Acetabular fracture is a kind of intra-articular fracture with complicated anatomy and difficult treatment. The core of treatment lies in anatomic reduction and strong fixation. The low incidence and intricate anatomical structure present significant challenges for treatment of acetabular fractures. In recent years, significant progress has been made in the treatment of acetabular fractures, particularly in surgical approaches, robotic-assisted technology, the application of tranexamic acid, and treatment strategies for elderly patients, providing new therapeutic options. This article reviews the latest progress in acetabular fracture treatment research.

Objective:To evaluate the pulmonary protective effect of individualized positive end-expiratory pressure (PEEP) ventilation guided by driving pressure in patients undergoing rib fracture surgery.Methods:In this prospective randomized controlled trial, 80 American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients of either sex, aged 18-64 yr, with a body mass index of 19-28 kg/m 2, who underwent elective open reduction and internal fixation of unilateral rib fractures at the Third Hospital of Hebei Medical University from March to October 2024, were selected and divided into 2 groups ( n=40 each) by the random number table method: fixed PEEP ventilation group (group C) and driving pressure-guided individualized PEEP ventilation group (group DP). Group C adopted the ventilation strategy of fixed PEEP with 5 cmH 2O. Group DP adopted the ventilation strategy guided by the driving pressure: PEEP was titrated from 10 cmH 2O, being gradually decreased to 3 cmH 2O at intervals of 1 cmH 2O. Each PEEP level was maintained for 10 respiratory cycles, and the driving pressure of the last cycle was calculated, and the PEEP that could achieve the lowest driving pressure was selected and applied. Lung ultrasound examinations were performed immediately after entering the operating room (T 0) and at 30 min after entering the anesthesia recovery room (T 3), and the lung ultrasound score was recorded. The occurrence of severe postoperative pulmonary complications within 7 days was recorded. Arterial blood gas analysis was performed at T 0, 1 h after PEEP setting (T 1), at the end of suture at the surgical site (T 2) and at T 3, and the oxygenation index was calculated. The peak airway pressure, PEEP and driving pressure were recorded at T 1 and T 2. The duration of the indwelling thoracic drainage tube use and length of postoperative hospital stay were recorded. Results:The incidence of severe postoperative pulmonary complications within 7 days after surgery was 28%(11/40) in group C and 10% in group DP, and the incidence was significantly lower in DP group than in C group ( P<0.05). Compared with group C, the lung ultrasund score was significantly decreased at T 3, the oxygenation index was increased at T 1-3, the PEEP was increased and the driving pressure was decreased at T 1-2, and the length of postoperative hospital stay was shortened in group DP ( P<0.05). Conclusions:Driving pressure-guided individualized PEEP ventilation can decrease the risk of severe postoperative pulmonary complications, alleviate postoperative lung injury and provide a certain degree of lung protection in patients undergoing rib fracture surgery.

Objective:To investigate the role and molecular mechanisms of signal transducer and activator of tran-scription 3(STAT3)in the paraventricular nucleus(PVN)of the hypothalamus in regulating body weight and energy metabolism in mice.Methods:AAV2/9-hSyn-Cre-EGFP virus was stereotactically injected into the PVN of STAT3Flox/Flox mice to conditionally knock out(CKO)STAT3 in the PVN.STAT3 expression was verified via immunoflu-orescence staining and Western blot.Body weight and temperature were monitored,glucose tolerance was assessed using glucose tolerance tests in mice,and morphological changes in the liver,interscapular brown adipose tissue(IBAT),in-guinal white adipose tissue(IWAT),and quadriceps muscle were evaluated via hematoxylin-eosin(HE)staining.RT-qPCR was used to measure mRNA levels of platelet-derived growth factor receptor α(PDGFRα),peroxisome prolifera-tor-activated receptor γ(PPARγ),hormone-sensitive lipase(HSL),and adipose triglyceride lipase(ATGL)in these tissues.Results:STAT3 protein expression in the PVN of CKO mice was significantly reduced,and the number of STAT3-positive neurons was also decreased.Compared to wild-type(WT)mice,CKO mice exhibited increased body weight,impaired thermogenesis in IBAT,and reduced glucose tolerance.HE staining revealed lipid droplet accumula-tion in hepatocytes of the liver,enlarged adipocytes with hypertrophic lipid droplets and leukocyte infiltration in adipose tissues,and intermuscular fat deposition in the quadriceps muscle.RT-qPCR analysis showed decreased mRNA levels of PDGFRα,HSL,and ATGL in the liver;upregulated PPARγ mRNA but downregulated HSL and ATGL mRNA in IBAT and IWAT;and reduced PPARγ and HSL mRNA levels in the quadriceps muscle of CKO mice.Conclusion:The STAT3 signaling pathway in the PVN is critical for maintaining systemic energy balance and serves as a key node in met-abolic regulation.

Purpose To explore the feasibility and clinical value of deep learning-based image reconstruction technology in 5.0T MRI for nasopharyngeal carcinoma.Materials and Methods A prospective study was conducted on 50 newly diagnosed nasopharyngeal carcinoma patients from August to December 2024 at Sun Yat-sen University Cancer Center.5.0T MRI was performed to scan the nasopharynx region.Routine scanning protocols included transverse T2WI,transverse T1WI,transverse contrast-enhanced T1WI and coronal fat-suppressed contrast-enhanced T1WI sequences.Based on these standard scanning protocols,DeepRecon deep learning reconstruction technology with different levels(grade 1-5)was applied,generating a total of 24 sets of images.Qualitative evaluation employed a Likert scale(5-point system)for subjective scoring on lesion detection,lesion edge clarity,artifacts and overall image quality.Quantitative evaluation was performed using the signal-to-noise ratio and contrast-to-noise ratio to objectively assess the quality of the 24 image sets.Differences in qualitative and quantitative indicators between different groups were compared,while the Kappa coefficient was used to analyze the consistency of subjective evaluations by two radiologists.Results In the qualitative assessment of 24 image sets from four MRI sequences(with and without DeepRecon reconstruction),DeepRecon images(grade 2-4)significantly outperformed traditional images in all features except for artifact reduction(Z=-12.11--6.23,all P<0.001).Images reconstructed at DeepRecon grade 3 had the highest overall score and the best image quality.Furthermore,compared with traditional images,DeepRecon images(grade 2-5)demonstrated significantly improved signal-to-noise ratio for both lesions and the lateral pterygoid muscle(t=-15.67--3.44,Z=-6.09--4.63,all P<0.01).In addition,in the transverse T2WI,transverse contrast-enhanced T1WI and coronal fat-suppressed contrast-enhanced T1WI images with DeepRecon reconstruction(grade 2-5),the contrast-to-noise ratio(lesion/lateral pterygoid muscle)also showed significant improvement compared to traditional images(t=-12.71--3.19,Z=-6.08--4.47,all P<0.001).The inter-observer agreement for the overall subjective quality score between the two radiologists was good(Kappa=0.75-0.82,all P<0.01).Conclusion DeepRecon deep learning reconstruction technology significantly increases the signal-to-noise ratio and resolution of traditional magnetic resonance images of nasopharyngeal cancer,improving image clarity and bringing more possibilities for the advancement of imaging diagnosis.

Objective:To evaluate the pulmonary protective effect of individualized positive end-expiratory pressure (PEEP) ventilation guided by driving pressure in patients undergoing rib fracture surgery.Methods:In this prospective randomized controlled trial, 80 American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients of either sex, aged 18-64 yr, with a body mass index of 19-28 kg/m 2, who underwent elective open reduction and internal fixation of unilateral rib fractures at the Third Hospital of Hebei Medical University from March to October 2024, were selected and divided into 2 groups ( n=40 each) by the random number table method: fixed PEEP ventilation group (group C) and driving pressure-guided individualized PEEP ventilation group (group DP). Group C adopted the ventilation strategy of fixed PEEP with 5 cmH 2O. Group DP adopted the ventilation strategy guided by the driving pressure: PEEP was titrated from 10 cmH 2O, being gradually decreased to 3 cmH 2O at intervals of 1 cmH 2O. Each PEEP level was maintained for 10 respiratory cycles, and the driving pressure of the last cycle was calculated, and the PEEP that could achieve the lowest driving pressure was selected and applied. Lung ultrasound examinations were performed immediately after entering the operating room (T 0) and at 30 min after entering the anesthesia recovery room (T 3), and the lung ultrasound score was recorded. The occurrence of severe postoperative pulmonary complications within 7 days was recorded. Arterial blood gas analysis was performed at T 0, 1 h after PEEP setting (T 1), at the end of suture at the surgical site (T 2) and at T 3, and the oxygenation index was calculated. The peak airway pressure, PEEP and driving pressure were recorded at T 1 and T 2. The duration of the indwelling thoracic drainage tube use and length of postoperative hospital stay were recorded. Results:The incidence of severe postoperative pulmonary complications within 7 days after surgery was 28%(11/40) in group C and 10% in group DP, and the incidence was significantly lower in DP group than in C group ( P<0.05). Compared with group C, the lung ultrasund score was significantly decreased at T 3, the oxygenation index was increased at T 1-3, the PEEP was increased and the driving pressure was decreased at T 1-2, and the length of postoperative hospital stay was shortened in group DP ( P<0.05). Conclusions:Driving pressure-guided individualized PEEP ventilation can decrease the risk of severe postoperative pulmonary complications, alleviate postoperative lung injury and provide a certain degree of lung protection in patients undergoing rib fracture surgery.

Objective:To investigate the role and molecular mechanisms of signal transducer and activator of tran-scription 3(STAT3)in the paraventricular nucleus(PVN)of the hypothalamus in regulating body weight and energy metabolism in mice.Methods:AAV2/9-hSyn-Cre-EGFP virus was stereotactically injected into the PVN of STAT3Flox/Flox mice to conditionally knock out(CKO)STAT3 in the PVN.STAT3 expression was verified via immunoflu-orescence staining and Western blot.Body weight and temperature were monitored,glucose tolerance was assessed using glucose tolerance tests in mice,and morphological changes in the liver,interscapular brown adipose tissue(IBAT),in-guinal white adipose tissue(IWAT),and quadriceps muscle were evaluated via hematoxylin-eosin(HE)staining.RT-qPCR was used to measure mRNA levels of platelet-derived growth factor receptor α(PDGFRα),peroxisome prolifera-tor-activated receptor γ(PPARγ),hormone-sensitive lipase(HSL),and adipose triglyceride lipase(ATGL)in these tissues.Results:STAT3 protein expression in the PVN of CKO mice was significantly reduced,and the number of STAT3-positive neurons was also decreased.Compared to wild-type(WT)mice,CKO mice exhibited increased body weight,impaired thermogenesis in IBAT,and reduced glucose tolerance.HE staining revealed lipid droplet accumula-tion in hepatocytes of the liver,enlarged adipocytes with hypertrophic lipid droplets and leukocyte infiltration in adipose tissues,and intermuscular fat deposition in the quadriceps muscle.RT-qPCR analysis showed decreased mRNA levels of PDGFRα,HSL,and ATGL in the liver;upregulated PPARγ mRNA but downregulated HSL and ATGL mRNA in IBAT and IWAT;and reduced PPARγ and HSL mRNA levels in the quadriceps muscle of CKO mice.Conclusion:The STAT3 signaling pathway in the PVN is critical for maintaining systemic energy balance and serves as a key node in met-abolic regulation.

Purpose To explore the feasibility and clinical value of deep learning-based image reconstruction technology in 5.0T MRI for nasopharyngeal carcinoma.Materials and Methods A prospective study was conducted on 50 newly diagnosed nasopharyngeal carcinoma patients from August to December 2024 at Sun Yat-sen University Cancer Center.5.0T MRI was performed to scan the nasopharynx region.Routine scanning protocols included transverse T2WI,transverse T1WI,transverse contrast-enhanced T1WI and coronal fat-suppressed contrast-enhanced T1WI sequences.Based on these standard scanning protocols,DeepRecon deep learning reconstruction technology with different levels(grade 1-5)was applied,generating a total of 24 sets of images.Qualitative evaluation employed a Likert scale(5-point system)for subjective scoring on lesion detection,lesion edge clarity,artifacts and overall image quality.Quantitative evaluation was performed using the signal-to-noise ratio and contrast-to-noise ratio to objectively assess the quality of the 24 image sets.Differences in qualitative and quantitative indicators between different groups were compared,while the Kappa coefficient was used to analyze the consistency of subjective evaluations by two radiologists.Results In the qualitative assessment of 24 image sets from four MRI sequences(with and without DeepRecon reconstruction),DeepRecon images(grade 2-4)significantly outperformed traditional images in all features except for artifact reduction(Z=-12.11--6.23,all P<0.001).Images reconstructed at DeepRecon grade 3 had the highest overall score and the best image quality.Furthermore,compared with traditional images,DeepRecon images(grade 2-5)demonstrated significantly improved signal-to-noise ratio for both lesions and the lateral pterygoid muscle(t=-15.67--3.44,Z=-6.09--4.63,all P<0.01).In addition,in the transverse T2WI,transverse contrast-enhanced T1WI and coronal fat-suppressed contrast-enhanced T1WI images with DeepRecon reconstruction(grade 2-5),the contrast-to-noise ratio(lesion/lateral pterygoid muscle)also showed significant improvement compared to traditional images(t=-12.71--3.19,Z=-6.08--4.47,all P<0.001).The inter-observer agreement for the overall subjective quality score between the two radiologists was good(Kappa=0.75-0.82,all P<0.01).Conclusion DeepRecon deep learning reconstruction technology significantly increases the signal-to-noise ratio and resolution of traditional magnetic resonance images of nasopharyngeal cancer,improving image clarity and bringing more possibilities for the advancement of imaging diagnosis.

Vesicular glutamate transporter 2(VGlut2)is expressed in the PVN of the hypothalamic paraventricular nucleus(PVNVG1ut2)as an excitatory neurotransmitter,which regulates food intake and energy metabolism and plays an important role in maintaining homeostasis.However,it is not clear that the upstream and downstream projection network of PVNVGut2 neurons hinders the anal-ysis of glutamatergic neuron circuit function.Anterograde and retrograde tracer viruses were injec-ted into the PVN of VGlut2 mice by stereotactic brain injection technique to find the input and output nuclei of PVNVGlut2 neurons.Anterograde tracing results showed that PVNVGlut2 neurons pro-jected to the downstream medial amygdala(MeAD)and arcuate nucleus(ARC).Retrograde trac-ing results showed that PVNVGlut2 received input from the prefrontal nucleus(Pr),the reticular tegmental nucleus(RtTg),and the hypoglossal nucleus(12N).In addition,VGlut2 was found to be co-expressed with neuronal nitric oxide synthase(nNOS)neurons in the PVN.The anatomical net-work of PVNVG1ut2 neurons was analyzed by virus tracking tool,which laid the anatomical founda-tion for further study on the functional regulation of PVNVGlut2.

Objective:To compare the surgical outcomes of robotic natural orifice specimen extraction surgery (NOSES) and robotic-assisted radical resection for rectal cancer.Methods:A retrospective analysis using propensity score matching (PSM) was conducted on 547 patients who had undergone radical resection of rectal cancer at the First Affiliated Hospital of Nanchang University from June 2018 to March 2024. The study cohort comprised 157 patients in the robotic NOSES group and 390 in the robotic-assisted group. PSM was used in a 1:1 manner to match relevant general clinical preoperative data of the study patients (age, sex, body mass index, preoperative comorbidities, abnormal preoperative carcinoembryonic antigen (>6.5 μg/L) and carbohydrate antigen 19-9 levels (>27 kU/L), preoperative American Society of Anesthesiologists score, tumor diameter, tumor distance from the anal margin, and TNM stage), with a clamp value of 0.05. After performing PSM to match the general clinical data of the two groups of patients, 77 patients in each of the robotic NOSES and robotic-assisted groups were included in the analysis. We found no statistically significant difference in preoperative general clinical data between the robot NOSES and robot-assisted groups ( P>0.05). We compared the surgical outcomes, postoperative recovery, postoperative pathological data, and incidence of complications between the robotic NOSES and robot-assisted groups. Results:Compared with the robot-assisted groups. the robot NOSES group had a significantly shorter time to first postoperative passage of flatus (48 [38, 50] hours vs. 56 [50, 60] hours, Z=-7.513, P<0.001), time to taking a liquid diet (60 [54,63] hours vs. 66 [62, 72] hours, Z=-6.303, P<0.001), lower pain scores (3 [3, 4] vs. 4 [4, 5], Z=-5.237, P<0.001), and lower incision infection rates (0 vs. 5 [6.5%], χ 2=5.237, P=0.028) within 24 hours after surgery ( P<0.05). However, there were no significant differences in surgical time, intraoperative blood loss, postoperative hospital stay, postoperative anastomotic complications, or incidence of other complications between the two groups (all P>0.05). Conclusion:Robotic NOSES surgery is a safe and feasible procedure for resecting rectal cancer and postoperative recovery is faster after robotic NOSES than after standard robot-assisted surgery.

Objective To investigate the geographical distribution and seasonal fluctuations of visceral leishmaniasis vectors sandflies in Henan Province in 2023, so as to provide insights into the prevention and control of visceral leishmaniasis vectors. Methods A total of 23 counties (districts) were sampled from 18 cities of Henan Province from May to September, 2023 as sandfly surveillance sites, and sandflies were captured using human capture and light trapping methods. Following morphological identification, the changes in the sandfly density were calculated at different months and in different breeding habitats. Results A total of 406 light traps were set at sandfly surveillance sites in Henan Province from May to September, 2023, and a total of 3 137 female sandlies were captured, with an average density of 7.73 sandlies/(light·night). A total of 1 494 Phlebotomus chinensis sandflies were captured, including 1 222 female sandflies, with an average density of 3.01 sandflies/(light·night), and the highest density of P. chinensis was found in Gongyi City [17.00 sandflies/(light·night)]. A total of 5 544 sandflies were captured using the human capture method, including 230 P. chinensis, and the density of P. chinensis appeared a unimodal distribution, with a peak in early July [5.81 sandflies/(light·night)]. Among different breeding habitats, the highest P. chinensis density was detected in pigpens [4.50 sandflies/(light·night)]. Conclusions P. chinensis was predominantly distributed in hilly areas of northern and central-western Henan Province in 2023, and the sandfly density appeared a unimodal distribution. Intensified monitoring of visceral leishmaniasis vectors is recommended.