ObjectiveTo investigate the application value of liver/spleen CT value （CT_L/S）， controlled attenuation parameter （CAP）， and magnetic resonance imaging-proton density fat fraction （MRI-PDFF） in chronic hepatitis B （CHB） patients with hepatic steatosis. MethodsA retrospective analysis was performed for the clinical data of 213 CHB patients who underwent liver CT， CAP， and MRI-PDFF examinations in Affiliated Hospital of Yan’an University from October 2018 to December 2022. According to MRI-PDFF， the 213 patients were divided into CHB group with 111 patients （MRI-PDFF<5%） and CHB+hepatic steatosis group with 102 patients （MRI-PDFF≥5%）， among whom there were 69 patients with mild hepatic steatosis and 33 patients with moderate to severe hepatic steatosis. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. The Bland-Altman plot was used to evaluate the consistency in MRI-PDFF measurement between two physicians. The Spearman’s correlation coefficient was used to analyze the correlation between CT_L/S and MRI-PDFF and between CAP and MRI-PDFF. The receiver operating characteristic （ROC） curve was plotted and the area under the ROC curve （AUC） was calculated to investigate the value of CT_L/S and CAP in the diagnosis of different degrees of hepatic steatosis， and the DeLong test was used to compare the AUCs of the two radiological examinations. ResultsMRI-PDFF had relatively high repeatability and stability in CHB patients. There is a significant negative correlation between CT_L/S and MRI-PDFF （r=-0.800， P<0.001） and a significant positive correlation between CAP and MRI-PDFF （r=0.692， P<0.001）. Both CT_L/S and CAP had a relatively high accuracy in the diagnosis of hepatic steatosis in CHB patients， with an AUC of 0.951 and 0.902， respectively， and CT_L/S had a better accuracy than CAP （P<0.05）. In the diagnosis of mild and moderate-to-severe hepatic steatosis， CT_L/S had an AUC of 0.921 and 0.895， respectively， and CAP had an AUC of 0.859 and 0.825， respectively， suggesting that CT_L/S had a slightly higher diagnostic efficiency than CAP. ConclusionMRI-PDFF has high repeatability and stability in CHB patients， and CT_L/S and CAP have a high diagnostic value for different degrees of hepatic steatosis in CHB patients.

OBJECTIVE:Cement-augmentation pedicle screws have been widely used in spinal internal fixation surgery combined with osteoporosis in recent years,which can significantly improve the fixation strength,but compared with conventional methods,whether it has more advantages is still inconclusive of evidence-based medicine.To systematically evaluate the efficacy and safety of cement-augmented pedicle screw in the treatment of thoracolumbar degenerative diseases with osteoporosis. METHODS:Clinical controlled trials concerning the cement-augmented pedicle screw and the traditional pedicle screw placement for thoracolumbar degenerative diseases with osteoporosis were retrieved from the electronic databases such as CNKI,CBM,WanFang,VIP,PubMed,Cochrane Library,Web of Science and Embase.According to the unified criteria,we performed literature screening and quality evaluation.The meta-analysis was performed using RevMan 5.4 software. RESULTS:(1)Totally 20 articles were selected eventually,involving 2 randomized controlled studies and 18 retrospective cohort studies,totally 1 566 patients.Among them,789 cases were in the cement-augmented screw group and 777 cases in the conventional screw group.(2)Meta-analysis results showed that Japanese Orthopaedic Association score,intervertebral space height and fusion rate were higher in the cement-augmented screw group than those in the conventional screw group(MD=1.60,95%CI:1.14,2.07,P<0.000 01;MD=1.26,95%CI:0.62,1.90,P=0.000 1;OR=11.24,95%CI:2.86,44.14,P=0.000 5).Operation time was longer in the cement-augmented screw group than that in the conventional screw group(SMD=0.82,95%CI:0.42,1.23,P<0.000 1).Postoperative visual analog scale score,Oswestry dysfunction index score and incidence of screw loosening were lower in the cement-augmented screw group than those in the conventional screw group(MD=-0.50,95%CI:-0.78,-0.21,P=0.000 7;SMD=-0.49,95%CI:-0.88,-0.10,P=0.01;OR=0.08,95%CI:0.05,0.12,P<0.000 01).Hospitalization time,intraoperative blood loss,and postoperative drainage volume were not significantly different between the two groups(P>0.05). CONCLUSION:Compared with conventional pedicle screw placement,cement-augmented pedicle screw is more effective in the treatment of osteoporotic thoracolumbar degenerative disease by improving fusion rate and interbody height,reducing the incidence of screw loosening,and elevating long-term efficacy.

BACKGROUND:Atlantoaxial dislocation,because of its high difficulty and high risk of surgery,has been regarded as the"surgical restricted area"by the international orthopedic community.However,with the rapid development of intelligent digitization in orthopedics,robot-assisted navigation screw placement technology has been widely used in clinical practice,which significantly reduces the difficulty and risk of surgery and improves the safety of surgery.However,there are few reports on the application of this technique in the treatment of atlantoaxial dislocation. OBJECTIVE:To explore the application value of robot-assisted pedicle screw internal fixation in the treatment of atlantoaxial dislocation. METHODS:The medical records of five patients with atlantoaxial dislocation treated with C1-C2 pedicle screw fixation under robot-assisted navigation in Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine from October 2021 to July 2022 were retrospectively analyzed.Operation time,length of neck incision,blood loss,postoperative drainage volume,and length of hospital stay were recorded.Attention should be paid to cerebrospinal fluid leakage,vertebral artery injury,nerve injury,operative area infection and other complications.The visual analog scale score of neck pain,the spinal cord injury grade of the American Spinal Injury Association,the cervical spine score of the Japanese Orthopaedic Association,and the imaging indicators were collected before surgery and at the last follow-up.Screw placement accuracy was assessed. RESULTS AND CONCLUSION:(1)Five patients were successfully completed surgery,without vascular,nerve injury or other complications,and were followed up for 12-20 months.(2)A total of 20 cervical pedicle screws were placed in 5 patients,including 9 type A screws,10 type B screws,and 1 type C screw.The accuracy of screw placement was 95%.(3)At the last follow-up,the visual analog scale score was(0.80±0.71)points,which was significantly lower than that before operation(4.00±2.83)points;the Japanese Orthopaedic Association score was(14.80±0.84)points,which was significantly higher than that before operation(8.00±0.71)points.Anterior atlantodental interval decreased from(7.86±3.25)mm to(2.82±0.93)mm;space available of the spinal cord increased from(6.74±1.99)mm to(12.10±3.51)mm;cervicomedullary angle increased from(133.32±13.55)° to(153.44±9.53)°;clivus-canal angle increased from(128.02±9.92)° to(143.25±12.99)°.The results of the last follow-up indexes were improved compared with those before operation,and the differences were significant(all P<0.05).(4)Postoperative imaging follow-up showed that all patients had bone fusion in the bone graft area,and no internal fixation loosening,fracture or pull-out occurred.(5)This method can avoid relying on the doctor's experience and hand feeling,ensure the accuracy of upper cervical screw placement,reduce the risk of surgery,and obtain satisfactory results in mid-term follow-up.

ObjectiveTo construct a macro-evaluation tool for dampness syndrome （DS） animal model， which will provide a basis for experimental research on dampness syndrome in traditional Chinese medicine （TCM）. MethodsConceptual framework of this study was clarified through discussions within the core working group， and dimensions of the evaluation of the animal model of DS were identified according to TCM principles. We searched CNKI， Wanfang， VIP and SinoMed databases from the inception to June 30th， 2023， on experiments involving dampness syndrome animals to create a pool of items about DS animal models. The core items were selected and extracted for factor analysis and cluster analysis. An expert importance rating questionnaire was developed based on the results of the literature review， analyzing the distribution of item scores， importance averages， and coefficient of variation. Through a comprehensive analysis of literature， expert importance scoring， and specific expert opinions， items that did not meet anyone of the criteria of average importance rating ≥2.04， coefficient of variation ≤30%， or literature eva-luation frequency ≥2% were removed， thereafter， the macro-evaluation tool for DS animal model was preliminarily constructed. ResultsSpirit and body state， autonomic activity state， body surface characteristics， diet， urination and defecation， tongue manifestation， and motor behavior assessment were constructed as the seven dimensions in the evaluation of DS animal model. A total of 348 papers about animal experiments were included and analyzed， resulting in a saturated pool of 72 items， which was refined to 38 core items of DS animal models. Factor analysis obtained 16 common factors， which were further clustered into two categories， named dampness transforming from heat syndrome and dampness transforming from cold syndrome. The expert importance scoring showed that the Kendall harmony coefficient was 0.359 （P＜0.05） indicating a high level of agreement， coordination and reliability among the experts. Notably， 50% or more of the experts considered the items thick and greasy tongue coating， unclean perianal area， loose stools， lethargy， unformed stools， and listless expression as very important. The median scores for all items were 2.04（1.73， 2.37）， with a coefficient of variation ranging from 19.73% to 53.38%. After expert evaluation， the macro-evaluation tool for DS animal model in TCM with 33 items and corresponding criteria for assessing the formation of DS models was finally contructed. ConclusionThe Macro-evaluation tool for DS animal model in TCM is highly scientific， credible， and operable， and can be utilized in DS animal experiments after its characteristics are actually evaluated.

Objective:To investigate the efficacy and safety of retroperitoneal soft tissue sarcoma resection combined with nephrectomy.Methods:The clinical data of 27 cases undergoing retroperitoneal soft tissue sarcoma resection combined with nephrectomy at the Gastrointestinal Tumor Center , Guangdong Provincial Hospital , Traditional Chinese Medicine from Jun 2017 to Aug 2022 were retrospectively analyzed for the indication of nephrectomy, postoperative progression of renal insufficiency and survival rate.Results:Twenty-six cases (96%) achieved R 0/R 1 resection and 1 case nderwent R 2 resection. Six cases underwent combined unilateral nephrectomy and 21 patients underwent combined multi-organ resection with a median number of resections of 4 (2,5). Postoperative pathology suggested that the combined resected kidney was positive for tumor infiltration in 17 cases. Five cases had Clavien-Dindo grade 3 or higher complications and no deaths occurred within 30 days after surgery. At the 90th day after surgery, 19 cases (70%) had decreased renal function ( Z=2.88, P=0.04), with a median decrease of -3.96 (-30.36, 0.31)ml·(min·1.73 m 2) -1, including 8 cases of preoperative Chronic Kidney Disease(CKD)1 stage progression (6 cases of CKD 2 stage, 2 cases of CKD 3 stage); 2 cases of CKD 2 stage progressed to CKD 3 stage; 1 case of preoperative CKD 3 stage progressed to CKD 4 stage. During the follow-up period of 3-38 months, no patient progressed to CKD 5 stage and no patient required dialysis treatment. Conclusion:Retroperitoneal soft tissue sarcoma resection combined with nephrectomy is safe and feasible while improving tumor radicality.

Objective To investigate the value of liver/muscle ratio (LMR) on susceptibility-weighted imaging (SWI) and serum markers in the diagnosis of the severity of chronic hepatitis B liver fibrosis after grouping based on alanine aminotransferase (ALT) level. Methods A retrospective analysis was performed for 255 patients with chronic hepatitis B who attended Affiliated Hospital of Yan'an University from October 2018 to September 2021, and the patients were divided into severe liver fibrosis group (SLF group) and non-severe liver fibrosis group (non-SLF group). The SLF group was defined as liver stiffness measurement (LSM) > 9.0 kPa and ALT level within the normal range or LSM > 12.0 kPa and ALT level greater than 1-5 times of the upper limit of normal. LMR was calculated by measuring the mean SWI value of the liver (SWI liver ) and the signal intensity of the erector spinae. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two group; the chi-square test was used for comparison of categorical data between two groups. The binary logistic regression analysis was used to investigate the influencing factors for SLF. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic performance of LMR and its combination with serum markers, and the DeLong test was used to compare the difference in the area under the ROC curve (AUC). Results Compared with the non-SLF group, the SLF group had significantly higher ALT ( Z =-3.569, P < 0.001), aspartate aminotransferase (AST) ( Z =-5.495, P < 0.001), hyaluronic acid (HA) ( Z =-6.746, P < 0.001), laminin (LN) ( Z =-5.459, P < 0.001), type Ⅳ collagen (Ⅳ-C)( Z =-8.470, P < 0.001), type Ⅲ procollagen (PCⅢ) ( Z =-6.326, P < 0.001), aspartate aminotransferase-to-platelet ratio index ( Z =-9.004, P < 0.001), and FIB-4 ( Z =-8.357, P < 0.001) and significantly lower prothrombin time activity (PTA) ( t =10.088, P < 0.001), platelet count ( t =9.163, P < 0.001), SWI liver ( t =2.347, P =0.02), and LMR×10 ( Z =-4.447, P < 0.001). PTA, HA, Ⅳ-C, and LMR×10 were independent influencing factors for SLF. LMR×10 had an AUC of 0.675 (95% confidence interval [ CI ]: 0.614-0.732) in the diagnosis of SLF, which was significantly higher than that of SWI liver (AUC=0.594, 95% CI : 0.531-0.655) ( Z =3.984, P < 0.001). PTA+HA+Ⅳ-C+LMR×10 and PTA+HA+Ⅳ-C had an AUC of 0.937 (95% CI : 0.896-0.966) and 0.905 (95% CI : 0.858-0.941), respectively, suggesting that PTA+HA+Ⅳ-C+LMR×10 had a better diagnostic performance than PTA+HA+Ⅳ-C ( Z =2.228, P =0.026). Conclusion LMR and serum markers can accurately distinguish SLF after grouping based on ALT level. LMR is a quantitative and objective imaging indicator and is better than SWI liver , and it can also improve the diagnostic performance of serum markers for SLF in clinical practice.

Objective:To investigate the molecular etiology of Perrault syndrome by analyzing the clinical phenotype and pathogenic gene variants of 2 male patients with bilateral severe sensorineural deafness.Methods:Two male patients with Perrault syndrome characterized by severe sensonrineual deafness adimitted to the First Affiliated Hospital of Zhengzhou University between February 2021 and March 2022 were selected, and the clinical phenotype and pathogenic gene variants of them and their family members were summarized. The whole exome sequencing technology was used to screen the pathogenic variants of the probands, and the candidate variants were determined by combining with clinical phenotype. The probands and their family members were verified by the Sanger sequencing method.Results:The whole exome sequencing results showed that the proband of family 1 had a compound heterozygous variants of the LARS2 (NM_015340.4) gene c.1565C>A (p.Thr522Asn) and c.1079T>C (p.Ile360Thr). The reported pathogenic variant c.1565C>A came from the mother, and the novel variant c.1079T>C came from the father. The second proband harbored compound heterozygous variants of HARS2 gene (NM_012208.4) c.1273C>T (p.Arg425Trp) and c.1403G>C (p.Gly468Ala), with the former from the proband′s mother, the latter from the father. The c.1273C>T was novel and c.1403G>C was the reported pathogenic variant. All above variants were respectively classified as pathogenic, uncertain significance, uncertain significance and likely pathogenic based on the ACMG guidelines. Conclusion:This study expands the mutational spectrum of LARS2 and HARS2 genes, which highlights that genetic testing plays an important role in the early diagnosis of syndromic deafness.

Objective? To evaluate and summarize the best evidence for management of peristomal irritant dermatitis in patients with a urostomy. Methods? Clinical practice guidelines, evidence summary and systematic review related to peristomal irritant dermatitis were retrieved and screened from various guideline websites and databases (from their founding to July 2018). The quality of these literatures were evaluated with the Appraisal of Guidelines for Research & Evaluation Ⅱ (AGREE Ⅱ) and the Joanna Briggs Institute Critical Appraisal Tools. Evidence was extracted and summarized from high-quality literatures. Results? Totally 7 literatures were included, including 5 clinical practice guidelines, 1 evidence summary and 1 systematic review. Evidence for recognition, evaluation, prevention, treatment, health education and follow-up visits of peristomal irritant dermatitis was summarized. Conclusions? It is recommended that medical institutions refer to the content of evidence summary, make evidence-based practice plans based on the conditions of clinical departments, use the evidence efficiently, and bridge the gap between evidence and practice.

Spectrophotometric seawater pH measurement system is an urgent need of device due to its quick speed and high precision. Based on spectrophotometric method and flow injection analysis technique, an automated system for pH measurement of seawater was developed by integrating pump and valve flow path, LED light source, flow cell and spectrophotometer. This measurement system effectively avoided bubbles. The indicator of concentration gradient in the seawater sample was used to correct for the pH perturbation caused by the indicator, thus the operation of system was simple and convenient. with this system, only 1. 5 min was needed for a sample measurement with a precision of 0. 0013 pH units and an offset of 0. 0059 pH units. This system could be used for the rapid determination of pH of seawater collected by laboratory or research ship with high precision pH values.

Chronic kidney disease (CKD) is a chronic renal structure change and dysfunction caused by a variety of causes.The incidence and prevalence of CKD have been on the rise,becoming a major global health problem.An increasing number of studies had shown that one of the important indicators of CKD progression was the disorder of gut microbiome and elevated levels of sernm endotoxin.Modern physicians of traditional Chinese medicine (TCM) believed that the main pathogenesis of CKD was spleen and kidney deficiency.And the therapeutic regimen was invigorating spleen and nourishing the kidney.Spleen is in the middle burner.It has the function of transportation and resistance to evil,which was extremely similar to the function of gut microbiome in metabolism and immunity.The latter might be one of the biological bases of physiological function of spleen.This comprehensive review presented the modern theoretical basis of spleen-based TCM treatment methods for CKD from the insight of modern gut microbiome and metabolism.Firstly,gut microbiome and its metabolism were associated with the spleen in TCM theory.Gut microbiome affected individual metabolism and immune function,which could provide a modern biological basis for explaining the physiological function of the spleen.Secondly,gut microbiome and its metabolism were correlated with CKD:intestinal flora disturbance occurred in CKD patients,producing enterogenous toxins as their metabolites,which become the important factors affecting prognosis.Thirdly,as for its origin,development and current status based on the spleen theory,CKD was one of various consumptive diseases.Spleen insufficiency was one of their critical pathogenic mechanisms.Therefore,tonifying the spleen should be a treatment method to maintain throughout the entire treatment.On the basis of our previous clinical studies and the hypothesis of gut microbiome and metabolism,we proposed further studies which were also based on system biology and its technology.