With the rapid development of computer science, the application of artificial intelligence (AI) in the field of medical imaging has become increasingly extensive. The temporomandibular joint (TMJ) is structurally complex, with a high incidence of related disorders and diverse clinical manifestations. This review analyzes the current state of research on AI in TMJ imaging diagnosis. Deep learning models based on U-Net and its derivatives have demonstrated outstanding performance in segmentation of condyle and articular disc. Various object detection and feature extraction algorithms have shown excellent diagnostic efficacy for common conditions, such as osteoarthrosis and disc displacement, with some models even achieving expert-level performance on test datasets. Meanwhile, explainable AI provides intuitive justification for model decisions through techniques such as heatmap visualization. Notably, current studies still face critical challenges, including coverage of disease spectra, integration of multimodal data, and model generalizability. Future studies should focus on developing integrated systems that combine diagnosis, segmentation, generation, and interpretation functions. Through multicenter data validation and algorithmic optimization, these efforts will enhance the clinical applicability and decision transparency of models, ultimately laying the foundation for precise imaging diagnosis and intelligent management of TMJ disorders.

Objective:To investigate the effect of long non-coding RNA glucuronidase β pseudogene 11(GUSBP11)regulating miR-339-5p/mouse two-minute homolog 2(MDM2)axis on the proliferation,migration,and invasion of gastric cancer AGS cells.Methods:Cancerous and adjacent tissues from 25 gastric cancer patients who underwent surgical treatment at Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from December 2023 to June 2024 were collected.Gastric cancer AGS cells and normal gastric mucosal epithelial GES-1 cells were routinely cultured.The control plasmids and knockdown plasmids were transfected into AGS cells using transfection reagents,dividing the cells into Ctrl group,sh-NC group,sh-GUSBP11 group,sh-GUSBP11+anti-NC group,and sh-GUSBP11+anti-miR-339-5p group.The mRNA expression of GUSBP11,miR-339-5p,and MDM2 in gastric cancer tissues and cells of each group was detected by qPCR.A dual-luciferase reporter gene assay was used to detect the targeting relationship between GUSBP11 or MDM2 and miR-339-5p.EdU staining,scratch healing assay,and Transwell chamber assay were adopted to assess the proliferation,migration,and invasion abilities of AGS cells,respectively.WB assay was used to measure the protein expression of CDK1,MMP-2,and MMP-9 in AGC cells.The effects of GUSBP11 knockdown on tumor growth were examined through AGS cell xenograft experiments.Results:The mRNA expression of GUSBP11 and MDM2 were significantly upregulated in gastric cancer tissues and cells(both P<0.05),while miR-339-5p was significantly downregulated(P<0.05).A targeting relationship was found between GUSBP11 and miR-339-5p,as well as between MDM2 and miR-339-5p.Knockdown of GUSBP11 in AGS cells significantly inhibited MDM2 protein expression and promoted miR-339-5p expression,while inhibition of miR-339-5p promoted MDM2 protein expression.GUSBP11 knockdown significantly inhibited the proliferation,migration,and invasion of AGS cells,while inhibition of miR-339-5p reversed this effect.GUSBP11 knockdown significantly inhibited the protein expression of CDK1,MMP-2,and MMP-9,and inhibition of miR-339-5p reversed this effect.Furthermore,GUSBP11 knockdown significantly inhibited the growth of AGS cell xenografts.Conclusion:GUSBP11 is highly expressed in gastric cancer tissues and cells,and knocking down GUSBP11 expression may inhibit malignant biological behaviors of gastric cancer cells through regulating the miR-339-5p/DM2 axis.

Objective This study preliminarily investigated the potential mechanisms of the Huoxue Tongluo prescription(HXTLP)in treating spinal cord injury(SCI)through a combination of network pharmacology,molecular docking technology,and in vivo experimental verification.Methods The traditional Chinese medicine systems pharmacology database and analysis platform(TCMSP)were utilized to select the active ingredients,targets of action were obtained from Swiss target prediction database,and an"active ingredients-targets"network was constructed.SCI-related targets were obtained by accessing online mendelian inheritance in man(OMIM)and human gene database(GeneCards),and a protein interaction network of the common targets of HXTLP and SCI was established based on the search tool for the retrieval of interacting genes/protein(STRING)database.The Metascape database was used in KEGG pathway enrichment and GO analyses of the common targets.Molecular docking of active ingredients and key targets was performed through Autodock 1.5.7 software,and the results were visualized with Pymol 2.4.0 software.Finally,the effect of HXTLP on SCI was verified by animal experiments.Results A total of 184 intersection targets were obtained,and the key targets were serine/threonine kinase(AKT1),signal transducer and activator of transcription 3(STAT3),heat shock protein 90 kDa alpha,class A member 1(HSP90AA1),phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha(PIK3CA),phosphoinositide-3-kinase regulatory subunit 1(PIK3R1),harvey ras(HRAS),estrogen receptor 1(ESR1),mitogen-activated protein kinase 1(MAPK1),and epidermal growth factor receptor(EGFR).Molecular docking result showed strong binding abilities between the core active components and key targets.In the animal experiments,the behavioral scores of mice in the HXTLP group increased(P＜0.05),the motor function of hind limbs was improved,and the histological morphology of the injured area was more complete compared with those of the model group.Western Blot result revealed that HXTLP effectively inhibited the key target protein(HSP90AA1)and the expression of phospho-STAT3(P-STAT3)and promoted the expression of phospho-phosphatidylinositol-3-kinase(P-PI3K)and phospho-AKT1(P-AKT1).Conclusions This study verified that HXTLP has multi-component,multi-target,and multi-pathway synergistic effects in the treatment of SCI and has provided experimental and theoretical bases for further clinical medication research for SCI.

ABSTRCT AIM:To verify the effect of polygona-tum polysaccharide(PSP)combined with TGF-β3 in inducing the differentiation of rat tendon-derived stem cells(TDSCs)into chondrocytes by activating the TGF-β3/Smad2 pathway.METHODS:TDSCs were extracted from rat tail tendons using enzyme digestion,purified,passaged,and identified via flow cytometry.TDSCs were treated with different concentrations of PSP,and the optimal growth con-centration was determined using the CCK-8 assay.TDSCs were divided into four groups:PSP,TGF-β3,PSP+TGF-β3,and Control for differentiation induc-tion.Chondrogenic differentiation was evaluated using morphological observations,toluidine blue staining,immunofluorescence staining,and West-ern blot analysis to detect COLⅡ,SOX9,and AGG.Western blot was also used to measure the expres-sion levels of Smad2 and p-Smad2 to evaluate the activation of the TGF-β3/Smad2 pathway after chondrogenic induction.RESULTS:Flow cytometry analysis showed that TDSCs highly expressed CD90 and CD29,while CD11b and CD45 expression was low.The CCK-8 assay indicated that 5 μmol/L PSP was the optimal intervention dose.Toluidine blue staining revealed that the blue staining area in the PSP,PSP+TGF-β3,and TGF-β3 groups was larger compared to the Control group.Immunofluores-cence analysis demonstrated that COLⅡ expression was significantly increased in the PSP,TGF-β3,and PSP+TGF-β3 groups,with the highest expression in the PSP+TGF-β3 group(P＜0.05).Western blot analy-sis showed that the levels of p-Smad2/Smad2,COLⅡ,SOX9,and AGG were elevated in the PSP,TGF-β3,and PSP+TGF-β3 groups,with the highest ex-pression in the PSP+TGF-β3 group(P＜0.05).Compared to the Control group,the TGF-β3 and PSP groups also showed significantly increased expression(P＜0.05).CONCLUSION:PSP promotes the proliferation and chondrogenic differentiation of TDSCs,possibly by activating the TGF-β3/Smad2 pathway.

ABSTRCT AIM:To verify the effect of polygona-tum polysaccharide(PSP)combined with TGF-β3 in inducing the differentiation of rat tendon-derived stem cells(TDSCs)into chondrocytes by activating the TGF-β3/Smad2 pathway.METHODS:TDSCs were extracted from rat tail tendons using enzyme digestion,purified,passaged,and identified via flow cytometry.TDSCs were treated with different concentrations of PSP,and the optimal growth con-centration was determined using the CCK-8 assay.TDSCs were divided into four groups:PSP,TGF-β3,PSP+TGF-β3,and Control for differentiation induc-tion.Chondrogenic differentiation was evaluated using morphological observations,toluidine blue staining,immunofluorescence staining,and West-ern blot analysis to detect COLⅡ,SOX9,and AGG.Western blot was also used to measure the expres-sion levels of Smad2 and p-Smad2 to evaluate the activation of the TGF-β3/Smad2 pathway after chondrogenic induction.RESULTS:Flow cytometry analysis showed that TDSCs highly expressed CD90 and CD29,while CD11b and CD45 expression was low.The CCK-8 assay indicated that 5 μmol/L PSP was the optimal intervention dose.Toluidine blue staining revealed that the blue staining area in the PSP,PSP+TGF-β3,and TGF-β3 groups was larger compared to the Control group.Immunofluores-cence analysis demonstrated that COLⅡ expression was significantly increased in the PSP,TGF-β3,and PSP+TGF-β3 groups,with the highest expression in the PSP+TGF-β3 group(P＜0.05).Western blot analy-sis showed that the levels of p-Smad2/Smad2,COLⅡ,SOX9,and AGG were elevated in the PSP,TGF-β3,and PSP+TGF-β3 groups,with the highest ex-pression in the PSP+TGF-β3 group(P＜0.05).Compared to the Control group,the TGF-β3 and PSP groups also showed significantly increased expression(P＜0.05).CONCLUSION:PSP promotes the proliferation and chondrogenic differentiation of TDSCs,possibly by activating the TGF-β3/Smad2 pathway.

Objective This study preliminarily investigated the potential mechanisms of the Huoxue Tongluo prescription(HXTLP)in treating spinal cord injury(SCI)through a combination of network pharmacology,molecular docking technology,and in vivo experimental verification.Methods The traditional Chinese medicine systems pharmacology database and analysis platform(TCMSP)were utilized to select the active ingredients,targets of action were obtained from Swiss target prediction database,and an"active ingredients-targets"network was constructed.SCI-related targets were obtained by accessing online mendelian inheritance in man(OMIM)and human gene database(GeneCards),and a protein interaction network of the common targets of HXTLP and SCI was established based on the search tool for the retrieval of interacting genes/protein(STRING)database.The Metascape database was used in KEGG pathway enrichment and GO analyses of the common targets.Molecular docking of active ingredients and key targets was performed through Autodock 1.5.7 software,and the results were visualized with Pymol 2.4.0 software.Finally,the effect of HXTLP on SCI was verified by animal experiments.Results A total of 184 intersection targets were obtained,and the key targets were serine/threonine kinase(AKT1),signal transducer and activator of transcription 3(STAT3),heat shock protein 90 kDa alpha,class A member 1(HSP90AA1),phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha(PIK3CA),phosphoinositide-3-kinase regulatory subunit 1(PIK3R1),harvey ras(HRAS),estrogen receptor 1(ESR1),mitogen-activated protein kinase 1(MAPK1),and epidermal growth factor receptor(EGFR).Molecular docking result showed strong binding abilities between the core active components and key targets.In the animal experiments,the behavioral scores of mice in the HXTLP group increased(P＜0.05),the motor function of hind limbs was improved,and the histological morphology of the injured area was more complete compared with those of the model group.Western Blot result revealed that HXTLP effectively inhibited the key target protein(HSP90AA1)and the expression of phospho-STAT3(P-STAT3)and promoted the expression of phospho-phosphatidylinositol-3-kinase(P-PI3K)and phospho-AKT1(P-AKT1).Conclusions This study verified that HXTLP has multi-component,multi-target,and multi-pathway synergistic effects in the treatment of SCI and has provided experimental and theoretical bases for further clinical medication research for SCI.

Objective:To explore the efficacy and safety of mitotane in adrenal cortical carcinoma (ACC) at high risk of recurrence.Methods:A prospective observational study was designed from September 2022 to November 2023. ACC patients undergoing surgery with high recurrence risk (positive margin or Ki-67 index >10% or capsule rupture or large size or high-grade ACC) in Peking Union Medical College Hospital were enrolled in this study. All patients started mitotane treatment within 3 months after surgery, with a dose of 1.5 g/d, increased by 0.5 g per week. Once the dose reached 3 g/day, adjustments were made based on blood concentration levels. All patients received mitotane therapy for at least 1 year, and CT was performed every 12 weeks to evaluate the efficacy. The primary endpoint was 1-year progression-free survival (PFS) and safety. The efficacy was analyzed by Kaplan-Meier method for survival, and the occurrence of treatment-related adverse events was summarized.Results:A total of 12 ACC patients at high risk of recurrence were screened, comprising 6 males and 6 females. Tumors were located on the left side in 8 patients, on the right in 3, and bilaterally in 1. Five patients were classified as ENSAT stageⅡ, while 7 were classified as ENSAT stage Ⅲ. The maximum diameter of tumor was (9.07 ± 2.86) cm; the median age at diagnosis was 48 (35, 51) years, and the median Ki-67 index was (28.9 ± 16.1)%. The median time from surgery to initiation of mitotane therapy was 31 (23.0, 43.2) days, and 9 patients had blood drug concentrations of 14-20 mg/L. The median follow-up time was 16.7 (12.4, 25.2) months. At 1 year after mitotane therapy, 10 (83.8%) patients were still in disease-free survival state, with a median mitotane PFS of 27.6 months (95% CI 16.4-not reached). All ACC patients experienced 1-2 grade adverse events after taking mitotane. One patient (8.3%) experienced grade 3 adverse event, including the increasing of alanine aminotransferase and aspartate aminotransferase, as well as anorexia. No grade 4-5 adverse events occurred. The most common adverse events were gastrointestinal symptoms (10 cases), including nausea, vomiting, anorexia, and diarrhea, followed by liver function damage(9 cases) and neurotoxicity(4 cases). Conclusions:Mitotane has shown the prospect of improving the prognosis of ACC patients at high risk of recurrence after surgery. Because of its serious toxic and side effects, it is necessary to monitor its blood concentration to adjust the dosage, and take measures for adverse reactions to ensure the safety of patients.

Objective:To explore the clinical characteristics of bilateral nodular adrenal cortical disease（BmacAD）and primary pigmentary nodular adrenal cortical disease（PPNAD）.Methods:A retrospective analysis was conducted on the clinical records of 58 patients with BmacAD and 26 patients with PPNAD who were treated at Peking Union Medical College Hospital from January 2005 to December 2024. The clinical manifestations，endocrine examination，and surgical results between BmacAD patients and PPNAD patients were compared. Endocrine related examinations were reexamined 1 to 7 days and 15 to 30 days after the operation，and the recovery of cortisol within 30 days after the operation was recorded.Results:The male to female ratios of BmacAD patients and PPNAD patients were 31/27 and 11/15，with no statistically significant difference（ P > 0.05）. The age of BmacAD patients and PPNAD patients were 53.5（45.0，61.0）years and 19.0（15.8，24.0）years，respectively，with a statistically significant difference（ P < 0.001）. In terms of clinical manifestations，the proportion of BmacAD patients and PPNAD patients with Cushing syndrome appearance were 50.00%（29/58）and 96.15%（25/26），respectively，with a statistically significant difference（ P < 0.001）. There were no statistically significant differences between BmacAD and PPNAD patients in hypertension［87.93%（51/58）and 80.77%（21/26）］，abnormal glucose tolerance/diabetes［39.66%（23/58）and 34.62%（9/26）］and hypokalemia［18.97%（11/58）and 15.38%（4/26）］（ P > 0.05）. The difference in the proportion of osteopenia/osteoporosis /fracture between the two group was statistically significant［13.79%（8/58）and 53.85%（14/26）， P < 0.001］. In terms of hormone secretion，the median levels of 24-hour urinary free cortisol in BmacAD and PPNAD patients before surgery were 174.00（85.35，531.43）μg/24 h and 408.35（334.28，800.78）μg/24h（ P < 0.001），respectively. The proportion of preoperative plasma adrenocorticotropic hormone（ACTH）levels less than 5 pg/ml were 60.34%（35/58）and 84.62%（22/26）（ P < 0.05），respectively. Among the BmacAD patients 32 underwent unilateral total adrenalectomy，23 underwent unilateral partial adrenalectomy，and 3 underwent unilateral total adrenalectomy+contralateral partial adrenalectomy；the proportion of patients with increased preoperative cortisol secretion who recovered to normal within 30 days after surgery was 79.17%（38/48）. All 26 PPNAD patients underwent unilateral adrenalectomy. Within 30 days after surgery，68.00%（17/25）of the PPNAD patients had normal 24-hour urinary free cortisol levels. Conclusions:The cortisol secretion level in PPNAD patients is significantly higher than that in BmacAD patients，and the proportion of abnormal bone metabolism is higher. The short-term therapeutic efficacy of unilateral adrenalectomy or unilateral partial adrenalectomy is significant for both BmacAD and PPNAD.

Objective To explore the feasibility and precautions of small incision bile duct stone removal in primary hospitals in extremely high-altitude areas.Methods The experience of small incision biliary exploration and cholecystectomy under general anesthesia at primary hospitals during the author's medical aid to Xizang in the high-altitude areas of northern Xizang was summarized(from June 2022 to December 2022).Results A total of 11 cases of small incision common bile duct stone removal were completed.Abdominal drainage was performed in all patients,including 6 cases with T-shaped tubes and 5 cases with primary closure of the common bile duct.The patients recovered well after surgery and was discharged.Conclusion In extreme high-altitude areas,under the guidance of medical aid doctors,it is completely feasible for primary hospitals to carry out small incision bile duct stone removal by selecting appropriate cases,training surgical skills,and performing detailed preoperative preparation.

Clinically,the incidence of portal vein thrombosis(PVT)in patients with cirrhosis can be up to 10％-23％.When PVT is not treated promptly,it may develop to cavernous transformation of the portal vein(CTPV).CTPV can aggravate portal hypertension,accelerate the progression of esophagogastric varices bleeding,refractory ascites,refractory peritonitis,biliary tract diseases,and hepatic insufficiency.At present,noninvasive imaging techniques such as portal vein reconstruction,enhanced CT and ultrasound are mostly used to make the diagnosis and evaluation of CTPV.It is rather difficult to perform portosystemic shunt surgery in patients with CTPV complicated by portal hypertension,which was once regarded as a contraindication for interventional portosystemic shunt procedures.With the improvement of related technologies and surgical instruments,the transjugular intrahepatic portosystemic shunt(TIPS)has become an important treatment for CTPV.This paper aims to make a comprehensive review about the relevant researches concerning the portosystemic shunt surgery in patients with CTPV so as to clarify the importance of TIPS in the treatment of CTPV.