Objective To observe the alterations in functional complexity of brain regions in autism spectrum disorder(ASD)patients and correlations with the predicted brain age.Methods Open brain resting-state functional MRI(rs-MRI)data of 93 ASD patients and 96 typically developing adolescents(healthy subjects)were downloaded.The functional complexity in brain regions were extracted with self-developed virtual digital brain software,and the alterations in functional complexity of brain regions in ASD patients and correlations with their ages were analyzed.Two networks were prospectively trained with data of 65 ASD patients and 67 healthy subjects as the training set to predict brain age,and the results were evaluated,and the predicting errors were compared using test set,i.e.the other 28 ASD patients and 29 healthy subjects.Results Compared to healthy subjects,on the basis of anatomical automatic labeling(AAL)atlas,ASD patients exhibited significantly reduced functional complexity based on Shannon entropy in the left precuneus,left cuneus and right parahippocampal gyrus.Conversely,functional complexity of ASD patients based on permutation entropy significantly increased in the left cuneus and right cerebellar Crus Ⅱ region.The left hippocampus showed reduced functional complexity based on Pearson correlation coefficient,while the left middle temporal gyrus showed increased functional complexity based on Pearson correlation coefficient.The functional complexity in brain regions of ASD patients were not closely correlated with ages(all|r|＜0.4).According to the trained fully connected network,the predicted brain ages of ASD patients and healthy subjects in test set were all lower than their physiological ages,but no significant difference was found between the prediction errors of ASD patients and healthy subjects(P=0.283).Conclusion Functional complexity changed in some brain region functions in ASD patients.The predicted brain ages of ASD patients based on the obtained fully connected network were on the low side,but not obviously affected by the alterations of functional complexity in brain regions.

Objective:To investigate the clinical, pathological and genetic features of 3 cases of limb-girdle muscular dystrophy 2A (LGMD2A) caused by non-canonical splice site mutations in the CAPN3 gene. Methods:For the 3 LGMD2A patients admitted to Qilu Hospital of Shandong University from July 2016 to July 2018 were selected as the subjects. Clinical data were collected, whole exome sequencing was conducted, and the candidate variants were verified by Sanger sequencing. Total RNA was extracted from the skeletal muscle tissue of 3 probands and effects of splicing mutations on pre-mRNA splicing in the CAPN3 gene were verified by reverse-transcription polymerase chain reaction. Total protein was extracted from the muscle tissue of the probands and expression level of calpain 3 protein was detected by Western blotting. Results:All the 3 probands presented muscle weakness in upper and lower limbs, and muscle weakness in proximal limbs was more severe. Muscle biopsies all indicated myogenic impairment. Genetic sequencing showed proband 1 carried compound heterozygous c.2185-14T>G and c.2305C>T (p.R769W) mutations in the CAPN3 gene, proband 2 carried compound heterozygous c.1193+30G>A and c.2069_2070delAC (p.H690Rfs *9) mutations, and proband 3 carried homozygous c.1194-9A>G mutations in the CAPN3 gene. Splicing assay showed the c.2185-14T>G mutation located in intron 20 induced retention of the entire intron 20, the c.1193+30G>A mutation in intron 9 induced retention of the first 31 nucleotides of intron 9, and the c.1194-9A>G mutation in intron 9 induced retention of the last eight nucleotides of intron 9. Western blotting revealed deficiency of calpain 3 protein in skeletal muscle of proband 1 and proband 2. Conclusions:The clinical manifestation of LGMD2A is muscle weakness predominantly in proximal limbs, and the muscle pathology is mostly characterized by myogenic impairment.Moreover, aberrant splicing of pre-mRNA caused by non-canonical splice site mutations plays a pathogenic role in this disease.

Objective:To investigate the correlation between paraspinal muscle atrophy, morphological changes of facet joints and adjacent segment disease (ASDis) after lumbar fusion operation.Methods:A retrospective study was conducted among 195 patients who underwent posterior lumbar fusion again for ASDis at this institution from January 2014 to December 2020, including 29 patients with ASDis whose initial surgical fusion segment was L 4,5. According to Roussouly's staging, there were 5 cases of type I, 9 cases of type II, 10 cases of type III, and 5 cases of type IV. Another 29 cases were selected from patients without ASDis after lumbar fusion as a control group. The control group was paired 1∶1 with the ASDis group according to gender, fusion segment, and Roussouly typing of the lumbar spine. The cross-sectional area (CSA) and fat infiltration (FI) of paravertebral muscle, facet joint angle (F-J) and pedicle facet (P-F) angle before the first (second) operation were measured and compared between the two groups. Then logistic regression analysis was used to determine the predictors of ASDis after posterior lumbar fusion. Finally, the receiver operation characteristic (ROC) curve was described, and the area under the curve (AUC) and cut-off point were calculated. At the same time, the paraspinal muscle atrophy before the second operation in ASDis group was measured. Results:The average follow-up time of 98 patients was 59.25±6.38 months (range, 49-73 months). The average body mass index (BMI) of ASDis group was 24.76±3.64 kg/m 2, which was higher than that in control group (22.24±2.92 kg/m 2) ( t=2.481, P=0.041). The average CSA and relative cross-sectional area (rCSA) of paraspinal muscle in ASDis group were 3 214.32± 421.15 mm 2 and 1.69±0.36 respectively, which were less than 3 978.91±459.87 mm 2 and 2.26±0.29 in control group ( t=10.22, P=0.012; t=9.47, P=0.038). The FI degree of paraspinal muscle in ASDis group (21.95%±5.89%) was significantly higher than that in control group (14.64%±7.11%) ( t=7.32, P=0.002). The F-J angle in ASDis group was 35.06°±3.45°, which was less than 38.39°±4.67° in control group ( t=4.76, P=0.027). The P-F angle in ASDis group was 117.39°±8.13°, which was greater than 111.32°±4.78° in control group ( t=5.25, P=0.031). Multivariate logistic regression analysis showed that higher BMI ( OR=1.34, P=0.038), smaller rCSA of paraspinal muscle ( OR=0.02, P=0.017) and higher FI of paraspinal muscle ( OR=1.58, P=0.032) were the risk factors of postoperative ASDis. The ROC curve showed that the AUC of BMI was 0.680 and the cut-off point was 22.58 kg/m 2; The AUC of the FI of paraspinal muscle was 0.716 and the cut-off point was 15.69%; The AUC of rCSA of paraspinal muscle was 0.227 and the cut-off point was 1.92. For ASDis patients, the paraspinal muscle before the second operation had a higher degree of FI (25.47%±6.59% vs. 21.95%±5.89%, t=3.99, P=0.042) and a smaller rCSA (1.52±0.28 vs. 1.69±0.36, t=3.85, P=0.038) than that before the first operation. The difference between the FI degree of paraspinal muscle before the second operation and the first operation was negatively correlated with the occurrence time of ASDis ( r=-0.53, P=0.039) , and the difference of rCSA was positively correlated with the occurrence time of ASDis ( r=0.64, P=0.043) . Conclusion:When BMI >22.58 kg/m 2, FI of paraspinal muscle >15.69%, and rCSA of paraspinal muscle <1.92, it suggests that ASDis is more likely to occur after operation. And the more obvious paraspinal muscle atrophy after the first operation, the earlier ASDis may occur. Morphological changes of facet joints cannot be used as an index to predict the occurrence of ASDis.

Fusion surgery has been an effective modality for the treatment of spinal disorders for more than 100 years. With the increasing understanding of the disease and the increasing maturity of surgical techniques, lumbar fusion has become more widely performed and its efficacy has been conclusively proven. However, fusion surgery inevitably disrupts the original physiologic motion of the spine and limits segmental motion, resulting in a significant increase in disc and joint protrusion stress in adjacent segments. When a newly identified degenerative change on imaging is present in an adjacent segment or an existing degeneration is more aggravated, this is known as adjacent segment degeneration. When clinical symptoms such as pain and numbness in the lower extremities are present that are consistent with degeneration, this is known as adjacent segment disease. Real world studies (RWS) have become a major focus in medical research in recent years. Since it is closer to clinical practice and more practical for decision-making compared with randomized controlled trail (RCT), it is gaining importance in clinical practice. By searching major national and international databases, this article provides a review of risk factors as well as advances in the treatment of lumbar adjacent segment disease in RWS. According to the retrieved literature, there are many factors that contribute to the development and progression of adjacent segment degeneration and disease, which are mainly divided into patient-related factors and surgery-related factors. In general, patient age, weight, spinal-pelvic sagittal parameters, and internal diseases influence the progression of adjacent segment degeneration. Surgery-related risk factors include the number of segments operated on, the surgical approach, interference with adjacent segments, and whether the spinal-pelvicsagittal imbalance is corrected. To prevent the development of adjacent segment disease, patients can slow the progression of adjacent segment degeneration by reducing their own weight and controlling their internal diseases. The physician can also avoid the influence of surgery-related factors through adequate surgical planning and careful intraoperative management. At the same time, surgeries may be performed in patients who have developed adjacent segmental disease and for whom conservative treatment has failed. The current revision surgical approaches include endoscopic simple decompression and posterior decompression with extended internal fixation.Short-term RWS revealed that the efficacy of endoscopic treatment of adjacent spondylosis might be equivalent to re-fusion internal fixation surgery. Studies with large samples and long-term follow-up are still needed to guide the treatment of adjacent segment disease in the future, in order to improve clinical decision-making.

Objective:To observe the effects of veno-venous extracorporeal membrane oxygenation (VV-ECMO)combined with prone position ventilation (PPV) on oxygenation index (PaO 2/FiO 2), respiratory compliance (Crs) and vasoactive inotropic score (VIS) in severe acute respiratory distress syndrome (ARDS) patients. Methods:Eighteen patients with severe ARDS requiring VV-ECMO support in Liuzhou People's Hospital from June 2018 to April 2020 were selected for retrospective analysis, and 8 patients among of these cases received PPV after VV-ECMO. The differences in PaO 2/FiO 2, VIS and Crs before and 1, 2 or 3 days after treatment were compared between VV-ECMO group and VV-ECMO combined with PPV group, as well as the differences in these indices before PPV and 2 hours after PPV daily in VV-ECMO combined with PPV group. The incidence of adverse events in two groups were also observed. Results:Before treatment, there was no significant difference in PaO 2/FiO 2, Crs between two groups. Over time, PaO 2/FiO 2 and Crs increased and VIS decreased in both groups. Compared with before treatment, there were statistically significant differences in PaO 2/FiO 2 and VIS from 1 day after treatment [PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): VV-ECMO group was 197.75±39.80 vs. 75.57±7.44, VV-ECMO combined with PPV group was 255.20±31.92 vs. 68.24±11.64; VIS: VV-ECMO group was 5.51±3.72 vs. 10.20±7.10, VV-ECMO combined with PPV group was 6.73±3.32 vs. 14.50±2.48, all P < 0.05], up to 3 days after treatment [PaO 2/FiO 2 (mmHg): VV-ECMO group was 231.96±32.76 vs. 75.57±7.44, VV-ECMO combined with PPV group was 285.61±19.40 vs. 68.24±11.64; VIS: VV-ECMO group was 2.26±1.90 vs. 10.20±7.10, VV-ECMO combined with PPV group was 2.13±1.55 vs. 14.50±2.48, all P < 0.05], and the PaO 2/FiO 2 1 day and 3 days after treatment in VV-ECMO combined with PPV group were significantly higher than those in VV-ECMO group (mmHg: after 1 day of treatment was 255.20±31.92 vs. 197.75±39.80, after 3 days of treatment was 285.61±19.40 vs. 231.96±32.76, both P < 0.05). Before treatment, Crs of VV-ECMO combined with PPV group was significantly lower than that of VV-ECMO group (mL/cmH 2O: 17.91±0.82 vs. 20.54±1.26, P < 0.05). From 1 day after treatment, the Crs in VV-ECMO combined with PPV group was significantly higher than that before treatment (mL/cmH 2O: 21.20±1.50 vs. 17.91±0.82), the peak value was (24.93±2.18) mL/cmH 2O on 3 days after treatment, however, there was no significant difference between the two groups (all P > 0.05). In VV-ECMO combined with PPV group, compared with before PPV treatment, the PaO 2/FiO 2 and Crs of 2 hours after PPV treatment in 1, 2 and 3 days were significantly rose, and it reached the highest level in 3 days [PaO 2/FiO 2(mmHg): 285.61±19.40 vs. 189.91±28.34, Crs (mL/cmH 2O): 24.93±2.18 vs. 23.35±1.45, both P < 0.05]; the VIS was only increased in 2 hours after PPV treatment on the first day than before (6.73±3.32 vs. 6.38±3.22, P < 0.05). There were no related serious adverse events happened after PPV treatment. Conclusions:The combination of PPV during VV-ECMO could further increase PaO 2/FiO 2, improve hypoxemia and implement further protective lung ventilation to reduce the potential hazards during mechanical ventilation. In addition, no serious adverse events were observed in this study, suggesting PPV is safe during VV-ECMO.

Objective:To investigate the effect of fluid resuscitation and circulatory support, directed by different target mean arterial pressure (MAP), on abdominal blood flow, gastrointestinal function and inflammatory response in septic shock patients with hypertension.Methods:A prospective randomized controlled study was conducted. Hypertensive patients with septic shock admitted to the department of intensive care unit (ICU) of Liuzhou People's Hospital from January 1, 2019 to May 31, 2020 were enrolled. Patients were randomly divided into the low MAP groups (low standard group, LS group) or high MAP group (high standard group, HS group). According to the Surviving Sepsis Campaign Guidelines in 2016 and the updated guideline in 2018, all patients were given treatment of primary disease, fluid resuscitation, supportive management. The target MAP was 65-70 mmHg (1 mmHg = 0.133 kPa) in LS group, and was 75-80 mmHg in HS group. Acute gastrointestinal function injury (AGI) classification was performed on the 1st, 3rd and 7th day. The mean flow rate (Vm) and resistance index (RI) of superior mesenteric artery were evaluated using ultrasound, and the gastrointestinal function was dynamically evaluated using the modified single section ultrasonic gastric antrum method. The gastric antrum movement index (MI) and gastric empaging time (GET) were recorded. The levels of inflammatory markers in serum were detected by enzyme linked immunosorbent assay (ELISA), such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), procalcitonin (PCT) and vascular endothelial growth factor (VEGF). The target MAP, the days of use of vasopressors and the amount of fluid resuscitation were recorded.Results:A total of 208 hypertensive patients with septic shock were enrolled, including 109 in the LS group and 99 in the HS group. There were no significant differences in gender, age, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score between the two groups when diagnosed. After treatment, there was no significant difference in AGI classification between the LS group and HS group on the 1st day. On the 3rd and 7th day, there were statistical differences between the two groups (3rd day: proportion of Ⅰ, Ⅱ, Ⅲ, Ⅳ grades were 25.69%, 56.88%, 11.93%, 5.50% in LS group, 15.15%, 54.55%, 25.25%, 5.05% in HS group, respectively, χ 2 = 7.900, P = 0.048; 7rd day: proportion of Ⅰ, Ⅱ, Ⅲ, Ⅳ grades were 44.96%, 49.54%, 3.67%, 1.83% in LS group, 31.31%, 52.53%, 11.11%, 5.05% in HS group, respectively, χ 2 = 8.178, P = 0.042). The Vm of superior mesenteric artery was higher and the RI was lower in the LS group than those in the HS group on day 1, 3 and 7 [Vm (cm/s): 21.72±3.02 vs. 19.50±2.83, 20.42±2.62 vs. 17.02±1.99, 26.52±2.70 vs. 22.47±4.03; RI: 0.86±0.05 vs. 0.92±0.04, 0.87±0.05 vs. 0.95±0.05, 0.81±0.03 vs. 0.85±0.03, all P < 0.01]. The MI was higher and the GET was shorter in the LS group than those in the HS group on day 3 and day 7 [MI: 3.00±0.33 vs. 2.60±0.29, 4.50±0.51 vs. 3.90±0.33; GET (minutes): 86.01±19.78 vs. 100.99±25.01, 71.00±16.37 vs. 84.98±20.18, all P < 0.01]. In addition, the levels of serum TNF-α, IL-6, PCT, VEGF were lower in the LS group than those in the HS group after 3 days of treatment [TNF-α (ng/L): 147.05±28.32 vs. 256.99±27.04, IL-6 (ng/L): 762.99±57.83 vs. 1 112.30±118.32, PCT (μg/L): 37.00±5.58 vs. 56.00±12.36, VEGF (ng/L): 123.00±19.78 vs. 167.01±21.55, all P < 0.05]. The target MAP was maintained at (68.02±4.71) mmHg in LS group, and (79.04±3.04) mmHg in HS group. The difference between the two groups was statistically significant ( P < 0.01). Compared with the HS group, the days of using vasopressors was shorter in LS group (days: 3.50±1.27 vs. 4.55±1.47), and the amountof fluid was reduced significantly (mL: 1 602.29±275.49 vs. 2 000.30±272.59, both P < 0.01). Conclusion:Maintaining a low target mean arterial pressure (65-70 mmHg) in hypertensive patients with septic shock can improve blood supply of superior mesenteric artery, protect the gastrointestinal function, reduce the level of inflammatory factors, and diminish the duration of using vasopressors and the amount of fluid.

Objective: To understand the cognition and attitudes of men who have sex with men (MSM) towards HIV testing and explore in-depth reasons preventing them from testing. Methods: The function of "opinion" in Blued, a gay geo-social networking application (GSN), was adopted to collect qualitative data of ideas and attitudes towards HIV testing of the users between December 2017 and January 2018. The data was analyzed based on grounded theory approach. Results: 28 269 Blued users participated in the activity and 1 977 posted comments. Four key themes were identified, i.e. no/low risk of contracting HIV, stigmatization of HIV testing, long-term relationship and conventional impediments of HIV testing. Conclusion The cognition and attitudes of the target population derived from the analysis of "opinion" function in Blued, such as the stigmatization of the behavior of HIV testing influencing the attitude of HIV testing, could help researchers build a more accurate detection and promotion strategy instead of a very general intervention on the public.

Objective To evaluate the CT imaging after laminoplasty for the patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine.Methods From June 2011 to June 2016,Retrospectively analyzed the data of OPLL patients who underwent posterior cervical open-door laminoplasty.There were 21 patients finally enrolled in this study,which consisted of 11 male and 10 female aging from 55-69,mean(61.48±4.29).The preoperative patients all had severe symptoms of spinal compression.Collected the Japanese Orthopaedic Association Scores(JOA) Scores of all patients for gender,age,preoperative and postoperative follow-up.The length,width and thickness of OPLL were measured by CT scan and two-dimensional reconstruction of cervical spine during preoperative and follow-up,and the average progress rate was calculated.The relationship between OPLL size before surgery and OPLL progress rate after surgery was analyzed.Results A total of 21 patients were included in this study,with an average age of 61.48±4.29 years-old.The mean follow-up time was 3.36± 1.92 years.The JOA score of cervical spine was 11.81 ± 1.75 before operationand 14.43± 1.69 at the last follow-up time (t=3.8,P＜0.01).The progression rate of OPLL length,width and thickness was 3.54± 2.89 mm/year,0.49± 0.52 mm/year and 0.34± 0.21 mm/year,respectively.Compared with the width and thickness,the average progress speed of the length was statistically significant (t=3.6,P=0.003;t=3.8,P=0.002).The progression rate of the rostraland caudal of OPLL was 1.54 ±1.19 mm/year and 1.60±1.33 mm/year (t=0.1,P=0.559).Linear regression showed that OPLL length progression speed (mm) =0.05×preoperative length + 1.23,R2=0.26 and P=0.02.Theprogression rate of width and thickness of OPLL had no correlation with preoperative OPLL width and thickness.The progression rates of local,segmental,continuous,and mixed OPLL were 3.02±0.26 mm,2.97±0.65 mm,3.65± 1.14 mm,and 3.82± 1.27 mm per year.Conclusion The JOA score of the posterior open-door laminoplasty of the cervical OPLL patients was significantly improved during a short-term follow up.CT imaging follow-up showed there was progression of OPLL in length,width and thickness,and the progression rate of length was faster than width and thickness.However,there was no significant difference between the progression of rostral and caudal of OPLL.In addition,short-term follow-up showed a positive correlation between the progression rate of OPLL length and the length of OPLL preoperation.The progress rate of mixed and continuous OPLL may be greater than that of segmental and limited OPLL.

Objective To study the effect of fufangxuanju capsule combined with tamoxifen citrate tablet on seminal plasma biochemistry in patients with asthenospermia.Methods One hundred and fifty patients with asthenospermia were divided into group A(treated with tamoxifen citrate tablet,45 cases),group B(treated with fufangxuanju capsule,45 cases)and group C(treated with tamoxifen citrate tablet and fufangxuanju capsule, 60 cases) according to random digits table method.All patients were treated for 2 months.The semen parameters and semen biochemical parameters were detected, and the pregnancy rate was followed up for 6 months.Results The semen volume,sperm density,sperm survival rate, grade a sperm percentage and grade a+b sperm percentage after treatment in group C were significantly higher than those in group A and group B: (4.41 ± 1.21) ml vs.(4.01 ± 0.87) and(3.97 ± 1.10)ml,(24.63 ± 4.44)×109/L vs.(20.45 ± 4.69)and(18.04 ± 3.05)×109/L,(64.05 ± 7.98)% vs.(45.15 ± 8.87)% and(51.47 ± 10.01)%,(26.05 ± 5.62)% vs.(15.01 ± 3.67)% and(18.31 ± 2.21)%, (55.30 ± 9.65)% vs.(38.07 ± 8.26)% and (44.35 ± 9.03)%, and there were statistical differences (P<0.05).There were no statistical differences between group A and group B (P>0.05).The fructose, a-glucosidase and acid phosphatase levels after treatment in group C were significantly higher than those in group A and group B:(30.36 ± 5.30)mmol/L vs.(24.01 ± 6.32)and(26.03 ± 5.53)mmol/L,(60.61 ± 8.86) U/L vs.(45.46 ± 8.87)and(50.56 ± 5.56)U/L,(140.12 ± 10.25)U/L vs.(98.36 ± 8.36)and(100.36 ± 8.36) U/L,and there were statistical differences(P<0.05);there were no statistical differences between group A and group B(P>0.05).The zinc after treatment in group C was significantly higher than that in group A and group B:(2 406.96 ± 187.60)μmol/L vs.(1 508.30 ± 135.87)and(2 001.30 ± 130.26)μmol/L,the zinc after treatment in group B was significantly higher than that in group A, and there were statistical differences(P<0.05).The pregnancy rate within 6 months in group C was significantly higher than that in group A and group B: 51.6% (31/60) vs.37.8% (17/45) and 33.3% (15/45), and there was statistical difference (P<0.05).There was no statistical difference between group A and group B (P>0.05).Conclusions Fufangxuanju capsule combined with tamoxifen citrate tablet can increase the concentration of fructose, a-glycosidase, zinc and acid phosphatase in seminal plasma, and improve the semen quality of patients with asthenospermia so as to increase the woman pregnancy rate.

Objective To determine the most cost-effective modality for breast cancer screening in women living in Shanghai.Methods A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district,Shanghai,during 2008 to 2012.Parameters of the model were derived from literatures.General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years.Incremental cost-effectiveness ratio (ICER) was used to determine the most cost-effective modality.Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness.Results The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one.The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year (QALY) saved,which were within the threshold of 2-3 times of local per capita Gross Domestic Product.Results from sensitivity analysis showed that,due to higher incidence rate of breast cancer in Shanghai,the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China.Conclusion Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai,and thus be widely promoted in this population elsewhere.