Background: En bloc resection is recommended for the treatment of malignant and aggressive benign spinal tumors; however, it often requires a combined anterior-posterior approach, which is usually accompanied by longer surgical duration, increased blood loss, larger trauma, and surgical complexity. The present study describes a novel rotation-reversion technique for en bloc resection of the thoracic and upper lumbar spinal tumors using a posterior-only approach and evaluate its safety and efficacy. Methods: Thirteen patients with thoracic and upper lumbar (L1-L3) spinal tumors were treated with en bloc resection using the rotation-reversion technique through a posterior-only approach at our institution between 2015 and 2023. The clinical characteristics and surgical results of the patients were reviewed and analyzed. Results: Posterior-only en bloc resection was performed successfully in all 13 patients using the rotation-reversion technique, with a median follow-up of 30.4 months (range, 6–74 months). The average maximum size of these 13 tumors was 5.7 × 5.8 × 4.8 cm.The mean operation time and blood loss were 458.5 minutes (range, 220–880 minutes) and 3,146.2 mL (range, 1,000–6,000 mL), respectively, with 4 of the 13 patients (30.8%) experiencing perioperative complications. Negative margins were achieved in all the 13 patients (100%). One patient experienced local recurrence (7.7%) and 1 patient experienced instrumentation failures. Interbody fusion was confirmed in 11 of the 13 patients (84.6%), with a median fusion time of 6.9 months. All of the 13 patients experienced varying degrees of mild postoperative neurological deficits owing to resection of the nerve roots affected by tumor invasion of the vertebrae. No vessel injury or postoperative neurological paralysis occurred, except 1 patient who had been completely paralyzed before surgery. Conclusions The rotation-reversion technique is an effective procedure for en bloc resection of selected thoracic and upper lumbar spinal tumors through the posterior-only approach.

Background: En bloc resection is recommended for the treatment of malignant and aggressive benign spinal tumors; however, it often requires a combined anterior-posterior approach, which is usually accompanied by longer surgical duration, increased blood loss, larger trauma, and surgical complexity. The present study describes a novel rotation-reversion technique for en bloc resection of the thoracic and upper lumbar spinal tumors using a posterior-only approach and evaluate its safety and efficacy. Methods: Thirteen patients with thoracic and upper lumbar (L1-L3) spinal tumors were treated with en bloc resection using the rotation-reversion technique through a posterior-only approach at our institution between 2015 and 2023. The clinical characteristics and surgical results of the patients were reviewed and analyzed. Results: Posterior-only en bloc resection was performed successfully in all 13 patients using the rotation-reversion technique, with a median follow-up of 30.4 months (range, 6–74 months). The average maximum size of these 13 tumors was 5.7 × 5.8 × 4.8 cm.The mean operation time and blood loss were 458.5 minutes (range, 220–880 minutes) and 3,146.2 mL (range, 1,000–6,000 mL), respectively, with 4 of the 13 patients (30.8%) experiencing perioperative complications. Negative margins were achieved in all the 13 patients (100%). One patient experienced local recurrence (7.7%) and 1 patient experienced instrumentation failures. Interbody fusion was confirmed in 11 of the 13 patients (84.6%), with a median fusion time of 6.9 months. All of the 13 patients experienced varying degrees of mild postoperative neurological deficits owing to resection of the nerve roots affected by tumor invasion of the vertebrae. No vessel injury or postoperative neurological paralysis occurred, except 1 patient who had been completely paralyzed before surgery. Conclusions The rotation-reversion technique is an effective procedure for en bloc resection of selected thoracic and upper lumbar spinal tumors through the posterior-only approach.

Background: En bloc resection is recommended for the treatment of malignant and aggressive benign spinal tumors; however, it often requires a combined anterior-posterior approach, which is usually accompanied by longer surgical duration, increased blood loss, larger trauma, and surgical complexity. The present study describes a novel rotation-reversion technique for en bloc resection of the thoracic and upper lumbar spinal tumors using a posterior-only approach and evaluate its safety and efficacy. Methods: Thirteen patients with thoracic and upper lumbar (L1-L3) spinal tumors were treated with en bloc resection using the rotation-reversion technique through a posterior-only approach at our institution between 2015 and 2023. The clinical characteristics and surgical results of the patients were reviewed and analyzed. Results: Posterior-only en bloc resection was performed successfully in all 13 patients using the rotation-reversion technique, with a median follow-up of 30.4 months (range, 6–74 months). The average maximum size of these 13 tumors was 5.7 × 5.8 × 4.8 cm.The mean operation time and blood loss were 458.5 minutes (range, 220–880 minutes) and 3,146.2 mL (range, 1,000–6,000 mL), respectively, with 4 of the 13 patients (30.8%) experiencing perioperative complications. Negative margins were achieved in all the 13 patients (100%). One patient experienced local recurrence (7.7%) and 1 patient experienced instrumentation failures. Interbody fusion was confirmed in 11 of the 13 patients (84.6%), with a median fusion time of 6.9 months. All of the 13 patients experienced varying degrees of mild postoperative neurological deficits owing to resection of the nerve roots affected by tumor invasion of the vertebrae. No vessel injury or postoperative neurological paralysis occurred, except 1 patient who had been completely paralyzed before surgery. Conclusions The rotation-reversion technique is an effective procedure for en bloc resection of selected thoracic and upper lumbar spinal tumors through the posterior-only approach.

Background and Aims:Chronic skin ulcers are a significant disease affecting patients'daily lives and psychological well-being.Abnormalities in the cells and extracellular matrix within the tissue may disrupt the balance of the microenvironment,hindering the normal skin repair process and leading to delayed healing of the ulcer.There is currently a lack of research on the mechanisms underlying the development of chronic ulcers and their diagnostic biomarkers.Single-cell sequencing,a newly developed high-throughput sequencing method in recent years,uses gene sequencing at the single-cell resolution to precisely reveal disease mechanisms and has been applied in various diseases.This study used single-cell transcriptome sequencing(scRNA-Seq)to investigate the cellular heterogeneity in chronic skin ulcer tissue to elucidate the potential molecular mechanisms behind delayed healing and provide new insights for clinical treatment.Methods:The scRNA-Seq technology was used to compare the differences in cell subpopulations and gene expression between chronic ulcer tissue and normal skin tissue.Single cells were sorted using a microfluidic platform,and cDNA libraries were constructed for subsequent differential gene analysis and functional enrichment analysis.Results:scRNA-Seq analysis revealed significant immune-metabolic remodeling features in chronic ulcer tissue:the number of B cells,monocytes,and macrophages in ulcer tissue increased by 2.1 to 3.5 times compared to the normal tissue control.This was accompanied by widespread activation of collagen synthesis genes(COL1A1/COL3A1)and synergistic suppression of immune regulators(e.g.,granzyme family GZMA/GZMB/H).Cross-cell subpopulation functional network analysis showed that hypoxia response mediated by the HIF-1 signaling pathway and PI3K/Akt pathway abnormalities formed a positive feedback loop,exacerbating the imbalance in the secretion of inflammatory factors(CXCL3/8,TGFBI)and compensatory upregulation of mitochondrial oxidative phosphorylation.Conclusion:Chronic skin ulcers exhibit significant differences in cellular heterogeneity and gene expression,suggesting that chronic ulcers are not simply tissue defects but a complex pathological process dominated by chronic inflammation and immune dysregulation.The coordinated dysregulation of multiple cell subpopulations in the ulcer microenvironment,along with persistent inflammatory responses and metabolic abnormalities,is interconnected through the HIF-1/TNF/MAPK pathway network.Downregulation of granzyme gene family members and abnormal histone modifications may contribute to immune clearance defects,providing a theoretical basis for developing novel therapies targeting epigenetic regulation or mitochondrial function.

Objective To investigate the expression and regulatory role of adenosine triphosphate binding transporter C4(ABCC4)in patients with type 2 diabetes mellitus(T2DM)and macrovascular disease(MD).Methods A total of 137 patients with T2DM were enrolled in this study from Zhongnan Hospital of Wuhan University during March 2015 and March 2017.All the participants were divided into T2DM group(n=64)and T2DM with MD group(n=73)according to the presence or absence of MD.Another 75 healthy subjects were selected as normal control(NC)group.The general data and biochemical indicators were collected and compared among the three groups.The mRNA expression level of ABCC4 was detected by real-time fluorescence quantitative PCR(qPCR),and the correlation between each indicator and ABCC4 mRNA was analyzed.ABCC4 knockout stable HepG2 cell line was constructed and transcriptome sequencing analysis(RNA-Seq)was performed.Results BMI,FPG,TC,TG and LDL-C were higher,while HDL-C was lower in T2DM and MD groups than in NC group(P<0.05).The expression levels of SBP and ABCC4 mRNA were higher in MD group than in T2DM and NC groups(P<0.05).Spearman correlation analysis showed that the level of ABCC4 mRNA was negatively correlated with cholinesterase(r=-0.359,P<0.05)and positively correlated with lipoprotein(a)(r=0.241,P<0.05).A total of 280 differentially expressed genes were screened out by RNA-Seq in ABCC4 knockout cell lines.GO and KEGG analysis showed that these differentially expressed genes were mainly enriched in biological functions such as vesicle transport and growth factor activity.It is involved in cytokine receptor interaction,glycation products-receptor for advanced glycation end products signaling pathway of DM complications,leukocyte transendothelial migration and other pathways.Conclusions ABCC4 is elevated in patients with T2DM and macrovascular disease.ABCC4 might play a role in occurrence and development of macrovascular disease through affecting the biological function of membrane,inflammation and glycation metabolism pathways.

Objective:To investigate the clinical value of a fully autonomous ultrasound robot in splenic ultrasound imaging.Methods:A retrospective study was conducted by enrolling 56 adult volunteers from the Third Medical Center of the Chinese PLA General Hospital between February 1-8，2024 as research subjects.A senior physician sequentially performed splenic ultrasound examinations using both the fully autonomous ultrasound robot and a matched portable ultrasound device. The acquired images were randomly coded and scored via a double-blind method by 3 physicians. The differences of the image quality scores and high-quality image proportions between the two groups were compared. Examination durations were recorded and compared between the two groups.Results:Both modalities successfully acquired splenic images in all 56 volunteers. No statistically significant differences were observed in image quality scores among the 3 physicians：（3.52 ± 1.31）points vs.（3.83 ± 1.23）points，（2.77 ± 1.23）points vs.（3.17 ± 1.17）points，and（3.48 ± 0.97）points vs.（3.79 ± 0.94）points（all P>0.05）. The numbers of images scoring ≥ 3 points showed no significant differences：45（80.36%） vs. 50（89.29%），30（53.57%） vs. 38（67.86%），and 48（85.71%） vs. 52（92.86%）（all P>0.05）. The fully autonomous ultrasound robot required significantly longer examination time［（60.86 ± 50.55）s vs.（7.95 ± 4.35）s， t=6.88， P＜0.01］. Conclusions:The fully autonomous ultrasound robot demonstrates comparable image quality and clinically acceptable image proportions to conventional portable ultrasound in splenic examinations. These findings suggest its potential equivalence to operator-dependent ultrasound for splenic imaging，supporting its feasibility as an alternative ultrasound modality despite longer procedural duration.

Objective:To evaluate a novel self-designed elbow flexion-extension axis guide that is easy to operate, accurately positioned, and X-ray-free.Methods:This study collected the elbow joint CT scans from 60 normal adults [40 males and 20 females with an age of (38.1±9.3) years] at Department of Orthopedics, The Third Hospital of Xiamen between September and December 2024. The scan images were imported into 3D modeling software for systematic measurement of key anatomical parameters of the distal humerus. The structural design of a novel elbow flexion-extension axis guide was completed based on these measurements, combined with the anatomical data of the distal humerus reported in 6 relevant articles between January 2008 and December 2024 retrieved from the CNKI and PubMed databases. After physical models of the distal humerus from the 60 healthy adults were fabricated using 3D printing technology, they were divided into 2 even groups: a guide-assisted group ( n=30) where the positioning needle was inserted with the assistance of the elbow flexion-extension axis guide and a conventional group ( n=30) where the positioning needle was inserted freehand. The entry deviation, exit deviation, inter-axial angle, inter-axial distance, operation time, and fluoroscopic verifications in positioning of elbow flexion-extension axis were compared between the 2 groups. Results:The guide-assisted group demonstrated significantly smaller values than the conventional group in entry deviation [(1.52±0.70) mm versus (2.29±1.00) mm], exit deviation [(2.83±1.49) mm versus (4.95±1.63) mm], inter-axial angle (3.46°±0.93° versus 6.45°±1.21°), and operation time [(92.0±17.0) s versus (509.5±42.3) s] (all P<0.05). The conventional group required an average of (10.7±2.1) fluoroscopic verifications, while the guide-assisted group eliminated radiation exposure. No statistically significant difference was observed in the inter-axial distance between the 2 methods in positioning of elbow flexion-extension axis ( P>0.05). Conclusion:As the novel self-designed elbow flexion-extension axis guide can improve accuracy in positioning the elbow flexion-extension axis without requiring fluoroscopy, it significantly shortens intraoperative positioning time, and is handy to use.

Objective To investigate the effects of Bushen Zhuanggu decoction on total N-terminal propeptide of type Ⅰprocollagen(t-PINP)and β-C-terminal telopeptide of type Ⅰ collagen(β-CTX)in patients with knee osteoarthritis(KOA).Methods A total of 120 patients with liver-kidney deficiency KOA treated in Linping District Hospital of Traditional Chinese Medicine from June 2021 to April 2024 were selected and divided into study group and control group according to random number table method,with 60 cases in each group.The patients of control group was given oral treatment with etocoxib and omeprazole,and patients of study group was given oral treatment of Bushen Zhuanggu decoction on the basis of control group.Both groups were treated for one month.The clinical efficacy,TCM syndrome scores,serum t-PINP and β-CTX leves,t-PINP/β-CTX,Western Ontario and Mcmaster Universities osteoarthritis index(WOMAC)scores and adverse reactions during treatment were compared between two groups.Results The total effective rate in study group was significantly higher than that in control group(x2=4.5 13,P=0.034).After treatment,the TCM syndrome scores,serum t-PINP and β-CTX levels and WOMAC scores in two groups were significantly lower than before treatment,and t-PINP/β-CTX were significantly higher than before treatment(P＜0.05).The TCM syndrome scores,serum t-PINP and β-CTX levels and WOMAC scores in study group were significantly lower than those in control group,and t-PINP/β-CTX was significantly higher than that in control group(P＜0.05).There was no significant difference in incidence of adverse reactions between two groups(x2=0.686,P=0.408).Conclusion Bushen Zhuanggu decoction can improve the clinical efficacy of KOA patients with liver-kidney deficiency,relieve clinical symptoms and pain,increase t-PINP/β-CTX,and reduce the incidence of adverse reactions.

China is facing the double burden of high incidence of lung cancer and tuberculosis epidemic. Lung cancer combined with tuberculosis has a high incidence and complexity in clinical practice. High-risk groups include immunocompromised people, long-term smokers and people with a history of tuberculosis. The coexistence of the two diseases not only increases the difficulty of diagnosis and treatment decision-making, but also increases the risk of treatment-related adverse reactions and drug interactions. The guideline was developed by Committee of Integrated Rehabilitation for Lung Cancer, Chinese Anti-Cancer Association; Chinese and Western Integrated Lung Cancer Committee of Chinese Anti-Cancer Association; Society of Tuberculosis, Chinese Medical Association, aiming to standardize the diagnosis and treatment of lung cancer complicated with pulmonary tuberculosis. The guideline emphasizes the core position of combined diagnosis of multimodal imaging, etiology and pathology. It is proposed that anti-tuberculosis and anti-tumor treatment should be coordinated under the framework of multidisciplinary team, and drug interactions and timing optimization should be paid attention to. For surgical treatment, minimally invasive resection combined with systematic lymph node dissection is recommended after infection control. Systemic therapy requires individualized risk stratification and dynamic monitoring of efficacy and adverse reactions. Based on evidence-based medicine and Chinese clinical practice, combined with the accessibility of drugs and technologies, this guideline proposes a whole-process management pathway covering screening, diagnosis, treatment and follow-up, in order to improve the prognosis and quality of life of patients.