Objective:To observe the clinical efficacy of posterior vertebral column resection (PVCR) combined with double row nanomimetic bone column implantation and internal fixation in the treatment of stage Ⅲ Kümmell's disease plus kyphosis.Methods:A retrospective study was conducted to analyze the clinical data of the 12 patients with stage Ⅲ Kümmell's disease plus kyphosis who had been admitted to Department of Spine Surgery, Zhengzhou Orthopedic Hospital from March 2017 to September 2023. There were 2 males and 10 females, with an age of (63.4±6.4) years and a disease duration of (8.6±5.1) months. The injured segment was T 11 in 1 patient, T 12 in 5 ones, and L 1 in 6 ones. The preoperative spinal nerve injury was graded according to American Spinal Injury Association (ASIA): grade D in 5 cases and grade E in 7 cases. All the patients were treated with PVCR combined with double row nanomimetic bone column implantation and internal fixation. The operation time, intraoperative blood loss, shortening rate of the osteotomy area, complications during follow-up, and spinal nerve recovery at the last follow-up were recorded. The visual analogue scale (VAS) pain scores, Oswestry Disability Indexes (ODIs), and local kyphosis Cobb angles were compared between pre-surgery, 2 weeks after surgery, and the last follow-up. Results:Incisions in all the 12 patients healed at the primary stage. Their operation duration was (268.4±26.5) min, intraoperative blood loss (994.9±180.4) mL, shortening rate of the osteotomy area 3.94%±7.58%, and follow-up duration (24.1±13.5) months. At 2 weeks after surgery and the last follow-up, the VAS pain scores [(3.08±0.79) points and (1.17±0.58) points] and ODIs (27.59%±6.10% and 16.67%±2.22%) were significantly lower than those before surgery [(8.08±0.79) points and 73.14%±5.64%], and the values at the last follow-up were further significantly lower than those at 2 weeks after surgery (all P<0.05). There was no statistically significant difference in the Cobb angle at the last follow-up (5.29°±1.30°) compared with 2 weeks after surgery (4.74°±1.31°) ( P>0.05), but there was a statistically significant difference compared with the preoperative value (49.41°±4.40°) ( P<0.05). At the last follow-up, the ASIA grading in all the 12 patients recovered to grade E, with good bone healing at the fixation segment. No screw loosening or fracture was found. Two patients had a biomimetic bone column sinking of 3.5 and 4.0 mm, respectively, but their Marchi's grading was still 0. During the follow-up period, one patient developed proximal junctional kyphosis, and one patient developed an osteoporotic fracture of the proximal vertebral body at the fixed level. Conclusions:In the treatment of stage Ⅲ Kümmell's disease plus kyphosis, PVCR combined with double row nanomimetic bone column implantation and internal fixation can significantly correct the kyphosis and improve clinical symptoms, leading to good clinical efficacy.

Objective: To explore the regulatory effects of ginkgo biloba extract on airway inflammatory injury and Toll⁃like receptor 4(TLR4)/nucleotide⁃binding oligomerization domain⁃containing 3(NLRP3) pathway in rats with vided into four groups : the normal control group , Methods: Thirty⁃six male SD rats were selected and randomly divided into four groups : the normal control group , the model group , the prednisone treatment group , and the ginkgo biloba extract treatment group , with 9 rats in each group. Except for the normal control group , the COPD rat mod⁃els in the other groups was constructed by intratracheal instillation of lipopolysaccharide (LPS) combined with ciga⁃rette smoke exposure. After successful modeling , the rats were continuously administered drugs for 12 weeks , fol⁃lowed by sampling. The general conditions and respiratory symptoms of the rats were observed. The pathological changes of lung tissues were observed by hematoxylin⁃eosin (HE) staining technique ; the mRNA and protein ex⁃pression levels of TLR4 , tumor necrosis factor⁃α (TNF⁃α ) , interleukin⁃1β (IL⁃1β) and NLRP3 in rat lung tissueswere detected by real⁃time quantitative polymerase chain reaction (RT⁃qPCR) and Western blot. Results: Com⁃pared with the normal control group , the lung tissues of rats in the model group were significantly damaged , and the protein and mRNA expression of TLR4 , TNF⁃α , IL⁃1β , and NLRP3 increased ( P < 0. 05 ) . Compared with the model group , lung tissue damage was reduced in the prednisone group and the ginkgo biloba extract group , and TLR4 , TNF⁃α , IL⁃1β , NLRP3 protein and mRNA expression decreased (P < 0. 05) . Conclusion Ginkgo biloba airway inflammatory response by inhibiting the TLR4/NLRP3 signaling pathway.

Objective:To explore the value of an integrated modeling approach combining radiomics, dosiomics, and clinical factors in the prediction of the locoregional recurrence (LRR) risk after radiotherapy for patients with locoregionally advanced hypopharyngeal squamous cell carcinoma (HPSCC), in order to provide supplementary clinical evidence and decision-making basis for personalized treatment for this rare disease characterized by low incidence and poor prognosis.Methods:The clinical images and pathological data were retrospectively enrolled from 76 HPSCC patients treated at the Peking University Cancer Hospital from October 2011 to July 2020. The planning gross tumor volumes (PGTVs) were taken as the volumes of interest (VOIs). A total of 1 316 radiomic and dosiomic features were extracted from the planning CT and dose distribution images. After stability testing, feature dimensionality reduction was achieved using least absolute shrinkage and selection operator (LASSO) regression and principal component analysis (PCA), with radiomic principal components (RPCs) and dosiomic principal components (DPCs) obtained, respectively. Using various combinations of RPCs, DPCs, and clinical variables as predictors, multivariate Cox regression models were developed after 5-fold cross-validation 100 times. The model performance was evaluated based on the Akaike information criterion (AIC) and concordance index (C-index).Results:Using two RPCs and three DPCs selected, dosiomics and radiomic Cox proportional hazards models were constructed, with C-index values of 0.781 and 0.778 and AIC values of 94.44 and 92.27, respectively. The result indicated that one RPC and three DPCs showed significant associations in Cox regression ( P < 0.05). Other prediction models were established by integrating the clinical data of patients with radiomic features, dosiomic features, or both. The prediction result demonstrated that compared to models based on individual factors or dual components, the multi-omics model yielded the highest prediction accuracy (C-index: 0.823, AIC: 84.94). Conclusions:Integrated models that combine radiomic features, dosiomic features, and clinical factors demonstrate great potential for enhancing the accuracy of LRR risk prediction. These models are expected to provide decision-making support for devising personalized treatment strategies and ultimately improve the prognosis of HPSCC patients.

Objective:To evaluate the clinical efficacy of a novel reduction device in the treatment of A3N0/1 thoracolumbar fracture using navigation-assisted techniques.Methods:A retrospective analysis was conducted on 45 patients (29 males, 16 females; mean age 40.67±16.11 years, range 24-57) with thoracolumbar fractures who underwent fracture reduction and pedicle screw fixation via the Wiltse approach at Zhengzhou Orthopaedic Hospital between January 2022 and January 2023. Injury levels included: T 10 in 2 cases, T 11 in 5 cases, T 12 in 13 cases, L 1 in 20 cases, L 2 in 3 cases, L 3 in 2 cases. All patients underwent fracture reduction via the Wiltse approach using the spinal fracture reduction instrument for vertebral body reduction. Among them, 20 patients received O-arm navigation-assisted internal fixation and vertebral reduction (O-arm group), while 25 received C-arm fluoroscopy-guided internal fixation and vertebral reduction (C-arm group). Operative time, intraoperative blood loss, vertebral reduction time using the instrument, first-time screw placement success rate, screw placement accuracy, and complications were compared. Mid-vertebral body height ratio (MVBHr), local Cobb angle of the fractured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) were compared preoperatively, at 1 week postoperatively, 3 months postoperatively, and final follow-up. Results:All surgeries were successfully completed in both groups. Operative time was significantly shorter in the O-arm group (106.8±14.4 min) than in the C-arm group (119.1±16.4 min, P<0.05). All patients were followed up for a mean duration of 15.9±3.9 months (range 12-20 months). Vertebral reduction time was significantly shorter in the O-arm group (11.0±2.2 min) than in the C-arm group (20.4±5.7 min, P<0.05). The first-time screw placement success rate was significantly higher in the O-arm group (100%) than in the C-arm group (95.3%, P<0.05). Screw placement accuracy (Grade I) was significantly higher in the O-arm group (117 screws, 97.5%) than in the C-arm group (136 screws, 90.7%, P<0.05). No cases of wrong-level surgery, infection, or spinal cord/nerve injury occurred. Both groups showed significant improvements in MVBHr, Cobb angle, VAS, and ODI at all postoperative time points compared to preoperative values ( P<0.05). At final follow-up, the O-arm group demonstrated significantly better outcomes than the C-arm group in MVBHr (90.6%±4.5% vs. 86.4%±6.9%, P<0.05), Cobb angle (7.6°±1.8° vs. 10.1°±3.2°, P<0.05), VAS (1.3±0.4 vs. 1.7±0.6, P<0.05), and ODI (4.6%±1.9% vs. 7.7%±2.0%, P<0.01). Conclusion:O-arm navigation-assisted intrasegmental push reduction for A3N0/1 type thoracolumbar fractures demonstrates advantages including faster and more accurate screw placement, precise reduction with improved outcomes, and significant postoperative pain relief.

Objective:To evaluate the clinical efficacy of a novel reduction device in the treatment of A3N0/1 thoracolumbar fracture using navigation-assisted techniques.Methods:A retrospective analysis was conducted on 45 patients (29 males, 16 females; mean age 40.67±16.11 years, range 24-57) with thoracolumbar fractures who underwent fracture reduction and pedicle screw fixation via the Wiltse approach at Zhengzhou Orthopaedic Hospital between January 2022 and January 2023. Injury levels included: T 10 in 2 cases, T 11 in 5 cases, T 12 in 13 cases, L 1 in 20 cases, L 2 in 3 cases, L 3 in 2 cases. All patients underwent fracture reduction via the Wiltse approach using the spinal fracture reduction instrument for vertebral body reduction. Among them, 20 patients received O-arm navigation-assisted internal fixation and vertebral reduction (O-arm group), while 25 received C-arm fluoroscopy-guided internal fixation and vertebral reduction (C-arm group). Operative time, intraoperative blood loss, vertebral reduction time using the instrument, first-time screw placement success rate, screw placement accuracy, and complications were compared. Mid-vertebral body height ratio (MVBHr), local Cobb angle of the fractured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) were compared preoperatively, at 1 week postoperatively, 3 months postoperatively, and final follow-up. Results:All surgeries were successfully completed in both groups. Operative time was significantly shorter in the O-arm group (106.8±14.4 min) than in the C-arm group (119.1±16.4 min, P<0.05). All patients were followed up for a mean duration of 15.9±3.9 months (range 12-20 months). Vertebral reduction time was significantly shorter in the O-arm group (11.0±2.2 min) than in the C-arm group (20.4±5.7 min, P<0.05). The first-time screw placement success rate was significantly higher in the O-arm group (100%) than in the C-arm group (95.3%, P<0.05). Screw placement accuracy (Grade I) was significantly higher in the O-arm group (117 screws, 97.5%) than in the C-arm group (136 screws, 90.7%, P<0.05). No cases of wrong-level surgery, infection, or spinal cord/nerve injury occurred. Both groups showed significant improvements in MVBHr, Cobb angle, VAS, and ODI at all postoperative time points compared to preoperative values ( P<0.05). At final follow-up, the O-arm group demonstrated significantly better outcomes than the C-arm group in MVBHr (90.6%±4.5% vs. 86.4%±6.9%, P<0.05), Cobb angle (7.6°±1.8° vs. 10.1°±3.2°, P<0.05), VAS (1.3±0.4 vs. 1.7±0.6, P<0.05), and ODI (4.6%±1.9% vs. 7.7%±2.0%, P<0.01). Conclusion:O-arm navigation-assisted intrasegmental push reduction for A3N0/1 type thoracolumbar fractures demonstrates advantages including faster and more accurate screw placement, precise reduction with improved outcomes, and significant postoperative pain relief.

Objective:To explore the value of an integrated modeling approach combining radiomics, dosiomics, and clinical factors in the prediction of the locoregional recurrence (LRR) risk after radiotherapy for patients with locoregionally advanced hypopharyngeal squamous cell carcinoma (HPSCC), in order to provide supplementary clinical evidence and decision-making basis for personalized treatment for this rare disease characterized by low incidence and poor prognosis.Methods:The clinical images and pathological data were retrospectively enrolled from 76 HPSCC patients treated at the Peking University Cancer Hospital from October 2011 to July 2020. The planning gross tumor volumes (PGTVs) were taken as the volumes of interest (VOIs). A total of 1 316 radiomic and dosiomic features were extracted from the planning CT and dose distribution images. After stability testing, feature dimensionality reduction was achieved using least absolute shrinkage and selection operator (LASSO) regression and principal component analysis (PCA), with radiomic principal components (RPCs) and dosiomic principal components (DPCs) obtained, respectively. Using various combinations of RPCs, DPCs, and clinical variables as predictors, multivariate Cox regression models were developed after 5-fold cross-validation 100 times. The model performance was evaluated based on the Akaike information criterion (AIC) and concordance index (C-index).Results:Using two RPCs and three DPCs selected, dosiomics and radiomic Cox proportional hazards models were constructed, with C-index values of 0.781 and 0.778 and AIC values of 94.44 and 92.27, respectively. The result indicated that one RPC and three DPCs showed significant associations in Cox regression ( P < 0.05). Other prediction models were established by integrating the clinical data of patients with radiomic features, dosiomic features, or both. The prediction result demonstrated that compared to models based on individual factors or dual components, the multi-omics model yielded the highest prediction accuracy (C-index: 0.823, AIC: 84.94). Conclusions:Integrated models that combine radiomic features, dosiomic features, and clinical factors demonstrate great potential for enhancing the accuracy of LRR risk prediction. These models are expected to provide decision-making support for devising personalized treatment strategies and ultimately improve the prognosis of HPSCC patients.

Objective:To observe the clinical efficacy of posterior vertebral column resection (PVCR) combined with double row nanomimetic bone column implantation and internal fixation in the treatment of stage Ⅲ Kümmell's disease plus kyphosis.Methods:A retrospective study was conducted to analyze the clinical data of the 12 patients with stage Ⅲ Kümmell's disease plus kyphosis who had been admitted to Department of Spine Surgery, Zhengzhou Orthopedic Hospital from March 2017 to September 2023. There were 2 males and 10 females, with an age of (63.4±6.4) years and a disease duration of (8.6±5.1) months. The injured segment was T 11 in 1 patient, T 12 in 5 ones, and L 1 in 6 ones. The preoperative spinal nerve injury was graded according to American Spinal Injury Association (ASIA): grade D in 5 cases and grade E in 7 cases. All the patients were treated with PVCR combined with double row nanomimetic bone column implantation and internal fixation. The operation time, intraoperative blood loss, shortening rate of the osteotomy area, complications during follow-up, and spinal nerve recovery at the last follow-up were recorded. The visual analogue scale (VAS) pain scores, Oswestry Disability Indexes (ODIs), and local kyphosis Cobb angles were compared between pre-surgery, 2 weeks after surgery, and the last follow-up. Results:Incisions in all the 12 patients healed at the primary stage. Their operation duration was (268.4±26.5) min, intraoperative blood loss (994.9±180.4) mL, shortening rate of the osteotomy area 3.94%±7.58%, and follow-up duration (24.1±13.5) months. At 2 weeks after surgery and the last follow-up, the VAS pain scores [(3.08±0.79) points and (1.17±0.58) points] and ODIs (27.59%±6.10% and 16.67%±2.22%) were significantly lower than those before surgery [(8.08±0.79) points and 73.14%±5.64%], and the values at the last follow-up were further significantly lower than those at 2 weeks after surgery (all P<0.05). There was no statistically significant difference in the Cobb angle at the last follow-up (5.29°±1.30°) compared with 2 weeks after surgery (4.74°±1.31°) ( P>0.05), but there was a statistically significant difference compared with the preoperative value (49.41°±4.40°) ( P<0.05). At the last follow-up, the ASIA grading in all the 12 patients recovered to grade E, with good bone healing at the fixation segment. No screw loosening or fracture was found. Two patients had a biomimetic bone column sinking of 3.5 and 4.0 mm, respectively, but their Marchi's grading was still 0. During the follow-up period, one patient developed proximal junctional kyphosis, and one patient developed an osteoporotic fracture of the proximal vertebral body at the fixed level. Conclusions:In the treatment of stage Ⅲ Kümmell's disease plus kyphosis, PVCR combined with double row nanomimetic bone column implantation and internal fixation can significantly correct the kyphosis and improve clinical symptoms, leading to good clinical efficacy.

OBJECTIVE To investigate the improvement effect and potential mechanism of “Layers adjusting external application” paste on synovial fibrosis （SF） in rats with knee osteoarthritis （KOA）. METHODS Male SD rats were randomly divided into sham operation group， KOA group and Layers adjusting external application group， with 8 rats in each group. KOA model was induced by the anterior cruciate ligament disruption method in KOA group and Layers adjusting external application group. Fourteen days after modeling， the Layers adjusting external application group was given “Layers adjusting external application” paste [Sanse powder （8 g for every 100 cm2）， Compound sanhuang ointment （5 g for every 100 cm2）] on the knee joint， 8 h every day， for 28 d in total. After the last administration， the degree of synovitis and fibrosis in rats was observed， and Krenn scoring was performed in each group. The expressions of collagen Ⅰ， high mobility group protein B1 （HMGB1） and phosphorylated nuclear factor-κB p65 （p-NF-κB p65） were detected in the synovial membrane； the contents of interleukin-1β （IL- 1β）， IL-6 and tumor necrosis factor-α （TNF-α） in serum as well as the expressions of fibrosis-related and HMGB1/Toll-like receptor 4 （TLR4）/NF-κB signaling pathway-related proteins and mRNA were detected in synovial tissue. RESULTS Compared with the sham operation group， the synovial lining cells in the KOA group showed significant proliferation and disordered arrangement， the inflammatory cell infiltration and collagen fiber deposition were obvious； the positive expressing cells of collagen Ⅰ， HMGB1 and p-NF-κB p65 were increased significantly； the contents of IL-1β， IL-6 and TNF-α in serum， the expressions of fibrosis-related protein （transforming growth factor-β， collagen Ⅰ， tissue inhibitor of metalloproteinase 1， α-smooth muscle actin） and their mRNA as well as theexpressions of HMGB1， TLR4 protein and their mRNA， the expressions of p-NF-κB p65 protein and NF-κB p65 mRNA were all increased significantly in synovial tissues of rats （P＜0.01）. Compared with the KOA group， the pathological changes in the synovial tissue of rats in Layers adjusting external application group were significantly improved， and the above quantitative indicators were significantly reversed （P＜0.05 or P＜0.01）. CONCLUSIONS “Layers adjusting external application” paste could significantly improve SF in KOA rats， the mechanism of which may be associated with the inhibition of the activation of HMGB1/ TLR4/NF-κB signaling pathway.

Objective:To evaluate the clinical efficacy of pushing reduction with our self-designed spinal fracture reduction device in the treatment of A3N0/1 thoracolumbar fractures.Methods:A retrospective study was conducted to analyze the medical records of 53 patients who had undergone surgery for thoracolumbar vertebrae fracture at Department of Minimally Invasive Spine Surgery, Zhengzhou Orthopedic Hospital from January 2019 to January 2022. All patients were treated by internal fixation via the Wiltse approach and bone grafting through the pedicle of the injured vertebrae. Clinical data: 35 males and 18 females; age: (37.8±10.2) years; injured segments: 23 cases at the thoracic spine and 30 cases at the lumbar spine; time from injury to surgery: (3.3±1.5) days. According to whether our self-designed spinal fracture reduction device was used or not, the patients were assigned into group A (23 cases) in which the injured vertebrae were pushed and reduced using our novel spinal fracture reduction device after vertebral distraction reduction by the pedicle screw and group B (30 cases) in which the injured vertebrae were distracted and reduced using the pedicle screw alone. The operation time, intraoperative blood loss and complications were compared between the 2 groups. The anterior vertebral body height ratio (AVBHr), middle vertebral body height ratio (MVBHr), posterior vertebral body height ratio (PVBHr), Cobb angle of the injured vertebra, visual analogue scale (VAS) and Oswestry disability index (ODI) at preoperation, postoperative 3 and 6 months, and the last follow-up were compared between the 2 groups.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (16.3±5.9) months. All incisions healed at one stage postoperatively without any related complications. The operation time in group A was significantly longer than that in group B [(115.1±16.6) min. versus (101.0±11.5) min.], the intraoperative blood loss in group A was significantly greater than that in group B [(136.5±17.0) mL versus (121.6±19.8) mL], the MVBHr at postoperative 3 months in group A (93.9%±4.0%) was significantly better than that in group B (83.3%±7.6%), and the MVBHr, AVBHr, Cobb angle, VAS, and ODI at the last follow-up in group A [86.6%±5.5%, 89.8%±4.1%, 4°(4°, 6°), 1 (0, 1) point, and 4.7%±2.0%] were significantly better than those in group B [78.0% (74.0%, 79.0%), 84.5%±4.9%, 12.2°±3.3°, 2 (1, 3) points, and 7.3%±2.7%] (all P<0.05). However, there was no statistically significant difference in PVBHr between the 2 groups at postoperative 3 months or at the last follow-up ( P>0.05). Conclusion:In the treatment of A3N0/1 thoracolumbar fractures, pushing reduction with our self-designed spinal fracture reduction device can directly and effectively reduce the fracture zone of the injured vertebra, which is conducive to maintaining postoperative vertebral reduction, reducing vertebral height loss and kyphotic deformity at a later stage, relieving lumbar pain and improving lumbar spine function.

OBJECTIVE To investigate the improvement effect mechanism of Xibining prescription （XBN） on knee osteoarthritis （KOA） model rats based on AMP-activated protein kinase（AMPK）/mammalian target of rapamycin （mTOR） signaling pathway. METHODS Totally 36 rats were randomly divided into blank group， model group， XBN group （12.56 g/kg）， XBN+metformin （AMPK agonist） group （12.56 g/kg XBN+100 mg/kg metformin）， with 9 rats in each group. Except for blank group， KOA model was induced by anterior cruciate ligament transection in other groups. After modeling， each group was given relevant medicine/normal saline， XBN and normal saline intragastrically， once a day， and metformin intraperitoneally， every other day， for 4 consecutive weeks. The pathomorphological changes of cartilage tissue in rats were observed and Mankin scoring was conducted. The expression level of Aggrecan in rat cartilage， mRNA and protein expressions of platelet reactive protein disintegrin and metalloproteinase with thrombospondin motifs 4 （ADAMTS-4）， ADAMTS-5， matrix metalloproteinase 3 （MMP-3） and MMP- 13， and the phosphorylation level of AMPK and mTOR proteins were detected. RESULTS Compared with blank group， the structure of cartilage tissue in the model group was disordered， the matrix of cartilage layer was lightly stained，the tide line was distorted or interrupted， and Mankin score was significantly increased （P＜0.05）. The protein expression of Aggrecan in cartilage tissue and the phosphorylation level of AMPK protein were all decreased significantly （P＜0.05）； mRNA and protein expressions of ADAMTS-4， ADAMTS-5， MMP-3 and MMP-13 and the phosphorylation levels of mTOR protein were significantly increased in cartilage tissues （P＜0.05）. Compared with model group， the pathological morphology of cartilage was improved significantly in each administration group， and above score or indexes were reversed significantly （P＜0.05）. Compared with XBN group， the degree of cartilage lesions in rats was further alleviated in XBN+ metformin group， and the levels of above score or indicators were further improved （P＜0.05）. CONCLUSIONS XBN can ameliorate cartilage injury in KOA model rats， promote cartilage synthesis and reduce cartilage degradation， the mechanism of which may be associated with activating AMPK/mTOR signaling pathway.