Methods: Sixty-two patients (2014–2019) were divided into the SC (n=32) and PC (n=30) groups. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), modified Japanese Orthopedic Association (mJOA) score, and Neck Disability Index (NDI). Radiological parameters, including cervical lordosis (CL), fused segment angle (FSA), and disc height (DH), were assessed. Cage subsidence, adjacent segment degeneration (ASD), and other complications were also documented. The relationship between postoperative radiological changes and symptoms was also analyzed. Results: Both groups showed significant improvement in symptoms, with fusion achieved in all surgical segments. The SC group had a shorter operative time and reduced intraoperative blood loss. However, the SC group had a higher subsidence rate (16.7% vs. 5.6%, p=0.017). The PC group maintained better cervical alignment in terms of CL, FSA, and DH (p<0.05), with an increased incidence of dysphagia and ASD (p<0.05). Spearman correlation analyses showed that neither CL nor FSA loss at the 5-year follow-up was significantly associated with improvements in the mJOA, VAS, and NDI scores (p>0.05) in either group. Regression analyses indicated that subsidence or loss of lordosis did not correlate with the degree of postoperative symptoms (p<0.05). Conclusions Both SC and PC achieved sustained pain relief, neurological improvement, and solid fusion in three-level ACDF at the 5-year follow-up. SC demonstrated significant advantages in reducing dysphagia and ASD, while PC better maintained cervical alignment and segmental stability. Patient-specific factors should be used to guide implant selection. Further multicenter studies are required to validate these findings.

Objective:To analyze the factors associated with non-radiographic bone erosion in gout pa-tients,to improve the understanding of bone erosion in gout,and to promote the early detection of bone erosion.Methods:A retrospective analysis was conducted on the medical records of gout patients treated at Beijing Jishuitan Hospital from January 2018 to January 2022.Bone erosion was detectable by ultra-sound but not detected by X-ray as non-radiographic bone erosion;no bone erosion was detected by both ultrasound and joint X-ray as undetected bone erosion.A case-control study was used,and the two groups were matched 1∶2 according to age and sex.The differences between the two groups were com-pared in terms of general information,joint involvement characteristics,laboratory indicators and compli-cations.In the univariate analysis,P＜0.1 was included in the multivariate analysis,and the conditional Logistic regression was used for the multivariate analysis.P＜0.05 was considered to have statistically significant differences.Results:Among the 41 patients with non-radiographic bone erosion,the top three joints with bone erosion before its occurrence were metatarsophalangeal joint(12 cases),ankle(10 ca-ses),and knee(7 cases).There were 82 patients undetected with bone erosion.There were no signifi-cant differences in general information between the two groups(P＞0.05),including age,gender,body mass index,and alcohol consumption history.The characteristics of affected joints in the non-radio-graphic bone erosion group were compared with those in the no bone erosion detected,and the former had more affected joints(P=0.02),and a higher proportion of patients with at least 3 attacks of gout per year(P＜0.001).There were no significant differences in serum uric acid,fasting blood glucose,cholesterol,triglycerides,low-density lipoprotein,high-density lipoprotein,creatinine,homocysteine,white blood cell count,and urine pH between the two groups(P＞0.05).The results of multivariate analysis showed that at least 3 flares of gout per year was an independent risk factor for radiologically negative bone erosion in patients with gout,with an OR(95％CI)of 5.139(1.529-17.271).Conclusion:At least 3 flares of gout per year predicts the occurrence of radiologically negative bone erosion,and these patients should be given more attention to achieving treatment targets.

Systemic sclerosis is an autoimmune rheumatic disease that often leads to multisystem diseases,frequently resulting in pulmonary interstitial fibrosis.According to the theory of sanjiao(triple energizers)membranous channels,sanjiao connects the five zang-organs and six fu-viscera internally and the skin,muscles,and bones externally.It serves as a four-way membranous channel that connects internal organs and external structures,linking with the micromembranes of organs and blood vessels.The pathogenesis of pulmonary interstitial fibrosis secondary to systemic sclerosis involves external cold obstructing the skin and interstitial layers,impairing the defense qi and defense yang,which originate in the essence of the kidney.This leads to weak defensive qi and kidney deficiency,causing stagnation in sanjiao's energy flow and disruption of water and gasification and loss of fluid,resulting in accumulation of dampness,phlegm,and blood stasis.These obstructive factors spread along sanjiao's membranous channels,leading to multiorgan micromembrane involvement and systemic damage.The lungs,which are in direct contact with the external environment,are particularly susceptible to invasion by external pathogens.When combined with stagnation of dampness,phlegm,and blood in the lungs,this leads to secondary pulmonary fibrosis,resulting in lung dysfunction.Continuous stagnation of sanjiao exacerbates the overall condition of the patient,leading to a mixed cold-heat imbalance.Treatment focuses on"unblocking,transforming,and regulating"to restore sanjiao function,promote qi and fluid circulation,invigorate blood,and adjust the cold-heat imbalance,ultimately restoring the overall condition of the patient.

Objective To observe the efficacy and safety of Yifei Sanjie Decoction in the treatment of multiple pulmonary nodules.Methods A prospective randomized controlled clinical study was conducted to select 189 patients with multiple pulmonary nodules who saught medical attention at the Pulmonary Nodule Diagnosis and Treatment Center of Dongfang Hospital,Beijing University of Chinese Medicine and the Department of Thoracic Surgery of Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2023 to March 2025.According to the random number table method,126 cases were randomly divided into the trial group and 63 cases in the blank control group at a ratio of 2∶1.The trial group was treated with modified Yifei Sanjie Decoction,and the blank control group was only followed up without intervention.The course of treatment was 3 months.The patients in the two groups were reexamined with lung CT after 3 months.The efficacy was evaluated by the area reduction rate of the major pulmonary nodules and the cumulative multiple pulmonary nodules in patients with multiple pulmonary nodules combined with the average diameter and malignant signs.According to the property of the major pulmonary nodules,we divided the patients into ground glass,solid,and mixed ground glass subgroups to evaluate the efficacy of different types of pulmonary nodules.We evaluated the change of malignant risk of pulmonary nodules according to the change of Mayo score.We evaluated the safety of the treatment medicine by blood routine,urine routine,and liver and kidney function.Results A total of 175 patients completed the study,117 in the trial group and 58 in the blank control group.The total effective rates of the major pulmonary nodules and the cumulative multiple pulmonary nodules in the trial group were 41.03%and 42.74%,respectively,the total effective rate of nodule number change was 29.91%which were significantly higher than those in the blank control group(P<0.05).In the trial group,the total effective rates of the major pulmonary nodules in the ground glass(72 cases),solid(28 cases),and mixed ground glass(17 cases)subgroups were 40.28%,32.14%,and 58.82%,respectively,the total effective rates of the cumulative multiple pulmonary nodules were 38.89%,42.86%,and 58.82%,respectively,which were significantly higher than those in corresponding subgroups of ground glass(37 cases),solid(14 cases),and mixed ground glass(7 cases)of the blank control(P<0.05).After treatment,the average diameter,area,and Mayo score of the major pulmonary nodules and the cumulative multiple pulmonary nodules in the trial group were significantly lower than those in the blank control group and before treatment(P<0.05),the average diameter,area,and Mayo score of the major pulmonary nodules and the cumulative multiple pulmonary nodules in the ground glass,solid,and mixed ground glass subgroups were lower than those in corresponding subgroups of the blank control group,and significantly lower than those before treatment(P<0.05).The number of nodules and malignant signs in the trial group were lower than before,while those in the blank control group were higher than before.There were no serious adverse events in the two groups during the study.Conclusion Yifei Sanjie Decoction can effectively treat the major pulmonary nodules and the cumulative multiple pulmonary nodules in patients with multiple pulmonary nodules,reduce the average diameter and area of nodules,reduce the Mayo score,and reduce the malignant signs and number of nodules.In the ground glass,solid,and mixed ground glass groups,the curative effect is well,and the safety is high,it can be used for the clinical treatment of multiple pulmonary nodules.

Based on the theory of the liver's"using bitter herbs to nourish or purge"from Huangdi Neijing,this paper systematically elucidates the theoretical foundation for treating functional constipation from liver.Focusing on the physiological characteristic of"liver desires to disperse"and the pathological manifestation of"liver bitterness and urgency,"combined with the"liver communicates with the large intestine"theory,this paper establishes a diagnostic and therapeutic framework for managing functional constipation by regulating liver function.The pathological evolution of functional constipation manifests in three distinct stages:in the early stage,liver qi stagnation leads to large intestine qi obstruction,where damaged by an excess of seven emotions resulting in symptoms such as difficult defecation,abdominal bloating,and hypochondriac pain;in the middle stage,liver depression transforms into fire,scorching bodily fluids to generate dryness,thereby creating a pathological interplay of stagnation,fire,and dryness,which is marked by anal heat,dry mouth,and yellow urine;in the late stage,yin deficiency in liver and kidney causes large intestine malnutrition,resulting in a complex pathological state where yin deficiency,collateral blockage,dryness accumulation,and blood stasis intertwine,clinically manifesting as pellet-like stools(resembling sheep feces)and soreness and weakness of the waist and knees.In treatment,the formula design follows the principle of"sweetness to relieve,acridity to tonify,and sourness to purge,"with treatment principles varying across stages.In the early stage,the focus is on dispersing liver and regulating qi,and unblocking the zang-fu viscera;in the middle stage,the priority shifts to clearing heat-fire,nourishing large intestine,and promoting fluid production;whereas,in the late stage,the emphasis lies on nourishing yin,unblocking collaterals,and promoting blood circulation.This staged treatment of functional constipation overcomes the limitations of solely focusing on nourishing large intestine and facilitating feces excretion,thereby advancing the treatment of different stages based on syndrome differentiation and personalized treatment.It provides theoretical support for improving patients' intestinal function and enhancing overall health outcomes.

Objective:To investigate the effect of nuclide distribution with time from the in vivo metabolism based on measurement of radioactive contamination using lung counting method. Methods:The distribution of nuclides in the body with time was calculated on a basis of a single inhalation of aerosols containing 235U and the International Commission of Radiological Protection(ICRP) nuclide metabolism compartment model. A passive efficiency calibration of the lung counter, was performed using the simulation and calculation software Geant4 to obtain the contribution of the tissue or organs of interest to the lung counter, and to investigate the effect of the nuclide distribution on the lung counting method. Results:The time elapsed after inhalation of radionuclides, as well as their physicochemical state, has the effect on their distribution in the body and on the detection efficiency of the lung counter. Radionuclides with smaller particulate sizes have a higher initial retention in the lungs, and those with an activity median aerodynamic diameter (ADAM) of 1 μm contributed more fraction to the lung counter than those with an ADAM of 5 μm. F-type compounds were metabolized more rapidly by the respiratory system, and after 8 h of ingestion, nuclides were distributed in the lungs. F-type compounds were metabolized in the respiratory system at a relatively fast rate, and 8 h after inhalation, the fraction of nuclides retained in the lung contributed no more than 30% to the lung counter. Within 3 d after ingestion of M-type and S-type compounds, radioactive particulats largely deposites in the nasopharyngeal region. With biological metabolization and clearance, the fraction contributed by lung to counter is in rising, and the fraction to the lung counter typically remained larger than 80% after 3 d.Conclusions:Radionuclide metabolization in the body varies with their physicochemical properties and measurement time and site. For estimating internal contamination, consideration should be given to the distribution of nuclides, in order to avoid the overestimation.

AIM:To investigate the impact of mitochondrial carrier homologous protein 2(MTCH2)on the metastasis of oral squamous cell carcinoma and to elucidate its underlying mechanisms.METHODS:Human tongue squamous cell carcinoma CAL-27 cells were selected as the study model.An MTCH2 inhibition and overexpression model was established using small interfering RNA(siRNA)technology and overexpression plasmids.Based on the experimental design,cells were categorized into the following groups:siRNA negative control(siRNA-NC)group,MTCH2 siRNA(siRNA-MTCH2)group,empty vector(OE-NC)group,and MTCH2 overexpression(OE-MTCH2)group.Transwell as-says and wound healing assays were conducted to assess the invasion and migration capabilities of cells in each group.The morphological changes and distribution of actin microfilaments were examined using a red fluorescent probe.The mito-chondrial membrane potential was evaluated using a mitochondrial membrane potential detection kit.The levels of reactive oxygen species(ROS)were measured using a ROS detection kit.Adenosine triphosphate(ATP)production levels were assessed with an ATP detection kit.The protein expression levels of MTCH2 and matrix metalloproteinase 14(MMP14)were analyzed through cell fluorescence and Western blot techniques.RESULTS:The number of invasive cells in the siRNA-MTCH2 group was significantly reduced,and the cell migration rate was notably decreased.Conversely,the OE-MTCH2 group exhibited a significant increase in both the number of invasive cells and the cell migration rate(P<0.01).The fluorescence intensity of F-actin and MTCH2 in the siRNA-MTCH2 group was significantly diminished,while these in-tensities were markedly elevated in the OE-MTCH2 group(P<0.01).The ROS levels in the siRNA-MTCH2 group were significantly higher than those in the siRNA-NC group,whereas the levels of ATP and mitochondrial membrane potential were significantly lower.Conversely,the ROS levels in the OE-MTCH2 group were significantly lower than those in the OE-NC group,with corresponding increases in ATP levels and mitochondrial membrane potential(P<0.01).The expres-sion levels of MTCH2 and MMP14 proteins in the siRNA-MTCH2 group were significantly lower than those in the siRNA-NC group,while the OE-MTCH2 group showed significantly higher expression levels compared to the OE-NC group(P<0.01).CONCLUSION:The MTCH2 is associated with the development of oral squamous cell carcinoma and may facili-tate the metastasis of CAL-27 cells by regulating mitochondrial function and MMP14 protein expression.Therefore,MTCH2 may represent a novel therapeutic target for the treatment of oral cancer.

Background and Aims:Poorly differentiated thyroid carcinoma(PDTC)is a relatively rare but highly aggressive type of thyroid malignancy.Its biological behavior lies between differentiated and undifferentiated thyroid carcinoma,and it is often characterized by early metastasis,high recurrence rates,and poor survival outcomes.At present,prognostic assessment for PDTC patients primarily relies on traditional indicators such as TNM staging,and there remains a lack of systematic,multi-factorial,and individualized predictive tools.As a visual and quantitative method,the nomogram model has been widely applied in the prognostic evaluation of various tumors;however,its use in PDTC remains limited.This study aims to identify key risk factors associated with poor prognosis in PDTC patients and to construct a risk prediction nomogram model based on multivariate analysis,in order to provide clinical support for individualized postoperative prognostic assessment.Methods:A total of 55 PDTC patients who underwent surgical treatment at our hospital from January 2015 to December 2020 were retrospectively enrolled and followed up for three years.Based on tumor recurrence,metastasis,and mortality during the follow-up period,patients were divided into a good prognosis group and a poor prognosis group.Univariate analysis was performed to screen for clinical features associated with prognosis,followed by multivariate logistic regression to identify independent risk factors.A nomogram risk prediction model was constructed using R software(version 3.5.3),and its predictive performance and calibration were evaluated by receiver operating characteristic(ROC)curve and Bootstrap validation.Results:During the 3-year follow-up,15 patients experienced tumor progression and 1 patient died,resulting in a poor prognosis rate of 29.1%.Univariate analysis showed statistically significant differences in tumor diameter,TNM stage,local invasion,surgical approach,vascular invasion,and nerve involvement between the two groups(all P<0.05).Multivariate logistic regression identified tumor diameter≥3 cm,advanced TNM stage,local invasion,subtotal thyroidectomy,vascular invasion,and nerve involvement as independent risk factors for poor prognosis(all P<0.05).The nomogram model constructed based on these variables demonstrated a C-index of 0.794(95%CI=0.725-0.846),an AUC of 0.817,sensitivity of 82.26%,and specificity of 86.35%,indicating good discriminatory ability and predictive accuracy.Conclusion:Tumor diameter,TNM stage,local invasion,surgical approach,vascular invasion,and nerve involvement are important factors influencing postoperative prognosis in PDTC patients.The nomogram model based on these variables exhibits strong predictive performance and may serve as a valuable tool for individualized risk assessment and therapeutic decision-making in clinical practice.

Objective:To investigate protective effect and mechanism of Tim-3 on sepsis-induced acute lung injury(ALI)by pro-moting mitophagy of alveolar macrophages and inhibiting activation of NLRP3 inflammasome.Methods:LPS-stimulated mouse alveo-lar macrophage(MH-S)model and sepsis-induced ALI mouse model were constructed.Tim-3 siRNA interference technique was used to knock down Tim-3 expression in MH-S cells,and anti-Tim-3 antibody mice were injected intraperitoneally to block Tim-3 function.Western blot was used to detect protein expressions of NLRP3,ASC,cleaved-caspase-1 and mitophagy-related proteins(LC3B,P62,PINK1 and Parkin)in MH-S cells and lung tissue of mice with sepsis-induced ALI.Laser confocal fluorescence staining was used to measure ROS level and mitochondrial membrane potential of MH-S cells.Pathological examination of lung tissue was performed in mice with sepsis-induced ALI in each group,and degree of lung tissue injury was evaluated by Smith scoring system.Bronchoalveolar lavage fluid(BALF)and lung tissue were collected from mice with ALI induced by sepsis in each group.BCA protein quantification method was used to determine protein concentration in BALF.MPO activity in lung tissue was detected by colorimetry.MDA content in lung tissue was detected by TBA method.LC3B protein expression in lung tissue was detected by immunohistochemistry.Results:In mouse alveolar macrophages,Tim-3 knockdown could promote expressions of NLRP3,ASC,cleaved-caspase-1 and P62 proteins,increase ROS release,inhibit PINK1/Parkin pathway activation and LC3B protein expression,and reduce mitochondrial membrane potential.In mice with sepsis-induced ALI,Tim-3 functional blockade could promote expressions of NLRP3,ASC,cleaved-caspase-1 and P62 proteins in lung tissue,aggravate lung pathological injury and pulmonary edema,increase MPO activity and MDA content in lung tissue,and reduce positive rate of LC3B protein.Conclusion:Tim-3 plays a protective role in sepsis-induced ALI by promoting mitophagy in alveolar macrophages and inhibiting NLRP3 inflammasome activation via PINK1/Parkin.

Objective:To evaluate the clinical efficacy of endoscopic treatment of superficial non-ampullary duodenal adenoma.Methods:A retrospective analysis was performed on the clinical data and follow-up information of patients diagnosed with superficial duodenal non-ampullary adenomas via preoperative endoscopy and treated endoscopically at Peking University First Hospital between January 2013 and January 2024. The overall en bloc resection rate, complete resection rate of the lesion, perioperative complications, and recurrence rates were evaluated. Patients were categorized into three groups based on their treatment modality: endoscopic mucosal resection (EMR)（ n=46）, endoscopic submucosal dissection (ESD)（ n=16）, and modified ESD (ESD with snare, ESD-S)（ n=24）. Comparative analyses were conducted to evaluate operative time, en bloc resection rate, and complete resection rate among the three groups. Results:Among 86 patients, the overall en bloc and complete resection rates were 87.2% (75/86) and 86.0% (74/86), respectively. No case of delayed bleeding was observed during the perioperative period. Intraoperative perforation occurred in two patients, both of whom improved following conservative management. Delayed perforation was noted in four patients, and three of them were successfully managed with surgical intervention, while one case was resolved after conservative treatment. During the follow-up period, local recurrence was identified in two patients. Following re-treatment with endoscopy and continuous surveillance, no further recurrence was observed. The operative times for the EMR group, ESD-S group, and ESD group were 4 (1-36) minutes, 25 (5-190) minutes, and 46 (5-150) minutes, respectively. Significant differences were observed in operative times among the three groups ( Hc=49.892, P<0.001). The en bloc resection rates for the EMR, ESD-S, and ESD groups were 80.4% (37/46), 91.7% (22/24), and 100.0% (16/16), respectively. The complete resection rates were 80.4% (37/46), 91.7% (22/24), and 93.8% (15/16) for the respective groups. Conclusion:Endoscopic treatment demonstrates favorable efficacy and safety for superficial non-ampullary duodenal adenoma. In addition to traditional EMR and ESD, ESD-S is also an effective procedure for endoscopic treatment of non-ampullary duodenal adenoma.