Objective To analyze the effect of releasing the lower pulmonary ligament on right residual lung expansion after right upper lobe resection under different body mass index (BMI) levels. Methods The clinical data of patients who underwent thoracoscopic right upper lobe resection in the First Affiliated Hospital with Nanjing Medical University from 2021 to 2022 were retrospectively analyzed. Patients were divided into a group A (17 kg/m2＜BMI≤23 kg/m2), a group B (23 kg/m2＜BMI≤29 kg/m2) and a group C (BMI＞29 kg/m2) according to BMI. The presence of residual cavity was judged by chest X-ray at 7-10 days after operation, the degree of compensation change of the right main bronchus angle was measured, and the changes in lung volume were determined by CT three-dimensional reconstruction. Results A total of 157 patients who underwent thoracoscopic right upper lobe resection were included, including 71 males and 86 females, with an average age of (59.7±11.2) years. There were 50 patients in the group A, 75 patients in the group B, and 32 patients in the group C. In the group A, compared with those without releasing the lower pulmonary ligament, patients with releasing had a lower incidence of postoperative residual cavity (P=0.016), greater changes in bronchus angle (P<0.001), and smaller changes in lung volume (P<0.001). In the group B and C, there was no significant effect of releasing the lower pulmonary ligament on postoperative residual cavity, bronchus angle, and lung volume changes (P>0.05). Conclusion For patients with thin and long body shape and low BMI, releasing the lower pulmonary ligament is helpful to promote the expansion of the residual lung after right upper lobe resection and reduce the occurrence of postoperative residual cavity in patients.

OBJECTIVE To analyze the prototype components absorbed into blood and brain of Lithocarpus litseifolius leaves， so as to provide a reference for clarifying the pharmacological material basis of its prevention and treatment of central nervous system dis eases. METHODS The ethanol extract of L. litseifolius leaves， as well as the gastric lavage fluid and perfusion solution were prepared. Using rats as subjects， plasma samples of intestinal wall metabolism， intestinal flora metabolism and hepatic metabolism were prepared via in situ intestinal perfusion and closed intestinal loop method； while comprehensive metabolic plasma samples， brain tissue samples， and cerebrospinal fluid samples were collected after intragastric administration. UPLC-HRMS technology was utilized to analyze and identify chemical components and prototype components absorbed into blood and brain of L. litseifolius leaves. RESULTS A total of 66 chemical constituents were identified in L. litseifolius leaves， primarily consisting of flavonoids， organic acids， and others. A total of 16， 13， 11， and 5 prototype components were identified in intestinal wall metabolism， intestinal flora metabolism， hepatic metabolism， and comprehensive metabolic plasma samples， respectively. Additionally， 4 prototype components were detected in brain tissue and 9 in cerebrospinal fluid. Phloridzin， trilobatin， phloretin-2- O -malonyl hexoside， and phloretin were identified as common components across all sample types. CONCLUSIONS Prototype components absorbed into blood and brain of L. litseifolius leaves， such as phloridzin， trilobatin， phloretin， and other components may serve as the pharmacological material basis for their therapeutic effects on central nervous system diseases.

ObjectiveTo investigate the mechanisms of mitochondrial dynamics and metabolic reprogramming in the treatment of diabetic nephropathy （DN） by Shenxiao Tongluo prescription via the peroxisome proliferator-activated receptor γ coactivator-1α （PGC-1α）/sirtuin-3 （SIRT3）/hypoxia-inducible factor-1α （HIF-1α） signaling pathway. MethodsSixty-five SD rats were randomized into a sham group （10 rats） and a modeling group （55 rats）， and the modeling rats underwent left nephrectomy and intraperitoneal injection of streptozotocin （35 mg·kg^-1） to prepare a DN model. After successful modeling， the rats were randomized into model， empagliflozin （10 mg·kg^-1）， and low-， medium-， and high-dose （7.656， 15.312， 30.624 g·kg^-1， respectively） Shenxiao Tongluo prescription groups. The urine microalbumin （UmAlb）， blood urea nitrogen （BUN）， and serum creatinine （SCr） levels of rats in each group were assessed after continuous gavage for 8 weeks. The corresponding kits were used to measure the levels of lactate， superoxide dismutase （SOD）， and malondialdehyde （MDA） in the kidney tissue. Hematoxylin-eosin staining， Masson staining， and periodic acid-Schiff staining were performed to observe the pathological changes in the kidney tissue. Transmission electron microscopy was employed to observe mitochondrial morphology. Immunohistochemistry was employed to determine the expression levels of dynamin-related protein 1 （DRP1） and pyruvate kinase M2 （PKM2） in the kidney tissue. Western blot was adopted to assess the protein levels of PGC-1α， SIRT3， HIF-1α， dynamin-related protein 1 （Drp1）， optic atrophy 1 （OPA1）， hexokinase 2 （HK2）， and pyruvate kinase M2 （PKM2） in the kidney tissue. ResultsCompared with the sham group， the model group showed elevated levels of UmAlb， BUN， SCr， lactate， and MDA， decreased SOD level （P<0.05）， glomerular hypertrophy， thickening of the mesangial basement membrane， vacuolar degeneration of renal tubular epithelial cells， and infiltration of renal interstitial inflammatory cells， oval mitochondria with disordered， blurred or disappearing cristae， down-regulated protein levels of PGC-1α， SIRT3， and OPA1， and up-regulated protein levels of HIF-1α， DRP1， HK2， and PKM2 （P<0.05）. Compared with the model group， the treatment in all the groups increased the body weight， lowered the levels of GLU， UmAlb， BUN， and MDA， raised the level of SOD， alleviated the pathological damage in the kidney tissue and mitochondrial damage， up-regulated the expression of PGC-1α， SIRT3， and OPA1， and down-regulated the expression of HIF-1α， DRP1， and PKM2 （P<0.05）. Empagliflozin and Shenxiao Tongluo prescription at medium and high doses lowered the levels of SCr and lactate and down-regulated the expression of HK2 （P<0.05）， which had no statistical significance in the low-dose Shenxiao Tongluo prescription group. ConclusionShenxiao Tongluo prescription may regulate mitochondrial dynamics and metabolic reprogramming by activating the PGC-1α/SIRT3/HIF-1α pathway， thereby alleviating oxidative damage in the kidney tissue and delaying the progression of DN.

ObjectiveTo investigate the mechanisms of mitochondrial dynamics and metabolic reprogramming in the treatment of diabetic nephropathy （DN） by Shenxiao Tongluo prescription via the peroxisome proliferator-activated receptor γ coactivator-1α （PGC-1α）/sirtuin-3 （SIRT3）/hypoxia-inducible factor-1α （HIF-1α） signaling pathway. MethodsSixty-five SD rats were randomized into a sham group （10 rats） and a modeling group （55 rats）， and the modeling rats underwent left nephrectomy and intraperitoneal injection of streptozotocin （35 mg·kg^-1） to prepare a DN model. After successful modeling， the rats were randomized into model， empagliflozin （10 mg·kg^-1）， and low-， medium-， and high-dose （7.656， 15.312， 30.624 g·kg^-1， respectively） Shenxiao Tongluo prescription groups. The urine microalbumin （UmAlb）， blood urea nitrogen （BUN）， and serum creatinine （SCr） levels of rats in each group were assessed after continuous gavage for 8 weeks. The corresponding kits were used to measure the levels of lactate， superoxide dismutase （SOD）， and malondialdehyde （MDA） in the kidney tissue. Hematoxylin-eosin staining， Masson staining， and periodic acid-Schiff staining were performed to observe the pathological changes in the kidney tissue. Transmission electron microscopy was employed to observe mitochondrial morphology. Immunohistochemistry was employed to determine the expression levels of dynamin-related protein 1 （DRP1） and pyruvate kinase M2 （PKM2） in the kidney tissue. Western blot was adopted to assess the protein levels of PGC-1α， SIRT3， HIF-1α， dynamin-related protein 1 （Drp1）， optic atrophy 1 （OPA1）， hexokinase 2 （HK2）， and pyruvate kinase M2 （PKM2） in the kidney tissue. ResultsCompared with the sham group， the model group showed elevated levels of UmAlb， BUN， SCr， lactate， and MDA， decreased SOD level （P<0.05）， glomerular hypertrophy， thickening of the mesangial basement membrane， vacuolar degeneration of renal tubular epithelial cells， and infiltration of renal interstitial inflammatory cells， oval mitochondria with disordered， blurred or disappearing cristae， down-regulated protein levels of PGC-1α， SIRT3， and OPA1， and up-regulated protein levels of HIF-1α， DRP1， HK2， and PKM2 （P<0.05）. Compared with the model group， the treatment in all the groups increased the body weight， lowered the levels of GLU， UmAlb， BUN， and MDA， raised the level of SOD， alleviated the pathological damage in the kidney tissue and mitochondrial damage， up-regulated the expression of PGC-1α， SIRT3， and OPA1， and down-regulated the expression of HIF-1α， DRP1， and PKM2 （P<0.05）. Empagliflozin and Shenxiao Tongluo prescription at medium and high doses lowered the levels of SCr and lactate and down-regulated the expression of HK2 （P<0.05）， which had no statistical significance in the low-dose Shenxiao Tongluo prescription group. ConclusionShenxiao Tongluo prescription may regulate mitochondrial dynamics and metabolic reprogramming by activating the PGC-1α/SIRT3/HIF-1α pathway， thereby alleviating oxidative damage in the kidney tissue and delaying the progression of DN.

Objective To systematically evaluate the efficacy and safety of proximal gastrectomy (PG) versus total gastrectomy (TG) for the treatment of Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG). Methods PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang, and VIP databases were searched for literature comparing the efficacy and safety of PG and TG for the treatment of Siewert type Ⅱ/Ⅲ AEG. The search period was from database inception to March 2023. Meta-analysis was performed using Review Manager 5.4 software. Results A total of 23 articles were included, including 16 retrospective cohort studies, 5 prospective cohort studies, and 2 randomized controlled trials. The total sample size was 2 826 patients, with 1 389 patients undergoing PG and 1 437 patients undergoing TG. Meta-analysis results showed that compared with TG, PG had less intraoperative blood loss [MD=−19.85, 95%CI (−37.20, −2.51), P=0.02] and shorter postoperative hospital stay [MD=−1.23, 95%CI (−2.38, −0.08), P=0.04]. TG had a greater number of lymph nodes dissected [MD=−6.20, 95%CI (−7.68, −4.71), P<0.001] and a lower incidence of reflux esophagitis [MD=3.02, 95%CI (1.24, 7.34), P=0.01]. There were no statistically significant differences between the two surgical approaches in terms of operative time, postoperative survival rate (1-year, 3-year, 5-year), and postoperative overall complications (P>0.05). Conclusion PG has advantages in terms of intraoperative blood loss and postoperative hospital stay, while TG has advantages in terms of the number of lymph nodes dissected and the incidence of reflux esophagitis. There is no significant difference in long-term survival between the two surgical approaches.

Objective To observe the correlations of artificial intelligence(AI)measured parameters on anteroposterior and lateral spinal X-ray films with the severity of adolescent idiopathic scoliosis(AIS).Methods Totally 1 786 AIS patients were retrospectively enrolled.Parameters including Cobb angle(CA),coronal balance distance(CBD),T1 slope(T1S),pelvic tilt(PT),sacral slope(SS),apical vertebral translation(AVT),thoracic trunk shift(TTS),thoracic kyphosis(TK)and sagittal vertical axis(SVA)on anteroposterior and lateral spinal X-ray films were measured using uAI DR scoliosis analysis system.The severity of AIS was evaluated according to CA,and the correlations between other parameters and the severity of AIS were explored.The above parameters were compared under different severity levels and coronal/sagittal equilibrium states.Multivariate logistic regression analysis was performed to screen the independent impact factors on the severity of AIS.Results Significant differences of the above parameters were found among different severity levels except for SVA(all P＜0.001).With the aggravation of AIS,CA,CBD,AVT and TTS increased successively(all P＜0.001).T1S of severe AIS was higher than that of mild and moderate AIS(both P＜0.001),PT and SS of moderate and severe AIS were all bigger,while their TK were smaller than those of mild AIS(all P＜0.001).Significant differences of CA,T1S,PT,SS,AVT,TTS and TK were found between coronal balanced and imbalanced AIS(all P＜0.05),while of TK were found between sagittal balanced and unbalanced AIS(P=0.026).CBD,T1S,PT,SS,AVT and TTS were all positively correlated(r,=0.136-0.606,all P＜0.001),while TK was negatively correlated(r,=—0.404,P＜0.001)with the severity of AIS.T1S,AVT and TTS were all independent impact factors of the severity of AIS(all P＜0.001).Conclusion Among AI measured parameters on anteroposterior and lateral spinal X-ray films,CBD,T1S,PT,SS,AVT and TTS were positively correlated,while TK was negatively correlated with the severity of AIS.

Objective:Micro-and nanostructures with sharp disordered and rounded ordered features were fabricated on titanium surfaces,respectively,and their osteogenic potential was evaluated both in vitro and in vivo.Methods:Sharp disordered titanium surfaces(SLA-Ti)and rounded ordered titanium surfaces(Laser-Ti)were prepared using sandblast acid etching and high-repeti-tion-rate femtosecond laser,respectively.Smooth titanium(Ti)was used as the control group,SLA-Ti and Laser-Ti were used as the experimental groups.Characterization was conducted using scanning electron microscopy coupled with hydrophilicity assess-ments.The adhesion,elongation,and osteogenic differentiation capabilities of osteoblasts in vitro were evaluated through cell mor-phology observations,cytoskeletal fluorescence staining,cell viability assays,and PCR experiments.Osteogenic potential in vivo of rabbits was assessed through Micro CT scans and histological staining(HE and Masson).Results:The surface of Laser-Ti exhibits a rounded,ordered,multi-scale micro-and nano-morphology with the best hydrophilicity(P＜0.01).In vitro,it promotes cell adhe-sion,extension,and osteogenic differentiation,while in vivo,it enhances bone regeneration around the implants.Overall,a trend of Laser-Ti＞SLA-Ti＞Ti is observed,with a higher bone volume fraction(BV/TV)(P＜0.05),greater trabecular thickness(Tb.Th)(P＜0.05),an increased number of trabeculae(Tb.N)(P＜0.05),and a larger area of bone around the implants(P＜0.05).Conclusion:The rounded ordered micro-and nano-structures fabricated using high-repetition-rate fem-tosecond laser demonstrate enhanced osteoinductive capac-ity both in vitro and in vivo.

Objective To explore the feasibility of using cell-free DNA(cfDNA)in blastocyst fluid for preimplantation embryo aneuploidy.Methods A total of 17 patients undergoing assisted reproductive technology at Taizhou Hospital of Zhejiang from 2023 to 2024.A total of 38 discarded blastocysts were collected.Whole-genome amplification and next-generation sequencing were performed on both blastocyst fluid cfDNA and trophoblast cells.Using the trophoblast cells as reference,the amplification success rates of blastocyst fluid cfDNA were compared.The consistency,specificity,and sensitivity of the detection results were evaluated.Results The success rate of cfDNA amplification in the blastocyst fluid was 78.95％,and that of the trophoblast cells was 90.61％,with a consistency of 57.1％.The sensitivity of cfDNA amplification in the blastocyst fluid was 100％,the specificity was 66.7％,the positive likelihood ratio was 3,and the negative likelihood ratio was 0.Conclusion Blastocyst fluid cfDNA screening can be used as a screening method to exclude chromosomal embryos aneuploidy and can be used for preimplantation embryo selection.

Fecal microbiota transplantation (FMT) has the potential to rebuild the intestinal microbiome of patients, which can influence the disease course, alleviate symptoms, or even cure the disease. It is seen as a promising breakthrough for treating major chronic diseases that are difficult to manage. Currently, FMT therapy has been clinically studied for over 80 diseases and has led to significant breakthroughs. However, there are still four main challenges: (1) identifying the effective characteristics of donor microbiota and ensuring precise matching between donors and recipients; (2) understanding the pathways and molecular mechanisms by which key FMT bacteria and metabolites improve disease outcomes; (3) studying strain interactions and colonization mechanisms to restore intestinal microbiota balance; and (4) refining the precision of microbiome and functional microbiota transplantation. To address these clinical challenges, this article reviews the latest research both domestically and internationally, outlines the response patterns of FMT therapy, examines the reasons behind FMT failure, and explores future directions for the development of FMT. The aim is to accelerate the scientific and precise advancement of FMT technology in China.

Objective To observe the correlations of artificial intelligence(AI)measured parameters on anteroposterior and lateral spinal X-ray films with the severity of adolescent idiopathic scoliosis(AIS).Methods Totally 1 786 AIS patients were retrospectively enrolled.Parameters including Cobb angle(CA),coronal balance distance(CBD),T1 slope(T1S),pelvic tilt(PT),sacral slope(SS),apical vertebral translation(AVT),thoracic trunk shift(TTS),thoracic kyphosis(TK)and sagittal vertical axis(SVA)on anteroposterior and lateral spinal X-ray films were measured using uAI DR scoliosis analysis system.The severity of AIS was evaluated according to CA,and the correlations between other parameters and the severity of AIS were explored.The above parameters were compared under different severity levels and coronal/sagittal equilibrium states.Multivariate logistic regression analysis was performed to screen the independent impact factors on the severity of AIS.Results Significant differences of the above parameters were found among different severity levels except for SVA(all P＜0.001).With the aggravation of AIS,CA,CBD,AVT and TTS increased successively(all P＜0.001).T1S of severe AIS was higher than that of mild and moderate AIS(both P＜0.001),PT and SS of moderate and severe AIS were all bigger,while their TK were smaller than those of mild AIS(all P＜0.001).Significant differences of CA,T1S,PT,SS,AVT,TTS and TK were found between coronal balanced and imbalanced AIS(all P＜0.05),while of TK were found between sagittal balanced and unbalanced AIS(P=0.026).CBD,T1S,PT,SS,AVT and TTS were all positively correlated(r,=0.136-0.606,all P＜0.001),while TK was negatively correlated(r,=—0.404,P＜0.001)with the severity of AIS.T1S,AVT and TTS were all independent impact factors of the severity of AIS(all P＜0.001).Conclusion Among AI measured parameters on anteroposterior and lateral spinal X-ray films,CBD,T1S,PT,SS,AVT and TTS were positively correlated,while TK was negatively correlated with the severity of AIS.