OBJECTIVE To explore the improvement effect and potential mechanism of modified Yanghe decoction on bone destruction in rats with breast cancer bone metastasis based on the receptor-interacting serine/threonine-protein kinase 1 （RIPK1）/RIPK3 pathway. METHODS The rat model of breast cancer bone metastasis was established by injecting a suspension of breast cancer cells into the bone marrow cavity. The rats with successful modeling were randomly divided into a model group （intragastric administration of equal volume of normal saline）， modified Yanghe decoction low-， medium-， and high-dose groups （intragastric administration of corresponding decoction at 1.30， 2.60 and 5.20 g/kg， calculated by the dosage of crude drug）， high-dose modified Yanghe decoction+si-RIPK1 group （intragastric administration of corresponding decoction at 5.20 g/kg， calculated by the dosage of crude drug； simultaneous injection of small interfering RNA for RIPK1 via the tail vein）， and high-dose modified Yanghe decoction+si-NC group （intragastric administration of corresponding decoction at 5.20 g/kg， calculated by the dosage of crude drug； simultaneous injection of small interfering RNA for negative control via the tail vein）， with 12 rats in each group. Another 12 healthy rats were selected as the control group and were given the same volume of normal saline intragastrically， once a day， for 14 consecutive days. Body weight was measured before administration and at the end of the last administration. The mechanical pain threshold and thermal pain threshold were measured， and the bone destruction， pathological changes and osteoclast formation of the tibia were observed. The positive expression of receptor activator of nuclear factor-κB （RANK） and receptor activator of nuclear factor-κB ligand （RANKL） in the tibial tissue， as well as the phosphorylation levels of RIPK1， RIPK3 and mixed lineage kinase domain-like protein （MLKL） were detected. RESULTS Compared with the control group， the tumor cells of tibia tissues in rats of the model group showed significant proliferation and diffuse infiltration into the bone marrow cavity. Extensive areas of tumor necrosis of cells， severe bone destruction， thinning of the bone cortex， and damage to the bone trabeculae were observed. The body weight （before administration and at the end of the last administration）， mechanical pain threshold， thermal pain threshold， and the phosphorylation levels of RIPK1， RIPK3 and MLKL were decreased significantly； the tumor volume， the proportion of bone destruction area， the number of osteoclasts， and the positive expressions of RANK and RANKL were increased/up-regulated significantly （P＜0.05）. Compared with the model group， the above pathological changes in the tibial tissues of rats in modified Yanghe decoction low-， medium- and high-dose groups were all alleviated， and all quantitative indicators showed dose-dependent improvement （P＜0.05）. After silencing RIPK1， the aforementioned beneficial effects of high-dose modified Yanghe decoction were significantly weakened （P＜0.05）.CONCLUSIONSModified Yanghe decoction can alleviate bone destruction in rats with breast cancer bone metastasis. The above effect is related to the activation of the RIPK1/RIPK3 pathway.

Objective To evaluate the relationship between anxiety levels and clinicopathological characteristics in patients with papillary thyroid carcinoma (PTC). Methods Among the patients who underwent surgical treatment in our center from July 2022 to September 2023, 304 patients completed the Hamilton anxiety rating scale (HAM-A) questionnaire. The clinical and pathological characteristics of these patients and their association with anxiety levels were investigated. Results Among the 304 patients, 271 were pathologically confirmed to have PTC. Of the 271 patients, 75 had higher levels of anxiety (according to HAM-A scoring system, a score ≥14 indicates clinically significant anxiety) and were assigned to the anxiety group. Univariate statistical analysis showed that the proportion of patients with elevated thyroid peroxidase antibody (TPOAb) in the anxiety group was higher than that in the non-anxiety group (34.7% vs. 16.8%, P=0.002 4). Moreover, the proportion of patients with multifocal tumors in the anxiety group was also higher than that in the non-anxiety group (33.3% vs. 16.7%, P=0.004 4). Multivariate Logistic regression confirmed that anxiety levels were associated with elevated TPOAb (P=0.005 6) and tumor multifocality (P=0.001 9). Conclusions Anxiety levels may be related to elevated TPOAb and tumor multifocality in PTC patients.

Objective Based on Network pharmacology to explore the mechanism of Compound Danshen Dripping Pills in treating Psycho-cardiological disease.Methods To obtain the validated targets of the complete formulation of Compound Danshen Dripping Pills,data were sourced from databases including China National Knowledge Infrastructure,Wanfang,VIP,and PubMed.Additionally,genes associated with Psycho-cardiological disease were retrieved from the Genecards database.Utilizing the Digital Intelligence Traditional Chinese Medicine Innovation Platform,network proximity was calculated for the obtained targets and genes.The potential targets of Compound Danshen Dripping Pills in the treatment of Psycho-cardiological disease conduct enrichment analysis,trace the source of medicinal materials and effective components absorbed into the blood.Results Obtained 192 targets for the Compound Danshen Dripping Pills,1137 genes for Psycho-cardiological disease,and the network proximity calculation showed a significant correlation between the two(Z-score=-6.5282).The enrichment analysis of the 95 potential targets predominantly reveals their association with several key pathways,including AGE-RAGE signaling in diabetic complications,Lipid and atherosclerosis,fluid shear stress and atherosclerosis,the HIF-1 signaling pathway,TNF signaling.The traceability analysis indicates that 80 targets are associated with three distinct medicinal materials,10 targets are linked to two medicinal materials,and 5 targets are connected to a single medicinal material.95 targets are mainly related to 17 effective blood components such as salvianolic acid B,tanshinone ⅡA,and salvianolic acid A.The top 16 key genes were obtained by sorting the targets based on the Betweenness values corresponding to the blood components.The enrichment analysis of the key gene indicated that the treatment of Psycho-cardiological disease with Compound Danshen Dripping Pills is associated with the positive regulation of smooth muscle cell proliferation and the hypoxia response.Additionally,it is linked to the AGE-RAGE signaling pathway in diabetic complications,fluid shear stress and atherosclerosis,the relaxin signaling pathway,lipid and atherosclerosis,and the TNF signaling pathway,etc.Conclusion The Compound Danshen Dripping Pills may improve Psycho-cardiological disease by regulating inflammatory response,oxidative stress,myocardial ischemia,neuroprotection,and neurotoxicity inhibition through components such as salvianolic acid B,tanshinone ⅡA,tanshinone Ⅰ,salvianolic acid A,protocatechuic acid,etc.

Objective:To investigate the diagnostic and surgical strategies in managing patients with coexisting thyroid carcinoma and cervical vagal schwannoma.Methods:We retrospectively analyzed three cases treated at Guangzhou First People’s Hospital between Jun. 2019 and Dec. 2024.Results:All patients presented with neck masses or thyroid nodules. Ultrasonography identified suspicious malignant thyroid nodules and lateral neck lesions—interpreted as metastatic lymphadenopathy in two cases and as a possible nerve sheath tumor in one. Fine-needle aspiration cytology (FNAC) of thyroid nodules yielded Bethesda VI results in all cases. FNAC of the lateral neck lesions revealed no evidence of malignancy in all cases; in one case, a core needle biopsy confirmed a vagal schwannoma. Two patients underwent MRI, which supported the diagnosis of vagal schwannoma. Surgical management included single-stage resection in two patients and staged surgery in one. Postoperative histopathology confirmed papillary thyroid carcinoma and schwannoma in all cases. Transient postoperative hoarseness occurred in two patients, with recovery within 3-6 months.Conclusions:When thyroid carcinoma is complicated by cervical vagal schwannoma, the schwannoma may be misdiagnosed as metastatic cervical lymph nodes, potentially leading to iatrogenic vagus nerve injury during neck dissection. Although cervical vagal schwannoma can be diagnosed preoperatively, simultaneous surgical treatment of both conditions may increase the risk of vocal cord paralysis, and in severe cases, result in airway compromise. Therefore, comprehensive preoperative evaluation is important. It is recommended to classify cases based on the anatomical locations of the thyroid carcinoma and vagal schwannoma to guide surgical planning, and to use intraoperative nerve monitoring to enhance surgical safety and avoid serious complications.

Objective:To investigate the diagnostic and surgical strategies in managing patients with coexisting thyroid carcinoma and cervical vagal schwannoma.Methods:We retrospectively analyzed three cases treated at Guangzhou First People’s Hospital between Jun. 2019 and Dec. 2024.Results:All patients presented with neck masses or thyroid nodules. Ultrasonography identified suspicious malignant thyroid nodules and lateral neck lesions—interpreted as metastatic lymphadenopathy in two cases and as a possible nerve sheath tumor in one. Fine-needle aspiration cytology (FNAC) of thyroid nodules yielded Bethesda VI results in all cases. FNAC of the lateral neck lesions revealed no evidence of malignancy in all cases; in one case, a core needle biopsy confirmed a vagal schwannoma. Two patients underwent MRI, which supported the diagnosis of vagal schwannoma. Surgical management included single-stage resection in two patients and staged surgery in one. Postoperative histopathology confirmed papillary thyroid carcinoma and schwannoma in all cases. Transient postoperative hoarseness occurred in two patients, with recovery within 3-6 months.Conclusions:When thyroid carcinoma is complicated by cervical vagal schwannoma, the schwannoma may be misdiagnosed as metastatic cervical lymph nodes, potentially leading to iatrogenic vagus nerve injury during neck dissection. Although cervical vagal schwannoma can be diagnosed preoperatively, simultaneous surgical treatment of both conditions may increase the risk of vocal cord paralysis, and in severe cases, result in airway compromise. Therefore, comprehensive preoperative evaluation is important. It is recommended to classify cases based on the anatomical locations of the thyroid carcinoma and vagal schwannoma to guide surgical planning, and to use intraoperative nerve monitoring to enhance surgical safety and avoid serious complications.

Objective Based on Network pharmacology to explore the mechanism of Compound Danshen Dripping Pills in treating Psycho-cardiological disease.Methods To obtain the validated targets of the complete formulation of Compound Danshen Dripping Pills,data were sourced from databases including China National Knowledge Infrastructure,Wanfang,VIP,and PubMed.Additionally,genes associated with Psycho-cardiological disease were retrieved from the Genecards database.Utilizing the Digital Intelligence Traditional Chinese Medicine Innovation Platform,network proximity was calculated for the obtained targets and genes.The potential targets of Compound Danshen Dripping Pills in the treatment of Psycho-cardiological disease conduct enrichment analysis,trace the source of medicinal materials and effective components absorbed into the blood.Results Obtained 192 targets for the Compound Danshen Dripping Pills,1137 genes for Psycho-cardiological disease,and the network proximity calculation showed a significant correlation between the two(Z-score=-6.5282).The enrichment analysis of the 95 potential targets predominantly reveals their association with several key pathways,including AGE-RAGE signaling in diabetic complications,Lipid and atherosclerosis,fluid shear stress and atherosclerosis,the HIF-1 signaling pathway,TNF signaling.The traceability analysis indicates that 80 targets are associated with three distinct medicinal materials,10 targets are linked to two medicinal materials,and 5 targets are connected to a single medicinal material.95 targets are mainly related to 17 effective blood components such as salvianolic acid B,tanshinone ⅡA,and salvianolic acid A.The top 16 key genes were obtained by sorting the targets based on the Betweenness values corresponding to the blood components.The enrichment analysis of the key gene indicated that the treatment of Psycho-cardiological disease with Compound Danshen Dripping Pills is associated with the positive regulation of smooth muscle cell proliferation and the hypoxia response.Additionally,it is linked to the AGE-RAGE signaling pathway in diabetic complications,fluid shear stress and atherosclerosis,the relaxin signaling pathway,lipid and atherosclerosis,and the TNF signaling pathway,etc.Conclusion The Compound Danshen Dripping Pills may improve Psycho-cardiological disease by regulating inflammatory response,oxidative stress,myocardial ischemia,neuroprotection,and neurotoxicity inhibition through components such as salvianolic acid B,tanshinone ⅡA,tanshinone Ⅰ,salvianolic acid A,protocatechuic acid,etc.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To evaluate the impact of orthopedic robotic assistance and conventional freehand methods on surgical strategies, the safety of pedicle screw placement, and clinical efficacy in patients with upper cervical spine diseases.Methods:From January 2017 to March 2023, a total of 63 cases with upper cervical spine disease, were divided into two groups based on the screw placement technique: the robot-assisted pedicle screw placement (RA) group (41 cases) and the conventional freehand pedicle screw placement (CF) group (22 cases), were retrospectively included. These patients in the RA and CF groups underwent two types of posterior cervical surgery, including occipitocervical fusion (9 cases and 8 cases) and fixation and fusion of atlantoaxial and distal vertebrae (32 cases and 14 cases). The outcome parameters, including the disease course, surgical time, intraoperative blood loss, fluoroscopy frequency, radiation dose, hospital stay, treatment costs, complications, the rate of the pedicle screw placement, accuracy of upper cervical pedicle screw placement, and the risk factors that possibly affected the accuracy were recorded and analyzed. Postoperative follow-up was conducted for at least 6 months, and the efficacy of patients was assessed using imaging parameters, ASIS classification, VAS, and JOA scores.Results:Both groups had no screw-related complications and no spinal cord or vertebral artery injuries. In the RA group, the pedicle screw placement rates for the patients with occipitocervical fusion, and fixation and fusion of atlantoaxial and distal vertebrae were 100% (48/48) and 89.6% (138/154), respectively, far exceeding the placement rate in the CF group 42.9% (18/42) and 78.3% (54/69) (χ 2=37.403, P<0.001; χ 2=5.128, P=0.024). The fluoroscopic exposure dose and operation time of the two types of surgical patients in the RA group were both higher than those in the CF group ( P<0.05). Compared with the CF group, the accuracy of C 1 screws in the RA group increased from 42% (11/26) to 80% (51/64), with statistical significance (χ 2=13.342, P=0.004); while the accuracy of C 2 screws improved from 77% (33/43) to 88% (63/72) with no statistical difference (χ 2=2.863, P=0.413). Non-parametric correlation analysis found a significant correlation between the accuracy of C 1 and C 2 pedicle screw placement and the order of guide wire insertion in the RA group ( r=0.580, P<0.001; r=0.369, P=0.001). Postoperatively, both groups showed significant differences in cervicomedullary angle (CMA), Chamberlain angle (CL), McGregor angle, Boogard angle, Bull angle, clivus-canal angle (CCA), occipitocervical (C 0-C 2) angle, posterior occipitocervical angle (POCA), C 2-C 7 angle, and anterior atlantodental interval (ADI) ( P<0.05). The ASIA classification improved to varying degrees for both groups postoperatively, but there were no statistically significant differences between preoperative, postoperative, and last follow-up evaluations. VAS and JOA scores significantly improved for both groups postoperatively and at the last follow-up ( P<0.05). Conclusion:Both orthopedic robotic-assisted and conventional freehand pedicle screw placement techniques achieved satisfactory therapeutic effects in the treatment of upper cervical spine diseases. The orthopedic robot can effectively ensure the accuracy of upper cervical pedicle screw placement, the increase placement rate of pedicle screws in the upper cervical spine, and reduce fluoroscopy exposure. However, it is necessary to avoid the vertebral displacement caused by the priority insertion of the guide needle, which may affect the accuracy of subsequent planning.

Objective To explore the ability of the DNA-repair gene O6-methylguanine-DNA methyltransferase(MG-MT)to repair DNA damage and control apoptosis of lens epithelial cells(LECs)in an oxidative damage environment.Methods The cultured LECs were treated with different concentrations of hydrogen peroxide(H2O2)(0 μmol·L-1,200μmol·L-1,400 μmol·L-1,and 600 μmol·L-1)to confirm the effects of different concentrations of H2O2 on LECs.The LECs were divided into Control group(without treatment),H2O2 group(adding 400 μmol·L-1 H2O2),H2O2+HA group[adding 400 μmnol·L-1 H2O2 and hemagglutinin(HA)]and H2O2+OE-MGMT group[adding 400 μmol·L-1 H2O2 and 5 μL pcDNA3.1-MGMT(overexpression plasmid)and 12 μL Lipofectamine8000(liposome transfection reagent)].Cell viability was detected by Cell Counting Kit-8(CCK-8).Western blot was used to detect the expression levels of proteins(DNA dam-age marker protein γH2A and pro-apoptotic protein Bax/Bcl2)in anterior capsular tissue of lens of age-related cataract(ARC)patients(ARC group)and other groups.DNA damage repair ability(DNA damage marker 15A3)of LECs in each group was detected by immunofluorescence,and apoptosis in each group was detected by TUNEL staining.Results Western blot results showed that the relative protein expression level of MGMT in LECs of the Control group and the ARC group was 1.000±0.002 and 0.597±0.001,and the difference was statistically significant(P＜0.0001).The relative pro-tein expression level of MGMT in LECs decreased with the increase of H2O2 concentration.The relative expression level ofγH2A in the Control group,H2O2 group,H2O2+HA group and H2O2+OE-MGMT group was 1.000±0.005,1.424±0.011,1.359±0.009,and 0.586±0.004,respectively,and the expression level of Bax/Bcl2 was 1.000±0.003,2.132±0.017,1.491±0.006,and 0.687±0.008,respectively,with those expression levels in the H2O2+OE-MGMT group being signifi-cantly lower than the H2O2+HA group(all P＜0.001).Immunofluorescence detection results showed that the relative ex-pression level of 15A3 in the Control group,H2O2 group,H2O2+HA group and H2O2+OE-MGMT group was 1.000±0.128,1.842±0.207,2.104±0.267,and 0.723±0.073,respectively,with the fluorescence intensity of 15A3 staining in the H2O2+OE-MGMT group being significantly lower than the H2O2 group(P＜0.001).TUNEL staining results showed that the fluorescence intensity of apoptosis in the Control group,H2O2 group,H2O2+HA group and H2O2+OE-MGMT group was 1.800±0.002,13.660±0.002,18.000±0.011,and 2.150±0.003,respectively,with decreased fluorescence intensity of apoptosis in the H2O2+OE-MGMT group compared with the H2O2 group(P＜0.000 1).The results of CCK-8 showed that the cell viability of the Control group,H2O2 group,H2O2+HA group and H2O2+OE-MG-MT group were 100.09±1.54,57.09±2.09,60.39±3.87,and 74.16±1.96,respectively,with increased cell viability in the H2O2+OE-MGMT group compared with the H2O2 group(P＜0.05).Conclusion MGMT expression is reduced in the anterior capsular tissue of ARC patients and the H2O2-induced LEC oxidative damage models.MGMT overexpression is involved in the double-strand break repair pathway and base excision repair pathway to promote the repair of DNA damage in LECs,thereby increasing cell vitality,reducing apoptosis,and regulating the occurrence and development of ARC.