A case of an adult patient who was admitted to the hospital with the primary complaint of dysuria was presented. CT imaging of the urinary tract revealed incomplete duplication of the bladder, accompanied by multiple diverticula in the left bladder. Urodynamic studies indicated low detrusor contraction of the bladder. Cystoscopy revealed that the left bladder was connected to the urethra, with both bladders linked by a narrow connection. Laparoscopic expansion of this junction alleviated dysuria; however, it did not significantly reduce bladder residual volume during the short-term follow-up.

Objective:To investigate the effect of exosomes from lung cancer cells on the ability of lung cancer metastasis in-duced by M2 macrophages.Methods:The exosomes secreted by 16HBE,A549 and H522(16HBE exo,A549 exo,H522 exo)were extracted and identified.M0 macrophages co-incubated with 10 μg/ml 16HBE exo,A549 exo,H522 exo,PBS(16HBE exo group,A549 exo group,H522 exo group,PBS group),the expressions of Arginase-1,CD206,CD163,TGF-β,iNOS,and IL-1β in macro-phages in each group were detected by qRT-PCR,the proportion of CD206+CD163+macrophages was detected by flow cytometry,the phosphorylation levels of ERK1/2 and STAT3 in macrophages were detected by Western blot.A549 and H522 cells were co-incubated with macrophages in the above groups(16HBE exo+M0 group,A549 exo+M0 group,H522 exo+M0 group,PBS+M0 group),and the migration and invasive ability of A549 and H522 cells in each group were detected by Transwell chamber method.Results:Compared with PBS group,the expressions of Arginase-1,CD206,CD163 and TGF-β in macrophages in A549 exo group and H522 exo group were significantly up-regulated(P<0.001),and the expressions of iNOS and IL-1β were significantly down-regulated(P<0.001).The proportion of CD206+CD163+macrophages was increased significantly(P<0.001),and the phosphorylation levels of ERK1/2 and STAT3 were increased significantly(P<0.001).There was no significant difference in the above indicators between the 16HBE exo group and the PBS group(P>0.05).The migration ablility and invasion ablility of A549 and H522 cells in A549 exo+M0 group and H522 exo+M0 group were significantly increased(P<0.001).Conclusion:Lung cancer cell exosomes can induce the polarization of M2 macrophages by activating the ERK1/2/STAT3 signaling pathway to promote tumor migration and invasion.

A case of an adult patient who was admitted to the hospital with the primary complaint of dysuria was presented. CT imaging of the urinary tract revealed incomplete duplication of the bladder, accompanied by multiple diverticula in the left bladder. Urodynamic studies indicated low detrusor contraction of the bladder. Cystoscopy revealed that the left bladder was connected to the urethra, with both bladders linked by a narrow connection. Laparoscopic expansion of this junction alleviated dysuria; however, it did not significantly reduce bladder residual volume during the short-term follow-up.

N6-methyladenosine (m6A) modification, as a widespread and high-profile type of epigenetic modification, can dynamically and reversibly regulate the whole process of RNA metabolism. This modification governs RNA stability, splicing, and translation via m6A regulators, which are categorized as Writers, Erasers, and Readers. m6A modification also plays a critical role in the development of tumors. Disruptions in the homeostasis of m6A modification levels lead to dysregulation of m6A regulators. Consequently, these dysregulated regulators modulate the proliferation, migration, and invasion of tumor cells and interfere with the normal functions of suppressor genes and oncogenes. This article aims to comprehensively elucidate the specific regulatory impacts of m6A modification on tumor-related gene expression. It focuses on the regulatory mechanisms of m6A modification on mRNA stability. Additionally, it explores the influence of m6A on the molecular translation of key signaling pathways. Moreover, it investigates the indirect regulatory effects mediated by non-coding RNAs (ncRNAs), etc. The intention is to offer a novel analysis of the pathogenesis of cancer at a new level, and also provide a theoretical basis for finding new effective treatment methods.

Objective:To explore the clinical effect of treating complex talar neck fractures with double-column fixation using plates and cannulated screws.Methods:A retrospective analysis was performed on the data of 13 patients with complex talar neck fractures treated with double-column fixation using plates and cannulated screws at Tianjin Hospital, Tianjin University from June 2019 to November 2023. There were 9 males and 4 females, with an age of 42.1±17.7 years (range, 15-66 years). There were 5 cases on the left and 8 cases on the right. Four cases were caused by traffic accidents, 8 by falling from a height, and 1 by a heavy object injury. According to the Hawkins classification, there were 12 cases of type II and 1 case of type III talar neck fractures. All the fractures were comminuted, including 12 cases of talar neck combined with talar body, and 3 cases combined with subluxation of subtalar joint. The time from injury to surgery was 3.3±1.6 d (range, 1-6 d). All patients were treated with anteromedial combined anterolateral approach, plate and cannulated screw double-column fixation pattern. The healing time of fractures and the occurrence of complications were recorded. Postoperative anteroposterior and lateral X-ray images were taken to assess the quality of fracture reduction based on the presence or absence of step-offs and angulation after reduction of fractures at the neck or body of the talus. The functional outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results:All 13 patients were followed up for 33.8±15.2 months (range, 12-53 months). All fractures healed, and the healing time was 17.2±2.8 weeks (range, 13-23 weeks). Postoperative X-ray evaluation showed that 10 cases had anatomical reduction and 3 cases had near-anatomical reduction. After operation, there was no loosening or breakage of implant, loss of fracture reduction, irritation of skin and soft tissue by internal fixation. The AOFAS score was 88.1±13.0 points (range, 48-100 points), with 9 excellent cases, 3 good cases, and 1 poor case. Superficial skin necrosis in one surgical incision healed after dressing exchange. At the 1-year follow-up after surgery, 1 case developed avascular necrosis of the talus without collapse. And at the last follow-up (postoperative 13 to 53 months), 5 cases developed post-traumatic arthritis.Conclusion:Plate and cannulated screw double-column fixation in the treatment of complex talar neck fractures can achieve satisfactory reduction and strong fixation effects, which is beneficial in reducing complications related to poor reduction.

Talar fractures are difficult to treat clinically, and complications such as traumatic arthritis and osteonecrosis often occur after surgery, which seriously affects the foot and ankle function of patients. At present, the treatment options of talus fractures include surgical treatment and conservative treatment, while the surgical treatment is mainly open reduction and internal fixation. There are many options for internal fixation, including Kirschner wires, cannulated screws, and absorbable screws. Although these internal fixations have shown good results in the treatment of simple fractures, they have been less effective when applied to complex, comminuted talar fractures. With the continuous development of technology, plate internal fixation has been gradually used in the treatment of talus fractures. Internal plate fixation can better achieve accurate fracture reduction and maintain stability after reduction, thus reducing the occurrence of osteonecrosis and malunion. Although there is no significant difference in stiffness, yield point and loading between plate fixation and conventional screw fixation, it has a better reduction effect, maintains anatomical reduction, resists collapse and shortening, and is more advantageous in fixing complex comminuted fractures. For patients with severe fracture collapse and combined bone defects requiring bone grafting, plate fixation in the bone graft area can prevent displacement and rotation of the graft. In the treatment of talar body fractures with plate internal fixation, internal and external bilateral approaches are often selected, which can obtain a broad surgical field and is conducive to fracture reduction. At present, there is no unified standard for the placement of plate for internal fixation of talar neck fractures. Clinicians need to comprehensively evaluate the severity and injury mechanism of talar fractures to formulate reasonable and effective surgical strategies.

Objective To investigate the predictive value of quantitative parameters of contrast-enhanced ultrasound (CEUS) in evaluating kidneys from donation after brain death (DBD) for the occurrence of delayed graft function (DGF) in recipients. Methods The clinical data of 134 DBD donors and 202 corresponding kidneys and recipients were retrospective analyzed. The recipients were divided into DGF group (n=39) and non-DGF group (n=163) according to the renal function after kidney transplantation. Conventional ultrasound, CEUS parameters, and clinical data were compared between the two groups. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values for predicting DGF using CEUS parameters, clinical parameters, and their combination, based on the highest Youden index. The predictive ability of different parameters for DGF was evaluated. Results There were statistically significant differences in cortical peak intensity (PIc), medullary peak intensity (PIm), donor albumin (ALB), serum creatinine (Scr) after admission, and the Na⁺ concentration of recipients between the two groups (all P<0.05). The area under the curve (AUC) for predicting DGF using the combination of CEUS parameters PIc and PIm was 0.711, with an optimal cut-off value of 0.193 and a Youden index of 0.382. The AUC for predicting DGF using the combination of CEUS parameters PIc, PIm and clinical parameters was 0.808, with an optimal cut-off value of 0.191 and a Youden index of 0.517. The sensitivity and specificity were 0.769 and 0.613 for the former, and 0.769 and 0.748 for the latter, respectively. The AUC for predicting DGF using CEUS parameters PIc and PIm combined with clinical parameters was significantly higher than that using CEUS parameters PIc and PIm (P<0.05). Conclusions The CEUS quantitative parameters PIc and PIm have good predictive value in assessing kidneys from DBD donors for DGF in recipients, and the diagnostic efficacy is better when combined with clinical parameters.

Objective:To explore the clinical effect of treating complex talar neck fractures with double-column fixation using plates and cannulated screws.Methods:A retrospective analysis was performed on the data of 13 patients with complex talar neck fractures treated with double-column fixation using plates and cannulated screws at Tianjin Hospital, Tianjin University from June 2019 to November 2023. There were 9 males and 4 females, with an age of 42.1±17.7 years (range, 15-66 years). There were 5 cases on the left and 8 cases on the right. Four cases were caused by traffic accidents, 8 by falling from a height, and 1 by a heavy object injury. According to the Hawkins classification, there were 12 cases of type II and 1 case of type III talar neck fractures. All the fractures were comminuted, including 12 cases of talar neck combined with talar body, and 3 cases combined with subluxation of subtalar joint. The time from injury to surgery was 3.3±1.6 d (range, 1-6 d). All patients were treated with anteromedial combined anterolateral approach, plate and cannulated screw double-column fixation pattern. The healing time of fractures and the occurrence of complications were recorded. Postoperative anteroposterior and lateral X-ray images were taken to assess the quality of fracture reduction based on the presence or absence of step-offs and angulation after reduction of fractures at the neck or body of the talus. The functional outcome was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results:All 13 patients were followed up for 33.8±15.2 months (range, 12-53 months). All fractures healed, and the healing time was 17.2±2.8 weeks (range, 13-23 weeks). Postoperative X-ray evaluation showed that 10 cases had anatomical reduction and 3 cases had near-anatomical reduction. After operation, there was no loosening or breakage of implant, loss of fracture reduction, irritation of skin and soft tissue by internal fixation. The AOFAS score was 88.1±13.0 points (range, 48-100 points), with 9 excellent cases, 3 good cases, and 1 poor case. Superficial skin necrosis in one surgical incision healed after dressing exchange. At the 1-year follow-up after surgery, 1 case developed avascular necrosis of the talus without collapse. And at the last follow-up (postoperative 13 to 53 months), 5 cases developed post-traumatic arthritis.Conclusion:Plate and cannulated screw double-column fixation in the treatment of complex talar neck fractures can achieve satisfactory reduction and strong fixation effects, which is beneficial in reducing complications related to poor reduction.

Talar fractures are difficult to treat clinically, and complications such as traumatic arthritis and osteonecrosis often occur after surgery, which seriously affects the foot and ankle function of patients. At present, the treatment options of talus fractures include surgical treatment and conservative treatment, while the surgical treatment is mainly open reduction and internal fixation. There are many options for internal fixation, including Kirschner wires, cannulated screws, and absorbable screws. Although these internal fixations have shown good results in the treatment of simple fractures, they have been less effective when applied to complex, comminuted talar fractures. With the continuous development of technology, plate internal fixation has been gradually used in the treatment of talus fractures. Internal plate fixation can better achieve accurate fracture reduction and maintain stability after reduction, thus reducing the occurrence of osteonecrosis and malunion. Although there is no significant difference in stiffness, yield point and loading between plate fixation and conventional screw fixation, it has a better reduction effect, maintains anatomical reduction, resists collapse and shortening, and is more advantageous in fixing complex comminuted fractures. For patients with severe fracture collapse and combined bone defects requiring bone grafting, plate fixation in the bone graft area can prevent displacement and rotation of the graft. In the treatment of talar body fractures with plate internal fixation, internal and external bilateral approaches are often selected, which can obtain a broad surgical field and is conducive to fracture reduction. At present, there is no unified standard for the placement of plate for internal fixation of talar neck fractures. Clinicians need to comprehensively evaluate the severity and injury mechanism of talar fractures to formulate reasonable and effective surgical strategies.

N6-methyladenosine (m6A) modification, as a widespread and high-profile type of epigenetic modification, can dynamically and reversibly regulate the whole process of RNA metabolism. This modification governs RNA stability, splicing, and translation via m6A regulators, which are categorized as Writers, Erasers, and Readers. m6A modification also plays a critical role in the development of tumors. Disruptions in the homeostasis of m6A modification levels lead to dysregulation of m6A regulators. Consequently, these dysregulated regulators modulate the proliferation, migration, and invasion of tumor cells and interfere with the normal functions of suppressor genes and oncogenes. This article aims to comprehensively elucidate the specific regulatory impacts of m6A modification on tumor-related gene expression. It focuses on the regulatory mechanisms of m6A modification on mRNA stability. Additionally, it explores the influence of m6A on the molecular translation of key signaling pathways. Moreover, it investigates the indirect regulatory effects mediated by non-coding RNAs (ncRNAs), etc. The intention is to offer a novel analysis of the pathogenesis of cancer at a new level, and also provide a theoretical basis for finding new effective treatment methods.