Objective:To investigate the value of a deep learning radiomics (DLR) nomogram model based on intra-tumoral and peri-tumoral MRI features for differentiating IgG4-related ophthalmic disease (IgG4-ROD) from orbital mucosa-associated lymphoid tissue (MALT) lymphoma.Methods:This was a case-control study. The clinical and imaging data of 233 patients pathologically confirmed with either IgG4-ROD or orbital MALT lymphoma were retrospective collected between January 2020 and December 2024 from the Second Hospital of Jilin University (Center 1) and Beijing Tongren Hospital, Capital Medical University (Center 2). Patients from Center 1 ( n=158) were used as the training cohort, while those from Center 2 ( n=75) served as the validation cohort. Among the cases, 102 were IgG4-ROD (70 in training, 32 in validation) and 131 were orbital MALT lymphoma (88 in training, 43 in validation). Univariate and multivariate logistic regression analyses were used to identify independent clinical imaging predictors and build a clinical imaging model. Based on T 1WI, T 2WI, and diffusion weighted images, intra-tumoral regions were manually delineated, a 2 mm peri-tumoral margin was automatically generated, and both regions were combined as a single region of interest for radiomics feature extraction. Deep learning features were extracted using a ResNet-50 backbone, and after feature selection and dimensionality reduction, a DLR model was constructed. The clinical imaging features and DLR features were integrated to build a combined nomogram model. Model performance in differentiating IgG4-ROD from orbital MALT lymphoma was assessed using receiver operating characteristic curves, calibration curves, and decision curve analysis. The area under the curve (AUC) were compared using the DeLong test. Results:Bilateral orbital involvement ( OR=1.983, 95% CI 1.166-2.843, P=0.046) and extraocular muscle involvement ( OR=1.246, 95% CI 1.079-1.764, P=0.015) were identified as independent predictors for distinguishing IgG4-ROD from orbital MALT lymphoma and were used to construct the clinical model. Fourteen features (9 radiomics and 5 deep learning features) were selected for the DLR model, and a nomogram was developed. In the training set, the AUCs for the clinical model, DLR model, and nomogram were 0.762 (95% CI 0.712-0.812), 0.865 (95% CI 0.822-0.908), and 0.943 (95% CI 0.909-0.953), respectively. In the validation set, the AUCs were 0.733 (95% CI 0.675-0.791), 0.823 (95% CI 0.762-0.884), and 0.924 (95% CI 0.902-0.958), respectively. The nomogram showed significantly higher AUCs than those of the clinical and DLR models alone (training set: Z=3.92, 2.87, P0.001, P=0.004; validation set: Z=3.25, 2.46, P=0.001, 0.014). Calibration curves indicated good agreement between predicted and actual IgG4-ROD incidence, and decision curve analysis demonstrated the highest net benefit for the nomogram. Conclusion:A nomogram that incorporates both intra-tumoral and peri-tumoral DLR features and clinical imaging characteristics demonstrates excellent performance in distinguishing IgG4-ROD from orbital MALT lymphoma.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

BACKGROUND:Studies have shown that upregulation of heme oxygenase-1 expression enhances cellular antioxidant and anti-apoptotic abilities.However,the effects of upregulating heme oxygenase-1 expression on the proliferation and differentiation of neural stem cells under oxidative stress conditions remain unclear.OBJECTIVE:To investigate the influence of heme oxygenase-1 overexpression on the survival and differentiation capacity of neural stem cells under oxidative stress conditions.METHODS:(1)Mouse primary neural stem cells were isolated and cultured from newborn Balb/c mice.Immunofluorescence was used to detect the neural stem cell marker Nestin.(2)Lentivirus was used to infect neural stem cells to induce heme oxygenase-1 overexpression.Flow cytometry was used to assess green fluorescent protein fluorescence.Western blot assay was performed to detect the expression levels of heme oxygenase-1.(3)H2O2 was added to the lentivirus-infected neural stem cell culture medium to simulate the oxidative stress microenvironment after spinal cord injury.Effects of heme oxygenase-1 overexpression on neural stem cell proliferation and apoptosis levels were analyzed using cell proliferation assay kits,cell apoptosis assay kits,and TUNEL staining kits.(4)The levels of lipid oxidation markers malondialdehyde,catalase,superoxide dismutase,and glutathione peroxidase were detected using assay kits.(5)Flow cytometry was used to measure intracellular reactive oxygen species levels,and neural stem cell differentiation into astrocytes and neurons.(6)The effect of heme oxygenase-1 overexpression on neuronal axon growth during neural stem cell differentiation was observed under optical and fluorescence microscopes.RESULTS AND CONCLUSION:(1)Mouse neural stem cells exhibited stable morphology,good growth status,and high expression of Nestin as detected by immunofluorescence.(2)Western blot analysis showed that the overexpression of heme oxygenase-1 in the overexpression group was significantly higher than that in the empty carrier control group.Flow cytometry was used to detect the expression of green fluorescent protein in the neural stem cells of the heme oxygenase-1 overexpression group and empty vector control group.(3)Overexpression of heme oxygenase-1 maintained the proliferative activity of neural stem cells and significantly reduced the number of apoptotic cells under oxidative stress conditions.(4)Overexpression of heme oxygenase-1 inhibited lipid peroxidation of neural stem cells under oxidative stress microenvironment,enhanced the expression of enzymes related to maintaining the oxidative-reductive balance,and significantly reduced intracellular reactive oxygen species levels.(5)Overexpression of heme oxygenase-1 promoted the differentiation of neural stem cells into neurons and reduced differentiation into astrocytes.(6)The heme oxygenase-1 overexpression group exhibited longer axons,and more intercellular connections.The above results indicate that overexpression of heme oxygenase-1 can alleviate oxidative damage of H2O2-induced neural stem cells,reduce neural stem cell apoptosis,promote proliferation,and facilitate differentiation of neural stem cells into neurons.

Objective:To compare the infection status of severe fever with thrombocytopenia syndrome (SFTS) between the non-endemic area (Yixian county, Huangshan city) and the endemic area (Qianshan city, Anqing city) in Anhui province, and to explore the possibility of Yixian county being a natural focus of SFTS, thereby providing a scientific basis for the formulation of prevention and control strategies.Methods:In Xidi town, Yixian county, and Shuihou town, Qianshan city, one administrative village with the highest number of reported cases in the past three years was selected as the study village in each area, along with one control village with no reported cases. The study investigated the total antibody positivity rates of SFTS virus (SFTSV) in natural populations and host animals, as well as the density and virus-carrying rate of the vector ticks. Differences in total antibody positivity rates between the two regions were compared.Results:The total SFTSV antibody positivity rates in the natural population and host animals in the surveyed villages (control villages) of Qianshan city and Yi county were 8.7% and 8.0% (3.3%, 4.1%) and 0.0%, 9.1% (50.0%, 66.7%), respectively. There was no statistically significant difference in the infection rates of the natural population and host animals between the surveyed villages (control villages) in different endemic regions (all P>0.05). In the surveyed villages of Qianshan city and Yi county, the free-living tick densities were 1.4 ticks/hour per flag and 1.7 ticks/hour per flag, respectively; the parasitic tick densities were 0.4 ticks/host and 2.5 ticks/host, respectively; the tick infestation rates were 33.3% and 35.3%, respectively; and the tick density indices were 1.3 ticks/host and 7.2 ticks/host, respectively. Conclusions:The natural populations and host animals in some areas of Yixian county exhibit high SFTSV infection rates, and the tick density is also high, suggesting that the region may have become a natural focus of SFTS. Therefore, it is necessary to further strengthen capabilities in surveillance, diagnosis, and clinical treatment to address the potential risk of SFTS outbreaks.

BACKGROUND:Formononetin demonstrates potent anti-inflammatory and antioxidant abilities.However,its protective effect on nucleus pulposus mesenchymal stem cells is not yet clear.OBJECTIVE:To investigate the effect and mechanism of formononetin on nucleus pulposus mesenchymal stem cells under an inflammatory microenvironment.METHODS:(1)Primary nucleus pulposus mesenchymal stem cells were isolated from the intervertebral discs of SD rats,and flow cytometry was performed to identify the surface markers of mesenchymal stem cells.(2)The CCK-8 assay was employed to evaluate the impact of lipopolysaccharide and formononetin on the proliferation viability of nucleus pulposus mesenchymal stem cells,aiming to determine the appropriate concentration of formononetin for subsequent cell treatments.(3)An inflammatory microenvironment was simulated by adding 5 μg/mL lipopolysaccharide to the DMEM/F-12 culture medium,and nucleus pulposus mesenchymal stem cells were treated with different concentrations of formononetin for 24 hours.Levels of inflammation markers were detected using western blot assay,real-time quantitative PCR,and immunofluorescence.Western blot assay was conducted to measure the protein levels of the nuclear factor kappa B signaling pathway.RESULTS AND CONCLUSION:(1)The nucleus pulposus mesenchymal stem cells cultured in adherent wall were shuttle-shaped with good growth status.The results of flow cytometry showed that the surface markers of mesenchymal stem cells were positive for CD29,CD44,and CD90,and the surface markers of hematopoietic stem cells were negative for CD34 and CD45.(2)The treatment with formononetin at 12.5,25,50,100,and 200 μmol/L concentrations for 24 hours had no significant proliferation inhibitory effect on nucleus pulposus mesenchymal stem cells.Compared with the lipopolysaccharide group,the cell viability of nucleus pulposus mesenchymal stem cells treated with 12.5,25,and 50 μmol/L formononetin for 24 hours was significantly increased,so formononetin at 12.5,25,and 50 μmol/L concentrations was subsequently selected as the low,medium,and high concentrations for treating nucleus pulposus mesenchymal stem cells.(3)Compared with the lipopolysaccharide group,the protein and mRNA expressions of matrix metalloproteinase-3,matrix metalloproteinase-13,and tumor necrosis factor-α in nucleus pulposus mesenchymal stem cells in the low,medium,and high concentrations of formononetin groups were significantly decreased(P＜0.05)in a dose-dependent manner.(4)Compared with the lipopolysaccharide group,the expressions of phosphorylated nuclear factor kappa B and phosphorylated nuclear factor kappa B inhibitor protein in nucleus pulposus mesenchymal stem cells in the low,medium,and high concentrations of formononetin groups were significantly decreased(P＜0.05)in a dose-dependent manner.The above results suggest that formononetin may attenuate lipopolysaccharide-induced inflammation in rat nucleus pulposus mesenchymal stem cells by inhibiting the activation of the nuclear factor kappa B signaling pathway.

BACKGROUND:Formononetin demonstrates potent anti-inflammatory and antioxidant abilities.However,its protective effect on nucleus pulposus mesenchymal stem cells is not yet clear.OBJECTIVE:To investigate the effect and mechanism of formononetin on nucleus pulposus mesenchymal stem cells under an inflammatory microenvironment.METHODS:(1)Primary nucleus pulposus mesenchymal stem cells were isolated from the intervertebral discs of SD rats,and flow cytometry was performed to identify the surface markers of mesenchymal stem cells.(2)The CCK-8 assay was employed to evaluate the impact of lipopolysaccharide and formononetin on the proliferation viability of nucleus pulposus mesenchymal stem cells,aiming to determine the appropriate concentration of formononetin for subsequent cell treatments.(3)An inflammatory microenvironment was simulated by adding 5 μg/mL lipopolysaccharide to the DMEM/F-12 culture medium,and nucleus pulposus mesenchymal stem cells were treated with different concentrations of formononetin for 24 hours.Levels of inflammation markers were detected using western blot assay,real-time quantitative PCR,and immunofluorescence.Western blot assay was conducted to measure the protein levels of the nuclear factor kappa B signaling pathway.RESULTS AND CONCLUSION:(1)The nucleus pulposus mesenchymal stem cells cultured in adherent wall were shuttle-shaped with good growth status.The results of flow cytometry showed that the surface markers of mesenchymal stem cells were positive for CD29,CD44,and CD90,and the surface markers of hematopoietic stem cells were negative for CD34 and CD45.(2)The treatment with formononetin at 12.5,25,50,100,and 200 μmol/L concentrations for 24 hours had no significant proliferation inhibitory effect on nucleus pulposus mesenchymal stem cells.Compared with the lipopolysaccharide group,the cell viability of nucleus pulposus mesenchymal stem cells treated with 12.5,25,and 50 μmol/L formononetin for 24 hours was significantly increased,so formononetin at 12.5,25,and 50 μmol/L concentrations was subsequently selected as the low,medium,and high concentrations for treating nucleus pulposus mesenchymal stem cells.(3)Compared with the lipopolysaccharide group,the protein and mRNA expressions of matrix metalloproteinase-3,matrix metalloproteinase-13,and tumor necrosis factor-α in nucleus pulposus mesenchymal stem cells in the low,medium,and high concentrations of formononetin groups were significantly decreased(P＜0.05)in a dose-dependent manner.(4)Compared with the lipopolysaccharide group,the expressions of phosphorylated nuclear factor kappa B and phosphorylated nuclear factor kappa B inhibitor protein in nucleus pulposus mesenchymal stem cells in the low,medium,and high concentrations of formononetin groups were significantly decreased(P＜0.05)in a dose-dependent manner.The above results suggest that formononetin may attenuate lipopolysaccharide-induced inflammation in rat nucleus pulposus mesenchymal stem cells by inhibiting the activation of the nuclear factor kappa B signaling pathway.

Objective:To investigate the value of a deep learning radiomics (DLR) nomogram model based on intra-tumoral and peri-tumoral MRI features for differentiating IgG4-related ophthalmic disease (IgG4-ROD) from orbital mucosa-associated lymphoid tissue (MALT) lymphoma.Methods:This was a case-control study. The clinical and imaging data of 233 patients pathologically confirmed with either IgG4-ROD or orbital MALT lymphoma were retrospective collected between January 2020 and December 2024 from the Second Hospital of Jilin University (Center 1) and Beijing Tongren Hospital, Capital Medical University (Center 2). Patients from Center 1 ( n=158) were used as the training cohort, while those from Center 2 ( n=75) served as the validation cohort. Among the cases, 102 were IgG4-ROD (70 in training, 32 in validation) and 131 were orbital MALT lymphoma (88 in training, 43 in validation). Univariate and multivariate logistic regression analyses were used to identify independent clinical imaging predictors and build a clinical imaging model. Based on T 1WI, T 2WI, and diffusion weighted images, intra-tumoral regions were manually delineated, a 2 mm peri-tumoral margin was automatically generated, and both regions were combined as a single region of interest for radiomics feature extraction. Deep learning features were extracted using a ResNet-50 backbone, and after feature selection and dimensionality reduction, a DLR model was constructed. The clinical imaging features and DLR features were integrated to build a combined nomogram model. Model performance in differentiating IgG4-ROD from orbital MALT lymphoma was assessed using receiver operating characteristic curves, calibration curves, and decision curve analysis. The area under the curve (AUC) were compared using the DeLong test. Results:Bilateral orbital involvement ( OR=1.983, 95% CI 1.166-2.843, P=0.046) and extraocular muscle involvement ( OR=1.246, 95% CI 1.079-1.764, P=0.015) were identified as independent predictors for distinguishing IgG4-ROD from orbital MALT lymphoma and were used to construct the clinical model. Fourteen features (9 radiomics and 5 deep learning features) were selected for the DLR model, and a nomogram was developed. In the training set, the AUCs for the clinical model, DLR model, and nomogram were 0.762 (95% CI 0.712-0.812), 0.865 (95% CI 0.822-0.908), and 0.943 (95% CI 0.909-0.953), respectively. In the validation set, the AUCs were 0.733 (95% CI 0.675-0.791), 0.823 (95% CI 0.762-0.884), and 0.924 (95% CI 0.902-0.958), respectively. The nomogram showed significantly higher AUCs than those of the clinical and DLR models alone (training set: Z=3.92, 2.87, P0.001, P=0.004; validation set: Z=3.25, 2.46, P=0.001, 0.014). Calibration curves indicated good agreement between predicted and actual IgG4-ROD incidence, and decision curve analysis demonstrated the highest net benefit for the nomogram. Conclusion:A nomogram that incorporates both intra-tumoral and peri-tumoral DLR features and clinical imaging characteristics demonstrates excellent performance in distinguishing IgG4-ROD from orbital MALT lymphoma.

BACKGROUND:Studies have shown that upregulation of heme oxygenase-1 expression enhances cellular antioxidant and anti-apoptotic abilities.However,the effects of upregulating heme oxygenase-1 expression on the proliferation and differentiation of neural stem cells under oxidative stress conditions remain unclear.OBJECTIVE:To investigate the influence of heme oxygenase-1 overexpression on the survival and differentiation capacity of neural stem cells under oxidative stress conditions.METHODS:(1)Mouse primary neural stem cells were isolated and cultured from newborn Balb/c mice.Immunofluorescence was used to detect the neural stem cell marker Nestin.(2)Lentivirus was used to infect neural stem cells to induce heme oxygenase-1 overexpression.Flow cytometry was used to assess green fluorescent protein fluorescence.Western blot assay was performed to detect the expression levels of heme oxygenase-1.(3)H2O2 was added to the lentivirus-infected neural stem cell culture medium to simulate the oxidative stress microenvironment after spinal cord injury.Effects of heme oxygenase-1 overexpression on neural stem cell proliferation and apoptosis levels were analyzed using cell proliferation assay kits,cell apoptosis assay kits,and TUNEL staining kits.(4)The levels of lipid oxidation markers malondialdehyde,catalase,superoxide dismutase,and glutathione peroxidase were detected using assay kits.(5)Flow cytometry was used to measure intracellular reactive oxygen species levels,and neural stem cell differentiation into astrocytes and neurons.(6)The effect of heme oxygenase-1 overexpression on neuronal axon growth during neural stem cell differentiation was observed under optical and fluorescence microscopes.RESULTS AND CONCLUSION:(1)Mouse neural stem cells exhibited stable morphology,good growth status,and high expression of Nestin as detected by immunofluorescence.(2)Western blot analysis showed that the overexpression of heme oxygenase-1 in the overexpression group was significantly higher than that in the empty carrier control group.Flow cytometry was used to detect the expression of green fluorescent protein in the neural stem cells of the heme oxygenase-1 overexpression group and empty vector control group.(3)Overexpression of heme oxygenase-1 maintained the proliferative activity of neural stem cells and significantly reduced the number of apoptotic cells under oxidative stress conditions.(4)Overexpression of heme oxygenase-1 inhibited lipid peroxidation of neural stem cells under oxidative stress microenvironment,enhanced the expression of enzymes related to maintaining the oxidative-reductive balance,and significantly reduced intracellular reactive oxygen species levels.(5)Overexpression of heme oxygenase-1 promoted the differentiation of neural stem cells into neurons and reduced differentiation into astrocytes.(6)The heme oxygenase-1 overexpression group exhibited longer axons,and more intercellular connections.The above results indicate that overexpression of heme oxygenase-1 can alleviate oxidative damage of H2O2-induced neural stem cells,reduce neural stem cell apoptosis,promote proliferation,and facilitate differentiation of neural stem cells into neurons.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.