BACKGROUND:The lower cervical vertebral pedicle is the main stress site of the posterior column of the spine,which is of great significance for the maintenance of the stability of the human center of gravity and the reduction of shock.At present,there are few reports on the characteristics of the internal bone trabeculae,and the characteristics of the joint site of the vertebral pedicle with the articular process and the vertebral body.It is urgent to understand the fine anatomical structure of the vertebral pedicle and the relationship and function of each part. OBJECTIVE:To observe the microanatomical morphology of the vertebral pedicle by Micro-CT scanning of cervical vertebra specimens,and to measure and analyze the microstructure and morphometric parameters of the bone trabecula in the cervical pedicle under normal conditions to evaluate the safety performance of the cervical spine. METHODS:Micro-CT scanning was performed on 31 sets of cervical vertebrae C3-C7.By checking and reconstructing the areas of interest in the bone trabecular within the vertebral pedicle,the morphological characteristics and distribution direction of the bone trabecular within the cervical pedicle were observed,and the bone microstructure parameters were detected,and the differences in the bone microstructure of the C3-C7 vertebral pedicle were analyzed and compared. RESULTS AND CONCLUSION:(1)The Micro-CT images showed that the honeycomb bone trabeculae of the pedicle of the lower cervical spine presented a complex network of microstructures.The trabeculae near the cortical bone were lamellar and relatively compact,extending forward toward the vertebral body and backward toward the articular process lamina.Abatoid bone trabeculae extended into the medullary cavity and transformed into a network structure,and then into rod-shaped bone trabeculae.The rod-shaped bone trabeculae were sparsely distributed in the medullary cavity.(2)Statistical results of morphological parameters of bone trabeculae showed that bone volume fraction values in C4 and C5 were higher than that in C7(P＜0.05).The bone surface/bone volume value in C7 was higher than that in C3,C4 and C6(P＜0.05).The bone surface density of bone trabeculae in C7 was higher than that in C3,C4,C5 and C6(P＜0.05).Trabecular thickness in C7 was higher than that in C3,C4 and C5(P＜0.05).Bone surface/bone volume and bone surface density of the left pedicle bone trabecular were greater than those on the right side(P＜0.05).(3)The microstructural changes of C3-C7 were summarized,in which the load capacity and stress of the C7 pedicle were poor,and the risk of injury was high in this area.

BACKGROUND:Warm-needling moxibustion can effectively treat knee osteoarthritis.Degeneration,injury and fracture of the anterior cruciate ligament can affect the local stability of the knee joint,and then induce the formation of knee osteoarthritis.Whether warm-needling moxibustion can repair the injured cruciate ligament and the mechanism of action are still unclear. OBJECTIVE:To observe the effects of warm-needling moxibustion on the morphology of the anterior cruciate ligament and the expression of insulin growth factor-1 and transforming growth factor-β in rabbits with knee osteoarthritis and to clarify the mechanism of anterior cruciate ligament repair by warm-needling moxibustion. METHODS:Thirty New Zealand rabbits were randomly divided into blank group,model group and warm-needling moxibustion group,with 10 rabbits in each group.Knee osteoarthritis model was established by plaster cast immobilization.The blank group was not intervened.Rabbits in the model group rabbits were fixed in a rabbit holder for 15 minutes every day.The warm-needling moxibustion group was treated with warm acupuncture,once a day,7 days as a course of treatment,a total of two courses.After treatment,the imaging changes of the anterior cruciate ligament were observed by MRI and MRI grading statistics were performed.Morphological changes of the anterior cruciate ligament were observed by transmission electron microscope and hematoxylin-eosin staining.mRNA and protein expressions of insulin growth factor-1 and transforming growth factor-β were detected by RT-PCR and western blot,respectively. RESULTS AND CONCLUSION:MRI examination:Compared with the blank control group,the anterior cruciate ligament in the model group was thickened,edematous,and partially torn,and the difference in grading statistics was statistically significant(P＜0.05).Compared with the model group,the anterior cruciate ligament in the warm-needling moxibustion group was slightly thickened,with mild edema and no tearing,and the difference in grading statistics was statistically significant(P＜0.05).General observation:In the model group,the surface of the anterior cruciate ligament was glossy and faded,with the edge being covered with flocculent periosteum and obvious tissue necrosis;in the warm-needling moxibustion group,the surface of the ligament was glossy,and the ligament was in a normal helical shape.Hematoxylin-eosin staining:In the model group,there was obvious tissue necrosis in the anterior cruciate ligament,a large number of new capillaries,loosely arranged fibroblasts and collagen fibers.In the warm-needling moxibustion group,there was a small amount of tissue necrosis and few new vessels in the anterior cruciate ligament,and the cells and collagen fibers were loosely and irregularly arranged.Transmission electron microscopy:In the model group,the fibers in the anterior cruciate ligament were arranged in a disordered way with uneven thickness and distribution,and there are more fibroblasts that were irregular in morphology;in the warm acupuncture group,the fibers were basically arranged longitudinally,with uneven thickness and distribution,and a small number of oval-shaped fibroblasts were observed.RT-PCR and western blot assay:mRNA and protein expressions of insulin growth factor-1 and transforming growth factor-β were significantly decreased in the model group compared with the blank control group(P＜0.05),but significant increased after treatment with warm-needling moxibustion(P＜0.05).To conclude,warm-needling moxibustion can alleviate anterior cruciate ligament injury and regulate the expression of insulin growth factor-1 and transforming growth factor-β to treat knee osteoarthritis.

Airway mucus plug is a common phenotype in asthma that increases the risk of acute asthma attacks by causing aggravation of airflow obstruction. Given its important role in asthma, treatment targeting airway mucus plugs may be a strategy to control asthma progression and prevent fatal asthma exacerbations. Previous studies have shown that acidosophils and T2 type inflammation are related with the formation of mucus plugs, and biotargeted drugs targeting the above pathways may be effective in the treatment of airway mucus plugs.

Airway mucus plug is a common phe-notype in asthma that increases the risk of acute asthma attacks by causing aggravation of airflow obstruction.Given its important role in asthma,treatment targeting airway mucus plugs may be a strategy to control asthma progression and prevent fatal asthma exacerbations.Previous studies have shown that acidosophils and T2 type inflammation are related with the formation of mucus plugs,and bio-targeted drugs targeting the above pathways may be effective in the treatment of airway mucus plugs.

OBJECTIVE To evaluate the efficacy and safety of dimethyl fumarate （DMF） in the treatment of multiple sclerosis （MS）. METHODS Retrieved from CBM， Web of Science， PubMed， the Cochrane Library， Embase， CNKI， Wanfang Data， and VIP， randomized controlled trials （RCTs） about DMF （trial group） versus other drugs or placebo （control group） were collected. After data screening and extraction， quality evaluation， meta-analysis was conducted by using RevMan 5.3 software. RESULTS A total of 6 literature were included， involving 638 patients. Results of meta-analysis showed that the proportion of patients with lesion changes after treatment in the trial group was lower than control group [MD＝－0.65， 95%CI（－1.27， －0.02）， P＝0.04]； there was no statistical significance in recurrence rate [RR＝1.06， 95%CI（0.52，2.17）， P＝0.88]， the proportion of patients with new lesions after treatment [RR＝1.05， 95%CI（0.62，1.80）， P＝0.85]， expanded disability status scale after treatment [MD＝0.02，95%CI （－0.18， 0.23）， P＝0.82]， the incidence of adverse events [RR＝1.33， 95%CI（0.97， 1.84）， P＝0.08] or severe adverse events [RR＝0.95，95%CI（0.48，1.90），P＝0.89] between 2 groups. Results of sensitivity analysis showed the study obtained unstable recurrence rate and the incidence of adverse events， while other results were robust. CONCLUSIONS DMF can control the lesion progression in MS patients to some extent and doesn’t increase the incidence of adverse events and serious adverse events， but there is no significant advantage in reducing the recurrence rate and controlling the disability progression.

Objective To study the effect of hesperetin(HSP)on renal ischemia-reperfusion injury(RIRI)in rats and its mechanism.Methods Fifty male SD rats were randomly divided into five groups:sham group,model group(renal ischemia-reperfusion injury I/R),HSP pretreatment(HSP+I/R)group,all-trans retinoic acid pretreatment(ATRA+I/R)group,HSP and ATRA pretreatment(HSP+ATRA+1/R)group.Each group had 10 rats.The sham group only exposed both kidneys by opening the abdominal cavity.In other groups,the RIRI model was established by occluding the bilateral renal pedicles for 45 min,followed by reperfusion for 24 h.Hematoxylin-eosin staining(HE)was used to ascertain the extent of kidney injury.The microplate method was used to measure serum creatinine(Scr)levels,while the urease method was used to measure blood urea nitrogen(BUN)levels.Enzyme-linked immunosorbent assay(ELISA)was used to detect the contents of interleukin-6(IL-6),interleukin-1β(IL-1 β)and tumor necrosis factor-α(TNF-α)in the serum.The kit method was used to examine the levels of superoxide dismutase(SOD),glutathione(GSH),malondialdehyde(MDA)and catalase(CAT)in kidney tissue.The Western blot analysis was conducted to detect the expression of nuclear factor erythroid 2 related factor 2(Nrf2)and its downstream antioxidant proteins heme oxygenase-1(HO-1)and quinone oxide reductase 1(NQO1)in renal tissues.Results The scores for renal tubule damage in sham,I/R and HSP+I/R groups were 0.20±0.45,4.20±0.84 and 2.40±0.55;Scr contents were(55.52±11.23),(207.10±19.22)and(105.60±18.11)μmol·L-1;IL-6 contents were(33.66±6.83),(172.50±8.09)and(105.40±10.03)pg·mL-1.The SOD levels in sham,I/R,HSP+I/R,ATRA+I/R and HSP+ATRA+I/R groups were(57.04±3.44),(37.29±3.60),(51.61±9.41),(32.55±5.58)and(37.40±3.66)U·mg·prot-1;the relative expression levels of Nrf2 were 0.37±0.24,0.57±0.28,1.31±0.34,0.44±0.17 and 0.77±0.25;the relative expression levels of HO-1 protein were 0.26±0.14,0.57±0.30,1.32±0.61,0.53±0.28 and 0.67±0.50.There was significant difference in renal tubule damage score,Scr,IL-6 and SOD indexes in I/R group compared to sham group(P＜0.05,P＜0.01).The above indexes were statistically significant between HSP+I/R group and I/R group(P＜0.05,P＜0.01).Conclusion The activation of HSP may stimulate the Nrf2-antioxidant response element(ARE)pathway,enhance the expression of downstream antioxidant proteins,mitigate the renal damage caused by oxidative stress,and ultimately improve RIRI.

Objective:To utilize routinely available clinical parameters to uncover the clinical features of different clusters in patients with chronic rhinosinusitis with nasal polyp (CRSwNP) through unsupervised clustering analysis.Methods:The clinical data from 155 CRSwNP patients undergoing nasal endoscopic surgery at Renmin Hospital of Wuhan University from 2021 to 2023 were prospectively collected, including 112 males and 43 females, aged from 7 to 87 years. Unsupervised clustering analysis was conducted using various clinical parameters, including age, gender, smoking and drinking history, local eosinophil (EOS) and neutrophil (NEU) counts, comorbid allergic rhinitis (AR), comorbid asthma, recurrence status, serum-specific IgE, total IgE, cytokine levels, peripheral blood EOS count and percentage, Lund-Mackay CT score, the ratio of CT scores for the maxillary sinus and ethmoid sinus (E/M ratio), visual analogue scale (VAS) score, Lund-Kennedy endoscopic score, and other common clinical indicators to elucidate the clinical characteristics of each cluster. Statistical analysis was conducted using GraphPad Prism 9.5 software.Results:Hierarchical clustering analysis identified four main clusters (Cluster A1-A4), showcasing distinct characteristics such as mild nasal polyps with higher peripheral blood cytokines levels, nasal polyps accompanied by allergies and asthma, a subtype of nasal polyps with high recurrence rates dominated by neutrophils, and nasal polyps with high eosinophil levels. Further subset clustering revealed two clusters of mild polyps (Cluster B1-B2) featuring high cytokine expression and comorbid AR; and two clusters of severe polyps (Cluster B3-B4) presented with severe symptoms, high Lund-Mackay CT score, and high Lund-Kennedy endoscopic score. Variations between Cluster B3 and B4 included symptom complexity, the degree of eosinophil infiltration, and the probability of comorbid asthma. Further clustering analysis for eosinophilic nasal polyps revealed a cluster characterized by highly neutrophilic infiltration and recurrent nasal polyps. The comprehensive analysis of multi-index correlations demonstrated valuable insights into the relationships between common clinical parameters of nasal polyps, providing valuable information for a deeper understanding of the pathogenesis of CRSwNP.Conclusion:The clustering analysis in this study categorizes CRSwNP patients into different clusters based on clinical features and disease outcomes, providing a new perspective for more precise clinical treatment strategies.

OBJECTIVE To evaluate the consistency between the quetiapine LC-MS/MS kit and the laboratory-built method(reference method) in the detection results of quetiapine therapeutic drug monitoring. METHODS A total of 120 remaining plasma samples were collected from patients receiving quetiapine therapeutic drug monitoring from March to October in 2021. The plasma concentration of quetiapine was detected by kit and reference method respectively. The analysis of correlations and consistency was performed by outlier analysis, linear regression and Bland-Altman method. RESULTS No outliers were detected. The linear regression equation was Y=1.018X+4.400(r=0.998), indicating a good correlation. The Bland-Altman plot analysis showed good agreement between the two measurements. CONCLUSION The detection results of quetiapine LC-MS/MS kit and reference method are in good agreement. The kit can be used for clinical quetiapine treatment drug monitoring.

Objective:To investigate the sensitivity of tumor organoids derived from samples of colorectal cancer to lobaplatin and oxaliplatin hyperthermic perfusion in vitro and to assist clinical development of hyperthermic intraperitoneal chemotherapy. Method:Tumor samples and relevant clinical data were collected from patients with pathologically confirmed colorectal cancer in the Sixth Affiliated Hospital of Sun Yat-sen University from July 2021 to December 2022. Organoids were cultured and tumor tissue were passaged. In vitro hyperthermic perfusion experiments were performed on organoids with good viability. Firstly, 10 organoids were treated with oxaliplatin and lobaplatin at the following six concentrations: 1 000, 250, 62.5, 15.6, 3.9, and 0.98 μmol/L. The organoids were exposed to oxaliplatin at 42℃ for 30 minutes and to lobaplatin at 42℃ for 60 minutes. Dose-response curves of responses to in vitro hyperthermic perfusion with these two drugs were constructed and evaluated. Clinical doses of oxaliplatin and lobaplatin were further tested on 30 organoids. This testing revealed oxaliplatin was effective at 579 μmol/L at a hyperthermic perfusion temperature of 42℃ for 30 min and lobaplatin was effective at 240 μmol/L at a hyperthermic perfusion temperature of 42℃ for 60 minutes. Result:Thirty-two tumor organoids were cultured from samples of colorectal cancer. The median concentration required for oxaliplatin to eliminate 50% of tumor cells (IC50) was 577.45 μmol/L (IQR: 1846.09 μmol/L). The median IC50 for lobaplatin was 85.04 μmol/L (IQR: 305.01 μmol/L).The difference between the two groups was not statistically significant ( Z=1.784, P=0.084). In seven of 10 organoids, lobaplatin showed a greater IC50 after in vitro hyperthermic perfusion than did oxaliplatin. Testing of 30 organoids with clinical doses of oxaliplatin and lobaplatin revealed that oxaliplatin achieved an average inhibition rate of 39.6% (95%CI: 32.1%?47.0%), whereas the average rate of inhibition for lobaplatin was 89.7% (95%CI: 87.0%?92.3%): this difference is statistically significant ( t=?15.282, P<0.001). Conclusion:The rate of inhibition achieved by hyperthermic perfusion of lobaplatin in vitro is better than that achieved by hyperthermic perfusion with oxaliplatin. Lobaplatin is more effective than oxaliplatin when administered by hyperthermic intraperitoneal perfusion and therefore has the potential to replace oxaliplatin in this setting.

Robotic surgery has evolved to be a separate field, with enormous potential for future development in plastic surgery. In the past decade, surgical robots have been increasingly used in the areas of craniomaxillofacial surgery, reconstructive surgery, microsurgery, hair reconstructive surgery, and so on. Technical advantages of robotic surgery, such as 3D vision, stable and magnified image, physiologic tremor filtering, and motion scaling, have been considered as improvement over traditional minimally invasive surgery. Surgeon ergonomics, instrument precision and patients’ postoperative recovery were all objectively improved. However, specialized instruments and equipment, high cost, and lack of haptic feedback are the main limiting factors for the widespread adoption of robotics at present. This review summarizes the development of the robot-assisted techniques, including its outcomes, advantages and disadvantages in plastic surgery in recent years. Finally, the possibilities of combining surgical robots with artificial intelligence (AI), augmented reality (AR), 5G and other new technologies are also summarized.