BACKGROUND:Lumbar degenerative disease is a disease of the musculoskeletal system that primarily affects the intervertebral structures,and the disease is treated with lumbar fusion and disc replacement.OBJECTIVE:To conduct comparative analysis of the differences between lumbar fusion,mechanical lumbar disc prosthesis replacement,and viscoelastic lumbar disc prosthesis replacement.METHODS:The computerized tomography images of a healthy adult were used to construct a finite element model of the L2-L5 normal lumbar spine with Mimic,Geomagic,and Ansys software.The equipment required for lumbar fusion and lumbar spine replacement was constructed using modeling software,and the L3-L4 segment of the lumbar spine was processed according to the surgical requirements for lumbar fusion and intervertebral disc replacement,creating the corresponding finite element model.Specific boundary conditions were applied to extract the mobility of each lumbar spine segment,the stresses on the neighboring intervertebral discs,and the stresses on the prosthesis lining.RESULTS AND CONCLUSION:(1)Compared with the preoperative period,the maximum stress in the upper neighboring discs increased by 64.09％and 39.79％in the forward flexion and lateral bending states if the original mobility was maintained after lumbar fusion surgery.The maximum stress in the lower neighboring discs increased by 24.39％and 20.98％in forward flexion and lateral bending.This suggested that the upper adjacent discs would suffer greater stress changes than the lower adjacent discs during heavy physical labor.(2)Disc replacement did not show significant changes in adjacent disc stress,with mechanical prosthesis replacement slightly reducing adjacent disc stress,while viscoelastic prosthesis replacement was more in line with the biological properties of the disc,with maximum adjacent disc stress similar to that of the preoperative period.(3)In terms of stability,the mechanical prosthesis replacement segment showed a 51.67％increase in range of motion in the lateral bending state and a 53.27％increase in range of motion in the posterior extension state,whereas the viscoelastic prosthesis was better able to maintain mobility in the replacement segment.(4)In addition,the stresses in the liner of the mechanical prosthesis were mainly concentrated in the edge region,and this stress distribution may lead to edge wear and thus affect the service life of the prosthesis.

BACKGROUND:Lumbar degenerative disease is a disease of the musculoskeletal system that primarily affects the intervertebral structures,and the disease is treated with lumbar fusion and disc replacement.OBJECTIVE:To conduct comparative analysis of the differences between lumbar fusion,mechanical lumbar disc prosthesis replacement,and viscoelastic lumbar disc prosthesis replacement.METHODS:The computerized tomography images of a healthy adult were used to construct a finite element model of the L2-L5 normal lumbar spine with Mimic,Geomagic,and Ansys software.The equipment required for lumbar fusion and lumbar spine replacement was constructed using modeling software,and the L3-L4 segment of the lumbar spine was processed according to the surgical requirements for lumbar fusion and intervertebral disc replacement,creating the corresponding finite element model.Specific boundary conditions were applied to extract the mobility of each lumbar spine segment,the stresses on the neighboring intervertebral discs,and the stresses on the prosthesis lining.RESULTS AND CONCLUSION:(1)Compared with the preoperative period,the maximum stress in the upper neighboring discs increased by 64.09％and 39.79％in the forward flexion and lateral bending states if the original mobility was maintained after lumbar fusion surgery.The maximum stress in the lower neighboring discs increased by 24.39％and 20.98％in forward flexion and lateral bending.This suggested that the upper adjacent discs would suffer greater stress changes than the lower adjacent discs during heavy physical labor.(2)Disc replacement did not show significant changes in adjacent disc stress,with mechanical prosthesis replacement slightly reducing adjacent disc stress,while viscoelastic prosthesis replacement was more in line with the biological properties of the disc,with maximum adjacent disc stress similar to that of the preoperative period.(3)In terms of stability,the mechanical prosthesis replacement segment showed a 51.67％increase in range of motion in the lateral bending state and a 53.27％increase in range of motion in the posterior extension state,whereas the viscoelastic prosthesis was better able to maintain mobility in the replacement segment.(4)In addition,the stresses in the liner of the mechanical prosthesis were mainly concentrated in the edge region,and this stress distribution may lead to edge wear and thus affect the service life of the prosthesis.

ObjectiveTo compare the clinical efficacy of traditional Chinese medicine （TCM） manipulative reduction combined with small splint fixation versus surgical treatment for type A distal radius fracture （DRF） and to explore the factors influencing the choice of treatment. MethodsA multi-center retrospective study was conducted， collecting data from 1237 type A DRF patients treated in 11 hospitals in Jiangsu province from September， 2023 to April， 2025. Among them， 851 patients in the TCM group received manipulative reduction combined with small splint fixation， and 386 patients in the surgical group underwent open reduction and internal fixation. Visual analog scale （VAS） scores for pain and radiographic indicators including palmar tilt， ulnar deviation， and radial height were compared before treatment， 5-7 days after treatment， and 4-6 weeks after treatment. The wrist joint function scores including Dienst and Gartland-Werley scores at 12 weeks after treatment were recorded. Subgroup analysis was conducted for the excellent rate of Dienst and Gartland-Werley scores， stratified by age （＜50， 50-59， 60-69， ≥70 years old） and AO subtypes （A1， A2， A3）. A multivariate logistic regression model was used to identify independent factors influencing treatment choice. ResultsOn 5-7 days after treatment， the surgical group had lower VAS scores than the TCM group， while 4-6 weeks after treatment， the TCM group showed lower VAS scores than the surgical group （P＜0.01）. In terms of radiographic indicators， except for the palmar tilt before treatment being higher in the surgical group than in the TCM group （P＜0.01）， there were no significant differences in palmar tilt， ulnar deviation， and radial height at other timepoints （P＞0.05）. Twelve weeks after treatment， the surgical group had a higher average Gartland-Werley score and the excellent rate than the TCM group （P＜0.01）. Subgroup analysis showed that in patients with A2 type DRF aged 50-59 and 60-69 years old， the excellent rates of Dienst and Gartland-Werley scores in the TCM group were higher than those in the surgical group （P＜0.05）. Multivariate logistic regression analysis revealed that age， palmar tilt， ulnar deviation， and the degree of swelling on the affected side were independent factors influencing the choice of treatment （P＜0.05）. ConclusionBoth TCM manipulative reduction combined with small splint fixation and surgical treatment for type A DRF can achieve good therapeutic effects. TCM manipulative reduction combined with small splint fixation has certain advantages in medium- and long-term pain relief， especially in elderly patients， where wrist joint function recovery is more stable. Age， palmar tilt， ulnar deviation， and swelling degree are the main factors influencing the treatment choice.

ObjectiveTo explore the potential mechanism of Xiaoqinglong Decoction （小青龙汤， XD） in the treatment of allergic rhinitis. MethodsForty-five rats were randomly assigned to a control group， a model group， a loratadine group， low-， medium- and high-dose XD groups， and low-， medium- and high-dose Mahuang Decoction and Cang'erzi Powder （麻黄汤合苍耳子散， MDCP） groups. Except for the control group， rats were administered with ovalbumin （OVA） and aluminum hydroxide via intraperitoneal injection for 14 days to establish an allergic rhinitis model. After the 14th-day injection， nasal stimulation was continued with 20 μl of 10% OVA solution to maintain the model. Rats in the control group and the model group received 10 ml/（kg·d） of saline， whereas those in the loratadine group were administered with 0.9 mg/（kg·d） of loratadine. The low-， medium- and high-dose XD groups were administered XD at the dose of 2.7， 5.4， and 10.8 g/（kg·d）， respectively. The low-， medium- and high-dose MDCP groups were administered MDCP at the dose of 2.43， 4.86， and 9.72 g/（kg·d）， respectively. All treatments were administered by gavage once daily for 7 consecutive days. One hour after the final gavage， nasal symptom scores were recorded for all group of rats. The next day， serum levels of immunoglobulin E （IgE）， interleukin-4 （IL-4）， and interleukin-13 （IL-13） were measured. HE staining was used to observe the pathological morphology of the nasal mucosal tissue. Quantitative reverse transcription PCR （RT-qPCR） and Western Blot were performed to assess mRNA and protein expression of thymic stromal lymphopoietin （TSLP） and OX40 ligand （OX40L） in the nasal mucosa. ResultsCompared to the control group， total nasal symptom score in the model group significantly increased （P＜0.01）. HE staining revealed disrupted and adhered cilia， thickened basement membranes， and extensive inflammatory cell infiltration in the nasal mucosa. Serum levels of total IgE， IL-4， and IL-13， as well as TSLP and OX40L mRNA and protein expression in the nasal mucosa， were significantly elevated in the model group （P＜0.05 or P＜0.01）. Compared to the model group， the total nasal symptom scores in all drug intervention groups were significantly reduced； the serum total IgE levels in the loratadine group， the low- and medium-dose XD groups， and the low- and high-dose MDCP groups were significantly reduced； and the serum levels of IL-4 and IL-13 in the high-dose XD group and the high-dose MDCP group decreased （P＜0.05 or P＜0.01）. Nasal mucosal structure was improved. Except for the low-dose MDCP group， all other intervention groups showed a significant reduction in TSLP and OX40L mRNA expression in the nasal mucosa （P＜0.01）. All doses of XD and the medium- and high-dose MDCP groups significantly decreased the protein levels of TSLP and OX40L （P＜0.05）. The medium-dose XD group exhibited more improvement of nasal symptom scores and greater suppression of expression of TSLP and OX40L mRNA， and TSLP protein levels compared to the loratadine group （P＜0.05）. ConclusionXD may protect nasal mucosa of rats and alleviate allergic rhinitis by suppressing the TSLP/OX40L pathway， thereby attenuating Th2-mediated immune responses.

ObjectiveTo explore the potential mechanism of Xiaoqinglong Decoction （小青龙汤， XD） in the treatment of allergic rhinitis. MethodsForty-five rats were randomly assigned to a control group， a model group， a loratadine group， low-， medium- and high-dose XD groups， and low-， medium- and high-dose Mahuang Decoction and Cang'erzi Powder （麻黄汤合苍耳子散， MDCP） groups. Except for the control group， rats were administered with ovalbumin （OVA） and aluminum hydroxide via intraperitoneal injection for 14 days to establish an allergic rhinitis model. After the 14th-day injection， nasal stimulation was continued with 20 μl of 10% OVA solution to maintain the model. Rats in the control group and the model group received 10 ml/（kg·d） of saline， whereas those in the loratadine group were administered with 0.9 mg/（kg·d） of loratadine. The low-， medium- and high-dose XD groups were administered XD at the dose of 2.7， 5.4， and 10.8 g/（kg·d）， respectively. The low-， medium- and high-dose MDCP groups were administered MDCP at the dose of 2.43， 4.86， and 9.72 g/（kg·d）， respectively. All treatments were administered by gavage once daily for 7 consecutive days. One hour after the final gavage， nasal symptom scores were recorded for all group of rats. The next day， serum levels of immunoglobulin E （IgE）， interleukin-4 （IL-4）， and interleukin-13 （IL-13） were measured. HE staining was used to observe the pathological morphology of the nasal mucosal tissue. Quantitative reverse transcription PCR （RT-qPCR） and Western Blot were performed to assess mRNA and protein expression of thymic stromal lymphopoietin （TSLP） and OX40 ligand （OX40L） in the nasal mucosa. ResultsCompared to the control group， total nasal symptom score in the model group significantly increased （P＜0.01）. HE staining revealed disrupted and adhered cilia， thickened basement membranes， and extensive inflammatory cell infiltration in the nasal mucosa. Serum levels of total IgE， IL-4， and IL-13， as well as TSLP and OX40L mRNA and protein expression in the nasal mucosa， were significantly elevated in the model group （P＜0.05 or P＜0.01）. Compared to the model group， the total nasal symptom scores in all drug intervention groups were significantly reduced； the serum total IgE levels in the loratadine group， the low- and medium-dose XD groups， and the low- and high-dose MDCP groups were significantly reduced； and the serum levels of IL-4 and IL-13 in the high-dose XD group and the high-dose MDCP group decreased （P＜0.05 or P＜0.01）. Nasal mucosal structure was improved. Except for the low-dose MDCP group， all other intervention groups showed a significant reduction in TSLP and OX40L mRNA expression in the nasal mucosa （P＜0.01）. All doses of XD and the medium- and high-dose MDCP groups significantly decreased the protein levels of TSLP and OX40L （P＜0.05）. The medium-dose XD group exhibited more improvement of nasal symptom scores and greater suppression of expression of TSLP and OX40L mRNA， and TSLP protein levels compared to the loratadine group （P＜0.05）. ConclusionXD may protect nasal mucosa of rats and alleviate allergic rhinitis by suppressing the TSLP/OX40L pathway， thereby attenuating Th2-mediated immune responses.

Objective To evaluate the efficacy and safety of super-mini percutaneous nephrolithotomy(SMP)and standard percutaneous nephrolithotomy(sPCNL)in the treatment of 2-4 cm renal calculi, so as to provide reference for the management of medium-sized renal calculi. Methods A retrospective analysis was conducted on 168 patients with 2-4 cm renal calculi who underwent either SMP or sPCNL at our hospital during Sep. 2020 and Mar. 2025. The patients were divided into the SMP group(n=85)and sPCNL group(n=83). The baseline characteristics, stone features, operation time, perioperative complications, transfusion rate, postoperative hemoglobin drop, pain score, hospital stay, and stone-free rate(SFR)were compared between the two groups. Results There were no significant differences in baseline characteristics, stone features, and SFR between the two groups(P＞0.05). Compared to the sPCNL group, the SMP group had a longer operation time [(71.76±22.49)vs.(64.22±15.01)min, P=0.034]. However, it had lower postoperative pain score [(2.51 ±0.85)vs.(4.11±0.47), P＜0.001], shorter hospital stay [(3.16±1.45)vs.(4.30±1.06)days, P＜0.001], lower hospitalization costs [(19982.67±4267.80)vs.(21688.53±4575.74)RMB, P=0.004], a slighter decrease in hemoglobin [(6.64±10.56)vs.(12.22±11.50)g/L, P=0.032], and a significantly higher tubeless rate(83.53% vs. 0%, P＜0.001). There was no statistically significant difference in the overall complication rate between the two groups(P＞0.05). Conclusion For 2—4 cm renal calculi, SMP achieves a comparable SFR as sPCNL. Although the operation time with SMP is slightly longer, it offers significant advantages, including reduced postoperative pain, shorter hospitalization, lower costs, less bleeding, and a higher tubeless rate. SMP is a valuable technique worthy of broader clinical application.

Objective To establish a reliable prediction model for radiation pneumonitis(RP)based on multi-regional radiomics analysis of localizable CT images.Methods A retrospective analysis was conducted on 185 patients who received radiotherapy from January 2021 to June 2023 in the Department of Radiotherapy,Xuzhou Cancer Hospital.Patients were classified as having RP or not based on imaging combined with clinical diagnosis.Three regions of interest(ROI)were defined in the localizable CT images:Lung,Lung-PTV and PTV,and their radiomics features were extracted.After feature screening using methods such as Mann-Whitney Utest,recursive feature elimination,and Lasso,a prediction model was established using support vector machine classification algorithm.The model performance was validated using 6 evaluation metrics:the area under the receiver operating characteristic curve(AUC),accuracy,specificity,sensitivity,positive predictive value,and negative predictive value.Results The prediction model consisted of 7 radiomics features.The clinical model of target-to-lung ratio,PTV model,Lung model,and Lung-PTV model achieved AUC values of 0.535,0.801,0.672,and 0.706 in the test set,respectively.The AUC value and accuracy of PTV model reached 0.843 and 0.775 in the training set,while 0.801 and 0.750 in the test set.PTV model was superior to Lung model,Lung-PTV model,and clinical model in predictive performance.The AUC values of the combined PTV+(Lung-PTV)model in the training and test sets were 0.867 and 0.806,respectively,higher than those of PTV model and Lung-PTV model.Conclusion The predictive ability of the prediction models constructed from radiomics features in different ROI for symptomatic RP varies.The radiomics prediction model using PTV as ROI exhibits superior predictive performance,and the combined multi-regional radiomics model can further improve the predictive ability for RP.

Objective To establish a reliable prediction model for radiation pneumonitis(RP)based on multi-regional radiomics analysis of localizable CT images.Methods A retrospective analysis was conducted on 185 patients who received radiotherapy from January 2021 to June 2023 in the Department of Radiotherapy,Xuzhou Cancer Hospital.Patients were classified as having RP or not based on imaging combined with clinical diagnosis.Three regions of interest(ROI)were defined in the localizable CT images:Lung,Lung-PTV and PTV,and their radiomics features were extracted.After feature screening using methods such as Mann-Whitney Utest,recursive feature elimination,and Lasso,a prediction model was established using support vector machine classification algorithm.The model performance was validated using 6 evaluation metrics:the area under the receiver operating characteristic curve(AUC),accuracy,specificity,sensitivity,positive predictive value,and negative predictive value.Results The prediction model consisted of 7 radiomics features.The clinical model of target-to-lung ratio,PTV model,Lung model,and Lung-PTV model achieved AUC values of 0.535,0.801,0.672,and 0.706 in the test set,respectively.The AUC value and accuracy of PTV model reached 0.843 and 0.775 in the training set,while 0.801 and 0.750 in the test set.PTV model was superior to Lung model,Lung-PTV model,and clinical model in predictive performance.The AUC values of the combined PTV+(Lung-PTV)model in the training and test sets were 0.867 and 0.806,respectively,higher than those of PTV model and Lung-PTV model.Conclusion The predictive ability of the prediction models constructed from radiomics features in different ROI for symptomatic RP varies.The radiomics prediction model using PTV as ROI exhibits superior predictive performance,and the combined multi-regional radiomics model can further improve the predictive ability for RP.

Bladder cancer(BCa)is a common malignant tumor of the urinary system,and its conventional treatment methods have many limitations.Chimeric antigen receptor T cell(CAR-T)therapy,as an emerging immunotherapy method,has achieved significant success in hematological malignancies and has brought new hope for the treatment of solid tumors.This article reviews the research progress of CAR-T cell therapy in the treatment of BCa,including the basic structure of CAR-T cells,potential therapeutic targets in bladder cancer,current chal-lenges and corresponding strategies.

Objectives:To explore whether short-course radiotherapy (SCRT)-based total neoadjuvant therapy (TNT) combined with PD-1 inhibitors could further promote tumor regression and improve the prognosis.Methods:This is a prospective, multicenter, two-arm randomized controlled, seamless phase Ⅱ/Ⅲ trial for proficient mismatch repair or microsatellite stable (pMMR/MSS) locally advanced rectal cancer (LARC). Eligible patients were randomly assigned to the iTNT (TNT+PD-1) group or the TNT group. Patients in the TNT group received SCRT (5 Gy×5) followed by 4 cycles of CAPOX or 6 cycles of mFOLFOX chemotherapy, with the iTNT group receiving SCRT followed by the same regime in combination with 4 cycles of Sintilimab. Total mesorectal excision (TME) surgery or watch and wait (W&W) was performed after neoadjuvant therapy and then 2 cycles of same regimen as before were recommended. The primary endpoints are the complete response (CR) rate for phase Ⅱ trial and 3-year disease-free survival (DFS) for phase Ⅲ trial. A total of 588 patients will be enrolled for the phase Ⅱ/Ⅲ trial. Short-term efficacy and safety data from the initial 100 treated patients were analyzed as planned.Results:From 2022-8-31 to 2023-5-24 the initial 100 patients were enrolled from 10 hospitals in China, 76.0%(76/100) patients were male, and the median age was 61 years (21-74 years). More patients had tumors located in the lower rectum (78.0%, 78/100), staged T3-4 (97.0%, 97/100) and N1-2 (93.0%, 93/100), and about half of the tumors invaded the mesorectal fascia (52.0%, 52/100) and with extramural vascular invasion (51.0%, 51/100). Analyses were performed according to the per-protocal (PP) set. All patients in the iTNT group ( n=52) and the TNT group ( n=48) completed SCRT; The 4-cycle chemotherapy±Sintilimab completion rates were 86.5% and 100.0% in the iTNT and TNT groups, respectively. In the iTNT group, 82.7% (43/52), 11.5% (6/52), and 5.8% (3/52) of the patients received 4, 3, and 2 cycles of PD-1 inhibitor. After TNT, 68 patients underwent radical surgery and 15 patients achieved cCR and adopted W&W. The pathological complete response (pCR) rates were 48.5% (16/33) and 17.1% (6/35) in the iTNT and TNT groups, with CR rates of 50.0% (25/50) and 26.1% (12/46), respectively. The incidence of treatment-related grade 3-4 adverse events was 26.9% (14/52, iTNT group) and 18.8% (9/48, TNT group), with thrombocytopenia and leukopenia being the most common. Among patients receiving immunotherapy, grade 3 immunotherapy-related adverse events occurred in 2 (3.8%, 2/52) patients: one case was pancreatitis, another case was hepatitis combined with myositis and myocarditis. Conclusion:The preliminary results show that SCRT-based TNT combined with PD-1 inhibitors could further improve the CR rate for LARC without unexpected serious adverse events.