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 observe the clinical efficacy and radiographic outcomes of manipulative reduction combined with small splint fixation in the treatment of distal radius fractures. MethodsThe clinical data of 1051 patients with distal radius fractures were retrospectively collected from five hospitals included in the Jiangsu Diagnosis and Treatment Data Platform for Traditional Chinese Medicine（TCM） Dominant Diseases. Propensity score matching at a 1∶4 ratio was applied， resulting in 580 cases selected for final analysis， which comprised 448 patients in the TCM group（manipulative reduction plus small splint fixation） and 132 in the surgical treatment group（open reduction and internal fixation）. Each group was further stratified into type A， B， and C subgroups based on AO fracture classification. Radiographic indicators including palmar tilt， radial inclination， and radial height were compared between groups before treatment and 1 day， 1 week， and 4-6 weeks after treatment， and pain visual analog scale（VAS） scores before treatment and 1 week and 4-6 weeks after treatment were also compared. Wrist joint function was assessed 12 weeks after treatment， using the Dienst wrist function score and the Gartland and Werley（G-W） wrist function score. Additionally， the radiographic indicators at different timepoints and the 12-week wrist function levels were compared between groups across different fracture types. ResultsNo statistically significant difference was observed in radiographic indicators and VAS scores at all timepoints before and after treatment， as well as wrist joint function grades assessed by the Dienst score and the G-W score at 12 weeks after treatment （P＞0.05）. Compared to those before treatment， both groups showed increased palmar tilt， radial inclination， and radial height 1 week and 4-6 weeks after treatment， and decreased VAS scores （P＜0.05）. Compared to those 1 week after treatment， both groups showed a decrease in palmar tilt， an increase in radial inclination and radial height， and a reduction in VAS score 4-6 weeks after treatment（P＜0.05）. In type A and B subgroups， the surgical treatment group had a higher radial inclination than the TCM group 4-6 weeks after treatment， while in the type C subgroup， a higher radial height was shown in the surgical treatment group than in the TCM group 4-6 weeks after treatment（P＜0.05）. In type C subgroup， there was significant difference between groups in the wrist joint function by G-W scores 12 weeks after treatment（P＜0.05）. ConclusionManipulative reduction combined with small splint fixation can maintain fracture alignment and alleviate pain in treating distal radius fractures， which achieves therapeutic outcomes comparable to surgical treatment. It is particularly suitable for type A and B fractures and can be considered an effective treatment option for distal radius fractures.

ObjectiveTo construct an automatic measurement model for palmar tilt and radial inclination suitable for traditional Chinese medicine （TCM） clinical scenarios， and to validate its accuracy and efficiency in TCM manipulative reduction settings. MethodsData on anteroposterior （AP） and lateral X-rays of distal radius fractures were collected from patients admitted to 18 TCM/ integrated TCM and western medicine hospitals in Jiangsu province between September 1st， 2023， and September 1st， 2024， via the Jiangsu Diagnosis and Treatment Big Data Platform for TCM Dominant Diseases. A medical image segmentation framework based on multi-scale feature fusion and edge-awareness was employed， combined with anatomical knowledge specific to TCM orthopedics， to optimize the feature extraction strategy of an artificial intelligence （AI） model. This framework enabled automatic segmentation of fracture regions and measurement of distal radius palmar tilt and radial inclination. The accuracy of the AI model in measuring radial inclination and volar tilt was validated， and the measurement time and average time gain rate of the AI model were compared to those of manual measurement. ResultsA total of 15,444 AP and lateral X-ray images of distal radius fractures were collected， and were divided into a training set （11,144 images， 5066 AP and 6078 lateral）， a validation set （3700 images， 1840 AP and 1860 lateral）， and an independent test set （600 images， 300 AP and 300 lateral） after preprocessing. In the measurement of 300 AP X-rays in the independent test set for radial inclination， when the degree error between AI measurement and manual measurement was ＜3° and ＜5°， AI measurement accuracy was 83% and 93%， respectively. In 300 lateral X-rays in the test set for palmar tilt， when AI measurements had an error of ＜3° and ＜5° compared to manual measurements， corresponding accuracy rate was 78% and 90%， respectively. For 50 X-ray images， AI measurement time was （1.37±0.05） min for radial inclination while manual measurement time was （22.57±2.52） min （P＜0.001）； in terms of palmar tilt， the AI measurement time was （1.33±0.14） min， shorter than （23.70±2.80） min for manual measurement time （P＜0.001）. Average time gain rates for manual and AI measurements were 93.93% and 94.39% respectively. ConclusionAn automatic measurement model for palmar tilt and radial inclination in distal radius fractures has been established， enabling more accurate and efficient assessment as well as providing a tool to support the quantitative evaluation of the efficacy of TCM manipulative reduction and large-sample clinical research.

ObjectiveBased on ultra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high resolution mass spectrometry（UPLC-Q-Orbitrap-MS）， the chemical constituents of Qili Qiangxin capsules was identified， and their distribution in vivo was analyzed. MethodsUPLC-Q-Orbitrap-MS was used to detect the sample solution of Qili Qiangxin capsules， as well as the serum， brain， heart， lung， spleen， liver and kidney tissues of mice after oral administration. Using the Thermo Xcalibur 2.2 software， the compound information database was constructed， and the molecular formulas of compounds corresponding to the quasi-molecular ions were fitted. Based on the information of retention time， accurate relative molecular mass and fragments， the compounds and their distribution in vivo were analyzed by comparing with the data of reference substances and literature. ResultsA total of 233 compounds， including 70 terpenoids， 60 flavonoids， 23 organic acids， 17 alkaloids， 20 steroids， 7 coumarins and 36 others， were identified or predicted from Qili Qiangxin capsules， 73 of which were identified matching with standard substances. Tissue distribution results showed that 71， 17， 38， 33， 32， 58 and 43 migrating components were detected in blood， brain， heart， lung， spleen， liver and kidney， respectively. Thirty-seven components were absorbed into the blood and heart， including quinic acid， benzoylaconitine benzoylmesaconine and so on. Fourteen components were absorbed into the blood and six tissues， including calycosin， methylnissolin， formononetin， alisol B， alisol A and so on. ConclusionThis study comprehensively analyzes the chemical components of Qili Qiangxin capsules and their distribution in vivo. Among them， astragaloside Ⅳ， salvianolic acid B， ginsenoside Rb₁， ginsenoside Rb₃， ginsenoside Rd， ginsenoside Rg₃， calycosin-7-glucoside， and sinapine may be the important components for the treatment of heart failure， which can provide useful reference for its quality control and research on pharmacodynamic material basis.

Objective To compare the long-term prognosis differences between surgical radical resection and endoscopic resection for early gastric cancer patients based on the SEER database. Methods A total of 1 437 patients with stage Tis to T_1b gastric adenocarcinoma were selected from the SEER database from January 1, 2004 to December 31, 2013. They were divided into a surgery group (n=1 257) and an endoscope group (n=180) according to the treatment method. Kaplan-Meier survival curve and Cox regression model were used to analyze survival outcomes. Results The patients in the surgery group were younger than those in the endoscope group ([67.63±12.97] years old vs [71.29±10.82] years old), with higher rates of T₁ stage (97.45% vs 87.78%) and lymph node metastasis (19.73% vs 5.00%, all P＜0.001). The median follow-up time for all patients was 37 (15, 66) months, and the mortality rate of gastric cancer in the endoscope group was lower than that in the surgery group (23.33% vs 27.13%, P＜0.001). Univariate Cox analysis showed that treatment modality, age, sex, T stage, lymph node metastasis were all associated with early gastric cancer mortality (all P＜0.05), and the risk of death in the endoscope group was 43% of that in the surgery group (HR=0.43, P=0.015). After adjusting for multiple factors, there was no statistically significant difference in mortality risk between the two groups (P=0.067), but after excluding lymph node positive patients, the mortality risk in the endoscope group was 46% of that in the surgery group (HR=0.46, P=0.048). Conclusions For early gastric cancer patients with negative lymph nodes, endoscopic resection may provide better survival benefits than surgical procedures, suggesting that it can be the preferred treatment strategy for patients with low risk of lymph node metastasis.

Objective: To explore the association between preoperative aspartate transaminase to alanine transaminase (AST/ALT) ratio and the outcomes of urothelial cancers. Methods: After a systematic search of Web of Science，PubMed and Embase before Aug.2024，14 studies were included in the Meta-analysis.The hazard ratios (HRs) with 95% confidence interval (CI) for overall survival (OS)，cancer-specific survival (CSS)，and recurrence-free survival (RFS) were analyzed using STATA 15.0 software. Results: The Meta-analysis included a total of 8190 patients.Urothelial cancer patients with an elevated preoperative AST/ALT ratio had worse OS (HR=1.92，95% CI：1.38-2.67，P<0.001)，CSS (HR=2.12，95% CI：1.48-3.05，P<0.001)，and RFS (HR=1.63，95% CI：1.27-2.10，P<0.001).In subgroup analyses，preoperative AST/ALT ratio had a better predictive value for OS，CSS，and RFS in patients with bladder cancer than in patients with upper tract urothelial carcinoma，and a better predictive value in Asian population than in Caucasian population (P<0.001). Conclusion: A high preoperative AST/ALT ratio is associated with poor OS，CSS and RFS in urothelial cancers，particularly among the Asian population.

Lianggesan was first recorded in Taiping Huimin Heji Jufang， which was composed of Rhei Radix et Rhizoma， Natrii Sulfas， Gardeniae Fructus， Forsythiae Fructus， Scutellariae Radix， Glycyrrhizae Radix et Rhizoma（GRR）， Menthae Haplocalycis Herba， Lophatheri Herba and Mel. It was clinically applied to treat fire-heat syndrome in the upper and middle Jiao， and the curative effect was positive. In this study， the bibliometric method was used to conduct a detailed textual research on the formula name， medicinal composition， dosage evolution， origin and processing， functional indications and other aspects of Lianggesan. Research revealed that Lianggesan has six other names， such as Lianqiao Yinzi， Lianqiao Jiedusan， Jufang Lianggesan， Jiegu Lianggesan， Hejian Lianggesan and Qingji Lianggesan. Based on the edition of Taiping Huimin Heji Jufang， an analysis of the evolution of its formula composition revealed that the missing Chinese medicines were predominantly bamboo leaves and honey， while the added Chinese medicines were primarily supplements introduced to address changes in disease manifestations. After textual research， the dosage for one dose of Lianggesan from Taiping Huimin Heji Jufang was as follows：826 g of Rhei Radix et Rhizoma， 826 g of Natrii Sulfas， 826 g of GRR， 413 g of Gardeniae Fructus， 413 g of Menthae Haplocalycis Herba， 413 g of Scutellariae Radix， and 1652 g of Forsythiae Fructus. Decocting method was as following：Grinding the Chinese medicines into coarse powder（2-4 mm）， taking 8.16 g per dose， adding 300 mL of water， along with 2 g of Lophatheri Herba and 5 g of Mel， and decocting to 140 mL. The residue was removed and taken warmly 30 min after meals. It was recommended to take it three times daily until improvement was achieved. The origins of the 9 Chinese medicines were consistent with the 2020 edition of Pharmacopoeia of the People's Republic of China. Except for GRR， which required single frying（stir-frying）， the remaining medicines were all raw products. The description of the function of this formula in ancient books was summarized as purging fire and promoting bowel movements， clearing heat from the upper body and purging the lower body， and the main syndromes included facial redness， tongue swelling， red eyes， etc. In modern applications， the formula is primarily used for respiratory and digestive system diseases， including acute lung injury， chronic obstructive pulmonary disease， herpetic angina and aphthous stomatitis， covering 142 types of diseases. In summary， this paper can provide a basis for further research and development of Lianggesan through the literature review and key information combing.

AIM: To investigate the effect of intravitreal injection of recombinant tissue plasminogen activator(r-TPA)before pars plana vitrectomy(PPV)on surgical outcomes in patients with rupture of the globe(RG).METHODS: A retrospective study was conducted on 37 patients(37 eyes)with RG who underwent PPV 7-10 d after Stage Ⅰ suturing and stabilization at our hospital between April 2020 and November 2023. Based on whether an intravitreal r-TPA injection was administered 1 d before PPV, patients were divided into two groups, with 14 cases(14 eyes)in pre-operative r-TPA injection group, and 23 cases(23 eyes)in control group without pre-operative r-TPA injection. The intraoperative retinal reattachment rate, intraoperative silicone oil application, postoperative intraocular rebleeding, postoperative hypotony, and best-corrected visual acuity(BCVA)were compared between the two groups.RESULTS: The baseline characteristics were comparable between the two groups(P>0.05). Significant differences were found between the two groups in the intraoperative retinal reattachment rate, the volume of silicone oil injected, and the proportion of BCVA(all P<0.05). No statistically significant differences were observed in the intraoperative silicone oil tamponade rate, postoperative intraocular rebleeding, or postoperative hypotony rates(all P>0.05).CONCLUSION: RG patients who received an intravitreal r-TPA injection 1 d before PPV demonstrated significantly higher intraoperative retinal reattachment rates and better postoperative visual acuity outcomes.