Objective:To investigate the risk factors for proximal junctional kyphosis (PJK) in adult spinal deformity patients with concomitant osteoporosis undergoing long-segment spinal fusion surgery.Methods:A retrospective analysis was conducted on 76 adults spinal deformity patients with osteoporosis who underwent long-segment spinal fusion surgery at the Department of Orthopaedics, Beijing Chaoyang Hospital, between June 2013 and December 2019. The cohort included 19 males and 57 females, with a mean age of 66.26±6.10 years (range, 54-78 years). Patients were categorized into two groups based on the occurrence of PJK within a 2-year postoperative follow-up: the PJK group (21 cases) and the non-PJK group (55 cases). Comparative analyses were performed on baseline characteristics, surgical details, preoperative and postoperative spinal-pelvic parameters, Hounsfield Units (HU) of the vertebral bodies, and paraspinal muscle morphology between the groups. Spinal-pelvic parameters included the main Cobb angle, lumbar lordosis (LL), lumbosacral lordosis (LSL), sagittal vertical axis (SVA), T 1 pelvic angle (TPA), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI). Preoperative CT was used to measure HU values at the upper instrumented vertebra (UIV), UIV+1, and UIV+2. Paraspinal muscle morphology, including the relative functional cross-sectional area (rFCSA) and functional muscle-fat index (FMFI) at the L 4 lower endplate level, was assessed using preoperative MRI. Optimal cutoff values for HU and paraspinal muscle parameters were determined using receiver operating characteristic curve analysis. Multivariable logistic regression was employed to identify independent risk factors for PJK. Results:Significant differences were observed between the PJK and non-PJK groups in preoperative PT (17.60°±8.39° vs. 24.12°±9.37°), postoperative LL (35.61°±10.62° vs. 42.22°±13.11°), LSL (30.24°±10.10° vs. 35.87°±11.12°), and SVA (37.82°±20.46° vs. 21.37°±17.35°). The differences were statistically significant ( P<0.05). The HU values of UIV (113.62±17.25 vs. 133.94±16.61), UIV+1 (123.14±16.03 vs. 138.27±13.69), and UIV+2 (121.00±15.91 vs. 134.47±15.53) were significantly lower in the PJK group ( P<0.05). Optimal cutoff values for HU at UIV, UIV+1, and UIV+2 were identified as 120.72, 127.51, and 121.50, respectively. Significant differences were also found in rFCSA (156.87±48.06 vs. 204.87±50.16) and FMFI (0.31±0.10 vs. 0.23±0.09). The differences were statistically significant( P<0.05), with optimal cutoff values of 175.43 for rFCSA and 0.24 for FMFI. Multivariable logistic regression analysis indicated that postoperative SVA [ OR=1.049, 95% CI (1.003, 1.097), P=0.037], HU of UIV [ OR=0.938, 95% CI (0.887, 0.991), P=0.024], and rFCSA of paraspinal muscles [ OR=0.883, 95% CI (0.792, 0.983), P=0.023] were independent risk factors for PJK. Conclusion:Reduced HU values of the UIV, decreased rFCSA of lumbar paraspinal muscles, and inadequate sagittal alignment correction are independent risk factors for PJK in adult spinal deformity patients with osteoporosis undergoing long-segment spinal fusion surgery.

Objective:To explore the relation of depressive and anxiety symptoms to defense mechanism in transgender population.Methods:Totally 451 transgender patients in the sexual and psychological outpatient depart-ment of a hospital were selected.They were assessed with the self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS)and Defense Mechanism Scale(DSQ).The SDS standard score of ≥53 was classified as having depressive symptoms,and the SAS standard score of ≥50 was classified as having anxiety symptoms.Re-sults:The detection rates of depression and anxiety were 46.8％and 28.8％respectively.Multiple linear regression analysis showed that SDS scores were positively correlated with DSQ scores of projection,conceit,complaint,with-drawal,somatization,control,isolation and identity(β=0.08-0.22),while SDS scores were negatively correlated with DSQ scores of sublimation,depression,omnipotence with incompetence and denial(0=-0.09--0.19).The SAS scores were positively correlated with the DSQ scores of projection,latent manifestation,somatization,control,isolation,identity,and consumption tendency(0=0.09-0.26),while the SAS scores were negatively cor-related with the DSQ scores of sublimation,depression,omnipotence accompanied by incompetence,and denial(β=-0.09--0.15).Conclusion:The proportion of depression and anxiety symptoms detected in the transgender group is higher,which may be related to the use of some defenses.

Gut microbiota dysbiosis is an avenue for the promotion of atherosclerosis (AS) and this effect is mediated partly via the circulating microbial metabolites. More microbial metabolites related to AS vascular inflammation, and the mechanisms involved need to be clarified urgently. Paeonol (Pae) is an active compound isolated from Paeonia suffruticoas Andr. with anti-AS inflammation effect. However, considering the low oral bioavailability of Pae, it is worth exploring the mechanism by which Pae reduces the harmful metabolites of the gut microbiota to alleviate AS. In this study, ApoE^-/- mice were fed a high-fat diet (HFD) to establish an AS model. AS mice were administrated with Pae (200 or 400 mg·kg^-1) by oral gavage and fecal microbiota transplantation (FMT) was conducted. 16S rDNA sequencing was performed to investigate the composition of the gut microbiota, while metabolomics analysis was used to identify the metabolites in serum and cecal contents. The results indicated that Pae significantly improved AS by regulating gut microbiota composition and microbiota metabolic profile in AS mice. We also identified α-hydroxyisobutyric acid (HIBA) as a harmful microbial metabolite reduced by Pae. HIBA supplementation in drinking water promoted AS inflammation in AS mice. Furthermore, vascular endothelial cells (VECs) were cultured and stimulated by HIBA. We verified that HIBA stimulation increased intracellular ROS levels, thereby inducing VEC inflammation via the TXNIP/NLRP3 pathway. In sum, Pae reduces the production of the microbial metabolite HIBA, thus alleviating the ROS/TXNIP/NLRP3 pathway-mediated endothelial inflammation in AS. Our study innovatively confirms the mechanism by which Pae reduces the harmful metabolites of gut microbiota to alleviate AS and proposes HIBA as a potential biomarker for AS clinical judgment.
Animals ; Mice ; Atherosclerosis/drug therapy* ; Diet, High-Fat ; Endothelial Cells ; Inflammation/drug therapy* ; Mice, Inbred C57BL ; NLR Family, Pyrin Domain-Containing 3 Protein/genetics* ; Reactive Oxygen Species

OBJECTIVE: To explore the biomarkers of tinnitus in vestibular schwannoma patients using electroencephalographic (EEG) microstate technology. METHODS: The EEG and clinical data of 41 patients with vestibular schwannoma were collected. All the patients were evaluated by SAS, SDS, THI and VAS scales. The EEG acquisition time was 10-15 min, and the EEG data were preprocessed and analyzed using MATLAB and EEGLAB software package. RESULTS: Of the 41 patients with vestibular schwannoma, 29 patients had tinnitus and 12 did not have tinnitus, and their clinical parameters were comparable. The average global explanation variances of the non-tinnitus and tinnitus groups were 78.8% and 80.1%, respectively. The results of EEG microstate analysis showed that compared with those without tinnitus, the patients with tinnitus had an increased frequency (P=0.033) and contribution (P=0.028) of microstate C. Correlation analysis showed that THI scale scores of the patients were negatively correlated with the duration of microstate A (R=-0.435, P=0.018) and positively with the frequencies of microstate B (R=0.456, P=0.013) and microstate C (R=0.412, P=0.026). Syntax analysis showed that the probability of transition from microstate C to microstate B increased significantly in vestibular schwannoma patients with tinnitus (P=0.031). CONCLUSION EEG microstate features differ significantly between vestibular schwannoma patients with and without tinnitus. This abnormality in patients with tinnitus may reflect the potential abnormality in the allocation of neural resources and the transition of brain functional activity.
Humans ; Neuroma, Acoustic/complications* ; Electroencephalography ; Patients ; Probability

Objective:To retrospectively analyze clinical efficacy and safety of omalizumab in the treatment of chronic urticaria (CU) in southern Zhejiang, China.Methods:A retrospective observational study was conducted on CU patients who received omalizumab treatment at the First Affiliated Hospital of Wenzhou Medical University from January 1st, 2018 to August 1st, 2021. Through the outpatient follow-up visits, the disease activity, condition control, and quality of life were evaluated using the 7-day urticaria activity score (UAS7) , urticaria control test (UCT) , and dermatology life quality index (DLQI) . In addition, changes in disease condition, recurrence after withdrawal, and adverse events were assessed. Independent-sample t test was used for intergroup comparisons of normally distributed measurement data, Wilcoxon signed-rank sum test or Kruskal-Wallis H test was used for comparisons of non-normally distributed measurement data, and chi-square test or Fisher′s exact test was used for comparisons of enumeration data. Results:A total of 252 CU patients with poor response to antihistamines were included, with a baseline UCT score of 5.0 ± 2.4 points, a UAS7 score of 25.6 ± 6.2 points, and a DLQI score of 17.5 ± 4.7 points; among them, 204 (81.0%) were treated with omalizumab at an initial dose of 300 mg, and 48 (19.0%) with omalizumab at an initial dose of 150 mg. At the end points (12.0 ± 1.4 months after the start of treatment) , an overall control rate of 90.3% (224/248) was achieved after the omalizumab treatment; concretely, 137 (55.2%) patients achieved complete control (UCT = 16 points) , 87 (35.1%) achieved partial control (12 points ≤ UCT < 16 points) , and 24 (9.7%) showed no response (UCT < 12 points) , while 10 with partial response shifted to complete control after dose increase. During the treatment period, recurrence occurred in 50 patients (36.5%) , of whom 32 patients opted for retreatment with omalizumab, and then 30 (93.8%) achieved partial or complete control. Adverse events were reported in 8 patients (3.2%) , and all were mild or moderate.Conclusion:Omalizumab was effective in the real-world treatment of CU, and could improve patients′ quality of life, with a favorable safety profile.

Liver transplantation is a vital treatment for end-stage liver disease. However, the shortage of donor livers has limited the development of liver transplantation. How to expand the source of donor livers has become a challenge in the academic community. In recent years, the proportion of donors with non-alcoholic fatty liver disease (NAFLD) has been increased. Rational use of steatotic donor livers is a feasible approach to expand the donor pool. Cold ischemia injury during donor liver preservation before liver transplantation increases the risk of postoperative organ dysfunction. Therefore, it is of significance to unravel the mechanism and intervention measures of cold ischemia injury of steatotic donor livers. Cold ischemia injury of steatotic donor livers is characterized as the damage of mitochondria, lysosomes and endoplasmic reticulum at the organelle level, and up-regulated expression of adenosine monphosphate activated protein kinase (AMPK), aldehyde dehydrogenase 2 (ALDH2) and heme oxygenase (HO)-1 at the protein level. In this article, the research progresses on cold ischemia injury of steatotic donor livers and relevant intervention measures were reviewed.

Objective: To investigate the prevalence of depression and anxiety among transgender populations and the correlation with defense mechanism, so as to provide the evidence for improving mental health among transgender populations. Methods: Transgender populations that visited Psychosexual Outpatient Department of Beijing Huilongguan Hospital for the first time from December 2020 to December 2021 were enrolled. Participants' demographics, depression, anxiety and type of defense mechanisms were collected using self-designed questionnaires, Self-rating Depression Scale, Self-rating Anxiety Scale and Defense Style Questionnaire (DSQ). Factors affecting depression and anxiety were identified using a multivariable logistic regression model. Results: Totally 126 transgender individuals were enrolled, including 95 men (75.40%) with a mean age of (21.53±4.55) years and 31 women (24.60%) with a mean age of (23.58±5.55) years. The prevalence of depression was 46.83% among participants, including 44.07% of participants with mild depression, 30.51% with moderate depression and 25.42% with severe depression, and the prevalence of anxiety was 26.19% among participants, including 60.61% of participants with mild anxiety, 21.21% with moderate anxiety and 18.18% with severe anxiety. The detection of depression was 54.74% among men and 22.58% among women (P<0.05), and the detection of both depression (62.79% vs. 38.55%, P<0.05) and anxiety (41.86% vs. 18.07%, P<0.05) was significantly higher among transgender populations with self-injury or suicide behaviors than among those without. Multivariable logistic regression analysis showed that immature defense mechanisms increased the risk of depression (OR=1.034, 95%CI: 1.018-1.051) and anxiety (OR=1.031, 95%CI: 1.014-1.049) among transgender populations, while mature defense mechanisms reduced the risk of depression (OR=0.887, 95%CI: 0.832-0.946) and anxiety (OR=0.878, 95%CI: 0.821-0.938) among transgender populations. Conclusions The prevalence of depression and anxiety was 46.83% and 26.19% among transgender populations included in this study. Mature defense mechanisms are beneficial to reduce the risk of depression and anxiety among transgender populations. Key words： transgender population depression anxiety defense mechanism

Ferroptosis is a novel iron-dependent mode of programmed cell death characterized by iron deposition and accumulation of lipid peroxidation. More and more studies have found that ferroptosis is closely related to the pathogenesis of type 2 diabetes mellitus （T2DM）. The yin-fire theory is an important part of LI Gao's spleen-stomach theory， and it is believed that qi-fire imblance and yin-fire internal generation is the main pathogenesis of T2DM. Abnormal iron metabolism may be an important prerequisite for T2DM yin-fire internal generation， while oxidative stress is the specific manifestation of T2DM qi-fire imbalance. Reactive oxygen species （ROS） is the end product of qi-fire imbalance， and lipid peroxide is the pathological products of T2DM yin-fire internal generation. This study intends to explore the pathological mechanism of qi-fire imbalance and yin-fire internal generation from the perspectives of iron metabolism， oxidative stress and lipid peroxidation， enriching the modern connotation of yin-fire theory， and benefiting traditional Chinese medicine to target against ferroptosis， and prevent and treat T2DM precisely.

Objective:To explore the role of endothelial biomarkers in predicting damp-heat syndrome in diabetic kidney disease (DKD).Methods:A total of 183 patients with DKD were divided into 3 groups:the early DKD group,established DKD group,and advanced DKD group.All patients were classified according to traditional Chinese medicine (TCM) syndrome type,and clinical indexes were collected for statistical analysis.Results:A total of 183 DKD patients were included in this study.Fibroblast growth factor 23 (FGF23),chitinase-3-like protein 1 (CHI3L1),endocan,tumor necrosis factor receptor 1 (TNFR1),secretory leukocyte protease inhibitor (SLPI),and vascular endothelial growth factor A (VEGF-A) were increased in advanced DKD.FGF23,CHI3L1,endocan,SLPI,and TNFR1 showed a negative correlation with estimated glomerular filtration rate (eGFR),while they had a positive correlation with 24 h urine protein.After adjusting for age,gender,diabetes duration,body mass index (BMI),hemoglobin,glucose,uric acid,24 h urine protein,cholesterol,triglyceride,low-density lipoprotein,and hemoglobin A1c (HbA1c),the multiple regression analysis showed that FGF23,endocan,TNFR1,and SLPI significantly correlated with eGFR.Conclusions:FGF23,endocan,TNFR1,and SLPI are elevated in advanced DKD compared with early stage,and they may take part in the pathogenesis and progression of DKD.Our study provides useful bio-markers for predicting the appearance of damp-heat syndrome,including FGF23,endocan,TNFR1,and SLPI.

Objective: To investigate the mechanism of miR-31-5p/tension protein 1 gene (TNS1) axis modulating radiotherapy resistance in breast cancer. Methods: The breast cancer tissues and corresponding para-cancerous tissues of 21 patients with breast cancer, who underwent surgical resection at Department of Cancer Radiotherapy of Nanyang Central Hospital from July 2017 to December 2017, were collected for this study; breast cancer cell lines (MCF-7，MDA-MB-23 and SKBR-3) were also collected; qPCR was applied to detect the expression level of miR-31-5p in breast cancer tissues and cell lines. The radiation resistant cell line MCF-7R was constructed by using 6 MV-X ray radiotherapy treatment. Subsequently, the influence of over-expression/kockdown of miR-31-5p on radiation sensitivity of MCF-7 and MCF-7R cells were detected by colony formation assay, Transwell assay and Annexin V-FITC/PI double staining flow cytometry assay, respectively. Moreover, luciferase reporter assay was used to verify whether TNS1 was a target gene of miR-31-5p. Results: Compared with para-cancerous tissues, normal mammary epithelial MCF-10A cells and MCF-7 cells, miR-31-5p was low-expressed in breast cancer, cell lines and MCF-7R (all P<0.01). Over-expression of miR-31-5p resulted in inhibited invasion and promoted apoptosis of MCF-7R cells (P<0.01), whereas miR-31-5p knockdown got opposite results in MCF-7 cells. Moreover, luciferase reporter assay confirmed that TNS1 was a target gene of miR-31-5p. Over-expression of miR-31-5p inhibited invasion and increased radio-sensitivity, apoptosis of MCF-7R cell via targeting TNS1 (P<0.01), whereas knockdown of miR-31-5p significantly promoted the invasion but reduced apoptosis of MCF-7R cells (all P<0.01), and further up-regulated the radio-sensitivity of MCF-7R cells. Conclusion: miR-31-5p/TNS1 axis regulates the radiotherapy resistance of breast cancer, and over-expression of miR-31-5p may reverse the resistance of MCF-7R to radiotherapy.