Methods: Fifty patients who underwent UBE-TLIF and 50 patients who underwent W-TLIF, each with >2 years of follow-up, were retrospectively analyzed. Outcomes included operative parameters, time to postoperative mobilization, paravertebral muscle atrophy and fat infiltration rates, clinical scores (Visual Analog Scale [VAS], Oswestry Disability Index [ODI], Japanese Orthopaedic Association [JOA]), modified Macnab criteria, fusion rates, and complications. Results: Compared with W-TLIF, the UBE-TLIF group had significantly less intraoperative blood loss, shorter operative times, and lower postoperative drainage volumes (p <0.05). The UBE-TLIF group showed faster postoperative recovery and shorter hospital stays. At 6 months, 1 year, and 2 years, W-TLIF patients had higher multifidus and erector spinae atrophy, and greater paravertebral muscle fat infiltration (p <0.05). The UBE-TLIF group also had lower VAS and ODI scores at 1 year and 2 years (p <0.05) and fewer surgical complications (6% vs. 10%). Fusion rates (94% vs. 92%) and modified Macnab outcomes (88% vs. 86%) were comparable (p >0.05). Conclusions UBE-TLIF is associated with reduced intraoperative trauma, quicker recovery, and fewer complications. In the long-term, it better preserves paravertebral muscle integrity and provides superior pain and functional outcomes.

Alzheimer’s disease (AD) is characterized by progressive cognitive deterioration and significant depression. However, the mechanisms linking depression to AD pathology remain unclear. Here, we investigated whether Notch2 signaling mediates depressionlike behaviors in presenilin-2 (PS2) N141I mutant mice, an early-onset AD model. PS2 wild-type (WT) and mutant (MT) mice aged 12-15 months were subjected to unpredictable chronic mild stress (UCMS) for 4 weeks, followed by sucrose preference, tail-hanging, and forced swimming tests. Behavioral assessments showed that UCMS exacerbated anhedonia and immobility only in PS2 MT mice. Molecular analysis revealed concomitant increases in plasma corticosterone, hippocampal γ-secretase activity, and Notch2 expression, and elevated total and phosphorylated glucocorticoid receptor levels in PS2 MT-UCMS mice. Gene expression profiling of human hippocampal datasets confirmed upregulation of NOTCH2 in Alzheimer’s disease and depression.Pharmacological inhibition of γ-secretase and Notch signaling with DAPT normalizes depressive behavior, reduces corticosterone release, attenuates GR phosphorylation, and inhibits Notch2 signaling in PS2 MT mice. These findings identify Notch2 as a pivotal mediator linking chronic stress to molecular changes associated with depression and AD, and suggest that targeting Notch2 signaling may provide therapeutic benefits for comorbid mood and neurodegenerative disorders.

Purpose: The male predominance in the incidence of gastric cancer (GC) is established; however, sex differences in the prognosis of GC remain controversial. As such, this study analyzed the prognosis of patients with GC based on age and sex. Materials and Methods: Data from 14,739 patients diagnosed with GC at Seoul National University Bundang Hospital between 2003 and 2023 were analyzed. Baseline characteristics, histological types of GC, overall and GC-specific survival rates (age and stage stratification), and associated risk factors were analyzed. Results: Females were significantly younger (p < 0.001) and exhibited more gastric body cancers (p < 0.001) and tumors with diffuse-type or poorly differentiated histology (p < 0.001) than males. Females exhibited an advantage over males in terms of overall survival (p=0.004), but not in GC-specific survival. However, age stratification revealed significant sex differences, that females < 50 years of age exhibited survival disadvantages (p < 0.001); however, this trend was reversed with age, and females > 60 years exhibited survival advantages (p < 0.001) for both overall and GC-specific survival. This may be explained by the lower ratio of diffuse-type GC as females age. Furthermore, in the analysis according to stage, females with stage IV disease exhibited significant survival disadvantages, with significantly younger age and a higher proportion of diffuse-type GC which exhibits aggressive features, resulting in poorer survival than in males. Conclusion Age and stage stratification revealed significant differences in survival between the sexes, which can be helpful for public health strategies.

Background: The conventional magnetic resonance imaging (MRI) grading system for foraminal stenosis (FS), known as the Lee classification, was introduced in 2010 and is widely utilized in clinical practice. Previous studies have reported that the conventional grading system for FS lacks prediction ability for surgical treatment. The purpose of this study was to develop a novel MRI grading system for lumbar FS with improved prediction ability for surgical treatment by incorporating facet effusion to indicate segmental instability. Methods: We retrospectively reviewed patients diagnosed with lumbar FS between 2011 and 2017 who had a follow-up period of at least 5 years. The FS severity was assessed using a conventional MRI grading system developed by Lee et al. We recorded whether the patient underwent surgical treatment for FS during the follow-up period and the time from the initial diagnosis to surgery. Survival analysis using a Kaplan-Meier curve and log-rank test was performed to verify the impact of FS severity on the surgical treatment. We performed additional survival analysis after modifying the grading system by incorporating the presence of excessive facet joint effusion assessed using axial MRI. We also compared the discrimination ability of the modified and conventional grading systems using Uno’s concordance index (C-index). Results: In total, 235 patients with a mean age of 63.7 years were included in this study. During the mean follow-up period of 8.1 years, 63 patients underwent surgical treatment for FS. The conventional grading system revealed no significant difference in survival between the grade 2 and 3 groups (p = 0.104). Conversely, the modified grading system revealed a significant difference in survival between the new grade 2 and 3 groups (p < 0.001). After modification, the discrimination ability, assessed using Uno’s Cindex, significantly improved from 0.69 to 0.73. Conclusions The Facet Effusion-Incorporating Grading System, which adds excessive facet joint effusion to the conventional MRI grading framework, demonstrated improved predictive value for surgical treatment and better discriminatory ability compared with the original system.

Background: and Purpose Induced hypertension therapy (IHT) is effective for treating early neurological deterioration (END) in patients with single subcortical infarction (SSI). However, the underlying pathophysiology of SSI is diverse and may affect the efficacy of IHT. Methods: We reviewed patients with SSI who experienced END and received IHT were enrolled. END was defined as ≥2-point increase in the National Institutes of Health Stroke Scale (NIHSS) score, ≥1 motor point increase. IHT was performed by using phenylephrine infusion to raise systolic blood pressure by 10%–20% over baseline. SSI was classified into three subtypes: distal (dSSI), proximal (pSSI), and SSI with parental artery disease (SSIPAD; with stenosis at parental artery disease <50%). Responders were defined as patients who showed neurological improvement (decrease of ≥2 points in NIHSS, ≥1 motor point decrease) within one day after IHT initiation. Multivariable analysis identified factors associated with responders. Results: Characteristics were compared between responders and non-responders, and factors associated with response to IHT were investigated. Among 96 patients (mean age, 64.7± 12.9 years; 61.5% male), 49 (51.0%) patients were categorized as responders. Multivariable analysis showed that pSSI (adjusted odds ratio [aOR]=18.10, 95% confidence interval [CI] 5.04–80.60, p<0.001) and SSIPAD (aOR=4.56, 95% CI 1.31–19.00, p=0.024) were associated with a positive response to IHT compared to dSSI. Additionally, less white matter changes (Fazekas scale 0–1) were associated with a better response to IHT (aOR=0.15, 95% CI 0.03–0.67,p=0.019). Conclusions Response to IHT varied according to SSI subtypes and the severity of small vessel changes.

Transoral endoscopic thyroidectomy vestibular approach(TOETVA)has become a research hotspot because of its cosmetic advantages of no scar on the body surface,but there is still a risk of unique complications,among which mandibular sensory dysfunction is the most common,mainly related to mental nerve injury.This review focuses on the key anatomical structures closely related to the establishment of TOETVA space and the occurrence of complications.A deep understanding of the related anatomical structures of maxillofacial region and neck,especially the location and variation of mental nerve,the course of mandibular marginal branches of facial nerve,the level of mandibular muscles and the adjacent relationship of blood vessels,is the key to safely implement TOETVA and reduce postoperative complications.Preoperative image evaluation,intraoperative precise anatomy,following the design of safe area and improving the operation method in the future will contribute to the further promotion of this operation.

Objective To investigate the role and clinical significance of Calpain activity and 145 kDa cleavage fragments of αⅡ-spec-trin breakdown products(SBDP145)in systemic lupus erythematosus(SLE).Methods 124 patients with confirmed SLE and de-tailed clinical data were collected as the SLE group,and 75 healthy individuals who underwent physical examination during the same period were selected as the control group.Their serum samples were collected,and serum SBDP145 levels and Calpain activity were de-tected by the enzyme-linked immunosorbent assay(ELISA)and substrate-based method,respectively.The Mann-Whitney U test,Spearman rank correlation,univariate and multivariate Logistic regression,and receiver operating characteristic(ROC)curve were used to evaluate the clinical value of Calpain activity and SBDP145 in the diagnosis and assessment of SLE.Results Compared with healthy controls,serum Calpain activity([17.000[8.5000,33.500]RFU vs 7.500[4.000,12.500]RFU)and SBDP145 levels(5.283[3.532,9.463]ng/mL vs 1.472[0.994,2.212]ng/mL)in SLE patients were significantly increased(Z=-9.229,P<0.001;Z=-6.881,P<0.001).Furthermore,the Calpain activity was significantly correlated with SLE disease activity index(SLEDAI-2K)score(r=0.349,P<0.001).Logistic regression analysis showed that the increased Calpain activity and SBDP145 levels were significantly associated with the occurrence of SLE(OR=1.164,95％CI:1.016-1.334,P=0.029;OR=3.822,95％CI:1.928-7.574,P<0.001).The ROC curve analysis showed that the area under the ROC curve(AUCROC)of serum Calpain activity in distin-guishing SLE and healthy controls was 0.762(95％CI:0.697-0.827).When the cut-off value was 13.75 RFU,its sensitivity and speci-ficity were 63.1％and 81.1％,respectively.The AUCROC of serum SBDP145 levels in distinguishing SLE and healthy controls was 0.891(95％CI:0.845-0.936).When the cut-off value was 2.377 ng/mL,its sensitivity and specificity were 88.7％and 80.0％,re-spectively.The AUCROC,sensitivity,and specificity of combining the two with traditional SLE clinical indicators,including complement C3,erythrocyte sedimentation rate,and anti-dsDNA antibodies,in the diagnosis of SLE reached 0.986(95％CI:0.972-1.000),93.3％,and 96.0％,respectively.The Spearman correlation analysis results showed that the organ damage index(SDI)score of SLE patients was positively correlated with serum Calpain activity and SBDP145 levels(r=0.342,P<0.001;r=0.250,P=0.005).Con-clusion The elevated Calpain activity and SBDP145 levels are closely related to the occurrence and development of SLE,suggesting that they may be served as potential biomarkers for the diagnosis and assessment of SLE patients.

Objective:To investigate the clinical manifestation, therapy, and prognosis of Susac syndrome and enhance the understanding of this disease.Methods:A case summary was made.The clinical data of two siblings with Susac syndrome treated at Children′s Medical Center, Peking University First Hospital in January 2024 were summarized.Reported cases of pediatric Susac syndrome were reviewed.Results:The onset of the disease in the two siblings was at the age of 3.00 and 6.75 years, with recurrent headaches, tinnitus, hearing loss and encephalopathy symptoms.Cranial magnetic resonance imaging showed multiple cerebral microbleeding and microinfarction lesions, " snowball like" in the corpus callosum and diffuse white matter edema in the brain.Audiometry revealed sensorineural hearing loss.In one case, ophthalmic fluorescein angiography revealed ischemic changes due to branch retinal artery occlusions.No pathogenic variants were detected in gene testing.This child was diagnosed with Susac syndrome, and the symptoms were improved after treatment with Corticosteroids and Rituximab.No relapse was observed during the 9-month follow-up.A total of 20 pediatric cases of Susac syndrome were retrieved, including 18 reported previously and 2 cases from this study.There were 2 boys and 18 girls, with the age of onset ranging from 2.5 to 17.0 years.The common initial symptoms included headache (19 cases), vertigo and tinnitus or hearing loss (9 cases), and vision impairment or visual field defect (4 cases). The symptoms were improved after immunotherapy.Conclusions:With a low incidence, Susac syndrome is rare in children and difficult to diagnose.There may be a genetic predisposition in such disease.Early diagnosis and immunotherapy can low the relapse and improve the prognosis.

Objective:To explore the establishing Nomoplot prediction model for Kawasaki disease(KD)combined with coronary artery lesion(CAL)children was established based on logistic regression,and to evaluate its predictive efficacy.Methods:The clinical data of 367 KD children who were admitted to our hospital from January 2014 to June 2024 were retrospectively analyzed,the children were divided into CAL(n=91)and NCAL(n=276)groups according to whether they had concurrent CAL.The influencing factors for CAL children combine with KD were analyzed by univariate and multivariate logistic regression.Nomoplot prediction model for CAL children combine with KD was constructed.The predictive efficacy of the Nomoplot prediction model for CAL children combine with KD was evaluated by receiver operating characteristic(ROC)curve.Results:The incidence of CAL in 367 KD children was 24.80％(91/367),univariate analysis results showed that,the proportion of delayed intravenous immunoglobulin(IVIG)treatment and the proportion of IVIG resistance in CAL group were higher than those in NCAL group(P＜0.05),the fever duration was longer than that in NCAL group(P＜0.05),and the age,hemoglobin(Hb)and platelet count(PLT)levels were lower than those in NCAL group(P＜0.05),erythrocyte sedimentation rate(ESR),B-type natriuretic peptide(BNP),C-reactive protein(CRP),procalcitonin(PCT),albumin(ALB)and alanine aminotransferase(ALT)levels were higher than those in NCAL group(P＜0.05).Delayed IVIG treatment,prolonged fever duration,elevated CRP,ESR and BNP levels were independent risk factors for CAL children combine with KD(P＜0.05),Older age,elevated Hb level were protective factor(P＜0.05).The predicted curve of the Nomoplot prediction model was in good agreement with the ideal curve,the area under the curve(AUC)of the model for predicting CAL children combine with KD was 0.971.Conclusions:Delayed IVIG treatment,fever duration,age and Hb,CRP,ESR and BNP are independent Influencing factors for CAL children combine with KD,the Nomoplot prediction model constructed based on the above logistic regression results has a high predictive value for CAL children combined with KD.