Endoscopic transforaminal lumbar interbody fusion (TLIF) offers substantial advantages in the management of degenerative spinal diseases, including accelerated postoperative recovery. However, its technical complexity and steep learning curve pose risks for nerve root injury. Optimizing nerve root protection in full-endoscopic facet-sparing TLIF (FE fs-TLIF) and full-endoscopic facet-resecting TLIF (FE fr-TLIF) is essential for enhancing surgical safety. This study aimed to improve the nerve root protection in FE fs-TLIF and FE fr-TLIF by optimizing cage glider selection and insertion techniques based on the specific cage shape—banana-shaped or bullet-shaped. The goal was to ensure safe cage positioning and mitigate nerve root injury during discectomy, endplate preparation, and cage insertion. These strategies were validated through cadaveric simulations and clinical implementation. In FE fr-TLIF utilizing bullet-shaped (straight) cages, one-tip and two-tip cage gliders effectively protected the traversing nerve root by facilitating medial cage entry, thereby minimizing irritation of the exiting nerve root. Conversely, in FE fr-TLIF with banana-shaped cages, the lateral tilt of the cage holder during implantation required the use of a two-tip cage glider to protect the traversing and exiting nerve roots, thereby mitigating the potential risk of nerve irritation. In FE fs-TLIF, a one-tip cage glider is preferred for safeguarding the exiting nerve root, while the traversing root is inherently protected by the medial wall of the facet joint. The use of a two-tip cage glider in FE fs-TLIF can cause injury to the nerve root during glider insertion. In addition to the selection of cage gliders, improper cage insertion steps can also contribute to postoperative neurapraxia. The appropriate selection of cage gliders with corresponding insertion techniques is critical for nerve root protection in endoscopic TLIF. Tailoring these choices to the specific approach (FE fs-TLIF or FE fr-TLIF) and cage type (banana or bullet) enhances surgical safety and clinical outcomes.

Asthenospermia is one of the important causes of male infertility,and its etiology and pathogenesis are complex.Traditional Chinese medicine(TCM)offers unique advantages in treating this disease.The"kidney deficiency and toxic-stasis"theory reveals the dynamic relationship between kidney essence deficiency and the interaction of toxic-stasis in disease pathogenesis,which can be applied clinically to guide the differentiation and treatment of asthenospermia.The formation of asthenospermia is closely related to the deficiency of kidney essence and the blockage of toxic stasis.The kidney essence is the source of reproductive essence.If the kidney essence is depleted for a long time and the kidney essence is deficient,the essence chamber cannot be enriched,resulting in spermatozoa dysfunction and poor spermatozoa mobility.The poison stasis interferes with the spermatozoa and turns into spermatotoxin,which directly harms spermatozoa fertility and leads to the decrease of spermatozoa mobility.Tongjing Jiedu Formula takes tonifying kidney to supply essence,diuresis and detoxification,activating blood circulation and removing blood stasis as the treatment principle,focusing on tonifying kidney to fill essence and nourishing healthy qi to restore the nourishing effect of kidney essence,and also emphasizes clearing heat and detoxification,activating blood circulation and removing blood stasis,promoting diuresis and dredging collaterals to remove poisonous damp-heat and static blood and harmonize blood and vessel,improving spermatogenic environment and improving sperm vitality to help men have children.This article analyzes the application of Tongjing Jiedu Formula in treating asthenospermia from the perspective of"kidney deficiency and toxic stasis",aiming to provid new ideas and methods for the explanation of the pathogenesis of the disease and TCM treatment.

Asthenospermia is one of the important causes of male infertility,and its etiology and pathogenesis are complex.Traditional Chinese medicine(TCM)offers unique advantages in treating this disease.The"kidney deficiency and toxic-stasis"theory reveals the dynamic relationship between kidney essence deficiency and the interaction of toxic-stasis in disease pathogenesis,which can be applied clinically to guide the differentiation and treatment of asthenospermia.The formation of asthenospermia is closely related to the deficiency of kidney essence and the blockage of toxic stasis.The kidney essence is the source of reproductive essence.If the kidney essence is depleted for a long time and the kidney essence is deficient,the essence chamber cannot be enriched,resulting in spermatozoa dysfunction and poor spermatozoa mobility.The poison stasis interferes with the spermatozoa and turns into spermatotoxin,which directly harms spermatozoa fertility and leads to the decrease of spermatozoa mobility.Tongjing Jiedu Formula takes tonifying kidney to supply essence,diuresis and detoxification,activating blood circulation and removing blood stasis as the treatment principle,focusing on tonifying kidney to fill essence and nourishing healthy qi to restore the nourishing effect of kidney essence,and also emphasizes clearing heat and detoxification,activating blood circulation and removing blood stasis,promoting diuresis and dredging collaterals to remove poisonous damp-heat and static blood and harmonize blood and vessel,improving spermatogenic environment and improving sperm vitality to help men have children.This article analyzes the application of Tongjing Jiedu Formula in treating asthenospermia from the perspective of"kidney deficiency and toxic stasis",aiming to provid new ideas and methods for the explanation of the pathogenesis of the disease and TCM treatment.

Objective To investigate the relationship between plasma dipeptidyl peptidase 4 (DDP4) level and the progression of abdominal aortic aneurysm. Methods Forty-three patients with abdominal aortic aneurysm admitted to Baoji Central Hospital from January 2020 to May 2021 were selected. The follow-up was conducted at least 12 months,the absolute measurement of the maximum anterior-posterior diameters of the aneurysm and the rate of progression were obtained based on the first and last computed tomography angiography data,and the patients were divided into the progression group (with the rate of progression≥0.5 mm/year) and the progression-free group (with the rate of progression<0.5 mm/year) according to the rate of the abdominal aortic aneurysm progression. The clinical characteristics of the two groups were compared. Plasma DDP4 levels were detected by enzyme-linked immunosorbent assay. The correlation between plasma DDP4 and the rate of abdominal aortic aneurysm progression was analyzed by Pearson correlation and multiple linear regression. The predictive performance of plasma DDP4 on abdominal aortic aneurysm progression was analyzed by Logistic regression model and receiver operating characteristic (ROC) curve. Results The thickness of intracavitary thrombus (P=0.046) and the rate of abdominal aortic aneurysm progression (P<0.001) in the progression group were greater/faster than those in the the progression-free group,and the plasma level of DDP was significantly higher than that in the progression-free group (P<0.001). Multivariate Logistic regression analysis showed that plasma DDP4 level was an independent predictor of abdominal aortic aneurysm progression (P<0.05). Pearson correlation analysis showed that plasma DDP4 level was positively correlated with the rate of abdominal aortic aneurysm progression (r=0.517,P<0.001). After adjusting for other confounding factors,multiple linear regression showed that there was still a significantly positive correlation between plasma DDP4 level and abdominal aortic aneurysm progression rate (β=0.312,95％CI:0.002 to 0.484,P=0.048). The area under the curve of baseline plasma DDP4 level for predicting abdominal aortic aneurysm progression was 0.840 (95％CI:0.704 to 0.976),with corresponding cutoff value of 13.89 pg/mL,specificity of 85.7％,and sensitivity of 79.3％. Conclusion Elevated plasma DDP4 levels in patients with abdominal aortic aneurysm are associated with a higher risk of aneurysm progression. Plasma DDP4 is expected to be a predictive biomarker for abdominal aortic aneurysm progression.

To investigate the transcriptionally regulatory mechanism of the senp8 promoter in yellow cat-fish(Pelteobagrus fulvidraco);this study used P.fulvidraco as the research subject.Dual-luciferase re-porter assay and electrophoretic mobility shift assay were employed to analyze the functional activity of the promoter;coupled with in vivo experiments.The results indicated that the 2 045 bp senp8 promoter se-quence contained key transcription factor binding sites such as SP1;TATA-Box;CCAAT-Box;SREBP1;PPARα;and PPARγ.The binding sites of SREBP1(-901/-910 bp);PPARα(-1 291/-1 308 bp);and PPARγ(-1 292/-1 306 bp)in the senp8 promoter positively regulate its activity;and oleic acid or palmitic acid promote this binding.Furthermore;high-fat feeding promoted the expression of the senp8 gene and its protein in the liver of P.fulvidraco;oleic acid or palmitic acid treatment significantly en-hanced the activity of the senp8 promoter;and this enhancement could be achieved through the regulatory effects of SREBP1;PPARα;and PPARγ response elements.Additionally;high-fat feeding influenced the mRNA and protein expression levels of genes related to deSUMOylation modification in the liver of P.fulvidraco.This study provides new insights into the relationship between deSUMOylation modification and the regulation of lipid metabolism in the vertebrates.

Background: and Purpose Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking. Methods: This study used data from patients aged ≥20 years who underwent EVT for anterior circulation stroke from the nationwide Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). A predictive model including factors associated with an increased risk of sICH after EVT was developed to differentiate between patients with and without sICH. This model was compared existing predictive models using nationwide registry data to evaluate its relative performance. Results: Of the 2,507 identified patients, 158 developed sICH after EVT. Factors such as diastolic blood pressure, Alberta Stroke Program Early CT Score, platelet count, glucose level, collateral score, and successful reperfusion were associated with the risk of sICH after EVT. The TREAT-AIS score demonstrated acceptable predictive accuracy (area under the curve [AUC]=0.694), with higher scores being associated with an increased risk of sICH (odds ratio=2.01 per score increase, 95% confidence interval=1.64–2.45, P<0.001). The discriminatory capacity of the score was similar in patients with symptom onset beyond 6 hours (AUC=0.705). Compared to existing models, the TREAT-AIS score consistently exhibited superior predictive accuracy, although this difference was marginal. Conclusions The TREAT-AIS score outperformed existing models, and demonstrated an acceptable discriminatory capacity for distinguishing patients according to sICH risk levels. However, the differences between models were only marginal. Further research incorporating periprocedural and postprocedural factors is required to improve the predictive accuracy.

Background: and Purpose Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking. Methods: This study used data from patients aged ≥20 years who underwent EVT for anterior circulation stroke from the nationwide Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). A predictive model including factors associated with an increased risk of sICH after EVT was developed to differentiate between patients with and without sICH. This model was compared existing predictive models using nationwide registry data to evaluate its relative performance. Results: Of the 2,507 identified patients, 158 developed sICH after EVT. Factors such as diastolic blood pressure, Alberta Stroke Program Early CT Score, platelet count, glucose level, collateral score, and successful reperfusion were associated with the risk of sICH after EVT. The TREAT-AIS score demonstrated acceptable predictive accuracy (area under the curve [AUC]=0.694), with higher scores being associated with an increased risk of sICH (odds ratio=2.01 per score increase, 95% confidence interval=1.64–2.45, P<0.001). The discriminatory capacity of the score was similar in patients with symptom onset beyond 6 hours (AUC=0.705). Compared to existing models, the TREAT-AIS score consistently exhibited superior predictive accuracy, although this difference was marginal. Conclusions The TREAT-AIS score outperformed existing models, and demonstrated an acceptable discriminatory capacity for distinguishing patients according to sICH risk levels. However, the differences between models were only marginal. Further research incorporating periprocedural and postprocedural factors is required to improve the predictive accuracy.

Background: and Purpose Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking. Methods: This study used data from patients aged ≥20 years who underwent EVT for anterior circulation stroke from the nationwide Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). A predictive model including factors associated with an increased risk of sICH after EVT was developed to differentiate between patients with and without sICH. This model was compared existing predictive models using nationwide registry data to evaluate its relative performance. Results: Of the 2,507 identified patients, 158 developed sICH after EVT. Factors such as diastolic blood pressure, Alberta Stroke Program Early CT Score, platelet count, glucose level, collateral score, and successful reperfusion were associated with the risk of sICH after EVT. The TREAT-AIS score demonstrated acceptable predictive accuracy (area under the curve [AUC]=0.694), with higher scores being associated with an increased risk of sICH (odds ratio=2.01 per score increase, 95% confidence interval=1.64–2.45, P<0.001). The discriminatory capacity of the score was similar in patients with symptom onset beyond 6 hours (AUC=0.705). Compared to existing models, the TREAT-AIS score consistently exhibited superior predictive accuracy, although this difference was marginal. Conclusions The TREAT-AIS score outperformed existing models, and demonstrated an acceptable discriminatory capacity for distinguishing patients according to sICH risk levels. However, the differences between models were only marginal. Further research incorporating periprocedural and postprocedural factors is required to improve the predictive accuracy.

To investigate the transcriptionally regulatory mechanism of the senp8 promoter in yellow cat-fish(Pelteobagrus fulvidraco);this study used P.fulvidraco as the research subject.Dual-luciferase re-porter assay and electrophoretic mobility shift assay were employed to analyze the functional activity of the promoter;coupled with in vivo experiments.The results indicated that the 2 045 bp senp8 promoter se-quence contained key transcription factor binding sites such as SP1;TATA-Box;CCAAT-Box;SREBP1;PPARα;and PPARγ.The binding sites of SREBP1(-901/-910 bp);PPARα(-1 291/-1 308 bp);and PPARγ(-1 292/-1 306 bp)in the senp8 promoter positively regulate its activity;and oleic acid or palmitic acid promote this binding.Furthermore;high-fat feeding promoted the expression of the senp8 gene and its protein in the liver of P.fulvidraco;oleic acid or palmitic acid treatment significantly en-hanced the activity of the senp8 promoter;and this enhancement could be achieved through the regulatory effects of SREBP1;PPARα;and PPARγ response elements.Additionally;high-fat feeding influenced the mRNA and protein expression levels of genes related to deSUMOylation modification in the liver of P.fulvidraco.This study provides new insights into the relationship between deSUMOylation modification and the regulation of lipid metabolism in the vertebrates.

Varicocele is a common disease of the male reproductive system, and the pampiniform plexus in the spermatic cord manifests abnormal dilatation, extension, and circuity, which is a vasculopathy. In this article, we believe that the relevance of the essence chamber collaterals to the spermatic vein in terms of anatomical morphology and physiological function is high and that when pathogenic qi invades the essence chamber, the qi and collaterals of the essence chamber are out of harmony, the fluid collaterals are impassable, and the blood collaterals are obstrcuted, and the essence chamber collaterals are blockaded with several pathological products, and even intermingled phlegm and blood stasis in the blood collaterals and form vascular clusters, resulting in the formation and development of varicocele. Based on this, this article proposes the core treatment principle of healing, harmonizing, activating, and dredging the collaterals, with the basic treatment method of nourishing qi and harmonizing collaterals, activating blood collaterals, and dredging blood stasis to, respectively treat degree Ⅰ, Ⅱ, and Ⅲ varicocele, aiming to prevent the change of the varicocele, dredge the curvature of the varicocele, and dissipate the knots of the varicocele. The proposal of essence chamber collaterals is of great significance to understanding the common law and pathological aspects of the occurrence and development of essence collateral and vascular lesions from the perspective of integrated traditional Chinese and Western medicine.