OBJECTIVE: To evaluate the functional and aesthetic evaluation of external fixator lengthening through plantar approach for fourth brachymetatarsia. METHODS: A retrospective analysis was conducted on 20 patients (23 feet) with fourth brachymetatarsia who met the selection criteria between January 2016 and January 2024, including 3 males and 17 females, with 8 left, 9 right, and 3 bilateral cases. The mean age was 24.7 years (range, 14-51 years). The preoperative metatarsal shortening length was (13.8±3.2) mm. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was 79.5±3.9, the visual analogue scale (VAS) score of appearance satisfaction was 1.7±0.8, and the appearance index (AI) score was 13.6±0.9. All patients underwent external fixator lengthening through plantar approach. The lengthening length of metatarsal bone, lengthening ratio, healing time, and healing index were recorded. Functional outcomes were assessed using the AOFAS forefoot score, VAS score of appearance satisfaction, and quality-of-life impact with AI questionnaire. RESULTS: All 20 patients were followed up 14-55 months with an average of 36.3 months. During the follow-up, complications occurred in 4 cases (17.4%), including 2 cases of metatarsophalangeal joint stiffness, which had no significant effect on the function and appearance. Delayed union of osteotomy occurred in 1 case (healed at 12 weeks after operation). Pin loosening occurred in 1 case and recovered after outpatient reinforcement. No complications related to plantar scar occurred. At last follow-up, the lengthening length of metatarsal bone was (13.9±3.1) mm, and the lengthening ratio was 25.8%±5.6%. All cases achieved bony union, with a mean healing time of (64.3±12.5) days and a healing index of (46.9±4.8) d/cm. At last follow-up, AOFAS score was 98.9±2.1, the VAS score of appearance satisfaction was 9.3±0.7, and the AI score was 0.6±0.8, which significantly improved when compared with those before operation ( t=27.398, P<0.001; t=32.994, P<0.001; t=56.135, P<0.001). CONCLUSION External fixator lengthening through plantar approach is a safe and effective technique for fourth brachymetatarsia, achieving satisfactory functional and aesthetic outcomes.
Humans ; Male ; Female ; Adult ; External Fixators ; Retrospective Studies ; Bone Lengthening/instrumentation* ; Middle Aged ; Metatarsal Bones/abnormalities* ; Adolescent ; Young Adult ; Treatment Outcome ; Patient Satisfaction ; Esthetics ; Osteotomy/methods* ; Foot Deformities, Congenital/surgery*

Lipidomics is an emerging discipline that systematically studies the various types,functions,and metabolic pathways of lipids within living organisms.This field compares changes in diseases or drug impact,identifying biomarkers and molecular mechanisms present in lipid metabolic networks across different physiological or pathological states.Through employing analytical chemistry within the realm of lipidomics,researchers analyze traditional Chinese medicine(TCM).This analysis aids in uncovering potential mechanisms for treating diverse physiopathological conditions,assessing drug efficacy,un-derstanding mechanisms of action and toxicity,and generating innovative ideas for disease prevention and treatment.This manuscript assesses recent literature,summarizing existing lipidomics technologies and their applications in TCM research.It delineates the efficacy,mechanisms,and toxicity research related to lipidomics in Chinese medicine.Additionally,it explores the utilization of lipidomics in quality control research for Chinese medicine,aiming to expand the application of lipidomics within this field.Ultimately,this initiative seeks to foster the integration of traditional medicine theory with modern science and technology,promoting an organic fusion between the two domains.

Lipidomics is an emerging discipline that systematically studies the various types, functions, and metabolic pathways of lipids within living organisms. This field compares changes in diseases or drug impact, identifying biomarkers and molecular mechanisms present in lipid metabolic networks across different physiological or pathological states. Through employing analytical chemistry within the realm of lipidomics, researchers analyze traditional Chinese medicine (TCM). This analysis aids in uncovering potential mechanisms for treating diverse physiopathological conditions, assessing drug efficacy, understanding mechanisms of action and toxicity, and generating innovative ideas for disease prevention and treatment. This manuscript assesses recent literature, summarizing existing lipidomics technologies and their applications in TCM research. It delineates the efficacy, mechanisms, and toxicity research related to lipidomics in Chinese medicine. Additionally, it explores the utilization of lipidomics in quality control research for Chinese medicine, aiming to expand the application of lipidomics within this field. Ultimately, this initiative seeks to foster the integration of traditional medicine theory with modern science and technology, promoting an organic fusion between the two domains.

OBJECTIVE To establish a liquid chromatography massspectrometry(LC-MS/MS)method for quantitatively determining the concentration of cepharanthine in rat plasma and tissue samples after intravenous injection of cepharanthine hydrochloride.METHODS ①The LC-MS/MS method was adopted.A Phenomenex C18(3.0 mm×50 mm,2.6 μm)column was employed with a mobile phase consisting of 0.05%formic acid-2 mmol·L-1 ammonium acetate-water solution and 0.1%formic acid-acetonitrile solution under gradient elution at a flow rate of 0.6 mL·min-1.The determination was performed using positive ion multiple reaction monitoring mode assays:cepharanthine(m/z:607.3→365.1)and buspirone(IS)(m/z:386.4→122.2).② Blood samples were collected from 6 SD rats at different time points following a single iv administration of cepharanthine to determine the concentration of the drug.The main pharmacokinetic parameters were calculated using a non-compartmental model.③72 SD rats were subjected to tissue distribution experiments after a single and multiple iv administra-tion of cepharanthine,and tissue samples were collected at six different time points(n=6)for the quanti-fication of drug concentrations.④ The whole blood plasma distribution ratio(Rb/p)of cepharanthine hydrochloride(7.5 mg·kg-1)in 3 SD rats was determined 2 h after iv administration.⑤The protein binding of cepharanthine to rat plasma and lung tissue homogenates was determined by equilibrium dialysis before the concentration of the free drug within the lungs was calculated.RESULTS ① An LC-MS/MS method for quantitatively determining cepharanthine in rat plasma and tissue homogenates was devel-oped,which demonstrated an excellent linear relationship(r2>0.999)within the concentration range of 2 to 1000 μg·L-1,with a lower limit of quantification at 2 μg·L-1.The obtained results met all the require-ments for accurate quantitative detection.②The main pharmacokinetic parameters of cepharanthine in rats following a single iv administration were as follows:C0=(686.91±238.43)μg·L-1,t1/2=(29.70±6.29)h,Vz=(62.70±7.93)L·kg-1,Vss=(62.55±11.28)L·kg-1,CL=(1.50±0.23)L·h-1·kg-1 and AUC(0-t)=(4.52±0.61)h·mg·L-1.③ Concentrations in tissues exceeded those in plasma after both a single and multiple iv administration,with the highest levels in the lung.The values of AUC(0-t)in lungs were(2 547.35±156.56)and(4 481.35±479.21)h·mg·L-1 after a single and multiple iv administration,respectively.④ The content of cepharanthine in blood cells was higher than that in plasma,and Rb/p was 3.5±0.8.⑤ After correction by the protein-binding rate,the minimum concentration of free drugs in the lungs(95.04 μg·L-1)exceeded the reported antiviral activity threshold against coronaviruses(EC50=60.67 μg·L-1).CONCLUSION An LC-MS/MS method has been established to rapidly and sensitively determine the concentration of cepharanthine in rat plasma and tissues.Following intravenous administration of ceph-aranthine hydrochloride,the pulmonary exposure level of the drug is significantly higher in plasma and other tissues,providing data for evaluating its in vivo pharmacological activities.

Nucleic acid aptamers are a type of single-stranded oligonucleotides screened through in vitro exponentially enriched ligand phylogenetic technology, and they can bind to various targets with high specificity and high affinity. AS1411 is a 26-base guanine-rich DNA aptamer, and its target nucleolin is widely distributed in multiple locations within the cell, including the nucleolus, nucleoplasm, cytoplasm and cell membrane. AS1411 demonstrates multiple advantages, such as weak immunogenicity, low toxicity, easy structural modification, and strong tissue penetration ability. Despite numerous challenges in the clinical transformation process, with the continuous advancement of molecular imaging technology, AS1411 has demonstrated great potential in the fields of targeted imaging and targeted delivery of cancer drugs. This article mainly focuses on the research progress of AS1411 in the field of molecular imaging, covering its applications in magnetic resonance imaging, fluorescence imaging and nuclear medicine imaging, etc.

Nucleic acid aptamers are a type of single-stranded oligonucleotides screened through in vitro exponentially enriched ligand phylogenetic technology, and they can bind to various targets with high specificity and high affinity. AS1411 is a 26-base guanine-rich DNA aptamer, and its target nucleolin is widely distributed in multiple locations within the cell, including the nucleolus, nucleoplasm, cytoplasm and cell membrane. AS1411 demonstrates multiple advantages, such as weak immunogenicity, low toxicity, easy structural modification, and strong tissue penetration ability. Despite numerous challenges in the clinical transformation process, with the continuous advancement of molecular imaging technology, AS1411 has demonstrated great potential in the fields of targeted imaging and targeted delivery of cancer drugs. This article mainly focuses on the research progress of AS1411 in the field of molecular imaging, covering its applications in magnetic resonance imaging, fluorescence imaging and nuclear medicine imaging, etc.

OBJECTIVE To establish a liquid chromatography massspectrometry(LC-MS/MS)method for quantitatively determining the concentration of cepharanthine in rat plasma and tissue samples after intravenous injection of cepharanthine hydrochloride.METHODS ①The LC-MS/MS method was adopted.A Phenomenex C18(3.0 mm×50 mm,2.6 μm)column was employed with a mobile phase consisting of 0.05%formic acid-2 mmol·L-1 ammonium acetate-water solution and 0.1%formic acid-acetonitrile solution under gradient elution at a flow rate of 0.6 mL·min-1.The determination was performed using positive ion multiple reaction monitoring mode assays:cepharanthine(m/z:607.3→365.1)and buspirone(IS)(m/z:386.4→122.2).② Blood samples were collected from 6 SD rats at different time points following a single iv administration of cepharanthine to determine the concentration of the drug.The main pharmacokinetic parameters were calculated using a non-compartmental model.③72 SD rats were subjected to tissue distribution experiments after a single and multiple iv administra-tion of cepharanthine,and tissue samples were collected at six different time points(n=6)for the quanti-fication of drug concentrations.④ The whole blood plasma distribution ratio(Rb/p)of cepharanthine hydrochloride(7.5 mg·kg-1)in 3 SD rats was determined 2 h after iv administration.⑤The protein binding of cepharanthine to rat plasma and lung tissue homogenates was determined by equilibrium dialysis before the concentration of the free drug within the lungs was calculated.RESULTS ① An LC-MS/MS method for quantitatively determining cepharanthine in rat plasma and tissue homogenates was devel-oped,which demonstrated an excellent linear relationship(r2>0.999)within the concentration range of 2 to 1000 μg·L-1,with a lower limit of quantification at 2 μg·L-1.The obtained results met all the require-ments for accurate quantitative detection.②The main pharmacokinetic parameters of cepharanthine in rats following a single iv administration were as follows:C0=(686.91±238.43)μg·L-1,t1/2=(29.70±6.29)h,Vz=(62.70±7.93)L·kg-1,Vss=(62.55±11.28)L·kg-1,CL=(1.50±0.23)L·h-1·kg-1 and AUC(0-t)=(4.52±0.61)h·mg·L-1.③ Concentrations in tissues exceeded those in plasma after both a single and multiple iv administration,with the highest levels in the lung.The values of AUC(0-t)in lungs were(2 547.35±156.56)and(4 481.35±479.21)h·mg·L-1 after a single and multiple iv administration,respectively.④ The content of cepharanthine in blood cells was higher than that in plasma,and Rb/p was 3.5±0.8.⑤ After correction by the protein-binding rate,the minimum concentration of free drugs in the lungs(95.04 μg·L-1)exceeded the reported antiviral activity threshold against coronaviruses(EC50=60.67 μg·L-1).CONCLUSION An LC-MS/MS method has been established to rapidly and sensitively determine the concentration of cepharanthine in rat plasma and tissues.Following intravenous administration of ceph-aranthine hydrochloride,the pulmonary exposure level of the drug is significantly higher in plasma and other tissues,providing data for evaluating its in vivo pharmacological activities.

Objective:To explore the disease characteristics and TCM constitutions of patients with nonunion; To analyze the risk factors of nonunion and its correlation with TCM constitution; To provide research ideas for the prevention and treatment of nonunion with TCM based on the concept of "prevention of disease".Methods:This study was an observational case-control study. 334 orthopedic patients who visited the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from September 2020 to September 2022 were selected. 167 patients were collected according to the diagnostic criteria of nonunion, then 167 patients who met the criteria of fracture healing were included as the control group. General information and the classification of TCM constitutions of the patients were collected. The distribution rules of TCM constitution and patients' risk factors were statistically analyzed, and the correlation between the two was explored.Results:The unbalanced constitution was found in 126 cases (75.45%) in the bone nonunion group and 108 cases (62.87%) in the fracture healing group, with statistical significance ( χ2=4.63, P=0.032). The proportion of TCM constitutional types distributed among the patients with nonunion were in the following order: phlegm-dampness constitution, yang-deficiency constitution, mild constitution, qi-deficiency constitution, yin-deficiency constitution, damp-heat constitution, qi-stagnation constitution, blood-stasis constitution and inherited-special constitution. There was statistical significance between the nonunion group and the fracture healing group in the phlegm-dampness and yang-deficiency in men and yang-deficiency in women ( χ 2 values were 19.12, 4.96, 4.92, respectively, P<0.01 or P<0.05). Diabetes [ OR (95% CI): 2.672(1.067, 6.693), P=0.036], BMI≥24 [ OR (95% CI): 1.903 (1.182,3.063), P=0. 008], phlegm-dampness [ OR (95% CI): 3.099 (1.624,5.913), P=0.001] and yang-deficiency [ OR (95% CI): 2.424 (1.252,4.693), P=0.009] as independent risk factors for the development of nonunion in multifactorial logistic regression analysis. Conclusions:The proportion of unbalanced constitution in patients with nonunion is significantly higher than that in patients with fracture healing. Phlegm-dampness constitution and yang-deficiency constitution are independent risk factors for the development of nonunion. TCM constitutional types can be an important factor in the risk assessment of nonunion and the prevention and treatment of nonunion based on the concept of "prevention of disease" has a sound theoretical basis and wide application prospects.

Objective: To compare the clinical outcomes and biomechanical characteristics of 1-, 2-, and 3-level pedicle subtraction osteotomy (PSO), and establish selection criteria based on preoperative radiographic parameters. Methods: Patients undergone PSO to treat ankylosing spondylitis from February 2009 to May 2019 in Sun Yat-sen Memorial Hospital of Sun Yat-sen University were enrolled. According to the quantity of osteotomy performed, the participants were divided into group A (1-level PSO, n = 24), group B (2-level PSO, n = 19), and group C (3-level PSO, n = 11). Clinical outcomes were assessed before surgery and at the final follow-up. Comparisons of the radiographic parameters and quality-of-life indicators were performed among and within these groups, and the selection criteria were established by regression. Finite element analysis was conducted to compare the biomechanical characteristics of the spine treated with different quantity of osteotomies under different working conditions. Results: Three-level PSO improved the sagittal parameters more significantly, but resulted in longer operative time and greater blood loss (p < 0.05). Greater stress was found in the proximal screws and proximal junction area of the vertebra in the model simulating 1-level PSO. Larger stress of screws and vertebra was observed at the distal end in the model simulating 3-level PSO. Conclusion Multilevel PSO works better for larger deformity correction than single-level PSO by allowing greater sagittal parameter correction and obtaining a better distribution of stress in the hardware construct, although with longer operation time and greater blood loss. Three-level osteotomy is recommended for the patients with preoperative of global kyphosis > 85.95°, T1 pelvic angle > 62.3°, sagittal vertical alignment > 299.55 mm, and pelvic tilt+ chin-brow vertical angle > 109.6°.

Objective To construct a 3D ResNet deep learning model based on multi-parametric prostate MRI(mpMRI),and to observe its value for automatically identifying the main MR sequences.Methods Totally 1 153 sets pre-biopsy prostate mpMRI data of 1 086 patients who underwent ultrasound-guided prostate biopsy in 3 hospitals were collected and divided into different image datasets,i.e.T2WI,diffusion-weighted imaging(DWI)and apparent diffusion coefficient(ADC)maps with a total of 5 151 images.Then the images were categorized into non-fat-suppressed T2WI(T2WI_nan,n=1 000),fat-suppressed T2WI(T2WI_fs,n=1 188),high b-value DWI(DWI_High,b-value≥500 s/mm2,n=1 045),low b-value DWI(DWI_Low,b-value＜500 s/mm2,n=1 012)or ADC map(n=906),also divided into training set(n=4 122),verification set(n=513)and test set(n=516)at the ratio of 8∶1∶1.After preprocessing and augmentation,a 3D ResNet model for automatically identifying image categories was trained and optimized in the training and verification sets,and its classification efficiency was evaluated in the test set.Results The identifying accuracy,sensitivity,specificity,positive predictive value,negative predictive value,F1 score and Kappa value of the obtained model for automatically identifying categories of images in the test set was 0.995-1.000,0.990-1.000,0.998-1.000,0.990-1.000,0.998-1.000,0.995-1.000 and 0.994-1.000,respectively.Conclusion The obtained 3D ResNet deep learning model could effectively and automatically identify the main sequences of prostate mpMRI.