Methods: Sixty-two patients (2014–2019) were divided into the SC (n=32) and PC (n=30) groups. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), modified Japanese Orthopedic Association (mJOA) score, and Neck Disability Index (NDI). Radiological parameters, including cervical lordosis (CL), fused segment angle (FSA), and disc height (DH), were assessed. Cage subsidence, adjacent segment degeneration (ASD), and other complications were also documented. The relationship between postoperative radiological changes and symptoms was also analyzed. Results: Both groups showed significant improvement in symptoms, with fusion achieved in all surgical segments. The SC group had a shorter operative time and reduced intraoperative blood loss. However, the SC group had a higher subsidence rate (16.7% vs. 5.6%, p=0.017). The PC group maintained better cervical alignment in terms of CL, FSA, and DH (p<0.05), with an increased incidence of dysphagia and ASD (p<0.05). Spearman correlation analyses showed that neither CL nor FSA loss at the 5-year follow-up was significantly associated with improvements in the mJOA, VAS, and NDI scores (p>0.05) in either group. Regression analyses indicated that subsidence or loss of lordosis did not correlate with the degree of postoperative symptoms (p<0.05). Conclusions Both SC and PC achieved sustained pain relief, neurological improvement, and solid fusion in three-level ACDF at the 5-year follow-up. SC demonstrated significant advantages in reducing dysphagia and ASD, while PC better maintained cervical alignment and segmental stability. Patient-specific factors should be used to guide implant selection. Further multicenter studies are required to validate these findings.

Objective To explore the role of chloride intracellular channel 5 (CLIC5) in the development of lung adenocarcinoma (LUAD). Methods The expression levels of CLIC5 in LUAD samples were determined using bioinformatics and qRT-PCR. The correlation between CLIC5 expression and LUAD progression was revealed through survival analysis and clinicopathological feature analysis. After the knockdown or overexpression of CLIC5 in the LUAD cells, cell proliferation was assessed through colony formation assay, cell apoptosis rate by flow cytometry, and cell migration and invasion by scratch and Transwell invasion assay. The protein levels of vimentin and Snail were detected by Western blot. Results Bioinformatics analysis results showed low CLIC5 expression levels in the LUAD samples. This finding was associated with the aggressive progression of LUAD and the poor survival of patients with LUAD. The qRT-PCR results confirmed that CLIC5 was mainly expressed in the cytoplasm of the LUAD cells. CLIC5 overexpression inhibited cell activity and proliferation and promoted the apoptosis of LUAD cells. The knockdown of CLIC5 exhibited the opposite effect. CLIC5 overexpression inhibited the migration and invasion of LUAD cells, downregulated Bcl-2, vimentin, and Snail and upregulated Bax, cleaved caspase-3 and E-cadherin in the LUAD cells. CLIC5 knockdown exhibited opposite effects. Conclusion CLIC5 overexpression promotes cell apoptosis and inhibits cell proliferation and invasion, thereby inhibiting the development of LUAD. Hence, CLIC5 is a novel biomarker of prognosis and therapeutic target for LUAD.

This study examined the effect of islet macrophages on β-cell function changes during type 2 diabetes mellitus (T2DM) progression based on the traditional Chinese medicine theory that " moderate fire generating qi, hyperactive fire consuming qi" . T2DM is closely associated with chronic low-grade inflammation, with islet macrophages playing a central role in this process. Under physiological conditions, islet macrophages secrete anti-inflammatory and growth factors to regulate the immune response, promote cell proliferation, and support islet β-cell survival and function, reflecting the concept of " moderate fire generating qi" . However, during the pathological process of T2DM, islet macrophages become over-activated and dysfunctional, secreting large amounts of pro-inflammatory factors that trigger severe inflammatory responses and oxidative stress. This process damages islet β-cells, disrupts the islet microenvironment and blood supply, exacerbates local inflammation and structural damage, and worsens the survival environment of β-cells. Ultimately, this leads to fewer β-cells and function loss, aligning with the " hyperactive fire consuming qi" theory, where excessive fire depletes qi and blood. This study enhances the understanding and application of traditional Chinese medicine theories in modern medicine, offering a new perspective on T2DM prevention and treatment. Regulating islet macrophage function and reducing their pro-inflammatory responses may become key strategies for preserving β-cell function and slowing T2DM progression.

Purpose: Erectile dysfunction (ED) is a common male sexual dysfunction. Gut microbiota plays an important role in various diseases. To investigate the effects and mechanisms of intestinal flora dysregulation induced by high-fat diet (HFD) on erectile function. Materials and Methods: Male Sprague–Dawley rats aged 8 weeks were randomly divided into the normal diet (ND) and HFD groups. After 24 weeks, a measurement of erectile function was performed. We performed 16S rRNA sequencing of stool samples. Then, we established fecal microbiota transplantation (FMT) rat models by transplanting fecal microbiota from rats of ND group and HFD group to two new groups of rats respectively. After 24 weeks, erectile function of the rats was evaluated and 16S rRNA sequencing was performed, and serum samples were collected for the untargeted metabolomics detection. Results: The erectile function of rats and the species diversity of intestinal microbiota in the HFD group was significantly lower, and the characteristics of the intestinal microbiota community structure were also significantly different between the two groups. The erectile function of rats in the HFD-FMT group was significantly lower than that of rats in the ND-FMT group. The characteristics of the intestinal microbiota community structure were significantly different. In the HFD-FMT group, 27 metabolites were significantly different and they were mainly involved in the several inflammation-related pathways. Conclusions Intestinal microbiota disorders induced by HFD can damage the intestinal barrier of rats, change the serum metabolic profile, induce low-grade inflammation and apoptosis in the corpus cavernosum of the penis, and lead to ED.

Although fertility-preserving treatment strategies have demonstrated significant clinical efficacy in patients with early-stage endometrial cancer(EC)and atypical endometrial hyperplasia(AEH),some patients who experience recurrence still express a strong desire for fertility and request conservative retreatment.This poses new challenges for clinical management.This article reviews the latest research advances in retreatment for recurrent patients and synthesizes findings from previous studies to draw the following conclusions.First,before formulating a retreatment plan,it is crucial to comprehensively evaluate key factors such as tumor characteristics,fertility intentions,and overall health status of the patient.These factors collectively determine the feasibility and appropri-ateness of an individualized retreatment strategy.Second,studies have shown that retreatment options for AEH/EC are diverse,with high-dose oral progestin remaining the primary approach.Combining progestin with metformin,GnRH-a,and hysteroscopic resection can enhance treatment outcomes.Individualized treatment plans should be tailored to the specific conditions of each patient.Based on literature analysis,the complete remission(CR)rate of retreatment ranges from 81.1%to 88.6%,with a pregnancy rate of 26.5%-50.0%and a live birth rate of 14.3%-29.0%.However,the recurrence rate remains high at 24.5%-45.5%,significantly higher than that of initial treatment.This indicates that while retreatment has achieved some success in disease control and fertility preservation,the risk of recurrence still requires significant attention.Therefore,a strict monitoring and follow-up system must be established during retreatment.Additionally,studies have identified factors associated with a higher risk of recurrence,including age over 35,overweight or obesity,polycystic ovarian syndrome,metabolic syndrome,high pathological grade,and advanced clinical stage.On the other hand,pregnancy following CR,weight loss,and maintenance therapy serve as protective factors against disease recurrence.Patients are encouraged to actively engage in weight management during treatment and consider initiating assisted reproductive technology promptly after achieving CR to optimize pregnancy outcomes while minimizing the risk of recurrence.Future research should prioritize investigating precision treatment strategies informed by molecular classification and identifying predictive biomarkers,thereby enabling the development of more personalized and precise treatment plans tailored to indi-vidual patients.

Objective To explore the feasibility and value of synthetic MRI combined with reduced field of view(r FOV)intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI)in preoperative predicting TN stage of rectal cancer.Methods The ima-ging and clinical data of 40 patients with rectal cancer confirmed by operation and pathology were collected and divided into low T stage group(T1-T2 stage)and high T stage group(T3-T4 stage),N0 stage group and N1-N2 stage group according to postoperative pathological staging as the golden standard.Independent sample t-tests were conducted to compare the parameter differences of synthetic MRI[T1,T2,and proton density(PD)values]and IVIM-DWI(D,D*,and f values)between the two groups.Receiver operating charac-teristic(ROC)curves were used to evaluate the efficacy of each parameter with statistically significant differences.Results Signifi-cant differences were observed in the T2 values of synthetic MRI and the D and f values of IVIM-DWI between high and low T stage groups,as well as between N0 and N1-N2 stage groups(P<0.05).The D value showed the highest area under the curve(AUC)(AUC=0.888)in predicting T stage group,and the T2 value was predominant(AUC=0.790)for N stage group prediction.The combination models of T2,D,and f values yielded superior predictive capability for TN stage in preoperative predicting rectal cancer,with AUC of 0.890 and 0.807,respectively.Conclusion Synthetic MRI combined with r FOV IVIM-DWI is feasible in preoperative prediction of TN stage of rectal cancer,which shows a higher efficacy,and is a useful supplement to conventional MRI technology.

Purpose To evaluate the long-term efficacy of radiofrequency ablation(RFA)for T1N0M0 papillary thyroid carcinoma(PTC)with rich blood supply and poor blood supply.Materials and Methods Clinical data,ultrasound and contrast-enhanced ultrasound(CEUS)images,RFA parameters,and postoperative follow-up indicators of 375 T1N0M0 PTC patients who received RFA from June 2014 to December 2018 were retrospectively collected.The propensity score matching method was used to match the baseline data of the two groups in a 1:1 ratio,finally a total of 212 patients were included in the study.The RFA parameters,volume,tumor disappearance,and local tumor progression(LTP)were compared between the groups.Besides,the correlation between rich blood supply and LTP was analyzed using multivariate COX regression.Results According to the peak intensity displayed by preoperative CEUS,all lesions were divided into a group with rich blood supply(n=129)and another with poor blood supply(n=246).After a mean follow-up time of(84.48±14.44)months,the tumor disappearance in the rich blood supply group was 87.74%,while in the poor blood supply group it was 88.68%,and there was no statistically significant difference(Z=0.05,P=0.831).There were 10 cases of LTP in the rich blood supply group(6 cases of residual cancer and 4 cases of new cancer),and 6 cases of LTP in the poor blood supply group(2 cases of residual cancer and 4 cases of new cancer).The LTP rates of the two groups were 9.43%and 5.67%,with no statistically significant difference(x2=1.08,P=0.298).The Kaplan-Meier survival curve showed no statistically significant difference in progression free survival between both groups(P=0.265).The adjusted multivariate COX proportional risk model analysis showed that rich blood supply was no association with LTP(HR=1.54,P=0.409).Conclusion RFA for T1N0M0 PTC with rich blood supply can achieve effective ablation,and its long-term efficacy is similar to that of poor blood supply.RFA can serve as an effective alternative treatment for T1N0M0 PTC patients with different blood supply.

AIM:This study aims to investigate the mechanisms through which Astragaloside IV(AS)pre-vents and treats osteoporosis by regulating intestinal flora.METHODS:Thirty 3-month-old female Sprague-Dawley(SD)rats were selected for the study.Ten rats were randomly assigned to a sham group,while the remaining twenty underwent bilateral ovariectomy(OVX)to simulate osteoporosis.Following the modeling,the twenty OVX rats were randomly divid-ed into two groups:the OVX group and the AS treatment group,which received continuous gavage for 12 weeks.Bone mineral density(BMD)of the femur and lumbar vertebrae was measured using dual-energy X-ray absorptiometry(DXA).Hematoxylin-eosin(HE)staining was employed to assess the microstructure of the femur and colonic mucosa,while immu-nohistochemistry was used to measure the expression of collagen type Ⅰ alpha 1 chain(COL1A1)protein in the femur.Ad-ditionally,RT-qPCR was utilized to analyze the mRNA expression of bone formation-related indicators,including alkaline phosphatase(ALP),COL1A1,and Runt-related transcription factor 2(RUNX2).Fresh fecal samples were collected from the rats for 16S rDNA sequencing to detect changes in intestinal microbiota composition.RESULTS:Compared to the sham group,OVX rats exhibited a significant increase in body weight and a marked decrease in femur and lumbar ver-tebrae bone density.HE staining revealed trabecular bone fractures with a disrupted reticular structure in the OVX group,along with the presence of numerous cavities and fat vacuoles in the bone marrow.The colonic mucosa showed signs of vil-lous shedding and mild crypt atrophy.Immunohistochemistry results demonstrated a substantial reduction in brown-yellow granules and COL1A1 expression in the OVX group.Conversely,in the AS group,there was a reduction in body weight and a significant increase in bone density of the femur and lumbar vertebrae.The trabecular architecture appeared more or-ganized,with less severe fractures compared to the OVX group.In the AS group,the number of cavities and fat vacuoles in the bone marrow was also reduced,and the colonic mucosa exhibited improved villous structure and less crypt atrophy.Immunohistochemical analysis indicated that AS treatment significantly enhanced COL1A1 expression.Furthermore,after AS intervention,the mRNA expression levels of ALP,COL1A1,and RUNX2 were notably increased.16S rDNA sequenc-ing revealed a significant increase in the abundance of Firmicutes,Proteobacteria,f_Pseudonocardiaceae,f_Marinifilace-ae,f_Oscillospiraceae,f_Ruminococcaceae,and f_Peptostreptococcaceae,while p_Euryarchaeota,Bacteroidetes,and f_Muribaculaceae showed significant reductions.Overall,OVX led to increased diversity in the species distribution of in-testinal microbiota,whereas AS treatment helped recalibrate the aforementioned phyla(families)and reduce diversity.CONCLUSION:Astragaloside IV can increase bone density in OVX rats,improve bone microstructure,promote bone formation,and prevent colonic mucosal damage by regulating the relative abundance of intestinal flora.

To construct a safe and effective multi-epitope vaccine against the S1 protein of chicken infectious bronchitis virus(IBV).In this study,homologous and non-homologous dominant epitopes of IBV M41,T,QX and H120 virulent strain S1 proteins were screened by various online bioprediction software,respectively,and a new peptide W with high immunogenicity was construc-ted by connecting the screened B-cell and T-cell epitopes with a linker peptide.W was ligated to the truncated sequence of the four viral strains by T2A yietding to the eukaryotic expression vector pEGFP-N1,and it was identified by PCR and double digestion,the obtained recombinant plasmid was transfected into HEK293A cells and target protein expression was measured by Western blot.The constructed plasmid was injected intramuscularly twice to detect the antibody level,cytokine level,and peripheral blood T cell subsets were detected after two immunizations.The epitope pro-tein W was successfully constructed,which was structurally stable,antigenic,and soluble;the re-combinant plasmid pEGFP-WMQtH,pEGFP-W,and pEGFP-MQtH matched the expected size;anti-IBV IgG antibody levels in pEGFP-N1 was increased greatly compared to the PBS group.cyto-kines IL-2,and γ interferon(IFN-γ)were increased greatly(P＜0.05);peripheral blood CD4+/CD8a value(P＜0.05)was increased greatly.The W epitope protein was successfully constructed,which can effectively activate the humoral immunity and cellular immunity against four infectious bronchitis viruses(IBV),laying a foundation for the development of an effective vaccine against IB.

Objective·To compare the safety and short-term outcomes of robot-assisted versus laparoscopic-assisted proximal gastrectomy combined with double-flap esophagogastrostomy in the treatment of early upper gastric cancer.Methods·A retrospective cohort study was conducted to analyze the clinical and pathological data of 31 early gastric cancer patients who underwent proximal gastrectomy combined with double-flap esophagogastrostomy for gastrointestinal reconstruction at the Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,from September 2023 to March 2024.Based on the surgical approach,patients were divided into the robot-assisted surgery group(robotic group,20 cases)and the laparoscope-assisted surgery group(laparoscopic group,11 cases).General clinical data,intraoperative conditions,and postoperative recovery between the two groups were compared.At the 6-month postoperative follow-up,upper gastrointestinal radiography and esophagogastroscopy were performed to assess anastomotic stricture and gastroesophageal reflux disease.Additionally,the gastric cancer-specific module of the European Organization for Research and Treatment of Cancer(EORTC),Quality of Life Questionnaire-Stomach 22(QLQ-STO22),was used to evaluate the patients' quality of life.Results·The general data of the two groups,including gender,age,preoperative comorbidities,American Society of Anesthesiologists(ASA)classification,Siewert classification,and pathological staging of tumors,showed no statistically significant differences(all P>0.05).All patients successfully underwent the procedure without conversion to open surgery.The time for gastroesophageal anastomosis was significantly shorter in the robotic group compared to the laparoscopic group[(31.09±8.23)min vs(43.73±8.83)min,P<0.001],while there were no statistically significant differences in other intraoperative and postoperative parameters,including operative time,intraoperative blood loss,number of lymph nodes removed,duration of gastric tube placement,time to start a liquid diet,length of postoperative hospital stay,and incidence of postoperative complications(all P>0.05).At the 6-month postoperative follow-up,30 patients completed the follow-up,with one patient lost to follow-up in the robotic group.Upper gastrointestinal radiography and esophagogastroscopy results showed that only one patient in the laparoscopic group developed an anastomotic stricture,while one patient in the robotic group developed grade A and one developed grade B gastroesophageal reflux disease(GERD).In addition,one patient in the laparoscopic group also developed grade B GERD.The incidences of GERD and anastomotic stricture showed no statistically significant differences between the two groups(both P>0.05).EORTC QLQ-STO22 results indicated that the robotic group had significantly lower scores in the dimensions of dysphagia,gastroesophageal reflux,and dietary restrictions,as well as in the total score,compared to the laparoscopic group(all P<0.05).Conclusion·Robot-assisted proximal gastrectomy combined with double-flap esophagogastrostomy is safe and feasible.It shortens anastomosis time and offers potential advantages in postoperative functional recovery and quality of life improvement.