ObjectiveTo establish an animal model of atrial fibrillation（AF） that accurately reflects the phlegm-heat and blood stasis（TRYZ） pathogenesis in traditional Chinese medicine. MethodsForty SPF-grade SD rats were randomly assigned using a random number table to the following groups：the control group， the TRYZ+AF group，the AF group and the TRYZ group， with ten rats in each group. The TRYZ+AF and TRYZ groups underwent a high-fat diet combined with intraperitoneal lipopolysaccharide（LPS） injection to simulate the pathological alterations of TRYZ syndrome. Groups TRYZ+AF and AF were induced with acetylcholine-calcium chloride（Ach-CaCl₂） via caudal vein injection to induce AF. The control group received no intervention and was maintained under normal conditions. The modeling period lasted 3 weeks. Electrocardiography was used to assess AF episodes and duration， echocardiography evaluated left atrial dimensions and cardiac function， fully automated biochemical analyzer measured the levels of total cholesterol（TC）， triglycerides（TG）， high-density lipoprotein cholesterol（HDL-C） and low-density lipoprotein cholesterol（LDL-C）， hemoreometer analyzed the whole blood viscosity， plasma viscosity， and whole blood reduced viscosity， a coagulation analyzer assessed prothrombin time（PT）， activated partial thromboplastin time（APTT）， thrombin time（TT）， and fibrinogen（FIB）， enzyme-linked immunosorbent assay（ELISA） was used to determine the levels of C-reactive protein（CRP）， interleukin（IL）-1β， IL-6， IL-17， tumour necrosis factor（TNF）-α， matrix metalloproteinase-9（MMP-9）， galectin-3（Gal-3）， Collagen Ⅰ， and α-smooth muscle actin（α-SMA）. Hematoxylin-eosin（HE） staining and Masson's trichrome staining were used to analyze pathological changes in atrial myocardium， Western blot was employed to detect MMP-9， Collagen Ⅰ and α-SMA protein expression in myocardial tissue， real-time quantitative polymerase chain reaction（Real-time PCR） evaluated fibrous factor gene expression levels. Changes in the TRYZ syndrome were assessed via body weight， tongue color［red（R）， green（G）， and blue（B）］， and rectal temperature. Ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS） was employed to detect differential metabolites between the control group and the TRYZ+AF group. ResultsFollowing three weeks of sustained modeling， compared with the control group， rats in the TRYZ+AF and the TRYZ groups exhibited reduced body weight， dry faeces， elevated rectal temperature， dark red tongue， decreased RGB values on the tongue surface， and markedly elevated TC and LDL-C levels（P<0.05， P<0.01）. The TRYZ+AF， TRYZ， and AF groups exhibited significantly decreased TT， APTT and PT， along with markedly elevated whole blood viscosity and FIB（P<0.05， P<0.01）. Rats in the TRYZ+AF and AF groups exhibited AF rhythm， markedly decreased heart rate， prolonged RR intervals， enlarged left atrium， and significantly reduced ejection fraction and shortening fraction（P<0.05， P<0.01）. Serum levels of CRP， IL-1β， IL-6， IL-17， TNF-α， MMP-9， Gal-3， Collagen Ⅰ， and α-SMA were elevated in rats from the TRYZ+AF， TRYZ， and AF groups compared to the control group， with the most pronounced increase observed in the TRYZ+AF group（P<0.05， P<0.01）. Histopathology revealed that the collagen fiber deposition in the atrial of rats in the TRYZ+AF， TRYZ and AF groups was higher than that in the control group（P<0.05， P<0.01）. Western blot and Real-time PCR results further demonstrated that the protein and mRNA expression levels of MMP-9， Collagen Ⅰ and α-SMA in the myocardial tissue of the TRYZ+AF group were higher than those in the other three groups（P<0.05， P<0.01）. Metabolomic analysis revealed 173 differentially expressed metabolites in the TRYZ+AF group and the control group， primarily enriched in pathways such as glycerophospholipid metabolism and glycolysis/gluconeogenesis. ConclusionThis study successfully establishes a rat model of AF integrated with the TRYZ syndrome， demonstrating the pathological process where the interactions of phlegm， heat and stasis jointly trigger tremor， this provides a reliable experimental tool for in-depth research into the biological basis of this disease syndrome.

Objective To explore the imaging characteristics of lung cancers associated with cystic airspaces (LCCA) and the effects of different treatment regimens. Methods A retrospective analysis was conducted on the clinical and radiological data of LCCA patients who underwent surgical resection and pathological confirmation at the Department of Thoracic Surgery, the First Affiliated Hospital of Soochow University from 2016 to 2023. The relationship between various radiological classifications and clinical pathology was studied. Based on the postoperative adjuvant treatment follow-up results, the effects of different treatment regimens were analyzed. Results A total of 147 patients were included, including 90 males and 57 females, with a median age of 63 (55, 70) years. There were 21 patients of imaging typeⅠ, 50 patients of typeⅡ, 57 patients of type Ⅲ, and 19 patients of type Ⅳ. The lobulation sign or burr sign of typeⅠcyst walls (P=0.004), and intracystic septa (P=0.030) were more commonly seen in the high-aggressiveness group. The components of the cyst walls or nodules of types Ⅰ-Ⅳ in the high-aggressiveness group were mostly solid or sub-solid (P<0.05). Multivariate logistic regression analysis indicated that subsolid cyst wall (OR=4.734, P=0.023), solid cyst wall (OR=97.972, P<0.001), and the lobulation sign or burr sign of the cyst wall (OR=13.215, P=0.024) were independent risk factors for aggressiveness. Fifty-eight patients received adjuvant therapy after surgery, including 22 in the chemotherapy group, 15 in the targeted therapy group, and 21 in the combined therapy group. The progression-free survival of the combined therapy group was better than the other two groups (P=0.045). Conclusion There is a correlation between the imaging features of LCCA and pathological aggressiveness. Compared to postoperative targeted therapy or chemotherapy alone, postoperative chemotherapy combined with targeted therapy can improve the progression-free survival of LCCA patients.

Objective:To investigate the application value of intraoperative motor nerve monitoring in cervical neurogenic tumor surgery.Methods:The efficacy of intraoperative neuromonitoring (IONM) was analyzed retrospectively in 18 patients, including 6 males and 12 females, aged from 15 to 74 years, treated in Affiliated Drum Tower Hospital, Medical School of Nanjing University from June 2019 to September 2022 who underwent total cystectomy of cervical neurogenic tumors under intraoperative nerve monitoring.Results:All 18 patients had complete tumor removal, including 8 patients with tumors from the vagus nerve and 10 patients with tumors from the brachial plexus nerve. Postoperative nerve functions were normal in patients with tumors from brachial plexus nerve, and incomplete vocal cord paralysis occurred in 2 patients with tumors from vagus vagus nerve. The total incidence of motor nerve injury was 11.1% (2/18). All patients were followed up for 6 to 45 months, with no tumor recurrence.Conclusion:Intraoperative neuromonitoring has significant values in surgery of cervical neurogenic tumors, which is helpful to remove completely the tumors on the basis of protecting the nerve functions to the maximum extent.

AIM:To explore the impact of Delta-like ligand 3(DLL3)on the progression of prostate cancer(Pca)and to elucidate its potential molecular mechanisms.METHODS:Overexpression and interference plasmids of DLL3 gene were constructed,and the effects of DLL3 on the proliferation,migration and invasion of Pca cells were as-sessed.Tumorigenesis assay was employed to determine whether DLL3 influenced the proliferation of PC-3 cells in vivo.The impact of DLL3 on epithelial-mesenchymal transition(EMT)and mitogen-activated protein kinase(MAPK)signaling was investigated through Western blotting.RESULTS:Overexpression of DLL3 significantly enhanced the proliferation,migration,invasion and EMT processes of Pca cells compared with empty vector group and blank control group(P＜0.05).Conversely,knockdown of DLL3 expression yielded opposite effects(P＜0.05).Moreover,up-regulation of DLL3 promoted tumor growth in the nude mouse xenograft model(P＜0.05).Further investigation demonstrated that DLL3 up-regulation led to increases in the levels of MAPK signaling pathway-related proteins.Interestingly,MAPK inhibitor effec-tively reduced the proliferation,migration and invasion of Pca cells caused by DLL3 overexpression(P＜0.05).CON-CLUSION:DLL3 promotes the proliferation,migration and invasion of Pca through the MAPK pathway.

Objective:To investigate the value of the decrease rate of parathyroid hormone (PTH) in predicting permanent hypoparathyroidism (PHP) in one month after operation of papillary thyroid carcinoma (PTC) .Methods:The clinical data of 322 patients with PTC who underwent at least total thyroidectomy and unilateral central lymph node dissection in the Thyroid Surgery Center of West China Hospital of Sichuan University from Jan. 2013 to Jun. 2018 were retrospectively analyzed. There were 257 women and 65 men. According to the time when PTH returned to normal, they were divided into 307 cases in the temporary hypoparathyroidism (THP) group and 15 cases in the PHP group. The decrease rate of PTH and the incidence of hypoparathyroidism in one month after operation were counted, the clinical characteristics and operation information were observed, and the risk factors of PHP were analyzed. SPSS 23.0 statistical software was used for data processing. χ 2 test and t test were used for comparison between THP and PHP. The related factors were analyzed by multivariate logistic regression. Results:307 cases of THP and 15 cases of PHP were included. Multivariate logistic analysis showed that age ≥ 55 years old ( OR, 35.193; 95% CI, 2.936 - 421.870; P=0.005) and PTH before operation closer to normal lower limit ( OR, 2.349; 95% CI, 1.161 - 4.755; P = 0.018) were independent risk factors for PHP. Patients with PHP had a higher rate of PTH decline in 1 month after operation ( OR, 373.439; 95% CI, 26.568 - 5248.983; P=0.000) . The ROC curve showed that the sensitivity and specificity of predicting PHP were 86.7% and 94.8% respectively. Conclusions:The age of patients with PTC ≥ 55 years old and PTH before operation closer to normal lower limit are independent risk factors for the occurrence of PHP. The decline rate of PTH in one month after operation which more than 73.2% can predict PHP.

Current advances of immunotherapy have greatly changed the way of cancer treatment. At the same time, a great number of nanoparticle-based cancer immunotherapies (NBCIs) have also been explored to elicit potent immune responses against tumors. However, few NBCIs are nearly in the clinical trial which is mainly ascribed to a lack understanding of

Objective:To evaluate the effects of weight-bearing area compression injury of the femoral head on the prognosis of elderly acetabular fractures after open reduction and internal fixation.Methods:A retrospective analysis of 36 elderly patients with acetabular fractures treated with open reduction and internal fixation during January 2014 to January 2018 were conducted. All patients with compression injury of the weight-bearing area of the femoral head, including 22 males and 14 females with 73.2±6.5 years old (range 60-87 years old), were included. The compression injury of weight-bearing area of the femoral head was not treated. According to the Letournel-Judet classification of acetabular fractures, there were 14 cases with both-column, 12 cases with anterior column and posterior hemitransverse, 4 cases with T type, 4 cases with transverse, and 2 cases with posterior column+ posterior wall. A total of 14 cases were accompanied by acetabular joint surface compression, while 29 cases were accompanied by joint dislocation. The Merle d'Aubigné score was used to evaluate the hip function during follow-up. The Matta classification method was used to evaluate the results of acetabular fracture reduction. The Kellgren-Lawrence classification standard and Ficat-Alert staging method were used to evaluate the traumatic arthritis of the hip and femoral head necrosis, respectively. During the follow-up, the femoral head necrosis with stage III, IV, or traumatic arthritis III, IV, or with indications for joint replacement was defined as surgery failure. CT scans of the pelvis were performed before and at 2-5 days after operation. The compression size of the femoral head on the coronal and axial planes of the CT scan was calculated for the compression volume. The compression severity was divided into small (<1 cm 3), medium (1-2 cm 3) and large (>2 cm 3) according to the volume. Binary Logistic regression analysis was used to analyze whether the postoperative measurement of the femoral head compression volume was associated with the risk of surgical failure. Results:All patients were followed up for 34.7±8.9 months (range 25-54 months). There were 7 cases with large compression of femoral head, 14 cases with medium, and 15 cases with small pre-operatively. However, there were 12 cases, 10 cases and 14 cases with large, medium and small at 2-5 days after operation, respectively. Six cases were excellent reduction, 22 cases were good, and 8 cases were poor. Thus, the excellent and good rate was 78% (28/36). At the last follow-up, Merle d'Aubigné score was excellent in 2 cases, good in 8 cases, fair in 5 cases, and poor in 21 cases. The excellent and good rate was 28% (10/36). There were 20 cases with surgery failure with 56% (20/36) failure rate. There were no statistically significant differences in the patient's age, body mass index, operation duration, blood volume, fracture type, fracture reduction, combined acetabular joint surface compression, and combined joint dislocation between the two groups. However, there was a statistically significant difference in the frequency distribution of compression volume in the weight-bearing area of the femoral head after surgery (χ 2=22.047, P<0.001). In patients with large, medium, and small-volume compression of the femoral head weight-bearing area, the surgery failure rates were 92%, 80%, and 7%, respectively. The large and medium-volume compression of the femoral head weight-bearing area were independent risk factors for surgical failure. Conclusion:Open reduction and internal fixation can be used to treat elderly patients with acetabular fractures combined with femoral head compression injury. Despite satisfactory reduction for acetabular fractures, the larger volume of femoral head compression affects the clinical outcomes with extremely high rate of surgical failure within 2 years.

Nowadays, nanotechnology is revolutionizing the approaches to different fields from manufacture to health. Carbon nanotubes (CNTs) as promising candidates in nanomedicine have great potentials in developing novel entities for central nervous system pathologies, due to their excellent physicochemical properties and ability to interface with neurons and neuronal circuits. However, most of the studies mainly focused on the drug delivery and bioimaging applications of CNTs, while neglect their application prospects as therapeutic drugs themselves. At present, the relevant reviews are not available yet. Herein we summarized the latest advances on the biomedical and therapeutic applications of CNTs and for neurological diseases treatments as inherent therapeutic drugs. The biological mechanisms of CNTs-mediated bio-medical effects and potential toxicity of CNTs were also intensely discussed. It is expected that CNTs will exploit further neurological applications on disease therapy in the near future.

Objective To evaluate the clinical treatment of unstable pelvic fractures by posterior ring fixation using percutaneous minimally invasive pedicle screws following anterior ring fixation.Methods From January 2010 to January 2016,31 patients with unstable pelvic fracture were treated at our department.They were 20 males and 11 females,with an average age of 44.4 years (range,from 18 to 65 years).According to the Tile classification,6 cases were type B2,8 cases type B3,12 cases type C1,and 5 cases type C2.The anterior pelvic ring was fixated in supine position first,and the posterior pelvic ring was fixated next using percutaneous minimally invasive pedicle screws.The operation time,intraoperative bleeding,and frequency of fluoroscopy needed for the posterior ring fixation were recorded.Reduction quality,complications like loss of reduction and pelvic function at the final follow-up were also assessed.Results For the posterior ring fixation in the 31 patients,the operation time ranged from 40 to 60 minutes (average,50.7 minutes),blood loss from 30 to 80 mL (average,42.9 mL),and fluoroscopic frequency from 7 to 12 times (average,9.7 times).By the Tornetta evaluation,the reduction was rated postoperatively as excellent in 15 cases and as good in 16 ones,yielding an excellent and good rate of 100％.Twenty-nine patients obtained complete follow-up for 12 to 83 months (average,34.7 months),and they achieved bone union after an average of 14.5 weeks (range,from 12 to 16 weeks).According to the Majeed criteria for pelvic function at the final follow-up,10 cases were rated as excellent,16 cases as good,and 3 cases as fair,giving an excellent and good rate of 89.7％.No reduction loss,incision infection,vascular or nerve injury,screw loosening or breakage,or fracture displacement was observed during follow-up.Conclusion In the treatment of unstable pelvic fractures,posterior ring fixation using percutaneous minimally invasive pedicle screws following anterior ring fixation can lead to less operation time,intraoperative bleeding and fluoroscopic radiation,and satisfactory fracture reduction and functional recovery of the pelvis as well.

Objective To investigate the therapeutic efficacy of contralateral less invasive stabilization system (LISS) through a medial-posterior approach for fractures of femoral medial condyle.Methods From December 2010 to December 2014,14 patients with fracture of femoral medial condyle were treated surgically at our department.They were 10 males and 4 females,aged from 33 to 64 years (average,44.6 years).By AO classification,10 cases were type 33-B2 and 4 cases type 33-B3.Causes of injury included traffic accident in 7 cases,falling in 6 and heavy object crush in one.Internals from injury to operation ranged from 3 to 10 days (average,5.4 days).All the patients were treated by open reduction and internal fixation with contralateral LISS plate or T plate through a knee medial posterior approach.Results The 14 patients were followed up for 12 to 24 months (average,18 months).All fractures got bony healing after 3 to 5 months (average,3.5 months).No collapse of joint surface,joint stiffness,joint infection,malunion or nonunion occurred.According to the Schatzker-Lambert criteria for functional recovery of the distal femoral fractures,the function of the affected knee was assessed at the last follow-up as excellent in 9 cases,good in 3,fair in one and poor in one.Conclusion Open reduction and internal fixation with contralateral LISS plate through a medial-posterior approach is effective for fractures of femoral medial condyle due to its strong buttress,rigid fixation,advantage for early functional exercise,and satisfactory therapeutic outcome.