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*

Blood-bi-syndrome is primarily characterized by localized numbness and mild pain in the limbs.Records about the diagnosis and treatment of blood-bi-syndrome are scattered throughout classical medical literature.According to the theory of Yindan and Yangdan formulas in the classical prescription system,when the body's ascending function of qi movement is insufficiency,Yangdan formulas which contain Astragali Radix can be used for warming and uplifting yang qi.Conversely,when the descending function of qi movement is insufficiency,Yindan formulas which contain containing Bupleuri Radix can be used for astringing,descending,clearing and purging.This article,based on the principles of Yindan and Yangdan formulas,analyzed the fundamental pathogenesis of blood-bi-syndrome developing from the transmission of superficial syndromes,as well as its clinical manifestations during the transmission and change between taiyin disease and yangming disease.And the therapeutic strategies for blood-bi-syndrome were also summarized.It is proposed that taiyin blood-bi-syndrome arises in individuals with constitutionally deficient cold after the attack of pathogenic factors,resulting from fluid depletion,blood insufficiency,and stomach deficiency,which should be treated by Yangdan Formulas with pungent-sweet-warm properties for warming and uplifting yang qi.For the treatment of patients with taiyin blood-bi-syndrome characterized by exterior syndrome,Astragali Radix-containing classical prescriptions like Astragali Radix and Cinnamomi Ramulus Five-Component Decoction(Huangqi Guizhi Wuwu Decoction)can be chosen;for the treatment of patients with taiyin blood-bi-syndrome characterized by interior syndrome,Zingiberis Rhizoma Recens-containing classical prescriptions like Citri Reticulatae Pericarpium and Bambusae Caulis in Taenia Decoction(Jupi Zhuru Decoction)is adopted.Conversely,yangming blood-bi-syndrome occurs in individuals with constitutionally excessive heat after the attack of pathogenic factors,resulting from the internal accumulation of blood stasis and heat and the impairment of the fluid and blood,which should be treated by Yindan Formulas with pungent-sweet-cold or sour-cold properties for astringing,descending,clearing and purging.For the treatment of patients with yangming blood-bi-syndrome characterized by exterior syndrome,Puerariae Lobatae Radix-containing classical prescriptions like Phyllostachydis Henonis Folium and Puerariae Lobatae Radix Decoction(Zhuye Gegen Decoction)can be used;for the treatment of patients with yangming blood-bi-syndrome characterized by interior syndrome,Paeoniae Radix Alba-containing classical prescriptions like Rhei Radix et Rhizoma and Eupolyphaga seu Steleophaga Decoction(Dahuang Zhechong Wan)is recommended.

Objective:To observe the clinical effect of the new type of lung body projection flashlight for percussion back in patients with cerebral hemorrhage, so as to promote patient lung rehabilitation, reduce pulmonary complications, and improve prognosis.Methods:Adopting a randomized controlled trial method, a total of 102 patients with cerebral hemorrhage who were hospitalized in the Department of Neurosurgery of The First Hospital of Jiaxing from January 2022 to December 2023 and their caregivers were selected as the research objects by convenience sampling method. The patients were divided into the control group (51 cases) and the observation group (51 cases) by the random number table method. The control group received traditional back tapping on the basis of routine nursing and back tapping guidance. The observation group used a new type of lung body projection flashlight for percussion back to assist in back tapping nursing and health guidance on the basis of routine nursing.The incidence of pulmonary infection, white blood cell count, levels of hypersensitive C-reactive protein and procalcitonin, the quality of discharge guidance, the scores of satisfaction of patients, and the assessment score of caregivers′ percussion back skills were evaluated in the two groups.Results:Finally, a total of 49 patients were enrolled in the observation group, including 38 males and 11 females, aged (67.08 ± 11.05) years old. A total of 49 patients were enrolled in the control group, including 31 males and 18 females, aged (68.84 ± 10.46) years old. There were 8 males and 41 females, aged (58.00 ± 8.17) years old in the caregivers of the observation group. There were 6 males and 43 females, aged (57.57 ± 9.15) years old in the caregivers of the observation group. The incidence of pulmonary infection in the observation group was 28.6% (14/49), which was lower than that in the control group 32.7% (16/49), and the difference was not statistically significant ( P>0.05). There was no significant difference in the level of white blood cell count, hypersensitive C-reactive protein and procalcitonin between the two groups when the time of pulmonary infection was diagnosed and after 2 weeks of treatment ( P>0.05). The levels of white blood cell count, hypersensitive C-reactive protein and procalcitonin after 1 week of treatment were (7.97 ± 1.30)×10 9/L, (30.71 ± 11.96) mg/L, 0.04(0.02, 0.07) μg/L in the observation group, which were all lower than those in the control group (9.46 ± 2.16) × 10 9/L, (58.34 ± 48.96) mg/L, 0.09(0.04, 0.20) μg/L, and the differences were statistically significant ( t=5.06, 4.22, Z=1.98, all P<0.05). The total score of discharge guidance quality, obtained content, guidance skills and effect scores were (134.94 ± 7.34), (47.80 ± 2.86), (87.14 ± 5.98) points in the observation group, which were significantly higher than those in the control group (117.04 ± 7.04), (39.80 ± 3.15), (77.24 ± 5.60) points, and the differences were statistically significant ( t=12.32, 13.15, 8.46, all P<0.05). The scores of the satisfaction of patients including six aspects(operation convenience, precise positioning, goal orientation, operation specification, nursing confidence and mission satisfaction) in the observation group were 91.84%(45/49), 95.92%(47/49), 91.84%(45/49), 93.88%(46/49), 91.84%(45/49), 97.96%(48/49), which were higher than those in the control group 73.47%(36/49), 57.14%(28/49), 53.06%(26/49), 67.35%(33/49), 73.47%(36/49), 81.63%(40/49), and the differences were statistically significant ( χ2 values were 5.76-20.51, all P<0.05). The assessment score of percussion skills of caregivers in the observation group was (79.55 ± 3.98) points, which was significantly higher than that in the control group (75.35 ± 4.94) points, and the difference was statistically significant ( t=4.64, P<0.05). Conclusions:The clinical application of the new type of lung body projection flashlight for percussion back in patients with cerebral hemorrhage can achieve accurate and standardized percussion back to promote the improvement of pulmonary infection and improve the skill level of caregivers of cerebral hemorrhage patients, as well as improve the quality of discharge guidance and the satisfaction of patients.

Non-small cell lung cancer(NSCLC)is one of the most common and deadly malignant tumors worldwide,with surgical resection being the primary treatment for early-stage NSCLC.Tumor spread through air spaces(STAS)is a novel pattern of tumor dissemination into the air spaces in the lung.Its occurrence after sublobar resection is closely associated with recurrence and distant metastasis,making its con-sideration a vital factor in surgical strategy selection and prognostic evaluation.Patients with STAS-positive status exhibit significantly higher postoperative recurrence rates than do STAS-negative patients,with molecular mechanisms involving tumor microenvironment remodeling,specific genetic mutations,and epithelial-mesenchymal transition(EMT).Imaging techniques including computed tomography(CT)and positron emission tomography/CT have shown potential for preoperative STAS prediction,although their accuracy and practicality require improvement.This paper reviews the definition,pathological characteristics,and related mechanisms of STAS,with a focus on surgical ap-proach selection for STAS-positive patients and its role in cancer recurrence after sublobar resection of early-stage NSCLC.Future research directions include optimization of preoperative diagnostic methods for STAS,exploration of molecular targeted therapies,and development of imaging-based precision prediction models.

Non-small cell lung cancer(NSCLC)is one of the most common and deadly malignant tumors worldwide,with surgical resection being the primary treatment for early-stage NSCLC.Tumor spread through air spaces(STAS)is a novel pattern of tumor dissemination into the air spaces in the lung.Its occurrence after sublobar resection is closely associated with recurrence and distant metastasis,making its con-sideration a vital factor in surgical strategy selection and prognostic evaluation.Patients with STAS-positive status exhibit significantly higher postoperative recurrence rates than do STAS-negative patients,with molecular mechanisms involving tumor microenvironment remodeling,specific genetic mutations,and epithelial-mesenchymal transition(EMT).Imaging techniques including computed tomography(CT)and positron emission tomography/CT have shown potential for preoperative STAS prediction,although their accuracy and practicality require improvement.This paper reviews the definition,pathological characteristics,and related mechanisms of STAS,with a focus on surgical ap-proach selection for STAS-positive patients and its role in cancer recurrence after sublobar resection of early-stage NSCLC.Future research directions include optimization of preoperative diagnostic methods for STAS,exploration of molecular targeted therapies,and development of imaging-based precision prediction models.

Objective:To observe the clinical effect of the new type of lung body projection flashlight for percussion back in patients with cerebral hemorrhage, so as to promote patient lung rehabilitation, reduce pulmonary complications, and improve prognosis.Methods:Adopting a randomized controlled trial method, a total of 102 patients with cerebral hemorrhage who were hospitalized in the Department of Neurosurgery of The First Hospital of Jiaxing from January 2022 to December 2023 and their caregivers were selected as the research objects by convenience sampling method. The patients were divided into the control group (51 cases) and the observation group (51 cases) by the random number table method. The control group received traditional back tapping on the basis of routine nursing and back tapping guidance. The observation group used a new type of lung body projection flashlight for percussion back to assist in back tapping nursing and health guidance on the basis of routine nursing.The incidence of pulmonary infection, white blood cell count, levels of hypersensitive C-reactive protein and procalcitonin, the quality of discharge guidance, the scores of satisfaction of patients, and the assessment score of caregivers′ percussion back skills were evaluated in the two groups.Results:Finally, a total of 49 patients were enrolled in the observation group, including 38 males and 11 females, aged (67.08 ± 11.05) years old. A total of 49 patients were enrolled in the control group, including 31 males and 18 females, aged (68.84 ± 10.46) years old. There were 8 males and 41 females, aged (58.00 ± 8.17) years old in the caregivers of the observation group. There were 6 males and 43 females, aged (57.57 ± 9.15) years old in the caregivers of the observation group. The incidence of pulmonary infection in the observation group was 28.6% (14/49), which was lower than that in the control group 32.7% (16/49), and the difference was not statistically significant ( P>0.05). There was no significant difference in the level of white blood cell count, hypersensitive C-reactive protein and procalcitonin between the two groups when the time of pulmonary infection was diagnosed and after 2 weeks of treatment ( P>0.05). The levels of white blood cell count, hypersensitive C-reactive protein and procalcitonin after 1 week of treatment were (7.97 ± 1.30)×10 9/L, (30.71 ± 11.96) mg/L, 0.04(0.02, 0.07) μg/L in the observation group, which were all lower than those in the control group (9.46 ± 2.16) × 10 9/L, (58.34 ± 48.96) mg/L, 0.09(0.04, 0.20) μg/L, and the differences were statistically significant ( t=5.06, 4.22, Z=1.98, all P<0.05). The total score of discharge guidance quality, obtained content, guidance skills and effect scores were (134.94 ± 7.34), (47.80 ± 2.86), (87.14 ± 5.98) points in the observation group, which were significantly higher than those in the control group (117.04 ± 7.04), (39.80 ± 3.15), (77.24 ± 5.60) points, and the differences were statistically significant ( t=12.32, 13.15, 8.46, all P<0.05). The scores of the satisfaction of patients including six aspects(operation convenience, precise positioning, goal orientation, operation specification, nursing confidence and mission satisfaction) in the observation group were 91.84%(45/49), 95.92%(47/49), 91.84%(45/49), 93.88%(46/49), 91.84%(45/49), 97.96%(48/49), which were higher than those in the control group 73.47%(36/49), 57.14%(28/49), 53.06%(26/49), 67.35%(33/49), 73.47%(36/49), 81.63%(40/49), and the differences were statistically significant ( χ2 values were 5.76-20.51, all P<0.05). The assessment score of percussion skills of caregivers in the observation group was (79.55 ± 3.98) points, which was significantly higher than that in the control group (75.35 ± 4.94) points, and the difference was statistically significant ( t=4.64, P<0.05). Conclusions:The clinical application of the new type of lung body projection flashlight for percussion back in patients with cerebral hemorrhage can achieve accurate and standardized percussion back to promote the improvement of pulmonary infection and improve the skill level of caregivers of cerebral hemorrhage patients, as well as improve the quality of discharge guidance and the satisfaction of patients.

With an aging population, the incidence of osteoporotic vertebral fractures (OVFs) is on the rise, posing new challenges for developing personalized treatment strategies. For patients who do not respond to conservative treatment, percutaneous vertebroplasty or percutaneous kyphoplasty (PVP/PKP) remains the preferred surgical option due to its minimal invasiveness and rapid recovery time. However, progressive local kyphosis (PLK) is one of the most severe complications following PVP/PKP, with an incidence rate of 1.5%-25.8%. PLK often presents with recurring thoracic and lower back pain, and in severe cases, spinal stenosis, causing symptoms like numbness and pain in the lower limbs. The severity of PLK varies, and treatments can range from conservative management and bone cement reinforcement to internal fixation or osteotomy. Current studies suggest that re-fracture of the affected vertebra, intervertebral disc degeneration, and osteonecrosis may be underlying mechanisms. These conditions shift the axial load forward, promoting postoperative PLK, which tends to progress over time. Postoperative PLK is closely associated with patient characteristics, fracture details, surgical factors, and post-surgery osteoporosis management. 1) The severity of osteoporosis, as indicated by the T-score from bone mineral density testing, can help predict postoperative PLK. While factors like age and gender influence osteoporosis severity, no direct relationship has been established between these factors and PLK. 2) Thoracolumbar fractures, old nonunion fractures, endplate fractures, or severe preoperative compression changes with kyphosis can increase PLK risk. Surgical factors, including the use of balloons or implants and the distribution of bone cement, also play a role. Personalized treatment plans should be developed based on the patient's general condition and imaging results to ensure adequate bone cement diffusion, as enhanced integration can reduce PLK risk. 3) Postoperative anti-osteoporosis therapy is also crucial; long-term therapy, particularly with teriparatide, can prevent PLK. Recognizing the related risk factors and establishing predictive models can help clinicians tailor treatments. Machine learning models, utilizing big data, are particularly adept at handling complex interrelated risk factors and may provide a powerful tool for personalized treatment in the future.

OBJECTIVE: To review the clinical research progress of spinal epidural lipomatosis (SEL). METHODS: The clinical studies on SEL at home and abroad in recent years were extensively reviewed, and the pathogenesis, clinical and imaging manifestations, and treatment status of SEL were summarized and analyzed. RESULTS: SEL is a disease characterized by compression of the spinal cord and nerve roots due to abnormal accumulation of epidural adipose tissue in the spinal canal. Its prevalence and diagnosis rate are low and the pathogenesis is not fully understood. MRI is the most sensitive and specific diagnostic test for SEL. Surgical decompression and removal of excess adipose tissue are the only options for patients with acute SEL or those who have failed conservative management, and conservative management should be considered for other patients. CONCLUSION SEL is a rare disease and related research still needs to be improved. In the future, high-quality, multi-center and large-sample studies will be of great significance for evaluating the choice of treatment methods and effectiveness of SEL patients.
Humans ; Decompression, Surgical/methods* ; Epidural Space/surgery* ; Lipomatosis/surgery* ; Magnetic Resonance Imaging ; Spinal Cord Diseases/surgery*

Ex vivo culture-amplified mesenchymal stem cells (MSCs) have been studied because of their capacity for healing tissue injury. MSC transplantation is a valid approach for promoting the repair of damaged tissues and replacement of lost cells or to safeguard surviving cells, but currently the efficiency of MSC transplantation is constrained by the extensive loss of MSCs during the short post-transplantation period. Hence, strategies to increase the efficacy of MSC treatment are urgently needed. Iron overload, reactive oxygen species deposition, and decreased antioxidant capacity suppress the proliferation and regeneration of MSCs, thereby hastening cell death. Notably, oxidative stress (OS) and deficient antioxidant defense induced by iron overload can result in ferroptosis. Ferroptosis may inhibit cell survival after MSC transplantation, thereby reducing clinical efficacy. In this review, we explore the role of ferroptosis in MSC performance. Given that little research has focused on ferroptosis in transplanted MSCs, further study is urgently needed to enhance the in vivo implantation, function, and duration of MSCs.
Humans ; Antioxidants/metabolism* ; Ferroptosis ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stem Cells ; Iron Overload/metabolism*

Complex structural variants(CSVs)are genomic alterations that have more than two breakpoints and are considered as the simultaneous occurrence of simple structural variants.How-ever,detecting the compounded mutational signals of CSVs is challenging through a commonly used model-match strategy.As a result,there has been limited progress for CSV discovery com-pared with simple structural variants.Here,we systematically analyzed the multi-breakpoint con-nection feature of CSVs,and proposed Mako,utilizing a bottom-up guided model-free strategy,to detect CSVs from paired-end short-read sequencing.Specifically,we implemented a graph-based pattern growth approach,where the graph depicts potential breakpoint connections,and pattern growth enables CSV detection without pre-defined models.Comprehensive evaluations on both simulated and real datasets revealed that Mako outperformed other algorithms.Notably,validation rates of CSVs on real data based on experimental and computational validations as well as manual inspections are around 70％,where the medians of experimental and computational breakpoint shift are 13 bp and 26 bp,respectively.Moreover,the Mako CSV subgraph effectively characterized the breakpoint connections of a CSV event and uncovered a total of 15 CSV types,including two novel types of adjacent segment swap and tandem dispersed duplication.Further analysis of these CSVs also revealed the impact of sequence homology on the formation of CSVs.Mako is publicly available at https://github.com/xjtu-omics/Mako.