Objective:To investigate the impact of correcting rotational subluxation through circumferential fusion and transforaminal lumbar interbody fusion (TLIF) on postoperative coronal plane imbalance in degenerative scoliosis.Methods:A retrospective analysis was conducted on the data of 108 patients with type A degenerative scoliosis in the Nanjing classification who underwent primary multi-segment posterior column osteotomy (PCO) with deformity correction and internal fixation at Nanjing Gulou Hospital from June 2017 to June 2021. Patients were divided into two groups based on the presence of preoperative rotational subluxation: the rotational subluxation group and the non-rotational subluxation group. The rotational subluxation group consisted of 60 patients, with 8 males and 52 females, aged 63.7±5.5 years (range, 56-75 years). The non-rotational subluxation group included 48 patients, with 5 males and 43 females, aged 64.4±5.2 years (range, 53-72 years). Within the rotational subluxation group, depending on whether TLIF was performed on the rotational subluxation segment, they were further categorized into the TLIF group and the PCO group. The TLIF group comprised 28 patients, while the PCO group had 32 patients. Full-spine anteroposterior and lateral X-rays were taken preoperatively, postoperatively, and at the last follow-up to measure coronal balance types and radiographic parameters. The differences in the lumbar Cobb angle, coronal balance distance (CBD), and the Cobb angle of the lumbosacral curve (Cobb-Fra angle) were compared between the rotational subluxation group and the non-rotational subluxation group, as well as between the TLIF group and the PCO group.Results:The average surgery duration ranged from 200 to 310 min, with a mean of 235±47 min. The intraoperative blood loss ranged from 700 to 2,400 ml, with an average of 950±355 ml. The number of fused segments in the rotational subluxation group was 7.6±2.1, ranging from 5 to 11 segments, while in the non-rotational subluxation group, it was 7.4±2.0, ranging from 5 to 10 segments. Postoperatively, 13%(8/60) of patients in the rotational subluxation group developed type C coronal imbalance, significantly higher than the 2%(1/48) in the non-rotational subluxation group. The immediate postoperative and final follow-up lumbar Cobb angles, CBD, and Cobb-Fra angles in the rotational subluxation group were 20.60°±10.73° and 20.33°±10.92°, 22.53±16.45 mm and 18.53±17.31 mm, 13.14°±4.40° and 11.23°±4.92°, respectively, which were higher than those in the non-rotational subluxation group (13.92°±7.02° and 12.92°±6.64°, 18.62±17.44 mm and 8.83±8.95 mm, 11.91°±3.03° and 9.52°±3.30°), with statistical significance ( P<0.05).. Among patients in the rotational subluxation group, the probability of new-onset coronal imbalance postoperatively was 4%(1/28) in the TLIF group, which was lower than the 22%(7/32) in the PCO group, with a statistically significant difference (χ 2=4.330, P=0.037). The immediate postoperative and final follow-up lumbar Cobb angles, CBD, and Cobb-Fra angles in the PCO group were 25.63°±11.00° and 25.13°±11.04°, 27.37±18.95 mm and 25.25±18.67 mm, 15.50°±3.62° and 14.08°±4.77°, respectively, which were significantly higher than those in the TLIF group (14.86°±6.96° and 14.86°±5.37°, 17.08±10.94 mm and 10.86±7.86 mm, 10.14°±3.37° and 8.46°±2.66°), with statistical significance ( P<0.05). Conclusion:For patients with Type A degenerative scoliosis combined with rotational subluxation according to the Nanjing classification, performing a 360-degree circumferential release and interbody fusion at the segment with rotatory subluxation can reduce the risk of developing new postoperative coronal imbalances.

Objective:To analyze the clinical features and prognosis of patients with lymphoplasmacytic lymphoma/Waldenstr?m macroglobulinemia (LPL/WM) transformed into diffuse large B-cell lymphoma (DLBCL) .Methods:This study retrospectively analyzed the clinical data of five patients with LPL/WM transformed to DLBCL diagnosed and treated at a multicenter hospital in Hunan Province from December 2020 to April 2023. Clinical manifestations, treatment regimens, and therapeutic efficacy before and after the transformation were compared.Results:Of the five patients, four were male and one was female, with a median age of 64.0 (57.0–80.0) years, all of whom had abnormally increased β 2-microglobulin levels at diagnosis, and two were combined with increased lactate dehydrogenase levels. The MYD88 L265P mutation was detected in 4 patients, whereas 1 carried the FAT1 and NOTCH1 mutations, and none demonstrated CXCR4 mutations. Three patients were negative for the TP53 mutation, and two were not tested. Before transformation, three patients were treated with Bruton tyrosine kinase inhibitor therapy, and one patient was treated with the bendamustine plus rituximab regimen. All patients eventually transformed into non-growth center-derived DLBCL, with a median time to conversion of 11.8 (4.0–19.0) months, and most of them presented with weight loss, lymph node enlargement, splenomegaly, and extranodal involvement. Posttransformation, the patients were mainly treated with the rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (R-CHOP) regimen, with an optimal outcome of partial remission. Disease progression occurred in 4 of the patients, with a median overall survival of 16.8 (10.0–26.0) months. Conclusion:Transformation from LPL/WM to DLBCL is rare. Patients should remain highly vigilant for transformation if they develop rapidly enlarging lymph nodes and/or newly involved lymph nodes, worsening systemic symptoms, and declining body mass. R-CHOP regimen may induce a partial response in some cases; however, the overall prognosis remains poor.

Objective: To explore the mechanism of cistanche deserticola(meat cistanche) in treating Alzheimer′s disease(AD) through network pharmacology, molecular docking, and animal experiments. Methods : Effective components of meat cistanche were mined from the TCMSP database, and AD-related targets were filtered using the SwissTargetPrediction, DisGeNET, and GeneCards databases. The intersection of these targets was analyzed using protein-protein interaction(PPI) networks. Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analyses were conducted via the Metascape database. Molecular docking of meat cistanche′s active components with core targets was performed using AutoDock Vina. Based on network pharmacology predictions, an AD model was established using 8-month-old SAMP8 mice, with Morris water maze tests assessing learning and cognitive functions, Nissl staining observing hippocampal neuron morphology, and enzyme-linked immunosorbent assays and Western blotting detecting the expression levels of cAMP signaling pathway-related proteins in hippocampal tissues. Results : Network pharmacology analysis predicted that meat cistanche might act on 74 AD targets through 8 active components. Molecular docking showed high affinity of active components like acteoside with core targets such as ESR1, BDNF, MAPK1, and APP. KEGG analysis indicated involvement in pathways related to cancer, cAMP signaling, and AD. Animal experiments demonstrated that meat cistanche effectively improved learning and cognitive impairments in AD mice and alleviated hippocampal neuron damage. ELISA and Western blotting results indicated that meat cistanche significantly increased the expression levels of cAMP, PKA, P-CREB in the cAMP pathway and promoted the expression of downstream neurotrophic factor BDNF. Conclusion Meat cistanche can improve learning and cognitive disorders in AD model mice and may exert therapeutic effects on AD by up-regulating the cAMP signaling pathway and the expression of downstream BDNF protein targets, thereby improving hippocampal neuron injury.

Objective To analyze the risk factors for chronic cough following pulmonary surgery in patients with non-small cell lung cancer (NSCLC). Methods A retrospective analysis was conducted on 427 NSCLC patients who underwent pulmonary surgery in the Department of Thoracic Surgery, The First Affiliated Hospital of the University of Science and Technology of China, between January 2021 and June 2023. Patients were categorized into a chronic cough group (103 patients) and a non-chronic cough group (324 patients) based on the presence of cough at 8 weeks post-surgery. A comparative analysis was performed between the two groups, considering gender, age, smoking history, comorbidities, preoperative pulmonary function indicators, pleural adhesion, anesthesia duration, surgical site, operative techniques, lymph node dissection methods, tumor maximum diameter, and postoperative chest tube duration. Factors showing statistical significance in univariate analysis underwent multivariate logistic regression analysis. Results Among the 427 patients undergoing pulmonary surgery, there were 165 males and 262 females, with an average age of (59.93±12.11) years. The incidence of chronic cough was 24.12%. Univariate analysis revealed significant differences in smoking history, preoperative pulmonary function indicators, pleural adhesion, anesthesia duration ≥135.5 minutes, surgical site, operative techniques, lymph node dissection methods, tumor maximum diameter, and postoperative chest tube duration (P<0.05). Multivariate logistic regression analysis indicated that the surgical site (right upper lung), operative techniques (lobectomy), lymph node dissection, and anesthesia time ≥135.5 minutes were independent risk factors for chronic cough following pulmonary surgery. Conclusion Patients undergoing right upper lung surgery, lobectomy, lymph node dissection, and experiencing anesthesia duration ≥135.5 minutes are at a higher risk of developing chronic cough post-pulmonary surgery.

Objective:To analyze the clinical features and prognosis of patients with lymphoplasmacytic lymphoma/Waldenstr?m macroglobulinemia (LPL/WM) transformed into diffuse large B-cell lymphoma (DLBCL) .Methods:This study retrospectively analyzed the clinical data of five patients with LPL/WM transformed to DLBCL diagnosed and treated at a multicenter hospital in Hunan Province from December 2020 to April 2023. Clinical manifestations, treatment regimens, and therapeutic efficacy before and after the transformation were compared.Results:Of the five patients, four were male and one was female, with a median age of 64.0 (57.0–80.0) years, all of whom had abnormally increased β 2-microglobulin levels at diagnosis, and two were combined with increased lactate dehydrogenase levels. The MYD88 L265P mutation was detected in 4 patients, whereas 1 carried the FAT1 and NOTCH1 mutations, and none demonstrated CXCR4 mutations. Three patients were negative for the TP53 mutation, and two were not tested. Before transformation, three patients were treated with Bruton tyrosine kinase inhibitor therapy, and one patient was treated with the bendamustine plus rituximab regimen. All patients eventually transformed into non-growth center-derived DLBCL, with a median time to conversion of 11.8 (4.0–19.0) months, and most of them presented with weight loss, lymph node enlargement, splenomegaly, and extranodal involvement. Posttransformation, the patients were mainly treated with the rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (R-CHOP) regimen, with an optimal outcome of partial remission. Disease progression occurred in 4 of the patients, with a median overall survival of 16.8 (10.0–26.0) months. Conclusion:Transformation from LPL/WM to DLBCL is rare. Patients should remain highly vigilant for transformation if they develop rapidly enlarging lymph nodes and/or newly involved lymph nodes, worsening systemic symptoms, and declining body mass. R-CHOP regimen may induce a partial response in some cases; however, the overall prognosis remains poor.

Objective:To investigate the impact of correcting rotational subluxation through circumferential fusion and transforaminal lumbar interbody fusion (TLIF) on postoperative coronal plane imbalance in degenerative scoliosis.Methods:A retrospective analysis was conducted on the data of 108 patients with type A degenerative scoliosis in the Nanjing classification who underwent primary multi-segment posterior column osteotomy (PCO) with deformity correction and internal fixation at Nanjing Gulou Hospital from June 2017 to June 2021. Patients were divided into two groups based on the presence of preoperative rotational subluxation: the rotational subluxation group and the non-rotational subluxation group. The rotational subluxation group consisted of 60 patients, with 8 males and 52 females, aged 63.7±5.5 years (range, 56-75 years). The non-rotational subluxation group included 48 patients, with 5 males and 43 females, aged 64.4±5.2 years (range, 53-72 years). Within the rotational subluxation group, depending on whether TLIF was performed on the rotational subluxation segment, they were further categorized into the TLIF group and the PCO group. The TLIF group comprised 28 patients, while the PCO group had 32 patients. Full-spine anteroposterior and lateral X-rays were taken preoperatively, postoperatively, and at the last follow-up to measure coronal balance types and radiographic parameters. The differences in the lumbar Cobb angle, coronal balance distance (CBD), and the Cobb angle of the lumbosacral curve (Cobb-Fra angle) were compared between the rotational subluxation group and the non-rotational subluxation group, as well as between the TLIF group and the PCO group.Results:The average surgery duration ranged from 200 to 310 min, with a mean of 235±47 min. The intraoperative blood loss ranged from 700 to 2,400 ml, with an average of 950±355 ml. The number of fused segments in the rotational subluxation group was 7.6±2.1, ranging from 5 to 11 segments, while in the non-rotational subluxation group, it was 7.4±2.0, ranging from 5 to 10 segments. Postoperatively, 13%(8/60) of patients in the rotational subluxation group developed type C coronal imbalance, significantly higher than the 2%(1/48) in the non-rotational subluxation group. The immediate postoperative and final follow-up lumbar Cobb angles, CBD, and Cobb-Fra angles in the rotational subluxation group were 20.60°±10.73° and 20.33°±10.92°, 22.53±16.45 mm and 18.53±17.31 mm, 13.14°±4.40° and 11.23°±4.92°, respectively, which were higher than those in the non-rotational subluxation group (13.92°±7.02° and 12.92°±6.64°, 18.62±17.44 mm and 8.83±8.95 mm, 11.91°±3.03° and 9.52°±3.30°), with statistical significance ( P<0.05).. Among patients in the rotational subluxation group, the probability of new-onset coronal imbalance postoperatively was 4%(1/28) in the TLIF group, which was lower than the 22%(7/32) in the PCO group, with a statistically significant difference (χ 2=4.330, P=0.037). The immediate postoperative and final follow-up lumbar Cobb angles, CBD, and Cobb-Fra angles in the PCO group were 25.63°±11.00° and 25.13°±11.04°, 27.37±18.95 mm and 25.25±18.67 mm, 15.50°±3.62° and 14.08°±4.77°, respectively, which were significantly higher than those in the TLIF group (14.86°±6.96° and 14.86°±5.37°, 17.08±10.94 mm and 10.86±7.86 mm, 10.14°±3.37° and 8.46°±2.66°), with statistical significance ( P<0.05). Conclusion:For patients with Type A degenerative scoliosis combined with rotational subluxation according to the Nanjing classification, performing a 360-degree circumferential release and interbody fusion at the segment with rotatory subluxation can reduce the risk of developing new postoperative coronal imbalances.

Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.

Objective:To investigate the effect of perineal single-port robot-assisted radical prostatectomy.Methods:A retrospective analysis was conducted on clinical data from 60 patients who underwent perineal single-port robot-assisted laparoscopic radical prostatectomy at our hospital between July 2019 and July 2022. The mean age of the patients was (65.9±7.6) years and the mean BMI was (24.1±2.9) kg/m 2. The median (IQR) prostate volume was 32.7 (23.8, 41.2) ml, and the median (IQR) preoperative PSA value was 8.8 (6.8, 12.6) ng/ml. Preoperative pathology revealed a Gleason score of 6 in 21 patients, Gleason score of 7 in 35 patients and Gleason score of 8 in 4 patients. There were 12 patients clinically staged as T 1 and 48 patients as T 2. A total of 18 patients underwent a total of 23 previous abdominopelvic surgeries. The patient is placed in an exaggerated lithotomy position with the head down and feet elevated approximately 15°. A 3-5 cm incision was made approximately 2 cm above on the mid-perineum between the bilateral ischial tuberosities. Next, the rectourethral muscle was divided, and the space anterior to the rectum was developed by blunt dissection. The levator ani muscles were separated to expose Denonvilliers’ fascia. Then, the disposable multi-channel laparoscopic surgical access system is inserted with a surgical wound protector. Denonvilliers’ fascia was incised transversely and the ampulla of the vas deferens, which were subsequently divided. Blunt separation is performed on both sides along the capsule of the prostate, and then, the vascular pedicles of the prostate are ligated. The membranous urethra was severed after complete urethral separation at the tip of the prostate at the urethral junction. The bladder neck was freed and dissected. The prostate and seminal vesicles were removed and a vesicourethral anastomosis is performed. A perineal drain were left in place. Preoperative and postoperative variables, complications, early urinary continence rate(Return of urinary continence status was defined as using no more than one safety pad per day) and oncological outcomes of patients were recorded. Results:All 60 surgeries were successfully completed without conversions or additional incisions. The median (IQR) total operative time was 200.0(153.8, 236.3) min, the median (IQR) console operating time was 107.5(90.0, 150.0) min and the median (IQR) estimated blood loss was 50.0(50.0, 100.0) ml. Positive surgical margins were detected in five patients (8.3%). The continence rate was 43.1%(22/51), 64.7%(33/51), 92.0%(46/50) and 98.0%(49/50), and the PSA undetectable rate was 94.6%(48/51), 98.2%(49/51), 96.6%(47/50) and 100%(50/50) at the 1, 3, 6, and 12 months after surgery. Only 1(1.7%) patient experienced biochemical recurrence 9 months after surgery. The overall complication rate was 20%, including two cases of acute respiratory distress syndrome, one case of rectal injury, one case of urinary tract injury, two cases of poor wound healing, three cases of incision infection, two cases of urinary tract infection and one case of bladder neck-urethral orifice anastomotic stricture.Conclusions:Perineal single-port robot-assisted radical prostatectomy might be safe and feasible surgical treatments for localized prostate cancer, especially for patients with a history of complex abdominal or pelvic surgery. It also showed advantages in early continence. The anatomical structure of the perineal region should be considered, and the correct incision position should be chosen. Specific incision protection measures should also be used for the incision in this particular area of the perineal region to reduce the risk of perioperative complications.

‍ ObjectiveTo investigate the diagnostic efficacy and optimal cut-off values of alpha-fetoprotein （AFP） and alpha-fetoprotein variant L3 （AFP-L3） in hepatitis B virus （HBV）-related early-stage hepatocellular carcinoma （HCC）. MethodsA total of 1 080 patients with HBV-related HCC （HBV-HCC） who were diagnosed for the first time and not yet treated in The Third Affiliated Hospital of Sun Yat-Sen University from January 2019 to July 2022 were enrolled as HCC group in the study， among whom there were 620 patients with CNLC Ⅰ‍a-‍Ⅱ‍a HCC， and in addition， 346 patients with HBV-related chronic hepatitis B （CHB group） and 293 patients with HBV-related liver cirrhosis （LC group） were enrolled as controls. The diagnostic efficacy of AFP and AFP-L3% in screening for HBV-related early-stage HCC was analyzed， including sensitivity， specificity， and the area under the ROC curve （AUC）. The Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups； the Kruskal-Wallis H test was used for comparison between multiple groups， and the Bonferroni method was used for further comparison between two groups. ResultsThe HCC group had significantly higher levels of AFP and AFP-L3% than the CHB group and the LC group （H=542.479 and 418.974， both P<0.001）. In early-stage HCC， AFP and AFP-L3% had an optimal cut-off value of 8.7 ng/mL and 5%， respectively， and AFP alone had the largest AUC of 0.816， with a sensitivity of 66.9% and a specificity of 85.1%. There was no significant difference in AUC between AFP-L3%+AFP and AFP alone （Z=0.609， P=0.543）， but both AFP-L3%+AFP and AFP alone had a significantly larger AUC than AFP-L3% alone （AFP vs AFP-L3%： Z=8.173， P<0.001； AFP+AFP-L3% vs AFP-L3%： Z=8.802， P<0.001）. ConclusionAFP has a good value and is superior to AFP-L3% in the diagnosis of HBV-related early-stage HCC， and the screening cut-off value of AFP should be lowered in order to improve the detection rate of early-stage HCC.

Objective:To examine a new technique of robot-assisted nephroureterectomy without robot reldocking or patient repositioning.Methods:Patients diagnosed as upper tract urothelial carcinoma treated with this modality between November 2015 and January 2019 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this analysis. Data collection including patient demographics, operative procedure and postoperative morbidities were conducted by retrospective charts review, after receiving the institutional review board′s approval. There were 35 males and 27 females with a median age of 70 years (range: 30 to 91 years) underwent single docking robot-assisted nephroureterectomy without repositioning. Among the 62 cases, 37 patients had pelvic carcinoma while 25 patients had ureteral carcinoma (with proximal portion 12 cases, middle portion 5 cases and distal portion 8 cases). The patient was placed in a 60 to 80-degree, modified flank position with a 15-degree Trendelenburg tilt. The contralateral arm was positioned perpendicular to the torso on an arm board while the ipsilateral arm was taped to the patient′s side with ample padding. The robot cart was then docked at a 90-degree angle, perpendicular to the patient. A “W”-shape, three robotic-arm configurations was used for port placement.Results:The surgical procedures were performed successfully in all the 62 patients. The operation time was (171.6±54.7) minutes (range: 60 to 370 minutes). The estimated blood loss during the operation was 50(50) ml (range: 20 to 400 ml) with 4 patients had transfusion. No perioperative death was encountered. Eleven patients had post-operative complications (Clavien-Dindo grade 2) including 3 cases of hemorrhage and 8 cases of chylous leakage. All cases were regularly followed up with a median time of 37 months (range: 17 to 55 months). There were 8, 30, 19, 4 and 1 case followed up for 48, 36, 24, 18 and less than 18 months, respectively. Three patients had reginal recurrences and 11 cases of distant metastasis occurred, with 5 patients died for cancer. The survival rate within 24 months was estimated as 75.4%(43/57).Conclusion:Robot-assisted nephroureterectomy without robot redocking or patient repositioning could be safely reproduced, with surgical outcomes comparable to other established techniques.