1.New perspectives on the neuro-immune mechanisms of itch in allergic conjunctivitis
Yuhua MA ; Lu ZHANG ; Junyang PAN ; Chunli WU ; Dinghuan NIE ; Yanting WANG ; Ao PENG ; Nan MA
International Eye Science 2026;26(7):1203-1209
Allergic conjunctivitis is a common ocular inflammatory disease, with intense itching being the most typical and distressing symptom for patients. In recent years, with the in-depth study of the interaction between the nervous and immune systems, significant progress has been made in understanding the mechanism of itching in allergic conjunctivitis. This review elaborates on the neurobiological basis of itching in allergic conjunctivitis, with a focus on the complex dialogue between immune cells and sensory neurons, particularly the core role of the IL-33-ST2-CGRP signaling axis in mediating itching. Additionally, this article introduces new findings in genetic susceptibility research, including the identification of susceptibility genes for allergic conjunctivitis through transcriptome-wide association studies. The sensory nervous system not only transmits itch signals but also actively participates in the formation of antigen channels related to conjunctival goblet cells, thereby regulating the local uptake of allergens and the initiation of the immune response. Moreover, targeted novel therapeutic strategies offer hope for patients with refractory allergic conjunctivitis. Exploring the molecular and cellular mechanisms of itching in allergic conjunctivitis will provide a theoretical basis for the development of more effective treatment methods.
2.Analysis of completion rate of tumor evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer : a national multicenter real-world study
Kexuan LI ; Tixian XIAO ; Xiaodong WANG ; Bin WU ; Guole LIN ; Yuchen GUO ; Ming QU ; Si WU ; Xiaodong YANG ; Yinshengbo′er BAO ; Baohua WANG ; Fan ZHANG ; Xiangwang YU ; Beizhan NIU ; Junyang LU ; Lai XU ; Guannan ZHANG ; Zhen SUN ; Guoyou ZHANG ; Yan SHI ; Hong JIANG ; Yongjing TIAN ; Yongxiang LI ; Hongwei YAO ; Jun XUE ; Quan WANG ; Lie YANG ; Qian LIU ; Yi XIAO
Chinese Journal of Digestive Surgery 2025;24(1):113-119
Objective:To investigate the completion rate of tumor evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients in the national multicenter real-world database.Methods:The prospective real-world study was conducted. The clinicopathological data of 1 074 patients who underwent surgical treatment for mid and low rectal cancer in 47 national medical institutions, including Peking Union Medical College Hospital et al, from May 12,2023 to May 11,2024 were collected. Observation indicators: (1) clinical characteristics of patients with mid and low rectal cancer; (2) initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer; (3) initial imaging evaluation of patients with mid and low rectal cancer; (4) imaging evaluation after neoadjuvant therapy for patients with mid and low rectal cancer. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3). Count data were described as absoluter numbers and/or percentages. Results:(1) Clinical characteristics of patients with mid and low rectal cancer. Of the 1 074 patients, there were 713 males and 361 females, aged 63(56,70)years. The body mass index of 1 074 patients was 24(21,26)kg/m 2.For American Society of Anesthesiologists classification, there were 147 cases of stage Ⅰ, 641 cases of stage Ⅱ, 157 cases of stage Ⅲ, 2 cases of stage Ⅳ, and there were 127 cases missing data. (2) Initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer. Of the 1 074 patients, there were 787 cases (73.28%) undergoing complete colonoscopy, and there were only 197 cases (18.34%) undergoing immunohistochemical evaluation of all four mismatch repair proteins. (3) Initial imaging evaluation of patients with mid and low rectal cancer. Of the 1 074 patients, there were 842(78.40%) patients completing magnetic resonance imaging (MRI) or ultrasound evaluation, and there were 914(85.10%) patients completing chest, abdomen, and pelvis enhanced computed tomography (CT) evaluation. In the 149 patients completing rectal ultrasound evaluation, there were 122 cases (81.88%) comple-ting T staging evaluation, and there were 81 cases (54.36%) completing N staging evaluation. In the 808 patients completing rectal MRI evaluation, there were 708 cases (87.62%) completing T staging evaluation, and there were 590 cases (73.02%) completing N staging evaluation. (4) Imaging evalua-tion after neoadjuvant therapy for patients with mid and low rectal cancer. Of the 388 patients with neoadjuvant therapy, there were 332 patients (85.57%) completing MRI or ultrasound evaluation, and there were 327 patients (84.28%) completing chest, abdomen, and pelvis enhanced CT evalua-tion. In the 70 patients completing rectal ultrasound evaluation, there were 65 cases (92.86%) com-pleting T staging evaluation, and there were 49 cases (70.00%) completing N staging evaluation. In the 327 patients completing rectal MRI evaluation, there were 246 cases (75.23%) completing T staging, and there were 228 cases (69.72%) completing N staging evaluation. Conclusion:The com-pletion rate of tumor imaging evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients on a national scale is relatively good.
3.Lymph node dissection extent in stage Ⅲ right-sided colon cancer: a single-center, retrospective cohort study
Kexuan LI ; Huaqing ZHANG ; Bin WU ; Guole LIN ; Junyang LU ; Xiyu SUN ; Beizhan NIU ; Lai XU ; Guannan ZHANG ; Zheng SUN ; Yi XIAO
Chinese Journal of Gastrointestinal Surgery 2025;28(9):1026-1033
Objective:To compare the prognostic impact of complete mesocolic excision (CME) versus D2 lymphadenectomy in patients with stage III right-sided colon cancer.Methods:A retrospective cohort study was conducted. Clinical data of 263 patients with stage III colon cancer undergoing right hemicolectomy in the Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital (January 1, 2016 to August 8, 2023) were included. Of the 263 patients, 152 underwent CME and 111 received D2 dissection. Propensity score matching (PSM) was employed to balance baseline characteristics between the two groups. Continuous variables were compared using the Mann-Whitney U test or Student's t-test; categorical variables were compared using the χ2 test or Fisher exact test. Survival curves were constructed using the Kaplan-Meier method, and the Log-Rank test was used to compare disease-free survival (DFS) and overall survival (OS) between groups. Cox proportional hazards models were utilized to analyze prognostic factors, with subgroup analyses performed.Results:Patients undergoing CME surgery were younger (proportion >75 years: 4.6% vs. 25.2%, P<0.001), had a lower burden of comorbidities (Charlson comorbidity index ≥ 1: 25.0% vs. 36.9%, P=0.045), The rates of open surgery and converted open surgery were lower [0.6% (1/152) vs. 4.5% (5/111) and 0.6% (1/152) vs. 2.7% (3/111), respectively; P=0.040].They also had a higher rate of receiving adjuvant therapy (92.7% vs. 76.0%, P<0.001). In terms of short-term postoperative outcomes, the CME group had a greater number of harvested lymph nodes (median: 30 vs. 25, P<0.001) and less blood loss (median: 20 ml vs. 20 ml, P=0.041). There were no significant differences between the groups in terms of the number of metastatic lymph nodes, operation time, and the incidence of postoperative complications. Survival analysis demonstrated significantly longer DFS in the CME group both before and after PSM. CME was an independent favorable prognostic factor for DFS (pre-PSM: HR=0.53, 95%CI: 0.31-0.91, P=0.022; post-PSM: HR=0.50, 95%CI: 0.26-0.97, P=0.042). No significant difference in OS was detected between the two groups across models. The subgroup analysis based on clinicopathological features revealed DFS benefits associated with CME in patients with tumor deposits (HR=0.41, 95%CI: 0.18-0.94, P=0.035), moderately-to-well-differentiated adenocarcinoma(HR=0.48, 95%CI: 0.26-0.90, P=0.023), proficient mismatch repair tumors (HR=0.55, 95%CI: 0.32-0.94, P=0.030), and pN2 stage disease (HR=0.43, 95%CI: 0.19-0.95, P=0.036). Conclusion:An extended lymph node dissection, as exemplified by CME, may confer a DFS advantage in patients with stage III right-sided colon cancer, especially those exhibiting a substantial burden of lymph node metastases.
4.Prognostic analysis of local excision following neoadjuvant therapy for rectal cancer: a single-center study
Yihan LU ; Junyang LU ; Xiaoyuan QIU ; Xiao ZHANG ; Yang AN ; Jiaolin ZHOU ; Guole LIN
Chinese Journal of Gastrointestinal Surgery 2025;28(11):1260-1266
Objective:To investigate the complications, along with their diagnosis and management, that follow local excision for rectal cancer after neoadjuvant therapy.Methods:The clinical data of 53 patients with rectal cancer who underwent local resection after neoadjuvant treatment in Peking Union Medical College Hospital from January, 2010 to December, 2024 were retrospectively collected for this descriptive case series study. Indications for local resection were: (1) age ≥ 18 years; (2) American Society of Anesthesiologists (ASA) classification I-III; (3) pathologically confirmed rectal adenocarcinoma; (4) distance from the lower edge of the tumor to the anal edge of less than 8 cm; and (5) use of preoperative neoadjuvant therapy. Contraindications of local resection were: (1) multiple primary colorectal cancer and (2) intestinal obstruction, intestinal perforation, or and gastrointestinal bleeding that required emergency surgery. There were 36 males and 17 females, and the median age was 62 (26-85) years. After neoadjuvant therapy, the median distance from the tumor to the anal margin was 4.5 (range, 2.2-6.9) cm. The main outcome measures included: surgical details, pathological findings, postoperative complications, anorectal function, and oncological outcomes (recurrence and survival).Results:Surgical methods included transanal endoscopic microsurgery (TEM) in 47 cases, transanal minimally invasive surgery (TAMIS) in 3 cases, and traditional transanal local resection in 3 cases. Of the 53 patients, 29 (54.7%) had pathological complete response (pCR), namely pT0 stage; 8 cases were pT1, 15 cases were pT2, and 1 case was pT3. Twenty-four cases (45.3%) had 33 complications. Clavien-Dindo grade I-II accounted for 97.0% (32/33), including 14 cases (26.4%) of wound dehiscence. Low anterior resection syndrome (LARS) occurred in 7 cases (13.2%), including 5 minor cases and 2 major cases. Postoperative fever occurred in 7 cases (13.2%); urinary retention occurred in 3 cases (5.7%); and diarrhea occurred in 1 case (1.9%). Clavien Dindo grade III was observed in only 3.0% (1/33) of patients, which was a rectovaginal fistula. Among the 14 patients with wound dehiscence, 7 cases only suffered anal pain and were cured after symptomatic analgesic treatment. Five cases suffered anal pain with hematochezia but improved after treatment with essential diet, hemostasis, intravenous antibiotics, pain relief, and sitz bath. Two cases of secondary perianal infection were treated with intravenous antibiotics, local drainage, parenteral nutrition support, and symptomatic treatment, and the wounds healed within 2 months. One patient with rectovaginal fistula underwent transverse colostomy. After six months, the fistula healed and stoma reversal was performed. Seven patients with LARS received anal lifting exercise and defecation reflex training, and anal function recovered to the preoperative level after 1 year. Other complications improved after symptomatic treatment, pain relief, or catheter replacement. The median follow-up time was 60 months. Local recurrence occurred in 4 patients (7.5%) and distant metastasis occurred in 12 patients (22.6%). Seven patients (13.2%) died. The 5-year disease-free survival rate was 75.5%, and the 5-year overall survival rate was 86.8%.Conclusions:Local excision for rectal cancer following neoadjuvant therapy has a high incidence of complications, mainly wound-related, due to the decline of rectal wound healing ability after radiotherapy. However, most of the complications were relieved after symptomatic treatment, and the risk was controllable.
5.Prognostic factors and survival analysis in rectal cancer patients with poor response to neoadjuvant therapy
Hongbo LI ; Yi QIAN ; Kexuan LI ; Chen WANG ; Zhen SUN ; Xiyu SUN ; Lai XU ; Guannan ZHANG ; Bin WU ; Guole LIN ; Junyang LU ; Ke HU ; Yi XIAO
Chinese Journal of Gastrointestinal Surgery 2025;28(1):48-57
Objective:To compare the impact of different treatment strategies on the survival outcomes in rectal cancer patients with poor response to neoadjuvant therapy, and to explore the survival-related influencing factors.Methods:A retrospective cohort study was conducted. Between January 2018 and November 2022, the clinical, pathological, and follow-up data of 106 rectal cancer patients who received neoadjuvant therapy and were evaluated as grade 4 or 5 based on the Magnetic Resonance Tumor Regression Grade (mrTRG) from the rectal cancer database at Peking Union Medical College Hospital were retrospectively collected. Based on the post-neoadjuvant therapy assessment, patients were classified into three groups: the chemotherapy-radiotherapy group (23 patients), the consolidation therapy group (18 patients), and the standard treatment group (65 patients). General condition, pathological findings, selection of neoadjuvant therapy, comorbidities, as well as 3-year expected DMFS and OS were observed in the three groups.Results:All 106 patients were followed up, with a median follow-up time of 28 (21, 38) months. The overall 3-year DMFS rate was 60%, and the 3-year OS rate was 74%. The 3-year DMFS in the standard treatment and consolidation therapy groups were 74% and 72%, respectively; the 3-year OS were 84%, 81%, respectively. The Log-rank test showed that there was no significant difference in the 3-year expected DMFS and OS between the standard treatment group and the consolidation therapy group (both P>0.05), but both groups had better survival outcomes than the chemotherapy-radiotherapy group (10% and 39%, respectively; all P<0.001). Multivariate Cox regression analysis indicated that the chemotherapy-radiotherapy only regimen was an independent risk factor for DMFS (HR=12.425, 95% CI: 4.436–34.594, P<0.001), and the independent risk factors for OS were chemotherapy-radiotherapy only regimen (HR=8.991, 95%CI:2.220–36.403, P=0.002) and age≥65 years (HR=3.495, 95%CI: 1.017–12.009, P=0.047). Stratified analysis showed that chemotherapy-radiotherapy only regimen was the independent risk factors for DMFS and OS in patients with extramural vascular invasion (EMVI) positive ( n=66) and mesorectal fascial invasion (MRF) positive (n=56) (all P<0.05). Whether consolidation therapy was added to the standard neoadjuvant treatment regimen was not an independent factor affecting 3-year expected DMFS or OS in rectal cancer patients with poor response to neoadjuvant therapy. Further comparisons between the standard neoadjuvant treatment and consolidation therapy groups showed no statistically significant differences in spincter-preservation rate or postoperative complication rates (both P>0.05). However, the consolidation therapy group had a longer interval between the end of radiotherapy and surgery [80.1 (50.8, 109.4) days vs. 61.8 (48.8, 74.8) days, P<0.001], and a higher incidence of chemotherapy-related adverse effects ([10/18] vs. 26.2% [17/65], P=0.018). Conclusion:In rectal cancer patients with poor response to neoadjuvant therapy and clear adverse prognostic features before surgery (locally advanced stage, MRF positive or EMVI positive), the addition of short- or long-course chemotherapy-based systemic therapy does not provide short- or long-term survival benefits. Moreover, an extended chemotherapy duration increases the incidence of chemotherapy-related adverse effects.
6.Characteristics and management of perioperative complications in laparoscopic surgery for colorectal cancer patients aged over 85 years
Ganbin LI ; Xiao ZHANG ; Xiaoyuan QIU ; Chentong WANG ; Lai XU ; Beizhan NIU ; Guannan ZHANG ; Junyang LU ; Bin WU ; Yi XIAO ; Guole LIN
Chinese Journal of Gastrointestinal Surgery 2025;28(4):368-373
Objective:To analyze the types and characteristics of post-operative complications in colorectal cancer patients aged over 85 years undergoing laparoscopic surgery, and to summarize peri-operative management strategies.Methods:This was an observational study. Inclusion criteria: pathologically confirmed adenocarcinoma; tumor located in ileocecum, ascending colon, transverse colon, descending colon, sigmoid colon, or rectum; undergoing laparoscopic radical resection for colorectal cancer; complete clinical data. Exclusion criteria included distant metastasis, synchronous resection of multiple primary cancers, simultaneous liver metastasis surgery, and follow-up duration <1 month. A retrospective analysis was conducted on 191 patients of colorectal cancer patients aged over 85 years who underwent laparoscopic radical surgery in the General Surgery Department at Peking Union Medical College Hospital from January 2019 to January 2024. Among 191 patients, 107 patients (56.0%) had colon cancer and 84 (44.0%) rectal cancer. All patients received "home-based prehabilitation" and post-operative "enhanced recovery after surgery" protocols. Patient characteristics, peri-operative complication types, treatments, and outcomes were analyzed.Results:Post-operative complications occurred in 97 patients (50.8%), including 53 colon cancer patients (54.6%) and 44 rectal cancer patients (45.4%). Comorbidities existed in 88 patients (90.7%), with 93 patients (95.9%) classified as ASA II-III pre-operatively and 86 (88.7%) having nutritional risks. Surgical procedures included Dixon procedure (38 patients, 39.2%), right hemicolectomy (33 patients, 34.0%), sigmoidectomy (10 patients, 10.3%), and 17 patients (17.5%) received prophylactic stomas. Complication types comprised non-anastomotic infections (38 patients, 19.9%), intestinal flora disorder (26 patients, 13.6%), anastomotic/wound/stoma-related complications (16 patients, 8.4%), thrombotic/hemorrhagic events (6 patients, 3.1%), and others (11 patients, 5.8%). By Clavien-Dindo classification: Grade I (12 patients, 6.3%), Grade II (69 patients, 36.1%), Grade III (12 patients, 6.3%), and Grade IV (4 patients, 2.1%). Except for 5 patients (2.6%) requiring unplanned re-operation, all complications resolved with conservative treatment. The median duration of post-operative hospitalization was 9.5 days (7–13).Conclusion:Non-anastomotic infections and intestinal flora disorder constitute predominant complications after laparoscopic surgery in colorectal cancer patients aged over 85 years, mostly manageable with conservative treatment. Strengthened peri-operative management incorporating pre-operative prehabilitation and post-operative enhanced recovery after surgery protocols is crucial for patients aged over 85 years.
7.Prognostic factors and survival analysis in rectal cancer patients with poor response to neoadjuvant therapy
Hongbo LI ; Yi QIAN ; Kexuan LI ; Chen WANG ; Zhen SUN ; Xiyu SUN ; Lai XU ; Guannan ZHANG ; Bin WU ; Guole LIN ; Junyang LU ; Ke HU ; Yi XIAO
Chinese Journal of Gastrointestinal Surgery 2025;28(1):48-57
Objective:To compare the impact of different treatment strategies on the survival outcomes in rectal cancer patients with poor response to neoadjuvant therapy, and to explore the survival-related influencing factors.Methods:A retrospective cohort study was conducted. Between January 2018 and November 2022, the clinical, pathological, and follow-up data of 106 rectal cancer patients who received neoadjuvant therapy and were evaluated as grade 4 or 5 based on the Magnetic Resonance Tumor Regression Grade (mrTRG) from the rectal cancer database at Peking Union Medical College Hospital were retrospectively collected. Based on the post-neoadjuvant therapy assessment, patients were classified into three groups: the chemotherapy-radiotherapy group (23 patients), the consolidation therapy group (18 patients), and the standard treatment group (65 patients). General condition, pathological findings, selection of neoadjuvant therapy, comorbidities, as well as 3-year expected DMFS and OS were observed in the three groups.Results:All 106 patients were followed up, with a median follow-up time of 28 (21, 38) months. The overall 3-year DMFS rate was 60%, and the 3-year OS rate was 74%. The 3-year DMFS in the standard treatment and consolidation therapy groups were 74% and 72%, respectively; the 3-year OS were 84%, 81%, respectively. The Log-rank test showed that there was no significant difference in the 3-year expected DMFS and OS between the standard treatment group and the consolidation therapy group (both P>0.05), but both groups had better survival outcomes than the chemotherapy-radiotherapy group (10% and 39%, respectively; all P<0.001). Multivariate Cox regression analysis indicated that the chemotherapy-radiotherapy only regimen was an independent risk factor for DMFS (HR=12.425, 95% CI: 4.436–34.594, P<0.001), and the independent risk factors for OS were chemotherapy-radiotherapy only regimen (HR=8.991, 95%CI:2.220–36.403, P=0.002) and age≥65 years (HR=3.495, 95%CI: 1.017–12.009, P=0.047). Stratified analysis showed that chemotherapy-radiotherapy only regimen was the independent risk factors for DMFS and OS in patients with extramural vascular invasion (EMVI) positive ( n=66) and mesorectal fascial invasion (MRF) positive (n=56) (all P<0.05). Whether consolidation therapy was added to the standard neoadjuvant treatment regimen was not an independent factor affecting 3-year expected DMFS or OS in rectal cancer patients with poor response to neoadjuvant therapy. Further comparisons between the standard neoadjuvant treatment and consolidation therapy groups showed no statistically significant differences in spincter-preservation rate or postoperative complication rates (both P>0.05). However, the consolidation therapy group had a longer interval between the end of radiotherapy and surgery [80.1 (50.8, 109.4) days vs. 61.8 (48.8, 74.8) days, P<0.001], and a higher incidence of chemotherapy-related adverse effects ([10/18] vs. 26.2% [17/65], P=0.018). Conclusion:In rectal cancer patients with poor response to neoadjuvant therapy and clear adverse prognostic features before surgery (locally advanced stage, MRF positive or EMVI positive), the addition of short- or long-course chemotherapy-based systemic therapy does not provide short- or long-term survival benefits. Moreover, an extended chemotherapy duration increases the incidence of chemotherapy-related adverse effects.
8.Characteristics and management of perioperative complications in laparoscopic surgery for colorectal cancer patients aged over 85 years
Ganbin LI ; Xiao ZHANG ; Xiaoyuan QIU ; Chentong WANG ; Lai XU ; Beizhan NIU ; Guannan ZHANG ; Junyang LU ; Bin WU ; Yi XIAO ; Guole LIN
Chinese Journal of Gastrointestinal Surgery 2025;28(4):368-373
Objective:To analyze the types and characteristics of post-operative complications in colorectal cancer patients aged over 85 years undergoing laparoscopic surgery, and to summarize peri-operative management strategies.Methods:This was an observational study. Inclusion criteria: pathologically confirmed adenocarcinoma; tumor located in ileocecum, ascending colon, transverse colon, descending colon, sigmoid colon, or rectum; undergoing laparoscopic radical resection for colorectal cancer; complete clinical data. Exclusion criteria included distant metastasis, synchronous resection of multiple primary cancers, simultaneous liver metastasis surgery, and follow-up duration <1 month. A retrospective analysis was conducted on 191 patients of colorectal cancer patients aged over 85 years who underwent laparoscopic radical surgery in the General Surgery Department at Peking Union Medical College Hospital from January 2019 to January 2024. Among 191 patients, 107 patients (56.0%) had colon cancer and 84 (44.0%) rectal cancer. All patients received "home-based prehabilitation" and post-operative "enhanced recovery after surgery" protocols. Patient characteristics, peri-operative complication types, treatments, and outcomes were analyzed.Results:Post-operative complications occurred in 97 patients (50.8%), including 53 colon cancer patients (54.6%) and 44 rectal cancer patients (45.4%). Comorbidities existed in 88 patients (90.7%), with 93 patients (95.9%) classified as ASA II-III pre-operatively and 86 (88.7%) having nutritional risks. Surgical procedures included Dixon procedure (38 patients, 39.2%), right hemicolectomy (33 patients, 34.0%), sigmoidectomy (10 patients, 10.3%), and 17 patients (17.5%) received prophylactic stomas. Complication types comprised non-anastomotic infections (38 patients, 19.9%), intestinal flora disorder (26 patients, 13.6%), anastomotic/wound/stoma-related complications (16 patients, 8.4%), thrombotic/hemorrhagic events (6 patients, 3.1%), and others (11 patients, 5.8%). By Clavien-Dindo classification: Grade I (12 patients, 6.3%), Grade II (69 patients, 36.1%), Grade III (12 patients, 6.3%), and Grade IV (4 patients, 2.1%). Except for 5 patients (2.6%) requiring unplanned re-operation, all complications resolved with conservative treatment. The median duration of post-operative hospitalization was 9.5 days (7–13).Conclusion:Non-anastomotic infections and intestinal flora disorder constitute predominant complications after laparoscopic surgery in colorectal cancer patients aged over 85 years, mostly manageable with conservative treatment. Strengthened peri-operative management incorporating pre-operative prehabilitation and post-operative enhanced recovery after surgery protocols is crucial for patients aged over 85 years.
9.A comparative study of the outcomes of primary reverse total shoulder arthroplasty and revision procedure after treatment failure of complex proximal humerus fractures in elderly patients
Bingshan YAN ; Ming XIANG ; Lei HAN ; Junyang LIU ; Bo ZHANG ; Xu TIAN ; Lintao LIU ; Jingming DONG
Chinese Journal of Orthopaedics 2025;45(15):984-992
Objective:To evaluate the clinical outcomesof primary reverse total shoulder arthroplasty (RTSA) and revision procedure with RTSA after treatment failure of complex proximal humeral fractures in the elderly.Methods:A retrospective analysis was conductedon 24 elderly patients with Neer three- or four-part proximal humeral fractures who underwent RTSA revision after treatment failure (RTSA revision group) from January 2017 to June 2022. There were 7 males and 17 females included, with a mean age of 78.23±5.78 years (range, 67-86 years). Forty-eight patients who underwent primary RTSA (primary RTSA group) during the same time period were selected by propensity score matchingin a 1∶2 ratio as controls, based on age, dominanthand, etiology, Neer typing, glenohumeral joint dislocation, rotator cuff integrity, and osteoporosis T-score. The primary RTSA group included 12 males and 36 females, with a mean age of 76.38±6.15 years (range, 65-87 years). Clinical indicators including demographic characteristics, healing rate of the greater tuberosity, visual analogue score (VAS), Constant-Murley score, American Shoulder and Elbow Surgeons (ASES), shoulder range of motion (ROM), patient satisfaction, and complication rate were collected and analyzed.Results:The mean follow-up duration was 40(32, 60) months (range, 25-72 months) in the primary RTSA group and 38(30, 61) months (range, 24-68 months) in RTSA revision group. There was no significant difference (χ 2=5.058, P=0.168) in the healing rate of the greater tuberosity between the primary RTSA group (41/48, 85.4%) and the RTSA revision group (15/24, 62.5%). Compared with preoperative status, the ROM of anterior elevation, abduction supination, external rotation, VAS score, Constant-Murley score, and ASES score were significantly improved at the last follow-up (all P<0.05) in the RTSA revision group. The anterior elevation (123.74°± 16.57°), abduction supination (113.73°±16.42°), and external rotation (36.45°±10.36°) in the primary RTSA group were superior to those in the RTSA revision group (109.43°±18.75°, 98.64°±15.47°, 30.47°±10.64°, respectively), the difference was statistically significant ( P<0.05). No statistical difference of ROM of internal rotation between the two groups was found (χ 2=4.034, P=0.133). At the last follow-up, the Constant-Murley scores (75.47±11.66) and ASES scores (73.58±15.72) of the primary RTSA group were higher than those in the RTSA revision group (60.43±10.24 and 63.28±18.77, respectively), and the differences were statistically significant ( P<0.05). In terms of VAS (1.66±0.93 vs. 2.02±1.15) and patient satisfaction [83%(40/48) vs. 88%(21/24)], no statistical difference was identified ( P>0.05). The complication rate were 10.4% (5/48) in the primary RTSA group and 20.8% (5/24) in the RTSA revision group (χ 2=1.452, P=0.285), with no serious complications requiring revision surgery in either group. Conclusions:For elderly patients with proximal humeral fractures after failed operation, RTSA revision might effectively improve the limb function and alleviatepain. However, compared with RTSA revision, primary RTSA demonstrated superiorearly clinical outcomes in shoulder ROM and functional recovery.
10.Biomechanical Effects of Tropelastin on Collagen Self-Assembly and Degradation in vitro
Jun LI ; Junyang ZHANG ; Chunqiu ZHANG ; Xin WANG
Journal of Medical Biomechanics 2025;40(1):210-215
Objective To investigate the biomechanical effects of tropoelastin on self-assembly and degradation of the collagen in vitro.Methods The real-time dynamic scanning with atomic force microscopy was utilized to observe and analyze the changes in microstructure,orientation,area fraction,and average diameter of collagen fibrils during the self-assembly process.The D-band structure of collagen fibrils was characterized using transmission electron microscopy.Finally,data analysis was performed using Gwyddion and Matlab software to assess the structural characteristics and degradation resistance of collagen fibrils.Results Compared to the control group,the addition of tropoelastin not only promoted the collagen self-assembly and significantly increased the area occupied by the assemblies,but also caused a shift in their orientation from unidirectional to multidirectional.Upon the addition of collagenase,the assemblies underwent degradation;however,the degradation half-period decreased with the inclusion of tropoelastin,indicating that tropoelastin accelerated the degradation of collagen assemblies.Conclusions The addition of tropoelastin promotes the collagen self-assembly,and increases the area occupied by the self-assembled structures.However,the consistency of orientation in the assemblies is weakened,resulting in a reduced resistance of collagen fibrils to degradation by collagenase.This study lays a theoretical foundation for the preparation of collagen-based biomimetic functional materials.

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