Objective:To explore the common risk factors of sarcopenia in middle-aged and elderly inpatients with type 2 diabetes mellitus(T2DM).Methods:A total of 1 125 middle-aged and elderly T2DM inpatients admitted to the Endocrinology Department of Beijing Hospital from January 2014 to December 2019 were selected and divided into three groups according to age: 50-<60 years old, 60-<75 years old, and ≥75 years old; According to the inclusion and exclusion criteria, 269 study subjects were divided into sarcopenia group( n=90)and non-sarcopenia group( n=179). General data of 1 125 subjects were collected and analyzed.With the presence or absence of sarcopenia as the dependent variable, multivariate logistic regression was used to analyze the relevant risk factors of sarcopenia in middle-aged and elderly inpatients with T2DM.With the comparison of the differences between the sarcopenia group and the non-sarcopenia group, stepwise regression analysis was used to explore the related factors of sarcopenia occurrence. Results:Among the 1 125 patients, the detection rate of muscle content reduction in male was 18.26%, which was significantly higher than that in female 9.28%( P<0.05). The detection rate of muscle content reduction in the senile group was higher than that in 50-<60 years old group and 60-<75 years old group( P<0.05). The proportion of patients with sarcopenia in ≥75 years old group was higher than that in 50-<60 years old group and 60-<75 years old group( P<0.05). The prevalence of sarcopenia in male and ≥75 years old groups was significantly higher than that in female in 50-<60 years old group and the senile group( P<0.05). Logistic regression analysis showed that T2DM patients aged ≥75( OR=4.992, 95% CI: 2.448-10.179)and with glycated hemoglobin(HbA1c)>10%( OR=3.563, 95% CI: 1.526-8.322)had a significantly increased risk of sarcopenia( P<0.05). The proportion of patients with ≥75 years, with a diatetes duration of ≥20 years, with hypertension, with coronary heart disease, with asthma, treated with dipeptidyl peptidase-4(DPP-4)inhibitors, with low albumin and with HbA1c<7% in the sarcopenia group was higher than that in the non-sarcopenia group( P<0.05). T2DM patients aged ≥75 years old( OR=12.140, 95% CI: 2.740-53.790), with a diabetes duration of ≥20 years( OR=3.270, 95% CI: 1.100-9.740), with asthma( OR=7.570, 95% CI: 1.270-45.150), no use of DPP-4 inhibitors( OR=1.950, 95% CI: 1.070-3.570), and with a 2-hour postpranpranal blood glucose ≥11.1mmol/L( OR=0.160, 95% CI: 0.060-0.420)had a significantly increased risk of sarcopenia.( P<0.05). Conclusions:Male and elderly inpatients with T2DM aged ≥ 75 years have a higher detection rate of muscle content reduction and sarcopenia.The main risk factors for sarcopenia in middle-aged and elderly inpatients with T2DM include age HbA 1C, diabetes duration, asthma, use of DPP-4 inhibitors and 2-hour postprandial blood glucose.

BACKGROUND:The development of calcium phosphate bone cement is limited due to its poor mechanical properties and weak osteogenic ability.Silicate bioactive glass is highly favored due to its excellent biological activity and osteogenic ability.Simultaneously,fiber structures can enhance the mechanical strength of materials.OBJECTIVE:To investigate the mechanical properties,biocompatibility,and osteogenic effect of silicate bioactive glass fiber composite calcium phosphate bone cement.METHODS:Different mass percentages(0％,10％,and 20％)of silicate bioactive glass fiber were added to the solid phase of calcium phosphate bone cement,mixed with the liquid phase and cured for 48 hours to obtain silicate bioactive glass fiber composite calcium phosphate bone cement.The mechanical properties,setting time,and ion precipitation of the cement were characterized.The three groups of bone cement extracts were co-cultured with MC3T3-E1 cells.The cell compatibility of the materials was evaluated by CCK-8 assay,live/dead staining,and phalloidin staining.After osteogenic induction,the osteogenic induction ability of the materials was evaluated by alkaline phosphatase staining,alizarin red staining,RUNX2 immunofluorescence staining,and RT-PCR.RESULTS AND CONCLUSION:(1)With the increase of silicate bioactive glass fiber content,the compressive strength and flexural strength of bone cement increased,and the setting time was prolonged.When bone cement was immersed in simulated body fluid,the precipitation of silicon ions,calcium ions,and phosphorus ions could be detected.Moreover,with the increase of silicate bioactive glass fiber content,the mass concentration of silicon ions and phosphorus ions released by bone cement increased,and the mass concentration of calcium ions decreased.(2)Live/dead staining and phalloidin staining results exhibited that silicate bioactive glass fiber composite calcium phosphate bone cement had no toxic effect on MC3T3-E1 cells.CCK-8 assay results showed that silicate bioactive glass fiber composite calcium phosphate bone cement could promote the proliferation of MC3T3-E1 cells.(3)With the increase of silicate bioactive glass fiber content in bone cement,the alkaline phosphatase activity and extracellular calcium deposition of MC3T3-E1 cells increased,the expression of RUNX2 protein increased,and the expression of alkaline phosphatase,osteocalcin,osteopontin,and RUNX2 mRNA expression increased.(4)The results indicate that silicate bioactive glass fibers can enhance the mechanical properties and osteogenic induction ability of calcium phosphate bone cement,among which 20％silicate bioactive glass fibers have a more obvious effect.

Complex liver resection (CLR) is a collective term for surgical procedures addre-ssing complex invasion of intrahepatic vasculobiliary structures that cannot be radically resected through conventional methods. The ex vivo liver resection and autotransplantation (ELRA) and its modified techniques have significantly enhanced the technical feasibility of CLR implementation. In recent years, advancements in modified ELRA techniques and derivative procedures, including conversion resection, in-situ hypothermic perfusion, and auxiliary liver transplantation, have further diversified CLR methodologies, offering more personalized treatment options for CLR candidates. Given the complexity of such cases and substantial variations in surgical approach selection, improving procedural safety and scalability remains a critical challenge in CLR practice. The authors review the current application of modified techniques based on ELRA in CLR, evaluate the clinical significance based on institutional experiences, and propose future directions and individual selection for advancing the safe implementation of CLR.

BACKGROUND:The development of calcium phosphate bone cement is limited due to its poor mechanical properties and weak osteogenic ability.Silicate bioactive glass is highly favored due to its excellent biological activity and osteogenic ability.Simultaneously,fiber structures can enhance the mechanical strength of materials.OBJECTIVE:To investigate the mechanical properties,biocompatibility,and osteogenic effect of silicate bioactive glass fiber composite calcium phosphate bone cement.METHODS:Different mass percentages(0％,10％,and 20％)of silicate bioactive glass fiber were added to the solid phase of calcium phosphate bone cement,mixed with the liquid phase and cured for 48 hours to obtain silicate bioactive glass fiber composite calcium phosphate bone cement.The mechanical properties,setting time,and ion precipitation of the cement were characterized.The three groups of bone cement extracts were co-cultured with MC3T3-E1 cells.The cell compatibility of the materials was evaluated by CCK-8 assay,live/dead staining,and phalloidin staining.After osteogenic induction,the osteogenic induction ability of the materials was evaluated by alkaline phosphatase staining,alizarin red staining,RUNX2 immunofluorescence staining,and RT-PCR.RESULTS AND CONCLUSION:(1)With the increase of silicate bioactive glass fiber content,the compressive strength and flexural strength of bone cement increased,and the setting time was prolonged.When bone cement was immersed in simulated body fluid,the precipitation of silicon ions,calcium ions,and phosphorus ions could be detected.Moreover,with the increase of silicate bioactive glass fiber content,the mass concentration of silicon ions and phosphorus ions released by bone cement increased,and the mass concentration of calcium ions decreased.(2)Live/dead staining and phalloidin staining results exhibited that silicate bioactive glass fiber composite calcium phosphate bone cement had no toxic effect on MC3T3-E1 cells.CCK-8 assay results showed that silicate bioactive glass fiber composite calcium phosphate bone cement could promote the proliferation of MC3T3-E1 cells.(3)With the increase of silicate bioactive glass fiber content in bone cement,the alkaline phosphatase activity and extracellular calcium deposition of MC3T3-E1 cells increased,the expression of RUNX2 protein increased,and the expression of alkaline phosphatase,osteocalcin,osteopontin,and RUNX2 mRNA expression increased.(4)The results indicate that silicate bioactive glass fibers can enhance the mechanical properties and osteogenic induction ability of calcium phosphate bone cement,among which 20％silicate bioactive glass fibers have a more obvious effect.

Complex liver resection (CLR) is a collective term for surgical procedures addre-ssing complex invasion of intrahepatic vasculobiliary structures that cannot be radically resected through conventional methods. The ex vivo liver resection and autotransplantation (ELRA) and its modified techniques have significantly enhanced the technical feasibility of CLR implementation. In recent years, advancements in modified ELRA techniques and derivative procedures, including conversion resection, in-situ hypothermic perfusion, and auxiliary liver transplantation, have further diversified CLR methodologies, offering more personalized treatment options for CLR candidates. Given the complexity of such cases and substantial variations in surgical approach selection, improving procedural safety and scalability remains a critical challenge in CLR practice. The authors review the current application of modified techniques based on ELRA in CLR, evaluate the clinical significance based on institutional experiences, and propose future directions and individual selection for advancing the safe implementation of CLR.

Objective:To explore the common risk factors of sarcopenia in middle-aged and elderly inpatients with type 2 diabetes mellitus(T2DM).Methods:A total of 1 125 middle-aged and elderly T2DM inpatients admitted to the Endocrinology Department of Beijing Hospital from January 2014 to December 2019 were selected and divided into three groups according to age: 50-<60 years old, 60-<75 years old, and ≥75 years old; According to the inclusion and exclusion criteria, 269 study subjects were divided into sarcopenia group( n=90)and non-sarcopenia group( n=179). General data of 1 125 subjects were collected and analyzed.With the presence or absence of sarcopenia as the dependent variable, multivariate logistic regression was used to analyze the relevant risk factors of sarcopenia in middle-aged and elderly inpatients with T2DM.With the comparison of the differences between the sarcopenia group and the non-sarcopenia group, stepwise regression analysis was used to explore the related factors of sarcopenia occurrence. Results:Among the 1 125 patients, the detection rate of muscle content reduction in male was 18.26%, which was significantly higher than that in female 9.28%( P<0.05). The detection rate of muscle content reduction in the senile group was higher than that in 50-<60 years old group and 60-<75 years old group( P<0.05). The proportion of patients with sarcopenia in ≥75 years old group was higher than that in 50-<60 years old group and 60-<75 years old group( P<0.05). The prevalence of sarcopenia in male and ≥75 years old groups was significantly higher than that in female in 50-<60 years old group and the senile group( P<0.05). Logistic regression analysis showed that T2DM patients aged ≥75( OR=4.992, 95% CI: 2.448-10.179)and with glycated hemoglobin(HbA1c)>10%( OR=3.563, 95% CI: 1.526-8.322)had a significantly increased risk of sarcopenia( P<0.05). The proportion of patients with ≥75 years, with a diatetes duration of ≥20 years, with hypertension, with coronary heart disease, with asthma, treated with dipeptidyl peptidase-4(DPP-4)inhibitors, with low albumin and with HbA1c<7% in the sarcopenia group was higher than that in the non-sarcopenia group( P<0.05). T2DM patients aged ≥75 years old( OR=12.140, 95% CI: 2.740-53.790), with a diabetes duration of ≥20 years( OR=3.270, 95% CI: 1.100-9.740), with asthma( OR=7.570, 95% CI: 1.270-45.150), no use of DPP-4 inhibitors( OR=1.950, 95% CI: 1.070-3.570), and with a 2-hour postpranpranal blood glucose ≥11.1mmol/L( OR=0.160, 95% CI: 0.060-0.420)had a significantly increased risk of sarcopenia.( P<0.05). Conclusions:Male and elderly inpatients with T2DM aged ≥ 75 years have a higher detection rate of muscle content reduction and sarcopenia.The main risk factors for sarcopenia in middle-aged and elderly inpatients with T2DM include age HbA 1C, diabetes duration, asthma, use of DPP-4 inhibitors and 2-hour postprandial blood glucose.

Yigongsan is derived from Xiaoer Yaozheng Zhijue written by QIAN Yi in the Northern Song dynasty， which is the No. 3 formula in the Catalogue of Ancient Famous Classical Formulas（The Second Batch of Pediatrics） released by the National Administration of Traditional Chinese Medicine（TCM） in September 2022， and it can be developed as a class 3.1 new TCM drug. By referring to ancient medical books and modern literature， this study conducted herbal textual research on Yigongsan from five aspects， including historical evolution， origin and processing， dosage conversion， usage and preparation methods， and functional application， then formed the key information table of this formula， in order to provide reference for the development of reference samples and preparations of Yigongsan. Based on the results of the study， it is recommended that Panax ginseng should be removed the basal part of stem（rhizoma）， Poria cocos should be removed the peel， Citrus reticulata should be cut into shreds and Glycyrrhiza uralensis should be used. According to 4.13 g/Qian（钱）， 1 g/slice for ginger， 3 g for each jujube and 300 mL/Zhan（盏）， the doses of Ginseng Radix， Poria， Atractylodis Macrocephalae Rhizoma， Glycyrrhizae Radix et Rhizoma， Citri Reticulatae Pericarpium， Zingiberis Rhizoma Recens， Jujubae Fructus were 1.652， 1.652， 1.652， 1.652， 1.652， 5， 6 g， and the total amount was 19.26 g. The decocting method was to crush the medicinal materials into fine powder with 50-80 mesh， add 300 mL of water and decoct to 210 mL for each dose， then remove the dregs and take it warmly. This formula was recorded in ancient books as the main treatment for the cold-deficiency of spleen and stomach， and Qi stagnation in children with vomiting and diarrhea and lack of appetite. It has been flexibly applied by later generations of physicians， and is often used to treat anorexia， inflammation of the digestive tract， diarrhea and other diseases in children.

Objective:To explore the clinical value of semi-ex vivo intestinal autotrans-plantation (IATx) for patients with mesenteric root regional tumors accompanied by vascular invasion.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 6 patients who underwent semi-ex vivo IATx in the Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital from September 2021 to December 2022 were collected. There were 4 males and 2 females, aged (47±21)years. Observation indicators: (1) surgical conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented by Mean± SD. Count data were represented by absolute numbers. Results:(1) Surgical conditions. All 6 patients completed semi-ex vivo IATx successfully. The operation time, warm ischemia time, cold ischemia time, volume of intraoperative blood transfusion were (10.2±2.1)hours, (2.3±1.6)minutes, (49.2±15.6)minutes, (707±263)mL. Of the 6 patients, 3 patients were intraoperatively perfused with cold UW solution, while the other 3 were not. (2) Postoperative conditions. Results of postoperative pathological examination of the 6 patients showed 4 cases of pancreatic ductal adenocarcinoma, 1 case of cholangiocarcinoma, and 1 case of mesenteric fibromatosis. All 6 cases had nega-tive surgical margins and the duration of postoperative hospital stay was (19±4)days. None of the patient had gastrointestinal bleeding or anastomotic leakage postoperatively, and the autotransplanted intestine functioned well. There was no perioperative death, and intravenous rehydration was not required after discharge. (3) Follow-up. All 6 patients were followed up for (12±5)months. Only 1 patient with mesenteric fibromatosis had recurrence in the 7th month postoperatively, while the remaining 5 patients showed no sign of recurrence or metastasis. There were 4 of 6 patients with chronic diarrhea. They were improved after oral loperamide, bifidobacterium and pancreatin capsules. All 6 patients survived.Conclusion:Semi-ex vivo IATx for the treatment of patients with mesenteric root regional tumors accompanied by vascular invasion is safe and feasible, which can achieve good short-term efficacy.

Objective    To investigate the safety and feasibility of laryngeal mask general anesthesia as a replacement of tracheal intubation general anesthesia in the "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch for thymoma patients without myasthenia. Methods    From January 2018 to June 2019, clinical data of patients with thymoma who underwent the novel "three-port" operation in our institution were analyzed retrospectively. The patients were divided into two groups according to the anesthesia methods, including a tracheal intubation general anesthesia group and a laryngeal mask general anesthesia group. There were 70 patients in the tracheal intubation general anesthesia group, including 42 males and 28 females, with an average age of 45.83±15.89 years. There were 39 patients in the laryngeal mask general anesthesia group, including 26 males and 13 females, with an average age of 43.31±15.64 years. The clinical data of the two groups were compared. Results    The baseline characteristics of the patients in the two groups were well balanced (P>0.05). No massive bleeding, conversion to thoracotomy, postoperative myasthenia or death occurred in those patients. No patient with laryngeal mask anesthesia had a conversion to tracheal intubation anesthesia during the operation. There was no significant difference in the operation time, intraoperative bleeding, intraoperative maximum partial pressure of CO2, lowest partial pressure of oxygen and anesthesia effect score between the two groups (P>0.05). There was also no statistical difference in postoperative aspiration, gastrointestinal discomfort, length of hospital stay, pain score and patient satisfaction degree between the two groups (P>0.05). However, the anesthesia time before operation and the time of awake after anesthesia in the laryngeal mask anesthesia group were significantly shorter than those in the tracheal intubation general anesthesia group (P<0.05), and the incidence of transient arrhythmia, laryngeal discomfort and hoarseness in the laryngeal mask general anesthesia group was significantly lower than that in the tracheal intubation general anesthesia group (P<0.05). Conclusion    The "three-port" thoracoscopic thymectomy via subxiphoid and subcostal arch under laryngeal mask general anesthesia is safe and feasible in the treatment of thymoma without myasthenia, and can be recommended routinely.

Objective    To evaluate the clinical outcomes of larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical esophageal squamous cell carcinoma (ESCC) without tumor involvement of the larynx and hypopharynx compared with the upper thoracic ESCC. Methods    Retrospective and comparative analysis of consecutive patients with cervical and upper thoracic ESCC who underwent R0 surgical resection from 2006 to 2011 in our center was performed. Kaplan-Meier method was used to calculate the patients’ survival. Results    In total, 44 pairs of patients, including 71 males and 17 females with an average age of 60.66±8.49 years were enrolled in the study after propensity score matching. The baseline characteristics of the two groups of patients were well balanced. There was no statistical difference in the operation time (P=0.100), blood loss (P=0.685), mortality rate in 30 days (P=1.000), total complication rate (P=0.829), cervical anastomosis leakage (P=0.816), mechanical ventilation (P=1.000), normal oral diet within 15 days (P=0.822) and anastomosis recurrence rate (P=0.676) between the two groups. Survival analysis showed that there was no statistical difference in survival time between the cervical group [31.83 (95%CI 8.65-55.02) months] and upper thoracic group [37.73 (95%CI 25.29-50.18) months, P=0.533]. The 5-year survival rates were 32.6% and 42.1%, respectively. Conclusion    Larynx-preserving limited resection  with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical ESCC without involvement of the larynx and hypopharynx may result in a similar clinical outcome to upper thoracic ESCC.