Objective To explore its application value of LNM in patients with gastric adenocarcinoma based on the construction of a radiomic nomogram prediction model for preoperative lymph node metastasis in gastric adenocarcinoma using enhanced CT imaging features and parameters.Methods 131 patients with gastric adenocarcinoma who underwent radical gastric cancer surgery(Billroth Ⅱ)+lymph node dissection in our hospital from August 2019 to October 2023 were retrospectively analysed,and the preoperative enhancement CT extracted lesions,histological features of lymph node images,and pathological examination of LNM were recorded respectively,and the statistically significant Enhanced CT image histological features and parameters,multifactorial logistic regression to analyse the independent risk factors of gastric adenocarcinoma LNM(+)and construct a column-line diagram,and evaluate its performance.The performance and clinical value of the prediction model were evaluated using subject work characteristic(ROC)curves,and the column-line diagram was internally validated.Results The results of univariate analysis showed that the maximum diameter of the tumour,the lymph node status,the short-axis length and volume of the largest lymph node in the lymph node group and the sum of the short-axis lengths of all the lymph nodes were associated with the occurrence of LNM,and the difference was statistically significant(P＜0.05);multifactorial logistic regression analysis suggested that the maximum diameter of the tumour was ≥15 mm and the lymph node status was positive in the enhanced CT imaging examination,maximum lymph node short-axis length ≥ 7 mm in the lymph node group,the sum of short-axis lengths of all lymph nodes ≥ 11 mm,and the maximum lymph node short-axis volume ≥ 300 mm3 in the lymph node group were the independent risk factors for gastric adenocarcinoma patients with LNM(+)(P＜0.05);the area under the curve of the model was plotted using a ROC curve with an AUC=0.816(95％ CI 0.810-0.939),with the sensitivity of 0.91 and the specificity of 0.86.Model validation was performed using the BOOTSTRAP method containing 500 resamples,and the results suggested that the differences between the fitted curves and the ideal curves of the constructed column-line graphical model were not significant,and the validity and reliability were good.Conclusion The radiomic nomogram prediction model based on enhanced CT imaging features and parameters can effectively predict preoperative lymph node metastasis in gastric adenocarcinoma,providing strong support for clinical decision-making in gastric adenocarcinoma patients.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Sacroiliac complex injuries are commonly seen in high-energy pelvic fractures. The injuries make a big difference in treatment patterns due to the diverse injury types, posing considerable challenges in formulating optimal treatment strategies, and hence are persistent clinical difficulties in orthopedic trauma. The clinical management of sacroiliac complex injuries presents several key challenges such as a non-negligible rate of missed diagnoses in associated vascular and visceral injuries, absence of standardized protocols for surgical approaches and reduction-fixation strategies across different injury patterns, and ongoing controversies regarding surgical indications and optimal timing for patients combined with concomitant lumbosacral plexus injuries. Currently, no systematic clinical guidelines are available for the diagnosis and treatment of sacroiliac complex injuries both domestically and internationally. To this end, the Pelvic and Acetabular Surgery Group, Orthopedic Branch, China International Exchange and Promotive Association for Medical and Health Care and Orthopedic Physician Branch, Chinese Medical Doctor Association organized a panel of domestic experts in the field to develop the Clinical guideline for the diagnosis and treatment of sacroiliac complex injuries ( version 2025), based on evidence-based medicine and adhering to the principles of scientific rigor, clinical applicability, and innovation. These guidelines provided 11 recommendations covering diagnosis, therapeutic principles and techniques, management protocols for lumbosacral plexus injuries, outcome evaluation, and postoperative rehabilitation pathways, etc., aiming to standardize the clinical management of sacroiliac complex injuries.

Background and Aims:Rhabdoid carcinoma of the colon(RCC)is an exceptionally rare and highly aggressive malignancy characterized by early metastasis and poor prognosis,with no standardized treatment available.We report a case of ascending colon RCC and summarize previously published cases to improve understanding of its clinicopathologic and molecular features.Methods:The clinical data,imaging,pathology,and immunohistochemistry of one patient treated at Xiangya Hospital were retrospectively analyzed.In addition,36 published RCC cases were systematically reviewed.Clinical characteristics,tumor location,immunophenotype,molecular alterations,treatments,and survival outcomes were extracted and summarized.Results:A 71-year-old man presented with abdominal distension,pain,and altered bowel habits.Imaging and colonoscopy indicated an obstructing ascending colon mass.Laparoscopic right hemicolectomy was performed.Pathology revealed poorly differentiated RCC infiltrating the serosa with 4/21 lymph-node metastases.Immunohistochemistry showed AE1/AE3(+),vimentin(+),CDX2(-),CK20(-),and Ki-67(80%+),with retained INI1 expression.Genetic testing indicated KRAS mutation and wild-type BRAFV600E.The patient received no adjuvant therapy and died of peritoneal metastasis within 3 months.Including this case,37 RCC patients(male to female ratio=1.3∶1;mean age 66 years)have been documented.Sixty-two percent of tumors were right-sided.Most exhibited rhabdoid morphology with diffuse vimentin positivity(97.06%)and AE1/AE3 positivity(100.00%),while CDX2 was negative in 85.71%.BRAFV600E mutation was present in 65.00%,and KRAS mutation in 22.73%of tested cases.Among 28 patients with MMR data,60.71%were pMMR and 39.29%dMMR.Although surgery was the primary treatment,78.79%of patients died within 1 year(median survival 6.0 months),with only a few long-term survivors following adjuvant chemotherapy or immunotherapy.Conclusion:RCC is a rapidly progressive colorectal malignancy with extremely poor prognosis and limited response to conventional chemotherapy.Tumor dedifferentiation,INI1 deficiency,and alterations in KRAS/BRAF-MAPK signaling may contribute to its pathogenesis.Surgery remains the mainstay of treatment,but incorporation of immunotherapy,targeted agents,and radiotherapy may offer potential benefits.Further studies are urgently needed to define effective therapeutic strategies.

Objective:To explore the expression of filaggrin(FLG)in melanoma tissues and its correlation with clinicopathological features and prognosis in patients.Methods:A total of 70 melanoma patients treated at the People's Hospital Affiliated to Shandong First Medical University from June 2019 to August 2020 were selected as research subjects.Tumor tissues and adjacent tissues obtained during surgery were examined for FLG expression using immunohistochemistry.Based on FLG expression,patients were divided into a positive group and a negative group.The positive expression rates of FLG in tumor tissues,adjacent tissues and melanoma tissues with different pathological features were compared.The patients were followed up for 3 years,and based on prognosis,they were divided into a survival group(n=43)and a death group(n=27).The FLG positive expression rates were compared between the two groups.Kaplan-Meier survival curves were plotted,and survival times were compared.Results:The positive FLG expression rate in melanoma tissues was significantly lower than that in adjacent tissues(P<0.05).The proportions of patients with tumor diameter>1 cm,Breslow thickness>2 mm,local ulcer,TNM stage Ⅲ-Ⅳ,lymph node metastasis,and tumor invasion in positive FLG expression group were significantly lower than those in negative group(P<0.05 or P<0.01).Among the 70 patients,27 cases died and 43 survived,with a survival rate of 61.42%.The positive FLG expression rate was significantly lower in death group than that in survival group(P<0.05).The survival time of FLG-positive patients was significantly longer than that of FLG-negative patients(P=0.010).Multivariate Cox regression analysis revealed that Breslow thickness>2 mm,TNM grade Ⅲ-Ⅳ,lymph node metastasis,and tumor invasion were risk factors for the prognosis of melanoma patients(P<0.01 or P<0.001),while positive FLG expression was a protective factor(P<0.01 or P<0.001).Conclusion:FLG expression is significantly decreased in melanoma tissues and is associated with pathological features such as Breslow thickness,tumor stage,invasion,lymph node metastasis,and prognosis.

Objective To explore its application value of LNM in patients with gastric adenocarcinoma based on the construction of a radiomic nomogram prediction model for preoperative lymph node metastasis in gastric adenocarcinoma using enhanced CT imaging features and parameters.Methods 131 patients with gastric adenocarcinoma who underwent radical gastric cancer surgery(Billroth Ⅱ)+lymph node dissection in our hospital from August 2019 to October 2023 were retrospectively analysed,and the preoperative enhancement CT extracted lesions,histological features of lymph node images,and pathological examination of LNM were recorded respectively,and the statistically significant Enhanced CT image histological features and parameters,multifactorial logistic regression to analyse the independent risk factors of gastric adenocarcinoma LNM(+)and construct a column-line diagram,and evaluate its performance.The performance and clinical value of the prediction model were evaluated using subject work characteristic(ROC)curves,and the column-line diagram was internally validated.Results The results of univariate analysis showed that the maximum diameter of the tumour,the lymph node status,the short-axis length and volume of the largest lymph node in the lymph node group and the sum of the short-axis lengths of all the lymph nodes were associated with the occurrence of LNM,and the difference was statistically significant(P＜0.05);multifactorial logistic regression analysis suggested that the maximum diameter of the tumour was ≥15 mm and the lymph node status was positive in the enhanced CT imaging examination,maximum lymph node short-axis length ≥ 7 mm in the lymph node group,the sum of short-axis lengths of all lymph nodes ≥ 11 mm,and the maximum lymph node short-axis volume ≥ 300 mm3 in the lymph node group were the independent risk factors for gastric adenocarcinoma patients with LNM(+)(P＜0.05);the area under the curve of the model was plotted using a ROC curve with an AUC=0.816(95％ CI 0.810-0.939),with the sensitivity of 0.91 and the specificity of 0.86.Model validation was performed using the BOOTSTRAP method containing 500 resamples,and the results suggested that the differences between the fitted curves and the ideal curves of the constructed column-line graphical model were not significant,and the validity and reliability were good.Conclusion The radiomic nomogram prediction model based on enhanced CT imaging features and parameters can effectively predict preoperative lymph node metastasis in gastric adenocarcinoma,providing strong support for clinical decision-making in gastric adenocarcinoma patients.

Background and Aims:Rhabdoid carcinoma of the colon(RCC)is an exceptionally rare and highly aggressive malignancy characterized by early metastasis and poor prognosis,with no standardized treatment available.We report a case of ascending colon RCC and summarize previously published cases to improve understanding of its clinicopathologic and molecular features.Methods:The clinical data,imaging,pathology,and immunohistochemistry of one patient treated at Xiangya Hospital were retrospectively analyzed.In addition,36 published RCC cases were systematically reviewed.Clinical characteristics,tumor location,immunophenotype,molecular alterations,treatments,and survival outcomes were extracted and summarized.Results:A 71-year-old man presented with abdominal distension,pain,and altered bowel habits.Imaging and colonoscopy indicated an obstructing ascending colon mass.Laparoscopic right hemicolectomy was performed.Pathology revealed poorly differentiated RCC infiltrating the serosa with 4/21 lymph-node metastases.Immunohistochemistry showed AE1/AE3(+),vimentin(+),CDX2(-),CK20(-),and Ki-67(80%+),with retained INI1 expression.Genetic testing indicated KRAS mutation and wild-type BRAFV600E.The patient received no adjuvant therapy and died of peritoneal metastasis within 3 months.Including this case,37 RCC patients(male to female ratio=1.3∶1;mean age 66 years)have been documented.Sixty-two percent of tumors were right-sided.Most exhibited rhabdoid morphology with diffuse vimentin positivity(97.06%)and AE1/AE3 positivity(100.00%),while CDX2 was negative in 85.71%.BRAFV600E mutation was present in 65.00%,and KRAS mutation in 22.73%of tested cases.Among 28 patients with MMR data,60.71%were pMMR and 39.29%dMMR.Although surgery was the primary treatment,78.79%of patients died within 1 year(median survival 6.0 months),with only a few long-term survivors following adjuvant chemotherapy or immunotherapy.Conclusion:RCC is a rapidly progressive colorectal malignancy with extremely poor prognosis and limited response to conventional chemotherapy.Tumor dedifferentiation,INI1 deficiency,and alterations in KRAS/BRAF-MAPK signaling may contribute to its pathogenesis.Surgery remains the mainstay of treatment,but incorporation of immunotherapy,targeted agents,and radiotherapy may offer potential benefits.Further studies are urgently needed to define effective therapeutic strategies.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Sacroiliac complex injuries are commonly seen in high-energy pelvic fractures. The injuries make a big difference in treatment patterns due to the diverse injury types, posing considerable challenges in formulating optimal treatment strategies, and hence are persistent clinical difficulties in orthopedic trauma. The clinical management of sacroiliac complex injuries presents several key challenges such as a non-negligible rate of missed diagnoses in associated vascular and visceral injuries, absence of standardized protocols for surgical approaches and reduction-fixation strategies across different injury patterns, and ongoing controversies regarding surgical indications and optimal timing for patients combined with concomitant lumbosacral plexus injuries. Currently, no systematic clinical guidelines are available for the diagnosis and treatment of sacroiliac complex injuries both domestically and internationally. To this end, the Pelvic and Acetabular Surgery Group, Orthopedic Branch, China International Exchange and Promotive Association for Medical and Health Care and Orthopedic Physician Branch, Chinese Medical Doctor Association organized a panel of domestic experts in the field to develop the Clinical guideline for the diagnosis and treatment of sacroiliac complex injuries ( version 2025), based on evidence-based medicine and adhering to the principles of scientific rigor, clinical applicability, and innovation. These guidelines provided 11 recommendations covering diagnosis, therapeutic principles and techniques, management protocols for lumbosacral plexus injuries, outcome evaluation, and postoperative rehabilitation pathways, etc., aiming to standardize the clinical management of sacroiliac complex injuries.

OBJECTIVE Amyotrophic lateral sclerosis(ALS)is a fetal neurodegenerative disease characterized by the progressive loss of upper and lower motor neu-rons,leading to skeletal muscle atrophy,weakness,and paralysis.Oxidative stress plays a crucial role in ALS pathogenesis,including the familial forms of the disease arising from mutations in the gene coding for superox-ide dismutase(SOD1).Additionally,the abnormal accu-mulation of TAR DNA-binding protein of 43 ku(TDP-43)is a pathological feature present in almost all patients,even though the pathogenesis of ALS is unclear.Current-ly,there is no drug that can cure ALS/FTLD.Tetramethyl-pyrazine nitrone(TBN)is a derivative of tetramethylapyr-azine,derived from traditional Chinese medicine Ligusti-cum chuanxiong,which has been extensively proven to have therapeutic effects on various models of neurode-generative diseases.METHODS We investigated the therapeutic effect of TBN in the SOD1G93A and TDP-43M337V ALS mouse models.In the SOD1G93A trans-genic mouse model,TBN was administered to mice via intraperitoneal or intragastric injection after the onset of motor deficits.We injected the TDP-43M337V virus into the striatum of mice unilaterally and bilaterally,and then administered TBN 30 mg·kg-1 intragastrically to observe changes in behavior and survival rate of mice.RESULTS TBN slowed the progression of motor neuron disease,as evidenced by improved motor performance,reduced spi-nal motor neuron loss and associated glial response,and decreased skeletal muscle fiber denervation and fibrosis.TBN treatment activated mitochondrial antioxidant activity through the PGC-1α/Nrf2/HO-1 pathway and decreased the expression of human SOD1.In the mice with unilateral injection of TDP-43M337V into the striatum,TBN improved motor deficits and cognitive impairment in the early stages of disease progression.In mice with bilateral injection of TDP-43M337V into the striatum,TBN not only improved motor function but also prolonged survival.Moreover,we demonstrate that its therapeutic effect may be through activation of the Akt/mTOR/GSK-3β and AMPK/PGC-1α/Nrf2 signaling pathways.CONCLUSION TBN shows promise as an agent for the treatment of ALS/FTLD.TBN is currently undergoing clinical investigation for several indications,including a Phase Ⅱ trial for ALS.