1.Epidemiological characteristics and disease burden of liver cancer in Guangdong Province
Ying ZHANG ; Yixuan CHEN ; Rong CAO ; Yue GAO ; Yutong HAN ; Ye WANG ; Ruilin MENG ; Xueyan ZHENG ; Yu LIAO ; Zhuanping ZENG
Journal of Public Health and Preventive Medicine 2026;37(1):68-72
Objective To analyze the epidemiological characteristics and disease burden of liver cancer in Guangdong Province in 2020, and to provide a scientific foundation for the development of regionalized prevention and control strategies for liver cancer. Methods According to the cancer registry data of Guangdong Province, the incidence, mortality and age-standardized rate by Chinese standard population in 2020 were calculated to analyze the epidemiological characteristics of liver cancer. The disability adjusted life years (DALYs), year of life loss (YLL), year of lived with disability (YLD), and cause-eliminated life expectancy were used to assess the disease burden of liver cancer. Results In 2020, the crude incidence rate and the age-standardized incidence rate of liver cancer in Guangdong Province were 27.79/100 000 and 20.84/100 000,respectively, and the crude mortality rate and the age-standardized mortality rate of liver cancer were 25.49/100,000 and 17.64/100 000, respectively. The total DALY and DALY rate of liver cancer in Guangdong Province were 515 311 person-years and 513.83/100 000, respectively. After eliminating the causes of death from liver cancer, the life expectancy in Guangdong Province increased from 84.60 years to 84.99 years. All indicators consistently demonstrated that the burden of liver cancer was higher in males than that in females, and the burden of liver cancer was higher in rural areas than that in urban areas. Conclusion Liver cancer in Guangdong Province exhibits a high incidence, mortality and disease burden level in 2020. There are obvious differences of gender, age and region in cancer burden. It is necessary to strengthen liver cancer screening and diagnosis and treatment in men, the elderly and those in rural areas to reduce the burden of liver cancer gradually in Guangdong Province.
2.Zuogui Wan Improve Ovarian Inflammatory Microenvironment and Stemness of Ovarian Germline Stem Cells in Ovarian Aging via cGAS/STING Signaling Pathway
Yunling ZHENG ; Xinyi PAN ; Zuang LI ; Yixuan WANG ; Junyi AN ; Yuxin ZOU ; Mengting XIAO ; Zheng CHEN ; Ling ZHU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(7):1-10
ObjectiveTo investigate the mechanism of Zuogui Wan (ZGW) in improving ovarian inflammatory microenvironment and stemness of ovarian germline stem cells (OSCs) for treating ovarian aging via the cyclic guanosine monophosphate/adenosine monophosphate synthase (cGAS)/stimulator of interferon genes (STING) signaling pathway. MethodsForty C57BL/6 female mice were randomly divided into a blank group, a model group, a low-dose ZGW group (2.7 g·kg-1), a high-dose ZGW group (5.4 g·kg-1), and an estradiol valerate group (0.15 mg·kg-1), with 8 mice in each group. Except the blank group, all other groups received a single intraperitoneal injection of cyclophosphamide at 120 mg·kg-1 to establish an ovarian aging mouse model. After successful modeling, each group was continuously administered for 4 weeks, once daily. The physiological status of the mice was observed, and the ovarian index was calculated. The estrus cycle of the mice was monitored. Hematoxylin-eosin (HE) staining was used to observe pathological changes in ovarian tissue. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum sex hormone levels. Serum inflammatory factors interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and mouse interleukin-6 (IL-6) levels were detected using kits. Western blot was used to detect the protein expression of ovarian cGAS, STING, p-STING, TANK-binding kinase 1 (TBK1), p-TBK1, interferon-induced transmembrane protein 3 (Fragilis), and Vasa homolog protein (MVH). Quantitative real-time polymerase chain reaction (Real-time PCR) was used to detect the mRNA expression of inflammatory factors in ovarian tissue. Immunofluorescence double labeling was performed to locate OSCs in ovarian tissues, and fluorescence intensities of OSCs markers MVH and octamer binding transcription factor 4 (Oct4) were calculated. ResultsCompared with the blank group, the model group showed reduced body weight, ovarian wet weight, and ovarian index (P<0.01) and a disordered estrus cycle (P<0.01). In addition, the levels of serum follicle-stimulating hormone (FSH), TNF-α, IL-6, and IL-1β were increased (P<0.01), while anti-Müllerian hormone (AMH) and estradiol (E2) levels were decreased (P<0.01). The protein expression of cGAS, p-STING/STING, and p-TBK1/TBK1 in ovarian tissue was increased (P<0.05, P<0.01), while that of OSCs stemness factors MVH and Fragilis was reduced (P<0.01). Immunofluorescence indicated a reduction in MVH and Oct4 expression in OSCs (P<0.01). The mRNA expression of inflammatory factors TNF-α, IL-6, and IL-1β in ovarian tissue was increased (P<0.05, P<0.01). Compared with the model group, the treatment groups exhibited improved body weight, ovarian wet weight, and ovarian index (P<0.05) and a reduced rate of estrus cycle disorder (P<0.05, P<0.01). The levels of serum FSH, TNF-α, IL-6, and IL-1β were decreased (P<0.05, P<0.01), while AMH and E2 levels were increased (P<0.01). The protein expression levels of cGAS, p-STING/STING, and p-TBK1/TBK1 in ovarian tissue were decreased (P<0.05), while the protein expression of MVH and Fragilis was increased (P<0.05), and the fluorescence intensities of MVH and Oct4 were increased (P<0.05, P<0.01). The mRNA expression of inflammatory factors in ovarian tissue was decreased (P<0.05). ConclusionZGW alleviate ovarian inflammatory response, regulate ovarian microenvironment homeostasis, and maintain stemness of OSCs in ovarian aging mice probably by modulating the cGAS-STING signaling pathway, thereby improving ovarian function and delaying ovarian aging.
3.Development and Validation of a High-Performance Liquid Chromatography-Tandem Mass Spectrometry Method for Detecting Adrenocortical Hormones and Establishment of Age-Stratified Reference Intervals in Reproductive-Aged Women from Guangxi, China
Yixuan LIU ; Tingwei JIN ; Yushuang WEI ; Xuelian QIN ; Siyu DENG ; Jie ZHENG ; Boteng YAN ; Yuanyuan NONG ; Yu YE ; Shengzhu HUANG ; Yu LONG ; Jianmin LI ; Ganqin WANG ; Pei HUANG ; Jinghang JIANG ; Fan WU ; Zengnan MO ; Yonghua JIANG
Annals of Laboratory Medicine 2026;46(2):146-154
Background:
Adrenocortical hormones, particularly 11-oxygenated androgens, are pivotal in female reproductive health and fertility. Standardized detection kits and population-specific reference intervals are lacking in China, hindering related clinical applications.
Methods:
A HPLC-tandem mass spectrometry (HPLC-MS/MS) pipeline was developed, rigorously validated, and applied to simultaneously quantify corticosterone, cortisone, cortisol, 18-OH cortisol, androstenedione (A4), 11β-hydroxyandrostenedione (11-OH A4), dehydroepiandrosterone, and dehydroepiandrosterone sulfate in serum samples from 455 reproductive-aged women (18–45 yrs) in Guangxi, China. Age-dependent concentration trends were analyzed, and reference intervals stratified by age (2.5th to 97.5th percentiles) were established. Correlations with body-composition metrics, ethnicity, and the menstrual cycle were investigated.
Results:
The HPLC-MS/MS method demonstrated high precision (intra- and inter-assay CVs < 15%), accuracy, and sensitivity. All eight hormones exhibited significant age-related declines (P < 0.001 for seven hormones; P = 0.001 for 11-OH A4). Notably, 11-OH A4 levels were significantly lower in the 35–45-yr (3.05 nmol/L) and 25–34-yr (3.09 nmol/L) age groups than in the 18–24-yr (3.57 nmol/L) age group, whereas no significant difference was observed between the 35–45-yr and 25–34-yr age groups. Weak negative correlations were observed between the body mass index and corticosterone and cortisone levels, whereas ethnicity and the menstrual cycle showed no significant associations with hormone levels.
Conclusions
We developed an HPLC-MS/MS-based method for simultaneously quantifying eight adrenocortical hormones, including 11-OH A4, and defined age-specific reference intervals for reproductive-aged Chinese women. These findings advance the clinical utility of adrenocortical hormones in diagnosing and managing reproductive disorders.
4.A cisplatin prodrug-based self-assembling ozone delivery nanosystem sensitizes radiotherapy in triple-negative breast cancer.
Tianyue XU ; Dan ZHENG ; Meixu CHEN ; Linlin SONG ; Zhihui LIU ; Yan CHENG ; Yujie ZHAO ; Liwen HUANG ; Yixuan LI ; Zhankun YANG ; Cong LI ; Biao DONG ; Jing JING ; Hubing SHI
Acta Pharmaceutica Sinica B 2025;15(5):2703-2722
Lacking therapeutic targets highlights the crucial roles of chemotherapy and radiotherapy in the clinical management of triple-negative breast cancer (TNBC). To relieve the side effects of the chemoradiotherapy combination regimen, we design and develop a self-assembled micelle nanosystem consisting of perfluorocarbon chain-modified cisplatin prodrug. By incorporating perfluorodecalin, this nanosystem can effectively carry ozone and promote irradiation-derived reactive oxygen species (ROS) production. By leveraging the perfluorocarbon sidechain, the nanosystem exhibits efficient internalization by TNBC cells and effectively escapes from lysosomal entrapment. Under X-ray irradiation, ozone-generated ROS disrupts the intracellular redox balance, thereby facilitating the release of cisplatin in a reduction-responsive manner mediated by reduced glutathione. Moreover, oxygen derived from ozone decomposition enhances the efficacy of radiotherapy by alleviating tumor hypoxia. Notably, the combination of irradiation with ozone-loaded cisplatin prodrug nano system synergistically prompts antitumor efficacy and reduces cellular/systemic toxicity in vitro and in vivo. Furthermore, the combo regimen remodels the tumor microenvironment into an immune-favored state by triggering immunogenic cell death and relieving hypoxia, which provides a promising foundation for a combination regimen of immunotherapy. In conclusion, our nanosystem presents a novel strategy for integrating chemotherapy and radiotherapy to optimize the efficacy and safety of TNBC clinical treatment.
5.Augmentation of PRDX1-DOK3 interaction alleviates rheumatoid arthritis progression by suppressing plasma cell differentiation.
Wenzhen DANG ; Xiaomin WANG ; Huaying LI ; Yixuan XU ; Xinyu LI ; Siqi HUANG ; Hongru TAO ; Xiao LI ; Yulin YANG ; Lijiang XUAN ; Weilie XIAO ; Dean GUO ; Hao ZHANG ; Qiong WU ; Jie ZHENG ; Xiaoyan SHEN ; Kaixian CHEN ; Heng XU ; Yuanyuan ZHANG ; Cheng LUO
Acta Pharmaceutica Sinica B 2025;15(8):3997-4013
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent inflammation and joint damage, accompanied by the accumulation of plasma cells, which contributes to its pathogenesis. Understanding the genetic alterations occurring during plasma cell differentiation in RA can deepen our comprehension of its pathogenesis and guide the development of targeted therapeutic interventions. Here, our study elucidates the intricate molecular mechanisms underlying plasma cell differentiation by demonstrating that PRDX1 interacts with DOK3 and modulates its degradation by the autophagy-lysosome pathway. This interaction results in the inhibition of plasma cell differentiation, thereby alleviating the progression of collagen-induced arthritis. Additionally, our investigation identifies Salvianolic acid B (SAB) as a potent small molecular glue-like compound that enhances the interaction between PRDX1 and DOK3, consequently impeding the progression of collagen-induced arthritis by inhibiting plasma cell differentiation. Collectively, these findings underscore the therapeutic potential of developing chemical stabilizers for the PRDX1-DOK3 complex in suppressing plasma cell differentiation for RA treatment and establish a theoretical basis for targeting PRDX1-protein interactions as specific therapeutic targets in various diseases.
6.Interleukin-33 Knockout Promotes High Mobility Group Box 1 Release from Astrocytes by Acetylation Mediated by P300/CBP-Associated Factor in Experimental Autoimmune Encephalomyelitis.
Yifan XIAO ; Liyan HAO ; Xinyi CAO ; Yibo ZHANG ; Qingqing XU ; Luyao QIN ; Yixuan ZHANG ; Yangxingzi WU ; Hongyan ZHOU ; Mengjuan WU ; Mingshan PI ; Qi XIONG ; Youhua YANG ; Yuran GUI ; Wei LIU ; Fang ZHENG ; Xiji SHU ; Yiyuan XIA
Neuroscience Bulletin 2025;41(7):1181-1197
High mobility group box 1 (HMGB1), when released extracellularly, plays a pivotal role in the development of spinal cord synapses and exacerbates autoimmune diseases within the central nervous system. In experimental autoimmune encephalomyelitis (EAE), a condition that models multiple sclerosis, the levels of extracellular HMGB1 and interleukin-33 (IL-33) have been found to be inversely correlated. However, the mechanism by which IL-33 deficiency enhances HMGB1 release during EAE remains elusive. Our study elucidates a potential signaling pathway whereby the absence of IL-33 leads to increased binding of P300/CBP-associated factor with HMGB1 in the nuclei of astrocytes, upregulating HMGB1 acetylation and promoting its release from astrocyte nuclei in the spinal cord of EAE mice. Conversely, the addition of IL-33 counteracts the TNF-α-induced increase in HMGB1 and acetylated HMGB1 levels in primary astrocytes. These findings underscore the potential of IL-33-associated signaling pathways as a therapeutic target for EAE treatment.
Animals
;
Encephalomyelitis, Autoimmune, Experimental/metabolism*
;
Astrocytes/metabolism*
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Interleukin-33/metabolism*
;
HMGB1 Protein/metabolism*
;
Acetylation
;
Mice, Knockout
;
Mice, Inbred C57BL
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p300-CBP Transcription Factors/metabolism*
;
Mice
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Spinal Cord/metabolism*
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Cells, Cultured
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Female
;
Signal Transduction
7.Exploring Effect of Buchong Tiaojing Prescription on Ferroptosis in Ovarian Tissue of Rat Model of Diminished Ovarian Reserve and Its Mechanism from Perspective of NLRP3 Inflammasome
Yixuan WANG ; Zuang LI ; Yunling ZHENG ; Yucheng LI ; Songping LUO ; Ling ZHU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(3):40-48
ObjectiveTo explore the therapeutic mechanism of Buchong Tiaojing prescription for rats with diminished ovarian reserve (DOR) from the perspectives of nucleotide-binding oligomerization domain (NOD)-like receptor protein 3 (NLRP3) inflammasome and ferroptosis. MethodsA total of 48 female SD rats were randomly divided into a normal group, a model group, low, medium, and high dose groups of Buchong Tiaojing prescription, and an MCC950 group, with eight rats in each group. Except the normal group, all the other groups were injected subcutaneously on the back of the neck with D-galactose to prepare the DOR rat model. From the 15th day of modeling, the rats in the low, medium, and high dose groups of Buchong Tiaojing prescription were subjected to gavage daily at doses of 14.4, 28.8, 57.6 g·kg-1, respectively. Rats in the MCC950 group were injected intraperitoneally with MCC950 at a dose of 10 mg·kg-1, once every other day. The interventions of all the groups lasted for 4 weeks. The estrous cycle of the rats was observed with vaginal exfoliated cell smear. Hematoxylin-eosin (HE) staining was performed to observe the development of follicles and corpus luteum in the ovary. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of serum sex hormones and interleukin-1β (IL-1β). Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR) and Western blot assay were performed to detect the mRNA and protein expression of NLRP3 inflammasome, acyl-CoA synthetase long-chain family member 4 (ACSL4), transferrin receptor 1 (TFR1), and glutathione peroxidase 4 (GPX4), and oxidative stress kits were used to detect ovarian superoxide dismutase (SOD) and malondialdehyde (MDA) levels. ResultsDuring the experiment, one rat died in the high dose group of Buchong Tiaojing prescription, and a total of 47 rats were finally included in the index tests and statistics. Compared with those in the normal group, rats in the model group had significantly disturbed estrous cycles, increased number of atretic follicles, and significant disorder of serum sex hormones. The mRNA and protein expression of NLRP3 inflammasome, ACSL4, and TFR1 in ovarian tissue was up-regulated (P<0.01), while that of GPX4 was significantly down-regulated (P<0.01). The SOD content in the ovary was decreased significantly, while the MDA level was increased (P<0.01). After drug intervention, the estrous cycle of rats was basically resumed, and the follicles at all levels were more structurally intact and significantly increased in number. Additionally, the levels of serum sex hormones and IL-1β were significantly improved. The mRNA and protein expression of NLRP3 inflammasome, ACSL4, and TFR1 were down-regulated, while that of GPX4 was significantly up-regulated, and the ovarian oxidative stress was alleviated (P<0.05, P<0.01), especially in the high dose group of Buchong Tiaojing prescription and the MCC950 group. ConclusionInflammatory injury and ferroptosis occur in the ovaries of DOR rats, and the Buchong Tiaojing prescription is able to inhibit ovarian NLRP3 inflammasome, alleviate the degree of ovarian ferroptosis, and improve ovarian reserve.
8.From tumor immunity to organ transplantation immunity
Guxiang ZHOU ; Yixuan LI ; Jin ZHENG
Organ Transplantation 2025;16(2):229-236
The major histocompatibility complex plays a crucial role in the immune response process, which is closely related to the occurrence and development of tumors and organ transplantation. Cellular immunity occupies an important position in tumor immunity and organ transplantation immunity, while humoral immunity also plays a significant role in organ transplantation immunity. Organ transplantation requires the induction and maintenance of immune tolerance, while tumors develop immune escape phenomena during their progression. In-depth exploration and comparison of the mechanisms of tumor immune escape and organ transplantation immune tolerance are of great significance for formulating reasonable immune tolerance induction strategies, improving the quality of life and prolonging the survival time of organ transplant patients.
9.The general pattern analysis of cirrhosis treatment based Ren-yin year's cases
Yirong HU ; Yixuan LIU ; Wenlong ZHENG
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care 2025;32(4):448-453
Objective A data mining method was used to analyse and summarize Professor Zheng Wenlong's ideas and prescription and medication rules for the treatment of cirrhosis,taking the case of cirrhosis of the liver in Ren-yin year(2022)as an example.Methods A collection of traditional Chinese medicine prescriptions for liver cirrhosis patients who received treatment at the clinic of chief traditional Chinese medicine physician Zheng Wenlong at Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University from January 20,2022 to January 19,2023,and who met the inclusion and exclusion criteria.An excel database was created to standardize the data,followed by frequency statistical analyzes of prescriptions,medications and the characteristics of herbal remedies.Association rule analysis was carried out using SPSS Modeler 18,which facilitated the creation of complex network diagrams,subsequently enhanced through visualization in software Cytoscape.Clustering analysis was executed utilizing SPSS 25.0.Results A total of 176 prescriptions were selected,and the top 3 most frequently used prescriptions were Lingzhu decoction,Shengming decoction and Beihua decoction,with the frequency of 10.13%(23/227),10.13%(23/227)and 9.69%(22/227).A diverse array of 155 herbal medicines were employed,and the top 3 most frequently used drugs were Glycyrrhiza,Poria and Zingiberis Rhizoma Recens,with the frequency of 4.75%(127/2 676),4.26%(114/2 676)and 3.21%(86/2 676).The predominant medicinal properties of these herbs were classified as either cold or warm,while the primary tastes identified were bitter,sweet and spicy,with channel tropism were liver,lung,stomach and spleen.According to the descending order of improvement percentage,the results showed that the strongly correlated pairs of herbs were Chaenomelis Fructus-Aconiti Lateralis Radix Praeparata and Citri Reticulatae Pericarpium Viride-Pericarpium Citri Reticulatae,with improvement degrees of 2.74%and 2.55%respectively;the strongly correlated 3-herb combinations(Jiao Yao)included Aconiti Lateralis Radix Praeparata-Poria-Chaenomelis Fructus and Aconiti Lateralis Radix Praeparata-Rhizoma Atractylodis Macrocephalae-Chaenomelis Fructus,with improvement degrees of 3.24%and 3.23%respectively.The clustering analysis categorized the high-frequency herbs into 3 distinct groups:C1:Citri Reticulatae Pericarpium Viride,Pericarpium Citri Reticulatae,Jujubae Fructus,Pinelliae Rhizoma Praeparatumcum Zingibere Et Alumine,and Zingiberis Rhizoma Recens;C2:Rhizoma Atractylodis Macrocephalae,Aconiti Lateralis Radix Praeparata,Artemisiae Scopariae Herba,and Paeoniae Radix Alba;C3:Schisandra Chinensis,Rhizoma Alismatis,Radix Glycyrrhizae,Poria,Zingiberis Rhizoma and Ramulus Cinnamomi.These correspond to the formulas of Erchen decoction,Yinchenshufu decoction and Wuling powder.Conclusions The underlying pathogenesis of cirrhosis is linked to dysfunctions of the Jueyin and Yangming meridians,as well as disturbances in the Shaoyang axis.The primary therapeutic approach of Professor Zheng Wenlong involves a comprehensive evaluate all of the patient's clinical presentation to identify the shared pathogenesis underlying various symptoms,integrating the patient's personal constitution with the annual cycle of the Five Phases(Wuyun)and Six Qi(Liuqi)as described in traditional Chinese medicine,and formulate prescriptions based on the interactions of the Five Phases(Wuxing)and guided by the yin-yang theory of"Opening-Closing-Pivot"(Kai-He-Shu).The focus of prescriptions is rehabilitation and the final goal is reach the state of"Tian Ren He Yi".
10.Surgical techniques and clinical outcomes of upper urinary tract reconstruction for stone-related ureteral strictures
Xiaoteng YU ; Yixuan HUANG ; Xinfei LI ; Changfu CHEN ; Fangzhou ZHAO ; Honggang YING ; Zihao TAO ; Yiming ZHANG ; Liqing XU ; Zhihua LI ; Kunlin YANG ; Liqun ZHOU ; Xuesong LI ; Zheng ZHAO
Journal of Peking University(Health Sciences) 2025;57(4):670-675
Objective:To summarize the surgical strategies and to evaluate the clinical outcomes of up-per urinary tract reconstruction in patients with stone-related ureteral strictures.Methods:This retro-spective study included 71 patients diagnosed with ureteral strictures secondary to urinary stones who un-derwent upper urinary tract reconstructive surgery at Peking University First Hospital between March 2014 and November 2023.Patient data were collected,including demographic characteristics,clinical presen-tation,laboratory results,imaging findings,surgical procedures,and follow-up outcomes.Ureteral stric-tures were classified according to anatomical location into upper,middle,lower,or multiple segments.Surgical procedures were carried out depending on the stricture characteristics.Surgical success was de-fined as resolution or improvement of clinical symptoms,radiographic improvement or stabilization of hy-dronephrosis,and maintenance of normal and stable renal function.Results:Among the 71 patients,36(50.7%)had strictures in the upper ureter,9(12.7%)in the middle ureter,15(21.1%)in the lower ureter,and 11(15.5%)had multifocal ureteral strictures.The median stricture length was 5.0 cm(interquartile range:3.0-15.0 cm).Surgical approach selection was individualized based on the location and extent of the stricture.For upper ureteral strictures,the most frequently employed techniques were oral mucosal graft ureteroplasty(13/36,36.1%)and appendiceal flap ureteroplasty(8/36,22.2%).Other options included ureteroureterostomy and ileal ureter replacement for longer or more complex strictures.In middle ureteral strictures,treatment was stratified by length:balloon dilation(1/9,11.1%)and ureteroureterostomy(1/9,11.1%)were applied in shorter strictures,while oral mucosal graft ureteroplasty(3/9,33.3%)and ileal ureter replacement(4/9,44.4%)were reserved for longer segments.For lower ureteral strictures,ureteral reimplantation into the bladder was the most common approach(10/15,66.7%),often combined with a psoas hitch or Boari flap when necessary.All the patients with multiple segmental strictures underwent ileal ureter replacement due to the extensive nature of the disease.The median follow-up period was 14.2 months(range:6.1-107.1 months).During follow-up,69 of 71 patients(97.2%)achieved surgical success.Conclusion:Stone-related ure-teral strictures present with considerable heterogeneity in terms of anatomical location,length,and com-plexity.Careful preoperative evaluation and individualized surgical planning are critical to successful re-construction.With appropriate selection of surgical methods,favorable long-term clinical outcomes can be achieved in the majority of patients.


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