Hepatocellular carcinoma （HCC） often has an insidious onset， and early diagnosis and accurate differential diagnosis are critical for improving the prognosis of patients. Ultrasound remains an important radiological examination for the screening and initial assessment of high-risk populations due to its advantages of convenience， real-time monitoring， repeatability， and suitability for dynamic follow-up. With the development of ultrasound technologies in recent years， the application of ultrasound in HCC has gradually expanded from lesion detection to lesion characterization， differential diagnosis， and prognostic evaluation. With reference to the clinical needs for the early and differential diagnosis of HCC， this article reviews the application value， clinical localization， and limitations of gray-scale ultrasound， Doppler ultrasound， and contrast-enhanced ultrasound in HCC， with a focus on their application in the evaluation and differential diagnosis of small HCC. It highlights that comprehensive evaluation should be performed based on liver background， lesion morphology， blood flow features， enhancement patterns， and dynamic changes during follow-up， so as to improve the early and differential diagnosis of HCC.

Objective To explore the neuroprotective effect of asiatic acid(AA)on brain damage after experimental subarachnoid hemorrhage(SAH)in rats.Methods A total of 108 adult SD rats were divided into the sham1 group,the SAH+vehicle group and the SAH+AA group,with 36 rats in each group.The 42 rats were divided into the sham2 group,3,6,12,24,48 and 72 h after SAH groups,with 6 rats in each group.Except the sham group,SAH model was established by unilateral external carotid artery puncture method in other groups.After modeling,the SAH+AA group was given AA solution(30 mg/kg)by gavage.Neurobehavioral changes were assessed by foot fault test and modified Garcia score.Western blot assay was used to detect the protein level of glutathione peroxidase 4(GPX4)in brain tissue.ELISA was used to detect the concentrations of glutathione(GSH)and malondialdehyde(MDA).Fluoro Jade B(FJB)staining was used to detect the neuronal death.Results Compared with the sham1 group,the SAH+vehicle group showed a significant increase in the proportion of empty steps and a significant decrease in the modified Garcia score,a significant decrease in GPX4 protein levels,a significant increase in MDA concentration(P＜0.05),a decrease in GSH concentration(P＜0.01)and a significant increase in the number of dead neurons(P＜0.05).Compared with the SAH+vehicle group,a significant decrease in the proportion of empty steps,a significant increase in the modified Garcia score,a significant increase in GPX4 protein level,a significant decrease in MDA concentration,a significant increase in GSH concentration(P＜0.05)and a significant decrease in the number of dead neurons in the SAH+AA group(P＜0.05).Conclusion AA may reduce brain injury after SAH in rats by inhibiting lipid peroxidation.

Objectives:To investigate the clinical characteristics of noncontiguous spinal tuberculosis and the efficacy and prognosis of one-stage posterior debridement,bone graft fusion and internal fixation for the treat-ment of noncontiguous spinal tuberculosis.Methods:The clinical data of 31 patients with noncontiguous spinal tuberculosis treated in our hospital between July 2016 and May 2022 were retrospectively analyzed,in-cluding 18 males and 13 females,aged 49.5±27.5 years.There were 24 cases with 2 lesions and 7 cases with 3 lesions.Responsible vertebrae were clarified,and surgical lesions,fusion segments,and internal fixation methods were determined for each patient,so as to develop individualized surgical plans.The patients were followed up for 29.7±14.7 months(15-85 months).The operative time,intraoperative blood loss,and intraoper-ative and postoperative complications were recorded.Erythrocyte sedimentation rate(ESR)and C-reactive pro-tein(CRP)were examined and recorded before operation,at 1 month,3 months,and 1 year after operation,and at the last follow-up.Visual analogue scale(VAS)was used to evaluate the pain before operation,at 1 week,1 month,3 months,1 year after operation and at the last follow-up.Cobb angle was measured before operation,at 1 week after operation,and at the last follow-up.The American Spinal Injury Association(ASIA)classification was recorded before operation and at the last follow-up.Bridwell bone healing criteria were used to evaluate postoperative tuberculosis activity,symptom improvement,deformity correction,and bone healing at the last follow-up.Results:Among the 31 patients,20(65.4％)had only one lesion(65.4％),23(74.2％)were admitted to the hospital with pain as the main complaint,15(48.4％)had only pain symptoms during the course of the disease,11 cases(35.5％)had only one lesion with pain symptoms,and 18(58.1％)patients had at least one lesion missed at the initial diagnosis.All the patients were successfully operated.The operative time was 280.0±52.2min(165-330min),and blood loss was 567.7±332.0mL(150-1000mL).There were 4 cases of cerebrospinal fluid leakage and 3 cases of incision infection after operation,which were cured after symptomatic treatment.All foci of tuberculosis were cured without recurrence or retransmission.At pre-operation,1 month,3 months,1 year after surgery,and at the last follow-up,ESR was 41.5±26.3mm/h,16.3±13.4mm/h,12.5±6.3mm/h,11.4±5.2mm/h,and 9.2±3.1mm/h,and the levels of CRP were 32.8±23.2mg/L,7.3±5.6mg/L,6.2±4.1mg/L,5.1±3.7mg/L,2.8±2.3mg/L,which were both significantly lower after operation than those before operation(P＜0.05).The VAS score was 6.4±2.4,2.4±1.7,2.3±1.3,1.6±0.9,0.9±0.7,and 0.4±0.3 before operation,at 1 week,1 month,3 months,1 year after operation,and at the last follow-up,which was significantly improved after operation when compared with that before operation(P＜0.05).The Cobb angle was 25.7°±4.9° before operation,15.4°±2.1° at 1 week after operation,and 17.1°±2.3° at the last follow-up,and there were significant differences between the postoperative angles and preoperative angles(P＜0.05).Among the 10 patients with preoperative neurological impairment,1 patient with preoperative grade A recovered to grade C at the last follow-up.Among the 4 patients with preoperative grade B,1 patient recovered to grade C and 3 to grade D.Of the 5 patients with preoperative grade C,2 recovered to grade D and 3 to grade E.All 42 bone graft lesions achieved bone fusion at 6-12 months after operation.At the last follow-up,34 lesions healed in Bridwell grade Ⅰ and 8 in Bridwell grade Ⅱ.Conclusions:For patients with noncontiguous spinal tuberculosis,one-stage posterior debridement,bone graft fusion and internal fixation is safe and efficient after determining responsible vertebrae and lesion features,which can obtain satisfactory results.

Graphene family nanomaterials(GFNs)are highly popular in the field of bone tissue engineering because of their excellent mechanical properties,biocompatibility,and ability to promote the osteogenic differentiation of stem cells.GFNs play a multifaceted role in promoting the bone regeneration microenvironment.First,GFNs activate the ad-hesion kinase/extracellularly regulated protein kinase(FAK/ERK)signaling pathway through their own micromorphology and promote the expression of osteogenesis-related genes.Second,GFNs adapt to the mechanical strength of bone tis-sue,which helps to maintain osseointegration;by adjusting the stiffness of the extracellular matrix,they transmit the me-chanical signals of the matrix to the intracellular space with the help of focal adhesions(FAs),thus creating a favorable physiochemical microenvironment.Moreover,they regulate the immune microenvironment at the site of bone defects,thus directing the polarization of macrophages to the M2 type and influencing the secretion of relevant cytokines.GFNs also act as slow-release carriers of bioactive molecules with both angiogenic and antibacterial abilities,thus accelerating the repair process of bone defects.Multiple types of GFNs regulate the bone regeneration microenvironment,including scaffold materials,hydrogels,biofilms,and implantable coatings.Although GFNs have attracted much attention in the field of bone tissue engineering,their application in bone tissue regeneration is still in the basic experimental stage.To promote the clinical application of GFNs,there is a need to provide more sufficient evidence of their biocompatibility,elucidate the mechanism by which they induce the osteogenic differentiation of stem cells,and develop more effective form of applications.

Objective:To investigate the efficacy of one-stage anterior debridement and bone graft fusion for the treatment of cervical pyogenic spondylodiscitis.Methods:This is a retrospective case series study. Retrospective analysis of clinical data from 23 patients with cervical pyogenic spondylodiscitis treated with one-stage anterior approach debridement and bone graft fusion was performed in the Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2020. There were 14 males and 9 females,aged (51.9±12.8) years (range:26 to 82 years). Preoperatively, 14 patients had neurological deficits, classified according to the American Spinal Injury Association (ASIA) impairment scale as follows: grade A in 1 case, grade B in 1 case, grade C in 5 cases, and grade D in 7 cases . All patients underwent the one-stage anterior debridement and fusion procedure. The surgical time, blood loss, hospital stay, fusion time, and surgical complications were documented. Clinical efficacy was assessed using the visual analogue scale (VAS), the neck disability index (NDI), and the ASIA impairment scale. Preoperative and postoperative data were compared using paired sample t tests, repeated measures analysis of variance, and generalized estimating equations. Results:All the 23 patients underwent the operative procedures successfully. The operation time was (102.8±19.8) minutes (range:60 to 140 minutes), blood loss was (84.4±40.2) ml (range:30 to 160 ml), and the length of hospital stay was (17.4±6.0) days (range:10 to 30 days). Blood cultures were positive for the causative pathogen in 14 cases (60.8% positivity rate), while 9 cases had negative results. Irrigation fluid cultures yielded the causative pathogen in 19 cases (82.6% positivity rate), with 4 cases negative. All patients were followed up for more than 12 months, with a follow-up duration of (19.0±5.9) months (range:12 to 36 months). At the final follow-up, VAS improved from (5.9±1.1) points preoperatively to (0.8±0.3) points; NDI improved from (38.3±6.0)% preoperatively to (9.3±3.0)%, with statistically significant differences (both P<0.01). All patients experienced improvement in neurological function, with the exception of one patient in grade C and two in grade D, all other patients recovered to grade E. The C 2-7 Cobb angle and the affected segment Cobb angle were corrected. white blood cell, erythrocyte sedimentation rate and C-reactive protein levels returned to normal. All patients achieved bony fusion, with a fusion time of (8.9±1.9) months (range:6 to 12 months). Two diabetic patients developed postoperative incision infection; no other surgery-related complications occurred in the remaining patients. Conclusion:One-stage anterior debridement and bone graft fusion can correct kyphosis, restore normal alignment, and improve neurological function in the treatment of single and double segment cervical pyogenic spondylodiscitis, representing a viable treatment option for cervical pyogenic spondylodiscitis.

Objective:To investigate the efficacy of one-stage anterior debridement and bone graft fusion for the treatment of cervical pyogenic spondylodiscitis.Methods:This is a retrospective case series study. Retrospective analysis of clinical data from 23 patients with cervical pyogenic spondylodiscitis treated with one-stage anterior approach debridement and bone graft fusion was performed in the Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2020. There were 14 males and 9 females,aged (51.9±12.8) years (range:26 to 82 years). Preoperatively, 14 patients had neurological deficits, classified according to the American Spinal Injury Association (ASIA) impairment scale as follows: grade A in 1 case, grade B in 1 case, grade C in 5 cases, and grade D in 7 cases . All patients underwent the one-stage anterior debridement and fusion procedure. The surgical time, blood loss, hospital stay, fusion time, and surgical complications were documented. Clinical efficacy was assessed using the visual analogue scale (VAS), the neck disability index (NDI), and the ASIA impairment scale. Preoperative and postoperative data were compared using paired sample t tests, repeated measures analysis of variance, and generalized estimating equations. Results:All the 23 patients underwent the operative procedures successfully. The operation time was (102.8±19.8) minutes (range:60 to 140 minutes), blood loss was (84.4±40.2) ml (range:30 to 160 ml), and the length of hospital stay was (17.4±6.0) days (range:10 to 30 days). Blood cultures were positive for the causative pathogen in 14 cases (60.8% positivity rate), while 9 cases had negative results. Irrigation fluid cultures yielded the causative pathogen in 19 cases (82.6% positivity rate), with 4 cases negative. All patients were followed up for more than 12 months, with a follow-up duration of (19.0±5.9) months (range:12 to 36 months). At the final follow-up, VAS improved from (5.9±1.1) points preoperatively to (0.8±0.3) points; NDI improved from (38.3±6.0)% preoperatively to (9.3±3.0)%, with statistically significant differences (both P<0.01). All patients experienced improvement in neurological function, with the exception of one patient in grade C and two in grade D, all other patients recovered to grade E. The C 2-7 Cobb angle and the affected segment Cobb angle were corrected. white blood cell, erythrocyte sedimentation rate and C-reactive protein levels returned to normal. All patients achieved bony fusion, with a fusion time of (8.9±1.9) months (range:6 to 12 months). Two diabetic patients developed postoperative incision infection; no other surgery-related complications occurred in the remaining patients. Conclusion:One-stage anterior debridement and bone graft fusion can correct kyphosis, restore normal alignment, and improve neurological function in the treatment of single and double segment cervical pyogenic spondylodiscitis, representing a viable treatment option for cervical pyogenic spondylodiscitis.

Humans ; Staphylococcus lugdunensis/genetics* ; Peptides, Cyclic ; Chromosomes ; Operon/genetics* ; Staphylococcal Infections/genetics* ; Bacterial Proteins/genetics* ; Anti-Bacterial Agents

Objective : To investigate the effect of electroacupuncture (EA) treatment at pinch points (EX⁃B2) on motor function and Notch signaling pathway after spinal cord injury(SCI) . Methods : Seventy⁃two Sprague⁃Dawley (SD) male rats weighing (250 ± 20) g were randomly divided into sham operation group , SCI , electroacupuncture group (SCI + EA) and acupuncture group (SCI + AP) , with 18 rats in each group. A rat acute SCI model of T10 was established by the modified Allen ′s method. The SCI + EA and SCI + AP groups received 15 minutes of electro acupuncture or acupuncture treatment per day. The motor function of the hind limbs of rats was assessed by Basso , Beattie and Bresnahan ( BBB) scoring method , the pathological recovery changes of spinal cord tissues were observed by Hematoxylin⁃eosin (HE) staining , and the mRNA and protein expression levels of Hes 3 , Notch 3 and Notch 4 were detected by real⁃time quantitative PCR and estern blot method , respectively , after 3 , 7 and 14 days of intervention. The expression of glial fibrillary acidic protein (GFAP) was detected by immunohistochemistry after 14 days of intervention. Results : Compared with the sham group , the BBB scores were reduced in rats after SCI surgery and there was significant hemorrhage , structural destruction and degeneration of spinal cord tissue ( P < 0. 05) , while the SCI + EA and SCI + AP groups were milder than the SCI group (P < 0. 05) . The mRNA expression levels and protein expression levels of Hes 3 , Notch 3 and Notch 4 as well as the expression levels of GFAP appeared significantly higher in the SCI group compared with the sham group (P < 0. 05) , while the SCI + EA group appeared lower compared with the SCI group (P < 0. 05) . Conclusion EA of EX⁃B2 can improve the locomotor function of rats with SCI , which may be related to inhibiting the expression of GFAP and the activation of Notch signaling pathway.

Objective:To explore the computer-aided navigation technology combined with personalized three-dimensional(3D) printing in the reduction and fixation of the multiple midface fractures.Methods:A retrospective analysis was performed on clinical data of patients suffering from multiple midface fractures treated at the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Anhui Medical University from August 2019 to December 2021. According to the operational method, the patients in the experimental group received the operation applied by AccuNavi-A 2.1 navigation software for surgical planning and surgical simulation, printing 3D head model before the operation, and reducing and fixing fractures with the aid of computer navigation technology. Patients in the control group received the operation applied by traditional surgery. Marking facial landmarks on the head CT 3D model of patients and constructing a spatial coordinate system before and 1 week after surgery, measuring and calculating the facial asymmetry index (AI) for each landmark, including the orbitale (O), the most outside of the zygomaticomaxillary suture of the 1/3 below of the margo infraorbitalis(MZ), the most concave point between the frontal process of zygomatic bone and the superior margin of processus temporalis(C), the most concave point of the superjacent of C of posterior margin of frontal process(SC) and the outermost point of zygomatic arch(Z). The duration of operation were recorded. Complications including diplopia, difficulty in mouth opening, facial numbness, malocclusion, scarring and pupil height were evaluated by patents 3 months after the operations. AI is represented by M( Q1, Q3), Wilcoxon rank test was used for intra-group comparison before and after operations, and Mann-Whitney U test was used for comparison between two groups. Operation time was represented by Mean±SD, and t-test was used for comparison between two groups. The result of self-assessment of patients’ complications are expressed as cases (%), and the chi-square test or Fisher’s exact test was used. Results:A total of 32 patients were included. There were 16 patients in the experimental group, 9 males and 7 females, aged 17-60 years. There were 16 patients in the control group, 8 males and 8 females, aged 18-65 years. The preoperative O, MZ, C, SC, and Z point in the experimental group were 8.9(6.9, 12.8), 10.0(7.7, 12.6), 7.6(5.9, 14.9), 10.7(7.2, 22.0), 11.2(10.1, 17.4), and 2.2(1.6, 3.4), 2.5(1.7, 3.4), 2.2(1.9, 2.9), 2.6(1.7, 3.1), 2.4(1.4, 2.8). The preoperative O, MZ, C, SC, and Z point in control group were 10.4(8.1, 12.5), 10.5(9.0, 12.6), 6.6(5.3, 8.2), 10.6(8.7, 13.1), 10.9(9.8, 13.4), and the postoperative were 4.0(3.6, 4.8), 4.3(3.8, 5.4), 5.2(4.8, 6.7), 4.3(3.1, 5.1), 4.6(3.2, 5.3). There was no significant difference in AI of each marker point between the two groups before surgery ( P>0.05). The AI of each landmark in the two groups was reduced after operation compared with that before operation to some extent ( P<0.01 or 0.05). The AI of each landmark in the experimental group was significantly lower than that in the control group( P<0.01). The operation time of the experimental group[(3.7±1.1) h] was shorter than that of the control group[(4.8±1.9) h] ( P<0.05). The incidence of scar[12.5% (2/16)] and inconsistent pupil height[6.3% (1/16)] in the experimental group was lower than that in the control group [43.8% (7/16), 37.5% (6/16)] ( P<0.05). And there was no significant difference in other items ( P>0.05). Conclusions:The computer-aided navigation technology combined with personalized 3D printing can shorten the time of operation, expedite the patients’ facial recovery with more symmetry and less likely to have complications.

Objective:To explore the computer-aided navigation technology combined with personalized three-dimensional(3D) printing in the reduction and fixation of the multiple midface fractures.Methods:A retrospective analysis was performed on clinical data of patients suffering from multiple midface fractures treated at the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Anhui Medical University from August 2019 to December 2021. According to the operational method, the patients in the experimental group received the operation applied by AccuNavi-A 2.1 navigation software for surgical planning and surgical simulation, printing 3D head model before the operation, and reducing and fixing fractures with the aid of computer navigation technology. Patients in the control group received the operation applied by traditional surgery. Marking facial landmarks on the head CT 3D model of patients and constructing a spatial coordinate system before and 1 week after surgery, measuring and calculating the facial asymmetry index (AI) for each landmark, including the orbitale (O), the most outside of the zygomaticomaxillary suture of the 1/3 below of the margo infraorbitalis(MZ), the most concave point between the frontal process of zygomatic bone and the superior margin of processus temporalis(C), the most concave point of the superjacent of C of posterior margin of frontal process(SC) and the outermost point of zygomatic arch(Z). The duration of operation were recorded. Complications including diplopia, difficulty in mouth opening, facial numbness, malocclusion, scarring and pupil height were evaluated by patents 3 months after the operations. AI is represented by M( Q1, Q3), Wilcoxon rank test was used for intra-group comparison before and after operations, and Mann-Whitney U test was used for comparison between two groups. Operation time was represented by Mean±SD, and t-test was used for comparison between two groups. The result of self-assessment of patients’ complications are expressed as cases (%), and the chi-square test or Fisher’s exact test was used. Results:A total of 32 patients were included. There were 16 patients in the experimental group, 9 males and 7 females, aged 17-60 years. There were 16 patients in the control group, 8 males and 8 females, aged 18-65 years. The preoperative O, MZ, C, SC, and Z point in the experimental group were 8.9(6.9, 12.8), 10.0(7.7, 12.6), 7.6(5.9, 14.9), 10.7(7.2, 22.0), 11.2(10.1, 17.4), and 2.2(1.6, 3.4), 2.5(1.7, 3.4), 2.2(1.9, 2.9), 2.6(1.7, 3.1), 2.4(1.4, 2.8). The preoperative O, MZ, C, SC, and Z point in control group were 10.4(8.1, 12.5), 10.5(9.0, 12.6), 6.6(5.3, 8.2), 10.6(8.7, 13.1), 10.9(9.8, 13.4), and the postoperative were 4.0(3.6, 4.8), 4.3(3.8, 5.4), 5.2(4.8, 6.7), 4.3(3.1, 5.1), 4.6(3.2, 5.3). There was no significant difference in AI of each marker point between the two groups before surgery ( P>0.05). The AI of each landmark in the two groups was reduced after operation compared with that before operation to some extent ( P<0.01 or 0.05). The AI of each landmark in the experimental group was significantly lower than that in the control group( P<0.01). The operation time of the experimental group[(3.7±1.1) h] was shorter than that of the control group[(4.8±1.9) h] ( P<0.05). The incidence of scar[12.5% (2/16)] and inconsistent pupil height[6.3% (1/16)] in the experimental group was lower than that in the control group [43.8% (7/16), 37.5% (6/16)] ( P<0.05). And there was no significant difference in other items ( P>0.05). Conclusions:The computer-aided navigation technology combined with personalized 3D printing can shorten the time of operation, expedite the patients’ facial recovery with more symmetry and less likely to have complications.