BACKGROUND:Currently,spinal endoscopic technology has become the mainstream technology in minimally invasive spinal surgery.The specifications of the instruments for different operating systems are different,and the choice of specific surgical protocols needs to be combined with the actual situation of the patient and the choice of the clinical surgeon. OBJECTIVE:To compare the early efficacy of percutaneous endoscopic interlaminar discectomy for L5-S1 disc herniation under the iLESSYS Delta System and Endo-Surgi Plus System. METHODS:Totally 80 patients with L5-S1 disc herniation were treated with percutaneous endoscopic interlaminar discectomy.Patients were divided into two groups based on the endoscopic system used.Among them,37 cases received the iLESSYS Delta System(Delta group)and 43 cases received the Endo-Surgi Plus System(Plus group).Patient demographic characteristics,perioperative indicators,and complications were analyzed between the two groups.Clinical outcomes were quantified using back and leg visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores at 1 day,1,3,and 6 months after surgery.Patient satisfaction was assessed according to modified MacNab criteria at final follow-up. RESULTS AND CONCLUSION:(1)The operative time and number of arthroplasties in the Plus group were less than those in the Delta group,and the differences were statistically significant(P<0.05).(2)Compared with the preoperative period,the visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores of patients in both groups improved at all follow-up time points,and the difference was statistically significant(P<0.001).(3)There was no statistically significant difference in the comparison of pain visual analog scale scores,Oswestry Disability Index,and Japanese Orthopaedic Association scores of patients in the two groups(P>0.05).(4)At 6-month follow-up after surgery,the MacNab standard excellent and good rates in the Delta group and Plus group were 81%and 79%,respectively,with no significant difference(P=0.823).(5)The incidence of complications was 3%in the Delta group and 2%in the Plus group,but there was no significant difference between the two groups(P=0.914).(6)It is concluded that both iLESSYS Delta and Endo-Surgi Plus surgical systems achieved satisfactory early clinical results in the treatment of lumbar disc herniation,with Endo-Surgi Plus surgical moulding being more efficient and safer.

Background/Aims: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a chronic liver disease characterized by hepatic steatosis. Ubiquitin-specific protease 29 (USP29) plays pivotal roles in hepatic ischemiareperfusion injury and hepatocellular carcinoma, but its role in MASLD remains unexplored. Therefore, the aim of this study was to reveal the effects and underlying mechanisms of USP29 in MASLD progression. Methods: USP29 expression was assessed in liver samples from MASLD patients and mice. The role and molecular mechanism of USP29 in MASLD were assessed in high-fat diet-fed and high-fat/high-cholesterol diet-fed mice and palmitic acid and oleic acid treated hepatocytes. Results: USP29 protein levels were significantly reduced in mice and humans with MASLD. Hepatic steatosis, inflammation and fibrosis were significantly exacerbated by USP29 deletion and relieved by USP29 overexpression. Mechanistically, USP29 significantly activated the expression of genes related to fatty acid β-oxidation (FAO) under metabolic stimulation, directly interacted with long-chain acyl-CoA synthase 5 (ACSL5) and repressed ACSL5 degradation by increasing ACSL5 K48-linked deubiquitination. Moreover, the effect of USP29 on hepatocyte lipid accumulation and MASLD was dependent on ACSL5. Conclusions USP29 functions as a novel negative regulator of MASLD by stabilizing ACSL5 to promote FAO. The activation of the USP29-ACSL5 axis may represent a potential therapeutic strategy for MASLD.

Background/Aims: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a chronic liver disease characterized by hepatic steatosis. Ubiquitin-specific protease 29 (USP29) plays pivotal roles in hepatic ischemiareperfusion injury and hepatocellular carcinoma, but its role in MASLD remains unexplored. Therefore, the aim of this study was to reveal the effects and underlying mechanisms of USP29 in MASLD progression. Methods: USP29 expression was assessed in liver samples from MASLD patients and mice. The role and molecular mechanism of USP29 in MASLD were assessed in high-fat diet-fed and high-fat/high-cholesterol diet-fed mice and palmitic acid and oleic acid treated hepatocytes. Results: USP29 protein levels were significantly reduced in mice and humans with MASLD. Hepatic steatosis, inflammation and fibrosis were significantly exacerbated by USP29 deletion and relieved by USP29 overexpression. Mechanistically, USP29 significantly activated the expression of genes related to fatty acid β-oxidation (FAO) under metabolic stimulation, directly interacted with long-chain acyl-CoA synthase 5 (ACSL5) and repressed ACSL5 degradation by increasing ACSL5 K48-linked deubiquitination. Moreover, the effect of USP29 on hepatocyte lipid accumulation and MASLD was dependent on ACSL5. Conclusions USP29 functions as a novel negative regulator of MASLD by stabilizing ACSL5 to promote FAO. The activation of the USP29-ACSL5 axis may represent a potential therapeutic strategy for MASLD.

Background/Aims: Metabolic dysfunction–associated steatotic liver disease (MASLD) is a chronic liver disease characterized by hepatic steatosis. Ubiquitin-specific protease 29 (USP29) plays pivotal roles in hepatic ischemiareperfusion injury and hepatocellular carcinoma, but its role in MASLD remains unexplored. Therefore, the aim of this study was to reveal the effects and underlying mechanisms of USP29 in MASLD progression. Methods: USP29 expression was assessed in liver samples from MASLD patients and mice. The role and molecular mechanism of USP29 in MASLD were assessed in high-fat diet-fed and high-fat/high-cholesterol diet-fed mice and palmitic acid and oleic acid treated hepatocytes. Results: USP29 protein levels were significantly reduced in mice and humans with MASLD. Hepatic steatosis, inflammation and fibrosis were significantly exacerbated by USP29 deletion and relieved by USP29 overexpression. Mechanistically, USP29 significantly activated the expression of genes related to fatty acid β-oxidation (FAO) under metabolic stimulation, directly interacted with long-chain acyl-CoA synthase 5 (ACSL5) and repressed ACSL5 degradation by increasing ACSL5 K48-linked deubiquitination. Moreover, the effect of USP29 on hepatocyte lipid accumulation and MASLD was dependent on ACSL5. Conclusions USP29 functions as a novel negative regulator of MASLD by stabilizing ACSL5 to promote FAO. The activation of the USP29-ACSL5 axis may represent a potential therapeutic strategy for MASLD.

Objective:To analyze the factors affecting the laxity of Oddi sphincter in patients with common bile duct stones prior to common bile duct exploration.Methods:Clinical data of 101 patients with common bile duct stones undergoing common bile duct exploration at Wenzhou Central Hospital from January 2020 to June 2024 were retrospectively analyzed, including 38 males and 63 females, aged (68.6±13.3) years. All patients underwent common bile duct exploration with choledochoscopy. The size, shape, and patency of the papillary opening at the lower end of Oddi sphincter were observed to classify the sphincter function into Grades 1 to 4. The morphology of the papillary opening at the lower end of common bile duct was defined as narrowed, normal, oversized, and relaxed, respectively. Univariate and multivariate logistic regression analysis were conducted to identify the influencing factors of the laxity of Oddi sphincter.Results:Among the 101 patients, there were two cases (2.0%) classified as Grade 1 of Oddi sphincter function, 40 (39.6%) classified as Grade 2, 43 (42.6%) classified as Grade 3, and 16 (15.8%) classified as Grade 4. Under choledochoscopy, the Oddi sphincter function was classified into Grades 1 to 3 (stenosis, normal and oversized, included in the control group, n=85). Grade 4 was included in the laxity group ( n=16). The proportion of endoscopic retrograde cholangiopancreatography (ERCP) history, preoperative level of alanine aminotransferase, preoperative common bile duct diameter, preoperative maximum diameter of common bile duct stones, and preoperative bile duct gas accumulation in the laxity group were all higher than those in the control group (all P<0.05). Multivariate logistic regression analysis showed that patients with larger preoperative common bile duct diameter ( OR=12.993, 95% CI: 1.913-88.263), larger preoperative maximum diameter of common bile duct stones ( OR=6.238, 95% CI: 1.266-30.730), and a history of ERCP ( OR=8.119, 95% CI: 1.125-58.584) had a higher risk of preoperative Oddi sphincter laxity (all P<0.05). Conclusion:History of ERCP, diameter of common bile duct, and maximum diameter of common bile duct stones are risk factors for the laxity of Oddi sphincter prior to common bile duct exploration in patients with common bile duct stones.

Hyperemesis gravidarum(HG)refers to persistent and severe nausea and vomiting during early pregnancy.Severe HG may lead to maternal dehydration,electrolyte imbalances,malnutrition,and even hypotension and arrhythmias,potentially affecting fetal growth and development.Due to the unique physiological state of pregnancy,treatment options for HG are limited.Metoclopramide,has become a commonly used drug in treating HG due to its prove efficacy and safety.Previous studies have primarily focused on the extrapyramidal side effects of metoclopramide,but research on its psychiatric adverse effects,such as mania and somnolence,remains limited,particularly in pregnant patients.This paper reports a case of psychiatric abnormalities in an HG patient following metoclopramide administration.By analyzing the patient's condition,medication use,and adverse reactions,this study explores the potential mechanisms underlying metoclopramide-induced psychiatric abnormalities and provides clinical recommendations for preventing and managing such psychiatric adverse effects during pregnancy.These findings offer valuable guidance for healthcare professionals regarding the appropriate use of this medication.

Objective:To analyze the factors affecting the laxity of Oddi sphincter in patients with common bile duct stones prior to common bile duct exploration.Methods:Clinical data of 101 patients with common bile duct stones undergoing common bile duct exploration at Wenzhou Central Hospital from January 2020 to June 2024 were retrospectively analyzed, including 38 males and 63 females, aged (68.6±13.3) years. All patients underwent common bile duct exploration with choledochoscopy. The size, shape, and patency of the papillary opening at the lower end of Oddi sphincter were observed to classify the sphincter function into Grades 1 to 4. The morphology of the papillary opening at the lower end of common bile duct was defined as narrowed, normal, oversized, and relaxed, respectively. Univariate and multivariate logistic regression analysis were conducted to identify the influencing factors of the laxity of Oddi sphincter.Results:Among the 101 patients, there were two cases (2.0%) classified as Grade 1 of Oddi sphincter function, 40 (39.6%) classified as Grade 2, 43 (42.6%) classified as Grade 3, and 16 (15.8%) classified as Grade 4. Under choledochoscopy, the Oddi sphincter function was classified into Grades 1 to 3 (stenosis, normal and oversized, included in the control group, n=85). Grade 4 was included in the laxity group ( n=16). The proportion of endoscopic retrograde cholangiopancreatography (ERCP) history, preoperative level of alanine aminotransferase, preoperative common bile duct diameter, preoperative maximum diameter of common bile duct stones, and preoperative bile duct gas accumulation in the laxity group were all higher than those in the control group (all P<0.05). Multivariate logistic regression analysis showed that patients with larger preoperative common bile duct diameter ( OR=12.993, 95% CI: 1.913-88.263), larger preoperative maximum diameter of common bile duct stones ( OR=6.238, 95% CI: 1.266-30.730), and a history of ERCP ( OR=8.119, 95% CI: 1.125-58.584) had a higher risk of preoperative Oddi sphincter laxity (all P<0.05). Conclusion:History of ERCP, diameter of common bile duct, and maximum diameter of common bile duct stones are risk factors for the laxity of Oddi sphincter prior to common bile duct exploration in patients with common bile duct stones.

Hyperemesis gravidarum(HG)refers to persistent and severe nausea and vomiting during early pregnancy.Severe HG may lead to maternal dehydration,electrolyte imbalances,malnutrition,and even hypotension and arrhythmias,potentially affecting fetal growth and development.Due to the unique physiological state of pregnancy,treatment options for HG are limited.Metoclopramide,has become a commonly used drug in treating HG due to its prove efficacy and safety.Previous studies have primarily focused on the extrapyramidal side effects of metoclopramide,but research on its psychiatric adverse effects,such as mania and somnolence,remains limited,particularly in pregnant patients.This paper reports a case of psychiatric abnormalities in an HG patient following metoclopramide administration.By analyzing the patient's condition,medication use,and adverse reactions,this study explores the potential mechanisms underlying metoclopramide-induced psychiatric abnormalities and provides clinical recommendations for preventing and managing such psychiatric adverse effects during pregnancy.These findings offer valuable guidance for healthcare professionals regarding the appropriate use of this medication.

There are few reports in China on the laparoscopic Burch procedure in the treatment of female stress urinary incontinence. Twenty-two female stress urinary incontinence patients admitted to our hospital were treated with laparoscopic Burch procedure, with an overall effective rate of 100%. The score of the International Continence Advisory Committee Urinary Incontinence Questionnaire-Short Form (ICI-Q-SF) at one month after treatment was lower compared to that before the procedure. There were no complications during two months of follow-up.

Objective:To assess the value of serum alpha-fetoprotein(AFP),protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)and glypican-3(GPC-3)in the diagnosis of hepatocellular carcinoma(HCC).Methods:Studies of AFP,PIVKA-Ⅱ,GPC-3 or in combination for the diagnosis of HCC since 2002 were searched in PubMed,Web of Science and Embase databases.The literature was screened according to the inclusion and exclusion criteria,the quality of the included articles was evaluated by QUADAS checklist,and relevant data were extracted by Meta DiSc,Review Manager 5.4 and Stata 15.1.The diagnostic values of AFP,PIVKA-Ⅱ and GPC-3 alone or in combination for HCC were assessed with receiver operating characteristic(ROC)curve.Results:A total of 32 articles were included in the study.Meta-analysis showed that when a single marker was used to diagnose HCC,the area under the ROC curve(AUC)of PIVKA-Ⅱ was the highest(0.88,95%CI:0.85-0.91),followed by GPC-3 and AFP.The AUC of combination of serum markers was higher than that of a single marker,and the AUC of PIVKA-Ⅱ combined with GPC-3 was the highest(0.90,95%CI:0.87-0.92).When a single marker was used for diagnosis,the sensitivity of PIVKA-Ⅱ and GPC-3 were relatively high(0.75 and 0.76),while the specificity of PIVKA-Ⅱ(0.88)and AFP(0.87)were higher than that of GPC-3(0.81).The sensitivity of the combination of serum markers was higher than that of a single marker,while the specificity was not significantly improved.When a single marker is used to diagnose HCC,the diagnostic odds ratio(DOR)of PIVKA-Ⅱ was the highest(22,95%CI:13-36),followed by GPC-3 and AFP.The DOR of the combination of two markers in the diagnosis of HCC was higher than that of a single marker,and the DOR of AFP combined with GPC-3 was the highest(25,95%CI:9-67).The DOR of the combination of the three markers was significantly reduced to 10(95%CI:7-45).Conclusions:When a single marker is used,PIVKA-Ⅱhas a higher diagnostic value for HCC.The combination of two markers can significantly improve the diagnostic sensitivity,and AFP combined with PIVKA-Ⅱ is recommended for the diagnosis of HCC.The combination of all three markers failed to further improve the diagnostic value.