OBJECTIVE To assess the scientific rigor， clarity and feasibility of the recommendations of the Guidelines for Evidence-based Use of Biological Agents for the Clinical Treatment of Osteoporosis （hereinafter referred to as the Guideline） through external review， in order to further revise and improve the Guideline recommendations. METHODS This study employed a cross-sectional survey research design， a convenience sampling method was adopted to select frontline medical workers in the field of osteoporosis （including clinical doctors， clinical pharmacists， and nurses） as well as patients or their family members. External review was conducted through a combination of closed-ended and open-ended electronic questionnaires to get feedback from them on the appreciation，clarity and feasibility of the 32 preliminary recommendations in the Guideline. RESULTS A total of 90 external review subjects from 15 hospitals were collected， including 45 clinical doctors， 15 clinical pharmacists， 15 nurses and 15 patients or their family members. The overall appreciation degree of recommendations was 99.38%， the overall clarity degree of recommendations was 98.92%， and the overall feasibility degree of recommendations was 99.65%. At the same time， 111 subjective suggestions were collected， which provided an important reference for the further improvement of the Guideline recommendations. Based on the above feedback， the Guideline steering committee and core expert group revised the wording of 12 draft recommendations without deletion， and finally determined 32 recommendations. CONCLUSIONS The external review provides an important basis for the final formation of the Guideline， further improves the scientific rigor， clarity and feasibility of the recommendations， and ensures the standardization， practicality and implementability of the Guideline.

BACKGROUND:There is an increasing demand for orthodontic treatment,and periodontally accelerated osteogenic orthodontics(PAOO)technique can make it possible to move orthodontic teeth that are limited by thin alveolar bone. OBJECTIVE:To investigate the biomechanics of orthodontic tooth movement before and after periodontally accelerated osteogenic orthodontics(PAOO)surgery to increase alveolar bone volume using the three-dimensional finite element method. METHODS:A patient undergoing PAOO surgery before orthodontic treatment to increase bone volume on the labial side of the mandibular anterior region was selected.The patient was under invisible orthodontics.Two three-dimensional finite element models were constructed based on the patient's preoperative and 6-month postoperative cone beam CT data.Both models simulated the movement of tooth 33:experiment Ⅰ:distal-central movement of 0.25 mm;experiment Ⅱ:lingual movement of 0.25 mm;and experiment Ⅲ:intrusion movement of 0.10 mm.The stress distribution and initial displacement trend of tooth 33,periodontal ligament and surrounding alveolar bone under the action of the invisible aligner were analyzed before and after the PAOO procedure. RESULTS AND CONCLUSION:Dental stress analysis:In the same orthodontic tooth movement,the maximum Von-Mises stress and overall stress values of tooth 33 were all higher before surgery than after surgery;there were similar distribution areas of maximum equivalent stress and overall distribution trends of Von-Mises stress before and after surgery.Periodontal ligament stress analysis:In the same orthodontic tooth movement,the maximum Von-Mises stress and overall stress values of the periodontal ligament were higher before surgery than after surgery,and there were similar distribution areas of the maximum equivalent stress and overall distribution trends of Von-Mises stress before and after surgery.Alveolar bone stress analysis:In the same orthodontic tooth movement,the maximum Von-Mises stress values of the alveolar bone around tooth 33 were higher before surgery than after surgery,while the equivalent stress distribution showed a gradual decrease from the top of the alveolar ridge to the root.Initial displacement analysis:In the same orthodontic tooth movement,the initial displacements in the main displacement direction for all six observation points of tooth 33 were smaller before surgery than after surgery,and showed a tendency to gradually decrease from the tooth tip to the apex.Therefore,there were differences in the biomechanical characteristics of orthodontic tooth movement before and after the PAOO surgery.With the clear aligner,the postoperative equivalent stress values on the dentition,periodontal ligament,and surrounding alveolar bone were lower than before the surgery,and the initial displacements of the orthodontic teeth after the surgery are larger than before.These findings suggest that PAOO can release the restriction of thin alveolar bone on the movement of orthodontic tooth by increasing alveolar bone thickness,effectively improving the force on the roots,periodontal ligament,and alveolar bone,avoiding the stress concentration on orthodontic tooth in the thin alveolar bone area that can cause complications when moving,and improving the efficiency of tooth movement.

Objective To observe the effect of a new cell delivery tool(MSC exo)on the proliferation of pancreatic cancer by transferring targeted genes.Methods Transmission Electron Microscope(TEM)and Nanoparticle Tracking Analysis(NTA)were used to identify human mesenchymal stem cell exosomes(MSC-exo)and transport miR-450a-5p into CFPAC-1,to explore the effect of miR-450a-5p targeting BZW2 on inhibiting the proliferation of pancreatic cancer cells.Results The expression of miR-450a-5p was low in pancreatic cancer tissue(P<0.05),and the expression of CD63 and TSG101 of MSC-exo-miR-450a-5p in CFPAC-1 cells was higher than that of MSC-exo by Western blot(P<0.05).CCK-8 and EdU results showed that MSC-exo-miR-450a-5p significantly inhibited the proliferation of CFPAC-1 cells(P<0.05).Cell scratch and Transwell experiments showed that MSC-exo-miR-450a-5p can inhibit the migration and invasion of CFPAC-1 cells(P<0.05).Through dual luciferase assay,it was confirmed that miR-450a-5p targets BZW2,and RT-qPCR and Western blotting showed a negative correlation(P<0.05)between miR-450a-5p and BZW2 expression.Overexpression of BZW2,CCK-8,EdU,cell scratch,and Transwell experiments confirmed that pc-BZW2 reversed the anti-cancer function of MSC-exo-miR-450a-5p on CFPAC-1.Western blot detected PCNA,Ki-67,MMP2,MMP9,and the results were consistent with the above experiments(P<0.05).Conclusion hMSC exo is a new delivery system,targeting BZW2 to transport miR-450a-5p to inhibit the biological malignancy of pancreatic cancer cells,which provides an important clue for the research of targeted treatment of pancreatic cancer.

Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for the treatment of muscle invasive bladder cancer and complex non-muscle invasive bladder cancer.Our department has routinely carried out laparoscopic radical cystectomy(ELRC)through the extraperitoneal approach in 340 cases.This article summarizes the establishment of the peritoneal space,the expansion of the peritoneal space,the operation steps of bladder resection and lymph node dissection through the peritoneal channel,and how to shorten the operation time and reduce the difficulty of the operation.During the surgery,the bladder is removed periperitoneally without destroying the peritoneum to preserve the functions of peritoneum support,secretion,protection and lubrication,which has little impact on the abdominal organs,reduces the incidence of complications,and provides favorable conditions for subsequent treatment.

Objective:To investigate the distribution of physical and chemical water improvement areas of drinking water-borne endemic fluorosis in Inner Mongolia Autonomous Region, as well as the use of household water purifiers.Methods:From April to October 2021, a survey was conducted in a drinking water-borne endemic fluorosis areas in Inner Mongolia Autonomous Region where physical and chemical water improvement was carried out. The survey included the basic situation of the affected villages (number of permanent households, number of permanent residents, historical water fluoride content) and the use of residential water purifiers. Household peripheral water samples were collected to test the water fluoride content. Water purifier installation rate, normal usage rate, qualified water fluoride rate in normal usage, and the proportion of households covered by filter replacement departments were calculated.Results:In Inner Mongolia Autonomous Region, the physical and chemical water improvement areas of drinking water-borne endemic fluorosis were distributed in 2 735 villages in 11 leagues (cities) throughout the region, with 192 950 permanent households and 540 216 permanent residents. The average historical water fluoride content in all leagues (cities) was 2.18 mg/L, and the current average water fluoride content was 0.40 mg/L. A total of 134 763 water purifiers were installed, with an installation rate of 69.84% (134 763/192 950). A total of 10 773 households were surveyed, with 10 396 households using water purifiers normally and a normal usage rate of 96.50% (10 396/10 773). Among them, 10 158 households had qualified water fluoride of normal usage, with a qualified water fluoride rate of 97.71% (10 158/10 396). Of the 10 396 households using water purifiers normally, 3 974 households (38.23%) had filter cartridges used within one year, and 3 961 households had qualified water fluoride, with a qualified rate of water fluoride of 99.67% (3 961/3 974). Six thousand four hundred and twenty-two households (61.77%) had filter cartridges used for more than one year, with 6 197 households had qualified water fluoride and a qualified rate of water fluoride of 96.50% (6 197/6 422). There was a statistically significant difference in the qualified rate of water fluoride between purifiers with different filter cartridge usage times (χ 2 = 110.73, P < 0.001). Among the 10 773 surveyed households, the filter cartridges replacement department covered 10 470 households, accounting for 97.19% (10 470/10 773). Conclusions:In Inner Mongolia Autonomous Region, the physical and chemical water improvement areas of drinking water-borne endemic fluorosis are widely distributed, and the normal usage rate of household water purifiers is relatively high. The qualified rate of water fluoride in household water purifiers with filter cartridges used for more than one year is low.

Objective:To investigate the epidemic status of drinking-tea type endemic fluorosis (fluorosis for short) in Inner Mongolia Autonomous Region (Inner Mongolia for short), and to provide theoretical basis and basic data for formulation and evaluation of prevention and control measures.Methods:From May to October 2022, a cross-sectional survey was conducted in key areas (168 administrative villages in 6 leagues or cities) identified in the 2019 regional census with tea drinking habits, daily per capita intake of tea fluoride > 3.5 mg, and patients with skeletal fluorosis. The drinking condition of brick tea in 10 households of each administrative village was investigated, and the brick tea samples were collected to detect fluoride level. The prevalence of dental fluorosis in children aged 8 - 12 and skeletal fluorosis in adults aged 16 and older was investigated, and urine samples of patients with skeletal fluorosis were collected to detect urinary fluoride levels.Results:Totally 98.40% (1 657/1 684) of the households in the surveyed areas had a habit of drinking brick tea, with an annual per capita consumption of brick tea and a daily per capita intake of tea fluoride of 5.07 kg and 5.38 mg, respectively. The qualified rate of fluoride level in brick tea samples was 55.64% (922/1 657), the average fluoride level of all other brick tea varieties exceeded the national standard limit (300 mg/kg) except for black brick tea (291.08 mg/kg). Totally 2 747 children aged 8 to 12 were examined, with a detection rate of 13.91% (382/2 747) for dental fluorosis. The disease was mainly mild. There was no statistically significant difference in the detection rate of dental fluorosis among different age groups (χ 2 = 5.53, P = 0.238). Totally 71 708 adults aged 16 and older were examined, and the detection rate of skeletal fluorosis was 1.02% (734/71 708). Patients were mainly aged between 50 and 70 years old, and the condition in each age group was mainly mild. Totally 715 urine samples of skeletal fluorosis patients were collected and tested, and 55.24% (395/715) of the urine samples had fluoride levels higher than 1.6 mg/L. Conclusions:In Inner Mongolia, the proportion of high fluoride brick tea in endemic areas of drinking-tea type fluorosis is high. The detection rates of dental fluorosis in children and skeletal fluorosis in adults are relatively high. The prevention and control situation of drinking-tea type fluorosis is still serious.

【Objective】 To explore the safety and efficacy of a modified one-piece posterior laparoscopic total nephroureterectomy with cystic sleeve resection in the treatment of upper urinary tract uroepithelial carcinoma (UTUC). 【Methods】 A total of 24 patients treated during Jan. and Jun. 2022 were involved, including 16 males and 8 females, aged 62 to 90 (average 73) years. The UTUC was in the left side in 15 cases, and in the right side in 9 cases. There were 10 cases of renal pelvis tumor, 6 cases of upper ureteral tumor and 8 cases of lower ureteral tumor. 【Results】 All operations were successful without conversion to open surgery. The operation time ranged from 60 to 100 minutes, average (71.25±9.80) minutes. The intraoperative bleeding volume was 20 to 200 mL, average (30.03±8.13) mL. No significant intraoperative or postoperative complications occurred. The postoperative hospital stay was 4 to 7 days, average (5.83±1.44) days. Bladder perfusion chemotherapy was performed after surgery. 【Conclusion】 The modified one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection for UTUC is an effective and feasible procedure with satisfactory tumor control, which is worth further promotion in clinical practice.

【Objective】 To investigate the efficacy and safety of single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy in the treatment of upper tract urothelial carcinoma (UTUC). 【Methods】 Clinical data of 31 UTUC cases treated in our hospital during Nov.2018 and Jun.2022 were retrospectively analyzed, including 11 tumors in the right side, and 20 in left side. There were 14 cases of renal pelvic carcinoma, 16 cases of ureter carcinoma, and 1 case of renal pelvic carcinoma plus ureter carcinoma. 【Results】 All surgeries were successfully performed without conversion to open surgery. The mean operation time was (81.45±19.80) min, and the estimated blood loss was (69.03±24.13) mL. No serious perioperative complications were observed. The average postoperative hospital stay was (6.13±2.44) d, and the median follow-up was 28 (3.0-49.0) months. At the last follow-up, 2 patients died, 3 had recurrence, but no contralateral recurrence was observed. 【Conclusion】 Single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy is safe, effective and feasible in the treatment of UTUC. It is worth clinical popularization.

【Objective】 To explore the correlation between CSAG1 expression and the prognosis and tumor-infiltrating lymphocytes in renal clear cell carcinoma (RCCC), and to predict the survival and tumor progression. 【Methods】 The gene expression profiles and clinical information of CSAG1 were downloaded from the Cancer Genome Atlas (TCGA). Based on the differential mRNA expression, GO annotation and KEGG pathway analysis were performed. The relationship between CSAG1 and tumor immune infiltration was assessed with Tumor Immunoassay Resource (Timer 2.0) database. The mRNA expression of CSAG1 in human RCCC specimens was validated with qRT-PCR. 【Results】 CSAG1 expression was significantly higher in RCCC tissues than in normal tissues (P<0.05). The qRT-PCR results revealed that the mRNA level of CSAG1 was consistent with that predicted by bioinformatic analysis. The KEGG analysis and GO annotation indicated high GSAG1 expression in RCCC was related to transmembrane transport, tricarboxylic acid cycle and lysosome. CSAG1 expression was positively related to the infiltration of pDC, aDC, CD8⁺ T cells, cytotoxic cells, TFH, TH1 cells, Tem, NK CD56^dm cells, Treg and T cells, but negatively correlated with macrophage infiltration. 【Conclusion】 CSAG1 may be associated with poor prognosis of RCCC and become a potential immunotherapy target.

Objective:To explore the effect of different blood sodium levels on the condition and prognosis of patients with severe craniocerebral injury.Methods:A retrospective cohort study was conducted on 150 cases of severe craniocerebral injury admitted to Zhangye People′s Hospital Affiliated to Hexi University from January 2020 to October 2022. According to the five blood sodium values measured on the first day after admission and during the peak period of brain edema (2-4 days after injury) and 7 days after injury, 102 cases of blood sodium metabolic disorder, 43 cases of low sodium group: average blood sodium value<135 mmol/L, 59 cases of high sodium group: average blood sodium value>145 mmol/L. The characteristics of sodium ion metabolism imbalance and the relationship between serum sodium level and Glasgow coma score (GCS), Glasgow prognosis score (GOS) and APACHE Ⅱ score at 2 weeks after injury were analyzed. Measurement data with normal distribution were represented as mean±standard deviation ( ± s), and comparison between groups was conducted using the t-test. count data were expressed as cases or percentages(%), and comparison between groups was conducted using the Chi-square test. Results:The imbalance rate of sodium metabolism in the acute phase after injury was 68.00%(102/150), including 57.84%(59/102) of hypernatremia and 42.16%(43/102) of hyponatremia. The imbalance rate of sodium metabolism at 7 days after injury was significantly higher than that immediately after injury. Hypernatremia occurred earlier than hyponatremia and lasted longer than hyponatremia ( P<0.05). There was no correlation between the low sodium group and the scores of GCS ( R=0.523), GOS ( R=0.367), APACHE Ⅱ ( R=-0.453) ( P>0.05), but the scores of GCS ( R=-0.448) and GOS ( R=-0.486) were negatively correlated with the blood sodium level of the high sodium group ( P<0.05), and the high sodium group was positively correlated with the scores of APACHE Ⅱ ( R=0.477, P<0.05). Conclusions:Patients with severe craniocerebral injury are often accompanied by blood sodium disorder. Hyponatremia can be corrected in a short time and has no effect on the patient′s condition and prognosis. However, hypernatremia seriously affects the recovery of consciousness, prognosis and quality of life of the injured.