Background: Disorders of the blood-brain barrier (BBB) arising from diabetes mellitus are closely related to diabetic encephalopathy. Previous research has suggested that neuron-glia antigen 2 (NG2)-glia plays a key role in maintaining the integrity of the BBB. However, the mechanism by which NG2-glia regulates the diabetic BBB remains unclear. Methods: Type 2 diabetes mellitus (T2DM) db/db mice and db/m mice were used. Evans-Blue BBB permeability tests and transmission electron microscopy techniques were applied. Tight junction proteins were assessed by immunofluorescence and transmission electron microscopy. NG2-glia number and signaling pathways were evaluated by immunofluorescence. Detection of matrix metalloproteinase-9 (MMP-9) in serum was performed using enzyme-linked immunosorbent assay (ELISA). Results: In T2DM db/db mice, BBB permeability in the hippocampus significantly increased from 16 weeks of age, and the structure of tight junction proteins changed. The number of NG2-glia in the hippocampus of db/db mice increased around microvessels from 12 weeks of age. Concurrently, the expression of MMP-9 increased in the hippocampus with no change in serum. Sixteen- week-old db/db mice showed activation of the Wnt/β-catenin signaling in hippocampal NG2-glia. Treatment with XAV-939 improved structural and functional changes in the hippocampal BBB and reduced MMP-9 secretion by hippocampal NG2-glia in db/db mice. It was also found that the upregulation of β-catenin protein in NG2-glia in the hippocampus of 16-week-old db/db mice was significantly alleviated by treatment with XAV-939. Conclusion The results indicate that NG2-glia can lead to structural and functional disruption of the diabetic BBB by activating Wnt/β-catenin signaling, upregulating MMP-9, and degrading tight junction proteins.

With the continuous deepening of the concept of precision diagnosis and treatment for lung cancer, how to achieve higher efficiency and accuracy in the screening, diagnosis, and treatment pathways in clinical practice has become an important issue that urgently needs to be overcome. The current clinical difficulty lies in the fact that despite continuous advancements in imaging and molecular diagnostic technologies, there are still limitations in manual efficiency and subjective experience when it comes to massive data analysis and multi-scale feature extraction. Artificial intelligence (AI), especially algorithm systems based on deep learning, is an innovative technology capable of deeply empowering medical big data. This method utilizes algorithms such as convolutional neural networks, combined with radiomics, pathomics, and multi-modal data fusion analysis, demonstrating immense potential in early precise detection and benign-malignant differentiation of pulmonary nodules, digital pathological subtype recognition and non-invasive prediction of driver genes, precise 3D surgical planning and automatic delineation of radiotherapy target volumes, as well as dynamic risk warning during follow-up. This innovative technology provides a brand-new solution for realizing intelligent and individualized lung cancer diagnosis and treatment models. This consensus, based on the latest evidence from evidence-based medicine and combined with the development trends in the AI field and real-world clinical needs, was ultimately formed by gathering the consensus opinions of multidisciplinary experts in radiology, pathology, thoracic surgery, and other fields. The main content covers the application specifications of AI in the three core scenarios of lung cancer screening, diagnosis, and treatment, the technical standards for data collection and algorithm validation, as well as the ethical and regulatory challenges faced at the current stage. It aims to clarify the applicable boundaries of AI as a clinical auxiliary decision support tool, providing scientific guidance and standardized exploration directions for peers currently engaged in or planning to carry out AI-assisted clinical diagnosis, treatment, and translation of lung cancer.

With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

Objective:To examine the clinical effect of the enlarged anterior cervical intervertebral cone-shape decompression and fusion(EACDF) for treating degenerative cervical kyphosis (DCK).Methods:This study is a retrospective case series research. From September 2018 to September 2023, the data of 51 patients with DCK who underwent EACDF at Department of Orthopaedics, the Second Affiliated Hospital, Naval Medical University were analyzed retrospectively. Among the 51 patients, there were 28 males and 23 females, with an age of (61.6±9.8) years old (range:39 to 74 years), and an body mass index of (25.9±2.7) kg/m 2 (range:20.7 to 31.7 kg/m 2). Patients underwent EACDF with expanded decompression by distracted intervertebral space, partial resections of posterior edge of vertebral body and uncinate vertebral joint. The operation duration, blood loss and length of hospital stay were recorded. The visual analog scale (VAS) of neck pain and arm pain, cervical disability index (NDI), and modified Japanese Orthopaedic Association (mJOA) score were recorded in patients before and immediately after surgery, as well as at follow-up. Imaging parameters such as C 2-7 Cobb angle of cervical global curvature, Cobb angle at the operative segment, C 2-7 sagittal vertical axis (C 2-7 SVA), T 1 slope and the height of operative segment were measured. The fusion rate and surgical complications of two groups were recorded. Fourty-five patients who underwent anterior cervical corpectomy with fusion (ACCF) during the same period were included to compare the effectiveness of deformity correction between the two groups. Repeated measures ANOVA was used for intra group data comparison and Dunnett- t test was used for pairwise comparison, and mixed design ANOVA was used for inter group data comparison. Results:All patients were successfully completed the operation. The follow-up period after surgery was (40.4±13.4) months (range:12 to 72 months). The neck pain and arm pain VAS, NDI and JOA in the two groups immediately after surgery, at 2 months, 12 months after surgery, and the final follow-up were significantly improved compared with those before operation (all P<0.05). In both groups, postoperative the C 2-7 Cobb angle, Cobb angle at the operative segment, C 2-7 SVA, T 1 slope, and height of operative segment were significantly improved immediately after surgery, at 2 months, 12 months, and the final follow-up (all P<0.05). The C 2-7 Cobb angle, Cobb angle at the operative segment, and height of operative segment immediately after surgery, at 2 months, 12 months, and the final follow-up in the EACDF group were significantly higher than those in the ACCF group (all P<0.05). There were no significant differences in C 2-7 SVA and T 1 slope between the two groups(all P>0.05). At the final follow-up, the angle of every intervertebral space correction in the EACDF group was (9.3±1.6) °(range:6.5° to 12.3°), while in the ACCF group was (3.1±1.8) °(range:1.2° to 5.6°), with a significant difference between the two groups ( P<0.05). Patients at the both groups got bone graft fusion at the final follow-up. Conclusions:The clinical effect of EACDF for treating DCK is satisfactory. EACDF maybe superior to ACCF in restoring intervertebral height, correcting and maintaining cervical curvature.

Objective To compare the efficacy and tolerability of the novel bowel-cleansing agent TCIC-001 and the traditional polyethylene glycol (PEG) regimen for bowel preparation prior to colonoscopy. Methods Prospective inclusion of 62 patients who were scheduled to undergo colonoscopy at Zhongshan Hospital, Fudan University from July 2021 to July 2022. They were randomly divided into TCIC-001 group (n=31) and PEG group (n=31) using a random number table method. The TCIC-001 group took TCIC-001 orally, drinking water in stages, with a total liquid intake of 1 500 mL; the PEG group took PEG orally, taking it in 4 doses, with a total liquid intake of 3 000 mL. The primary endpoint indicator is the quality of intestinal hygiene evaluated by the Boston Bowel Preparation Scale (BBPS), the secondary endpoint indicators were medication adherence, medication duration, frequency of bowel movements, duration of bowel movements, and incidence of adverse events between two groups. Results No significant differences were observed in sex, age, or defecation frequency between the two groups. For efficacy, both groups achieved equivalent bowel cleanliness, with a “good preparation” rate of 93.55% and comparable BBPS score of each intestinal segment and total scores. For tolerability, the TCIC-001 group had a shorter medication duration compared to the PEG group ([48.8±25.9] min vs [82.8±28.4] min, P<0.001), a longer defecation duration ([288.6±74.0] min vs [236.5±74.3] min, P<0.001), and a lower incidence of first defecation before medication completion (9.68% vs 41.94%, P=0.004). Regarding safety, no significant differences were observed between the TCIC-001 group and the PEG group in incidences of chloride disturbances (0% vs 9.68%) and calcium disturbances (3.23% vs 6.45%), and no other adverse events. Conclusions TCIC-001 demonstrated comparable bowel-cleansing efficacy to PEG while significantly improving tolerability (reduced medication time and lower risk of premature defecation) and maintaining favorable safety.

BACKGROUND: Lung cancer is currently the most prevalent malignancy and the leading cause of cancer deaths worldwide. Although the early stage non-small cell lung cancer (NSCLC) presents a relatively good prognosis, a considerable number of lung cancer cases are still detected and diagnosed at locally advanced or late stages. Surgical treatment combined with perioperative multimodality treatment is the mainstay of treatment for locally advanced NSCLC and has been shown to improve patient survival. Following the standard methods of neoadjuvant therapy, perioperative management, postoperative adjuvant therapy, and other therapeutic strategies are important for improving patients' prognosis and quality of life. However, controversies remain over the perioperative management of NSCLC and presently consensus and standardized guidelines are lacking for addressing critical clinical issues in multimodality treatment. METHODS: The working group consisted of 125 multidisciplinary experts from thoracic surgery, medical oncology, radiotherapy, epidemiology, and psychology. This guideline was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The clinical questions were collected and selected based on preliminary open-ended questionnaires and subsequent discussions during the Guideline Working Group meetings. PubMed, Web of Science, Cochrane Library, Scopus, and China National Knowledge Infrastructure (CNKI) were searched for available evidence. The GRADE system was used to evaluate the quality of evidence and grade the strengths of recommendations. Finally, the recommendations were developed through a structured consensus-building process. RESULTS: The Guideline Development Group initially collected a total of 62 important clinical questions. After a series of consensus-building conferences, 24 clinical questions were identified and corresponding recommendations were ultimately developed, focusing on neoadjuvant therapy, perioperative management, adjuvant therapy, postoperative psychological rehabilitation, prognosis assement, and follow-up protocols for NSCLC. CONCLUSIONS This guideline puts forward reasonable recommendations focusing on neoadjuvant therapy, perioperative management, adjuvant therapy, postoperative psychological rehabilitation, prognosis assessment, and follow-up protocol of NSCLC. It standardizes perioperative multimodality treatment and provides guidance for clinical practice among thoracic surgeons, medical oncologists, and radiotherapists, aiming to reduce postoperative recurrence, improve patient survival, accelerate recovery, and minimize postoperative complications such as atelectasis.
Humans ; Carcinoma, Non-Small-Cell Lung/therapy* ; Lung Neoplasms/therapy* ; Combined Modality Therapy ; Perioperative Care

Chronic thromboembolic pulmonary hypertension(CTEPH)is a severe form of pulmonary hypertension(PH),and is classified as the fourth major category of pulmonary arterial hypertension.CTEPH is primarily caused by chronic thrombosis,leading to the obstruction of blood flow in the pulmonary arteries and result ing in a sustained increase in pulmonary artery pressure.The unclear pathogenesis of CTEPH,however,means that its early diagnosis is challenging,treatment options are limited,and prognosis assessment is often inaccurate.In-depth research into these mechanisms will thus improve our understanding of the pathophysiological processes of CTEPH,and also provide a theoretical basis for developing new therapeutic strategies.This review focuses on the current method of establishing CTEPH rat models and their advantages and disadvantages,offering researchers a reference for selecting and constructing CTEPH rat models.

Objectives:To explore the effects of guttering on the lateral mass technique in enlarging the cross-sectional area of the spinal canal after unilateral open-door cervical laminoplasty.Methods:A retro-spective analysis was conducted on the clinical data of patients with cervical ossification of posterior longitudi-nal ligament treated with unilateral open-door cervical laminoplasty between February 2021 and February 2024.37 patients who underwent the conventional technique were included in the conventional group;31 pa-tients undergone guttering on the lateral mass technique were included in the lateral mass group.The opera-tive time,intraoperative blood loss,postoperative drainage volume,and incidence of complications were compared between the two groups.At preoperation,immediately after surgery,2 months after surgery,and the final follow-up,the neck pain was evaluated using the visual analog scale(VAS),the cervical function was assessed with the neck disability index(NDI),and the neurological function was appraised with the Japanese Orthopaedic Association(JOA)score.C2-7 Cobb angle,C2-7 sagittal vertical axis(SVA),and T1 slope were measured on the cervical lateral X-rays to eliminate the possibilities of guttering on the lateral mass affecting cervical stability and cervical curvature;The spinal canal area was measured on the CT cross-sectional image and the percentage increase in spinal canal area was compared between the two groups.Results:All the pa-tients underwent the surgery successfully.No serious complications such as spinal cord injury or infection oc-curred.There were no significant differences in operation time,intraoperative blood loss,postoperative drainage volume between the two groups(P＞0.05).The neck pain VAS scores,NDI and JOA scores in both groups showed significant improvement immediately after surgery,2 months after surgery,and at final follow-up(P＜0.05).There were no differences in neck pain VAS scores and NDI between the two groups at preoperation,immediately after surgery,2 months after surgery and final follow-up(P＞0.05).There was no statistical differ-ence in preoperative JOA scores between the two groups(P＞0.05),but there were statistically significant differ-ences in JOA scores between the two groups immediately after surgery,2 months after surgery,and at final follow-up(P＜0.05).There were no statistical differences in C2-7 Cobb angle,C2-7 SVA,and T1 slope in both groups immediately after surgery,at 2 months after surgery,and at final follow-up,comparing with those before operation(P＞0.05).No significant differences were found between the two groups in C2-7 Cobb angle,C2-7 SVA,and T1 slope at preoperation,immediately after surgery,at 2-month after surgery,and at the fi-nal follow-up(P＞0.05).The average cross-sectional area of the spinal canal in both groups showed significant improvement immediately after surgery,at 2-month after surgery,and at final follow-up(P＜0.05).There was no statistical difference in the preoperative average cross-sectional area of the spinal canal between the two groups(P＞0.05).However,the average cross-sectional area of the spinal canal in the lateral mass group imme-diately after surgery,at 2-month after surgery,and at the final follow-up was larger than that in the conven-tional group,and the differences were statistically significant(P＜0.05).Conclusions:Compared with the con-ventional unilateral open-door cervical laminoplasty,guttering on the lateral mass technique can significantly expand the cross-sectional area of the spinal canal and improve postoperative neurological function recovery.

Chronic thromboembolic pulmonary hypertension(CTEPH)is a severe form of pulmonary hypertension(PH),and is classified as the fourth major category of pulmonary arterial hypertension.CTEPH is primarily caused by chronic thrombosis,leading to the obstruction of blood flow in the pulmonary arteries and result ing in a sustained increase in pulmonary artery pressure.The unclear pathogenesis of CTEPH,however,means that its early diagnosis is challenging,treatment options are limited,and prognosis assessment is often inaccurate.In-depth research into these mechanisms will thus improve our understanding of the pathophysiological processes of CTEPH,and also provide a theoretical basis for developing new therapeutic strategies.This review focuses on the current method of establishing CTEPH rat models and their advantages and disadvantages,offering researchers a reference for selecting and constructing CTEPH rat models.

Objectives:To explore the effects of guttering on the lateral mass technique in enlarging the cross-sectional area of the spinal canal after unilateral open-door cervical laminoplasty.Methods:A retro-spective analysis was conducted on the clinical data of patients with cervical ossification of posterior longitudi-nal ligament treated with unilateral open-door cervical laminoplasty between February 2021 and February 2024.37 patients who underwent the conventional technique were included in the conventional group;31 pa-tients undergone guttering on the lateral mass technique were included in the lateral mass group.The opera-tive time,intraoperative blood loss,postoperative drainage volume,and incidence of complications were compared between the two groups.At preoperation,immediately after surgery,2 months after surgery,and the final follow-up,the neck pain was evaluated using the visual analog scale(VAS),the cervical function was assessed with the neck disability index(NDI),and the neurological function was appraised with the Japanese Orthopaedic Association(JOA)score.C2-7 Cobb angle,C2-7 sagittal vertical axis(SVA),and T1 slope were measured on the cervical lateral X-rays to eliminate the possibilities of guttering on the lateral mass affecting cervical stability and cervical curvature;The spinal canal area was measured on the CT cross-sectional image and the percentage increase in spinal canal area was compared between the two groups.Results:All the pa-tients underwent the surgery successfully.No serious complications such as spinal cord injury or infection oc-curred.There were no significant differences in operation time,intraoperative blood loss,postoperative drainage volume between the two groups(P＞0.05).The neck pain VAS scores,NDI and JOA scores in both groups showed significant improvement immediately after surgery,2 months after surgery,and at final follow-up(P＜0.05).There were no differences in neck pain VAS scores and NDI between the two groups at preoperation,immediately after surgery,2 months after surgery and final follow-up(P＞0.05).There was no statistical differ-ence in preoperative JOA scores between the two groups(P＞0.05),but there were statistically significant differ-ences in JOA scores between the two groups immediately after surgery,2 months after surgery,and at final follow-up(P＜0.05).There were no statistical differences in C2-7 Cobb angle,C2-7 SVA,and T1 slope in both groups immediately after surgery,at 2 months after surgery,and at final follow-up,comparing with those before operation(P＞0.05).No significant differences were found between the two groups in C2-7 Cobb angle,C2-7 SVA,and T1 slope at preoperation,immediately after surgery,at 2-month after surgery,and at the fi-nal follow-up(P＞0.05).The average cross-sectional area of the spinal canal in both groups showed significant improvement immediately after surgery,at 2-month after surgery,and at final follow-up(P＜0.05).There was no statistical difference in the preoperative average cross-sectional area of the spinal canal between the two groups(P＞0.05).However,the average cross-sectional area of the spinal canal in the lateral mass group imme-diately after surgery,at 2-month after surgery,and at the final follow-up was larger than that in the conven-tional group,and the differences were statistically significant(P＜0.05).Conclusions:Compared with the con-ventional unilateral open-door cervical laminoplasty,guttering on the lateral mass technique can significantly expand the cross-sectional area of the spinal canal and improve postoperative neurological function recovery.