopy.The corneal conditions in each group was observed for two weeks after drug withdrawal.Results:The corneal scraping and microscopic examination results of eight rabbits models showed that the fungal hyphae and spores were positive.The fungal culture results showed that the separated pathogen was Candida albicans.The success rate of modeling was 80%(8/10). The clinical scores in the model group at 7, 14 and 21 days after modeling were 14.50±0.58, 6.25±0.50 and 2.50±0.58, respectively, and were significantly higher than 7.25±1.26, 2.75±0.50 and 1.25±0.50 in the modified chitosan group (all at P<0.05). In the model group, corneal edema was significantly aggravated, and the central white ulcer area was enlarged within seven days after modeling.Between 7 and 28 days after modeling, the corneal ulcer was gradually healed, while the central corneal scar and neovascularization were remained.The average healing time was (24.5±2.6)days.In the modified chitosan group, the corneal infiltration was significantly alleviated within seven days after modeling, and the fungal hyphae and spores of corneal scraping were negative on the 14th day after modeling.The average healing time in the modified chitosan group was (13.5±1.3)days, which was significantly shorter than that in the the model group (P<0.01). No recurrence of keratitis was observed in the modified chitosan group after two weeks of drug withdrawal.The cure rate was 100%.In the normal control group, the conjunctival hyperemia, corneal edema, and lesions were not observed during topical administration.Conclusion:The treatment with modified chitosan eye drop is effective in a rabbit superficial Candida albicans keratitis model, and have no obvious toxic effects on ocular tissues.

Objective To evaluate the effectiveness of intense pulsed light (IPL) therapy for meibomian gland dysfunction (MGD).Methods A prospective senal cases observational study was designed.Thirty patients with MGD (60 eyes)in the Tianjin Medical University Eye Hospital from October 2017 to April 2018 were enrolled.All the subjects received IPL therapy at baseline,1 week and 3 weeks after the baseline,respectively.Before each treatment and 3 months after treatment,subjective symptoms (ocular surface disease index [OSDI] questionnaire,Standard Patient Evaluation of Eye Dryness [SPEED] questionnaire),palpebral margin score,lipiview ocular surface interferometer lipid layer thickness (LLT) measurement,tear meniscus height (TMH) and noninvasive tear film breakup time (NIBUT) measurement were performed to detect and assess the IPL treatment effect.The safety of the IPL treatment was evaluated through the visual acuity and intraocular pressure.Results The OSDI score,SPEED score and the score of lipid excretion and secretion of meibomian gland before treatment were significantly higher than those of the other three time points (all at P＜0.01).The TMH before treatment was significantly lower than that of the other three time points (all at P＜0.01).No significant differences were obtained on first time NIBUT,blinking times and incomplete blink ratio among different time points (all at P＞0.05).After treatment,the average thickness of tear film lipid layer was slightly increased,and the secretion of tarsal gland was improved.There were no adverse reactions during the treatment and follow-up,no changes in corrected vision,and the intraocular pressure fluctuated within the normal range.Conclusions IPL therapy can alleviate the symptoms and signs of dry eye of MGD patients,and the effect can last for at least 3 months.IPL is an effective and safe method in treatment of MGD.

Objective To retrospectively analyze the effects of nerve block anesthesia versus general anesthesia on intertrochanteric fracture in the elderly. Methods The 104 elderly inpatients undergoing closed reduction and intramedullary nailing for the treatment of femoral intertrochanteric fractures were recruited into this study at Department of Orthopedics ,Xiangya Hospital ,Central South University from January 2015 to June 2017.Medical records were collected and analyzed by SPSS 16.0 or GraphPad Prism 6.0 software. Results A total of 104 patients were divided into general anesthesia group(n= 48 )and nerve block anesthesia group (n= 56 ). There was no statistical difference in the demographic characteristics between the two groups. The changes in heart rate ,maximum changes of systolic/diastolic blood pressures ,and infusion volume during surgery were lower in the nerve block anesthesia group than in the general anesthesia group [(12.7 ± 7.3)vs. (18.1 ± 7.8)beats/min ,(22.5 ± 8.8/12.2 ± 7.5)mmHg vs. (34.3 ± 7.9/21.6 ± 6.6)mmHg ,(792.9 ± 387.0)ml vs. (1 083.0 ± 445.5)ml ,respectively ,t=3.64 ,7.14 ,6.73 ,5.16 ,all P＜0.01]. There was no statistically significant difference between two groups in other perioperative data and the number of deaths at three months and one year after surgery. Conclusions As compared with the general anesthesia ,the nerve block anesthesia has less effects on the heart rate ,less maximum changes of systolic and diastolic blood pressures ,and less infusion volume during surgery ,and has no significant increase in postoperative mortality ,which is safe and worthy of further promotion.

Objective To analyze the correlation between the dry eye symptom and signs in middle-aged and aged people by Lipiview(R) ocular surface interferometry.Methods A total of 170 eyes from 85 middle-aged and aged people (55-80 years old) were examined with Standard Patient Evaluaion of Eye Dryness(SPEED) questionnaire and Lipiview(R) ocular surface interferometry,meanwhile obtaining the consent of the subjects.Then the correlation between the symptom and Lipid Layer Thinckness (LLT) and partial blink rate were analyzed.Results SPEED questionnaire score was 6.13 ±4.60.LLT was(74.88 ± 21.16) nm.LLT variability was 4.47 ± 3.40.The partial blink rate was 0.62 ± 0.36.The Spearman correlation analysis indicated that the nega-tive correlation was shown between the SPEED questionnaire score and LLT (r =-0.823,P =0.000),SPEED questionnaire score and LLT variability(r =-0.268,P =0.018).The positive correlation were found between LLT and Std.Dev of LLT (r =0.339,P =0.030).However,the results of the SPEED score were uncorrelated with partial blink rate (P ＞ 0.05).Conclusion The results from this study demonstrate that correlation among symptom,LLT and LLT variability,but poor correlation between symptom and partial blink rate.

Objective:To discuss the necessity of upgrade and verification laboratory information management system( LIMS) in drug control institutes. Methods:LIMS was upgraded and validated in a laboratory. Results:The upgrade and verification of LIMS en-sured the primitiveness and accuracy of laboratory date, and improved the work efficiency. Conclusion:The application of LIMS sys-tem ensures the reliability of the date and is of great significance to the development of drug testing organizations.