BACKGROUND:Upper lumbar spinal stenosis is a multifactorial degenerative disorder of the spine.For narrowing of the spinal canal in the upper lumbar region(L1-L4),surgical decision-making is particularly complex.Existing minimally invasive surgeries each have their own advantages and limitations.Currently,there are few reports on biomechanical comparison and finite element analysis of different surgical methods for the treatment of high lumbar spinal stenosis.OBJECTIVE:To analyze the biomechanical impact of endoscopic unilateral laminotomy for bilateral decompression,transforaminal endoscopic lumbar decompression,and cross-overtop decompression in the treatment of upper lumbar spinal stenosis using endoscopy,and to verify the reliability and effectiveness of these three surgical techniques in treating upper lumbar spinal stenosis,providing a biomechanical basis for clinical decision-making.METHODS:The CT images of the lumbar spine of a healthy volunteer were selected,and the finite element model M0 of the normal lumbar L1-L5 segments was established using Mimics,Geomagic,Solid works,and Ansys software.The L2-L3 segment,representing upper lumbar characteristics,was chosen.Based on this model,the surgical models for endoscopic unilateral laminotomy for bilateral decompression(M1),transforaminal endoscopic lumbar decompression(M2),and cross-overtop decompression(M3)were established.Using software,the changes in the range of motion of the entire lumbar segment and the maximum Von Mises stress of the intervertebral discs were simulated and evaluated for each group of models under six loading conditions:flexion,extension,left lateral bending,right lateral bending,left rotation,and right rotation.RESULTS AND CONCLUSION:(1)Compared with model MO,the range of motion in M1,M2,and M3 increased under all six conditions,with M1 showing a greater increase.(2)M1 and M2 demonstrated significant increases in range of motion under forward bending,extension,and right rotation,while the increase under other conditions remained below 7％.(3)Compared with model M3,model M1 exhibited slightly increased overall joint range of motion during extension and left bending,while no significant changes were observed in other aspects,and the L1-L5 lumbar segments did not reach an unstable state.(4)In model M1,the maximum Von Mises stress of the intervertebral discs increased most significantly under flexion and extension loading conditions.However,under left lateral bending,right lateral bending,left rotation,and right rotation loading conditions,the increase did not exceed 5％.(5)These findings suggest that due to the sagittal anatomical characteristics of the facet joints,the unilateral laminotomy for bilateral decompression technique,while decompressing,involves resection of more facet joints,which impacts overall segmental stability.The transforaminal endoscopic lumbar decompression technique is suitable for patients with foraminal stenosis but cannot achieve complete decompression for those with severe ventral central stenosis.The Cross-Overtop technique effectively enlarges the volume of the central canal and lateral recess,optimizing decompression,and shows unique advantages in treating upper lumbar spinal stenosis.

BACKGROUND:Upper lumbar spinal stenosis is a multifactorial degenerative disorder of the spine.For narrowing of the spinal canal in the upper lumbar region(L1-L4),surgical decision-making is particularly complex.Existing minimally invasive surgeries each have their own advantages and limitations.Currently,there are few reports on biomechanical comparison and finite element analysis of different surgical methods for the treatment of high lumbar spinal stenosis.OBJECTIVE:To analyze the biomechanical impact of endoscopic unilateral laminotomy for bilateral decompression,transforaminal endoscopic lumbar decompression,and cross-overtop decompression in the treatment of upper lumbar spinal stenosis using endoscopy,and to verify the reliability and effectiveness of these three surgical techniques in treating upper lumbar spinal stenosis,providing a biomechanical basis for clinical decision-making.METHODS:The CT images of the lumbar spine of a healthy volunteer were selected,and the finite element model M0 of the normal lumbar L1-L5 segments was established using Mimics,Geomagic,Solid works,and Ansys software.The L2-L3 segment,representing upper lumbar characteristics,was chosen.Based on this model,the surgical models for endoscopic unilateral laminotomy for bilateral decompression(M1),transforaminal endoscopic lumbar decompression(M2),and cross-overtop decompression(M3)were established.Using software,the changes in the range of motion of the entire lumbar segment and the maximum Von Mises stress of the intervertebral discs were simulated and evaluated for each group of models under six loading conditions:flexion,extension,left lateral bending,right lateral bending,left rotation,and right rotation.RESULTS AND CONCLUSION:(1)Compared with model MO,the range of motion in M1,M2,and M3 increased under all six conditions,with M1 showing a greater increase.(2)M1 and M2 demonstrated significant increases in range of motion under forward bending,extension,and right rotation,while the increase under other conditions remained below 7％.(3)Compared with model M3,model M1 exhibited slightly increased overall joint range of motion during extension and left bending,while no significant changes were observed in other aspects,and the L1-L5 lumbar segments did not reach an unstable state.(4)In model M1,the maximum Von Mises stress of the intervertebral discs increased most significantly under flexion and extension loading conditions.However,under left lateral bending,right lateral bending,left rotation,and right rotation loading conditions,the increase did not exceed 5％.(5)These findings suggest that due to the sagittal anatomical characteristics of the facet joints,the unilateral laminotomy for bilateral decompression technique,while decompressing,involves resection of more facet joints,which impacts overall segmental stability.The transforaminal endoscopic lumbar decompression technique is suitable for patients with foraminal stenosis but cannot achieve complete decompression for those with severe ventral central stenosis.The Cross-Overtop technique effectively enlarges the volume of the central canal and lateral recess,optimizing decompression,and shows unique advantages in treating upper lumbar spinal stenosis.

Objective : To explore the effect and mechanism of CD151 on vascular permeability by regulating vesicle internalization and recycling. Methods: Wild-type mice and CD151 knockout mice were divided into WT-con group, WT-model group, KO-con group and KO-model group, with 6 mice in each group. WT-model group and KO-model group were intraperitoneally injected with LPS to prepare sepsis ALI model, and WT-con group and KO-con group were intraperitoneally injected with phosphate buffer saline(PBS) as a control. 24 h after modeling, pulmonary vascular permeability was measured by Miles test. The siRNA silencing CD151 expression(si-CD151) and negative control si-NC were transfected into EA.hy 926 cells. The permeability of endothelial cell layer to FITC-dextran at different time points was observed under basic conditions and vascular endothelial growth factor-A(VEGF-A) stimulation conditions. Transcriptome sequencing of endothelial cells in si-CD151 group and si-NC group; the distribution and internalization of CD151 in each group were measured using immunofluorescence. Western blot and real-time quantitative RT-qPCR were used to detect the expression of VE-cadherin in si-CD151 groupand other groups. The distribution and internalization of VE-cadherin in each group were measured using immunofluorescence. Results : Miles experiment results indicated that dye exudation in lung tissue of WT-model group was significantly higher than that of WT-con group(P<0.01). The dye exudation in the lung tissue of KO-model group increased compared with WT-model group(P<0.05). The results of endothelial cell layer permeability test showed that the permeability of FITC-dextran in si-CD151 group was significantly higher than that in control group after VEGF-A stimulation for 30, 60 and 120 min(P<0.05). Transcriptome sequencing results suggested that CD151 in endothelial cells was closely related to vesicle-mediated transport. Compared with other groups, protein and mRNA levels of VE-cadherin in CD151 knockdown endothelial cells was significantly lower(allP<0.01). The immunofluorescence assay demonstrated that after VEGF-A stimulation, the decrease of CD151 expression significantly impaired the expression of VE-cadherin at cell-cell contacts and reduced the CD151-VE-cadherin colocalization in the perinuclear region compared with other groups. Conclusion The absence of CD151 affects the internalization and recycling of endothelial cell vesicles, affects the expression and internalization of VE-cadherin, and then influences vascular permeability.

Objective:To evaluate the efficacy of an etoposide (Vp16) -intensified conditioning regimen in allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the treatment of relapsed/refractory acute myeloid leukemia (AML).Method:A retrospective analysis was conducted on the clinical data of 27 recipients with relapsed/refractory AML who underwent allo-HSCT using a Vp16-intensified conditioning regimen at Aerospace Center Hospital from January 2019 to January 2022. Transplantation-related complications and treatment outcomes were observed. Kaplan-Meier survival analysis was used to assess the overall survival (OS) and disease-free survival (DFS) rates.Result:Among the 27 recipients, there were 14 males and 13 females, with a median age of 41 years (range: 12~55 years). Except for one recipient who experienced primary graft failure, the remaining 26 recipients achieved hematopoietic reconstitution. The median neutrophil and platelet engraftment times were 13 days (range: 9~20 days) and 13.5 days (range: 11~33 days), respectively. Regimen-related toxicity (RRT) was mainly gastrointestinal toxicity and oral mucositis, and no deaths were attributed to RRT. A total of 12 recipients (44.44%) developed acute graft-versus-host disease (aGVHD), of whom 3 cases (11.11%) had grade III~IV aGVHD. Chronic GVHD (cGVHD) occurred in 13 recipients (48.15%), including 8 cases (29.63%) of extensive cGVHD. The median follow-up time after transplantation was 17 months (range: 1~48 months). Fifteen recipients (55.56%) survived without disease, while 12 recipients (44.44%) died— 9 due to relapse and 3 due to transplant-related complications. The 1-year overall survival and DFS rates were 74.07% and 59.26%, respectively; the 2-year overall survival and DFS rates were 59.26% and 55.56%, respectively. The 2-year relapse rate and transplant-related mortality (TRM) were 33.33% and 11.11%, respectively.Conclusion:The Vp16-intensified conditioning regimen in allo-HSCT appears to be a viable treatment option for patients with relapsed/refractory AML, offering favorable efficacy and manageable safety.

Objective To compare the serological and pathological characteristics of 3 nonalcoholic steatohepatitis(NASH)models:high-fat diet(HFD)with carbon tetrachloride(CCl4)injection,methionine and choline deficient diet(MCD),and Aymlin liver NASH(AMLN)diet-induced NASH models.Methods 3 NASH models were established by feeding mice an HFD with CCl4 injection for 10 weeks,MCD for 8 weeks and NASH for 26 weeks.After feeding,serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),glucose(GLU),liver triglyceride(TG),total cholesterol(TC),and malondialdehyde(MDA)levels and superoxide dismutase(SOD)activity were measured.Insulin levels were measured by enzyme-linked immunosorbent assay(ELISA)and the homeostasis model assessment of insulin resistant(HOMA-IR)index was calculated.Hematoxylin-eosin(HE),Sirius red,and oil red staining were used to indicate pathological changes to the liver.The NAS score was used to grade the pathology.Results Compared to each normal control(NC)group mice,all mice in the 3 model groups had an obvious increase in serum transaminase and liver TG,TC,MDA levels and SOD activity.The levels of serum FINS,GLU and the HOMA-IR index were significantly increased in the AMLN and CCl4+HFD model groups but decreased in the MCD model group.According to the HE,oil red staining and NAS score,mice in all 3 groups had NASH phenotypic changes.Liver collagen deposition was most obvious in mice in theCCl4+HFD model group.Liver lipid droplets were most abundant in the AMLN model group.Conclusions All the above 3 animal models can stably simulate the serological and pathological changes of NASH in human.The AMLN model can simulate the progress and mechanism of the disease,as well as systemic metabolic disorders such as insulin resistance and oxidative stress.However,it is time-consuming and the fibrosis progression rate is slow.The MCD diet can simulate the serological and pathological features of NASH in 8 weeks,but no obesity or insulin resistance occurred.The CCl4 combined with HFD model can induce NASH model in 10 weeks,which can simulate its serological and pathological changes,and the liver has obvious fibrous deposition and oxidative stress damage.

The intervertebral disc is a complex structure composed of the central nucleus pulposus, the peripheral annulus fibrosus, and the cartilaginous endplates located at the top and bottom. This unique arrangement effectively isolates the nucleus pulposus from the host’s immune system. Additionally, specific substances within the intervertebral disc exhibit inhibitory effects on the infiltration of immune cells and cytokines, which has led to the recognition of the intervertebral disc as an immune-privileged tissue. However, during intervertebral disc degeneration (IDD), the physical barriers that maintain this immune privilege are compromised. As a result, the nucleus pulposus may be perceived as a foreign antigen by the immune system. Simultaneously, inflammatory cytokines released by the degenerating disc attract a significant influx of immune cells, disrupting the delicate immunological balance within the nucleus pulposus and exacerbating the progression of IDD. Recent studies have confirmed the infiltration of immune cells such as macrophages and mast cells into the degenerative intervertebral disc, and the phenotypic characteristics and quantitative changes of these immune cells are closely related to the process of IDD. In terms of treatment strategies, biological agents such as mesenchymal stem cell therapy, gene therapy and growth factors that regulate the immune microenvironment of degenerative intervertebral discs have entered the stage of animal experiments. At the same time, small molecule drugs have shown unique regulatory potential in restoring the immune-privileged status of intervertebral discs.

Objective To investigate the differences of cerebral vascular morphology and serum indexes between patients with vascular cognitive impairment no dementia(VCIND)and cognitively normal cerebral vascular disease.Methods A total of 100 VCIND patients hospitalized in Quzhou Hospital of Zhejiang Medical and Health Group from June 2023 to September 2024 were included in experimental group,and 100 cognitively normal patients with cerebral vascular disease hospitalized during the same period were included in control group.Cerebral artery extension and dilation,cerebrovascular stenosis,collateral circulation establishment,inflammatory factors and lipid metabolism indexes were compared between two groups by means of cerebrovascular angiography and serum examination.The relationship between the severity of cognitive impairment and the vascular lesion of different responsibility was also explored.Results The rate of cerebral artery extension and dilation,rate of vascular stenosis in experimental group were higher than those in control group,and the rate of collateral circulation establishment was lower than that in control group(P＜0.05).The levels of interleukin-6,interleukin-1 β,tumor necrosis factor-α,total cholesterol,low density lipoprotein,apolipoprotein B and lipoprotein(a)in experimental group were significantly higher than those in control group,level of high density lipoprotein was lower than that in control group(P＜0.05).In experimental group,there were 20 cases of anterior cerebral artery vascular disease,22 cases of middle cerebral artery vascular disease,26 cases of posterior cerebral artery vascular disease,32 cases of vertebrobasilar artery vascular disease.There were no significant differences in the scores of mini-mental state examination,Montreal cognitive assessment and Hachinski ischemic scale among patients with different responsible vascular diseases(P＞0.05).Conclusion Patients with cerebral artery extension and dilation,cerebral artery stenosis,no establishment of collateral circulation,inflammatory response and abnormal lipid metabolism were high-risk groups for VCIND.Such patients need early cognitive intervention to prevent VCIND occurrence.

[Purpose]To analyze the disease burden of malignant tumors and its changing trends in Chinese and global non-smoking female population from 1990 to 2021.[Methods]Data of mortality and disability-adjusted life year(DALY)due to malignant tumors for Chinese and global non-smoking female malignant tumors from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021(GBD 2021),and the average annual percentage change(AAPC)were calculated using Joinpoint regression model.[Results]From 1990 to 2021,the number of deaths for malignant tu-mors in Chinese non-smoking female population increased from 13.7 1×104 to 26.8 1×104,with a higher increased trend compared with the global(China:AAPC=2.19％,95％CI:2.06％～2.33％;Global:AAPC=1.92％,95％CI:1.80％～2.04％,P=0.003);the age-standardized mortality rate decreased from 32.42/105 to 24.58/105,with a higher decreased trend compared with the global(China:AAPC=-0.88％,95％CI:-1.00％～-0.76％;Global:AAPC=-0.59％,95％CI:-0.68％～-0.51％,P＜0.001).From 1990 to 2021,the DALY for malignant tumors in Chinese non-smoking female population increased from 412.96×104 to 691.20×104 person-years,with a similar changing trend compared with the global(China:AAPC=1.68％,95％CI:1.56％～1.81％,Global:AAPC=1.63％,95％CI:1.52％～1.75％,P=0.536);the age-standardized DALY rate in Chinese non-smoking female population decreased from 889.58/105 to 642.65/105,with a higher decreased trend compared with the global(China:AAPC=-1.04％,95％CI:-1.15％～-0.92％;Global:AAPC=-0.69％,95％CI:-0.78％～-0.61％,P＜0.001).The top five malignant tumors of high age-standardized mor-tality rate in Chinese non-smoking female population in 2021 were tracheal,bronchus and lung cancer,colon and rectum cancer,cervical cancer,breast cancer,and liver cancer.The top five malignant tumors of high age-standardized mortality rate globally in 2021 were cervical cancer,colon and rectum cancer,breast cancer,tracheal,bronchus and lung cancer,and pancreatic cancer.The age-standardized mortality rate and DALY rate of breast cancer,liver cancer,pan-creatic cancer and corpus cancer showed overall upward trends(all P＜0.05).[Conclusion]From 1990 to 2021,the number of deaths and DALY of malignant tumors in Chinese and global non-smoking female population showed overall increased trends,and age-standardized mortality rate and DALY rate showed overall decreased trends.In future,more targeted cancer prevention measures are needed to reduce the disease burden of malignant tumors in non-smoking female population.

Objective:To compare the efficacy of closed reduction and internal fixation combined with percutaneous kyphoplasty (PKP) and non-operative treatment for intertrochanteric fracture combined with osteoporotic vertebral compression fracture (OVCF) in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 59 patients with intertrochanteric fracture combined with OVCF admitted to Tianjin Hospital from June 2020 to June 2023, including 16 males and 43 females, aged 66-91 years [(80.2±6.8)years]. The injured vertebral segments included T 10 in 3 patients, T 11 in 9, T 12 in 18, L 1 in 17, L 2 in 8, and L 3 in 4. According to the Genant semi-quantitative classification of vertebral fracture, 42 patients were scaled into grade 1 and 17 into grade 2. Based on the AO classification of intertrochanteric fracture, 33 patients were classified as type A1, 21 type A2, and 5 type A3. All the patients underwent closed reduction and internal fixation for intertrochanteric fractures, among whom 26 patients received PKP after the internal fixation of OVCF (PKP group) and 33 patients received non-surgical treatment after the internal fixation of OVCF (non-surgical group). The healing of the hip incision at 2 weeks after internal fixation and the healing of intertrochanteric fractures at 6 months after surgery were observed in both groups. The visual analogue scale (VAS) for low back pain was compared between the two groups before PKP, immediately after PKP, at 3 months after PKP, and at the last follow-up. The Oswestry disability index (ODI), anterior vertebral height ratio, and Cobb angle of the injured vertebrae were compared between the two groups before PKP, at 3 months after PKP, and at the last follow-up. The Harris hip function score was compared between the two groups at 3 months after internal fixation and at the last follow-up. Cement leakage was observed. The incidence of deep vein thrombosis (DVT) in the lower extremities after internal fixation were compared between the two groups. Results:All the patients were followed up for 10-46 months [(25.5±9.9)months]. The hip incisions of both groups all healed by first intention at 2 weeks after internal fixation, and the intertrochanteric fracture in both groups had bony union at 6 months after surgery. There were no significant differences between the two groups in VAS or ODI before PKP ( P>0.05). Immediately after PKP, at 3 months after PKP, and at the last follow-up, the VAS scores for low back pain were (2.6±0.6)points, (2.4±0.9)points, and (1.5±0.5)points in the PKP group, which were lower than those in the non-surgical group [(8.2±0.8)points, (3.7±1.2)points, and (3.3±0.6)points] ( P<0.01). At 3 months after PKP and at the last follow-up, the ODI values were (21.4±6.9)% and (16.2±6.3)% in the PKP group, which were lower than (38.6±11.6)% and (32.7±12.0)% in the non-surgical group ( P<0.01). The VAS for low back pain and ODI in both groups were gradually improved at each time point after PKP compared with those before PKP ( P<0.05 or 0.01). There were no significant differences in the anterior vertebral height ratio or Cobb angle of the injured vertebrae in the two groups before PKP ( P>0.05). At 3 months after PKP and at the last follow-up, the anterior vertebral height ratio was (79.8±9.6)% and (79.3±9.4)% in the PKP group, which were higher than (73.4±9.3)% and (62.0±10.4)% in the non-surgical group ( P<0.05 or 0.01); the values of the Cobb angle of the injured vertebrae were (12.6±3.6)° and (12.0±3.3)°in the PKP group, which were lower than (15.5±2.6)° and (20.4±4.9)° in the non-surgical group ( P<0.01). There were no significant differences in the anterior vertebral height ratio and Cobb angle of the injured vertebrae in the PKP group before PKP and at each time point after PKP ( P>0.05) while in the non-surgical group, the anterior vertebral height ratio at each time point after PKP was lower than that before PKP and the Cobb angle of the injured vertebrae was increased compared with that before PKP ( P<0.01). At 3 months after internal fixation and at the last follow-up, the Harris hip function scores in the PKP group were (76.4±3.4)points and (87.7±4.5)points, which were higher than (57.0±6.8)points and (76.3±8.9)points in the non-surgical group ( P<0.01). The Harris hip function scores in both groups were improved at the last follow-up, compared with those at 3 months after internal fixation. Five patients had cement leakage in the PKP group, all of which were lateral leakage.There was no occurrence of radiating pain in the lower extremities. The incidence of DVT at 1 month after internal fixation was 19.2% (5/26) in the PKP group, which was lower than 57.6% (19/33) in the non-surgical group ( P<0.01). Conclusion:Compared with non-operative treatment after the closed reduction and internal fixation, PKP after internal fixation can significantly relieve low back pain in the early stage, improve the functional restoration of the vertebral column, maintain vertebral height, prevent kyphosis, promote the recovery of the hip joint function, and reduce the occurrence of DVT in the lower extremities in the treatment of intertrochanteric fracture combined with OVCF.

Objective To investigate the expression of Cyclin O(CCNO)in cervical cancer and its molecular mechanism in the progression of cervical cancer.Methods The pathological sections of 60 patients with cervical cancer in the Department of Oncology and Gynecology of the First Affiliated Hospital of Bengbu Medical University from January 2018 to December 2023 were collected,and the expression of CCNO in cervical cancer was detected by immunohistochemistry.The cells were divided into Vector group,CCNO group,siNC group and siCCNO group by transfection technology.CCK-8 assay and colony formation assay were used to evaluate the ability of CCNO to affect cell proliferation.Transwell assay and wound healing assay were used to evaluate the effect of CCNO on cell invasion and migration.Glycolysis assay and Western blot assay were used to evaluate the effect and mechanism of CCNO on glycolysis of cervical cancer cells.Results The results of immunohistochemistry and WB showed that CCNO was highly expressed in cervical cancer(P<0.001).Overexpression of CCNO promoted the proliferation,invasion,migration and glycolysis of cervical cancer cells(P<0.05),whereas the opposite effect inhibited the proliferation,invasion,migration and glycolysis of cervical cancer cells(P<0.05).Bioinformatics analysis and WB results showed that CCNO overexpression may regulate the occurrence of cervical cancer by activating the PI3K/AKT signaling pathway(P<0.05).Conclusion Cyclin O may promote the proliferation and metastasis of cervical cancer cells by regulating glycolysis.