Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression Surgery in Severe Lumbar Stenosis Under Electrophysiological Monitoring-Focused on Full-Visualized Trephine/Osteotome.

OBJECTIVE: Although endoscopic drill has the advantages in manipulation and hemostasis, whose low efficiency and blurred vision reduce the efficacy of lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD). The present study was designed to evaluate the safety and efficacy of full-visualized trephine/osteotome in the LE-ULBD surgery for severe lumbar stenosis. METHODS: Fifty-seven severe lumbar stenosis patients who underwent LE-ULBD between January 2020 to January 2023 were enrolled, who were divided into drill and visualized trephine groups. The medical records including demographics, operative duration, intraoperative electrophysiological findings, postoperative hospital stay or hospital stay, postoperative outcomes and complications were retrospectively reviewed and analyzed. RESULTS: A total of 57 patients included 15 in drill and 42 in trephine group were enrolled in the study. There was significant difference in the pre- and postoperative visual analogue scale and Oswestry Disability Index scores in both groups (p < 0.05). The mean operative duration in the trephine group (101.05 ± 12.18 minutes) was shorter than that in the drill group (134.67 ± 9.68 minutes) (p < 0.05). There was no statistical difference between the 2 groups in electrophysiological monitoring, posthospital stays, postoperative outcomes and complications. Abnormal free-electromyography (EMG) were recorded in 2 (13.3%) and 5 patients (11.9%) in the drill and trephine group. Intraoperative somatosensory evoked potential changes occurred in 3 (20%) and 3 patients (7.1%) in the drill and trephine group and all patients recovered immediately when surgery ended. No serious complications and recurrence occurred in all the patients. CONCLUSION: Full-visualized trephine/osteotome has been approved to be convenient, safe and efficient in our study, which combined with translaminar inside-out technique and EMG monitoring especially free-EMG may offer a new choice in LE-ULBD surgery for lumbar stenosis patients.

Predicting diabetic kidney disease for type 2 diabetes mellitus by machine learning in the real world: a multicenter retrospective study.

Objective: Diabetic kidney disease (DKD) has been reported as a main microvascular complication of diabetes mellitus. Although renal biopsy is capable of distinguishing DKD from Non Diabetic kidney disease(NDKD), no gold standard has been validated to assess the development of DKD.This study aimed to build an auxiliary diagnosis model for type 2 Diabetic kidney disease (T2DKD) based on machine learning algorithms. Methods: Clinical data on 3624 individuals with type 2 diabetes (T2DM) was gathered from January 1, 2019 to December 31, 2019 using a multi-center retrospective database. The data fell into a training set and a validation set at random at a ratio of 8:2. To identify critical clinical variables, the absolute shrinkage and selection operator with the lowest number was employed. Fifteen machine learning models were built to support the diagnosis of T2DKD, and the optimal model was selected in accordance with the area under the receiver operating characteristic curve (AUC) and accuracy. The model was improved with the use of Bayesian Optimization methods. The Shapley Additive explanations (SHAP) approach was used to illustrate prediction findings. Results: DKD was diagnosed in 1856 (51.2 percent) of the 3624 individuals within the final cohort. As revealed by the SHAP findings, the Categorical Boosting (CatBoost) model achieved the optimal performance 1in the prediction of the risk of T2DKD, with an AUC of 0.86 based on the top 38 characteristics. The SHAP findings suggested that a simplified CatBoost model with an AUC of 0.84 was built in accordance with the top 12 characteristics. The more basic model features consisted of systolic blood pressure (SBP), creatinine (CREA), length of stay (LOS), thrombin time (TT), Age, prothrombin time (PT), platelet large cell ratio (P-LCR), albumin (ALB), glucose (GLU), fibrinogen (FIB-C), red blood cell distribution width-standard deviation (RDW-SD), as well as hemoglobin A1C(HbA1C). Conclusion: A machine learning-based model for the prediction of the risk of developing T2DKD was built, and its effectiveness was verified. The CatBoost model can contribute to the diagnosis of T2DKD. Clinicians could gain more insights into the outcomes if the ML model is made interpretable.

Diet composition and selection of Père David's deer in Hubei Shishou Milu National Nature Reserve, China.

Hubei Shishou Milu National Nature Reserve is an ideal place to restore the wild population of Père David's deer (Elaphurus davidianus). Understanding foraging ecology and diet composition is essential for assessing population development or establishing long-term effective conservation measures for endangered species. However, little is known about the diet composition of Père David's deer and its diet selection mechanism. In this study, we used stable isotope technology to investigate the diet composition of Père David's deer according to various tissues (i.e., fur, muscle, liver, heart, and feces) and seasons, and evaluated the correlation between the nutrient composition of plants and diet composition. Bayesian isotope analysis showed that the autumn and winter diet estimated by fur and fecal samples indicated a diet dominated by C3 grasses (42.7%-57.2%, mean), while the summer diet estimated by muscle and liver samples was dominated by C3 forbs (30.9%-41.6%, mean). The Pearson correlation test indicated that the contribution of winter diet composition reflected by fur and fecal samples was associated with correlations with crude protein (r = .666, p < .01) and soluble sugars (r = .695, p < .01). The results indicated that crude protein and soluble sugars were important factors influencing the winter diet selection of Père David's deer. In the context of the current reintroduction facing many challenges, such as habitat fragmentation, wetland degradation, and human disturbance, comprehensively evaluating the diet selection mechanism of Père David's deer under different resource specificities and temporal changes should be considered in the future.

Molecular therapeutics of hemophilia A and B.

INTRODUCTION: Hemophilia A (HA) or B (HB) is an X-linked recessive disorder caused by a defect in the factor VIII (FVIII) or factor IX (FIX) gene which leads to the dysfunction of blood coagulation. Protein replacement therapy (PRT) uses recombinant proteins and plasma-derived products, which incurs high cost and inconvenience requiring routine intravenous infusions and life-time treatment. Understanding of detailed molecular mechanisms on FVIII gene function could provide innovative solutions to amend this disorder. In recent decades, gene therapeutics have advanced rapidly and a one-time cure solution has been proposed. AREAS COVERED: This review summarizes current understanding of molecular pathways involved in blood coagulation, with emphasis on FVIII's functional role. The existing knowledge and challenges on FVIII gene expression, from transcription, translation, post-translational modification including glycosylation to protein processing and secretion, and co-factor interactions are deciphered and potential molecular interventions discussed. EXPERT OPINION: This article reviews the potential treatment targets for HA and HB, including antibodies, small molecules and gene therapeutics, based on molecular mechanisms of FVIII biosynthesis, and further, assessing the pros and cons of these various treatment strategies. Understanding detailed FVIII protein synthesis and secretory pathways could provide exciting opportunities in identifying novel therapeutics to ameliorate hemophilia state.

[Analysis of Transport Pathways and Potential Sources of Atmospheric Particulate Matter in Zigong, in South of Sichuan Province].

Atmospheric particulate matter pollution in Zigong City in southern Sichuan is quite severe. The average concentrations of PM10 and PM2.5 from 2015 to 2018 were (95.42±9.53) µg·m-3 and (65.95±6.98) µg·m-3, with an obvious trend of decline. The concentrations of PM10 and PM2.5 in winter were much higher than in other seasons, with the highest average concentrations being(138.08±52.29) µg·m-3 and (108.50±18.05) µg·m-3 in January, respectively, whereas in summer, the average concentrations were lowest. The average ratio of PM2.5 to PM10 is 69.12%, and the ratio in winter is about 1.17 times that in summer; thus, PM2.5 is mainly responsible for the air pollution. To explore the potential sources of fine particulate matter (PM2.5) in Zigong City and the pollution contributions of different sources in different seasons, the concentration of PM2.5 in Zigong and the daily trajectory after 72 h were calculated and clustered by the combined use of a variety of potential source analysis methods and data. These methods and data included the hybrid single particle lagrangian integrated trajectory (HYSPLIT) model, global data assimilation system (GDAS) meteorological data, potential source contribution analysis (PSCF), and concentration of weight trajectory analysis (CWT). The results showed that the area near Zigong is mostly controlled by southeasterly, westerly, and northwesterly winds in all seasons, and the high PM2.5 concentration is mostly located in the low-wind-speed zone of 0-2 m·s-1. The influence of different seasons and transport routes on PM2.5 pollution in Zigong is significant. In spring, it is mainly affected by short-distance air flow from the west and north; in summer, the pollution mainly comes from the southeast air flow of short-distance transportation; in autumn, it is mainly affected by short-distance transportation air flow from Ziyang, Suining, Chongqing, and Neijiang; and in winter, it is not only affected by the surrounding cities such as Ziyang, Suining, and Neijiang but also by the long-distance transportation air flow from central Tibet. In general, the potential source area of particulate matter in Zigong City is mainly located in the border area between the west of Chongqing and the south of Sichuan. In winter, the main contribution area is at its widest, while in summer, the potential source area is smallest.

Synthesis of in-plane and stacked graphene/hexagonal boron nitride heterostructures by combining with ion beam sputtering deposition and chemical vapor deposition.

Graphene/hexagonal boron nitride (h-BN) heterostructures have attracted a great deal of attention in recent years due to their unique and complementary properties for use in a wide range of potential applications. However, it still remains a challenge to synthesize large-area high quality samples by a scalable growth method. In this work, we present the synthesis of both in-plane and stacked graphene/h-BN heterostructures on Cu foils by sequentially depositing h-BN via ion beam sputtering deposition (IBSD) and graphene with chemical vapor deposition (CVD). Due to a significant difference in the growth rate of graphene on h-BN and Cu, the in-plane graphene/h-BN heterostructures were rapidly formed on h-BN domain/Cu substrates. The large-area vertically stacked graphene/h-BN heterostructures were obtained by using the continuous h-BN film as a substrate. Furthermore, the well-designed sub-bilayered h-BN substrates provide direct evidence that the monolayered h-BN on Cu exhibits higher catalytic activity than the bilayered h-BN on Cu. The growth method applied here may have great potential in the scalable preparation of large-area high-quality graphene/h-BN heterostructures.

[Ultrastructure of the upper airway skeletal muscle in patients with obstructive sleep apnea hypopnea syndrome patients].

OBJECTIVE: To observe the ultrastructure of the upper airway skeletal muscle from patients with obstructive sleep apnea hypopnea syndrome (OSAHS) . METHODS: Sixteen OSAHS patients were recruited during Oct 2010 to Oct 2011. Ten patients with chronic tonsillitis were recruited as the control. Body mass index (BMI) was above 25 kg/m(2) in all patients. The upper air way skeletal muscle cells were observed by a transmission electron microscope .The relation between the ultrastructure and apnea hypopnea index (AHI), the lowest saturation of blood oxygen (LSaO2) was detected by statistic analysis. RESULTS: AHI and LSaO2 in OSAHS patients were (53.6 ± 4.6)/h, and 0.754 ± 0.023 while that of the control group were (2.27 ± 1.1)/h and 0.968 ± 0.014, which had statistically significant difference (t = 8.84, t = 6.90, P < 0.01). In OSAHS patients, electron microscope showed that muscle fibers can not be identified with disordered arrangement of structure, some of mitochondria were severe swollen and disrupted, a lot of liposome was observed. In the control group, muscle fibers were identified with well arrangement, also there were some mitochondria swollen, but no liposome was found. The amount of liposome in upper airway skeletal muscle in OSAHS patients was analyzed with shape counting scale, it was found that it had positive correlation with AHI (r(2) = 0.761, P < 0.01) but no correlation with BMI and LSaO2 (P > 0.05). CONCLUSION: Fatty change is the characteristic change of the upper airway skeletal muscle in OSAHS patients which was caused by hypoxia and vibration.

Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin.

AIM: To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux by measuring the radioactivity of Tc99m-labeled diethylene triamine penta-acetic acid (DTPA) in the bile and whether the patients with duodenal-biliary reflux have sphincter of Oddi hypomotility, by measuring the level of plasma and serum gastrin of the patients. Finally to if there is close relationship among sphincter of Oddi hypomotility, duodenal-biliary reflux and gastrointestinal peptides. METHODS: Forty-five patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group. The level of plasma and serum gastrin of the patients and of 12 healthy volunteers were measured by radioimmunoassay. Thirty-four were selected randomly to undergo choledochoscope manometry. Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duration of contractions (SOD), duodenal pressure (DP) and common bile duct pressure (CBDP) were scored and analyzed. RESULTS: Sixteen (35.6%) patients were detected to have duodenal-biliary reflux. SOBP, SOCA and CBDP in the reflux group were much lower than the control group (t=5.254, 3.438 and 3.527, P<0.001). SOD of the reflux group was shorter than the control group (t=2.049, P<0.05). The level of serum gastrin and plasma motilin of the reflux group was much lower than the control group (t= -2.230 and -2.235, P<0.05). There was positive correlation between the level of plasma motilin and SOBP and between the level of serum gastrin and SOBP and CBDP. CONCLUSION: About 35.9% of the patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux. Most of them have sphincter of Oddi hypomotility and the decreased level of plasma motilin and serum gastrin. The disorder of gastrointestinal hormone secretion may result in sphincter of Oddi dysfunction. There is a close relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux.

Relationship between intraduodenal peri-ampullary diverticulum and biliary disease in 178 patients undergoing ERCP.

BACKGROUND: The presence of intraduodenal peri-ampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers in China and overseas reported that the diverticulum had something to do with the incidence of cholelithiasis. This study was undertaken to further test this notion and ascertain the relationship between intraduodenal peri-ampullary diverticulum and biliary disease, especially the formation of bile duct pigment stones. METHODS: A total of 178 patients who had undergone ERCP or endoscopic sphincterotomy (EST) were studied retrospectively. They were divided into 6 groups according to the category of biliary disease, and the incidence rates of intraduodenal peri-ampullary diverticulum were calculated. RESULTS: There were 44 patients with intraduodenal peri-ampullary diverticulum in 81 patients with primary bile duct pigment stones (54.32%), 4 in 8 patients with bile duct stones and gallbladder stones (50%), 7 in 33 patients with bile duct stones secondary to gallbladder stones (21.21%), 3 in 21 patients with inflammation and stricture of the end of the bile duct and papilla (14.29%), 1 in 22 patients with carcinoma of the end of the bile duct and papilla (4.54%), and 5 in 13 patients with post-cholecystectomy syndrome or sphincter of Oddi dysfunction (38.46%). CONCLUSIONS: The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation and stricture of the end of the bile duct and papilla, and patients with carcinoma of the end of the bile duct and papilla. These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones.

[The relationship between Oddi's sphincter and bile duct pigment gallstone].

OBJECTIVE: To investigate the relationship between anatomic abnormalities and malfunction of Oddi sphincter with formation of bile duct pigment gallstone. METHODS: One hundred and twenty-three patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group by measuring the amounts of radioactivity of (99m)Tc-DTPA in the bile. Among them 53 were selected randomly to undergo choledochoscopic manometry. Basal pressure of Oddi's sphincter (SOBP), amplitude of Oddi's sphincter (SOCA), frequency of contraction (SOF), duration of contraction (SOD), duodenal pressure (DP), common bile duct pressure (CBDP) were scored and analyzed. The level of plasma motilin and serum gastrin of 45 patients and 12 healthy volunteers were measured by radioimmunoassay. The incidence rates of duodenal descending part diverticulum in patients with bile duct pigment stones, patients without alimentary tract diseases, patients with gallbladder polyps, patients with gallbladder stones were studied by means of barium meal examination. The incidence rates of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stones, patients with bile duct stone and gallbladder stones, patients with bile duct stones originating from the gallbladder, patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla, patients with post-cholecystectomy syndrome were detected by duodenoscope. RESULTS: Of the patients, 44 were detected with duodenal-biliary reflux (35.8%). SOBP, SOCA and CBDP in the reflux group were much lower than those in control group (P < 0.001). The level of serum gastrin and plasma motilin of the reflux group were much lower than those of control group (P < 0.01). Positive correlation was found between level of motilin and SOBP while level of gastrin was positively correlated with SOBP and CBDP. The incidence of duodenal diverticulum in patients with bile duct pigment stone was 36.62%, which was higher than that of the other 3 groups. The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stone was higher than that of patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla and patients with bile duct stones originating from the gallbladder. CONCLUSIONS: The patients with bile duct pigment stone have apparent duodenal-biliary reflux and infection of the bile duct. The state of structure and function of Oddi's sphincter is correlated significantly with bile duct pigment stone. The anatomic abnormalities and malfunction of Oddi's sphincter played an important role in the formation of bile duct pigment stone.