Neural loops are formed by interconnections between neurons through synaptic structures,which are the basic units of information transmission and processing in the brain and play an important role in the regulation of neural functions.After stroke,neural connections between the infarct and peri-infarct regions and the remote area are damaged,resulting in patients being at risk of neurological dysfunction or even disability.However,with advances in detection technology,an increasing number of studies are demonstrating that patients with stroke can undergo some functional recovery during the chronic phase,possibly via a mechanism related to the re-establishment of synaptic connections and neural circuits.Therefore,the development of specific technology to identify and manipulate neuronal activity patterns,as well as the use of high-resolution temporal and spatial imaging strategies to decipher these neurological processes,will allow us to understand the whole-brain network dynamics of stroke recovery and the mechanisms by which neural loop reestablishment occurs.Furthermore,we may be able to neurobiologically comprehend the closed-loop mechanisms that underlie the development of stroke pathology and their relationship to behavioral outcomes.Current technologies used for studying neural circuits include optogenetics,chemical genetics,in vivo calcium imaging,and functional magnetic resonance imaging.This article introduces the working principles of these four major technologies and focuses on summarizing the result of their respective application in resolving neural remodeling after stroke.We briefly analyze the application scenarios,advantages and disadvantages,and future development trends of each technique.This paper will help clinical and basic researchers to use these technologies to discover new therapeutic strategies and evaluate the effectiveness of rehabilitation strategies.

Three novel sesquiterpenoid heterodimers,designated as auckcostusolides A-C(1-3),were isolated from Aucklandia costus leaves.The structures of compounds 1-3 were elucidated through comprehensive spectroscopic analysis,with their absolute configurations established using a combination of X-ray single-crystal diffraction and electronic circular dichroism(ECD)calculations.Notably,compounds 1 and 2,despite sharing identical planar structures derived from two identical sesquiterpenoids,exhibited oppos-ite configurations at C-11 and C-8'.This configurational difference can be attributed to distinct Diels-Alder cycloaddition processes between the sesquiterpenoid monomers.Additionally,the cytotoxic effects of compounds 1-3 were evaluated against colorectal can-cer HCT116 cells,fibrosarcoma HT1080 cells,and hepatocellular carcinoma HepG2 cells.Compounds 1-3 induced cell death was characterized by endoplasmic reticulum(ER)swelling and cytoplasmic vacuolization,typical morphological changes associated with paraptosis.Mechanistic studies revealed that compounds 1 and 3 triggered paraptosis-like cell death through the accumulation of react-ive oxygen species(ROS),activation of ER stress,and stimulation of the MAPK signaling pathway.

Type Ⅳ hiatal hernia with a high risk usually presents sudden or suddenly worsening epigas-tric pain,vomiting,and dysphagia.It is not conducive to early diagnosis and treatment when symptoms are atypi-cal.Type Ⅳ hiatal hernia with severe anemia is rare.This article reports an atypical case of typeⅣhiatal hernia with melena and severe anemia as the main manifestations,aiming to improve clinicians'identification of the atypical clinical presentations of type Ⅳ hiatal hernia.

Objective To analyze the thyroid hormone levels in patients with acute ischemic stroke (AIS) and non-valvular atrial fibrillation (NVAF). Methods A total of 121 patients with AIS were selected, and were divided into NVAF group (AIS patients with NVAF) and control group (AIS patients without atrial fibrillation). Serum levels of triiodothyronine (T₃), free triiodothyronine (FT₃), thyroxine (T₄), free thyroxine (FT₄) and thyroid stimulating hormone (TSH) in two groups were measured and compared. The survival of the two groups was compared. Results The serum T₃ level in the NVAF group was significantly lower than that in the control group (P < 0.05). There were no significant differences in serum FT₃, T₄, FT₄ and TSH levels between the two groups (P>0.05). There was no significant difference in survival between the two groups (P>0.05). Conclusion NVAF is associated with serum T₃ levels in AIS patients. There is no correlation between the risk of death and NVAF in AIS patients.

Objective:To evaluate the cerebral infarct volume and the nerve fiber connectivity between cortical and neurogenesis-related regions in the mouse model of reperfusion after middle cerebral artery occlusion (MCAO) by 11.7 Tesla(11.7 T) magnetic resonance imaging (MRI).Methods:MCAO models were established in SPF grade adult male C57BL/6 mice using the suture-occluded method.MRI scans were performed at 3 days before and 1 day after modeling.Infarct volumes were calculated, and nerve fiber tracking was performed on specific brain regions to analyze the nerve fiber number and the parameters of fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity (AD)and radial diffusivity(RD). SPSS 26.0 was used for statistical analysis, and paired t test was used to compare the data before and after modeling. Results:(1) After MCAO-induced ischemia, the infarct volume was up to (35.11±17.57)mm 3, and the FA value of the infarct area was significantly reduced compared with that of before modeling( t=4.73, P<0.01). (2) At the anterior-posterior(AP): + 1.2 mm section, the results of fiber tracking showed that compared with before modeling, the number of fiber bundles originating from the dorsal horn of the lateral sub-ventricle zone(SVZ)to the cortex reduced ((92 584.20±14 751.00) vs (59 815.60±6 752.46), t=4.87, P<0.01), and the number of fiber bundles projected to the infarcted area reduced ((107 671.40±10 497.57) vs (61 658.60±10 178.21), t=6.43, P<0.01). FA, AD, MD, and RD values were all decreased in different degrees( t=3.38-6.43, all P<0.05). (3) At the AP: -3.8 mm section, the number of fiber bundles originating from the dorsal horn of the SVZ to the cortex decreased (after modeling(96 944.00±18 331.09), before modeling(58 767.80±16 445.25), t=2.99, P<0.05), and the values of FA, AD, MD and RD decreased after ischemia ( t=7.30, 5.05, 6.74, 4.13, all P<0.05). Conclusion:The ultra-high field strength of 11.7 T MRI can accurately detect the following results that the number of nerve fiber bundles from the SVZ to the cortex or infarct area are both significantly reduced, and diffusion tensor parameters are consistently changed in mice after 1 day of ischemia-reperfusion.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Objective:To design an anatomical plate of ulna coronoid process using 3D printing and computer model design software based on a collection of CT scanning data of the ulna coronoid process.Methods:The CT scans of the elbow joint with no obvious anatomic variation, no fracture, or no history of elbow operation were collected which had been taken at Trauma Center, The First Affiliated Hospital of Kunming Medical University from September 2017 to January 2022. There were 52 males and 50 females. RadiAnt DICOM Viewer and Mimics Medical 21.0 were used to visualize the CT data of the elbow joint of 102 volunteers. The software was used to measure the angle between the tip of the ulna coronoid process and the tuberosity of the ulna, the width at 1/2 height of the ulna coronoid process, the distance between the tip of the ulna coronoid process and the horizontal plane of the ulna tuberosity, and the safety angle for screw placement. After the values were measured, Siemens Ungraphics NX12.0 software was used to design the anatomical plate and the screw guide device of the ulna coronoid process. After the plate model was designed, a 1:1 actual plate model of the ulna coronoid process was produced by 3D printing. The actual plate model was placed onto an adult model of the ulna coronoid process and an adult cadaveric specimen of the ulna coronoid process to verify its matching degree. An in vitro operation was simulated using the plate model to verify its operability. Results:There were no significant differences between the left and right sides in the angle between the tip of the ulna coronoid process and the tuberosity of the ulna, the width at 1/2 height of the ulna coronoid process, the distance between the tip of the ulna coronoid process and the horizontal plane of the ulna tuberosity, or the safety angle for screw placement in either males or females ( P>0.05). There were no significant differences between males and females in the angle between the tip of the ulna coronoid process and the tuberosity of the ulna or in the safety angle for screw placement ( P>0.05). There were statistically significant differences between males and females in the width of 1/2 height of the ulna coronoid process and the distance between the tip of the ulna coronoid process and the horizontal plane of the ulna tuberosity ( P<0.05). However, the experiments on computer simulative adaptation and plate model simulative adaptation found that the anatomical plates of the ulna coronoid process designed on various parameters of males and females were exchangeable, leading to similarly good marching degrees and safe angles for screw placement. Conclusions:The anatomical plate of the ulna coronoid process designed in this study demonstrates a good fit and a safe angle for screw placement, basically achieving the goal expected to provide a basis for fabrication of a titanium alloy plate. In design of an anatomical plate of ulna coronoid process, it is not necessary to differentiate males from females or to differentiate the left side from the right one, because only a general plate can be used for both males and females and for both the left and the right sides.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

The postoperative pathological staging system (pTNM) has become an important reference for the selection of various tumor treatment strategies and prognosis evaluation at a global scale, and is a powerful predictor of the prognosis of a variety of solid tumors, but the prognosis is still different in patients with the same pTNM staging. In recent years, studies have confirmed that the negative lymph nodes count (NLNC) is related to the prognosis of a variety of solid tumors. Higher NLNC can improve the prognosis of cancer patients, and NLNC can reduce staging migration, which is expected to be a supplement to the pTNM staging system. This article reviews the value of NLNC in the prognosis of solid tumors.

Objective:To compare the advantages and disadvantages of hemiarthroplasty (HA) and reverse shoulder arthroplasty (RSA) in the treatment of complex proximal humeral fractures in the elderly patients.Methods:Pubmed, the Cochrane Library, EMBASE, and Chinese databases like CNKI, Wanfang Data and Weipu were searched for studies comparing HA and RSA in the treatment of complex proximal humeral fractures in the elderly (>60 years) from 2000 to 2020. After the studies were included and excluded by a set of inclusion and exclusion criteria and evaluated for their quality, their radiological and functional data were extracted and analyzed using software Stata 14.0.Results:Included in this meta-analysis were 11 studies with a total of 771 patients. RSA was superior to HA in outcomes like forward flexion ( SMD=-1.043, 95% CI: -1.551 to -0.534, P=0.000), abduction ( SMD=-0.811, 95% CI: -1.470 to -0.153, P=0.016), Constant score ( SMD=-0.699, 95% CI: -1.118 to -0.280, P=0.001), American Shoulder Elbow Surgeons’ Form (ASES) ( SMD=-0.931, 95% CI: -1.256 to -0.606, P<0.001), and Simple Shoulder Test (SST) ( SMD=-0.598, 95% CI: -1.181 to -0.016, P=0.044). HA led to a higher complication rate ( RR=2.14, 95% CI: 1.11 to 4.14, P=0.024), a higher joint stiffness rate ( RR=6.467,95% CI: 1.923 to 21.755, P=0.003) and a higher revision rate ( RR=5.796, 95% CI: 1.927 to 17.434, P=0.002). There were no statistically significant differences between RSA and HA in tuber healing rate ( RR=0.850, 95% CI: 0.669 to 1.080, P=0.182), internal rotation ( SMD=0.536, 95% CI: -0.394 to 1.466, P=0.259), external rotation ( SMD=-0.366, 95% CI: -0.916 to 0.184, P=0.192), implant infection ( RR=1.550, 95% CI: 0.330 to 7.286, P=0.579) or Disabilities of the Arm, Shoulder and Hand (DASH) score ( SMD=0.286, 95% CI: -0.278 to 0.850, P=0.032). Although there was no significant difference between RSA and HA in visual analogue scale (VAS) score ( SMD=0.440, 95% CI: -0.113 to 0.993, P=0.119), RSA scored better ( SMD=-1.101, 95% CI: -2.090 to -0.112, P=0.029). Conclusion:For elderly patients (>60 years) with complex proximal humeral fracture, RSA may be a more effective surgical intervention which can lead to better early and mid-term clinical outcomes than HA.