BACKGROUND:Arthroscopic anchor repair has become the main treatment method for rotator cuff tears at present.Among them,the insertion status of the anchor is a key factor in the success or failure of the operation.However,currently,the impact of the insertion depth of the anchor on the stress of the bone tunnel and the anchor under different bone density conditions remains unclear.OBJECTIVE:To explore the stress distribution of the bone tunnel and the anchor when the insertion depth of the anchor varies under different bone density conditions by using three-dimensional finite element analysis technology.METHODS:The CT image data of the humerus of volunteers were collected,and the models of the humerus and the anchor were constructed by using Mimics,3-Matic,and Solidworks software.In 3-Matic,holes with distances of 0,2,4,6,and 8 mm from the surface of the humerus were respectively created at the same position of the humerus and assembled with the anchor.In Mimics,values were assigned based on the CT gray value to obtain a model with normal bone mass(T value ≥-1.0).The parameters were changed to construct models with reduced bone mass(-2.5＜T value＜-1.0)and osteoporosis(T value＜-2.5).In each model,a 70 N pulling force was applied to the anchor along the direction tangent to the inner edge of the bone tunnel.The stress distribution and magnitude of the bone tunnel and the anchor when inserted at different depths under different bone density conditions were observed.RESULTS AND CONCLUSION:(1)When the insertion depth was the same,as the bone density decreased,the maximum equivalent stress of the anchor increased,while the maximum equivalent stress of the bone tunnel decreased.(2)When the bone density was the same,as the insertion depth of the anchor increased,the maximum equivalent stress of the anchor decreased.When the insertion depth was 4 mm,the stress of the bone tunnel was the smallest and the distribution was relatively uniform.The stress of the anchor was mainly distributed around the lower anchor hole and the proximal thread,and the stress of the bone tunnel was mainly at the part in contact with the proximal thread.The increase in the insertion depth would change the uniformity and pattern of the stress distribution,while the bone density had a relatively small impact on the stress distribution pattern.(3)It is concluded that the bone density of the humerus is crucial for the anchor repair of rotator cuff tears.It is recommended that clinicians measure the bone density of the greater tuberosity of the humerus before the operation.Excessive insertion depth of the anchor does not significantly increase its stability.Clinicians can conduct personalized preoperative assessments by using the finite element analysis method in combination with the actual situation of patients to achieve the best surgical results.

BACKGROUND:Arthroscopic anchor repair has become the main treatment method for rotator cuff tears at present.Among them,the insertion status of the anchor is a key factor in the success or failure of the operation.However,currently,the impact of the insertion depth of the anchor on the stress of the bone tunnel and the anchor under different bone density conditions remains unclear.OBJECTIVE:To explore the stress distribution of the bone tunnel and the anchor when the insertion depth of the anchor varies under different bone density conditions by using three-dimensional finite element analysis technology.METHODS:The CT image data of the humerus of volunteers were collected,and the models of the humerus and the anchor were constructed by using Mimics,3-Matic,and Solidworks software.In 3-Matic,holes with distances of 0,2,4,6,and 8 mm from the surface of the humerus were respectively created at the same position of the humerus and assembled with the anchor.In Mimics,values were assigned based on the CT gray value to obtain a model with normal bone mass(T value ≥-1.0).The parameters were changed to construct models with reduced bone mass(-2.5＜T value＜-1.0)and osteoporosis(T value＜-2.5).In each model,a 70 N pulling force was applied to the anchor along the direction tangent to the inner edge of the bone tunnel.The stress distribution and magnitude of the bone tunnel and the anchor when inserted at different depths under different bone density conditions were observed.RESULTS AND CONCLUSION:(1)When the insertion depth was the same,as the bone density decreased,the maximum equivalent stress of the anchor increased,while the maximum equivalent stress of the bone tunnel decreased.(2)When the bone density was the same,as the insertion depth of the anchor increased,the maximum equivalent stress of the anchor decreased.When the insertion depth was 4 mm,the stress of the bone tunnel was the smallest and the distribution was relatively uniform.The stress of the anchor was mainly distributed around the lower anchor hole and the proximal thread,and the stress of the bone tunnel was mainly at the part in contact with the proximal thread.The increase in the insertion depth would change the uniformity and pattern of the stress distribution,while the bone density had a relatively small impact on the stress distribution pattern.(3)It is concluded that the bone density of the humerus is crucial for the anchor repair of rotator cuff tears.It is recommended that clinicians measure the bone density of the greater tuberosity of the humerus before the operation.Excessive insertion depth of the anchor does not significantly increase its stability.Clinicians can conduct personalized preoperative assessments by using the finite element analysis method in combination with the actual situation of patients to achieve the best surgical results.

The oocyte， as the origin of life， provides half the chromosomes to the embryo and supplies the proteins， substrates， energy， and other support necessary for embryonic development. It is the decisive factor determining the embryo's developmental potential. Infertility caused by reproductive endocrine diseases targets the oocyte as the final target cell. Improving oocyte quality represents a key and difficult point in the field of modern reproductive medicine. The decline of oocyte quality is related to meiosis abnormalities， DNA damage， mitochondrial dysfunction， oxidative stress， and other mechanisms. For oocyte quality problems， there is no unified international guideline to recommend drugs. Because the drug intervention research on oocytes involves strict clinical ethical restrictions， the current relevant research only stays in the animal and in vitro experimental stage and has not yet been applied to the clinic. Traditional Chinese medicine compound formula has a multi-target and multi-pathway regulation mechanism and is widely used in clinics. More and more research began to pay attention to the potential mechanism of traditional Chinese medicine compound formulas in improving oocyte quality. Traditional Chinese medicine compound formula has the advantages of multi-target and multi-channel synergy as well as better safety， individualization， and conformity to clinical ethics in improving oocyte quality. This article systematically reviewed the research progress on traditional Chinese medicine compound formula interventions for oocyte quality， aiming to summarize existing findings and provide recommendations to improve oocyte quality and optimize the clinical diagnosis and treatment of female infertility within traditional Chinese medicine.

The oocyte， as the origin of life， provides half the chromosomes to the embryo and supplies the proteins， substrates， energy， and other support necessary for embryonic development. It is the decisive factor determining the embryo's developmental potential. Infertility caused by reproductive endocrine diseases targets the oocyte as the final target cell. Improving oocyte quality represents a key and difficult point in the field of modern reproductive medicine. The decline of oocyte quality is related to meiosis abnormalities， DNA damage， mitochondrial dysfunction， oxidative stress， and other mechanisms. For oocyte quality problems， there is no unified international guideline to recommend drugs. Because the drug intervention research on oocytes involves strict clinical ethical restrictions， the current relevant research only stays in the animal and in vitro experimental stage and has not yet been applied to the clinic. Traditional Chinese medicine compound formula has a multi-target and multi-pathway regulation mechanism and is widely used in clinics. More and more research began to pay attention to the potential mechanism of traditional Chinese medicine compound formulas in improving oocyte quality. Traditional Chinese medicine compound formula has the advantages of multi-target and multi-channel synergy as well as better safety， individualization， and conformity to clinical ethics in improving oocyte quality. This article systematically reviewed the research progress on traditional Chinese medicine compound formula interventions for oocyte quality， aiming to summarize existing findings and provide recommendations to improve oocyte quality and optimize the clinical diagnosis and treatment of female infertility within traditional Chinese medicine.

Purpose To explore the application value of spectral CT vascular optimization technique for laparoscopic right hemicolectomy.Materials and Methods Ninety patients who underwent contrast-enhanced CT with spectral CT before scheduled laparoscopic right hemicolectomy from March to November 2022 in Shengjing Hospital of China Medical University were retrospectively analyzed.The raw images were reconstructed to obtain 120 kVp conventional images and spectral-based virtual monochromatic images(VMIs)at 40,50,60,70 keV.The CT value and image noise of gastrocolic trunk of Henle(GTH),right colic vein(RCV)and ileocolic vein(ICV)were measured.The CT value,image noise,signal noise ratio and contrast noise ratio of VMIs and conventional image were analyzed.The image quality and venous anatomical information of each group were evaluated subjectively with three-dimensional reconstruction technique.Results The CT value[(405.55±103.06)Hu,(406.61±103.42)Hu,402.35(337.95,477.45)Hu],image noise[19.90(12.10,34.55)Hu,21.10(10.95,44.30)Hu,19.70(11.25,44.80)Hu],signal noise ratio[19.46(10.60,36.31),20.16(8.73,37.42),18.49(9.99,36.24)]and contrast noise ratio[53.36(35.92,70.79),52.34(33.73,81.03),56.23(34.69,79.97)]of GTH,RCV,ICV of VMIs at 40 keV were significantly higher than those of conventional image and other VMIs(F/H=268.53,23.17,33.09,198.77,272.51,28.93,25.48,189.62,318.24,29.42,20.13,212.46,all P<0.001).Subjective scores showed that the image quality and vascular visualization of GTH,RCV and ICV at 40 keV were the best.Conclusion Spectral CT can improve the imaging quality and vascular visualization of GTH,RCV and ICV.VMIs at 40 keV has the optimal performance.

Purpose To investigate the value of peritumoral expansion-based radiomics from tumor regions of interest(ROIs)for predicting epidermal growth factor receptor(EGFR)mutation status and to identify the optimal peritumoral expansion margin.Materials and Methods This retrospective study included 390 patients with pathologically confirmed non-small cell lung cancer(NSCLC)and definitive EGFR genotyping results from the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University(December 2021 to September 2023).Patients were randomly divided into training and validation sets(8∶2 ratio,310 vs.80 patients;CT slice thickness:5-7 mm).An additional independent test set of 100 patients undergoing thin-section CT(1-2 mm)was included to assess model generalizability across slice thicknesses.Clinical characteristics and CT semantic features were analyzed.After automated tumor segmentation with manual refinement,ROIs were sequentially expanded outward by 1,2,3,4 and 5 mm.A total of 2 264 radiomic features were extracted from each ROI.Feature selection using minimum redundancy maximum relevance and least absolute shrinkage and selection operator algorithms was performed in the training set to calculate radiomics scores.Logistic regression was used to develop prediction models.A combined model integrating optimal peritumoral radiomics score with clinical and CT features was established,with performance compared across models.Results Gender(χ2=24.922,P<0.001),smoking history(χ2=11.199,P=0.001),emphysema(χ2=40.802,P<0.001),and lymph node metastasis(χ2=5.674,P=0.017)were associated with EGFR mutation status.In the validation set,the area under the curve for the tumor ROI-based radiomics model was 0.676,while the five expansion models achieved area under the curve of 0.723,0.720,0.734,0.681,and 0.598,respectively.The combined model based on 3 mm expansion demonstrated superior performance to individual radiomics and clinical models,with area under the curve of 0.826,0.734,0.711 in the validation set,and 0.809,0.760,0.702 in the independent test set.Conclusion Peritumoral expansion-based CT radiomics demonstrates value for predicting EGFR mutations in NSCLC,with 3 mm identified as the optimal expansion margin.Integration with clinical information further enhances predictive accuracy.

Purpose To investigate the value of peritumoral expansion-based radiomics from tumor regions of interest(ROIs)for predicting epidermal growth factor receptor(EGFR)mutation status and to identify the optimal peritumoral expansion margin.Materials and Methods This retrospective study included 390 patients with pathologically confirmed non-small cell lung cancer(NSCLC)and definitive EGFR genotyping results from the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University(December 2021 to September 2023).Patients were randomly divided into training and validation sets(8∶2 ratio,310 vs.80 patients;CT slice thickness:5-7 mm).An additional independent test set of 100 patients undergoing thin-section CT(1-2 mm)was included to assess model generalizability across slice thicknesses.Clinical characteristics and CT semantic features were analyzed.After automated tumor segmentation with manual refinement,ROIs were sequentially expanded outward by 1,2,3,4 and 5 mm.A total of 2 264 radiomic features were extracted from each ROI.Feature selection using minimum redundancy maximum relevance and least absolute shrinkage and selection operator algorithms was performed in the training set to calculate radiomics scores.Logistic regression was used to develop prediction models.A combined model integrating optimal peritumoral radiomics score with clinical and CT features was established,with performance compared across models.Results Gender(χ2=24.922,P<0.001),smoking history(χ2=11.199,P=0.001),emphysema(χ2=40.802,P<0.001),and lymph node metastasis(χ2=5.674,P=0.017)were associated with EGFR mutation status.In the validation set,the area under the curve for the tumor ROI-based radiomics model was 0.676,while the five expansion models achieved area under the curve of 0.723,0.720,0.734,0.681,and 0.598,respectively.The combined model based on 3 mm expansion demonstrated superior performance to individual radiomics and clinical models,with area under the curve of 0.826,0.734,0.711 in the validation set,and 0.809,0.760,0.702 in the independent test set.Conclusion Peritumoral expansion-based CT radiomics demonstrates value for predicting EGFR mutations in NSCLC,with 3 mm identified as the optimal expansion margin.Integration with clinical information further enhances predictive accuracy.

Purpose To explore the application value of spectral CT vascular optimization technique for laparoscopic right hemicolectomy.Materials and Methods Ninety patients who underwent contrast-enhanced CT with spectral CT before scheduled laparoscopic right hemicolectomy from March to November 2022 in Shengjing Hospital of China Medical University were retrospectively analyzed.The raw images were reconstructed to obtain 120 kVp conventional images and spectral-based virtual monochromatic images(VMIs)at 40,50,60,70 keV.The CT value and image noise of gastrocolic trunk of Henle(GTH),right colic vein(RCV)and ileocolic vein(ICV)were measured.The CT value,image noise,signal noise ratio and contrast noise ratio of VMIs and conventional image were analyzed.The image quality and venous anatomical information of each group were evaluated subjectively with three-dimensional reconstruction technique.Results The CT value[(405.55±103.06)Hu,(406.61±103.42)Hu,402.35(337.95,477.45)Hu],image noise[19.90(12.10,34.55)Hu,21.10(10.95,44.30)Hu,19.70(11.25,44.80)Hu],signal noise ratio[19.46(10.60,36.31),20.16(8.73,37.42),18.49(9.99,36.24)]and contrast noise ratio[53.36(35.92,70.79),52.34(33.73,81.03),56.23(34.69,79.97)]of GTH,RCV,ICV of VMIs at 40 keV were significantly higher than those of conventional image and other VMIs(F/H=268.53,23.17,33.09,198.77,272.51,28.93,25.48,189.62,318.24,29.42,20.13,212.46,all P<0.001).Subjective scores showed that the image quality and vascular visualization of GTH,RCV and ICV at 40 keV were the best.Conclusion Spectral CT can improve the imaging quality and vascular visualization of GTH,RCV and ICV.VMIs at 40 keV has the optimal performance.

Polycystic ovary syndrome （PCOS） is a common gynecological endocrine and reproductive disorder，with the main clinical manifestations including ovulation failure，insulin resistance，hyperandrogenism，and obesity. Its occurrence and development are closely related to cellular regulatory mechanisms such as apoptosis，autophagy，oxidative stress，and inflammatory response. Autophagy，as a clearance mechanism that maintains cellular homeostasis，plays a crucial role in maintaining the growth，development，and maturation of oocytes. Exploring the mechanism of autophagy during the occurrence and development of diseases can help develop treatment methods for PCOS by regulating autophagy. Studies have shown that autophagy plays an important role in the pathogenesis of PCOS，and it can affect the occurrence and development of PCOS through multiple pathways，levels，and targets. Traditional Chinese medicine （TCM） regulates autophagy in ovarian granulosa cells or endometrium of patients with PCOS by targeting the expression of autophagy signaling pathways，regulatory factors，and non-coding single-stranded RNA molecules，thereby alleviating inflammation，regulating metabolism disorders，and balancing hormone levels in PCOS. Accordingly，TCM can ameliorate pathological conditions such as insulin resistance，hyperandrogenism，and ovulation failure in PCOS. This article summarizes the TCM formulas and extracts for the treatment of PCOS，as well as the main autophagy pathways and regulatory factors involved，aiming to provide reference and suggestions for the future treatment of PCOS with TCM by regulating autophagy.

ObjectiveTo investigate the intervention effects of Suanzaoren Tang on depression model rats induced by isolation combined with chronic unpredictable mild stress （CUMS）， and to examine its influence on the c-Jun N-terminal kinase （JNK）/proto-oncogene protein （c-Myc）/tumor suppressor protein 53 （p53） signaling pathway， thereby revealing its potential functional mechanism. MethodsA total of 72 male SD rats were randomly divided into six groups using a strict random number table： blank group， model group， fluoxetine group （3.6 mg·kg^-1）， and high-， medium-， and low-dose Suanzaoren Tang groups （10， 5， 2.5 g·kg^-1），with 12 rats in each group. A depression model was established using isolation combined with CUMS. Fluoxetine and different doses of Suanzaoren Tang were administered continuously for 28 days. Behavioral indicators such as sucrose water consumption and open field test scores were recorded. Western blot and immunohistochemistry （IHC） were employed to analyze the expression of key proteins in the JNK/c-Myc/p53 signaling pathway， and the terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） assay was used to evaluate the number of apoptotic cells in the hippocampus. ResultsCompared with the blank group， the model group exhibited a significantly reduced sucrose preference index （P<0.01）， a lower total score of horizontal and vertical movements in the open field test （P<0.01）， significantly increased expression of JNK， c-Myc， and p53 proteins in the hippocampus （P<0.01）， and a higher number of TUNEL-positive cells in the hippocampus （P<0.01）. Compared with the model group， the sucrose preference index and the total score of horizontal and vertical movements in the open field test significantly increased in the high- and medium-dose Suanzaoren Tang groups and the fluoxetine group （P<0.05， P<0.01）. The expression of JNK， c-Myc， and p53 proteins significantly decreased in all Suanzaoren Tang groups （high， medium， and low doses） and the fluoxetine group （P<0.05， P<0.01）. The number of TUNEL-positive cells in the hippocampus also significantly decreased in these groups （P<0.01）. ConclusionSuanzaoren Tang can regulate the expression of JNK/c-Myc/p53 proteins in the hippocampus of depression model rats， and its antidepressant mechanism may be related to its protective effect on hippocampal neurons.