Objective To evaluate and compare the maturity of autografts and allografts as well as the postoperative clinical outcomes 10 years after anterior cruciate ligament reconstruction(ACLR).Methods A retrospective analysis was conducted on 64 patients who underwent anterior cruciate liga-ment reconstruction,with an average follow-up period of about 10 years.Autografts were used in 36 cases(56.2%),and allografts in 28 cases(43.8%).Both groups were recorded the knee Lysholm scores,IKDC subjective scores,and stability tests results(KT-1000 side-to-side difference and Lach-man test).Moreover,graft maturity was assessed using the knee magnetic resonance imaging(MRI),and the Signal-to-Noise Quotient(SNQ)for both types of grafts was measured.Results No significant differences were observed between the autograft and allograft groups in the average follow-up time(10.1±2.1 and 10.5±1.8 years)(P=0.376),the SNQ value(24.1±8.8 and 23.2±8.7)(P= 0.652),the Lysholm score(90±10.3 and 89.4±8.9)(P=0.805)and the anterior joint stability dur-ing follow-up(P=0.923).Moreover,the average IKDC score and incidence of abnormal tension of the ligament measured by KT1000 of the autograft group were higher than the allograft group[(84.5±8.3)vs.(80.4±7.8),P=0.075;14.3%vs.8.3%,P=0.724].Meanwhile,ACL re-tear occurred to two cas-es in the autograft group(5.6%)and the allograft group(7.1%),respectively,showing no significant dif-ference(P=0.795).Conclusion Ten years after ACLR,no significant differences are found in graft ma-turity,clinical outcomes,or joint stability between patients using autografts and allografts.Moreover,the rate of graft re-tear is comparable between the two groups.

The cisplatin-based concurrent chemoradiotherapy (CCRT) has been accepted as a standard treatment for most locally advanced cervical cancer. Compared with radiation therapy alone, CCRT can increase tumor control and survival rates, whereas it also can increase the incidence of acute hematological toxicity, which results in the treatment interruption or delay, and may even affect clinical efficacy and prognosis of patients. Therefore, how to reduce the incidence and severity of acute hematological toxicity induced by CCRT is a hot spot of clinical research. Previous studies have demonstrated that the occurrence of hematological toxicity is associated with the volume and dose of irradiated pelvic bone marrow. With the development of modern radiotherapy technology, precise radiotherapy technologies, such as intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT), not only guaranteed the enough dose for tumor, but also realized the protection of normal tissues. This article will focus on the feasibility of bone marrow sparing during CCRT for cervical cancer, and summarize the research progress in recent years.

OBJECTIVES: To analyze the clinical and genetic characteristics of children with autosomal dominant neurodevelopmental disorders caused by kinesin family member 1A (KIF1A) gene variation. METHODS: Clinical and genetic testing data of 6 children with KIF1A gene de novo heterozygous variation diagnosed in Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine from the year 2018 to 2020 were retrospectively analyzed. Pathogenic variants were identified based on whole exome sequencing, and verified by Sanger sequencing. Moreover, the effect of variants on three-dimensional structure and stability of protein was analyzed by bioinformatics. RESULTS: Among 6 patients there were 4 males and 2 females, and the age of consultation varied from 7 months to 18 years. All cases had varying degrees of motor developmental delay since childhood, and 4 of them had gait abnormalities or fell easily. In addition, 2 children were accompanied by delayed mental development, epilepsy and abnormal eye development. Genetic tests showed that all 6 cases had heterozygous de novo variations of KIF1A gene, including 4 missense mutations c.296C>T (p.T99M), c.761G>A (p.R254Q), c.326G>T (p.G109V), c.745C>G (p.L249V) and one splicing mutation c.798+1G>A, among which the last three variants have not been previously reported. Bioinformatics analysis showed that G109V and L249V may impair their interaction with the neighboring amino acid residues, thereby impacting protein function and reducing protein stability, and were assessed as "likely pathogenic". Meanwhile, c.798+1G>A may damage an alpha helix in the motor domain of the KIF1A protein, and was assessed as "likely pathogenic". CONCLUSIONS KIF1A-associated neurological diseases are clinically heterogeneous, with motor developmental delay and abnormal gait often being the most common clinical features. The clinical symptoms in T99M carriers are more severe, while those in R254Q carriers are relatively mild.
Male ; Female ; Humans ; Child ; Retrospective Studies ; China ; Mutation ; Epilepsy/genetics* ; Neurodevelopmental Disorders/genetics* ; Kinesins/genetics*

Background Aluminum and fluoride are neurotoxic, and aluminum exposure alone is closely related to the overall cognitive function of operational workers. It is unclear about the effect of aluminum and fluoride interactions on cognitive function. Objective To evaluate a potential interaction effect of blood aluminum and urinary fluoride on the overall cognitive function of workers working in an aluminum plant. Methods Using cluster sampling, 230 workers in the electrolysis workshop of an aluminum group company in Shanxi Province were selected, and plasma aluminum concentrations were determined by inductively coupled plasma mass spectrometry (ICP-MS) and urinary fluoride by ion-selective electrode. The study participants were divided into a low blood aluminum group and a high blood aluminum group according to the median (M) of blood aluminum concentration, and a low urinary fluoride group and a high urinary fluoride group by a predetermined cutoff point (2.160 mg·L⁻¹). The Montreal Cognitive Assessment-Beijing (MoCA-BJ) was used to assess overall cognitive function of the workers. Logistic regression model was used to analyze the relationship between blood aluminum, urinary fluoride, and mild cognitive impairment (MCI), including multiplicative interaction analysis and correlation analysis; R language was used to fit an additive interaction model of blood aluminum and urinary fluoride on MCI and to calculate synergy index (S), relative excess risk due to interaction (RERI), and attributable proportion due to interaction (API). Results Among the 230 operational workers, the median blood aluminum concentration (P₂₅, P₇₅) was 40.11 (25.16, 58.89) µg·L⁻¹, and there were 104 cases of abnormal urinary fluoride, with an abnormality rate of 45.2%. There was a multiplicative interaction (OR=7.783, 95%CI: 1.377, 43.991) and no additive interaction (RERI=0.030, 95%CI: −0.498, 0.559; API=0.018, 95%CI: −0.279, 0.316; S=1.049, 95%CI: 0.519, 2.118) for the effect between blood aluminum and urinary fluoride on overall cognitive function of the workers. The logistic regression analysis showed that the risk of MCI was 12.105 (95%CI: 2.802, 52.287) times higher in workers with both high blood aluminum and high urinary fluoride than in those with low blood aluminum and low urinary fluoride, after adjusting for selected influencing factors. Conclusion Occupational exposure related high blood aluminum and high urinary fluoride are risk factors for cognitive dysfunction, and the coexistence of both indicators increases the risk of MCI in workers with occupational aluminum exposure, with a multiplicative interaction.

Menopausal syndromes are mostly based on kidney deficiency， which could be expalined that kidney governing essence storage and controlling innateness， so when the kidney water was deficient and the liver fail to nourish， then led to liver depression and transform into fire； deficiency of the kidney， loss of warmth of the spleen， and inability to transport and transform the water and dampness will easily lead to phlegm and fire； the decline of the kidney yin and loss of water and fire will easily cause the exuberance of heart fire. Therefore， clinical symptoms of hot flashes， insomnia， and palpitations are common due to phlegm， depressions， and fire. Based on this， at the beginning of the treatment， we should treat the symptoms firstly by resolving phlegm， relieving depression and clearing fire， and commonly use Huanglian Wendan Decoction （黄连温胆汤）， Yigan Powder （抑肝散）， Chaihu plus Longgu Muli Decoction （柴胡加龙骨牡蛎汤）， and Qingxin Zishen Decoction （清心滋肾饮）， etc. After improving the symptoms of hot flashes and sweating， irritability， dreaming and frightening， then we should give the prescriptions to tonify kidney yang and nourish kidney yin， in order to eliminate the pathogens and reinforce healthy qi， and to treat both the manifestations and the root cause， so that the symptoms of the patients can be better alleviated.

At present , methamphetamine has become a major hidden danger in global public health safety. In order to judge methamphetamine addicts and methamphetamine abstainers more scientifically and reliably, this study analyzed the endogenous metabolites in plasma, serum and urine of methamphetamine addicts, methamphetamine abstainers and healthy volunteers by highly sensitive high-throughput liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) analytical instrument. The obtained metabolomic data were processed by univariate analysis (t-test) and multivariate analysis (PLS-DA and OPLS-DA) and eligible potential biomarkers were then screened.The identified biomarkers set enrichment analysis to find the connection between metabolites and metabolic pathways.Multivariate statistical results showed that methamphetamine acute group, recovery group and healthy group were clearly separated.3, 18 and 6 regulated metabolites were identified in serum, plasma and urine, respectively, suggesting that lipid metabolism was abnormal in methamphetamine acute group, and that fatty acid metabolism, sulfate/sulfite metabolism and sex hormone metabolism were abnormal in methamphetamine recovery group.The selected potential biomarkers in this study provide the possibility for scientific judgment of the clinical stage of methamphetamine detoxification.

A case of polyarteritis nodosa was reviewed. The patient was a 58-year-old middle-aged man. He developed fever, headache, fatigue and other symptoms. Three weeks after, massive hematuria was seen. CT plain scan and MRI indicated blood clots in renal pelvis, and pericardium and pleural effusion. Renal arteriography indicated multiple venous fistula in both kidneys. Enhanced CT scan showed multiple small aneurysms in abdominal aortic branches, bilateral renal arteries and pancreatic arteries. The diagnosis of nodular polyarteritis was confirmed. Glucocorticoid and immunosuppressive agents were given. Meanwhile, highly selective renal arteriovenous fistula embolization was performed, Postoperative hematuria was effectively controlled, and the general condition was gradually improved. The patient was followed up for 2 months, and the condition was stable.

Objective:To explore the safety and efficacy of immune checkpoint inhibitors(ICI)for patients with tumor recurrence after liver transplantation(LT).Methods:A single-center retrospective study was conducted for 6 recipients of tumor recurrence after LT on a therapy of ICI admitted into Shulan(Hang Zhou)Hospital from September 2015 to June 2018.The authors examined the occurrences of graft rejection and clinical outcomes of overall response rate, progression-free survival and overall survival after dosing of PD-1/PD-L1 inhibitors.Results:Six patients enrolled with tumor recurrence on a therapy of ICI undergoing LT due to hepatocellular carcinoma (HCC). Nivolumab (n=4) and duvalizumab (n=2) were administrated.The median session of treatment was 8.3(2-31) cycles.The disease outcomes were stable (3/6, 50%) and progressive (3/6, 50%), The progression-free survival time of 3 disease-controlled patients was 1.5, 16.2 and 18 months and the median survival time after recurrence was 19.75(10.8-37.8) months.Rejection occurred in 1 patients (1/6, 16.7%) and the occurring time of rejection was 28 days after PD-1 inhibitor dosing.After acute rejection, high-dose corticosteroids and immunoglobulin were ineffective and the patient died from acute rejection related liver failure.Conclusions:ICI may be employed as a salvage treatment for tumor recurrence after LT for HCC.Due to a possibility of severe acute rejection, usage should be cautious under close monitoring of liver function.

Objective:To observe the curative effects of triplane intra-articular osteotomy in the treatment of malunion of calcaneal intra-articular fracture.Methods:The 16 patients were retrospectively analyzed who had been admitted to Foot and Ankle Surgery Department, Honghui Hospital from January 2016 to December 2019 for malunion of calcaneal intra-articular fracture. They were 12 males and 4 females, with an average age of 43.4 years (from 31 to 58 years). The left side was affected in 10 cases and the right side in 6 cases. All malunions were type Yu Ⅱ (compressed bone fragments on the posterior articular surface) and treated with triplane intra-articular osteotomy. The curative effects were assessed by comparing the radiological parameters, American Orthopaedic Foot and Ankle Surgery Society (AOFAS) ankle-hindfoot score, pain visual analog scale (VAS) and psychological and physical scores in Health Survey 12-item Short Form (SF-12) between preoperation and the final follow-up.Results:All the patients were followed up for 20 to 60 months (average, 42.9 months); the bone healing time was 10 to 14 weeks (average, 11.5 weeks). At the final follow-up, their B?hler angle (25.7°±2.3°), Gissane angle (117.1°±5.8°), Meary angle (2.9°±1.3°), talocalcaneal angle (31.3°±3.0°), hindfoot alignment angle (3.9°±1.8°), ankle height [(82.3±2.6) mm], calcaneus height [(56.9±2.4) mm], calcaneus width [(41.4±2.1) mm], AOFAS ankle-hindfoot score [(82.3±7.3) points], median VAS score [3 (2, 3) points], SF-12 psychological score [(46.6±3.6) points], and SF-12 physiological score [(43.6±3.5) points] were significantly improved than the preoperative values [8.4°±2.7°, 137.5°±9.3°, 8.3°±4.3°, 24.6°±3.7°, -4.6°±3.2°, (76.1±3.1) mm, (53.8±3.0) mm, (50.2±2.2) mm, (51.9±7.7) points, 6 (6, 7) points, (37.5±3.8) points, and (31.0±2.6) points] (all P<0.01) Conclusion:In the treatment of type Yu Ⅱ malunion of calcaneal intra-articular fracture, triplane osteotomy can anatomically reduce the bone fragments of collapsed posterior articular surface, reshape the normal anatomy of the calcaneus, and preserve the subtalar joint, leading to positive short- and mid-term follow-up effects.

Objective:To explore the diagnostic value of quantitative 99Tc m-hydrazinonicotinamide(HYNIC)-prostate specific membrane antigen (PSMA) SPECT/CT in patients with prostate cancer. Methods:From November 2018 to March 2021, the data of 56 patients ((69.8±8.0) years) with clinically suspected prostate cancer, who had elevated radioactive uptake in prostate on 99Tc m-HYNIC-PSMA SPECT/CT images in Henan Provincial People′s Hospital, were retrospectively analyzed. According to the pathological results, patients were divided into prostate cancer group ( n=45) and non-prostate cancer group ( n=11). The xSPECT-QUANT software was used to quantitatively analyze the high uptake area of the prostate, and SUV max was measured. The independent-sample t test, Mann-Whitney U test, ROC curve and Spearman correlation analysis were used for data analysis. Results:The prostate cancer group had higher SUV max than non-prostate cancer group (10.79±5.96 vs 3.60±1.27; t=7.43, P<0.001). When SUV max≥6.46, the AUC of prostate cancer was 0.887, with the diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 73.3%(33/45), 11/11, 100%(33/33), 47.8%(11/23), 78.6%(44/56), respectively. The SUV max of prostate cancer group was positively correlated with Gleason score ( rs=0.632, P<0.001). The SUV max of 29 patients with Gleason score≥8 was higher than that of 16 patients with Gleason score≤7 ( z=-3.89, P<0.001). There was no statistical difference in PSA level between patients with Gleason score≤ 7 and patients with non-prostate cancer ( z=-1.63, P=0.110), but the SUV max was significantly different ( z=-2.22, P=0.026). The SUV max of 23 patients with metastases was higher than that of 22 patients without metastasis (12.99±5.85 vs 8.50±5.28; t=2.69, P=0.010). ROC analysis showed that the AUC was 0.709; with SUV max≥13.02 as the threshold, the sensitivity for diagnosing prostate cancer metastases was 56.5%(13/23), the specificity was 86.4%(19/22), and the accuracy was 71.1%(32/45). Conclusions:The 99Tc m-HYNIC-PSMA SPECT/CT quantitative analysis is feasible in patients with prostate cancer. SUV max of 99Tc m-HYNIC-PSMA can be used in the diagnosis of prostate cancer, assessment of the malignancy and prediction of metastasis.