Objective To compare of the efficacy of two distinct debridement techniques in membrane induction therapy for chronic tibial osteomyelitis.Methods A retrospective study was conducted on 52 patients with Cierny-Mader type IV A/B chronic tibial osteomyelitis who were treated at the Third Affiliated Hospital of Zunyi Medical University between July 2016 and December 2023.Five patients were diagnosed and treated before 2020,while 47 were managed from 2020 onward.Patients were divided into two groups:a local debridement group(n=28)and an en bloc osteotomy group(n=24).Perioperative outcomes—including operative time,incision length,intraoperative blood loss,and length of hospital stay—were assessed,along with clinical efficacy at 6 months,12 months,and final follow-up.Clinical outcomes were evaluated using the Hospital for Special Surgery(HSS)knee score,the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score,joint range of motion(knee flexion-extension and ankle plantarflexion-dorsiflexion),recurrence rate,and the Paley classification for infectious bone defects.Results The local debridement group exhibited significantly less intraoperative blood loss(P<0.05),shorter operative time(P<0.05),and reduced hospital stay(P<0.05),as well as higher AOFAS and HSS scores at both 6 and 12 months postoperatively(P<0.05).In contrast,the osteotomy group demonstrated superior Paley classification outcomes at 6 months,12 months,and final follow-up(P<0.05),along with lower rates of infection recurrence.Longitudinal analysis indicated significant improvements in AOFAS scores,HSS scores,and joint mobility over time in both groups(P<0.05).However,no statistically significant differences were observed between groups in terms of functional scores or joint mobility parameters at final follow-up(P>0.05).Conclusion En bloc osteotomy combined with the induced membrane technique(Masquelet technique)enables more comprehensive debridement,minimizes the necessity for repeated surgical interventions,reduces postoperative complications,lowers the risk of recurrence,and promotes enhanced bone healing.

Objective·To observe the impact of hip synovitis on the long-term outcomes of free vascularized fibular grafting(FVFG)for osteonecrosis of femoral head(ONFH).Methods·Between October 2001 and December 2013,370 patients diagnosed with ONFH(556 hips)underwent FVFG.Preoperative synovitis was assessed using magnetic resonance imaging(MRI)and quantified with the Hip Inflammation MRI Scoring System(HIMRISS).Patients were divided into no synovitis group,moderate synovitis group,and severe synovitis group.Harris hip scores and the incidence of total hip arthroplasty were collected with an average follow-up duration of 90.5 months(range:5-215 months).Hip survival failure(defined as a Harris hip score lower than 80 at the final follow-up or the occurrence of total hip arthroplasty)was calculated.Multivariable Cox regression analysis was adopted to compare the influence of different degrees of synovial inflammation on long-term prognosis.Results·The proportion of hip survival failure was 28.0％in patients without synovitis and 28.5％in those with moderate synovitis,whereas it was significantly higher(60.4％)in patients with severe synovitis.The results of multivariable Cox regression analysis showed that severe synovitis was an independent risk factor for poor prognosis(HR 2.06,95％CI 1.21-3.53)after adjusting for age,gender,education level,marital status,ONFH type,affected side of ONFH,smoking history,baseline Harris hip score and other hip MRI-based covariates(collapse,bone marrow edema,and degeneration).Conclusion·Severe synovitis in patients with ONFH significantly increases the failure rate of hip preservation after FVFG,and the severity of synovitis should be considered in surgical decision-making.

Objective:To assess the real-world triage performance of a dual-marker strategy (DMS) combining copeptin and high-sensitivity cardiac troponin T (hs-cTnT) in patients presenting with chest pain and suspected non-ST-segment elevation myocardial infarction (NSTEMI).Methods:It was conducted a prospective study of 277 consecutive chest pain patients admitted to the Emergency Department of Zhongshan Hospital, Fudan University, between July and August 2023. Admission levels of copeptin and hs-cTnT were measured. The safety, efficacy, and triage efficiency of the DMS (defined as copeptin <10 pmol/L and hs-cTnT <0.014 ng/mL) for excluding NSTEMI were evaluated based on final diagnoses and clinical outcomes.Results:Among 277 patients, 141 (50.9%) had cardiogenic diseases (51 NSTEMI, 37 unstable angina pectoris [UAP], 11 myocardial bridges, and 42 non-coronary artery disease), 29 (10.5%) had non-cardiac conditions, and 107 (38.6%) had low-risk chest pain of unknown etiology. A total of 103 patients (37.2%) were DMS-negative (copeptin and hs-cTnT both below cutoff), including 0 NSTEMI cases, 2 UAP cases, 1 myocardial bridge, 6 non-coronary artery diseases, 4 non-cardiac conditions, and 90 low-risk cases. The DMS demonstrated a negative predictive value (NPV) of 100% for excluding NSTEMI, with no major adverse cardiac events (MACE) observed in DMS-negative patients during 30-day follow-up. Real-world data revealed that only 42.2% of suspected NSTEMI patients received a second troponin test (timing: 1 hour—5.9%, 2 hours—23.9%, ≥3 hours—70.1%). The DMS enabled safe and efficient triage of 37.2% of chest pain patients at 0-hour, outperforming other strategies in applicability and feasibility ( P < 0.05). Conclusions:In real-world clinical practice, the DMS (copeptin combined with hs-cTnT) optimally complements guideline-recommended hs-cTnT algorithms. It provides a simple, rapid, and safe approach to managing acute chest pain, demonstrating superior applicability for improving emergency triage efficiency.

Objective To compare of the efficacy of two distinct debridement techniques in membrane induction therapy for chronic tibial osteomyelitis.Methods A retrospective study was conducted on 52 patients with Cierny-Mader type IV A/B chronic tibial osteomyelitis who were treated at the Third Affiliated Hospital of Zunyi Medical University between July 2016 and December 2023.Five patients were diagnosed and treated before 2020,while 47 were managed from 2020 onward.Patients were divided into two groups:a local debridement group(n=28)and an en bloc osteotomy group(n=24).Perioperative outcomes—including operative time,incision length,intraoperative blood loss,and length of hospital stay—were assessed,along with clinical efficacy at 6 months,12 months,and final follow-up.Clinical outcomes were evaluated using the Hospital for Special Surgery(HSS)knee score,the American Orthopaedic Foot&Ankle Society(AOFAS)ankle-hindfoot score,joint range of motion(knee flexion-extension and ankle plantarflexion-dorsiflexion),recurrence rate,and the Paley classification for infectious bone defects.Results The local debridement group exhibited significantly less intraoperative blood loss(P<0.05),shorter operative time(P<0.05),and reduced hospital stay(P<0.05),as well as higher AOFAS and HSS scores at both 6 and 12 months postoperatively(P<0.05).In contrast,the osteotomy group demonstrated superior Paley classification outcomes at 6 months,12 months,and final follow-up(P<0.05),along with lower rates of infection recurrence.Longitudinal analysis indicated significant improvements in AOFAS scores,HSS scores,and joint mobility over time in both groups(P<0.05).However,no statistically significant differences were observed between groups in terms of functional scores or joint mobility parameters at final follow-up(P>0.05).Conclusion En bloc osteotomy combined with the induced membrane technique(Masquelet technique)enables more comprehensive debridement,minimizes the necessity for repeated surgical interventions,reduces postoperative complications,lowers the risk of recurrence,and promotes enhanced bone healing.

Objective·To observe the impact of hip synovitis on the long-term outcomes of free vascularized fibular grafting(FVFG)for osteonecrosis of femoral head(ONFH).Methods·Between October 2001 and December 2013,370 patients diagnosed with ONFH(556 hips)underwent FVFG.Preoperative synovitis was assessed using magnetic resonance imaging(MRI)and quantified with the Hip Inflammation MRI Scoring System(HIMRISS).Patients were divided into no synovitis group,moderate synovitis group,and severe synovitis group.Harris hip scores and the incidence of total hip arthroplasty were collected with an average follow-up duration of 90.5 months(range:5-215 months).Hip survival failure(defined as a Harris hip score lower than 80 at the final follow-up or the occurrence of total hip arthroplasty)was calculated.Multivariable Cox regression analysis was adopted to compare the influence of different degrees of synovial inflammation on long-term prognosis.Results·The proportion of hip survival failure was 28.0％in patients without synovitis and 28.5％in those with moderate synovitis,whereas it was significantly higher(60.4％)in patients with severe synovitis.The results of multivariable Cox regression analysis showed that severe synovitis was an independent risk factor for poor prognosis(HR 2.06,95％CI 1.21-3.53)after adjusting for age,gender,education level,marital status,ONFH type,affected side of ONFH,smoking history,baseline Harris hip score and other hip MRI-based covariates(collapse,bone marrow edema,and degeneration).Conclusion·Severe synovitis in patients with ONFH significantly increases the failure rate of hip preservation after FVFG,and the severity of synovitis should be considered in surgical decision-making.

Purpose: To intelligently diagnose whether there is bladder outlet obstruction (BOO) in female with decent detrusor contraction ability by focusing on urodynamic study (UDS) data. Materials and Methods: We retrospectively reviewed the UDS data of female patients during urination. Eleven easily accessible urinary flow indicators were calculated according to the UDS data of each patient during voiding period. Eight diagnosis models based on back propagation neural network with different input feature combination were constructed by analyzing the correlations between indicators and lower urinary tract dysfunction labels. Subsequently, the stability of diagnostic models was evaluated by five-fold cross-validation based on training data, while the performance was compared on test dataset. Results: UDS data from 134 female patients with a median age of 51 years (range, 27–78 years) were selected for our study.Among them, 66 patients suffered BOO and the remaining were normal. Applying the 5-fold cross-validation method, the model with the best performance achieved an area under the receiver operating characteristic curve (AUC) value of 0.949±0.060 using 9 UDS input features. The accuracy, sensitivity, and specificity for BOO diagnosis model in the testing process are 94.4%, 100%, and 89.3%, respectively. Conclusions The 9 significant indicators in UDS were employed to construct a diagnostic model of female BOO based on machine learning algorithm, which performs preferable classification accuracy and stability.

Polycystic ovary syndrome (PCOS) is a common disease among women of childbearing age, and hyperandrogenism (HA) is a typical clinical feature of PCOS patients. In recent years, research has found that HA is closely related to the liver function of PCOS patients, in addition to causing reproductive, endocrine, and metabolic disorders. This article provides a review from four aspects: the relationship between PCOS and HA, the impact of HA on liver function in PCOS patients, the mechanism of HA affecting liver function in PCOS, and the intervention of HA on improving liver function in PCOS. The aim is to further raise awareness of the multi system effects of HA on PCOS patients and provide a basis and approach for improving liver function and clinical prognosis in PCOS patients.

Hepatocellular carcinoma(HCC)is one of the most common malignancies with high morbidity and mortality rates worldwide.With the advances in molecular biology and tumor immunology,molecular-targeted agents represented by tyrosine kinase inhibitors(such as sorafenib and lenvatinib)and immunotherapy represented by PD-1/PD-L1 monoclonal antibodies have brought hope for patients with advanced HCC.The combination of immunotherapy and anti-angiogenic therapy can further improve the treatment outcome of patients.In addition,the optimization and integration of stereotactic body radiotherapy,local treatment,and systemic treatment may maximize the benefits of patients.In the future,through a deep understanding of the heterogeneity of HCC,the development of precision molecular subtyping and individualized treatment,and the establishment of a multidisciplinary collaborative diagnosis and treatment system,systemic therapy is expected to achieve long-term management of advanced HCC.This article reviews the current status and advances in systemic therapy for advanced HCC.

Objective·To analyze the imaging characteristics and diagnostic value of 18F-fluorodeoxyglucose positron emission tomography-computed tomography(18F-FDG PET/CT)in mantle cell lymphoma(MCL)and explore its application to distinguishing between classic and aggressive variants of MCL.Methods·A retrospective analysis was conducted on the 18F-FDG PET/CT images and clinical data of 116 pathologically confirmed,newly diagnosed MCL patients.The imaging features of intra-and extra-nodal lesions were summarized.The accuracy of 18F-FDG PET/CT in diagnosing bone marrow and gastrointestinal involvement in MCL was evaluated.Furthermore,differences in 18F-FDG PET/CT findings and clinical characteristics between the classic and aggressive variants of MCL were analyzed.Results·Among the 116 patients,100.0%showed positive findings on 18F-FDG PET/CT,with 99.1%exhibiting abnormal lymph nodes and 85.3%having extra-nodal involvement.The most common extra-nodal sites were the spleen,Waldeyer's ring,bone marrow,and gastrointestinal tract.Compared with bone marrow aspiration results,the sensitivity,specificity,and accuracy of 18F-FDG PET/CT for detecting bone marrow involvement in MCL were 43.4%,91.5%,and 66.0%,respectively.When compared with endoscopic biopsy results,the sensitivity of 18F-FDG PET/CT for detecting gastric and intestinal involvement was 100.0%and 94.1%,respectively,with specificity of 75.0%and 100.0%,and accuracy of 92.9%and 94.7%,respectively.There were significant differences in the highest maximum standardized uptake value(SUVmax)and Ki-67 index between the classic and aggressive variants of MCL,with SUVmax positively correlated with Ki-67 index.By using SUVmax>10.4 as the diagnostic threshold,the sensitivity and specificity for differentiating between the classic and aggressive variants of MCL were 73.9%and 77.4%,respectively,with an AUC value of 0.797.Conclusion·18F-FDG PET/CT demonstrates a high detection rate for both intra-and extra-nodal lesions in MCL patients.It exhibits high specificity in diagnosing bone marrow involvement and high sensitivity and specificity in diagnosing gastrointestinal involvement,providing reliable non-invasive diagnostic information for MCL bone marrow and gastrointestinal involvement.However,it is not a substitute for pathological examination.Additionally,the positive correlation between SUVmax and Ki-67 index allows SUVmax to effectively differentiate between the classic and aggressive variants of MCL,with a higher SUVmax(>10.4)indicating a higher likelihood of the aggressive variant.These findings have clinical implications for treatment planning and prognosis assessment.

Objective·To analyze the imaging characteristics and diagnostic value of 18F-fluorodeoxyglucose positron emission tomography-computed tomography(18F-FDG PET/CT)in mantle cell lymphoma(MCL)and explore its application to distinguishing between classic and aggressive variants of MCL.Methods·A retrospective analysis was conducted on the 18F-FDG PET/CT images and clinical data of 116 pathologically confirmed,newly diagnosed MCL patients.The imaging features of intra-and extra-nodal lesions were summarized.The accuracy of 18F-FDG PET/CT in diagnosing bone marrow and gastrointestinal involvement in MCL was evaluated.Furthermore,differences in 18F-FDG PET/CT findings and clinical characteristics between the classic and aggressive variants of MCL were analyzed.Results·Among the 116 patients,100.0%showed positive findings on 18F-FDG PET/CT,with 99.1%exhibiting abnormal lymph nodes and 85.3%having extra-nodal involvement.The most common extra-nodal sites were the spleen,Waldeyer's ring,bone marrow,and gastrointestinal tract.Compared with bone marrow aspiration results,the sensitivity,specificity,and accuracy of 18F-FDG PET/CT for detecting bone marrow involvement in MCL were 43.4%,91.5%,and 66.0%,respectively.When compared with endoscopic biopsy results,the sensitivity of 18F-FDG PET/CT for detecting gastric and intestinal involvement was 100.0%and 94.1%,respectively,with specificity of 75.0%and 100.0%,and accuracy of 92.9%and 94.7%,respectively.There were significant differences in the highest maximum standardized uptake value(SUVmax)and Ki-67 index between the classic and aggressive variants of MCL,with SUVmax positively correlated with Ki-67 index.By using SUVmax>10.4 as the diagnostic threshold,the sensitivity and specificity for differentiating between the classic and aggressive variants of MCL were 73.9%and 77.4%,respectively,with an AUC value of 0.797.Conclusion·18F-FDG PET/CT demonstrates a high detection rate for both intra-and extra-nodal lesions in MCL patients.It exhibits high specificity in diagnosing bone marrow involvement and high sensitivity and specificity in diagnosing gastrointestinal involvement,providing reliable non-invasive diagnostic information for MCL bone marrow and gastrointestinal involvement.However,it is not a substitute for pathological examination.Additionally,the positive correlation between SUVmax and Ki-67 index allows SUVmax to effectively differentiate between the classic and aggressive variants of MCL,with a higher SUVmax(>10.4)indicating a higher likelihood of the aggressive variant.These findings have clinical implications for treatment planning and prognosis assessment.