BACKGROUND:Spinal canal decompression using uniportal endoscopic surgery is a new minimally invasive surgery in the treatment of lumbar spinal stenosis.However,this technique needs a steep learning curve and high requirements for surgical equipment and instruments,which limits its clinical application.We previously use the spinal endoscopy as a monitoring endoscopy and combined with unilateral biportal endoscopy to propose a hybrid technique of spinal endoscopy to achieve coaxial endoscopic operation and hands-separate operation. OBJECTIVE:To compare the clinical outcome of hybrid technique and uniportal endoscopic surgery in treatment of lumbar spinal stenosis with bilateral lower limb pain symptoms. METHODS:Ninety patients diagnosed of lumbar spinal stenosis with bilateral symptoms were included and retrospectively analyzed at First People's Hospital,Shanghai Jiao Tong University from August 2020 to August 2022.44 cases were included in group A(hybrid technique group),while 46 cases were included in group B(uniportal endoscopic surgery).The nerve decompression was observed during the surgery.Operation time,hospital stay time,and expenses were recorded in both groups.The visual analog scale scores of lower back pain and both lower extremities pain,Oswestry disability index scores of quality of life and excellent and good rate of modified Macnab criteria were recorded and compared at preoperative,postoperative 3 days,and postoperative 3 and 6 months. RESULTS AND CONCLUSION:(1)The operation time of group A was significantly shorter than that of group B(P<0.05).(2)The lower back pain and lower extremity pain of the severe side at postoperative 3 days,and 3 and 6 months were significantly relieved in both groups(P<0.05).The visual analog scale score of lower extremity pain on the mild side was significantly decreased at postoperative 3 days,3 and 6 months than preoperative score in the group A(P<0.05).The visual analog scale score of lower extremity pain on the mild side was significantly decreased at postoperative 3 days than preoperative score in the group B(P<0.05).The visual analog scale scores of lower extremity pain on the mild side at postoperative 3 and 6 months did not show significant difference than preoperative score in the group B.The comparison between the two groups showed that there was no significant difference in the visual analog scale scores of postoperative lower back pain and lower extremity pain of the severe side(P>0.05).The visual analog scale scores of lower extremity pain on the mild side in the group A were significantly lower than those of group B at postoperative 3 and 6 months(P<0.05).(3)The Oswestry disability index scores of both groups at postoperative 3 day were significantly lower than preoperative score(P<0.05),and there was no significant difference between the two groups 3 days after operation.Oswestry disability index scores of group A at postoperative 3 and 6 months were significantly decreased than preoperative score(P<0.05).The Oswestry disability index scores of group B at postoperative 3 and 6 months did not show significant differences than preoperative score(P>0.05).The comparison between the two groups showed the Oswestry disability index scores of group A were significantly lower than group B at postoperative 3 and 6 months(P<0.05).(4)The results of modified Macnab showed that the excellent and good rate of group A was significantly higher than that of group B(95%,78%,P<0.05).(5)It is indicated that the hybrid technique is a new spinal endoscopy technique,which has the advantages of less trauma and faster recovery as a minimally invasive surgery.The clinical outcome of hybrid technique is superior to that of uniportal endoscopic surgery in the treatment of lumbar spinal stenosis with bilateral symptoms.Additionally,it also has the advantages of good operational flexibility and high decompression efficiency as an open surgery.

The 2025 American Thyroid Association Guidelines for the Management of Differentiated Thyroid Cancer in Adults incorporate the latest evidence-based medical research to systematically update the strategies for diagnosis, treatment, and follow-up of thyroid cancer. Integrating multidisciplinary perspectives from internal medicine, surgery, radiology, pathology, and other fields—and for the first time including input from patient representatives—the guidelines comprehensively cover the entire management process of differentiated thyroid cancer, significantly enhancing their clinical applicability. Regarding the current focus on active surveillance, the new edition provides clear recommendations based on a rigorous evaluation of existing evidence and multidisciplinary input. This article reviews and discusses key updates and practical aspects of the active surveillance section in the guidelines, with reference to relevant Japanese and Korean guidelines, with the aim of improving the application of active surveillance in thyroid cancer management.

Ischemic stroke (IS) ranks as a leading cause of death and disability globally. The blood-brain barrier (BBB) poses significant challenges for effective drug delivery to brain tissues. Recent decades have seen the development of targeted nanomedicine and biomimetic technologies, sparking substantial interest in biomimetic drug delivery systems for treating IS. These systems are devised by utilizing or replicating natural cells and their derivatives, offering promising new pathways for detection and transport across the BBB. Their multifunctionality and high biocompatibility make them effective treatment options for IS. In addition, the incorporation of engineering techniques has provided these biomimetic drug delivery systems with active targeting capabilities, enhancing the accumulation of therapeutic agents in ischemic tissues and specific cell types. This improvement boosts drug transport and therapeutic efficacy. However, it is crucial to thoroughly understand the advantages and limitations of various engineering strategies employed in constructing biomimetic delivery systems. Selecting appropriate construction methods based on the characteristics of the disease is vital to achieving optimal treatment outcomes. This review summarizes recent advancements in three types of engineered biomimetic drug delivery systems, developed from natural cells and their derivatives, for treating IS. It also discusses their effectiveness in application and potential challenges in future clinical translation.
Humans ; Drug Delivery Systems/methods* ; Ischemic Stroke/drug therapy* ; Animals ; Blood-Brain Barrier/metabolism* ; Stroke/drug therapy*

OBJECTIVES: To analyze the differentially expressed exosomal miRNAs in patients with chronic heart failure (CHF) complicated by hyperuricemia (HUA) and explore their potential as novel diagnostic molecular markers and their target genes. METHODS: This study was conducted among 30 CHF patients with HUA (observation group) and 30 healthy volunteers (control group) enrolled between September, 2020 and September, 2023. Peripheral blood samples were collected from 6 CHF patients with HUA for analyzing exosomal miRNAs by high-throughput sequencing, and the results were validated in the remaining 24 patients using qRT-PCR. GO and KEGG enrichment analyses were performed to predict the the target genes of the identified differential miRNAs. We also validated the differentially expressed miRNAs by animal experiment. RESULTS: A total of 42 differentially expressed exosomal miRNAs were detected in observation group by high-throughput sequencing; among them, miR-27a-5p was significantly upregulated (P=0.000179), and miR-139-3p was significantly downregulated (P=0.000058). In the 24 patients with both CHF and PUA, qRT-PCR validated significant upregulation of miR-27a-5p (P=0.004) and downregulation of miR-139-3p (P=0.005) in serum exosomes. When combined, miR-27a-5p and miR-139-3p had a maximum area under the curve (AUC) of 0.899 (95% CI: 0812-0.987) for predicting CHF complicated by HUA. GO and KEGG enrichment analyses suggested that the differential expressions of miR-27a-5p and miR-139-3p was associated with the activation of the AMPK-mTOR signaling pathway to activate the autophagic response. We obtained the same conclusion from animal experiment. CONCLUSIONS Upregulated exosomal miR-27a-5p combined with downregulated exosomal miR-139-3p expression can serve as a novel molecular marker for diagnosis of CHF complicated by HUA, and their differential expression may promote autophagy in cardiomyocytes by activating the AMPK-mTOR signaling pathway.
Humans ; Hyperuricemia/diagnosis* ; Heart Failure/genetics* ; MicroRNAs/metabolism* ; Exosomes/metabolism* ; Chronic Disease ; Male ; Female ; Middle Aged ; Animals

Loss of protein homeostasis is a hallmark of cellular senescence, and ribosome pausing plays a crucial role in the collapse of proteostasis. However, our understanding of ribosome pausing in senescent cells remains limited. In this study, we utilized ribosome profiling and G-quadruplex RNA immunoprecipitation sequencing techniques to explore the impact of RNA G-quadruplex (rG4) on the translation efficiency in senescent cells. Our results revealed a reduction in the translation efficiency of rG4-rich genes in senescent cells and demonstrated that rG4 structures within coding sequence can impede translation both in vivo and in vitro. Moreover, we observed a significant increase in the abundance of rG4 structures in senescent cells, and the stabilization of the rG4 structures further exacerbated cellular senescence. Mechanistically, the RNA helicase DHX9 functions as a key regulator of rG4 abundance, and its reduced expression in senescent cells contributing to increased ribosome pausing. Additionally, we also observed an increased abundance of rG4, an imbalance in protein homeostasis, and reduced DHX9 expression in aged mice. In summary, our findings reveal a novel biological role for rG4 and DHX9 in the regulation of translation and proteostasis, which may have implications for delaying cellular senescence and the aging process.
G-Quadruplexes ; Cellular Senescence ; Ribosomes/genetics* ; Humans ; Animals ; Mice ; DEAD-box RNA Helicases/genetics* ; Protein Biosynthesis ; RNA/chemistry* ; Neoplasm Proteins

Objective To investigate the influence of intravenous esketamine infusion on anesthetic effect and awakening quality in elderly patients undergoing laparoscopic surgery for prostate cancer.Methods One hundred and twenty patients with laparoscopic radical prostatectomy were selected and divided into the esketamine group(group E)and control group(group C)by the random number table method,60 ca-ses in each group.The group E used esketamine for anesthesia induction and maintenance,while the group C received the same amount of physiological saline at the same time during operation process as control.The es-ketamine pumping infusion or normal saline in the two groups was stopped at 30 min before operation end.In addition,the types and doses of other drugs used during the induction and maintenance phase of anesthesia were identical between the two groups.The use total amounts of anesthetic drugs during perioperative period were recorded.The heart rate(HR)and mean arterial pressure(MAP)were recorded before operation(T1),instantly before tracheal intubation(T2),at 1 min after tracheal intubation(T3),1 h during surgery(T4),end of skin suture(T5),and 5 min after extubation(T6)in the two groups respectively;the anesthetic recovery time after extubation was recorded.The Riker sedation and restlessness score was used to conduct the agita-tion evaluation,the incidence rates of agitation and bucking and the resuscitation room stay time were recor-ded.The pain VAS score was used to conduct the pain evaluation in the patients.The incidence rates of ad-verse events such as respiratory depression,shiverring,nausea,vomiting,drowsiness after extubation were re-corded.Results The perioperative doses of resutanil and propofol in the group E were significantly lower than those in the group C,and the difference was statistically significant(P＜0.05).HR and MAP at T2 in the group E were higher than those in the group C,while HR and MAP at T3 in the group E were lower than those in the group C.The recovery time after extubation in the group E was longer than that in the group C,the agitation incidence rate,acute bucking incidence rate and VAS score were lower,the stay time in the recov-ery room was shorter.The incidence rate of drowsiness in the group E was significantly higher than that in the group C(P＜0.05).The incidence rates of other adverse events had no statistical differnece(P＞0.05).Con-clusion Esketamine is safe and effective in the elderly patients with laparoscopic prostate cancer surgery,which is conducive to stabilize the hemodynamic parameters and reduce the incidence rate of agitation and buc-king.

Based on the core collection retrieval of the Web of Science database,researches related to the medicinal field of plant-derived vesicles(PDVs)were retrieved.The research hotspots and their changes in the pharmaceutical field of PDVs are visually analyzed by using bibliometric software VOSviewer and CiteSpace.A detailed discussion is held around the author,institution,country,key research hotspots and annual develop-ment hotspots,revealing the current research status of PDVs in the pharmaceutical field and predicting future trends,which provides valuable perspectives for researchers to understand the current research status of PDVs in the pharmaceutical field and discover possible unexplored areas in this field.

Objective To explore the role and potential mechanism of Astragali Radix-derived extracelluar vesicles(EVs)-like particles(AR-EVLP)in diabetic wound healing,providing a novel therapeutic drug mode and theoretical basis for traditional Chinese medicine in treating diabetic skin ulcers.Methods AR-EVLP was extracted using ultracentrifugation.Untargeted metabolomics was used to analyze the potential active components of AR-EVLP,and the main active substances in AR-EVLP were identified by comparison with the Herb database.The targets of the active components were obtained through the Swiss Target Prediction database and the TCMSP database.Targets related to diabetic wound healing were obtained from the GeneCards database.Key targets were identified by intersecting drug targets and disease targets.GO functional annotation and KEGG pathway enrichment analysis were performed using the DAVID database.Based on the pathway enrichment results,a"drug components-targets-pathways"diagram was constructed to identify core targets.Molecular docking and visualization were performed using Autodock and PyMOL software.Results Formononetin was identified as the main active component in AR-EVLP,with 66 key targets related to diabetes and wound healing,including 15 key node proteins such as SRC,CASP3 and JUN.GO functional enrichment analysis suggested that formononetin can regulate biological processes such as protein phosphorylation and gene expression.KEGG pathway enrichment analysis indicated potential involvement in multiple signaling pathways,including VEGF and TNF.Seven targets,including PIK3CA,JUN and MAPK14,were identified as core targets for formononetin.Molecular docking showed that formononetin had the strongest binding affinity with MAPK14.Conclusion AR-EVLP may be a potential effective drug mode for the treatment of diabetic wound healing.

Objective To evaluate the application of rabbit liver cancer model in teaching interventional medicine for graduate students.Methods A total of 10 first-year master graduate students majoring in Radiological Imaging(Interventional Medicine).who were studying at Zhengzhou University of China,were enrolled in this study.The rabbit liver cancer model was used as the experimental teaching materials.The teaching contents included the establishment of rabbit liver cancer model,the interventional operation of rabbit liver cancer,the method of scientific research and teaching,the evaluation of the teaching effect,and the survey of student satisfaction.Results Under the guidance of teaching tutor,the success rate of VX2 rabbit liver cancer modeling performed by the 10 master graduate students majoring in interventional medicine was 100％,and the mean operational quality assessment score was(11.5±2.0)points.During the operation of interventional surgery,the success rate of femoral artery puncture was also 100％,and the mean score for each interventional operation was(11.8±2.3)points.The students'experimental designs were evaluated by the expert group,the results were as follows:2 cases were rated as excellent,7 cases were rated as good,and one case was rated as moderate.The degree of students'satisfaction with experimental teaching method was high,the specific scores of each item are as follows:the understanding of the rabbit liver cancer model was(4.80±0.40)points,the command of interventional technology was(4.60±0.49)points,and the quality and practicability of teaching materials was(4.90±0.30)points.Conclusion This teaching method of using rabbit liver cancer model experiment can improve the animal experiment ability,interventional operation ability and scientific research innovation ability of graduate students.Animal model teaching method is an innovation of teaching mode for graduate students majoring in interventional medicine.

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.