Objective:To explore the activation characteristics and synergistic mode of lumbar and abdominal core muscle group during abdominal breathing training.Method:Thirty-two healthy college students were recruited and randomly divided into the control group and the experimental group with 16 cases in each group.The control group received stan-pile training,while the experimental group received abdominal breathing and stan-pile training 5 times a week for 8 weeks.The sur-face electromyography of the lumbar and abdominal core muscles was collected before and after the interven-tion.Non-negative matrix factorization(NMF)was used to extract extract muscle synergy patterns from the EMG data.Result:In terms of cooperative elements,the number of cooperative elements increased after intervention in both groups compared with baseline,but there was no significant difference in the number of cooperative ele-ments between the two groups before intervention(P>0.05),and there was a significant difference in the num-ber of cooperative elements after intervention(P<0.05).In terms of cooperative patterns,the cooperative pat-terns before intervention in the two groups were similar.After intervention,the cooperative patterns in the two groups were different,the control group showed coactivation of the right transversus abdominis,left internal oblique,right erector spinae,and bilateral multifidus throughout the breathing cycle.In contrast,the experimen-tal group exhibited pronounced activation of bilateral erector spinae and multifidus during inhalation,and bilater-al transversus abdominis,left external oblique,and left erector spinae during exhalation.The activation curves before intervention in the two groups were similar,and the activation curves after intervention in the two groups trended towards slowing down,with the time feature of the activation curve in the experimental group being more obvious.Conclusion:Abdominal breathing training can increase the number of cooperative tuples of the waist and abdo-men muscles,and the muscles perform efficient division of labor after training to form an adaptive coopera-tive mode.

Objective:To explore the activation characteristics and synergistic mode of lumbar and abdominal core muscle group during abdominal breathing training.Method:Thirty-two healthy college students were recruited and randomly divided into the control group and the experimental group with 16 cases in each group.The control group received stan-pile training,while the experimental group received abdominal breathing and stan-pile training 5 times a week for 8 weeks.The sur-face electromyography of the lumbar and abdominal core muscles was collected before and after the interven-tion.Non-negative matrix factorization(NMF)was used to extract extract muscle synergy patterns from the EMG data.Result:In terms of cooperative elements,the number of cooperative elements increased after intervention in both groups compared with baseline,but there was no significant difference in the number of cooperative ele-ments between the two groups before intervention(P>0.05),and there was a significant difference in the num-ber of cooperative elements after intervention(P<0.05).In terms of cooperative patterns,the cooperative pat-terns before intervention in the two groups were similar.After intervention,the cooperative patterns in the two groups were different,the control group showed coactivation of the right transversus abdominis,left internal oblique,right erector spinae,and bilateral multifidus throughout the breathing cycle.In contrast,the experimen-tal group exhibited pronounced activation of bilateral erector spinae and multifidus during inhalation,and bilater-al transversus abdominis,left external oblique,and left erector spinae during exhalation.The activation curves before intervention in the two groups were similar,and the activation curves after intervention in the two groups trended towards slowing down,with the time feature of the activation curve in the experimental group being more obvious.Conclusion:Abdominal breathing training can increase the number of cooperative tuples of the waist and abdo-men muscles,and the muscles perform efficient division of labor after training to form an adaptive coopera-tive mode.

Objective: To construct and validate a prognosis model related to ferroptosis in urinary tract tumors using bioinformatics methods. Methods: RNA-seq and clinical data from TCGA′s BLCA and KIRC datasets were analyzed to establish the prognostic model, and then were validated using ICGC and GEO data. Prognostic genes associated with ferroptosis were identified through univariate Cox, LASSO-Cox, and multivariate Cox regression analyses. Co-expression and protein-protein interaction(PPI) network analyses determined the relationships among these genes. Immune infiltration analysis explored the association between ferroptosis-related prognostic genes and the immune microenvironment. Functional enrichment analysis of differentially expressed genes between high and low-risk groups in BLCA and KIRC prognostic models was conducted to investigate potential mechanisms by which ferroptosis-related genes regulate BLCA and KIRC prognosis. Results: Significant prognostic gene signatures associated with ferroptosis were identified in BLCA and KIRC. For BLCA, the genes EGR1, ZEB1, P4HB, WWTR1, JUN, CDO1,SCD,SREBF1,CAV1, and GALNT14 were significant. For KIRC, the genes ASMTL-AS1, CHAC1,MT1G, RRM2, TIMP1, DPEP1, GLRX5, and NDRG1 were significant. Ferroptosis-related miRNAs linked to the prognosis of both cancers were also identified. The constructed risk models based on these genes and miRNAs predicted patient prognosis in TCGA-BLCA and KIRC, with low-risk groups showing significantly higher overall survival(P<0.05). The hazard ratios for these models ranged from 2.54(95%CI: 1.73-3.74) to 4.74(95%CI: 3.47-6.47), with AUC values above 0.60. Co-expression analysis and PPI networks revealed high correlation levels between JUN and EGR1 in BLAC and between SCD and SREBF1. Immune infiltration analysis indicated positive correlations between EGR1, CAV1, JUN, and immune scores, while SREBF1 showed a negative correlation. Conclusion The prognosis model based on ferroptosis-related genes effectively predicts patient outcomes in BLCA and KIRC. This model can serve as a reference for targeting ferroptosis to assess the prognosis of BLCA and KIRC patients.

Background and purpose:With the aging population,the number of elderly patients with colorectal cancer(CRC)is increasing.To date,elderly patients with stage Ⅱ CRC often receive a weakened chemotherapy regimen or even no chemotherapy after radical surgery,and It is still unclear whether this will lead to adverse oncological outcomes.This study aimed to explore the prognostic impact of advanced age on stage Ⅱ CRC patients after removing bias through a multivariate COX regression approach.Methods:We retrospectively collected data of 3314 colorectal cancer patients with postoperative pathology of stage Ⅱ,no history of previous tumors,no secondary primary tumors within 5 years after surgery and no preoperative neoadjuvant therapy.This study was reviewed by the medical ethics committee of Fudan University Shanghai Cancer Center(ethics number:050432-4-2108*).The optimal threshold for calculating age relative to survival using survminer package of R software(version 3.0)(surv_cutpoint algorithm)was 73 years.We compared the clinical and pathological characteristics,overall survival(OS)and disease-free survival(DFS)between the older group(age＞73 years)and the younger group(age≤73 years).The alignment diagram prediction model was drawn using the survival package and RMS package.Results:The elderly and non-elderly groups were evenly comparable in terms of gender,tumor location,differentiation,vascular invasion,perineural invasion and pT stage.Multivariate COX regression showed that advanced age was an independent prognostic risk factor for OS[hazard ratio(HR)=3.725(3.051-4.549),P＜0.001]and DFS[HR=2.431(2.029-2.912),P＜0.001].The nomogram(alignment diagram)prediction model constructed based on multivariate COX regression could effectively evaluate the prognosis of stage Ⅱ CRC patients and provide guidance for practical clinical work.Conclusion:In stage Ⅱ CRC patients,older age is associated with shorter OS and DFS.Adequate intensity of adjuvant chemotherapy may be necessary.Treatment decisions can be adjusted based on the predicted model scores of the patient's alignment diagram.

Background and purpose:According to current consensus,adverse high-risk pathological features are only associated with adjuvant therapy for stage Ⅱ colorectal cancer(CRC).As important prognostic factors,we further explored the possibility of identifying patients with potential recurrence and poor prognosis based on these incorporating high-risk pathological features.Methods:This is a cohort study.A retrospective analysis was conducted on clinical data of CRC patients who underwent surgical treatment at the Second Department of Colorectal Surgery,Fudan University Affiliated Shanghai Cancer Center from 2008 to 2018.This study was approved by the Ethics Committee of the Fudan University Shanghai Cancer Center(approval No.:050432-4-2108*),and the study complies with the Declaration of Helsinki.A total of 9875 patients were enrolled,including 5859 males and 4016 females,aged[M(IQR)]60(16)years(range:16 to 94).Median follow-up time was 1779.0 days[95%CI:1750.1-1807.9].We used the Kaplan-Meier method to plot survival curves for different groups.Cox multivariate analysis was used to identify independent risk factors for 5-year overall survival(OS),disease-free survival(DFS)and recurrence-free survival(RFS).Finally,a column chart model was constructed to evaluate and stratify patient prognosis.The Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)checklist was followed for this cohort study.Results:According to the number of incorporating high-risk pathological features,patients were divided into five groups:Hr_0 group(0 incorporating high-risk pathological feature),Hr_1 group(1 incorporating high-risk pathological feature),Hr_2 group(2 incorporating high-risk pathological features),Hr_3 group(3 incorporating high-risk pathological features),and Hr_4 group(4 or more incorporating high-risk pathological features).The Kaplan-Meier survival curve results indicated significant differences in OS,DFS and RFS among different groups(all P<0.001).Subgroup analysis was conducted on stage Ⅱ colorectal cancer,and the survival curves of OS,DFS and RFS in different Hr groups overlapped with each other.Compared to the overall population,the survival differences in different groups were significantly reduced,indicating that stage Ⅱ colon cancer patients with incorporating high-risk pathological features may benefit from adjuvant chemotherapy.The independent prognostic factors for RFS included age,pT stage,pN stage and Hr group.The survival curves of OS,DFS and RFS indicated that the prognosis of Hr_4 group was significantly worse than that of stage Ⅲc patients;5.2%and 14.1%of stage Ⅰ and Ⅱ patients had two or more incorporating high-risk pathological features(Hr group≥2),respectively.Finally,a column chart model was constructed by incorporating the independent prognostic risk factors for CRC mentioned above.The calibration curve showed a good consistency between the actual observations and the predictions made by the nomogram,and the decision curve analysis(DCA)indicated that the model constructed in this study had good efficacy in stratifying recurrence.Conclusion:The number of incorporating high-risk pathological features is an independent prognostic factor for RFS in patients with stage Ⅰ-ⅢCRC.Combining it as a multiclass variable with age,pT and pN stage has good prognostic stratification and recurrence stratification efficacy,which is expected to guide clinical treatment.

Background and purpose:Currently,for patients with mid-to-low locally advanced rectal cancer and potentially resectable T4bM0 colon cancer,guidelines recommend neoadjuvant therapy strategies to enhance the response rate and increase the likelihood of conversion surgery.Among these patients,ypⅢ stage colorectal cancer(CRC)is assessed using the Union for International Cancer Control(UICC)/American Joint Committee on Cancer(AJCC)TNM staging system for postoperative pathological features.However,neoadjuvant therapy can lead to lymph node regression in the surgical area,resulting in an insufficient number of detected lymph nodes(less than 12),preventing classification according to conventional TNM staging.Thus,TNM staging often fails to predict the prognosis of ypⅢ patients who have undergone neoadjuvant therapy.This study aimed to evaluate the prognostic value of the positive lymph node ratio(LNR)in ypⅢ stage CRC patients treated with neoadjuvant therapy.Methods:Retrospective data was collected from ypⅢ stage CRC patients who received neoadjuvant therapy and underwent radical surgery at Fudan University Shanghai Cancer Center between 2008 and 2018.Collect clinical pathological characteristics such as age,gender,primary tumor location,tumor differentiation grade,pathological staging,and whether the patient has relapsed or died during follow-up at the time of surgery.Inclusion criteria:CRC patients who have received neoadjuvant therapy and surgery and have been confirmed to be stage Ⅲ by postoperative pathological examination.Exclusion criteria:① Preoperative imaging examination or intraoperative exploration reveals distant organ metastasis;② History of malignant tumors in the past;③ Multiple primary CRC.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(ethics number:050432-4-2108*).The R software survminer package(surv_cutpoint algorithm)was used to calculate the optimal cutoff value for LNR relative to disease-free survival(DFS),and patients were divided into low and high LNR groups accordingly.Clinical pathological characteristics and DFS were compared between the two groups.COX proportional hazards regression models were employed to identify adverse pathological features,and survival plots along with prediction models for DFS were generated using the survival and rms packages.Results:A total of 489 patients were included,comprising 289 males and 200 females,with a median age of 56 years(23-80 years)and a median follow-up time of 1 062 d.During the follow-up period,164 patients(33.5%)died.In the entire cohort,204(41.7%)patients had fewer than 12 lymph nodes detected.The optimal cutoff value for LNR was 0.29,classifying 317 patients into the low LNR group(LNR≤0.29)and 172 patients into the high LNR group(LNR＞0.29).The high LNR group exhibited shorter DFS compared to the low LNR group[hazard ratio(HR)=2.103,95%CI:1.582-2.796,P＜0.000 1].Multivariate COX regression indicated that LNR was an independent prognostic factor for DFS(HR=1.825,95%CI:1.391-2.394,P＜0.001).The inclusion of LNR in a multicategory DFS nomogram prediction model effectively assessed DFS in stage Ⅲ CRC patients who had undergone neoadjuvant therapy.Conclusion:LNR is an independent prognostic factor for ypⅢ stage CRC patients,showing good predictive power for DFS when combined with other adverse pathological features.Therefore,incorporating LNR as a supplement to TNM staging can improve the accuracy of CRC prognosis assessment.

Objective:To investigate the prognostic factors for all-cause mortality in patients with muscle-invasive bladder cancer(MIBC)with intermediate-to-high-risk primary prostate cancer.Methods:From January 2012 to October 2023,the clinical data of the patients with MIBC with intermediate-to-high-risk primary prostate cancer in Peking University Third Hospital were retrospectively analyzed.All the patients were monitored and the occurrence of all-cause death was documented as the outcome event in the prognostic study.Univariate and multivariate Cox proportional risk regression analysis models were implemented to search for independent influences on the prognosis of patients.For significant influencing factors(pathological T stage,M stage and perineural invasion of bladder cancer),survival curves were plotted before and after multifactorial Cox regression adjusting for confounding factors.Results:A total of 32 patients were included in this study.The mean age was(72.5±6.6)years;the median preoperative total prostate specific antigen(tPSA)was 6.68(2.47,6.84)μg/L;the mean preoperative creatinine was(95±36)μmol/L,and the median survival time was 65 months.The majority of the patients(87.5％)had high-grade bladder cancer,53.1％had lymphatic invasion,and 31.3％had perineural invasion.Prostate involvement was observed in 25.0％of the cases,and the positive rate of soft-tissue surgical margin was 37.5％.Multivariate Cox analysis revealed that preoperative creatinine level(HR=1.02,95％CI:1.01-1.04),pathological stage of bladder cancer T3(HR=11.58,95％CI:1.38-97.36)and T4(HR=19.53,95％CI:4.26-89.52)metastasis of bladder cancer(HR=9.44,95％CI:1.26-70.49)and perineural invasion of bladder cancer(HR=6.26,95％CI:1.39-28.27)were independent prognostic factors(P＜0.05).Survival curves with Log-rank test after adjusting for confounding factors demonstrated that bladder cancer pathology T3,T4,M1,and perineural invasion were unfavorable factors affecting the patients'survival prognosis(P＜0.05).Conclusion:Patients with MIBC with intermediate-to-high risk primary prostate cancer generally portends a poor prognosis.High preoperative serum creatinine,T3 or T4 pathological stage of bladder cancer,metastasis of bladder cancer and bladder cancer perineural invasion are poor prognostic factors for patients with MIBC with intermediate-to-high risk primary prostate cancer.

Objective To investigate the correlation of vertebral bone quality(VBQ)and paraspinal muscle changes with adjacent segment degeneration(ASD)after transforaminal lumbar interbody fusion(TLIF)through a retrospective analysis of patients who have undergone TLIF for lumbar degenerative diseases(LDD).Methods A total of 98 patients who underwent TLIF surgical treatment for LDD between January 2016 and December 2022 at Shenzhen People's Hospital were selected.Well-established follow-up imaging data were available for all subjects who were divided into two groups,the ASD group(n=43)and the non-ASD(N-ASD)group(n=55),according to whether they met the ASD evaluation criteria.Data on the basic characteristics of the patients in both groups were collected,and the relevant parameters,including VBQ and the total cross-sectional area(TCSA)and the functional cross-sectional area(FCSA)of psoas major(PM),erector spinae(ES),and multifidus(MF),were measured by magnetic resonance imaging of the lumbar spine performed preoperatively and at the last follow-up.Then,the relative fat infiltration(RFI)was calculated from the above metrics accordingly.Logistic regression analysis was conducted to investigate the risk factors for ASD.Results The incidence of ASD was 43.9％(n=43)at the final follow-up.The mean follow-up time was(27.23±4.15)months.The age,body mass index(BMI),preoperative bone mineral density(BMD),preoperative VBQ,△RFIPM,and△RFIES+MF showed significant differences between the ASD and N-ASD groups(P＜0.05).According to the results of the logistic regression analysis,BMI(odds ratio[OR]=1.450,95％confidence interval[CI]:1.081-1.945,P=0.013),preoperative VBQ(OR=6.191,95％CI:1.692-22.657,P=0.006),and △RFIES+MF(OR=1.117,95％CI:1.007-1.238,P=0.037)were independent risk factors for ASD.Conclusion The incidence of postoperative ASD in patients who have undergone TLIF for LDD was found to be associated with higher BMI,preoperative VBQ,and increased postoperative relative fat infiltration of the ES and MF muscles.Consequently,it is advisable to prioritize the intraoperative protection of the paraspinal muscles during TLIF.In the postoperative period,it is essential to strengthen exercises of the lower back muscles and to optimize bone mass and weight management,which is conducive to reducing the risk of ASD in the postoperative period.

Methods: This retrospective analysis included a total of 155 patients who underwent single-level lumbar fusion, with 81 patients in the traditional group and 74 patients in the Wiltse group (less paraspinal muscle damage). QCT was used to measure the volumetric BMD (vBMD), Hounsfield unit value, and cross-sectional area of the paraspinal muscles at the upper instrumented vertebrae (UIV), vertebrae one segment above the UIV (UIV+1), and the vertebrae one segment above the UIV+1 (UIV+2). Statistical analyses were performed. Results: No significant differences in general data were observed between the two groups (p>0.05). Strong correlations were noted between the preoperative and 1-week postoperative vBMD of each segment (p<0.01), with no significant difference between the two time points in both groups (p>0.05). Vertebral BMD loss was significantly higher in UIV+1 and UIV+2 in the traditional group than in the Wiltse group (−13.6%±19.1% vs. −4.2%±16.5%, −10.8%±20.3% vs. −0.9%±37.0%; p<0.05). However, no statistically significant difference was observed in the percent vBMD changes in the UIV segment between the two groups (37.7%±70.1% vs. 36.1%±78.7%, p>0.05). Conclusions QCT can reliably determine BMD in the instrumented spine after lumbar interbody fusion. With QCT, we found that reducing paraspinal muscle destruction through the Wiltse approach during surgery can help preserve the adjacent vertebral BMD; however, it does not help increase the BMD in the instrumented vertebrae.

Objective:To evaluate the biomechanical stability of our slot-designed compression bolt (SCB) combined with bilateral locking compression plates (LCPs) in the treatment of intra-articular distal femur fracture.Methods:In 24 adult male knee specimens treated with formalin, the femoral bony part was preserved to establish standard models of intra-articular distal femur fracture (AO type 33-C1). According to the random number table, the fracture models were divided into 2 equal groups: an experimental group ( n=12) subjected to fixation with one SCB combined with bilateral LCPs with 10 locking screws and a control group ( n=12) subjected to fixation with bilateral LCPs with 12 locking screws. In each model, a vertical ballast test was conducted to record the maximum axial displacement of the system and a horizontal torsion test to calculate the torsional stiffness of the system. When the loading pressure was 0-1,000 N in the biomechanical machine, structural abnormalities were observed in the 2 groups of models and the system maximum axial displacement and system torsional stiffness were compared between the 2 groups. Results:When the vertical ballast pressure was 400 N, 600 N, 800 N and 1,000 N, the maximum axial displacement of the system was, respectively, (0.14±0.01) mm, (0.25±0.01) mm, (0.41±0.02) mm and (0.63 ± 0.02) mm in the experimental group, and (0.15 ± 0.01) mm, (0.26 ± 0.01) mm, (0.46 ± 0.03) mm, and (0.67 ± 0.04) mm in the control group. Compared with the control group, the average maximum axial displacement in the experimental group decreased significantly under the axial pressure of 600-1,000 N ( P<0.05). When the horizontal torsion reached 5°, the torsional stiffness was, respectively, (2.00±0.12) Nm/° and (2.02±0.07) Nm/° in the experimental group and the control group, showing no significant difference between the 2 groups ( P>0.05). Conclusions:In the treatment of intra-articular distal femur fracture, compared with simple bilateral LCPs, our SCB combined with bilateral LCPs demonstrate similar torsional stability but better axial biomechanical stability. As our SCB has advantages of bilateral compression and minimal invasion in operation, it may be a new option for the reduction and compression treatment of intra-articular fractures.