A portion of patients undergoing implant restoration require bone augmentation procedures to ensure that there is sufficient bone volume around the implant. For the patients with horizontal bone ridge defects at edentulous sites, with or without mild to moderate vertical bone defects, the shell technique serves as a reliable and minimally invasive bone augmentation method with effective space maintenance. The shell technique involves fixating 1 mm cortical bone blocks to the recipient site, using retention screws and filling the gap between the bone block and recipient bed with particulate bone substitute materials, and covering the barrier membrane to achieve bone augmentation. The overlying tension-free soft tissue closure seals the surgical site while local peripheral blood releases osteoclasts and cytokines that gradually degrade the bone block. The rigid fixation of the bone block ensures a stable internal environment for osteogenesis and a new bone regeneration cycle. Although this technique demonstrates favorable bone augmentation outcomes, it is highly technique-sensitive. There are certain differences in the application scenarios and osteogenic processes for autologous and allogeneic bone shells. The selection of bone blocks and particulate bone substitute materials significantly influences the osteogenic biological process and the predictability of bone augmentation results. Complications associated with the shell technique possess distinct characteristics, such as the immunogenicity of allogeneic bone fragments, soft tissue cracking, and bone fragment loosening. Their prevention and subsequent management substantially impact the success rate of osteogenesis. This article delves into the biological mechanisms of osteogenesis in the bone block technique, summarizing the indications, clinical outcomes, classification of bone blocks, and surgical workflow management, as well as complication prevention and management, aiming to provide a reference for the future application and development of the bone shell technique.

Hodgkin lymphoma（HL）is one of the common pediatric malignancies（especially in adolescents）. The prognosis of pediatric patients with HL is excellent with traditional first-line treatment regimens involving short-course，high-dose combination chemotherapy and low-intensity radiotherapy，resulting in an overall response rate of 90%. However，10%-25% of pediatric HL patients are estimated to have relapsed/refractory（r/r）disease，and survivors of pediatric HL are at risk of late effects caused by traditional treatment regimens. For children with r/r HL，novel therapies，such as brentuximab vedotin，immune checkpoint inhibitors and immune cell therapy，including chimeric antigen receptor T-cell therapy and EBV-specific cytotoxic T lymphocytes are an integral part of their salvage treatment and consolidation treatment after hematopoietic stem cell transplantation. Furthermore，combining novel therapies with first-line treatment regimens for pediatric HL may help enhance therapeutic efficacy and reduce treatment toxicity. This review is aimed to describe current advances in novel therapies for pediatric HL，and serve as a reference for clinical practice.

Objective To establish a classification tree model for non-alcoholic fatty liver disease(NAFLD)among aircrews,screen for influencing factors of NAFLD,so as to provide scientific basis for prevention and intervention decisions for NAFLD.Methods Aircrews who underwent recuperation at a sanatorium from January 2019 to December 2023 were selected as the research objects.Their annual physical examination data were collected and the NAFLD detection rate was calculated.Age,body mass index(BMI),blood pressure,waist circumference,blood routine,biochemistry indexes,and thyroid function were incorporated,and a NAFLD risk model was constructed using classification regression tree method.The predictive performance of the NAFLD classification tree model was evaluated through model misclassification matrix,risk statistics,and receiver operating characteristic curve.Results A total of 4088 aircrews were included in the study,and NAFLD was detected in 380 persons(380/4088,9.30%).The NAFLD model consisted of three layers,and five explanatory variables affecting the onset of NAFLD were extracted,including BMI,triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),alanine aminotransferase(ALT),and total bilirubin(TBIL).BMI was located at the top of the classification tree and was the most important risk factor for NAFLD in aircrews.The area under the curve(AUC)of the model was 0.853.The predictive accuracy of NAFLD was 90.9%,indicating that the model has good accuracy and fitting effect.Conclusion In this study,the detection rate of NAFLD in aircrews was 9.30%.BMI,TG,HDL-C,ALT,and TBIL are risk factors for the onset of NAFLD.NAFLD is mainly related to weight gain and lipid metabolism disorders caused by unhealthy lifestyles.

objective To investigate the prognostic value of plasma ADAMTS13 in patients with heart failure complicated with type 2 diabetes mellitus(T2DM).Methods Clinical data were collected from adult patients with acute decompensated heart failure admitted to the Second People's Hospital of Yulin City from January 2019 to December 2020,with a total of 278 cases included.The level of ADAMTS13 was measured using an ELISA kit,and patients were divided into three groups based on the third quartile of ADAMTS13:T1<9.9 μg/L group(n=92),T2≥10.0-18.5 μg/L group(n=93),and T3≥18.5 μg/L group(n=93).The primary outcome was defined as the composite end point of all-cause mortality's or heart failure readmission.Secondary outcomes included all-cause mortality and heart failure readmission.Results Compared with the patients in the highest third quartile of ADAMTS13,the number of T2DM cases,body mass index,uric acid,fasting blood glucose,HbA1c and hs-CRP levels in the patients with the lowest third quartile of ADAMTS13 increased significantly(P<0.05).The absolute risks of main outcome,all-cause death and hospitalization of heart failure were higher in T2DM patients than in non-T2DM patients(χ2=12.028,8.725,9.023,all P=0.000).The differences in heart failure rate among patients with different ADAMTS13 levels were statistically significant(χ2=9.384,P=0.002).Every doubling of ADAMTS13 was related to a decreased risk of the main outcomes in HF patients with T2DM(HR=0.69,95%CI=0.61～0.79),all-cause mortality(HR=0.59,95%CI=0.47～0.74)and heart failure readmission(HR=0.75,95%CI=0.65～0.87).Conclusion ADAMTS13 is an independent biomarker for risk stratification in HF,especially in patients with T2DM.

Objective:To explore the relationship between childhood abuse, pleasure experience, sleep quality and self-injury behavior in adolescents with depressive disorder.Methods:One hundred and twenty adolescent patients with depressive disorder hospitalized in the Fourth People's Hospital of Hefei City from January 2021 to February 2024 were selected as the study group, as well as 120 healthy controls matched with the patients' age, gender and education level were selected as the control group.The adolescent non-suicidal self-injury assessment questionnaire, Pittsburgh sleep quality index, temporal experience of pleasure scale, and childhood trauma questionnaire were used for assessment. Statistical analysis was performed using SPSS 26.0 software. Independent sample t-test was used for comparison between the two groups. Pearson correlation analysis was used to analyze correlations between scale scores. Chain mediating modeling was used with the PROCESS macro program. Results:The differences of the study group and the control group in childhood abuse ((53.33±15.21), (39.07±11.81), t=8.081, P<0.001), pleasure experience ((85.60±15.77), (67.44±19.46), t=7.941, P<0.001), self-injury behavior ((29.01±9.89), (3.76±0.49), t=8.811, P<0.001), sleep quality ((12.24±4.15), (6.56±4.05), t=10.711, P<0.001), and depression ((30.62±7.97), (5.88±3.28), t=31.451, P<0.001) were all statistically significant. The self-injury behavior of the study group was positively correlated with the sleep quality ( r=0.487, P<0.001) and childhood abuse ( r=0.553, P<0.001), and negatively correlated with the pleasure experience ( r=-0.483, P<0.001). Childhood abuse had a negative predictive effect on pleasure experience ( β=-0.491, P<0.001), there was a positive predictive effect of childhood abuse on sleep quality ( β=0.363, P<0.001), there was a negative predictive effect of pleasure experience on sleep quality ( β=-0.321, P<0.001), there was a simultaneous predictive effect of childhood abuse, pleasure experience and sleep quality on self-injury behaviors predictive effect ( β=0.343, P<0.001, β=-0.211, P<0.001, β=0.208, P<0.001).The total effect of childhood abuse on self-injury behavior mediated by pleasure experience and sleep quality was 0.555(95% CI=0.448-0.663), and the direct effect was 0.343(95% CI=0.219-0.468).The mediating effect of pleasure experience between childhood abuse and self-injury behavior was 0.104(95% CI=0.007-0.196), accounting for 18.74% of the total effect, the mediating effect of sleep quality between childhood abuse and self-injury behavior was 0.075(95% CI=0.028-0.133), accounting for 13.51% of the total effect, and the chain mediating effect of pleasure experience and sleep quality between childhood abuse and self-injury behavior was 0.033(95% CI=0.011-0.060), accounting for 5.95% of the total effect. Conclusion:Sleep quality and pleasure experience exert the chain mediating effect between the childhood abuse and self-injury behavior in adolescents with depressive disorders.

T-cell inhibitory receptors(IR)are involved in the composing of co-inhibitory signaling pathways between T cells and immune cells,and transmit immunosuppressive signals to limit immune effects of T cells such as activation and proliferation.Ab-normal co-inhibitory signals may destroy the peripheral immune tolerance of the body,leading to hyperresponsiveness of various organ-specific autoimmunity.Rheumatoid arthritis(RA)is a complex systemic disease in which there is an immune disorder centered on T cells.In this process,the abnormal expression and distribution of T-cell IR are fully involved in the imbalance of T-cell subsets and pathological immune responses,affecting the development and progression of the disease.Targeting T-cell IR and its ligands and thus strengthening the co-inhibitory signaling pathway mediated by them has been studied for suppressing immune responses and maintain-ing immune tolerance,but their potential for clinical application in RA remains to be explored.In the present,we review the advances of T-cell IR involved in the immunopathology of RA,and discusses the therapeutic prospects of targeting these receptors.

Liver fibrosis is a key histologic marker of long-term outcome in chronic liver disease. Non-invasive tests (NITs) have been shown to have predictive value, but the superiority of "dynamic" versus "static" assessment remains controversial. This article systematically reviews the latest evidence to elucidate the association between longitudinal changes in NITs and hepatic adverse events and assess the incremental contribution of dynamic monitoring to the model. Additionally, it reveals that the dynamic monitoring of NITs is truly superior to single evaluation, but the evidence is limited and the heterogeneity is significant. Dynamic modeling approaches for NITs require a shift from traditional parameter estimation to time-series machine learning. Future studies should make breakthroughs in disease stratification, modeling method innovation, data quality improvement, and prediction ability assessment so as to promote the transition of NITs from "static risk label" to "dynamic individualized engine," which can truly serve clinical decision-making.

Gastric cancer (GC) is characterized by high morbidity and mortality rates. Chinese agarwood comprises the resin-containing wood of Aquilaria sinensis (Lour.) Gilg., traditionally utilized for treating asthma, cardiac ischemia, and tumors. However, comprehensive research regarding its anti-GC effects and underlying mechanisms remains limited. In this study, Chinese agarwood petroleum ether extract (CAPEE) demonstrated potent cytotoxicity against human GC cells, with half maximal inhibitory concentration (IC₅₀) values for AGS, HGC27, and MGC803 cells of 2.89, 2.46, and 2.37 μg·mL^-1, respectively, at 48 h. CAPEE significantly induced apoptosis in these GC cells, with B-cell lymphoma-2 (BCL-2) associated X protein (BAX)/BCL-2 antagonist killer 1 (BAK) likely mediating CAPEE-induced apoptosis. Furthermore, CAPEE induced G₀/G₁ phase cell cycle arrest in human GC cells via activation of the deoxyribonucleic acid (DNA) damage-p21-cyclin D1/cyclin-dependent kinase 4 (CDK4) signaling axis, and increased Fe²⁺, lipid peroxides and reactive oxygen species (ROS) levels, thereby inducing ferroptosis. Ribonucleic acid (RNA) sequencing, real-time quantitative polymerase chain reaction (RT-qPCR), and Western blotting analyses revealed CAPEE-mediated upregulation of heme oxygenase-1 (HO-1) in human GC cells. RNA interference studies demonstrated that HO-1 knockdown reduced CAPEE sensitivity and inhibited CAPEE-induced ferroptosis in human GC cells. Additionally, CAPEE administration exhibited robust in vivo anti-GC activity without significant toxicity in nude mice while inhibiting tumor cell growth and promoting apoptosis in tumor tissues. These findings indicate that CAPEE suppresses human GC cell growth through upregulation of the DNA damage-p21-cyclin D1/CDK4 signaling axis and HO-1-mediated ferroptosis, suggesting its potential as a candidate drug for GC treatment.
Animals ; Humans ; Mice ; Antineoplastic Agents, Phytogenic ; Apoptosis/drug effects* ; Cell Line, Tumor ; Cyclin D1/genetics* ; Cyclin-Dependent Kinase 4/genetics* ; DNA Damage/drug effects* ; Drugs, Chinese Herbal/pharmacology* ; Ferroptosis/drug effects* ; G1 Phase Cell Cycle Checkpoints/drug effects* ; Heme Oxygenase-1/genetics* ; Mice, Inbred BALB C ; Mice, Nude ; Plant Extracts/pharmacology* ; Stomach Neoplasms/physiopathology* ; Thymelaeaceae/chemistry* ; Up-Regulation/drug effects*

Objective:To compare the efficacy of robot system-assisted versus freehand screw revision for ankylosing spondylitis (AS) with lower cervical fractures.Methods:A multicenter retrospective cohort study was conducted to analyze the clinical data of 57 patients with AS combined with lower cervical fractures admitted to Honghui Hospital Affiliated to Xi'an Jiaotong University School of Medicine, Henan Provincial People's Hospital, Zhengzhou Orthopedic Hospital, and Qilu Hospital of Shandong University, including 46 males and 11 females, aged 38-77 years [(65.4±9.5)years]. Injury segments involved C 3 in 7 patients, C 4 in 13, C 5 in 25, C 6 in 10, and C 7 in 2. All the patients underwent revision surgery, among whom, 22 patients were treated with robot system-assisted cervical pedicle screw placement (robot nailing group, with 190 screws), and 35 with freehand cervical pedicle screw placement (freehand nailing group, with 300 screws). The operative duration, intraoperative bleeding volume, frequency of intraoperative fluoroscopy, incision length, and length of hospital stay of the two groups were compared; the time of single nscrew insertion, the number of single nail revisions, the distance between screws and the anterior cortex, the accuracy of screw placement of grade 0 and grade 0+1 were recorded in the two groups. The visual analogue scale (VAS), Japanese Orthopedic Society (JOA) score, neck dysfunction index (NDI), American Spine Injury Association (ASIA) classification before operation, at 3 days, 3 months after operation and at the last follow-up were compared between the two groups. The complication rate was also noted. Results:All the patients were followed up for 12-16 months [(14.3±2.1)months]. The operative duration, intraoperative bleeding volume, and frequency of intraoperative fluoroscopy were (186.4±12.9)minutes, (486.1±68.6)ml, and (3.4±1.3)times in the robot nailing group, which were shorter or less than (206.7±14.4)minutes, (660.3±45.2)ml, and (13.5±3.6)times in the freehand nailing group ( P<0.01). The incision length was (9.4±2.4)cm in the robot nailing group, longer than (5.6±1.2)cm in the freehand nailing group ( P<0.01), and the length of hospital stay was (3.7±0.4)days, shorter than (4.4±1.4)days in the freehand nailing group ( P<0.01). The length of single nail insertion, the number of single nail revision, and the distance between the screws and the front cortex were (6.5±0.4)minutes, (1.1±0.1)times, and (3.5±1.3)mm in the robot nailing group, which were shorter or less than (11.6±0.2)minutes, (1.5±0.2)times, and (12.4±4.7)mm in the freehand nailing group ( P<0.01). The accuracy of the screw placement in the robot nailing group was 90.0% (171/190) and 95.8% (182/190) with level 0 and 0+1 screws, better than 80.0% (240/300) and 89.0% (267/300) in the freehand nailing group ( P<0.05). There was no significant difference in VAS, JOA score, NDI, or ASIA grading between the two groups before operation ( P>0.05). The VAS, JOA, and NDI scores at 3 days after operation were (3.1±0.6)points, (12.1±1.2)points, and (15.6±2.9)points, respectively in the robot nailing group, which were better than (5.0±1.4)points, (11.3±1.1)points and (22.5±3.7)points, respectively in the freehand nailing group ( P<0.05). No statistically significant difference was observed in the ASIA grade between the two groups at 3 days after operation ( P>0.05). There were no significant differences in VAS, JOA, NDI scores, or ASIA grading between the two groups at 3 months after operation and at the last follow-up ( P>0.05). Compared with those before operation, the VAS, JOA, NDI scores, and ASIA grading were significantly improved at 3 days, 3 months after operation and at the last follow-up in the two groups, which were further improved with the passage of time. Two patients in the robot nailing group had pneumonia, with a complication rate of 9% (2/22), while 2 patients in the freehand nailing group had dural sac rupture and cerebrospinal fluid leakage and 3 had lung infection after operation, with a complication rate of 14% (5/35) ( P<0.05). Conclusion:Compared with freehand nailing, the robot system-assisted nailing revision for AS with lower cervical fracture has more advantages in terms of the operative duration, length of hospital stay, intraoperative bleeding volume, frequency of intraoperative fluoroscopy nailing speed and accuracy, screw holding force, early pain relief, function restoration, and complication rate, despite longer surgical incision.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.