Objective:To investigate the methods and skills required for the safe and swift removal of primary or secondary sacral tumors located between the second (inclusive) and fourth sacral vertebrae.Methods:The clinical images, pathology reports, surgical procedures, operation durations, intraoperative bleeding volumes, and postoperative functional follow-up data of 26 patients undergoing sacral tumor resection at the First Affiliated Hospital of Zhengzhou University and Xinjiang Production and Construction Corps Hospital between May 2020 and February 2025 were retrospectively examined. Additionally, the safety measures for sacral tumor resection and techniques for expedited specimen removal were evaluated.Results:According to magnetic resonance imaging (MRI) findings, all 26 patients presented with sacral tumors located between the second (inclusive) and fourth sacral vertebrae. Specifically, 9 patients were diagnosed with primary sacral tumors, pathologically confirmed as chordomas, while 17 patients had secondary sacral tumors. Among the secondary tumor cases, 12 were attributed to recurrent rectal cancer invading the sacrum, and 5 were due to malignant teratomas invading the sacrum. The 26 patients underwent a treatment strategy that began with managing the relationship between the internal iliac artery, vein branches, and the tumor, followed by the resection of the sacrum. During surgery, the bilateral sciatic foramina were accurately positioned, and the presacral fascia was dissected subsequent to the fracture of the sacrum. Among the 26 patients, 9 underwent sacral tumor resection directly through the posterior sacral approach. The average operation time for these patients was (71.1±4.9) minutes, with average blood loss of (186.7±72.8) milliliters. On the other hand, 17 patients underwent sacral tumor resection by transitioning from the supine position to the prone knife position through a combined abdominal and sacral approach. The average operation time for this group was (213.5±19.3) minutes, with average blood loss of (480.0±93.0) milliliters, significantly longer than that of the posterior sacral approach. The follow-up period ranged from 1 to 48 months, with a median of 20 months, ending on March 31, 2025. During this time, 26 patients achieved autonomous defecation with the aid of medication. None of the patients reported any functional movement disorders or pain in their lower limbs. It was observed that two out of the 26 patients developed distant metastasis, while the remaining 24 patients survived without any tumors.Conclusion:By pretreated the relationship between the internal iliac vessels and sacral tumors prior to resecting sacral tumors, utilizing the approach of initially fracturing the sacrum followed by rupturing the presacral fascia, the tumor can be entirely eliminated, resulting in a brief surgical procedure, reduced intraoperative bleeding, and minimal postoperative complications.

Objective:To evaluate the efficacy and safety of nebulized inhalation of recombinant human interferon (IFN) α1b injection in the treatment of respiratory syncytial virus (RSV) associated lower respiratory tract infections (pneumonia and bronchiolitis) in children.Methods:A randomized, double-blind, parallel, placebo-controlled add-on design was used.Children with pneumonia or bronchiolitis aged 2 months to 5 years who tested positive for RSV antigen within 72 hours of onset from 30 clinical trial sites including Beijing Children′s Hospital, Capital Medical University between February 2021 and December 2022 were included in this study and randomly divided into 2 groups at a ratio of 1∶1 based on a stratified-block method.Both groups received basic treatments such as cough control, asthma relieving, expectorant treatment, fever reduction, oxygen therapy, etc.The experimental group received additional nebulized inhalation of IFN α1b injection at a dose of 2.0 μg/(kg·time), twice a day.The control group received nebulized inhalation of placebo twice a day.Clinical efficacy was evaluated based on indicators such as the duration of clinical symptoms and signs, and the Kaplan-Meier method was used to calculate the median and 95% CI of the duration of clinical symptoms and signs.The Log-rank test was used to compared data between groups.Safety was assessed through the incidence of adverse reactions and laboratory tests, and the Chi-square test was used to analyze the difference between groups. Results:There were 123 children in the experimental group and 122 children in the control group.The median durations of all the 5 clinical symptoms and signs [including shortness of breath, wheezing, dyspnea (visible retractions), decreased transcutaneous oxygen saturation, and abnormal mental state] in the experimental group after treatment were slightly shortened than those in the control group [2.7 d(95% CI: 1.9-3.0 d)] vs.[2.9 d(95% CI: 2.6-3.6 d), P=0.027].The improvement in dyspnea (retractions) was especially pronounced in the experimental group, with a relief rate of 50.0% (0, 100%) on the first day of administration[compared with 0 (0, 50.0%) in the control group ( Z=2.002, P=0.025)].The median duration of dyspnea in the experimental group was nearly 1 day shorter than that in the control group [1.0 d(95% CI: 0.7-1.7 d) vs.1.8 d(95% CI: 1.0-2.5 d), P=0.046].There were no significant difference in hospital stay [6.0(5.0, 8.0) d vs.6.5(5.0, 8.0) d, Z=0.675, P=0.500], oxygen therapy duration [32.0(14.0, 96.3) h vs.39.0 (24.0, 83.2) h, Z=0.094, P=0.925], the recovery rate from clinical symptoms during treatment [(105/106, 99.1%) vs.(96/101, 95.0%)], and recurrence rate [(0/106, 0) vs.(2/101, 2.0%)] between the 2 groups (all P>0.05).However, the above-mentioned four indicators in the experimental group showed a trend of clinical benefits.The quantitative virus detection results showed that the RSV viral load in both groups decreased after treatment compared to before treatment.After 2 days of treatment, the decline rate of RSV viral load from the baseline was 0.90 lg copies/(mL·d) in the experimental group and 0.25 lg copies/(mL·d)in the control group, with a statistically significant difference ( P<0.05).Furthermore, there was no statistically significant difference in the incidence of adverse reactions between the 2 groups ( P>0.05).Importantly, no drug-related serious adverse reactions occurred in both groups. Conclusions:The nebulized inhalation therapy of IFN α1b demonstrates efficacy and safety in treating pediatric RSV associated lower respiratory tract infections.It particularly offers outstanding clinical therapeutic value for severe children.

Objective:To construct a training program for expert patients with type 2 diabetes mellitus (T2DM), so as to provide reference for T2DM education and management.Methods:Guided by the iceberg quality model, a preliminary training program was developed based on literature analysis and qualitative interviews. Using convenience sampling method, 22 experts were selected for two rounds of Delphi expert consultation from March to April 2024, and the final draft of the training program was discussed and revised based on the experts' opinions.Results:In the two rounds of expert consultation, the effective response rates of the questionnaire were 100.00% (22/22) and 95.45% (21/22), respectively, and the authority coefficient of the experts was all 0.905. The Kendall harmony coefficients ranged from 0.110 to 0.293 and 0.139 to 0.301, respectively ( P<0.05). The finalized training program included five modules of training content, assessment evaluation, training instructors, training time, and training forms. Conclusions:The constructed training program for expert patients with T2DM is scientific, reliable, and comprehensive, which can provide guidance for the next step of T2DM expert patient training.

Objective To re-assess the Meta-analyses/network Meta-analyses on baloxavir marboxil in the treat-ment of influenza,and provide evidence-based reference for clinical use of baloxavir marboxil.Methods Meta-ana-lyses/network Meta-analyses on baloxavir marboxil in the treatment of influenza were retrieved from PubMed,Em-base,Cochrane Library,China National Knowledge Infrastructure(CNKI),Wanfang,and VIP databases,with re-trieval time from the inception of each database to December 11,2023.Literatures were screened according to the inclusion and exclusion criteria.Information of included literatures was extracted,and the methodological quality,reporting quality and evidence quality of the included literatures were assessed by assessment of multiple systematic reviews 2(AMSTAR-2)scale,preferred reporting items for systematic reviews and Meta-analyses(PRISMA)statement,as well as grading of recommendations,assessment,development,and evaluation(GRADE)system,respectively.Results A total of 7 Meta-analyses/network Meta-analyses were included.The results showed that in terms of alleviation time of influenza symptoms,the efficacy of baloxavir marboxil was not inferior to oseltamivir,peramivir,and zanamivir.In terms of the decrease in influenza virus titer 48 hours after medication,baloxavir mar-boxil was superior to oseltamivir and zanamivir.In terms of safety,baloxavir marboxil had a lower risk of drug-re-lated adverse events than oseltamivir,and was comparable to peramivir and zanamivir.The overall assessment result of methodological quality of AMSTAR-2 scale was relatively low,with 2 literatures being classified as low-level and 5 as extremely low-level.PRISMA scores ranged 15.5-22.The quality of overall report was moderate.Two lite-ratures were scored＞21,and the reports were relatively complete.There were 5 literatures with scores ranging 15-21,and the reports had certain deficiencies.The GRADE evidence quality grading results showed that among the in-cluded 199 outcome indicators,4 indicators were high-level evidence,49 were moderate-level evidence,118 indica-tors were low-level evidence,and 28 indicators were extremely low-level evidence.Conclusion Baloxavir marboxil is comparable to neuraminidase inhibitors in the alleviation time of influenza symptoms,superior to oseltamivir and zanamisvir in decreasing virus titer,and has a lower risk of adverse drug events(especially nausea)than oseltamivir.

AIM:To investigate the effects of semaglutide on inflammation and autophagy in hu-man AC16 cardiomyocytes under hypoxia/reoxy-genation conditions.METHODS:AC16 cells were randomly divided into four groups:control(CON),hypoxia/reoxygenation(H/R),hypoxia/reoxygen-ation+semaglutide(H/R+SEM),and hypoxia/reoxy-genation+semaglutide+3-MA(H/R+SEM+3-MA).All groups except CON underwent 8 hours of hypoxia followed by 12 hours of reoxygenation.Cell viabili-ty was measured by CCK-8.Levels of IL-1β and TNF-α were assessed by ELISA.Western blot analysis evaluated AMPK,p-AMPK,mTOR,p-mTOR,ULK1,p-ULK1,Beclin-1,and LC3.Autophagosomes were an-alyzed using laser confocal microscopy and trans-mission electron microscopy.The structure of au-tophagosome and autolysosome was observed by transmission electron microscopy.RESULTS:IL-1βand TNF-α levels increased significantly in the H/R group compared to CON(P＜0.01)but decreased in the H/R+SEM group(P＜0.01).In the H/R+SEM+3-MA group,inflammatory levels increased com-pared to the H/R+SEM(P＜0.05).Compared with the CON group,p-AMPK/AMPK and p-ULK1/ULK1 ratios increased significantly in the H/R group(P＜0.05,P＜0.01).The ratios further increased in the H/R+SEM group compared to H/R(P＜0.05,P＜0.01).But the two ratios decreased in the H/R+SEM+3-MA group compared to H/R+SEM(P＜0.01,P＜0.05).The pmTOR/mTOR had the opposite trend to the two previous ratios.The expression of Beclin1 and LC3 were significantly increased in group H/R com-pared to CON(P＜0.05),and which further in-creased in the H/R+SEM group compared to H/R(P＜0.01).But the two indicators decreased in the H/R+SEM+3-MA group compared to H/R+SEM(P＜0.01,P＜0.05).Laser confocal microscopy revealed increased autophagosome numbers in H/R group compared to CON(P＜0.05),and which further in-creased in the H/R+SEM group compared to H/R(P＜0.01).While the H/R+SEM+3-MA group showed a decrease compared to H/R+SEM(P＜0.05).CON-CLUSION:Semaglutide may moderate regulate au-tophagy through AMPK/mTOR/ULK1 pathway,re-duce the release of inflammatory factors,and alle-viate hypoxia/reoxygenation-induced inflammatory injury.

Objective To explore the effects and mechanisms of Sanzi Sijun Formula(SSF)in non-alcoholic fatty liver disease(NAFLD)through network pharmacology,molecular docking and molecular dynamics simulation;To carry out experimental validation in vivo and in vitro.Methods The active components and target genes of SSF were screened using TCMSP,TCMIP and TCMIO databases.NAFLD-related targets were screened using the GeneCards database,and the intersection targets were obtained to construct a protein-protein interaction network and screen for core targets.The intersection targets were imported into the DAVID database for GO and KEGG enrichment analysis.Molecular docking was performed using AutoDock Vina software between the key active components of SSF and core targets,and molecular dynamics simulations were conducted using Gromacs 2022 for 100 ns.C57BL/6J mice NAFLD model was established by diet induction.SSF was administered by gavage for 8 weeks.Liver histopathological changes and the levels of non-esterified fatty acids(NEFA)were detected.In vitro NAFLD model was established by inducing AML12 cells with palmitic acid(PA)for 24 hours.SSF-containing serum was added to incubate simultaneously.The lipid accumulation and cell viability were detected.The core targets of SSF intervention in the in vitro and in vivo NAFLD models were verified by RT-qPCR and Western blot.Results Network pharmacological analysis identified 75 active components in SSF and revealed 179 shared targets between these components and NAFLD.Ten main active components including arachidonate,12-senecioyl-2E,8E,10E-atractylodin,cerebrosterol,glycyrrhizol B and sinapic acid,etc.as well as 8 core targets were identified.GO enrichment analysis of targets mainly involved protein phosphorylation,inflammatory response,and apoptosis,while the KEGG enrichment analysis mainly included AGE-RAGE,TNF,AMPK,PPAR and NF-κB signaling pathways.Molecular docking demonstrated that the major active components of SSF exhibited favorable binding affinity and stability with the core targets.Molecular dynamics simulation confirmed the stability of the complex of glyasperin B with AKT1,SIRT1,STAT3,PPARG,and TNF.SSF alleviated the pathological damage of liver tissues in mice NAFLD model,reduced NAS score and NEFA levels in liver tissues(P<0.05).Additionally,SSF reversed lipid accumulation and decreased cell viability of PA-induced AML12 cells(P<0.01).Further in vivo and in vitro experiments demonstrated that SSF significantly reversed the elevated mRNA levels of TNF-α,IL-6,IL-1β and PPARγ and protein expression of STAT3(P<0.05,P<0.01)in NAFLD models,up-regulated the protein levels of SIRT1 and p-Akt/Akt(P<0.05,P<0.01).Conclusion SSF can improve NAFLD of both in vitro and in vivo models.The regulation of multiple targets,such as AKT,SIRT1,STAT3 and PPARG,by its multiple active components,and adjustment of multiple approaches,such as lipid metabolism disorder,inflammatory responses,are involved in the potential underlying mechanisms.

AIM:To investigate the effects of semaglutide on inflammation and autophagy in hu-man AC16 cardiomyocytes under hypoxia/reoxy-genation conditions.METHODS:AC16 cells were randomly divided into four groups:control(CON),hypoxia/reoxygenation(H/R),hypoxia/reoxygen-ation+semaglutide(H/R+SEM),and hypoxia/reoxy-genation+semaglutide+3-MA(H/R+SEM+3-MA).All groups except CON underwent 8 hours of hypoxia followed by 12 hours of reoxygenation.Cell viabili-ty was measured by CCK-8.Levels of IL-1β and TNF-α were assessed by ELISA.Western blot analysis evaluated AMPK,p-AMPK,mTOR,p-mTOR,ULK1,p-ULK1,Beclin-1,and LC3.Autophagosomes were an-alyzed using laser confocal microscopy and trans-mission electron microscopy.The structure of au-tophagosome and autolysosome was observed by transmission electron microscopy.RESULTS:IL-1βand TNF-α levels increased significantly in the H/R group compared to CON(P＜0.01)but decreased in the H/R+SEM group(P＜0.01).In the H/R+SEM+3-MA group,inflammatory levels increased com-pared to the H/R+SEM(P＜0.05).Compared with the CON group,p-AMPK/AMPK and p-ULK1/ULK1 ratios increased significantly in the H/R group(P＜0.05,P＜0.01).The ratios further increased in the H/R+SEM group compared to H/R(P＜0.05,P＜0.01).But the two ratios decreased in the H/R+SEM+3-MA group compared to H/R+SEM(P＜0.01,P＜0.05).The pmTOR/mTOR had the opposite trend to the two previous ratios.The expression of Beclin1 and LC3 were significantly increased in group H/R com-pared to CON(P＜0.05),and which further in-creased in the H/R+SEM group compared to H/R(P＜0.01).But the two indicators decreased in the H/R+SEM+3-MA group compared to H/R+SEM(P＜0.01,P＜0.05).Laser confocal microscopy revealed increased autophagosome numbers in H/R group compared to CON(P＜0.05),and which further in-creased in the H/R+SEM group compared to H/R(P＜0.01).While the H/R+SEM+3-MA group showed a decrease compared to H/R+SEM(P＜0.05).CON-CLUSION:Semaglutide may moderate regulate au-tophagy through AMPK/mTOR/ULK1 pathway,re-duce the release of inflammatory factors,and alle-viate hypoxia/reoxygenation-induced inflammatory injury.

Objective:To evaluate the clinical value of three-dimensional(3D) printing-assisted fenestrated/branched endovascular aortic repair (F/B-TEVAR) for the treatment of endoleak after open surgery for type A aortic dissection.Methods:A multi-center retrospective case series analysis was conducted on 16 patients with anastomotic leakage following Stanford type A aortic dissection open repair, admitted to 12 medical centers between January 2019 and December 2023. All surgeries were led by the vascular surgery team from Department of Vascular Surgery, Nanjing Drum Tower Hospital. The study included 12 males and 4 females, with an age of (58.1±8.2) years (range: 42 to 75 years). Preoperative patient-specific 3D-printed models or 3D parametric surface topological guides were created based on aortic CT angiography data. These models assisted intraoperative external positioning of fenestration sites, combined with stent diameter selection and inner branch techniques to complete endovascular repair. Surgical procedures, complications, and clinical outcomes were evaluated, with follow-up CT imaging to assess efficacy.Results:All patients successfully underwent surgery without conversion to open repair. One patient had distal stent migration from a prior open repair, requiring intraoperative coverage of the main stent window and conversion to an in situ fenestration procedure. The mean operative time was (332.6±111.2)minutes (range: 80 to 460 minutes). No renal failure, paraplegia, or branch artery loss occurred. Postoperative follow-up ( M(IQR)) was 18(18) months(range: 6 to 36 months), with follow-up rates of 16/16 at 6 months, 10/16 at 12 months, 8/16 at 24 months, and 2/16 at 36 months. During follow-up, endoleak occurred in 3 patients, cerebral infarction in 1 patient, and death in 1 patient. The remaining patients demonstrated stable stent positioning, patent branches, and no endoleak. Conclusion:3D technology-guided F/B-TEVAR shows favorable mid-to short-term outcomes in treating anastomotic leakage after open repair of type A aortic dissection.

Objective To explore the effects of camellia honey on intestinal inflammation and injury induced by a high-fat diet(HFD)in Drosophila.Methods A HFD model group of fruit flies was created by feeding with standard culture medium containing 30％lard.Each camellia honey groups were fed the same high-fat medium containing different concentrations of camellia honey.The body mass,eclosion rate,climbing ability,size of lipid droplets,and levels of intestinal reactive oxygen species in adult flies were measured and analyzed.Results Compared with the model group,each camellia honey groups showed significant improvements.Specifically,camellia honey ameliorated the following HFD-induced alterations:decline in eclosion rate,increase in pupal volume,increase in adult average body mass,decrease in adult climbing ability,enlargement of the lipid droplet area,elevation in intestinal ROS levels,and intestinal damage.Conclusions Camellia honey improved the growth and development,intestinal inflammation,and injury induced by a HFD in Drosophila.

Objective To synthesize high-quality synthetic CT (sCT) images from cone beam CT (CBCT) by learning lung CT domain image features with a deep learning algorithm. Methods A sCT generation algorithm which employs perceptual loss-based cyclic generative adversarial network model (CycleGAN) and iterative registration was presented. CycleGAN model was trained to generate high-quality sCT images by combining perceptual loss and cycle consistency loss;and Elastix was used to register the generated sCT image and the planned CT (pCT) image,and iterate CycleGAN generator model. Results Experiments were conducted on the obtained pCT and CBCT data of 70 patients with lung tumors. From a quantitative perspective,the SSIM between sCT generated by the proposed algorithm and pCT was improved by 11.9％ as compared with that between CBCT and pCT,increasing from 0.825 to 0.923;additionally,RMSE dropped from 110.97 HU to 78.62 HU,PSNR increased from 32.21 dB to 34.74 dB,and mutual information increased from 1.187 to 1.418. The visual evaluation revealed that the proposed algorithm greatly eliminated the scattering artifacts of CBCT slices,highlighted the bone structure,and repaired the soft tissue structure. The comparisons with U-CycleGAN,R-CycleGAN and CUT models confirmed the effectiveness of the proposed algorithm. Conclusion Using the proposed algorithm for sCT images generation can effectively reduce the dose error and structural error between CBCT and pCT,making it possible to apply the proposed algorithm to accurate dose calculations and assist doctors in clinical diagnosis.