Objective:To assess the predictive value of the percentage of Gleason pattern 4 (G4%) in prostate biopsy for adverse pathology and biochemical recurrence.Methods:We retrospectively analyzed consecutive patients who underwent radical prostatectomy in our institution between January 2019 and December 2023, and included those who were diagnosed with ISUP 2-3 cancer at biopsy. A total of 109 patients were included in this study. The average age of patients was (67.40±6.11) years, and the average BMI of patients was (25.36±2.97) kg/m 2. 49 Cases (45.0%) had a PI-RADS score of 5, and the median prostate volume was 32.60 (24.57, 45.63) ml. The median of most recent tPSA before biopsy was 9.76 (6.89, 12.95) ng/ml, the median PSAD was 0.28 (0.17, 0.44) ng/ml 2, and the median f/tPSA was 0.11 (0.08, 0.16). Clinical T 2b or higher stage was found in 84 cases (77.1%). The total biopsy core length was (22.91±5.18) cm, with a median of 24 (20, 24) biopsy cores and a median of 6 (4, 9) positive cores. Gleason score 3+ 4 was found in 52 cases (47.7%), and Gleason score 4+ 3 in 57 cases (52.3%). Cribriform was present in 30 cases (27.5%). G4% was calculated based on the proportion of Gleason grade 4 tumor relative to total tumor, tumor proportion relative to total tissue, and tissue length. Patients were divided into high-G4% (≥2.45%) and low-G4% (<2.45%) groups based on the median G4% value, with 55 and 54 cases, respectively. No significant differences were observed in baseline characteristics between the two groups ( P>0.05). The main risk factor of adverse pathology was analyzed by logistic regression, and receiver operating characteristic (ROC) curve and area under curve (AUC) were performed. Patients were further stratified by the G4% cutoff value from ROC, and Kaplan-Meier survival curves were plotted to compare biochemical recurrence free survival (BCRFS) between groups. The main risk factor affecting BCRFS was analyzed by Cox regression. Adverse pathology was defined as postoperative Gleason score ≥4+ 3 or pathological stage ≥T 3a. Results:Adverse pathology occurred in 44 (80.0%) high-G4% and 16 (29.6%) low-G4% patients ( P<0.01). Multivariate analysis identified G4% as an independent risk factor for adverse pathology ( OR=1.23, 95% CI 1.02-1.50, P=0.033). The highest ROC AUC value was seen for G4% (0.799), significantly outperforming Gleason score (0.799 vs. 0.641, P=0.003), tPSA (0.799 vs. 0.615, P=0.003), PSAD (0.799 vs. 0.679, P=0.038), positive cores (0.799 vs. 0.677, P=0.009), clinical T stage (0.799 vs. 0.607, P=0.001) and cribriform (0.799 vs. 0.639, P=0.001). The G4% cutoff value for predicting biochemical recurrence was 10.97%. The median BCRFS was significantly higher in the low G4% (<10.97%) group than that in the high G4% (≥10.97%) group (55 vs. 28 months, P=0.002). Cumulative recurrence free survival rates at 1 and 3 years were 94.6% vs. 74.1% and 78.0% vs. 47.6%, respectively. Multivariate Cox regression analysis indicates that G4% was an independent risk factor affecting BCRFS ( HR=1.11, 95% CI 1.00-1.23, P=0.041). Conclusions:For patients with ISUP 2-3 nmPCa, a higher G4% in biopsy specimens demonstrates strong predictive ability for adverse pathology and biochemical recurrence, outperforming traditional clinical indicators such as Gleason score and PSA.

Objective To develop a Nomogram clinical prediction model for the pathological occurrence of extraprostatic extension(EPE)after radical prostatectomy in prostate cancer patients,using simplified site-specific magnetic resonance imaging(MRI)indicators and other clinical parameters.Methods A total of 181 prostate cancer patients[mean age(69.0±7.3)years]who underwent radical prostatectomy were included.These patients had received 3-Tesla multi-parametric magnetic resonance imaging(3-T mpMRI)within 6 months prior to surgery.Based on mpMRI measurements[capsular contact length(CCL)>15 mm,capsular bulging/irregularities,diameter of index lesion(dIL),and evident extraprostatic extension(eEPE)],the dIL?sEPE grading system was derived.The optimal cut-off value of dIL(denoted as dIL)was determined using the Youden J index,and categorized it into a binary variable.A Logistic regression model was established based on the dIL?sEPE grading and clinical scores.The predictive performance of clinical indicators,MRI indicators,and combined clinical and MRI indicators were compared.Finally,a clinical prediction model integrating both clinical and MRI data was developed.Results Pathological EPE was found in 46 out of 181 cases(25.4% ).A Nomogram prediction model for EPE was established with a combination of the dIL?sEPE grading and clinical indicators.Conclusion The combination of dIL?sEPE grading with clinical indicators accurately predicts extracapsular extension in prostate cancer.The Nomogram model that established,based on MRI imaging characteristics and clinical indicators has good performance and is easy to use.It is beneficial to stratifying management for prostate cancer patients,and it provides valuable guidance for patients suitable for nerve-sparing surgery.

Objective:To analyze the degree of intervertebral disc degeneration above and below the vertebral body in pilots with lumbar spondylolysis.Methods:The medical records of 66 pilots who underwent lumbar imaging examinations at the Air Force Medical Center between September 2011 and January 2025 were retrospectively analyzed. The degree of intervertebral disc degeneration was compared between 33 pilots with lumbar spondylolysis and another 33 age-matched pilots without spondylolysis. The spondylolysis group was divided into subgroups with/without spondylolisthesis and unilateral/bilateral subgroups. The degree of disc degeneration above and below the vertebral body was compared between these subgroups using the modified Pfirrmann grading system.Results:The modified Pfirrmann scores of the discs above and below the spondylolytic vertebral body in the spondylolysis group were significantly higher than those at the corresponding segments in the non-spondylolysis group ( Z=-2.39, -4.41, P=0.017,<0.001). In pilots with spondylolysis accompanied by spondylolisthesis, the modified Pfirrmann score of the disc below the slipped vertebral body was significantly higher than that in pilots without spondylolisthesis ( Z=-3.02, P=0.003). However, there was no statistically significant difference in the modified Pfirrmann score of the disc above the slipped vertebral body between pilots with and without spondylolisthesis ( P>0.05). No significant differences were observed in the modified Pfirrmann scores of the discs above and below the vertebral body between pilots with unilateral and bilateral spondylolysis (both P>0.05). Conclusions:Pilots with lumbar spondylolysis exhibit severe intervertebral disc degeneration above and below the affected vertebral body. Spondylolisthesis can continue to exacerbate degeneration in the disc inferior to the affected vertebra.

Objective To develop a Nomogram clinical prediction model for the pathological occurrence of extraprostatic extension(EPE)after radical prostatectomy in prostate cancer patients,using simplified site-specific magnetic resonance imaging(MRI)indicators and other clinical parameters.Methods A total of 181 prostate cancer patients[mean age(69.0±7.3)years]who underwent radical prostatectomy were included.These patients had received 3-Tesla multi-parametric magnetic resonance imaging(3-T mpMRI)within 6 months prior to surgery.Based on mpMRI measurements[capsular contact length(CCL)>15 mm,capsular bulging/irregularities,diameter of index lesion(dIL),and evident extraprostatic extension(eEPE)],the dIL?sEPE grading system was derived.The optimal cut-off value of dIL(denoted as dIL)was determined using the Youden J index,and categorized it into a binary variable.A Logistic regression model was established based on the dIL?sEPE grading and clinical scores.The predictive performance of clinical indicators,MRI indicators,and combined clinical and MRI indicators were compared.Finally,a clinical prediction model integrating both clinical and MRI data was developed.Results Pathological EPE was found in 46 out of 181 cases(25.4% ).A Nomogram prediction model for EPE was established with a combination of the dIL?sEPE grading and clinical indicators.Conclusion The combination of dIL?sEPE grading with clinical indicators accurately predicts extracapsular extension in prostate cancer.The Nomogram model that established,based on MRI imaging characteristics and clinical indicators has good performance and is easy to use.It is beneficial to stratifying management for prostate cancer patients,and it provides valuable guidance for patients suitable for nerve-sparing surgery.

Objective:To assess the predictive value of the percentage of Gleason pattern 4 (G4%) in prostate biopsy for adverse pathology and biochemical recurrence.Methods:We retrospectively analyzed consecutive patients who underwent radical prostatectomy in our institution between January 2019 and December 2023, and included those who were diagnosed with ISUP 2-3 cancer at biopsy. A total of 109 patients were included in this study. The average age of patients was (67.40±6.11) years, and the average BMI of patients was (25.36±2.97) kg/m 2. 49 Cases (45.0%) had a PI-RADS score of 5, and the median prostate volume was 32.60 (24.57, 45.63) ml. The median of most recent tPSA before biopsy was 9.76 (6.89, 12.95) ng/ml, the median PSAD was 0.28 (0.17, 0.44) ng/ml 2, and the median f/tPSA was 0.11 (0.08, 0.16). Clinical T 2b or higher stage was found in 84 cases (77.1%). The total biopsy core length was (22.91±5.18) cm, with a median of 24 (20, 24) biopsy cores and a median of 6 (4, 9) positive cores. Gleason score 3+ 4 was found in 52 cases (47.7%), and Gleason score 4+ 3 in 57 cases (52.3%). Cribriform was present in 30 cases (27.5%). G4% was calculated based on the proportion of Gleason grade 4 tumor relative to total tumor, tumor proportion relative to total tissue, and tissue length. Patients were divided into high-G4% (≥2.45%) and low-G4% (<2.45%) groups based on the median G4% value, with 55 and 54 cases, respectively. No significant differences were observed in baseline characteristics between the two groups ( P>0.05). The main risk factor of adverse pathology was analyzed by logistic regression, and receiver operating characteristic (ROC) curve and area under curve (AUC) were performed. Patients were further stratified by the G4% cutoff value from ROC, and Kaplan-Meier survival curves were plotted to compare biochemical recurrence free survival (BCRFS) between groups. The main risk factor affecting BCRFS was analyzed by Cox regression. Adverse pathology was defined as postoperative Gleason score ≥4+ 3 or pathological stage ≥T 3a. Results:Adverse pathology occurred in 44 (80.0%) high-G4% and 16 (29.6%) low-G4% patients ( P<0.01). Multivariate analysis identified G4% as an independent risk factor for adverse pathology ( OR=1.23, 95% CI 1.02-1.50, P=0.033). The highest ROC AUC value was seen for G4% (0.799), significantly outperforming Gleason score (0.799 vs. 0.641, P=0.003), tPSA (0.799 vs. 0.615, P=0.003), PSAD (0.799 vs. 0.679, P=0.038), positive cores (0.799 vs. 0.677, P=0.009), clinical T stage (0.799 vs. 0.607, P=0.001) and cribriform (0.799 vs. 0.639, P=0.001). The G4% cutoff value for predicting biochemical recurrence was 10.97%. The median BCRFS was significantly higher in the low G4% (<10.97%) group than that in the high G4% (≥10.97%) group (55 vs. 28 months, P=0.002). Cumulative recurrence free survival rates at 1 and 3 years were 94.6% vs. 74.1% and 78.0% vs. 47.6%, respectively. Multivariate Cox regression analysis indicates that G4% was an independent risk factor affecting BCRFS ( HR=1.11, 95% CI 1.00-1.23, P=0.041). Conclusions:For patients with ISUP 2-3 nmPCa, a higher G4% in biopsy specimens demonstrates strong predictive ability for adverse pathology and biochemical recurrence, outperforming traditional clinical indicators such as Gleason score and PSA.

Objective:To analyze the degree of intervertebral disc degeneration above and below the vertebral body in pilots with lumbar spondylolysis.Methods:The medical records of 66 pilots who underwent lumbar imaging examinations at the Air Force Medical Center between September 2011 and January 2025 were retrospectively analyzed. The degree of intervertebral disc degeneration was compared between 33 pilots with lumbar spondylolysis and another 33 age-matched pilots without spondylolysis. The spondylolysis group was divided into subgroups with/without spondylolisthesis and unilateral/bilateral subgroups. The degree of disc degeneration above and below the vertebral body was compared between these subgroups using the modified Pfirrmann grading system.Results:The modified Pfirrmann scores of the discs above and below the spondylolytic vertebral body in the spondylolysis group were significantly higher than those at the corresponding segments in the non-spondylolysis group ( Z=-2.39, -4.41, P=0.017,<0.001). In pilots with spondylolysis accompanied by spondylolisthesis, the modified Pfirrmann score of the disc below the slipped vertebral body was significantly higher than that in pilots without spondylolisthesis ( Z=-3.02, P=0.003). However, there was no statistically significant difference in the modified Pfirrmann score of the disc above the slipped vertebral body between pilots with and without spondylolisthesis ( P>0.05). No significant differences were observed in the modified Pfirrmann scores of the discs above and below the vertebral body between pilots with unilateral and bilateral spondylolysis (both P>0.05). Conclusions:Pilots with lumbar spondylolysis exhibit severe intervertebral disc degeneration above and below the affected vertebral body. Spondylolisthesis can continue to exacerbate degeneration in the disc inferior to the affected vertebra.

Objective:To investigate the clinical effect of saphenous artery perforating branch flap in repairing anterior knee soft tissue defects with patella exposure.Methods:From July 2010 to September 2017, 12 patients whose patella exposed due to anterior soft tissue defects of knee were treated. The 12 cases included 8 males and 4 females, aged from 24 to 60 years (42.6 years on average). The causes of injury included car accident in 5 cases, rolling injury in 3 cases, burn and scald in 2 cases, and postoperative patella fracture in 2 cases. The areas of the wounds ranged from 6 cm × 5 cm to 8 cm × 7 cm. The wounds were repaired by saphenous artery perforating flaps with the area ranged from 7 cm × 6 cm to 9 cm × 8 cm, and the donor sites were repaired with free skin grafting.Results:All the 12 cases ended up with the wounds healed primarily and no postoperative complications. The 12 cases were followed up for 6 months to 24 months, with an average of 12 months. The color, texture and appearance of the flaps were good, the thickness of the flap were moderate, and the function of knee joint was recovered well. Skin flap sensation was graded according to the criteria of the British Medical Research Society: 2 cases for Grade S 3+, 6 cases for Grade S 3 and 4 cases for Grade S 2. Conclusions:Saphenous artery perforating flap is an effective method to repair anterior knee soft tissue defect and patella exposure.

Objective:To investigate the clinical effect of saphenous artery perforating branch flap in repairing anterior knee soft tissue defects with patella exposure.Methods:From July 2010 to September 2017, 12 patients whose patella exposed due to anterior soft tissue defects of knee were treated. The 12 cases included 8 males and 4 females, aged from 24 to 60 years (42.6 years on average). The causes of injury included car accident in 5 cases, rolling injury in 3 cases, burn and scald in 2 cases, and postoperative patella fracture in 2 cases. The areas of the wounds ranged from 6 cm × 5 cm to 8 cm × 7 cm. The wounds were repaired by saphenous artery perforating flaps with the area ranged from 7 cm × 6 cm to 9 cm × 8 cm, and the donor sites were repaired with free skin grafting.Results:All the 12 cases ended up with the wounds healed primarily and no postoperative complications. The 12 cases were followed up for 6 months to 24 months, with an average of 12 months. The color, texture and appearance of the flaps were good, the thickness of the flap were moderate, and the function of knee joint was recovered well. Skin flap sensation was graded according to the criteria of the British Medical Research Society: 2 cases for Grade S 3+, 6 cases for Grade S 3 and 4 cases for Grade S 2. Conclusions:Saphenous artery perforating flap is an effective method to repair anterior knee soft tissue defect and patella exposure.

Objective: The related literatures on supra acetabular spinal pedicle screws and a subcutaneous connecting rod (INFIX) in recent years was reviewed, and the overall prognosis was analyzed by meta analysis. Methods: literatures were obtained by searching the PubMed, Google Scholar, and Wanfang Full-text Database according to the criteria of inclusion and exclusion. The two members independently screened the qualified literature, evaluated the quality of the literature and extracted the data information. The data information includes demographic and surgical information, main results and secondary results. A large number of data in the selected articles were analyzed and summarized by meta. Results: A total of 20 studies were included, including 567 patients. The clinical results were evaluated by Majeed standard in 6 articles, of which 5 articles described the number of excellent and general prognosis, including 185 patients. The excellent and good prognosis rate was 91% (95%CI: 80%-103%) by meta analysis. The general prognosis rate was 9% (95%CI: 3%-14%). Among the prognostic complications, the incidence of lateral femoral cutaneous nerve damage and heterotopic ossification was higher, and the incidence of other complications was less than 5%. There were 13 articles about the complications of ectopic ossification, of which 1 did not mention the specific number of asymptomatic heterotopic ossification, and the remaining 12 included 424 cases, including 132 cases of ectopic ossification. The incidence of ectopic ossification was 26% (95%CI: 11%-40%). Among the 567 cases, obvious symptoms of lateral femoral cutaneous nerve injury were reported. The patients with lateral femoral cutaneous nerve injury accounted for 25% (95%CI: 17%-32%), and the temporary nerve damage was found in 124 cases. The incidence of temporary agitation after subgroup analysis was 21% (95%CI: 14%-28%). Five articles mentioned the manifestations of postoperative femoral nerve damage, including 10 patients, the incidence of femoral nerve damage was 3% (95%CI: -1%-6%). A total of 18 articles on surgical site-related infections were reported, including 534 patients, of which 15 were infected, with an infection rate of 3% (95%CI: 2%-4%). 19 articles clearly reported the failure of internal fixation after INIFX operation, including 32 patients who needed reoperation for different reasons. The failure of internal fixation was 3% (95%CI: 2%-4%). A total of 585 cases of fracture non-prognosis data were reported, of which 473 cases were cured and 3 cases had bone nonunion. The non-union rate of fracture was 3% (95%CI: 1%-5%). Conclusion After InFix pelvic surgery, the patient's clinical follow-up prognosis score and imaging findings showed that the postoperative recovery was good, and the new technique also avoided the inconvenience and postoperative complications caused by many traditional pelvic external fixation techniques. However, it was also found that the lateral femoral cutaneous nerve damage and the incidence of heterotopic ossification were also higher.

Objective To investigate the effect of microRNA-1183 on proliferation and metastasis on gastric cancer cells and to explore the role of microRNA-1183 and CBL-B signaling pathways in this process. Methods MGC803 cells were transfected with a microRNA-1183 mimic. Real-time PCR detected the expression of microRNA-1183 in gastric cancer cell line MGC803. MTT detected the proliferative effect of microRNA-1183 on MGC803 gastric cancer cells. A Transwell assay detected the effect of microRNA-1183 on the metastasis of MGC803 gastric cancer cells. A dual luciferase reporter assay detected the binding ability between microRNA-1183 and CBL-B. The expression of the protein was tested by Western blotting. Results MTT assay results showed that microRNA-1183 promoted the proliferation of MGC803 cells. Transwell assay results revealed that microRNA-1183 promoted the metastasis of MGC803 cells. The results of BLAST contrast analysis show that CBL-B is one of the target genes of microRNA-1183. Western blotting analysis showed that the mimic microRNA-1183 inhibited the expression of CBL-B. A dual luciferase reporter assay showed that CBL-B was the target gene of microRNA-1183. A CBL-B knockdown promoted the proliferation and metastasis of MGC803 cells. microRNA-1183 promoted the proliferation and metastasis of MGC803 cells by inhibiting the expression of CBL-B. Conclusion microRNA-1183 can inhibit the proliferation and metastasis of gastric cancer cell lines by inhibiting the expression of CBL-B.