Objective:To observe the efficacy and safety of intraoperative neurophysiological monitoring (IONM) in spinal surgery.Methods:Clinical studies on the application of IONM in spinal surgery were retrieved from CNKI, VIP, Chinese Medical Journal Full-text Database, PubMed, and Web of Science, with the retrieval time ranging from January 2014 to March 2025. The incidence of intraoperative nerve injury, preoperative and postoperative Japanese Orthopaedic Association (JOA) score, and lesion clearance rate were collected. Meta-analysis was performed using Stata 18.0 statistical software. When the heterogeneity between groups was small, the fixed-effect model was used for analysis, and when the heterogeneity between groups was large, the random-effect model was used.Results:A total of 17 studies involving 1,865 patients were included in the meta-analysis. Among them, there were 13 Chinese literatures and 4 English literatures, 2 randomized controlled trials and 15 observational studies, all of which were of high quality. The results of meta-analysis showed that the incidence of intraoperative nerve injury in the monitoring group was lower than that in the non-monitoring group [ OR=0.52, 95% CI(0.37, 0.74), P<0.001]. There was no statistically significant difference in preoperative JOA scores between the two groups [ SMD=0.01, 95% CI(0.37, 0.74), P=0.971]. However, the postoperative JOA score in the monitoring-group was higher than the preoperative score, and the difference was statistically significant [ SMD=5.34, 95% CI(0.29, 10.39), P=0.038]. There was no statistically significant difference in JOA scores before and after surgery in the non-monitoring group [ SMD=3.51, 95% CI(-0.56, 7.59), P=0.091]. There was no statistically significant difference in lesion clearance rate between the two groups [ OR=1.17, 95% CI(0.88, 1.57), P=0.281]. Conclusion:The use of IONM in spinal surgery can reduce the incidence of intraoperative nerve injury and improve functional scores.

Hepatic encephalopathy and malnutrition due to hyperammonemia often interact with each other, forming a vicious circle in patients with cirrhosis. In addition, hepatic encephalopathy and malnutrition have a high incidence in patients with cirrhosis, which seriously affects the quality of life and prognosis. Therefore, identifying whether malnutrition is present in patients with cirrhosis combined with hepatic encephalopathy is crucial for providing appropriate interventions.This article reviews the pathogenesis, nutritional assessment methods, and nutritional management of malnutrition in patients with liver cirrhosis combined with hepatic encephalopathy.

Objective:To investigate the value of iSEND(inhaled,self-immunoregulatory,extracellular nanovesicle-based delivery)immune score combined with lung immune prognostic index(LIPI)in evaluating the prognosis of non-small cell lung cancer(NSCLC)patients undergoing immunotherapy.Methods:A retrospective analysis was conducted on the clinical data of 100 patients with advanced NSCLC who received immunotherapy from February 2018 to February 2023.The iSEND immune score and LIPI data of these patients were collected.Patients were divided into 3 groups(poor,moderate,and good)according to their iSEND and LIPI scores.Kaplan-Meier survival curves were polotted to analyze progression-free survival(PFS)among all patients and within different groups.Cox regression analysis was used to identify the risk factors affecting patient prognosis.Results:After immunotherapy,the objective response rate(ORR)was 42.00%(42/100)and the disease control rate(DCR)was 82.00%(82/100)among NSCLC patients.The ORR and DCR were lowest in the poor groups and highest in the good groups for both iSEND immune score and LIPI score,with significant differences among groups(all P<0.01).The mPFS for all 100 NSCLC patients was 7.63 month(95%CI[7.23,8.05]).The mPFS for the poor,moderate,and good groups in terms of iSEND immune score was 4.69,6.58,and 8.99 months,respectively,with the good group having the longest PFS,followed by the moderate group,and the poor group(χ2=125.391,P<0.000 1).Similarly,the mPFS for the poor,moderate,and good groups in terms of LIPI was 4.54,6.39,and 8.49 months,respectively,with the good group having the longest PFS,followed by the moderate group and poor group(χ2=115.707,P<0.000 1).Cox multivariate analysis identified ECOG PS>1,distant metastasis,iSEND immune score≥2,and LIPI≥2 as independent risk factors affecting patient prognosis.Conclusion:iSEND immune score and LIPI can serve as valuable prognostic indicators for NSCLC patients undergoing immunotherapy,demonstrating certain clinical value.

Hepatic encephalopathy and malnutrition due to hyperammonemia often interact with each other, forming a vicious circle in patients with cirrhosis. In addition, hepatic encephalopathy and malnutrition have a high incidence in patients with cirrhosis, which seriously affects the quality of life and prognosis. Therefore, identifying whether malnutrition is present in patients with cirrhosis combined with hepatic encephalopathy is crucial for providing appropriate interventions.This article reviews the pathogenesis, nutritional assessment methods, and nutritional management of malnutrition in patients with liver cirrhosis combined with hepatic encephalopathy.

Objective:To investigate the ultra-long-term antihypertensive efficacy, safety, major adverse events, and survival benefits of renal denervation (RDN) in patients with resistant hypertension (rHTN) and mild chronic kidney disease (CKD).Methods:This real-world, single-center retrospective study enrolled patients with rHTN and mild CKD who underwent RDN at Tianjin First Central Hospital between October 2011 and June 2016. Office blood pressure, home self-measured blood pressure, 24-hour ambulatory blood pressure, serum creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio were collected at baseline and at 1, 5, and 13 years post-RDN. The total daily defined dose of antihypertensive medications at 13 years post-RDN was recorded, along with endpoint events during follow-up, including cardiovascular death, all-cause death, hospitalization for heart failure, myocardial infarction, and stroke. Patients were stratified according to CKD stage (G1-G2 vs. G3a) and baseline systolic blood pressure (mild-to-moderate vs. severe hypertension), and follow-up data were compared across subgroups.Results:A total of 40 patients were included, aged (51±15) years, including 26 (65%) males. At the 13-year follow-up, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased by (-32±20) mmHg and (-15±14) mmHg (1 mmHg=0.133 kPa), respectively; reductions in home self-measured blood pressure (SBP: (-25±14) mmHg, DBP: (-10±11) mmHg) and 24-hour ambulatory blood pressure (SBP: (-16±9 mmHg, DBP: (-10±6) mmHg) were also observed, alongside a reduction in the total daily defined dose of antihypertensive medications by (1.1±0.9) compared to baseline. Renal function assessments showed no significant differences at 13 years versus baseline in serum creatinine ((105±51) μmol/L vs. (96±22) μmol/L), estimated glomerular filtration rate ((72±22) ml·min -1·1.73 m -2 vs. (78±17) ml·min -1·1.73 m -2), or urine albumin-to-creatinine ratio ((101±86) mg/g vs. (127±82) mg/g) (all P>0.05). All-cause and cardiovascular mortality rates during follow-up were 13% (5/40) and 8% (3/40), respectively. Subgroup analysis results showed that, although CKD G1-G2 patients had smaller reductions in office SBP ((-31±20) mmHg vs. (-34±19) mmHg) and DBP ((-13±10) mmHg vs. (-25±18) mmHg) compared to G3a patients at 13 years, intergroup differences were not significant (all P>0.05). In contrast, severe hypertension subgroup exhibited greater reductions in office SBP ((-55±13) mmHg vs. (-20±10) mmHg) and DBP ((-24±17) mmHg vs. (-13±10) mmHg) versus mild-to-moderate hypertension subgroup (all P<0.05). Conclusion:RDN demonstrates sustained antihypertensive efficacy with favorable renal safety in rHTN patients with mild CKD. Patients with higher baseline systolic blood pressure may exhibit better responsiveness to RDN.

Objective:To observe the efficacy and safety of intraoperative neurophysiological monitoring (IONM) in spinal surgery.Methods:Clinical studies on the application of IONM in spinal surgery were retrieved from CNKI, VIP, Chinese Medical Journal Full-text Database, PubMed, and Web of Science, with the retrieval time ranging from January 2014 to March 2025. The incidence of intraoperative nerve injury, preoperative and postoperative Japanese Orthopaedic Association (JOA) score, and lesion clearance rate were collected. Meta-analysis was performed using Stata 18.0 statistical software. When the heterogeneity between groups was small, the fixed-effect model was used for analysis, and when the heterogeneity between groups was large, the random-effect model was used.Results:A total of 17 studies involving 1,865 patients were included in the meta-analysis. Among them, there were 13 Chinese literatures and 4 English literatures, 2 randomized controlled trials and 15 observational studies, all of which were of high quality. The results of meta-analysis showed that the incidence of intraoperative nerve injury in the monitoring group was lower than that in the non-monitoring group [ OR=0.52, 95% CI(0.37, 0.74), P<0.001]. There was no statistically significant difference in preoperative JOA scores between the two groups [ SMD=0.01, 95% CI(0.37, 0.74), P=0.971]. However, the postoperative JOA score in the monitoring-group was higher than the preoperative score, and the difference was statistically significant [ SMD=5.34, 95% CI(0.29, 10.39), P=0.038]. There was no statistically significant difference in JOA scores before and after surgery in the non-monitoring group [ SMD=3.51, 95% CI(-0.56, 7.59), P=0.091]. There was no statistically significant difference in lesion clearance rate between the two groups [ OR=1.17, 95% CI(0.88, 1.57), P=0.281]. Conclusion:The use of IONM in spinal surgery can reduce the incidence of intraoperative nerve injury and improve functional scores.

Objective:To investigate the ultra-long-term antihypertensive efficacy, safety, major adverse events, and survival benefits of renal denervation (RDN) in patients with resistant hypertension (rHTN) and mild chronic kidney disease (CKD).Methods:This real-world, single-center retrospective study enrolled patients with rHTN and mild CKD who underwent RDN at Tianjin First Central Hospital between October 2011 and June 2016. Office blood pressure, home self-measured blood pressure, 24-hour ambulatory blood pressure, serum creatinine, estimated glomerular filtration rate, and urine albumin-to-creatinine ratio were collected at baseline and at 1, 5, and 13 years post-RDN. The total daily defined dose of antihypertensive medications at 13 years post-RDN was recorded, along with endpoint events during follow-up, including cardiovascular death, all-cause death, hospitalization for heart failure, myocardial infarction, and stroke. Patients were stratified according to CKD stage (G1-G2 vs. G3a) and baseline systolic blood pressure (mild-to-moderate vs. severe hypertension), and follow-up data were compared across subgroups.Results:A total of 40 patients were included, aged (51±15) years, including 26 (65%) males. At the 13-year follow-up, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased by (-32±20) mmHg and (-15±14) mmHg (1 mmHg=0.133 kPa), respectively; reductions in home self-measured blood pressure (SBP: (-25±14) mmHg, DBP: (-10±11) mmHg) and 24-hour ambulatory blood pressure (SBP: (-16±9 mmHg, DBP: (-10±6) mmHg) were also observed, alongside a reduction in the total daily defined dose of antihypertensive medications by (1.1±0.9) compared to baseline. Renal function assessments showed no significant differences at 13 years versus baseline in serum creatinine ((105±51) μmol/L vs. (96±22) μmol/L), estimated glomerular filtration rate ((72±22) ml·min -1·1.73 m -2 vs. (78±17) ml·min -1·1.73 m -2), or urine albumin-to-creatinine ratio ((101±86) mg/g vs. (127±82) mg/g) (all P>0.05). All-cause and cardiovascular mortality rates during follow-up were 13% (5/40) and 8% (3/40), respectively. Subgroup analysis results showed that, although CKD G1-G2 patients had smaller reductions in office SBP ((-31±20) mmHg vs. (-34±19) mmHg) and DBP ((-13±10) mmHg vs. (-25±18) mmHg) compared to G3a patients at 13 years, intergroup differences were not significant (all P>0.05). In contrast, severe hypertension subgroup exhibited greater reductions in office SBP ((-55±13) mmHg vs. (-20±10) mmHg) and DBP ((-24±17) mmHg vs. (-13±10) mmHg) versus mild-to-moderate hypertension subgroup (all P<0.05). Conclusion:RDN demonstrates sustained antihypertensive efficacy with favorable renal safety in rHTN patients with mild CKD. Patients with higher baseline systolic blood pressure may exhibit better responsiveness to RDN.

OBJECTIVE To explore the mechanism of limonin treating in hepatic fibrosis through network pharmacology, and validate its mechanism by molecular docking and animal experiments. METHODS Firstly, the targets of limonin and hepatic fibrosis were screened from the SwissTargetPrediction, GeneCards and DisGeNet database, etc. Meanwhile, the common targets of limonin and hepatic fibrosis were obtained from the bioinformatics website. The protein protein interaction network of common target was constructed by using STRING database and Cytoscape software, and the CytoNCA plug-in was used to screen core targets. And then the enrichment analysis of GO and KEGG on the common target was performed by Metascape database. Thereby, the possible mechanism of limonin against hepatic fibrosis were predicted. Finally, the AutoDock Vina was used for molecular docking verification, and the prediction results of network pharmacology were verified by animal experiments. RESULTS The prediction results indicated that limonin might acted on 86 targets including AKT1, VEGFA and HIF1A, and participated in biological processes including hormone response, protein phosphorylation, angiogenesis, and PI3K-Akt pathway, HIF-1 pathway, VEGF pathway and other signaling pathways related to hepatic fibrosis. The results of protein protein interaction network topology analysis showed that the 11 core targets including AKT1, VEGFA, HIF1A and PIK3CA, etc. Molecular docking results showed that limonin had strong affinity and relatively stable binding conformation with the core targets. In the animal experiments, compared with the model group, hyaluronidase(HA) and laminin(LN) in rat serume in high-dose group of limonin(LH) and low-dose group of limonin(LL)(except for LN in LL group) were declined(P<0.01 or P<0.05), and the degree of inflammation and hepatic fibrosis were relieved to different degrees in liver tissue of the LH group and LL group; Western blotting and qPCR detection showed that protein and mRNA expression levels of AKT, HIF-1α and VEGF(except for VEGF in LL group) was down-regulated in the LH group and LL group(P<0.01 or P<0.05). CONCLUSION Limonin may acts on AKT1, VEGFA, HIF1A and other core targets to treat hepatic fibrosis angiogenesis, which may be related to the inhibition of AKT/HIF-1α/VEGF signaling pathway.

The polyfoliate perforator flap is a new type of flap that was developed on the basis of the traditional polyfoliate myocutaneous flap, polyfoliate fascial flap and perforator flap. It overturns the traditional idea that the deep fascial vascular network is the fundamental for a survival of the flap, and enables the flaps to achieve the best profile and function of the recipient areas with minimal damage to the donor area. In order to improve the understanding of the polyfoliate perforator flap and further standardise its clinical application, this paper forms a consensus on the definition, classification, indications, operative points and precautions of the polyfoliate perforator flap, so as to provide references in diagnosis and treatment process and practical application for the surgeons.

A three-dimensional feature construction method based on spectral information is presented,in which the power values of each channel are arranged into two-dimensional feature vectors based on electrode positions.The different frequency band features are arranged into a three-dimensional integral feature tensor to extract the information in frequency domain.Meanwhile,in order to reduce the influence of volume conductor effect,functional connectivity is utilized to map the temporal electroencephalogram data to the spatial brain functional network for extracting the spatial information.By analyzing the relationship between features and target classes,a 3D-CNN-Attention network model is proposed to incorporate an Attention mechanism in 3D-CNN network to enhance the electroencephalogram feature learning capability.A series of comparative experiments on publicly available datasets show that 3D-CNN-Attention network framework outperforms other methods in depression detection,obtaining an accuracy rate of up to 96.32%.The proposed method provides an effective solution for depression detection.