With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

Objective:To analyze the trabecular bone score (TBS) and its association with muscle health in the postmenopausal population.Methods:It was a cross-sectional study. A total of 214 postmenopausal individuals who underwent dual-energy X-ray absorptiometry testing at the Beijing Research Institute of Sports Science between January and December 2023 were consecutively included. The participants were divided into two groups based on the presence or absence of osteoporosis (OP): 62 cases in the OP group and 152 cases in the non-OP group. All subjects completed body composition assessments and scans of bilateral hip and lumbar spine bone mineral density (BMD)(All the BMD in this study were areal BMD). Demographic data, including age, age at menarche, age at menopause, and fracture history, were also collected. TBS was calculated using the TBS iNsight software. Muscle health indicators included upper limb, lower limb, trunk, and total muscle mass, lean body mass, appendicular skeletal muscle mass index (ASMI), and grip strength. The Pearson correlation analysis was used to determine the relationship between TBS and muscle health indicators, as well as between TBS and the BMD of lumbar spine (L 1-4). Further, multiple linear regression analysis was conducted to explore the independent association between TBS and muscle health indicators. Results:TBS, lean body mass, ASMI, grip strength, and muscle mass of the upper limb, lower limb, trunk, whole body in the OP group were all lower than those in the non-OP group [(1.27±0.07) vs (1.35±0.07) score, (36.64±3.45) vs (39.14±3.62) kg, (6.16±0.56) vs (6.44±0.63) kg/m2, (23.87±3.31) vs (25.34±4.33) kg, (3.54±0.47) vs (3.78±0.47) kg, (11.70±1.33) vs (12.68±1.49) kg, (16.57±1.68) vs (17.50±1.69) kg, and (34.91±3.33) vs (37.13±3.47) kg] (all P<0.05). Pearson analysis showed that TBS was positively correlated with lean body mass, ASMI, grip strength, and muscle mass of the upper limb, lower limb, whole body (all P<0.05). TBS was negatively correlated with age ( P<0.01). TBS was positively correlated with the BMD of lumbar spine (L 1-4) ( r=0.660, P<0.01). Multiple regression analysis demonstrated that ASMI was positively correlated with TBS ( β=0.284, P<0.01). Conclusion:In the postmenopausal population, individuals with OP have lower TBS. Furthermore, TBS is closely associated with muscle health.

OBJECTIVE: To investigate the effectiveness of 5G remote robotic surgery in the treatment of pelvic fractures. METHODS: A retrospective analysis was conducted on the clinical data of 160 patients with pelvic fractures admitted between July 2023 and June 2024 who met the selection criteria. Among these patients, 80 underwent internal fixation surgery with the assistance of 5G remote robotic surgery (5G group), while 80 received local robotic surgical assistance (control group). Baseline characteristics, including gender, age, body mass index, disease duration, cause of injury, and fracture classification, were compared between the two groups, and no significant difference was found ( P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, accuracy of screw placement, maximum residual displacement postoperatively, quality of fracture reduction, incidence of complications, Majeed pelvic function score and classification at last follow-up were recorded and compared between the two groups. RESULTS: In the 5G group, 180 screws were implanted during surgery, while 213 screws were implanted in the control group. The 5G group demonstrated significantly reduced intraoperative blood loss and shorter incision length compared to the control group ( P<0.05). No significant difference was observed between the two groups in terms of operation time or hospital stay ( P>0.05). Radiographic evaluation revealed excellent and good reduction rates of 98.8% (79/80) in the 5G group and 97.5% (78/80) in the control group, while excellent and good screw placement accuracy rates were 98.3% (177/180) in the 5G group and 95.8% (204/213) in the control group. No significant difference was found between the two groups in maximum residual displacement, reduction quality, or screw placement accuracy ( P>0.05). All patients were followed up 7-16 months (mean, 11.3 months), with no significant difference in follow-up duration between the groups ( P>0.05). No perioperative or follow-up complication, such as wound infection, iatrogenic fractures, iatrogenic neurovascular injury, screw loosening or breakage, or nonunion, were observed in either group. The control group exhibited a worse degree of gait alteration compared to the 5G group ( P<0.05), while no significant difference was found in incidences of squatting limitation or persistent pain ( P>0.05). At last follow-up, no significant difference was observed between the groups in Majeed pelvic function scores or grading ( P>0.05). CONCLUSION Compared with the local surgery group, 5G remote robotic surgery supported by remote expert technical guidance demonstrated smaller incision lengths, less intraoperative blood loss, and fewer postoperative complications, and was shown to be a precise, minimally invasive, safe, and reliable surgical method.
Humans ; Robotic Surgical Procedures/instrumentation* ; Pelvic Bones/surgery* ; Male ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Female ; Fractures, Bone/surgery* ; Middle Aged ; Bone Screws ; Adult ; Operative Time ; Treatment Outcome ; Blood Loss, Surgical ; Length of Stay ; Postoperative Complications/epidemiology* ; Aged ; Young Adult

Radiation-induced esophageal injury (RIEI) is a frequent complication following radiotherapy for thoracic and head-neck malignancies, which may lead to severe sequelae including esophageal stricture and perforation, adversely affecting patients' quality of life and therapeutic outcomes. With advancements in radiotherapy techniques — particularly the adoption of unconventional fractionation regimens, concurrent chemoradiotherapy, and combined molecular targeted / immunotherapy — the incidence of RIEI has been increasing. In this review, recent advances in understanding the pathogenesis, clinical manifestations, risk factors, and management strategies for RIEI were comprehensively summarized. Current therapeutic approaches have evolved beyond conventional anti-inflammatory and nutritional support to include novel interventions such as targeted therapy, free radical scavengers, and microbiota modulation, etc. Future research should prioritize the development of optimized, individualized prevention and treatment protocols to mitigate RIEI risk and improve patient prognosis.

Objective:To compare the efficacy of robot-assisted percutaneous reduction and screw fixation versus open reduction and plate fixation via the sinus tarsi approach in the treatment of Sanders types II and III calcaneal fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 82 patients (90 feet) with calcaneal fractures admitted to the Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Capital Medical University from January 2020 to April 2024, including 74 males and 8 females, aged 24-87 years [(46.4±12.1)years]. According to Essex-Lopresti classification, the fractures were classified as tongue-type in 43 patients and joint-collapse-type in 47. According to Sanders classification, 69 feet were classified as type II and 21 as type III. Forty-seven patients (52 feet) were treated with robot-assisted percutaneous reduction and screw fixation (screw fixation group) and 35 (38 feet) with open reduction and plate fixation via the sinus tarsi approach (plate fixation group). The two groups were compared in terms of the operation duration, intraoperative blood loss, length of hospital stay and time to weight-bearing. The width, height, length, B?hler angle and Gissane angle of the calcaneus before surgery and at 1 day after surgery were compared. The Maryland foot and ankle function score, American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot function score, and visual analogue scale (VAS) score at 1, 3 months postoperatively, and at the last follow-up were compared. The incidence of postoperative complications and removal rate of internal fixation were also detected in the two groups.Results:All the patients were followed up for 9-60 months [(30.0±14.5)months]. There was no significant difference in the operation duration between the two groups ( P>0.05). The intraoperative blood loss, length of hospital stay and time to weight-bearing in the screw fixation group were 10.0(10.0, 20.0)ml, 7.0(5.0, 8.0)days and (5.0±0.8)weeks, which were significantly less or shorter than 30.0(20.0, 50.0)ml, 8.0(6.0, 11.0)days and (6.9±0.7)weeks in the plate fixation group ( P<0.05). The width, height, length, B?hler angle and Gissane angle of the calcaneus at 1 day after surgery were (43.4±4.2)mm, (46.2±4.0)mm, (81.6±5.1)mm, 27.1(20.4, 30.4)° and (113.4±10.1)° in the screw fixation group, which were all improved compared with those before surgery [(47.8±4.6)mm, (39.3±4.8)mm, (79.2±5.9)mm, 9.5(0.0,16.5)° and (119.3±13.4)°] ( P<0.01). The width, height, length and B?hler angle of the calcaneus at 1 day after surgery were (41.6±5.7)mm, (48.4±4.8)mm, (83.1±5.7)mm and 27.3(21.3, 31.6)° in the plate fixation group, which were all improved compared with those before surgery [(47.8±5.0)mm, (41.7±5.1)mm, (80.1±5.9)mm and 12.9(7.2,19.8)°] ( P<0.01), with no significant difference in the Gissane angle ( P>0.05). Before surgery and at 1 day postoperatively, no significant differences were found in the width, length, B?hler angle or Gissane angle of the calcaneus between the two groups ( P>0.05), while the height of the calcaneus in the screw fixation group was lower than that in the plate fixation group ( P<0.05). At 1 month after surgery and at the last follow-up, there were no significant differences in the Maryland foot and ankle function score, AOFAS ankle and hindfoot function score, and VAS score between the two groups ( P>0.05). At 3 months after surgery in the screw fixation group, the Maryland foot and ankle function score was (79.7±3.8)points, significantly higher than (74.7±2.8)points in the plate fixation group ( P<0.01); the AOFAS ankle and hindfoot function score was (77.1±5.0)points, significantly higher than (70.1±3.6)points in the plate fixation group ( P<0.01); the VAS score was 1.0(1.0, 2.0)points, significantly lower than 2.5(2.0, 3.0)points in the plate fixation group ( P<0.01). No significant difference was detected in the incidence of postoperative complications between the two groups ( P>0.05). The removal rate of internal fixation was 10% (5/52) in the screw fixation group, significantly lower than 29% (11/38) in the plate fixation group ( P<0.05). Conclusion:Compared with open reduction and plate fixation via the sinus tarsi approach, robot-assisted percutaneous reduction and screw fixation has the advantages of less intraoperative blood loss, shorter hospital stay, earlier weight-bearing exercises, better early functional recovery and pain relief, and lower internal fixation removal rate in the treatment of Sanders types II and III calcaneal fractures.

Objective To construct a predictive model for clinical pregnancy outcomes in frozen-thawed embryo transfer(FET)cycles in women with advanced maternal age(age≥35 years)and to analyze its influencing factors.Methods A retrospective analysis was conducted on the clinical data of 2717 older patients who underwent FET treatment at the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2023.These Patients were divided into a clinical pregnancy group(n=851)and a non-clinical pregnancy group(n=1866)based on whether the clinical pregnancy had occurred.The general characteristics and transplantation details of the two groups were compared,and a logistic regression analysis model was constructed.Results The clinical pregnancy rate(CPR)was 31.32%.The CPR for women aged 35-40 years(40.06%)was higher than that for women aged≥40 years(19.35%),with a statistically significant difference(χ2=133.371,P<0.05).The model results showed that the higher anti-Mullerian hormone(AMH)levels(OR=1.053,95%CI:1.012-1.095),the more high-quality blastocysts were transferred(OR=1.704,95%CI:1.143-2.542;OR=2.861,95%CI:1.921-4.262);the more high-quality blastocysts were transferred(OR=2.033,95%CI:1.077-3.836;OR=3.886,95%CI:2.035-7.420),the thicker the endometrial lining on the day of transfer(OR=1.150,95%CI:1.092-1.212)and it could increase the probability of clinical pregnancy.However,for women over 40 years of age(OR=0.551,95%CI:0.437-0.694)and secondary infertility(OR=0.704,95%CI:0.552-0.896),the probability of clinical pregnancy would be reduced;ROC curve analysis results showed that the AUC for predicting clinical pregnancy occurrence in the training set and validation set of the predictive model were 0.723(95%CI:0.699-0.748)and 0.726(95%CI:0.689-0.764),respectively,with cutoff values of 0.262 and 0.260 and the model fit was good(P>0.05).Conclusion Female age,AMH level,type of infertility,number of high-quality embryos(cleavage embryos,blastocysts)transferred,and endometrial thickness on the day of transfer are important factors affecting FET cycles in advanced maternal age women.The constructed prediction model based on these factors has a certain predictive ability for clinical pregnancy.

Cancer,as a major public health issue that seriously threatens public health,the im-provement of its three-level prevention system is crucial for reducing the disease burden.Integrative medicine,leveraging the combined advantages of the holistic concept and syndrome differentiation theory of traditional Chinese medicine(TCM)and the precise detection and standardized treat-ment techniques of Western medicine,demonstrates unique value in the field of cancer preven-tion.Currently,TCM has achieved certain results in the three-level prevention of cancer.However,it still faces challenges such as insufficient public awareness,lack of multi-disciplinary collabo-ration mechanisms,and a weak evidence-based research system.This paper systematically ana-lyzes the practical status quo,existing problems,and development directions of integrative medicine in the three-level prevention of cancer,aiming to provide theoretical basis and practical references for constructing an efficient and collaborative prevention system and promoting the standardization and internationalization of integrative medicine in cancer prevention.

Objective To evaluate the effectiveness of low-volume high-intensity interval training(LV-HIIT)protocols defined by the W'Balance(W'BAL)model in achieving maximal activation of both anaerobic and aerobic energy systems.Methods Twenty-eight national-level athletes(age:20±1 years old;height:174±9 cm;weight:65.1±9.4 kg)completed an incremental exercise test,followed by six supra-critical power(supra-CP)and five sub-CP constant-load tests to determine VO2max,maximal accumulated oxygen deficit(MAOD),critical power(CP),and W prime(W').They then performed three randomly ordered LV-HIIT protocols(each of 4-minute total duration),with a 10-second inter-val for passive recovery between bouts.The protocols consisted of 10s(HIIT10/10),20s(HIIT20/10),and 30 s(HIIT30/10).Exercise intensities were individually prescribed using the W'BAL model.Accu-mulated oxygen deficit(AOD)and net AOD(NAOD)were calculated for each protocol.Results Final 10-s oxygen uptake(VO2)reached 77％,88％,and 89％of VO2max in HIIT10/10,HIIT20/10,and HIIT30/10,respectively(P<0.05).VO2 in HIIT10/10 was significantly lower than in HIIT20/10 and HIIT30/10(P<0.05),with no significant difference between the latter two(P>0.05).AOD did not differ significantly from MAOD among the three protocols(P>0.05),whereas NAOD was significantly lower than MAOD in all cases(P<0.05).Additionally,NAOD in HIIT10/10 was significantly lower than in HIIT20/10 and HI-IT30/10(P<0.05),with no significant difference between the latter two(P>0.05).Conclusion The HIIT20/10 and HIIT30/10 intensity established by the W'BAL model can substantially elicit maximal activation of both anaerobic and aerobic energy systems.While the W'BAL model demonstrates potential for set-ting exercise intensities in LV-HIIT,future studies are necessary to develop specific W'recovery rate models for targeted populations and to refine CP models that are better suited for intermittent exercises.

Objective To compare the effectiveness of the heart rate variability threshold(HRVT),muscle oxygenation threshold(MOT),and their combined threshold(COMT)in predicting the ventila-tory threshold(VT)and lactate threshold(LT).Methods Twenty male athletes at or above the nation-al level were recruited to perform an incremental exercise test to determine VT and LT,during which gas exchange,muscle oxygenation,and heart rate variability were collected.The HRVT,MOT,and COMT methods were then applied,and their predictive validity was evaluated by comparing the correla-tions and agreements between heart rate(HR)and power output(PO)at VT and LT.Results For HR,VT1 showed strong correlation and agreement with MOT1(r=0.958,ICC=0.944)and COMT1(r=0.957,ICC=0.951),with COMT1 having the smallest mean bias(1.4 bpm)and the narrowest limits of agreement(LOA)(-5.4 to 8.2 bpm).Moreover,VT2 demonstrated the highest correlation and agree-ment with COMT2(r=0.985,ICC=0.982),with a mean bias of-0.7 bpm and LOA of-5.0 to 3.7 bpm.Meanwhile,LT showed high correlation and good agreement with COMT2(r=0.884,ICC=0.754)and MOT2(r=0.886,ICC=0.738),with mean biases of-6.8 bpm and-7.3 bpm,and LOA of-17.5 to 3.8 bpm and-17.9 to 3.2 bpm,respectively.For PO,VT1 had the best correlation and agreement with MOT1(r=0.836,ICC=0.808),with a mean bias of-0.2 W and LOA of-11.7 to 11.3 W.VT2 performed best correlation and agreement with COMT2(r=0.910,ICC=0.900),with a mean bias of 2.3 W and LOA of-8.9 to 13.5 W.In LT prediction,MOT2(r=0.736,ICC=0.692)outperformed COMT2(r=0.635,ICC=0.618),with mean biases of-2.6 W and 0.2 W,and LOA of-26.0 to 20.7 W and-26.6 to 27.1 W,respectively.Conclusion All three indicators—HRVT,MOT,and COMT—demonstrates high validity in predicting VT and LT.MOT1 performs best for predicting PO at VT1,while COMT2 shows the highest consistency for predicting both HR and PO at VT2.Howev-er,for LT prediction,MOT2 is more advantageous for predicting PO,whereas COMT2 is more accu-rate for predicting HR.Therefore,method selection should be tailored to the specific threshold type and measurement target.

Objective To compare the effectiveness of the heart rate variability threshold(HRVT),muscle oxygenation threshold(MOT),and their combined threshold(COMT)in predicting the ventila-tory threshold(VT)and lactate threshold(LT).Methods Twenty male athletes at or above the nation-al level were recruited to perform an incremental exercise test to determine VT and LT,during which gas exchange,muscle oxygenation,and heart rate variability were collected.The HRVT,MOT,and COMT methods were then applied,and their predictive validity was evaluated by comparing the correla-tions and agreements between heart rate(HR)and power output(PO)at VT and LT.Results For HR,VT1 showed strong correlation and agreement with MOT1(r=0.958,ICC=0.944)and COMT1(r=0.957,ICC=0.951),with COMT1 having the smallest mean bias(1.4 bpm)and the narrowest limits of agreement(LOA)(-5.4 to 8.2 bpm).Moreover,VT2 demonstrated the highest correlation and agree-ment with COMT2(r=0.985,ICC=0.982),with a mean bias of-0.7 bpm and LOA of-5.0 to 3.7 bpm.Meanwhile,LT showed high correlation and good agreement with COMT2(r=0.884,ICC=0.754)and MOT2(r=0.886,ICC=0.738),with mean biases of-6.8 bpm and-7.3 bpm,and LOA of-17.5 to 3.8 bpm and-17.9 to 3.2 bpm,respectively.For PO,VT1 had the best correlation and agreement with MOT1(r=0.836,ICC=0.808),with a mean bias of-0.2 W and LOA of-11.7 to 11.3 W.VT2 performed best correlation and agreement with COMT2(r=0.910,ICC=0.900),with a mean bias of 2.3 W and LOA of-8.9 to 13.5 W.In LT prediction,MOT2(r=0.736,ICC=0.692)outperformed COMT2(r=0.635,ICC=0.618),with mean biases of-2.6 W and 0.2 W,and LOA of-26.0 to 20.7 W and-26.6 to 27.1 W,respectively.Conclusion All three indicators—HRVT,MOT,and COMT—demonstrates high validity in predicting VT and LT.MOT1 performs best for predicting PO at VT1,while COMT2 shows the highest consistency for predicting both HR and PO at VT2.Howev-er,for LT prediction,MOT2 is more advantageous for predicting PO,whereas COMT2 is more accu-rate for predicting HR.Therefore,method selection should be tailored to the specific threshold type and measurement target.