Objective:To investigate the impact and clinical outcomes of intraoperative prone-position lumbar anteroposterior (AP) fluoroscopy under anesthesia on the selection of the lowest instrumented vertebra (LIV) in the patients with adolescent idiopathic scoliosis (AIS) plus structural lumbar curves.Methods:A retrospective analysis was conducted of the clinical data of 35 patients (29 females and 6 males) with AIS who had undergone surgical posterior correction and fusion at Scoliosis Center, The Third Affiliated Hospital, Sun Yat-sen University between January 2020 and October 2023. The mean age was (17.9±5.7) years. Lenke's classification: 6 cases of type 3, 12 cases of type 4, 7 cases of type 5 and 10 cases of type 6. Preoperatively, all patients underwent standing AP and lateral radiographs of the full-length spine, left and right bending radiographs of the spine, and full-spine CT. Intraoperatively, all patients underwent prone-position lumbar AP fluoroscopy under anesthesia. The criteria for LIV selection were: (1) it should be the most cephalad vertebra touched by the central sacral vertical line (CSVL); (2) its rotation should be ≤ grade Ⅱ by the Nash-Moe classification; (3) its tilt angle should be <25°. The preoperative and postoperative LIV rotation angles were compared, and the number of lumbar fusions was compared between preoperative planning and actual surgery. Comparisons were also made between preoperation, postoperation and the final follow-up, examining Cobb angle of the major curve, Cobb angle of the minor curve, LIV inclination, coronal balance distance (CBD), sagittal vertical axis (SVA), and distance between CSVL and LIV (CSVL-LIV). The correction rates of the major curve and the minor curve, and change in LIV inclination were compared between postoperation and the final follow-up.Results:The patients were followed for (18.0±3.0) months. The LIV rotation decreased from 8.34°±4.95° preoperatively to 5.03°±2.99° postoperatively. The intraoperative fluoroscopy reduced at least one segment fusion for 57.1% (20/35) of the patients so that the number of lumbar fusions decreased significantly from 4.2±0.7 in preoperative planning to 3.6±0.8 after actual surgery ( P<0.05). The Cobb angles of the major and minor curves, LIV inclination, and CSVL-LIV at postoperation and the final follow-up were significantly lower than the preoperative values ( P<0.05), but there were no significant differences between the final follow-up and postoperation in the Cobb angle of the major cure, Cobb angle of the minor curve, or LIV inclination ( P>0.05). None of the patients required surgical revision for distal junctional complications. Conclusions:In the surgical treatment of AIS patients with structural lumbar curves, compared to the preoperative X-rays using the same criteria, intraoperative prone-position lumbar AP fluoroscopy under anesthesia can not only be a safe and effective method for LIV selection but also effectively reduce the number of lumbar fusions to preserve more lumbar mobility.

Objective To explore the effects and mechanism of Dahuang Tangluo Pills on intestinal inflammatory injury in type 2 diabetes mellitus(T2DM)rats based on TLR4/NF-κB signaling pathway.Methods Eight ZDF(fa/+)rats were used as the blank group,and 40 ZDF(fa/fa)rats were fed with high-fat diet and then randomly divided into model group,metformin group(0.18 g/kg metformin)and TCM high-,medium-and low-dosage groups(2.16,1.08,0.54 g/kg Dahuang Tangluo Pills),respectively.The medication groups were gavaged with corresponding dosages for 12 consecutive weeks.The body mass and fasting blood glucose(FBG)of rats before and after intervention were detected.After the intervention,an oral glucose tolerance test(OGTT)was performed,the serum glucose(GLU),glycosylated serum protein(GSP),triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)contents were detected.ELISA was used to detect serum fasting insulin(FINS),free fatty acids(FFA)and tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-22,lipopolysaccharide(LPS),secreted immunoglobulin A(SIgA)contents in colonic tissue.HE staining was used to observe the morphology of colonic tissue,and Western blot was used to detect the expressions of Toll like receptor 4(TLR4),nuclear factor-κB p65(NF-κB p65),p-NF-κB p65,NF-κB inhibitor α(IκBα),p-IκBα,myeloid differentiation factor 88(MyD88)and zona pellucida protein-1(ZO-1)in colonic tissue.Results Compared with the blank group,the body mass and FBG significantly increased in the model group(P<0.01),blood glucose significantly increased at all time points of OGTT(P<0.01),serum GLU,GSP,TG,TC,LDL-C,FINS,FFA and TNF-α,IL-6,IL-22,LPS contents in colonic tissue significantly increased,serum HDL-C and colonic tissue SIgA contents significantly decreased(P<0.01),with colonic tissue nuclear condensation,cytoplasmic dissolution,inflammatory cell infiltration.The protein expressions of TLR4,NF-κB p65,p-NF-κB p65,p-IκBα and MyD88 in colonic tissue significantly increased,while the protein expressions of IκBα and ZO-1 significantly decreased(P<0.01).Compared with the model group,the body mass and FBG significantly decreased in metformin group,TCM high-and medium-dosage groups(P<0.01),blood glucose decreased at different time points of OGTT,and serum GLU,GSP,TG,TC,LDL-C,FINS,FFA and TNF-α,IL-6,IL-22,LPS contents in colonic tissue significantly decreased,serum HDL-C and colonic tissue SIgA contents significantly increased(P<0.05,P<0.01),with significant improvement in colonic tissue structure and reduction in inflammatory cell infiltration.The protein expressions of TLR4,NF-κB p65,p-NF-κB p65,p-IκBα and MyD88 in colonic tissue significantly decreased,while the proteins expression of IκBα and ZO-1 significantly increased(P<0.05,P<0.01).Conclusion Dahuang Tangluo Pills may inhibit the activation of the TLR4/NF-κB signaling pathway,reduce the release of inflammatory factors,improve intestinal inflammatory injury,restore intestinal homeostasis,thereby improving glucose and lipid metabolism and exerting therapeutic effects on T2DM.

Objective A biomechanical model of cervical kyphosis under the effects of axial traction load and lateral push load was establised,so as to provide a theoretical basis for the treatment of cervical curvature abnormalities,and formulate the most appropriate treatment plan for patients.Methods Based on the CT scan data of patients,the axial data of the cervical spine was extracted to fit the cervical curvature curve.Using the Timoshenko beam theory and the cervical rehabilitation training system,a mathematical model of cervical kyphosis was established for analytical calculations to obtain the recovery curve of the cervical spine under load and the total load required to cure cervical kyphosis,and its rationality was also verified.Results The biomechanical model of cervical kyphosis was established.Under the effects of axial traction load and lateral push load,the cervical spine effectively developed in the direction of physiological bending.The total axial load and lateral load were 353 N and 5 649 N,respectively,and the total axial load increased with the increase in traction angle.The therapeutic moment of the total lateral load decreased as the Bordon value increased.The therapeutic moment of the axial load was smaller than that of the lateral load in the range of normal Bordon value,confirming the rationality of the loads.Conclusions The established biomechanical model of cervical kyphosis can accurately simulate the biomechanical characteristics of the cervical spine,and the analysis results were valid,providing a mechanical theoretical basis for the design of treatment plans for patients.

Objective:To compare the curative effect of local anesthesia Lichtenstein, modified Kugel and general anesthetic transabdominal preperitoneal(TAPP) hemioplasty in the treatment of primary unilateral inguinal hernia in elderly patients.Methods:Six hundred and twenty-one patients with unilateral primary inguinal hernia admitted at Second Hospital of Tianjin Medical University from January 2021 to December 2023 were randomly divided into 3 groups before operation: Lichtenstein group, Modified-Kugel group, TAPP group,207 patients in each group. The clinical data were compared.Results:The average operation time of the Lichtenstein and modified Kugel hernia repair groups was significantly shorter than that of TAPP group ( P<0.01), and the hospitalization cost was also significantly lower than that of TAPP group. The postoperative pain score, time spent in the ground and hospital stay in TAPP group were significantly lower than those in Lichtenstein and modified Kugel groups ( P<0.05). There were no serious complications in the 3 groups. Conclusions:Three kinds of hernia repair are all safe and effective in the treatment of elderly patients with unilateral primary inguinal hernia. TAPP has lighter postoperative pain and quicker recovery. Lichtenstein and Modified-Kugel hernia repair under local anesthesia are suitable for those who cannot tolerate general anesthesia.

Objective:To explore the dosimetry optimization strategy based on filter thickness and shape selection for the bulb superficial X-ray radiotherapy unit.Methods:Monte Carlo code TOPAS was used to model tubular equipment, and the dose distribution from six X-ray energies (50-150 kV) and five conventional aluminum filters (0.5-3.0 mm) with different thickness were simulated in the water model. The percentage depth dose (PDD) curve along the central axis, the center-axis profile dose at different depths, and the lateral dose distribution were analyzed. The dose distribution of three different designs of aluminum filters (conventional cylindrical, conical and oblique cylindrical filters) was compared to evaluate the effect of dosimetric optimization of different filter shapes.Results:Under the same energy, increasing the thickness of the filter can optimize the superficial skin dose, and the optimization effect of depth dose uniformity can be increased by 26% at a depth of 5.5 mm at 70 kV energy. The raised, flat and inclined dose distribution modes can be achieved by using conventional cylindrical, conical and inclined aluminum filters.Conclusions:By selecting the appropriate X-ray energy and filter thickness, an ideal dose distribution matching the tumor depth can be achieved. The application of personalized filters is also of great significance for diverse target areas.

Objective:To investigate the application of the conjugate gradient (CG) algorithm to treatment plan optimization for intensity-modulated brachytherapy (IMBT).Methods:The general Monte Carlo software TOPAS was utilized to simulate the 192Ir source of IMBT, and the unit dose contribution matrix was calculated. An objective function was established using the weighted least squares method and was solved using the CG algorithm to achieve optimized IMBT treatment plans. The optimization was validated using five clinical cervical cancer cases under modulation width 60°. The dose distributions of IMBT treatment plans under 45°, 60°, 90°, 120°, and 180° modulation widths were compared using the Wilcoxon test to determine the optimal IMBT treatment plan for cervical cancer treatment. Results:The CG algorithm successfully optimized IMBT treatment plans under modulation width 60° for five cases within 22.2 s on average. On the premise of sufficient target dose coverage, the average D2 cm 3 values of the bladder and rectum in IMBT treatment plans were 3.66 and 1.97 Gy, respectively, representing reductions of 0.54 and 0.69 Gy compared to traditional brachytherapy plans. For the five modulation widths, the D90% values of all IMBT treatment plans reached 6 Gy, without statistically significant differences ( P > 0.05). The average D2 cm 3 values of the bladder in IMBT treatment plans were significantly lower than those in the traditional brachytherapy plans( P<0.05), with modulation width 60° associated with the greatest reduction of 0.61 Gy. In contrast, the average D2 cm 3 values of the rectum under 45°, 60°, and 90° modulation widths decreased by 0.63, 0.54, and 0.45 Gy, respectively, compared to traditional plans, with statistically significant differences( P<0.05). Conclusions:The CG method enables rapid achievement of optimized IMBT treatment plans that meet clinical requirements, and modulation width 60° contributes to valid dosimetric optimization. This study can serve as a guide for the clinical implementation of IMBT.

Objective:To explore the dosimetry optimization strategy based on filter thickness and shape selection for the bulb superficial X-ray radiotherapy unit.Methods:Monte Carlo code TOPAS was used to model tubular equipment, and the dose distribution from six X-ray energies (50-150 kV) and five conventional aluminum filters (0.5-3.0 mm) with different thickness were simulated in the water model. The percentage depth dose (PDD) curve along the central axis, the center-axis profile dose at different depths, and the lateral dose distribution were analyzed. The dose distribution of three different designs of aluminum filters (conventional cylindrical, conical and oblique cylindrical filters) was compared to evaluate the effect of dosimetric optimization of different filter shapes.Results:Under the same energy, increasing the thickness of the filter can optimize the superficial skin dose, and the optimization effect of depth dose uniformity can be increased by 26% at a depth of 5.5 mm at 70 kV energy. The raised, flat and inclined dose distribution modes can be achieved by using conventional cylindrical, conical and inclined aluminum filters.Conclusions:By selecting the appropriate X-ray energy and filter thickness, an ideal dose distribution matching the tumor depth can be achieved. The application of personalized filters is also of great significance for diverse target areas.

Objective:To investigate the application of the conjugate gradient (CG) algorithm to treatment plan optimization for intensity-modulated brachytherapy (IMBT).Methods:The general Monte Carlo software TOPAS was utilized to simulate the 192Ir source of IMBT, and the unit dose contribution matrix was calculated. An objective function was established using the weighted least squares method and was solved using the CG algorithm to achieve optimized IMBT treatment plans. The optimization was validated using five clinical cervical cancer cases under modulation width 60°. The dose distributions of IMBT treatment plans under 45°, 60°, 90°, 120°, and 180° modulation widths were compared using the Wilcoxon test to determine the optimal IMBT treatment plan for cervical cancer treatment. Results:The CG algorithm successfully optimized IMBT treatment plans under modulation width 60° for five cases within 22.2 s on average. On the premise of sufficient target dose coverage, the average D2 cm 3 values of the bladder and rectum in IMBT treatment plans were 3.66 and 1.97 Gy, respectively, representing reductions of 0.54 and 0.69 Gy compared to traditional brachytherapy plans. For the five modulation widths, the D90% values of all IMBT treatment plans reached 6 Gy, without statistically significant differences ( P > 0.05). The average D2 cm 3 values of the bladder in IMBT treatment plans were significantly lower than those in the traditional brachytherapy plans( P<0.05), with modulation width 60° associated with the greatest reduction of 0.61 Gy. In contrast, the average D2 cm 3 values of the rectum under 45°, 60°, and 90° modulation widths decreased by 0.63, 0.54, and 0.45 Gy, respectively, compared to traditional plans, with statistically significant differences( P<0.05). Conclusions:The CG method enables rapid achievement of optimized IMBT treatment plans that meet clinical requirements, and modulation width 60° contributes to valid dosimetric optimization. This study can serve as a guide for the clinical implementation of IMBT.

Objective A biomechanical model of cervical kyphosis under the effects of axial traction load and lateral push load was establised,so as to provide a theoretical basis for the treatment of cervical curvature abnormalities,and formulate the most appropriate treatment plan for patients.Methods Based on the CT scan data of patients,the axial data of the cervical spine was extracted to fit the cervical curvature curve.Using the Timoshenko beam theory and the cervical rehabilitation training system,a mathematical model of cervical kyphosis was established for analytical calculations to obtain the recovery curve of the cervical spine under load and the total load required to cure cervical kyphosis,and its rationality was also verified.Results The biomechanical model of cervical kyphosis was established.Under the effects of axial traction load and lateral push load,the cervical spine effectively developed in the direction of physiological bending.The total axial load and lateral load were 353 N and 5 649 N,respectively,and the total axial load increased with the increase in traction angle.The therapeutic moment of the total lateral load decreased as the Bordon value increased.The therapeutic moment of the axial load was smaller than that of the lateral load in the range of normal Bordon value,confirming the rationality of the loads.Conclusions The established biomechanical model of cervical kyphosis can accurately simulate the biomechanical characteristics of the cervical spine,and the analysis results were valid,providing a mechanical theoretical basis for the design of treatment plans for patients.

Objective To explore the effects and mechanism of Dahuang Tangluo Pills on intestinal inflammatory injury in type 2 diabetes mellitus(T2DM)rats based on TLR4/NF-κB signaling pathway.Methods Eight ZDF(fa/+)rats were used as the blank group,and 40 ZDF(fa/fa)rats were fed with high-fat diet and then randomly divided into model group,metformin group(0.18 g/kg metformin)and TCM high-,medium-and low-dosage groups(2.16,1.08,0.54 g/kg Dahuang Tangluo Pills),respectively.The medication groups were gavaged with corresponding dosages for 12 consecutive weeks.The body mass and fasting blood glucose(FBG)of rats before and after intervention were detected.After the intervention,an oral glucose tolerance test(OGTT)was performed,the serum glucose(GLU),glycosylated serum protein(GSP),triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C)contents were detected.ELISA was used to detect serum fasting insulin(FINS),free fatty acids(FFA)and tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-22,lipopolysaccharide(LPS),secreted immunoglobulin A(SIgA)contents in colonic tissue.HE staining was used to observe the morphology of colonic tissue,and Western blot was used to detect the expressions of Toll like receptor 4(TLR4),nuclear factor-κB p65(NF-κB p65),p-NF-κB p65,NF-κB inhibitor α(IκBα),p-IκBα,myeloid differentiation factor 88(MyD88)and zona pellucida protein-1(ZO-1)in colonic tissue.Results Compared with the blank group,the body mass and FBG significantly increased in the model group(P<0.01),blood glucose significantly increased at all time points of OGTT(P<0.01),serum GLU,GSP,TG,TC,LDL-C,FINS,FFA and TNF-α,IL-6,IL-22,LPS contents in colonic tissue significantly increased,serum HDL-C and colonic tissue SIgA contents significantly decreased(P<0.01),with colonic tissue nuclear condensation,cytoplasmic dissolution,inflammatory cell infiltration.The protein expressions of TLR4,NF-κB p65,p-NF-κB p65,p-IκBα and MyD88 in colonic tissue significantly increased,while the protein expressions of IκBα and ZO-1 significantly decreased(P<0.01).Compared with the model group,the body mass and FBG significantly decreased in metformin group,TCM high-and medium-dosage groups(P<0.01),blood glucose decreased at different time points of OGTT,and serum GLU,GSP,TG,TC,LDL-C,FINS,FFA and TNF-α,IL-6,IL-22,LPS contents in colonic tissue significantly decreased,serum HDL-C and colonic tissue SIgA contents significantly increased(P<0.05,P<0.01),with significant improvement in colonic tissue structure and reduction in inflammatory cell infiltration.The protein expressions of TLR4,NF-κB p65,p-NF-κB p65,p-IκBα and MyD88 in colonic tissue significantly decreased,while the proteins expression of IκBα and ZO-1 significantly increased(P<0.05,P<0.01).Conclusion Dahuang Tangluo Pills may inhibit the activation of the TLR4/NF-κB signaling pathway,reduce the release of inflammatory factors,improve intestinal inflammatory injury,restore intestinal homeostasis,thereby improving glucose and lipid metabolism and exerting therapeutic effects on T2DM.