OBJECTIVE To study the interventional effect and mechanism of 1，8-cineole on pancreatic β cell ferroptosis induced by type 2 diabetes. METHODS In vitro ferroptosis model was established in pancreatic β cells of mice by using high glucose. The effects of low-dose and high-dose 1，8-cineole （0.25， 0.5 μmol/L） on the level of Fe2+ in pancreatic β cells were investigated. The effects of 1，8-cineole （0.5 μmol/L） combined with ferroptosis inducer Erastin （20 μmol/L） and ferroptosis inhibitor Ferrostatin-1 （20 μmol/L） on the protein expressions of glutathione peroxidase-4 （GPX4） and cyclooxygenase-2 （COX2） were also detected. The type 2 diabetes model mice were established by feeding high-sugar and high-fat diet combined with intraperitoneal injection of streptozotocin. The effects of low-dose and high-dose 1，8-cineole （50， 200 mg/kg） on the pathological morphology of pancreatic tissue， the content of iron as well as the protein expressions of GPX4 and COX2 were investigated. RESULTS The results of the cell experiment showed that compared with the model group， pretreatment with 1，8-cineole significantly reduced intracellular Fe2+ levels and upregulated GPX4 protein expression， while downregulated COX2 protein expression in pancreatic β cells （P＜0.05）. After combining with Ferrostatin-1， the expression trends of the above two proteins were the same， while there was no statistically significant difference after combining with Erastin. The results of animal experiments showed that compared with the model group， after intervention with 1，8-cineole， the structure of the pancreatic islets in mice recovered intact and their morphology improved； the iron content of pancreatic tissue and protein expression of COX2 were decreased significantly （P＜0.05）， while protein expression of GPX4 was increased significantly （P＜0.05）. CONCLUSIONS 1，8-cineole could ameliorate pancreatic β cell injury induced by diabetes， the mechanism of which may be related to reducing intracellular iron deposition and regulating ferroptosis-related proteins.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To evaluate our self-designed guide device for Kirschner-wire placement in the surgery for paediatric fractures of supracondylar humerus.Methods:A retrospective study was conducted of the 117 children who had been treated for fractures of supracondylar humerus at Department of Orthopedics, The First People's Hospital of Huaian Affiliated to Nanjing Medical University from March 2019 to January 2023. There were 64 boys and 53 girls with an age of (5.8±1.5) years. By the Gartland classification, there were 67 fractures of type Ⅱ and 50 fractures of type Ⅲ. The time from injury to operation averaged (48.5±10.8) hours. The children were divided into 2 groups according to how their Kirschner-wires were placed. In the control group of 58 cases, external percutaneous Kirschner-wire placement was assisted using a syringe needle; in study group of 59 cases, external percutaneous Kirschner-wire placement was assisted using our self-designed guide device for Kirschner-wire placement. The operation time, rate of one-time placement of disposable K-wire, intraoperative fluoroscopy frequency, Baumann angle, carrying angle, fracture healing time, Flynn score of elbow joint function at the final follow-up, and postoperative complications were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The 117 pediatric patients were followed up for (15.3±3.2) months after operation. The operation time [(30.6±4.5) min] and intraoperative fluoroscopy frequency [(15.6±2.1) times] in the study group were significantly less than those in the control group [(40.6±7.3) min and (23.7±4.9) times], while the rate of one-time placement of disposable K-wire in the study group was significantly higher than that in the control group [84.2%(149/177) versus 32.2%(56/174)] ( P<0.05). There were no significant differences in Baumann angle, carrying angle, fracture healing time, or Flynn score of elbow joint function at the final follow-up between the 2 groups ( P>0.05). The incidence of complications in the study group (6.8%, 4/59) was significantly lower than that in the control group (20.7%, 12/58) ( P<0.05). Conclusions:Our self-designed guide device for Kirschner-wire placement is simple and convenient to use. In the surgery for paediatric fractures of supracondylar humerus, it can improve the rate of one-time placement of disposable K-wire, reduce intraoperative fluoroscopy, and decrease the incidence of complications.

Objective:To evaluate the impact of orthopedic robotic assistance and conventional freehand methods on surgical strategies, the safety of pedicle screw placement, and clinical efficacy in patients with upper cervical spine diseases.Methods:From January 2017 to March 2023, a total of 63 cases with upper cervical spine disease, were divided into two groups based on the screw placement technique: the robot-assisted pedicle screw placement (RA) group (41 cases) and the conventional freehand pedicle screw placement (CF) group (22 cases), were retrospectively included. These patients in the RA and CF groups underwent two types of posterior cervical surgery, including occipitocervical fusion (9 cases and 8 cases) and fixation and fusion of atlantoaxial and distal vertebrae (32 cases and 14 cases). The outcome parameters, including the disease course, surgical time, intraoperative blood loss, fluoroscopy frequency, radiation dose, hospital stay, treatment costs, complications, the rate of the pedicle screw placement, accuracy of upper cervical pedicle screw placement, and the risk factors that possibly affected the accuracy were recorded and analyzed. Postoperative follow-up was conducted for at least 6 months, and the efficacy of patients was assessed using imaging parameters, ASIS classification, VAS, and JOA scores.Results:Both groups had no screw-related complications and no spinal cord or vertebral artery injuries. In the RA group, the pedicle screw placement rates for the patients with occipitocervical fusion, and fixation and fusion of atlantoaxial and distal vertebrae were 100% (48/48) and 89.6% (138/154), respectively, far exceeding the placement rate in the CF group 42.9% (18/42) and 78.3% (54/69) (χ 2=37.403, P<0.001; χ 2=5.128, P=0.024). The fluoroscopic exposure dose and operation time of the two types of surgical patients in the RA group were both higher than those in the CF group ( P<0.05). Compared with the CF group, the accuracy of C 1 screws in the RA group increased from 42% (11/26) to 80% (51/64), with statistical significance (χ 2=13.342, P=0.004); while the accuracy of C 2 screws improved from 77% (33/43) to 88% (63/72) with no statistical difference (χ 2=2.863, P=0.413). Non-parametric correlation analysis found a significant correlation between the accuracy of C 1 and C 2 pedicle screw placement and the order of guide wire insertion in the RA group ( r=0.580, P<0.001; r=0.369, P=0.001). Postoperatively, both groups showed significant differences in cervicomedullary angle (CMA), Chamberlain angle (CL), McGregor angle, Boogard angle, Bull angle, clivus-canal angle (CCA), occipitocervical (C 0-C 2) angle, posterior occipitocervical angle (POCA), C 2-C 7 angle, and anterior atlantodental interval (ADI) ( P<0.05). The ASIA classification improved to varying degrees for both groups postoperatively, but there were no statistically significant differences between preoperative, postoperative, and last follow-up evaluations. VAS and JOA scores significantly improved for both groups postoperatively and at the last follow-up ( P<0.05). Conclusion:Both orthopedic robotic-assisted and conventional freehand pedicle screw placement techniques achieved satisfactory therapeutic effects in the treatment of upper cervical spine diseases. The orthopedic robot can effectively ensure the accuracy of upper cervical pedicle screw placement, the increase placement rate of pedicle screws in the upper cervical spine, and reduce fluoroscopy exposure. However, it is necessary to avoid the vertebral displacement caused by the priority insertion of the guide needle, which may affect the accuracy of subsequent planning.

Objective:To compare the clinical efficacy of robotic-assisted and fluoroscopy-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).Methods:A total of 27 patients with lumbar degenerative disease receiving robot-assisted MIS-TLIF (robot-assisted group) treatment in the First Affiliated Hospital of Nanjing Medical University from May 2020 to September 2021 were retrospectively analyzed, including 9 males and 18 females, aged 61.00±9.11 years (range, 41-71 years). Twenty-seven patients who received fluoroscopic-assisted MIS-TLIF (fluoroscopic-assisted group) during the same period were selected as controls, including 16 males and 11 females, aged 56.70±11.97 years (range, 32-76 years). Operation time, intraoperative bleeding, radiation exposure time, postoperative drainage, hospitalization time, visual analogue scale (VAS) for pain, Oswestry disability index (ODI), accuracy of pedicle screw placement, and postoperative complications were recorded. The learning curve of the robot-assisted group was drawn based on the amount of surgery and the operation time by fitting the logarithmic curve.Results:All patients successfully completed the operation and were followed up for 15.44±3.89 months (range, 12-24 months). The operation time, drainage volume, and hospitalization time in the robot-assisted group were 181.44±36.43 min, 43.70±22.04 ml, and 5.04±1.40 d, respectively, which were smaller than 223.22±59.40 min, 74.63±71.86 ml, 6.59±3.04 d in the fluoroscopy-assisted group, and the differences were statistically significant ( P<0.05). The radiation exposure time in robot-assisted group was 77.78±9.81 s, which was larger than fluoroscopy-assisted group (63.78±17.70 s). There were statistically significant differences in lumbar VAS scores between the two groups before and after surgery ( P<0.05), 3 days after operation and the last follow-up was smaller than those before operation. The VAS score on postoperative day 3 in the robot-assisted group was 2.52±0.98, which was less than 3.07±0.87 in the fluoroscopically-assisted group ( t=0.294, P=0.032). In both groups, 108 pedicle screws were placed, and the accuracy of nail placement in the robot-assisted group was 93.5% (101/108), which was greater than that in the fluoroscopically-assisted group 77.8% (84/108), and the difference was statistically significant (χ 2=11.821, P=0.008). By fitting a logarithmic curve to describe the relationship between the number of operations and the operation time of the robotic-assisted group of operators, the results showed that the operation time decreased with the increase of the number of operations, and the operation time fluctuated greatly in the first 10 cases, and then gradually shortened and stabilized after 10 operations. Conclusion:Robot-assisted MIS-TLIF can improve the accuracy of pedicle screw placement, improve the early postoperative pain and shorten the learning curve.

Objective:To evaluate the accuracy and safety of cervical pedicle screw (CPS) placement under orthopaedic robot navigation system guidance.Methods:From March 2019 to February 2021, the data of 33 patients (19 males and 14 females, aged from 26 to 75 years, with an average age of 50.5 years) treated with pedicle screw fixation with the assistance of orthopaedic surgery robot through the posterior cervical spine were retrospectively analyzed. In clinical diagnosis, there was upper cervical fracture with instability in 14 patients (fracture nonunion in 2 patients), upper & subaxial cervical fracture in 1 patient, cervical spinal cord injury with spinal stenosis in 2 patients, cervical spinal stenosis in 9 patients, occipitocervical deformity in 2 patients, post-operative revision of cervical spondylosis in 2 patients, cervical intraspinal tumor in 3 patients. A total of 151 CPSs were inserted in C 1-C 7 using robot navigation system based on intraoperative three-dimensional C-arm fluoroscopy to assist in screw placement in posterior cervical surgery. Among them, 74 screws were implanted into upper cervical spine; 77 screws were implanted in the lower cervical spine. CT was used to obtain image data within 7 days after operation, and Neo classification was used to evaluate the accuracy of cervical pedicle screw placement. The patients were followed up for 2 weeks to observe the clinical symptoms and signs, and to determine whether there were surgical complications such as nerve and blood vessel injury and incision infection. Results:According to Neo classification, 91.4% (138/151) screws were completely contained in the pedicle without breaking through the pedicle cortex (grade 0). Among them, the accuracy of C 1 screws was 97.1% (34/35), C 2 screws was 92.3% (36/39), C 3 screws was 88.2% (15/17), C 4 screws was 71.4% (10/14), C 5 screws was 85.7% (12/14), C 6 screws was 93.3% (14/15), C 7 screws was 100.0% (17/17). The screw accuracy was highest in C 7, the lowest in C 4. The Kruskal-Wallis H test was performed on the accuracy of screw placement in different cervical level, and the results showed that there was no statistical difference (χ 2=1.31, P=0.971). However, a total of 13 screws were found to perforate the cortex of pedicle, although any neural or vascular complications associated with CPS placement were not encountered. Among them, 9 screws were found to perforate laterally, and 4 screws were found to perforate medially. No postoperative incision infection occurred in all cases. Conclusion:The safety of CPS placement can be effectively guaranteed with the assistance of the orthopaedic robot system.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become one major threat to human population health. The RNA-dependent RNA polymerase (RdRp) presents an ideal target of antivirals, whereas nucleoside analogs inhibitor is hindered by the proofreading activity of coronavirus. Herein, we report that corilagin (RAI-S-37) as a non-nucleoside inhibitor of SARS-CoV-2 RdRp, binds directly to RdRp, effectively inhibits the polymerase activity in both cell-free and cell-based assays, fully resists the proofreading activity and potently inhibits SARS-CoV-2 infection with a low 50% effective concentration (EC

Objective To investigate the impact of endplate fracture on the clinical efficacy of minimally invasive percutaneous pedicle screwing for thoracolumbar burst fractures.Methods From September 2012 to June 2016,35 patients with thoracolumbar burst fracture underwent minimally invasive percutaneous pedicle screwing at Department of Orthopaedics,The First Affiliated Hospital to Nanjing Medical University.They were divided into 2 groups according to the severity of endplate fracture:a mild fracture group of 17 cases and a severe fracture group of 18 cases.Their clinical data were recorded and compared between the 2 groups before surgery,before discharge,6 months after surgery and at the last follow-up with respects to kyphosis cobb angle and height compression rate of the injured vertebra,and visual analogue scale (VAS),Oswestry disability index (ODI) and the MOS 36-item Short Form Health Survey (SF-36) scores.Results The kyphosis cobb angle and height compression rate of the injured vertebra,and VAS,ODI and SF-36 scores before discharge,6 months after surgery and at the last follow-up were all significantly improved in all the patients compared to the values before surgery (P ＜ 0.05).There were no significant differences between the 2 groups in the kyphosis cobb angle of the injured vertebra before surgery,before discharge,6 months after surgery or at the last follow-up (P ＞ 0.05).At the last follow-up,the height compression rate of the injured vertebra,and VAS,ODI and SF-36 scores in the mild fracture group were significantly lower than in the severe fracture group (P ＜ 0.05),and the height compression rate of the injured vertebra,and VAS,ODI and SF-36 scores of the severe fracture group were significantly higher than the values 6 months before (P ＜ 0.05).Conclusions The severity of endplate fracture may have no significant impact on the recovery of vertebral height in the early-to-mid stage after minimally invasive percutaneous pedicle screwing for thoracolumbar burst fractures.However,the patients complicated with severe endplate fracture are likely to suffer a height loss of the injured vertebral body and decreased quality of life in the long run.

Objective To investigate the mental health and the affecting factors on children cochlear implants and to provide the reference of comprehensive rehabilitation for them.Methods We used the Psychological Ques-tionnaire for 3~6 Years Children to evaluate the mental health status of 1 6 6 children of 3~4 years old with cochlear implants,and compare those with the standard values of children with normal hearing.We studied the affecting fac-tors on their psychological development.Results The pass rates in action,emotion and will,cognitive ability,sociali-ty,living habits and speech ability of children with cochlear implants decreased as their age increased.The scores of action,emotion and will,cognitive ability,sociality,living habits and speech ability of children with cochlear im-plants increased as the use time increased.The affecting factors on the psychological development of children with cochlear implants were the time length of usage and their residences before operation.Conclusion There were differ-ences between the children with cochlear implants and normal hearing in psychological development.We should fo-cus on their development of hearing and speech ability,and the psychological development.