For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:This study sought to examine the clinicopathological features of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) and to discuss its differential diagnosis.Methods:A total of 36 MEITL cases, collected between June 2015 and January 2024 from the Fourth Affiliated Hospital of Soochow University and the First Affiliated Hospital, College of Medicine, Zhejiang University, were analyzed. Patients underwent immunohistochemistry, in situ hybridization for Epstein-Barr virus-encoded small RNA (EBER), and T-cell receptor (TCR) gene rearrangement testing. Clinical data, laboratory results, and follow-up information were collected for correlation analysis.Results:The cohort included 36 patients (20 males and 16 females) aged 17-76 years (median: 57 years). Tumors outside the intestine were observed in 22 cases (61%). A total of 32 patients (89%) underwent surgical intervention and/or chemotherapy, and one patient received auto-HSCT. The median follow-up duration was 11.5 months (range: 8-73 months), with a median overall survival of 6 months (range: 1-67 months) ; 34 patients died during the follow-up period. Morphologically, nine cases (25%) exhibited significant pleomorphism. Immunohistochemical analysis revealed that high expression levels of both P53 and c-Myc were correlated with atypical morphology ( P=0.003 and P=0.016, respectively). Notably, patients with high P53 expression had significantly shorter survival times than those with low P53 expression ( χ2=4.922, P=0.027), whereas survival did not differ significantly based on c-Myc expression levels ( χ2=0.034, P=0.854). Furthermore, a PD-L1 CPS score ≥10 was observed in 22 cases (68.8%). Scattered EBER positivity in background cells was identified in four cases. All tested cases (17/17, 100.0%) showed clonal TCR gene rearrangements. Conclusions:MEITL is a rare but highly aggressive lymphoma with distinct clinical and pathological features. A subset of cases may exhibit atypical morphological patterns, complicating the diagnostic process. Improving awareness of this neoplasm is helpful for early and precise diagnosis as well as the estabolishment of novel therapy regimen.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:This study sought to examine the clinicopathological features of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) and to discuss its differential diagnosis.Methods:A total of 36 MEITL cases, collected between June 2015 and January 2024 from the Fourth Affiliated Hospital of Soochow University and the First Affiliated Hospital, College of Medicine, Zhejiang University, were analyzed. Patients underwent immunohistochemistry, in situ hybridization for Epstein-Barr virus-encoded small RNA (EBER), and T-cell receptor (TCR) gene rearrangement testing. Clinical data, laboratory results, and follow-up information were collected for correlation analysis.Results:The cohort included 36 patients (20 males and 16 females) aged 17-76 years (median: 57 years). Tumors outside the intestine were observed in 22 cases (61%). A total of 32 patients (89%) underwent surgical intervention and/or chemotherapy, and one patient received auto-HSCT. The median follow-up duration was 11.5 months (range: 8-73 months), with a median overall survival of 6 months (range: 1-67 months) ; 34 patients died during the follow-up period. Morphologically, nine cases (25%) exhibited significant pleomorphism. Immunohistochemical analysis revealed that high expression levels of both P53 and c-Myc were correlated with atypical morphology ( P=0.003 and P=0.016, respectively). Notably, patients with high P53 expression had significantly shorter survival times than those with low P53 expression ( χ2=4.922, P=0.027), whereas survival did not differ significantly based on c-Myc expression levels ( χ2=0.034, P=0.854). Furthermore, a PD-L1 CPS score ≥10 was observed in 22 cases (68.8%). Scattered EBER positivity in background cells was identified in four cases. All tested cases (17/17, 100.0%) showed clonal TCR gene rearrangements. Conclusions:MEITL is a rare but highly aggressive lymphoma with distinct clinical and pathological features. A subset of cases may exhibit atypical morphological patterns, complicating the diagnostic process. Improving awareness of this neoplasm is helpful for early and precise diagnosis as well as the estabolishment of novel therapy regimen.

Objective:To explore the influence of body mass index (BMI) changes on the doses to normal tissues and adverse reactions of the lower digestive system and urinary system in the brachytherapy for cervical cancer.Methods:Clinical data of 80 cervical cancer patients who received radical radiotherapy in our hospital from January 2020 to February 2021 were retrospectively analyzed. All patients received external beam radiation ± chemotherapy + brachytherapy. The delineation method of target areas and organs at risk (OAR) was determined based on the recommended scheme of GEC-ESTRO. The target areas included high risk (HR)-CTV and intermediate risk (IR)-CTV, and OAR consisted of rectum, sigmoid colon, bladder, and small intestine. The target area dose was evaluated by D 90% of the HR-CTV. The OAR volume dose was evaluated by using D2cm3. Correlation analysis was used to compare the dosimetric relationship between BMI and D2cm3, D1cm3 and D0.1cm3 in bladder, rectum, colon and small intestine. Logistic regression analysis was adopted to analyze the risk factors of acute and late adverse reactions in the lower gastrointestinal system and urinary system. Whether BMI was a risk factor was validated. Results:BMI was negatively correlated with the D2cm3, D1cm3 and D0.1cm3 of the small intestine ( P=0.034, 0.024, 0.034), and the correlation coefficients were -0.240, -0.255, and -0.241, respectively. Logistic regression analysis showed that BMI was not a risk factor for the occurrence of acute and late adverse reactions in the lower gastrointestinal system and urinary system. For every 1 Gy increase of D2cm3, D1cm3 and D0.1cm3 in the small intestine, the relative risk of acute adverse reactions in the lower gastrointestinal system was increased by 16.6%, 15.1%,and 12.7%, respectively. Conclusions:In brachytherapy for cervical cancer, there is a negative correlation between BMI and D2cm3, D1cm3 and D0.1cm3 of the small intestine. As the BMI of patients declines, the radiation dose to the small intestine shows an increasing trend, which may increase the risk of acute adverse reactions in the lower gastrointestinal system.

Objective:To investigate the expression changes at the transcriptional level in normal lung tissues of mice after exposure to heavy ion radiation for different durations at different doses, aiming to provide evidence for exploring sensitive genes of heavy ion radiation, heavy ion radiation effect and the damage mechanism.Methods:Experiments on the temporal kinetics: the whole thorax of mice was irradiated with 14.5Gy carbon-ions and the total RNA of lung tissue was extracted at 3days, 7days, 3 weeks and 24 weeks. In dose-dependent experiment, the total RNA of lung tissue was extracted at 1 week after irradiated with a growing thoracic dose of 0, 7.5, 10.5, 12.5, 14.5, 17.5 and 20Gy. Protein-to-protein interaction (PPI) analysis and gene-ontology biological process enrichment analysis were performed on significant differentially expressed genes (DEGs).Results:A clearly differential expression patterns were observed at 3-day (acute stage), 1-week (subacute stage), 3-week (inflammatory stage) and 24-week (fibrosis stage) following 14.5Gy carbon-ions irradiation. Among those, the 3-day time point was found to be the mostly different from the other time points, whereas the 7-day time point had the highest uniformity with the other time points. Cellular apoptosis was the main type of cell death in normal lung tissues following carbon-ions exposure. The interactive genes of Phlda3, GDF15, Mgmt and Bax were identified as the radiosensitive genes, and Phlda3 was the center ( R=0.76, P<0.001). Conclusion:The findings in this study provide transcriptional insights into the biological mechanism underlying normal lung tissue toxicity induced by carbon-ions.

Objective: To study dose-response relationships of fractionated irradiation induced pulmonary fibrosis in mice according to radiological imaging changes of lung. Methods: A total of 8-10 week old-female C57BL6 mice were randomized into different groups for whole thoracic irradiation. The prescribed doses were 0, 2.0, 4.0, 6.0, 7.0, 8.5 Gy per fraction in a total of 5 fractions. CT imaging was performed at 24 weeks post irradiation. The averaged lung density and volume changes were obtained by the three-dimensional segmentation algorithm, and further analyzed in Boltzmann regression modeling. Results: At the endpoint of 24 weeks, the dose-dependent pulmonary radiological alternations were revealed by coronal view of CT images. Translational analysis of fibrosis-related gene-signatures as well as histological collagen stainings further corroborated the radiological findings. According to Boltzmann modeling, the E₅₀ of radiation-induced lung density changes was found to be (30.80±0.80)Gy (adjusted R²=0.97); whereas the E₅₀ for radiation-induced lung volume reduction was determined as (31.31±7.07)Gy (adjusted R²=0.92). Both outcomes indicated a remarkable enhancement of tolerance to normal lung tissues after exposure with 5-fraction versus single fraction scheme. Conclusions The radiation-induced lung density and volume changes depend not only on total dose, but also the number and dose of fractions.

Objective To investigate the radiation induced pulmonary fibrosis with a dose-response mouse model, based on the CT image changes of pulmonary fibrosis.Methods Female C57BL6 mice aged 8-10 weeks were randomly divided into 20 Gy or escalated doses of X-ray whole thoracic irradiation ( WTI) groups. CT scan was performed at different time points before and after radiation. The average lung density and lung volume changes were obtained by three-dimensional segmentation algorithm. After gene chip and pathological validation, the parameters of CT scan were subject to the establishment of logistic regression model. Results At the endpoint of 24 weeks post-irradiation, the lung density in the 20 Gy irradiation group was (-289.81± 12.06) HU, significantly increased compared with (-377.97± 6.24) HU in the control group ( P<0.001) . The lung volume was ( 0.66±0.01) cm3 in the control group, significantly larger than ( 0.44±0.03) cm3 in the irradiated mice ( P<0.001) . The results of quantitative imaging analysis were in accordance with the findings of HE and Mason staining, which were positively correlated with the fibrosis-related biomarkers at the transcriptional level ( all R2=0.75, all P<0.001) . The ED50 for increased lung density was found to be ( 13.64± 0.14) Gy ( R2=0.99, P<0.001) and ( 16.17± 4.36) Gy ( R2=0.89, P<0.001) for decreased lung volume according to the logistic regression model. Conclusions Quantitative CT measurement of lung density and volume are reliable imaging parameters to evaluate the degree of radiation-induced pulmonary fibrosis in mouse models. The dose-response mouse models with pulmonary fibrosis changes can provide experimental basis for comparative analysis of high-dose hypofractioned irradiation-and half-lung irradiation-induced pulmonary fibrosis.

Objective To master the iodine nutritional status of residents and to evaluate the effect of iodine nutrition improvement on residents health after the adjustment of salt iodine concentration. Methods According to the method of population proportion sampling, 30 county-level monitoring sites were selected in 2014, a primary school was selected from each county (city, district) by the method of simple random sampling and 50 students aged 8 - 10 (half males and half females) were selected in each school, B ultrasound was used to detect thyroid volume, arsenic cerium catalytic spectrophotometry (WS/T 107-2006) was used to detect urinary iodine, direct titration was used to detect salt iodine; At the same time, 20 pregnant women were selected from each town and urinary iodine was determined. All results were compared with the results of 2011 to evaluate the effect of iodine nutrition improvement on resident's health after the adjustment of salt iodine concentration. Results A total of 1 437 edible salt samples were tested, the median of salt iodine concentration was 24.1 mg/kg. Based on the new standard (18 - 33 mg/kg), the coverage rate of iodized salt was 95.4%(1 371/1 437), the qualified rate of iodized salt was 80.3%(1 101/1 371), the consumption rate of qualified iodized salt was 76.6% (1 101/1 437). A total of 1 496 urine samples of children and 630 urine samples of pregnant women were tested, the median of urinary iodine of children and pregnant women was 224.6 and 177.1 μg/L, respectively, which were significantly lower than those of 2011 (274.6, 279.6μg/L), the differences were statistically significant (H=70.10, 153.50, all P<0.05). The proportion of counties which iodine nutrition of children and pregnant women in suitable range was 36.7% (11/30) and 56.7% (17/30), which were higher than those of 2011 [6.5%(2/31), 25.8%(8/31)], the differences were statistically significant (χ2 = 7.88, 5.00, all P < 0.05). Totally 1 552 children were examined thyroid in Shanxi Province, the rate of goiter was 4.4% (69/1 552). Conclusion The new standard of iodine concentration makes it possible to maintain a sustainable elimination of iodine deficiency disorders, and it can improve the iodine nutrition of children aged 8-10 years and pregnant women to more reasonable level.

Objective To investigate the value of ultrasound in typing of epididymal tuberculosis on the clinical treatment . Methods The sonographic characteristics and treatment outcomes were analyzed in 125 patients with epididymal tuberculosis . Results In 125 patients with epididymal tuberculosis ,5 types were divided:( 1 ) Diffusive type ( 37 cases ) presented images of the epididymal diffuse enlargement , abnormal shape ,not smooth surface and inhomogeneous reduced in echogenicity ,13 cases were treated conservatively and 24 cases underwent surgical treatment after failure of conservative treatment . (2) Mass type (24 cases) showed images of hypoechoic mass lesion of caput epididymidis or cauda epididymidis ,4 cases were treated with surgical operation and 20 cases were treat with conservative therapy . (3) Abscess type ( 33 cases) manifested images of irregular liquid anechoic of caput epididymidis and cauda epididymidis , poor ultrasound penetration ,and unclear border . (4) Ulcer‐fistula type (9 cases) revealed images of liquid hypoechoic caput epididymidis or cauda epididymidis extend to the surface of the scrotum . ( 5) Testicular involvement type (22 cases) detected inhomogeneous hypoechoic mass lesion within the testicle and unclear border . The patients of abscess type ,ulcer‐fistula type and testicular involvement type were all treated surgically . Conclusions Ultrasonic diagnosis of epididymal tuberculosis provided a reliable basis for clinical treatment scheme and it was worth recommending .