ObjectiveTo reveal the molecular mechanism by which the traditional Chinese medicine compound prescription Qiangjing tablets regulate the aging of the testicular tissue and Leydig cells in rats through the cyclin-dependent kinase 4 （CDK4）-early 2 factor （E2F） signaling pathway. MethodsFor the cell experiment， 2-month-old SPF-grade SD male rats were selected and randomly assigned into a blank control group （administrated with an equal volume of 0.9% sodium chloride injection） and a Qiangjing tablets group （20 rats in each group） according to body weight. The Leydig cell model of aging was established by treatment of TM3 cells with 100 μmol·L^-1 H₂O₂， and the modeling performance was evaluated based on the levels of p16 and p21 determined by Western blot. The antioxidant NAC （1 mmol·L^-1） was used as the positive control for eliminating reactive oxygen species （ROS）. Cells were intervened with Qiangjing tablets-containing serum at low （2.5%）， medium （5%）， and high （10%） concentrations. The testosterone level in the cell supernatant was determined by enzyme-linked immunosorbent assay （ELISA）， and the protein levels of CDK4， E2F1， and E2F2 were analyzed by Western blot. In the animal experiment， 19-month-old naturally aging rats were used as the model group， and 2-month-old rats as the young control group. The positive control group was subcutaneously injected with 5.21 mg·kg^-1·d^-1 testosterone propionate. Qiangjing tablets were administered by gavage at low， medium， and high doses of 0.72， 1.44， 2.88 g·kg^-1·d^-1， respectively. The general conditions of rats were observed， and the protein levels of CDK4， E2F1， and E2F2 in the testicular tissue were determined by Western blot. ResultsIn the cell experiment， compared with the blank control group， the model group showed upregulated expression of CDK4 and E2F1 （P<0.05） and slightly downregulated expression of E2F2. Compared with that in the model group， the expression of CDK4 was upregulated in the NAC group and the low-dose Qiangjing tablets group （P<0.05）， slightly upregulated in the medium-dose Qiangjing tablets group， and downregulated in the high-dose Qiangjing tablets group （P<0.05）. The NAC group showed downregulated expression of E2F1 （P<0.05） and E2F2， and the low-， medium-， and high-dose Qiangjing tablets groups showed downregulated expression of both E2F1 and E2F2 （P<0.05）. Compared with that in the NAC group， the expression of CDK4 was upregulated in the low-dose Qiangjing tablets group and downregulated in the medium-dose and high dose （P<0.05） groups. The expression of E2F1 was down-regulated in all the three dose groups， with statistically significance in the high dose group （P<0.05）， and that of E2F2 were downregulated in all the three dose groups （P<0.05）. In the animal experiment， compared with the young control group， the model group exhibited downregulated expression of CDK4 （P<0.05） and slightly upregulated expression of E2F1 and E2F2. Compared with that in the model group， the expression of CDK4 decreased in the testosterone propionate group and the low-dose Qiangjing tablets group （P<0.05） but increased in the medium-dose （P<0.05） and high-dose groups. In addition， the expression of E2F1 decreased （P<0.05）， and that of E2F2 was slightly elevated. Compared with that in the NAC group， CDK4 expression was elevated in the Qiangjing tablets groups， with statistical significance in the medium- and high-dose groups （P<0.05）. Similarly， the E2F1 expression was also upregulated in the Qiangjing tablets groups， with statistical significance in the medium-dose group （P<0.05）. The expression of E2F2 was downregulated in all the Qiangjing tablets groups. ConclusionQiangjing tablets delay the aging process of Leydig cells and testicular tissue by up-regulating the expression of CDK4 and lowering the levels of E2F1 and E2F2.

Objective To explore the clinical value of subcutaneous tunneling in the management of chronic subdural hematoma.Methods A retrospective analysis was conducted on 279 cases of unilateral chronic subdural hematoma treated at the Neurosurgery Department of The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to December 2019.The patients were randomly assigned to subcutaneous tunnel group(n=164)and control group(n=115)through double-blind randomization.In the subcutaneous tunnel group,the intraoperative drainage tube was extracted through a subcutaneous tunnel,while in the control group,the drainage tube was removed directly from the incision.We analyzed the hematoma clearance rate,complications,and hematoma recurrence rate after 6 months.Results There was no statistical significance in age,sex,comorbidities,hematoma side or hematoma volume between the two groups(P＞0.05).Subcutaneous tunnel group and control group did not significantly differ in operation time[(27.68±4.1)min vs.(27.50±4.02)min],hospital stay[(7.39±1.04)d vs.(7.42±1.04)d],tube removal time[(24.30±4.82)h vs.25.37±5.02)h],or other clinical features(all P＞0.05).The clearance rate of hematoma was significantly higher in subcutaneous tunnel group than in control group(97.6％vs.95.7％,Z=-3.897,P＜0.001).There were 6 cases(3.7％)of hematoma recurrence in the subcutaneous tunnel group and 11 cases(9.6％)in the control group.The subcutaneous tunnel group had significantly lower recurrence of hematoma than the control group(x2=4.122,P=0.042).Conclusion Subcutaneous tunneling for drainage in the treatment of chronic subdural hematoma can increase the hematoma clearance rate and reduce the rates of complications and recurrence.This technique is simple and worthy of broad clinical application.

Objective : To investigate the diagnostic value of linear array endoscopic ultrasonography ( EUS) for common bile duct microlithiasis． Methods : Data of patients who attended in the hospital and diagnosed as common bile duct microlithiasis and biliary sludge by EUS were selected．A total of 85 patients with magnetic resonance cholangiopancreatography ( MRCP) examination and ERCP treatment during hospitalization were enrolled．The results of endoscopic retrograde cholangiopancreatography / endoscopic sphincterotomy ( ERCP / EST) were the gold standard for diagnosis．The results of EUS，MRCP，and diagnostic ERCP were compared with the gold standard， and the sensitivity，specificity，positive predictive value，negative predictive value，and diagnostic accuracy of the three methods were calculated，respectively．The chi-square test was used for comparison of the above indices． Results : Of all 85 patients，63 had positive EUS results，among whom 5 had false positive results; 22 had negative EUS results，among whom 1 had false negative results．Of all 85 patients，49 had positive MRCP results，among whom 4 had false positive results; 36 had negative MRCP results，among whom 14 had false negative results．Of all 85 patients，59 had positive diagnostic ERCP results，among whom 10 had false positive results; 26 had negative diagnostic ERCP results，among whom 10 had false negative results．The sensitivity，specificity，positive predictive value( PPV) ，negative predictive value ( NPV) ，and accuracy of EUS in diagnosing common bile duct microlithia- sis were 98. 3% ，80. 8% ，92. 1% ，95. 4% and 92. 9% ，respectively． For MRCP，these values were 76. 3% ， 84. 6% ，91. 8% ，61. 1% and 78. 8% ，respectively．For diagnostic ERCP，these values were 83. 1% ，61. 5% ， 83. 1% ，61. 5% and 76. 5% ，respectively．The EUS group had a significantly higher accuracy than the MRCP group ( χ2 = 6. 986，P ＜0. 05) and diagnostic ERCP group ( χ2 = 8. 900，P ＜0. 05) ．The areas under the ROC curves ( AUC) and 95% CI of EUS group，MRCP group and diagnostic ERCP were 0. 895 ( 95% CI: 0. 802 - 0. 988，P＜0. 001) ，0. 804 ( 95% CI: 0. 702 －0. 907，P ＜0. 001) and 0. 723 ( 95% CI: 0. 598 －0. 848，P = 0. 001) ，respectively． Conclusion EUS has a high diagnostic value in the diagnosis of common bile duct microli- thiasis and thus can be used as the preferred examination before therapeutic ERCP．

Robotic surgical systems, with advantages such as 3D visualization, rotating instruments, and stable imaging, are increasingly utilized in transabdominal and transanal approaches for rectal cancer surgery. Compared to traditional laparoscopy, robotic systems could educe the technical difficulty of total mesorectal excision (TME) and enhance pelvic autonomic nerve preservation, while demonstrating comparable long-term outcomes. However, the high cost and limited clinical benefits have led to reflection. Controversies persist regarding prolonged operative time, lack of haptic feedback and limited cost-effectiveness. Studies suggest robotic surgery may benefit patients with complex conditions such as obesity, narrow pelvis or low rectal tumors. The rapid development of domestic surgical robots is expected to break market monopolies, reduce costs and expand applications through telemedicine. Future efforts should focus on identifying optimal patient cohorts and generating high-quality evidence to refine the clinical utility of robotic surgery.

Robotic surgical systems, with advantages such as 3D visualization, rotating instruments, and stable imaging, are increasingly utilized in transabdominal and transanal approaches for rectal cancer surgery. Compared to traditional laparoscopy, robotic systems could educe the technical difficulty of total mesorectal excision (TME) and enhance pelvic autonomic nerve preservation, while demonstrating comparable long-term outcomes. However, the high cost and limited clinical benefits have led to reflection. Controversies persist regarding prolonged operative time, lack of haptic feedback and limited cost-effectiveness. Studies suggest robotic surgery may benefit patients with complex conditions such as obesity, narrow pelvis or low rectal tumors. The rapid development of domestic surgical robots is expected to break market monopolies, reduce costs and expand applications through telemedicine. Future efforts should focus on identifying optimal patient cohorts and generating high-quality evidence to refine the clinical utility of robotic surgery.

Objective:To investigate the prenatal echocardiographic features of fetuses diagnosed with Ebstein anomaly (EA), identify prognostic factors affect the fetal and neonatal mortality, and evaluate the clinical value of the Simpson Andrews Sharland prognostic score (SAS prognostic score).Methods:A retrospective cohort study was conducted on 37 fetuses diagnosed with EA via prenatal and postnatal echocardiography at Guangdong Provincial People′s Hospital from June 2012 to June 2024. The echocardiographic features of EA patients were summarized. According to the patients′ survival statuses during the fetal and neonatal periods, they were divided into survival group and death group for a comparative analysis of key echocardiographic parameters, as well as SAS prognostic score. Also, receiver operator characteristic (ROC) curve was employed to assess the predictive abilities of various indicators. Finally, based on the medium-and long-term prognostic outcomes of EA cases, the predictive value of the SAS system was evaluated. The t test, Mann-Whitney U test, and Fisher exact test were used for group comparison. Results:Regarding the 37 EA cases, the gestational age at the initial diagnosis was (29±4) weeks. All of EA fetuses exhibited echocardiographic characterized by tricuspid regurgitation (TR) originating below the native tricuspid annulus with the severity varied, accompanied by manifestations such as right atrial enlargement. Of all cases, 5 cases (14%) died prenatally, and 32 cases (86%) were born alive. Postnatally, 4 cases died preoperatively, 1 case died postoperatively, and 27 cases survived. Compared with the survival group, the death group had a significantly higher average SAS prognostic score (6.9±1.1 vs. 2.0±1.5, t=9.17, P<0.001), right atrium (RA) to left atrium (LA) transverse diameter ratio (2.0±0.5 vs. 1.3±0.2, t=4.87, P=0.001) and TR area to RA area ratio (0.8±0.2 vs. 0.4±0.2, t=5.27, P<0.001). According to the ROC analysis, the optimal predictive value indicators are RA to LA transverse diameter ratio (AUC=0.93, 95% CI 0.81-1.00) and the TR area-to-RA area ratio (AUC=0.93, 95% CI 0.85-1.00); the optimal cut-point values were 1.5 and 0.5, respectively. Of 32 born alive cases, 21 cases (66%) didn′t undergo surgery, 2 cases (6%) underwent bidirectional Glenn surgery, and one case (3%) underwent tricuspid valvuloplasty. All 17 cases with SAS score≤2 survived, while all 9 cases with SAS score≥6 died. Among the 11 cases with a score from 3 to 5, 8 cases achieved a biventricular outcome. Conclusions:The typical echocardiographic feature of EA fetuses is that the originating point of TR is below the native tricuspid annulus and the severity can vary. The SAS score is essential for tiered prognosis. When the SAS is 3-5, dynamic monitoring for TR and RA enlargement should be employed to help guide prenatal intervention and reduce fetal and neonatal mortality.

Objective:To explore the clinical effectiveness of Masquelet technique combined with improved bone grafting in the treatment of open tibial fractures of Gustilo-Anderson ⅢB with segmental bone defects.Methods:A retrospective study was conducted to analyze the clinical data of 13 patients with open tibial fracture of Gustilo-Anderson ⅢB with segmental bone defects who had been admitted to Department of Orthopeadics, Xijing Hospital, Air Force Medical University from January 2021 to May 2023. There were 9 males and 4 females with an age of (36.9±9.3) years. The length of tibial defects after debridement was (8.1±2.8) cm, and the area of soft-tissue defects 95.0 (53.6, 202.0) cm 2. At the first stage, Masquelet technique was used, soft-tissue defects were covered simultaneously or step by step, skin grafting was conducted on the donor site surface simultaneously, and survival of the tissue and skin grafts was observed. At the second stage, intramedullary space occupation with bone cement rods was conducted using improved bone grafting for which iliac bone, artificial bone, platelet rich plasma (PRP), and recombinant human bone morphogenetic protein-2 (rhBMP-2) were mixed; internal fixation was replaced. The interval between 2 stages of surgery was 4 to 7 weeks. The occurrence of infection, bone defect healing time, knee Lysholm score, ankle Mazur score, and knee and ankle ranges of motion at the last follow-up were recorded. The knee and ankle function scores before the second stage bone grafting and at the last follow-up were compared. Results:After the first-stage surgery, all the 13 patients did not need any revision with fine wound healing. After the second-stage surgery, all patients were followed up for (14.9±4.4) months with no infection at all. The healing time for bone defects was 8.0 (6.0, 12.0) months. At the last follow-up, the knee Lysholm score and the ankle Mazur score were (77.2±5.2) points and (76.1±10.9) points respectively, significantly different from those before the second-stage bone grafting [(41.3±7.5) points and (37.4±5.2) points] ( P<0.05). In the 13 patients at the last follow-up, ankle dorsiflexion limitation was 5.0° (0, 10.0°), knee flexion 105.0°±9.6°, and knee extension limitation 5.0° (5.0°, 5.0°). Conclusion:In the treatment of open tibial fractures of Gustilo-Anderson ⅢB with segmental bone defects, Masquelet technique combined with improved bone grafting can effectively prevent infection, repair bone defects, and restore the function of lower extremities, leading to definite curative efficacy.

Liver cirrhosis as the terminal stage of chronic liver disease has seen many new insights and advances in its treatment strategies and perspectives in recent years. However, there are still many controversies about cirrhotic portal hypertension management, prevention, therapy, and complications. This article summarizes the main key controversial points in the current treatment of liver cirrhosis from an evidence-based medicine perspective, including the use of non-selective β-blockers during decompensated stages, exploration of precise strategies for albumin, re-evaluation of the risks of statins, weighing the pros and cons of proton pump inhibitors, new understandings of anticoagulation therapy, breakthroughs in targeting gut microbiota, and nutritional support management. In addition, it combines the latest research data and guideline recommendations to explore future development directions so as to provide clinical practice reference.

Objective To investigate the effects and underlying mechanisms of a spray prepared from exosomes derived from M2 macrophages induced by interleukin-4 （IL-4） and tantalum particles （Ta） on the healing of pressure ulcers. Methods Bone marrow-derived macrophages were polarized into M2 macrophages using IL-4 or Ta, and exosomes （Exo-IL-4/Exo-Ta） were extracted. The regulatory effects of Exo-IL-4/Exo-Ta on M1 macrophage phenotypes and fibroblast matrix secretion were evaluated in vitro. Proteomic analysis was conducted to explore the biological processes and regulatory networks associated with Exo-Ta. A rat pressure ulcer model was used to assess the effects of Exo-IL-4/Exo-Ta spray on wound healing rate, inflammatory cell infiltration, and collagen deposition. Results In vitro, Exo-IL-4/Exo-Ta induced the polarization of M1 macrophages to M2 macrophages, reduced the secretion of pro-inflammatory factors, and promoted the expression of anti-inflammatory substances. Additionally, Exo-IL-4/Exo-Ta enhanced the production of collagen and fibronectin in fibroblasts. Proteomic analysis revealed that Exo-Ta primarily participated in biological processes such as energy metabolism and macromolecule biosynthesis. In vivo, Exo-IL-4/Exo-Ta spray accelerated wound healing, reduced inflammatory infiltration, and improved tissue remodeling in the rat pressure ulcer model. Conclusion Exosome sprays derived from M2 macrophages could accelerate pressure ulcer healing by modulating inflammation and promoting tissue regeneration, which demonstrated excellent clinical application potential.

[This corrects the article DOI: 10.1016/j.apsb.2019.01.013.].