Objective To systematically evaluate the differences in clinicopathologic features and prog-nosis of colorectal cancer(CRC)between youth and middle-aged and elderly people.Methods The relevant literatures in Chinese and English databases before June 2024 were retrieved.The Stata 18 and RevMan5.3 softwares were used to perform the heterogeneity and sensitivity analyses as well as publication bias tests for the relevant outcome indicators.Results A total of 17 case-control studies were included,including a total of 6 817 patients with pathologically diagnosed CRC,among them 1 939 cases in the young group and 4 878 cases in the middle-aged and elderly group.The results of meta analysis showed that the proportion of family histo-ry in the young adult group(OR=3.09,95%CI:2.33-4.09),misdiagnosis rate(OR=4.40,95%CI:3.30-5.86),proportion of poorly differentiated carcinomas(OR=3.57,95%CI:2.73-4.67),proportion of mucin-ous adenocarcinomas and imprinted cell carcinomas(OR=3.41,95%CI:2.79-4.18),and proportion of TNM stage at diagnosis(stage Ⅲ-Ⅳ,OR=1.71,95%CI:1.44-2.02),incidence rate of lymph node metas-tasis(OR=1.92,95%CI:1.61-2.28),incidence rate of distant metastasis(OR=2.09,95%CI:1.53-2.86)were higher than those in the middle-aged and elderly group(all P<0.05);the CEA-positive rate at diagnosis(OR=0.68,95%CI:0.57-0.80)and 5-year survival rate(OR=0.24,95%CI:0.16-0.36)in the young group were lower than those in the middle-aged and elderly group(all P<0.05).The difference in the tumor diameter size(OR=1.32,95%CI:0.98-1.77)between the two groups was not statistically significant(P=0.07).Conclusion Compared with middle-aged and elderly CRC,young patients with CRC has a closer famil-ial correlation,may be more easily misdiagnosed clinically,its malignant degree would be higher,and the TNM stage in diagnosis is relatively late;in clinic the young population with CRC high risk could be appropriately relaxed in the age limit for screening.

Objective To design a custom 3D printed monoblock acetabular implant for reconstructing PaproskyⅢA acetabular bone defects and to analyze the stress distribution,displacement,and clinical reliability of the implant and surrounding bone using finite element analysis(FEA).Methods Bilateral hip computed tomography(CT)data of a patient with PaproskyⅢA acetabular bone defects were collected.Models were developed and analyzed using Mimics Medical 21.0,Geomagic Wrap 2021,Solidworks 2023,and ANSYS Workbench 2022 R1 softwares.The biomechanical performance of the custom 3D printed monoblock acetabular implant was simulated under a single-leg stance condition.Results The peak von Mises stress of the hip components was observed at the femoral stem,measuring 67.318 MPa.For the custom 3D printeded monoblock acetabular implant,the peak stress was located at the anterosuperior contact area between the implant and acetabular bone,measuring 6.935 MPa.The femoral stem exhibited a peak stress of 67.318 MPa at its junction with the femoral head.The liner's peak stress was 1.333 MPa near the fixation of screw 9 at the superior part of the acetabular cup.The screws showed a peak stress of 2.215 MPa at the junction with the implant.For the cortical bone,the peak stress was 9.844 MPa at the distal femur,while the cancellous bone exhibited a peak stress of 0.701 MPa at its distal connection with the femoral stem.The pelvic bone's peak stress was 8.002 MPa at the anterior transition zone between the normal acetabulum and the defect.The peak micromotion of the custom 3D printed monoblock acetabular implant at its posterosuperior area,measuring 0.114 mm.The femoral stem and head exhibited a peak micromotion of 0.132 mm at the contact interface with the acetabular liner.The micromotion range at the implant-acetabular bone interface was 0.098 mm to 0.131 mm.Conclusion Under a simulated single-leg stance condition,the stress distribution in all components and the acetabular bone surface remains below their respective yield strengths.The micromotion threshold between the acetabular cup and acetabular bone is within acceptable limits.Biomechanical analysis indicates that the patient can perform early weight-bearing rehabilitation postoperatively.However,walking or jogging rehabilitation should be approached with caution.

Pregabalin, a structural analog of γ-aminobutyric acid (GABA), has been widely prescribed since its approval in 2004 for treating various neuropathic pain conditions. In Western countries, it is also approved for managing anxiety disorders. However, concerns about its potential for abuse and dependence have led to its reclassification as a second-line treatment in recent years. Although pregabalin addiction has been reported in international studies, there have been no such reports within China. This article presents a case of addiction stemming from pregabalin abuse to manage anxiety symptoms. The patient experienced withdrawal symptoms after discontinuing the drug, which were successfully treated. The development of pregabalin addiction, withdrawal symptoms, and the OD(overdose) pattern of drug abuse in this case should draw the attention of clinicians in China.

BACKGROUND:With the development of unilateral biportal endoscopic technology,endoscopic lumbar fusion surgery has become an increasingly popular development trend in spinal surgery.Unilateral biportal endoscopic transforaminal lumbar interbody fusion shows significant advantages for preserving paravertebral muscle and reducing intraoperative bleeding in spinal stenosis and lumbar spondylolisthesis in the lumbar spine with degenerative changes.OBJECTIVE:To compare the effects of unilateral biportal endoscopic lumbar interbody fusion and traditional open transluminal lumbar interbody fusion on paraspinal muscles.METHODS:A retrospective analysis was conducted on the clinical data of 60 patients who visited the Department of Spine Surgery,Second Affiliated Hospital of Soochow University from October 2019 to November 2022 and underwent single segment unilateral decompression fusion.They were divided into two groups according to different surgical procedures.Group A received unilateral biportal endoscopic lumbar interbody fusion.Group B received traditional open transluminal lumbar interbody fusion.All patients underwent magnetic resonance imaging examination before and 3 months after surgery.Basic patient information,last follow-up time,magnetic resonance imaging images,visual analog scale scores for lower back and leg pain,and Oswestry Disability Index were collected.RESULTS AND CONCLUSION:(1)Three months after surgery,the cross-sectional area of the bilateral multifidus muscle in group A was significantly larger than that of group B(P＜0.05),and the degree of fat infiltration was lower(P＜0.01).(2)There was no significant difference in the cross-sectional area and degree of fat infiltration of bilateral erector spinae muscles between the two groups 3 months after surgery(P＞0.05).(3)It is concluded that unilateral biportal endoscopic lumbar interbody fusion is more effective than traditional open transluminal lumbar interbody fusion in protecting multifidus muscle,reducing multifidus muscle atrophy and fat infiltration.Both surgical methods did not have a significant impact on the erector spine muscle.

Objective To investigate the correlation between the expression of serum microRNA-21-5p(miR-21-5p),microRNA-1224-5p(miR-1224-5p),and microRNA-181a-5p(miR-181a-5p)with postoperative delayed healing in patients with femoral neck fracture(FNF).Methods From October 2021 to April 2024,371 patients with FNF admitted to our hospital were included as subjects.The patients were assigned into a study group(delayed healing,68 cases)and a control group(normal healing,303 cases)based on whether the fracture ends healed 4 months after surgery.Real-time fluorescence quantitative PCR(qRT-PCR)was applied to detect the expression levels of serum miR-21-5p,miR-1224-5p,and miR-181a-5p.Multivariate Logistic regression was applied to analyze the influencing factors of postoperative healing delay in FNF patients.ROC curve was applied to analyze the predictive value of serum miR-21-5p,miR-1224-5p,and miR-181a-5p for postoperative healing delay in FNF patients.Results The levels of serum miR-21-5p,miR-1224-5p,and miR-181a-5p in the study group were lower than those in the control group(P＜0.05).Multivariate Logistic analysis showed that age ≥ 60 years old,diabetes,and smoking were risk factors for postoperative delayed healing in FNF patients(P＜0.05),and miR-21-5p,miR-1224-5p and miR-181a-5p were protective factors for postoperative delayed healing in FNF patients(P＜0.05).ROC curve showed that the AUC values of miR-21-5p,miR-1224-5p,and miR-181a-5p for predicting postoperative healing delay in FNF patients were 0.845,0.809,and 0.797,respectively.When the three were combined for prediction,the AUC increased to 0.933.The combined detection effect of the three indicators was better than that of any individual indicator(Zcombination vs.miR-21-5p=3.444,Zcombination vs.miR-1224-5p=4.401,Zcombination vs.miR-181a-5p=4.279,P＜0.05).Conclusion The levels of serum miR-21-5p,miR-1224-5p,and miR-181a-5p are reduced in FNF patients with postoperative delayed healing.The combined detection of the three may have a certain predictive value for postoperative delayed healing in FNF patients.

Objective To investigate the correlation between the expression of serum microRNA-21-5p(miR-21-5p),microRNA-1224-5p(miR-1224-5p),and microRNA-181a-5p(miR-181a-5p)with postoperative delayed healing in patients with femoral neck fracture(FNF).Methods From October 2021 to April 2024,371 patients with FNF admitted to our hospital were included as subjects.The patients were assigned into a study group(delayed healing,68 cases)and a control group(normal healing,303 cases)based on whether the fracture ends healed 4 months after surgery.Real-time fluorescence quantitative PCR(qRT-PCR)was applied to detect the expression levels of serum miR-21-5p,miR-1224-5p,and miR-181a-5p.Multivariate Logistic regression was applied to analyze the influencing factors of postoperative healing delay in FNF patients.ROC curve was applied to analyze the predictive value of serum miR-21-5p,miR-1224-5p,and miR-181a-5p for postoperative healing delay in FNF patients.Results The levels of serum miR-21-5p,miR-1224-5p,and miR-181a-5p in the study group were lower than those in the control group(P＜0.05).Multivariate Logistic analysis showed that age ≥ 60 years old,diabetes,and smoking were risk factors for postoperative delayed healing in FNF patients(P＜0.05),and miR-21-5p,miR-1224-5p and miR-181a-5p were protective factors for postoperative delayed healing in FNF patients(P＜0.05).ROC curve showed that the AUC values of miR-21-5p,miR-1224-5p,and miR-181a-5p for predicting postoperative healing delay in FNF patients were 0.845,0.809,and 0.797,respectively.When the three were combined for prediction,the AUC increased to 0.933.The combined detection effect of the three indicators was better than that of any individual indicator(Zcombination vs.miR-21-5p=3.444,Zcombination vs.miR-1224-5p=4.401,Zcombination vs.miR-181a-5p=4.279,P＜0.05).Conclusion The levels of serum miR-21-5p,miR-1224-5p,and miR-181a-5p are reduced in FNF patients with postoperative delayed healing.The combined detection of the three may have a certain predictive value for postoperative delayed healing in FNF patients.

BACKGROUND:With the development of unilateral biportal endoscopic technology,endoscopic lumbar fusion surgery has become an increasingly popular development trend in spinal surgery.Unilateral biportal endoscopic transforaminal lumbar interbody fusion shows significant advantages for preserving paravertebral muscle and reducing intraoperative bleeding in spinal stenosis and lumbar spondylolisthesis in the lumbar spine with degenerative changes.OBJECTIVE:To compare the effects of unilateral biportal endoscopic lumbar interbody fusion and traditional open transluminal lumbar interbody fusion on paraspinal muscles.METHODS:A retrospective analysis was conducted on the clinical data of 60 patients who visited the Department of Spine Surgery,Second Affiliated Hospital of Soochow University from October 2019 to November 2022 and underwent single segment unilateral decompression fusion.They were divided into two groups according to different surgical procedures.Group A received unilateral biportal endoscopic lumbar interbody fusion.Group B received traditional open transluminal lumbar interbody fusion.All patients underwent magnetic resonance imaging examination before and 3 months after surgery.Basic patient information,last follow-up time,magnetic resonance imaging images,visual analog scale scores for lower back and leg pain,and Oswestry Disability Index were collected.RESULTS AND CONCLUSION:(1)Three months after surgery,the cross-sectional area of the bilateral multifidus muscle in group A was significantly larger than that of group B(P＜0.05),and the degree of fat infiltration was lower(P＜0.01).(2)There was no significant difference in the cross-sectional area and degree of fat infiltration of bilateral erector spinae muscles between the two groups 3 months after surgery(P＞0.05).(3)It is concluded that unilateral biportal endoscopic lumbar interbody fusion is more effective than traditional open transluminal lumbar interbody fusion in protecting multifidus muscle,reducing multifidus muscle atrophy and fat infiltration.Both surgical methods did not have a significant impact on the erector spine muscle.

Pregabalin, a structural analog of γ-aminobutyric acid (GABA), has been widely prescribed since its approval in 2004 for treating various neuropathic pain conditions. In Western countries, it is also approved for managing anxiety disorders. However, concerns about its potential for abuse and dependence have led to its reclassification as a second-line treatment in recent years. Although pregabalin addiction has been reported in international studies, there have been no such reports within China. This article presents a case of addiction stemming from pregabalin abuse to manage anxiety symptoms. The patient experienced withdrawal symptoms after discontinuing the drug, which were successfully treated. The development of pregabalin addiction, withdrawal symptoms, and the OD(overdose) pattern of drug abuse in this case should draw the attention of clinicians in China.

Objective To address the radioactive contamination of wounds caused by transuranic nuclides, wound radiation imaging based on coded aperture imaging technology was investigated. Methods By simulating multiple source terms using Monte Carlo method, the differences in imaging performance between two image reconstruction algorithms under near-field conditions were compared. The effects of detector pixels and detection plane pixels on image resolution were investigated. Results The imaging system was simulated based on the designed dimensions. The simulated imaging field of view was 89.4 mm × 89.4 mm and the simulated angular resolution was 1.98°. Based on the comparison of the average width at half height of the reconstructed point sources under different conditions, it was found that increasing the number of pixels in the detector and detection plane optimized the angular resolution but significantly prolonged the Monte Carlo simulation time. Conclusion According to the simulation results, the parameters of the imaging system can be used to effectively image radioactive contamination. Our results provide methodological support for the measurement of wound contamination caused by transuranic nuclides, and lay the foundation for the development of wound contamination imaging detection systems in the future.

BACKGROUND:Bone mineral density is the clinical gold standard for determining bone strength,but bone mineral density is less sensitive to changes in bone mass,with large changes in bone mineral density only occurring when bone mass is significantly reduced,so bone mineral density has limited ability to predict changes in bone strength and fracture risk. OBJECTIVE:A model of the normal and osteoporotic hip joint was developed to analyze the stresses and deformation in the hip of normal and osteoporotic patients under single-leg standing conditions. METHODS:A healthy adult female volunteer at the age of 36 years was selected as the study subject.The CT data of the hip joint of this volunteer were obtained and saved in DICOM format.The hip joint model was reconstructed in three dimensions,and the material properties were assigned by the gray value assignment method to obtain the normal and osteoporotic hip joint models according to the empirical formula.The same boundary conditions and loads were set to simulate the stresses and deformation in the normal and osteoporotic hip joints in the single-leg standing position. RESULTS AND CONCLUSION:(1)In the finite element model of the normal and osteoporotic hip,the stress distribution was more concentrated in the medial region of the femoral neck.(2)In the hip bone,the stress distribution was mainly concentrated in the upper part of the acetabulum.(3)The stress peaks in the medial femoral neck and upper acetabulum were larger in the normal hip model than in the osteoporotic hip model,probably due to the reduced bone strength of the osteoporotic bone.(4)The peak Von Mises of both normal and osteoporotic hip models were concentrated on the medial femoral neck,and the peak Von Mises of the hip bone was smaller,indicating that the overall effect of osteoporosis on hip bone stresses was relatively small.(5)In terms of deformation in the single-leg standing position,the maximum deformation in the normal hip model was located at the acetabulum and femoral head,and the maximum deformation was located at the upper part of the greater trochanter of the femur.(6)It is suggested that the finite element analysis method to model the values of parameters related to bone tissue in osteoporosis may improve clinical prediction of bone strength changes and fracture risk.It is explained from the biomechanical view that the intertrochanteric femur and femoral neck are good sites for osteoporotic hip fractures.