Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

OBJECTIVES: To investigate the clinical application of the digital-assisted reconstruction of the mandible and tumors with free fibula transplantation and immediate implantation via the intraoral approach. METHODS: Twelve patients with benign mandibular tumors were collected. Three-dimensional mandibular reconstruction was performed digitally before surgery to simulate mandibular tumor resection, fibula resection and reconstruction, and implant implantation. The intraoperative resection of the mandibular tumor was conducted through the intraoral approach under the guidance of a guide plate, and fibula resection, molding, reconstruction, and oral fixation were immediately performed. Implant implantation was performed during the second phase of implant surgery and denture restoration was performed 1-2 months after surgery. RESULTS: The types of mandibular defects were BrownⅠ (one case), Ⅰc (four cases), Ⅱ (one case), Ⅱc(three cases), and Ⅲ (three cases). The length of the fibular bone was 12-22 cm. The number of fibular molding amputations was as follows: two cases in two segments, six cases in three segments, three cases in four segments, and one case in five segments. All of these cases underwent folding fibular reconstruction of mandibular and alveolar bone defects. A total of 44 implants were implanted, and none failed after operation. CONCLUSIONS The intraoral approach is a reliable method for the resection of mandibular benign tumors, with few postoperative complications and the ability to position and fix accurately the reconstructed folded fibula under digital design. The immediate implantation of the transplanted fibula does not affect the blood supply and has a high success rate. It is an effective and reliable method for the resection and reconstruction of mandibular benign tumors.
Humans ; Fibula/transplantation* ; Mandibular Neoplasms/surgery* ; Mandibular Reconstruction/methods* ; Bone Transplantation/methods* ; Male ; Middle Aged ; Female ; Mandible/surgery* ; Adult ; Free Tissue Flaps ; Surgery, Computer-Assisted

OBJECTIVE: To investigate the effectiveness of posterior lateral perforator flap in lower limb combined with free fibula for maxillary tissue defect repair. METHODS: Between December 2018 and December 2023, 16 patients with the maxillary malignant tumors were admitted. There were 10 males and 6 females, with an average age of 64.3 years (range, 54-75 years). There were 7 cases of maxillary gingival cancer, 5 cases of hard palate cancer, and 4 cases of maxillary sinus cancer. According to the 2017 American Joint Committee on Cancer (AJCC) TNM stage, there were 8 cases of stage Ⅲ, 6 cases of stage Ⅳa, and 2 cases of stage Ⅳb. After resection of the lesion, the remaining maxillary defects were classified into class Ⅱa in 3 cases, class Ⅱb in 5 cases, and class Ⅲb in 8 cases according to Brown's classification. The size of soft tissue defects ranged from 4 cm×3 cm to 8 cm×6 cm. The posterior lateral perforator flap in lower limb in size of 5 cm×4 cm-9 cm×7 cm were harvested to repair soft tissue defects, and free fibula in length of 6-11 cm were used to repair bone defects. The donor sites of the lower limb were sutured directly (6 cases) or repaired with free skin grafting (10 cases). Six patients with positive lymph node pathology were treated with radiotherapy after operation. At 6 and 12 months after operation, the self-assessment was performed by the University of Washington Quality of Survival Questionnaire Form (QUW-4) in five dimensions (facial appearance, swallowing function, chewing function, speech function, and mouth opening), and swallowing function was evaluated by using the Kubota water swallowing test. RESULTS: Postoperative pathological examination showed that all patients were squamous cell carcinoma. One patient who was treated with radiotherapy developed osteomyelitis and 1 patient developed venous crisis of skin flap. The rest of the flaps and all skin grafts survived, and the wounds healed by first intention. All patients were followed up 1-5 years (mean, 2.8 years). Two patients died of local recurrence of the tumor at the 4th and 5th years after operation, respectively. Except for the chewing function score and total score at 6 months after operation, which showed significant differences compared to preoperative scores ( P<0.05), there was no significant difference in other QUW-4 scale scores between different time points ( P>0.05). The patients' swallowing function evaluated by Kubota water swallowing test reached normal in 4 cases, suspicious in 9 cases, and abnormal in 3 cases at 6 months after operation, and 10, 6, and 0 cases at 12 months after operation, respectively. The swallowing function at 12 months was significantly better than that at 6 months ( Z=-2.382, P=0.017). CONCLUSION The posterior lateral perforator flap in the lower limb combined with free fibula to repair maxillary tissue defects can repair soft and hard tissue defects at the same time, so that the patient's facial appearance, swallowing function, chewing function, speech function, and mouth opening are satisfactorily restored and the mid-term effectiveness is good.
Humans ; Middle Aged ; Male ; Female ; Fibula/surgery* ; Aged ; Perforator Flap ; Plastic Surgery Procedures/methods* ; Maxilla/surgery* ; Maxillary Neoplasms/surgery* ; Free Tissue Flaps/transplantation* ; Lower Extremity/surgery* ; Bone Transplantation/methods* ; Treatment Outcome

Objective To investigate the expression and clinical significance of serum cystatin SA(Cystatin SA)and long non-coding RNA(lncRNA)promoter of CDKN1A antisense DNA damage activated RNA(PANDAR)in patients with type 2 dia-betic kidney disease(T2DN).Method A total of 142 patients with type 2 diabetes mellitus(T2DM)admitted to Shanghai Jiao Tong University School of Medicine Suzhou Jiulong Hospital from February 2021 to October 2023 were selected.According to whether they had nephropathy,they were divided into T2DN group(n=82)and non-T2DN group(n=60).60 healthy people who underwent physical examination during the same period were used as the control group.Serum Cystatin SA levels were detected by enzyme-linked immunosorbent assay(ELISA).Serum lncRNA PANDAR level was detected by real-time fluorescence quanti-tative PCR.Pearson correlation analysis was used to analyze the correlation between serum Cystatin SA,lncRNA PANDAR and clinical parameters in T2DN patients.Logistic regression analysis was used to analyze the influencing factors of T2 DN.The re-ceiver operating characteristic(ROC)curve was used to analyze the value of serum Cystatin SA and lncRNA PANDAR in the evaluation of T2DN.Results Serum Cystatin SA(236.28±44.63 ng/L)and serum lncRNA PANDAR(3.21±0.34)in the T2DM group were higher than those in the control group(91.25±22.33 ng/L,1.06±0.23),and the differences were statistically significant(t=23.127,42.379,all P<0.001).Serum Cystatin SA(275.08±46.83 ng/L)and lncRNA PANDAR(3.64±0.38)in T2DN group were higher than those in non-T2DN group(183.25±40.88 ng/L,2.62±0.30),and the differences were statistically significant(t=12.169,17.226,all P<0.001).Serum Cystatin SA and lncRNA PANDAR in T2DN patients were positively correlat-ed with diabetes duration,serum creatinine(sCr),blood urea nitrogen(BUN)and UACR(r=0.562～0.750,all P<0.001),and neg-atively correlated with eGFR(r=-0.656,-0.634,all P<0.001).Serum Cystatin SA,lncRNA PANDAR,duration of diabetes,UACR,sCr were risk factors for T2DN,eGFR was a protective factor(Wald χ2=4.257～12.360,all P<0.001).The area under the curve(AUC)of serum Cystatin SA combined with lncRNA PANDAR in predicting T2DN was 0.920(0.899～0.960),which was greater than that of single index[0.847(0.791～0.887),0.851(0.803～0.896)],and the differences were statistically significant(Z=4.522,4.319,all P<0.05).Conclusion Serum Cystatin SA and lncRNA PANDAR are elevated in patients with T2DN,which are related to renal function indexes and are risk factors affecting the occurrence of T2DN.The combination of the two can effec-tively evaluate the occurrence of T2DN.

Objective To investigate the expression and clinical significance of serum cystatin SA(Cystatin SA)and long non-coding RNA(lncRNA)promoter of CDKN1A antisense DNA damage activated RNA(PANDAR)in patients with type 2 dia-betic kidney disease(T2DN).Method A total of 142 patients with type 2 diabetes mellitus(T2DM)admitted to Shanghai Jiao Tong University School of Medicine Suzhou Jiulong Hospital from February 2021 to October 2023 were selected.According to whether they had nephropathy,they were divided into T2DN group(n=82)and non-T2DN group(n=60).60 healthy people who underwent physical examination during the same period were used as the control group.Serum Cystatin SA levels were detected by enzyme-linked immunosorbent assay(ELISA).Serum lncRNA PANDAR level was detected by real-time fluorescence quanti-tative PCR.Pearson correlation analysis was used to analyze the correlation between serum Cystatin SA,lncRNA PANDAR and clinical parameters in T2DN patients.Logistic regression analysis was used to analyze the influencing factors of T2 DN.The re-ceiver operating characteristic(ROC)curve was used to analyze the value of serum Cystatin SA and lncRNA PANDAR in the evaluation of T2DN.Results Serum Cystatin SA(236.28±44.63 ng/L)and serum lncRNA PANDAR(3.21±0.34)in the T2DM group were higher than those in the control group(91.25±22.33 ng/L,1.06±0.23),and the differences were statistically significant(t=23.127,42.379,all P<0.001).Serum Cystatin SA(275.08±46.83 ng/L)and lncRNA PANDAR(3.64±0.38)in T2DN group were higher than those in non-T2DN group(183.25±40.88 ng/L,2.62±0.30),and the differences were statistically significant(t=12.169,17.226,all P<0.001).Serum Cystatin SA and lncRNA PANDAR in T2DN patients were positively correlat-ed with diabetes duration,serum creatinine(sCr),blood urea nitrogen(BUN)and UACR(r=0.562～0.750,all P<0.001),and neg-atively correlated with eGFR(r=-0.656,-0.634,all P<0.001).Serum Cystatin SA,lncRNA PANDAR,duration of diabetes,UACR,sCr were risk factors for T2DN,eGFR was a protective factor(Wald χ2=4.257～12.360,all P<0.001).The area under the curve(AUC)of serum Cystatin SA combined with lncRNA PANDAR in predicting T2DN was 0.920(0.899～0.960),which was greater than that of single index[0.847(0.791～0.887),0.851(0.803～0.896)],and the differences were statistically significant(Z=4.522,4.319,all P<0.05).Conclusion Serum Cystatin SA and lncRNA PANDAR are elevated in patients with T2DN,which are related to renal function indexes and are risk factors affecting the occurrence of T2DN.The combination of the two can effec-tively evaluate the occurrence of T2DN.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To investigate the radiation dose and fractionation regimens for limited stage small cell lung cancer (LS-SCLC) in Chinese radiation oncologists.Methods:Over 500 radiation oncologists were surveyed through questionnaire for radiation dose and fractionation regimens for LS-SCLC and 216 valid samples were collected for further analysis. All data were collected by online questionnaire designed by WJX software. Data collection and statistical analysis were performed by SPSS 25.0 statistical software. The differences in categorical variables among different groups were analyzed by Chi-square test and Fisher's exact test. Results:Among 216 participants, 94.9% preferred early concurrent chemoradiotherapy, 69.4% recommended conventional fractionation, 70.8% preferred a total dose of 60 Gy when delivering conventional radiotherapy and 78.7% recommended 45 Gy when administering hyperfractionated radiotherapy.Conclusions:Despite differences in LS-SCLC treatment plans, most of Chinese radiation oncologists prefer to choose 60 Gy conventional fractionated radiotherapy as the main treatment strategy for LS-SCLC patients. Chinese Society of Clinical Oncology (CSCO), National Comprehensive Cancer Network (NCCN) and Chinese Medical Association guidelines or expert consensus play a critical role in guiding treatment decision-making.

Objective:To investigate the association between preterm birth, low birth weight and the risk of hypospadias.Methods:According to the search strategy of Cochrance Collaborative Network, the China National Knowledge Internet (CNKI), VIP, Wanfang, Pubmed, Cochrance and Embase were searched from the establishment of the database to April 2022. The literature on the relationship between preterm birth, low birth weight and the risk of hypospadias was included. Meta analysis was conducted on the relationship between preterm birth, low birth weight and the risk of hypospadias.Results:A total of 13 articles were included, including cases from Asia, Europe, Australia and America. Newcastle-ottawa Scale was used for evaluation, and the scores were all above 6. There were 10 articles on the relationship between preterm birth and the risk of hypospadias, all of which were case-control studies. Heterogeneity test I2=46%, P=0.05. There were 3 521 cases in the case group and 95 816 cases in the control group. Compared with the control group, preterm birth was a risk factor for hypospadias ( OR: 2.13, 95% CI: 1.89-2.41), and the difference was statistically significant ( Z=12.21, P<0.01). There were 11 articles on the association between low birth weight and the risk of hypospadias, all of which were case-control studies. Heterogeneity test I2=47%, P=0.04. There were 2 460 cases in the case group and 94 260 cases in the control group. Compared with the control group, low birth weight was a risk factor for hypospadias ( OR: 3.29, 95% CI: 2.57-4.22), and the difference was statistically significant ( Z=9.40, P<0.01). Conclusions:Based on meta-analysis of published literature, preterm birth and low birth weight increase the risk of hypospadias.

Objective:To analyze the temperature difference of benign and malignant parotid gland tumors in preoperative infrared thermography (IRT), and to provide the basis for predicting tumor properties.Methods:The clinical data of 98 patients with parotid gland tumor admitted to the Department of Oral and maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College, from May 2021 to April 2023 were retrospectively analyzed. There were 61 males and 37 females, aged (51.1±16.0) years (10-86 years). In addition to routine examination, the temperature difference between the lesion site of parotid gland and the contralateral mirror area was measured by infrared thermal imager in all patients one day before surgery. The maximum diameter (dmax) and location of the tumor (deep or superficial lobe) were recorded according to preoperative clinical examination and imaging examinations such as CT and ultrasound. The patients were divided into three groups by tumor size: dmax≤2 cm, 2 cm4 cm. The patients were also divided into different groups: deep lobe group and superficial lobe group (according to the tumor location), benign group and malignant group (according to postoperative pathological results). The relationship between temperature difference, pathology, size and location was analyzed.Results:There were 79 cases in the benign group and 19 cases in the malignant group. The temperature difference of the healthy and affected side in the malignant group [(1.73±0.21) ℃] was significantly higher than that in the benign group [(0.73±0.32) ℃] ( t=16.70, P<0.001). There was no significant difference in temperature difference between the healthy and affected sides of tumors with different diameters ( P>0.05). The temperature difference of healthy and affected side of tumor in superficial lobe [(0.97±0.50) ℃] was significantly higher than that in deep lobe [(0.67±0.44) ℃] ( t=2.24, P=0.028). Conclusions:The difference of temperature difference between benign and malignant parotid gland tumors detected by IRT is statistically significant, which can be used to predict tumor properties, and has certain clinical application value.

Retinal pigment epithelial (RPE) is primarily impaired in age-related macular degeneration (AMD), leading to progressive loss of photoreceptors and sometimes choroidal neovascularization (CNV). mTOR has been proposed as a promising therapeutic target, while the usage of its specific inhibitor, rapamycin, was greatly limited. To mediate the mTOR pathway in the retina by a noninvasive approach, we developed novel biomimetic nanocomplexes where rapamycin-loaded nanoparticles were coated with cell membrane derived from macrophages (termed as MRaNPs). Taking advantage of the macrophage-inherited property, intravenous injection of MRaNPs exhibited significantly enhanced accumulation in the CNV lesions, thereby increasing the local concentration of rapamycin. Consequently, MRaNPs effectively downregulated the mTOR pathway and attenuate angiogenesis in the eye. Particularly, MRaNPs also efficiently activated autophagy in the RPE, which was acknowledged to rescue RPE in response to deleterious stimuli. Overall, we design and prepare macrophage-disguised rapamycin nanocarriers and demonstrate the therapeutic advantages of employing biomimetic cell membrane materials for treatment of AMD.