Objective To compare the smile incision combined with indirect reduction technique with traditional ORIF technique and systematically evaluate the advantages of this innovative surgical method in terms of functional recovery and postoperative cosmetic effects.Methods A total of 60 patients with midshaft clavicle fractures were enrolled between October 2022 and August 2024.The patients were randomly assigned to either ORIF group(open reduction and internal fixation,n=30)or MIPPO group(MIPPO combined with smile incision,n=30).Outcomes assessed included surgical trauma,functional recovery,and cosmetic outcomes.Results The MIPPO group exhibited significantly reduced intraoperative blood loss[(32.9±7.6)mL vs.(90.2±14.0)mL,P＜0.05],shorter incision length[(3.0±0.5)cm vs.(8.5±1.2)cm,P＜0.05],and reduced operative time compared to the ORIF group.Functional recovery indicators such as bone healing time[(10.1±1.7)weeks vs.(12.8±2.0)weeks,P＜0.05],initial and complete self-care time,and weight-bearing recovery were all significantly improved in the MIPPO group.The Constant-Murley score was higher in the MIPPO group(91.5±5.1 vs.82.4±6.0,P＜0.05).Cosmetic outcomes also favored the MIPPO group,with a superior SBSES score(9.2±0.4 vs.3.0±0.7,P＜0.05)and better results in scar visibility,pigmentation,thickness,and elasticity.Conclusion The smile incision combined with indirect reduction technique significantly reduces surgical trauma,accelerates postoperative recovery,and provides substantially better cosmetic outcomes compared to conventional methods,making it particularly suitable for patients with high aesthetic expectations.

Objective To compare the smile incision combined with indirect reduction technique with traditional ORIF technique and systematically evaluate the advantages of this innovative surgical method in terms of functional recovery and postoperative cosmetic effects.Methods A total of 60 patients with midshaft clavicle fractures were enrolled between October 2022 and August 2024.The patients were randomly assigned to either ORIF group(open reduction and internal fixation,n=30)or MIPPO group(MIPPO combined with smile incision,n=30).Outcomes assessed included surgical trauma,functional recovery,and cosmetic outcomes.Results The MIPPO group exhibited significantly reduced intraoperative blood loss[(32.9±7.6)mL vs.(90.2±14.0)mL,P＜0.05],shorter incision length[(3.0±0.5)cm vs.(8.5±1.2)cm,P＜0.05],and reduced operative time compared to the ORIF group.Functional recovery indicators such as bone healing time[(10.1±1.7)weeks vs.(12.8±2.0)weeks,P＜0.05],initial and complete self-care time,and weight-bearing recovery were all significantly improved in the MIPPO group.The Constant-Murley score was higher in the MIPPO group(91.5±5.1 vs.82.4±6.0,P＜0.05).Cosmetic outcomes also favored the MIPPO group,with a superior SBSES score(9.2±0.4 vs.3.0±0.7,P＜0.05)and better results in scar visibility,pigmentation,thickness,and elasticity.Conclusion The smile incision combined with indirect reduction technique significantly reduces surgical trauma,accelerates postoperative recovery,and provides substantially better cosmetic outcomes compared to conventional methods,making it particularly suitable for patients with high aesthetic expectations.

【Objective】 To investigate the clinical efficacy and significance of percutaneous cement discoplasty (PCD) in treating elderly patients with spinal instability and vacuum phenomenon on imaging. 【Methods】 We retrospectively analyzed 27 patients with spinal instability and vacuum phenomenon on imaging who underwent PVABC between June 2019 and September 2022. We recorded the surgery duration, bone cement usage, intraoperative bleeding, and total hospitalization time. We evaluated the improvement in pain and lumbar function by comparing pre- and postoperative visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and lumbar Japanese Orthopedic Association (JOA) scores. We also compared the change in intervertebral height and the distribution rate of bone cement in the intervertebral space by pre- and postoperative imaging data. 【Results】 All the 27 patients who underwent PCD had effective follow-up. The mean hospitalization time was (4.2±1.85) days, and the mean surgery duration was (32.3±4.51), (53.6±12.17), (74.4±6.33), and (90.0±10.36) minutes for single-, double-, triple-, and quadruple-level procedures, respectively. The intraoperative bleeding volume ranged from 2 to 13 mL, which was significantly lower than that of traditional intervertebral fusion surgery. Postoperative VAS pain scores, ODI scores, and JOA scores were significantly improved compared to those before surgery. In terms of imaging, the intervertebral height of the patients improved after surgery, and the distribution of bone cement in the intervertebral space was relatively good in the operated segments. Mechanical stability of the spine was restored. 【Conclusion】 For patients who are not suitable for open surgery due to severe complications, PCD is a feasible treatment option.

Objective:To investigate the safety and efficacy of intravascular intervention in ruptured intracranial vertebral artery dissecting aneurysm (IVADA).Methods:A retrospective analysis was performed; 25 patients with ruptured IVADA (25 aneurysms) admitted to Department of Neurosurgery, First Affiliated Hospital of University of Science and Technology of China from January 2020 to June 2023, were chosen. Aneurysm and parent artery occlusion or stent-assisted spring coil embolization were performed according to location of the aneurysms, degrees of aneurysm immediate embolization were evaluated by Raymond grading, and perioperative adverse events were recorded. The patients were followed up for 6-48 months, and aneurysm recurrence was determined according to DSA results; prognoses were assessed by modified Rankin Scale (mRS), with scores of 0-2 as good prognosis and scores of 3-6 as poor prognosis.Results:All 25 patients had unilateral ruptured IVADA, 10 (40%) received aneurysm and parent artery occlusion (occlusion of dissection segment) and 15 (60%) received stent-assisted embolization. Immediately after surgery, 19 patients (76%) had grading I embolization, 4 (16%) grading II embolization, and 2 (8%) grading III embolization. No aneurysm rupture or stent related thrombosis was observed during procedure; 3 patients (12%) died after procedure, with postoperative rebleeding in 1, postoperative cerebellar infarction with respiratory failure in 1, and severe pneumonia in 1. In the 22 survivals, 18 had good prognosis and 4 had poor prognosis. In the 5 relapsed patients (all accepted stent-assisted embolization), 4 underwent re-intervention, and one with visualization at aneurysm neck was relatively stable on re-examination and accepted regular follow up.Conclusion:Aneurysm and parent artery occlusion can be used for non-dominant vertebral artery aneurysms not involving posterior inferior cerebellar artery, whose recurrence rate is lower than that of stent-assisted coil embolization.

【Objective】 To investigate the effects of biomimetic bone trabecular with the same porosity and pore size and regular porous structure on the adhesion, proliferation, and differentiation of osteoblasts, so as to provide theoretical basis for the improvement of osseointegration performance of titanium alloy implants. 【Methods】 The biomimetic bone trabecular and regular porous structures with the same porosity and pore size were generated by computer-aided software, and then processed into disc-shaped Ti6Al4V scaffolds with a diameter of 10 mm and a height of 3 mm by selective laser melting technology. MC3T3-E1 cells, the precursor cells of mouse osteoblasts in the logarithmic growth phase, were seeded on two kinds of scaffolds and divided into biomimetic bone trabecular group and regular porous structure group. After 3 hours of culture, acridine orange staining and phalloidin /DAPI staining were used to evaluate the number of cell adhesion. After 3 days of culture, the scaffolds were examined by scanning electron microscopy to evaluate the adhesion state of cells. After 1, 3, and 5 days of culture, the scaffolds were taken for CCK8 detection to observe the proliferation of cells. After 7 and 14 days of differentiation, alkaline phosphatase (ALP) activity was detected. After 14 days of differentiation, the expressions of osteogenesis-related genes (ALP, OCN, RUNX2) were detected by RT-PCR. After 30 days of differentiation, the scaffolds were stained with alizarin red and 100 g/L cetylpyridinium chloride was used to dissolve mineralized nodules. Calcium salt deposition was qualitatively and quantitatively detected to evaluate cell differentiation. 【Results】 The results of acridine orange and phalloidin /DAPI staining showed that the biomimetic trabecular Ti6Al4V scaffold adhered to more MC3T3-E1 cells than the regular porous structure, and the cytoskeleton of the former scaffold was more densely distributed. The results of scanning electron microscopy showed that the pseudopodia of MC3T3-E1 cells on the biomimetic bone trabecular Ti6Al4V scaffold were longer and the extension state was better than that of the regular porous structure. CCK8 test showed that the proliferation of MC3T3-E1 cells on the biomimetic trabecular bone titanium alloy scaffold was significantly higher than that on the regular porous structure on the 3rd and 5th day, and the difference gradually increased with the increase of time, with statistical significance (P<0.05). The results of cell differentiation test showed that ALP activity on the bionic trabecular scaffold was higher than that on the regular porous structure (P<0.05). The expressions of osteogenic genes (ALP, OCN, RUNX2) in MC3T3-E1 cells on the biomimetic bone trabecular titanium alloy scaffold were significantly higher than those on the regular porous structure (P<0.05). After 30 days of induction, the amount of calcium salt deposited in the bionic trabecular titanium alloy scaffold was significantly larger than that in the regular porous structure (P<0.05). 【Conclusion】 The biomimetic bone trabecular with a porosity of 65% and an equivalent pore size of 600 μm is more conducive to the adhesion, proliferation and differentiation of mouse osteoblast precursor cells MC3T3-E1 on the titanium alloy scaffold than the regular porous structure with the same porosity and pore size. It is theoretically more conducive to improving the osseointegration performance of titanium alloy implants.

【Objective】 To explore the causal association between interleukin (IL) level and constipation by using two-sample Mendelian randomization. 【Methods】 Analyses were performed based on the data from gene-wide association studies (GWAS). Both interleukin and constipation data were obtained from European populations. IL as an exposure variable was obtained from two GWAS data sets: ⅰ. from a genetic map of the human plasma proteome containing 3 301 samples; ⅱ. from a GWAS data set on 90 circulating proteins, containing 30 931 samples. Constipation as an outcome variable was obtained from two GWAS data sets: ⅰ. from Finngene, containing 26919 cases and 282235 controls; ⅱ. from UKBiobank, containing a total of 3 328 cases and 459682 controls. Single nucleotide polymorphisms strongly associated with exposure variables were used as instrumental variables, with inverse variance weighted (IVW) as the main analysis method, MR-egger regression and weighted median method as supplementary evidence for IVW results, and horizontal pleiotropy and heterogeneity were tested to ensure the stability of the results. 【Results】 In both of the two different outcome variables GWAS data, IVW analysis results showed that decreased level of IL-17 receptor C was associated with an increased risk of constipation, with ORs of 0.956 (95% CI: 0.916-0.997, P=0.036‖Finngene) and 0.998 (95% CI: 0.997-0.999, P=0.040‖ukb). Increased level of IL-18 was associated with an increased risk of constipation, with ORs of 1.055 (95% CI: 1.008-1.104, P=0.022‖Finngene) and 1.001 (95% CI: 1.000-1.002, P=0.044‖ukb); while in the Finngene data, the IVW results also suggested that increased levels of IL-2 receptor alpha subunit α and decreased levels of IL-10 and IL-17 were associated with an increased risk of constipation, with ORs of 1.054 (95% CI: 1.001-1.110, P=0.049), 0.945 (95% CI: 0.896-0.996, P=0.035) and 0.934 (95% CI: 0.896-0.997, P=0.040). 【Conclusion】 IL-17 receptor C, IL-18, IL-2 receptor alpha subunit α, IL-10, and IL-17 were causally associated with the risk of constipation.

【Objective】 To investigate the clinical effects of treatment of single-segment lumbar tuberculosis by oblique lateral interbody fusion with autologous iliac bone and percutaneous pedicle screw fixation. 【Methods】 We collected the clinical data of 47 patients with lumbar tuberculosis treated in The First Affiliated Hospital of Xi’an Jiaotong University from March 2017 to January 2020. Among them， 22 patients underwent oblique lateral interbody fusion with autologous iliac bone and percutaneous pedicle screw fixation （minimally invasive group） and 25 patients underwent open surgery combined anterior-debridement and posterior-fixation （control group）. The related data were collected， including gender， sex， body mass index （BMI）， systemic symptoms of tuberculosis， operation duration， intraoperative bleeding， postoperative drainage， hospital stay， complications， visual analogue score （VAS）， erythrocyte sedimentation rate （ESR）， and Oswestry disability index （ODI）. 【Results】 Baseline clinical characteristics did not significantly differ between the two groups （P>0.05）. Compared with control group， the minimally invasive group had shorter operation duration ［（188.64±18.59） min vs. （201.60±22.67） min］， less intraoperative blood loss ［（118.64±22.95） mL vs. （553.60±100.54） mL］， less postoperative drainage ［（134.55±36.48） mL vs. （291.20±61.53） mL］， and shorter hospitalization time ［（12.86±2.17） d vs. （15.80±3.03） d］ （all P<0.05）. However， there was no significant difference in fusion time or complication rate （P>0.05）. Compared with the preoperative ones， ESR， VAS score and ODI score significantly decreased and Cobb angle significantly increased in both groups （all P<0.001）. At postoperative 3 months， the VAS score was lower in the minimally invasive group than in control group ［（3.59±0.96） vs. （4.16±0.85）］ （P<0.05）. With regard to other characteristics， there was no significant difference between the two groups at the same point （P>0.05）. 【Conclusion】 Both minimally invasive technique and open surgery can achieve excellent clinical results， but the minimally invasive technique can reduce the surgical trauma and shorten the hospitalization time.

Objective:To observe the short-term efficacy and complications of flow diverter device Tubridge in the treatment of complex intracranial aneurysms, and to summarize the indications and experience of Tubridge in treatment of complex intracranial aneurysms.Methods:Thirty-one patients with complex intracranial aneurysms accepted treatment with assistance of Tubridge in our hospital from January 2020 to December 2020 were enrolled. Raymond grading was used to evaluate the degrees of aneurysm embolization immediately after surgery. Modified Rankin scale (mRS) was used to evaluate the prognoses 6 months after surgery. The embolization of aneurysms was determined in these patients by DSA 6 and 12 months after surgery.Results:Thirty-seven aneurysms were noted in these 31 patients. A total of 32 diverters (Turbridge) were implanted into these 37 aneurysms, and all of which were successfully delivered and released. Thirteen aneurysms were filled with spring coils (8 with Raymond grading I, 2 with Raymond grading II, 3 with Raymond grading III by DSA immediately after surgery), and 24 aneurysms were not filled with spring coils. Postoperative ischemic complications occurred in 1 patient, and no hemorrhagic complications or death were noted. All 31 patients had good prognosis at follow-up. Six months after surgery, DSA re-examination in 24 patients (77.4%) showed that complete occlusion of aneurysms was achieved in 17 patients (70.8%). DSA re-examination 12 months after surgery showed complete occlusion of aneurysms in 19 of the 25 patients (76%).Conclusion:The new domestic flow diverter device Tubridge has a high success rate, less perioperative complications, high safety, and good recovery in the treatment of complex intracranial aneurysm.

Objective To observe the effect of brain-derived microvesicles (BDMVs) on cytoskeleton in human umbilical vein endothelial cells (HUVECs).Methods BDMVs were prepared in vitro and identified by transmission electron microscopy and particle size identification.HUVECs were co-cultured with PKH26-1abeled BDMVs for 0.5,1,and 2 h;flow cytometry was used to detect the phagocytosis of HUVECs for BDMVs at different time points.HUVECs cultured in vitro were divided into control group,BDMVs treatment group and nimodipine treatment group;cells in the BDMVs treatment group were given 1.5× 107/mL BDMVs;cells in the nimodipine treatment group were pretreated with 2 μg nimodipine (0.2 mg/mL) for 10 min,and then,given 1.5×107/mL BDMVs.After being stained with rhodamine-labeled phalloidin,the fluorescence intensity and number of stress fibers of fibroactin in HUVECs were observed by laser confocal microscopy.Results BDMVs had complete membrane structure with a diameter of 100-1000 nm under transmission electron microscopy.The proportion of cells phagocytizing BDMVs increased significantly with prolonged incubation time,enjoying significant differences (0.5h:22.7％±1.2％;1 h:52.3％±1.3％;2h:71.6％±1.9％,P＜0.05).Laser confocal microscopy showed that,as compared with the control group,the fluorescence intensity ofcytoskeletal protein was obviously increased and the number of stress fibers increased was obviously larger in the BDMVs treatment group.As compared with those in the BDMVs treatment group,the fluorescence intensity of cytoskeletal protein was decreased and the number of stress fibers was obviously smaller in the nimodipine group.Conclusion The role of BDMVs in phagocytosis of HUVECs becomes stronger as time being prolonged,and BDMVs phagocytosis leads to cytoskeletal remodeling,which can be partially blocked by nimodipine.

Objective To investigate the effect of astrocyte-derived microparticles on intracellular free calcium concentration in umbilical vein endothelial cells (UVECs).Methods Brain astrocytes were first isolated from 24 h new-born Sprague-Dawley rats and cultured in vitro.Then,they were stimulated with calcium ionophore,A23187,and microparticles were extracted by fractional centrifugation and verified by electron microscopy.UVECs cultured in vitro were divided into control group,nimotop group,and low,median and high concentrations ofmicroparticles groups;cells from nimotop group were pretreated with 10 μL nimotop for 10 min;cells from the later 4 groups were given 1×108,0.5×108,1×108,and 2× 108/mL microparticles respectively;cells from the control group were given the same volume of medium.Ten min after cultivation,they were loaded with fluorescent probe Fluo3-AM,respectively.Later,the concentration of Ca2+ in UVECs was measured by confocal laser scanning microscope and flow cytometry.Results The isolation and in vitro culture methods for rat astrocytes provided stable and reliable results.With A23187 stimulation and fractional centrifugation,astrocyte derived microparticles were available for extraction.Laser scanning confocal microscope indicated that the intracellular fluorescence intensity in the control group was the lowest;after incubating UVECs with low,median and high concentrations of astrocyte-derived microparticles,the intracellular fluorescence intensity increased,and it increased following the concentrations of astrocyte-derived microparticles;pretreatment with nimotop could moderately decrease the intracellular fluorescence intensity,but that in the nimotop group was still higher than that in the control group.The mean fluorescence values for intracellular free Ca2+ were 51 866,57 996 and 73 630,respectively,in the low,median and high concentrations of microparticles groups,which showed statistically significant increase as compared with that from the control group (45 759,P＜0.05).When nimotop was applied to the cells,it blocked the influx of calcium ions and the measured value was significantly changed to 49843,enjoying significant difference as compared with that from the low,median and high concentrations of microparticles groups (P＜0.05).Conclusion Astrocyte-derived microparticles are capable of increasing the intracellular free calcium concentration in UVECs,and the effects can be blocked by nimotop.