Cervical cancer is a prevalent gynecological malignancy worldwide， and despite established measures for prevention， detection， and treatment at different stages， limited success has been achieved in effectively reducing its incidence. While treatments such as surgery for early-stage patients， adjuvant chemoradiotherapy based on postoperative pathology assessment of high-risk factors and intermediate risk factors， combined radiochemotherapy for patients at all stages， and systemic treatment for advanced cervical cancer have demonstrated effectiveness in numerous cases. Recent advancements in surgical pathology staging， selection of surgical approaches， options available for early-stage cases， utilization of neoadjuvant chemotherapy， novel approaches to radiotherapy administration， as well as clinical trials investigating new drugs targeting recurrent and metastatic cervical cancer have contributed to more precise and individualized treatment strategies while providing a wider range of choices. Therefore， this manuscript comprehensively discusses important developments concerning the diagnosis and treatment of cervical cancer with the aim of offering an improved reference for clinical practice.

Mantle cell lymphoma （MCL） is a rare B-cell non-Hodgkin's lymphoma characterized by clinical and pathological features encompassing both indolent and aggressive subtypes. Significant progress has been made in the past decade regarding the development of novel therapeutic options for MCL. Particularly， Bruton's tyrosine kinase inhibitor （BTKi） has exhibited remarkable efficacy in treating patients with MCL by specifically targeting the BTK protein， thereby inhibiting B-cell proliferation and inducing potent anti-tumor effects. Currently， global approval has been granted to five BTK inhibitors for MCL treatment， including the first-generation Ibrutinib， second-generation Acalabrutinib， Zanubrutinib， Orelabrutinib， as well as the non-covalent BTKi Pirtobrutinib. This review provides a comprehensive summary of findings from clinical trials investigating the use of BTKi in MCL treatment and offers valuable insights for clinical practice.

Objective To investigate the impact of Sca-1 bone marrow derived stem cells on apoptosis in murine cardiac fibroblasts and the molecular mechanisms of young （Y） Sca?1 bone marrow stem cell （BMSC） on old （O） cardiac fibroblast cell （CFC） apoptosis. Methods The apoptosis and survival of Y and O CFC were assessed under hypoxic conditions. Co-cultures of Y and O Sca-1 bone marrow-derived mesenchymal stem cells （BMSC） with O CFC were established to investigate the impact of Sca-1 BMSC on the apoptotic response and viability of O CFC， employing TUNEL staining， qRT-PCR， Western Blot， and CCK8 assays. Furthermore， differential secretion profiles of growth factors by Y and O Sca-1 BMSC were compared using qRT-PCR and ELISA analysis. Results Compared to Y CFC， O CFC exhibited an increased rate of apoptosis and a decreased rate of cell survival. However， when compared to O cells， Y Sca-1 BMC significantly reduced apoptosis in O CFC and enhanced cell survival. Moreover， Y Sca-1 BMSC demonstrated a higher secretion of GDF5 （Growth Differentiation Factor 5） than O cells （P < 0.05）. Importantly， the protective effects of Y Sca-1 BMSC on apoptosis and survival in O CFC were abolished upon neutralization of GDF5 expression. Conclusion Y Sca-1 BMSC decreases O CFC apoptosis through GDF5.

Objective To investigate the effect of microRNA-223 （miR-223） on prostate cancer cell damage by regulating the Kelch?like epichlorohydrin related protein 1 （Keap1）/nuclear factor E2 related factor 2 （Nrf2）/antioxidant response element （ARE） signaling pathway. Methods The prostate cancer cell line PC3 was cultured and randomly divided into control， down-regulated miR-223， and up-regulated miR-223 groups. Changes in miR-223 expression， cell proliferation rate， cell migration number， cell invasion number， apoptosis rate， and expression level of Keap1/Nrf2/ARE signaling pathway were explored. Results Compared with the control group， the cell invasion number， cell migration number， cell proliferation rate， Nrf2 and ARE expression increased at 24， 48 and 72 h in down-regulated miR-223 group， while the expressions of miR-223， Keap1 and apoptosis rate decreased （P < 0.05）. Compared with the down-regulated miR-223 group， 24， 48 and 72 h cell proliferation rate， cell invasion number， cell migration number， ARE and Nrf2 expression decreased in the up-regulated miR-223 group， while miR-223， apoptosis rate and Keap1 expression increased （P < 0.05）. Conclusion Regulation of miR-223 effectively ameliorates prostate cell injury， and the mechanism may be related to the Keap1/Nrf2/ARE signaling pathway.

Objective To investigate the molecular mechanism of ALKBH5 reducing sepsis-induced myocardial dysfunction （SIMD）. Methods The expression levels of ALKBH5 and TRAF1 in the blood of 50 SIMD patients and 50 healthy individuals were detected using reverse transcription fluorescence quantitative polymerase chain reaction （RT-qPCR）， and the correlation between their expression levels was analyzed by person analysis； In vitro experiments， H9C2 myocardial cells were divided into 7 groups according to over expression of TARF1 and knockdown ALKBH5. The molecular mechanism of ALKBH5 targeting TRAF1 to regulate lipopolysaccharide （LPS）induced myocardial cell damage was studied through experiments such as CCK8， ELISA， and Western blot； In the in vivo experiment of rats， LPS induced rats were divided into 6 groups according to over expression of TARF1 and knockdown ALKBH5. Experimental methods such as colorimetry， ELISA， Western blot， HE staining， and immunohistochemistry were used to study the mechanism of ALKBH5 targeting TRAF1 through NF- κB pathway in reducing myocardial cell damage. Results The expression levels of ALKBH5 and TRAF 1 were downregulated in SIMD， and the Pearson analysis showed a positive correlation between them（P < 0.001）； In vitro experiments showed that overexpression of TRAF1 promotes cell proliferation， inhibits the expression of inflammatory factors and proteins involved in the NF- κB pathway， and knockdown ALKBH5 obtain the opposite resulst； In vivo experiments in rats showed that knockdown ALKBH5 promotes injury in cardiomyocytes， expression of inflammatory factors and NF- κB-related pathway proteins， and nuclear translocation of NF-κB p65 protein， but the overexpression of TRAF 1 yielded the opposite results. Conclusion ALKBH5 increases the stability of TRAF1 by reducing its methylation， thereby inhibiting NF- κB pathway， thereby reducing SIMD.

Objective To explore the assisted reproductive strategy and influencing factors for patients undergoing frozen?thawed cycle blastocyst transfer after hysteroscopic adhesiolysis for intrauterine adhesions. Methods A total of 275 patients who underwent frozen?thawed cycle blastocyst transfer after hysteroscopic adhesiolysis for infertility reasons at the Reproductive Genetics Center of the First Affiliated Hospital of University of Science and Technology of China from January 2018 to December 2022 were included in the study. They were divided into a single blastocyst transfer group （n = 182） and a double blastocyst transfer group （n = 93）. The clinical outcomes were analyzed and compared retrospectively between the group. Results The two groups showed no statistically significant differences in terms of age， day of endometrial thickness conversion， endometrial preparation method， clinical pregnancy rate， miscarriage rate， preterm birth rate， gestational week at delivery， and mode of delivery （P > 0.05）. The single blastocyst transfer group had significantly lower infertility duration （years） （2.43 ± 1.64 vs. 3.03 ± 2.13， P < 0.05）， significantly lower AFS prognosis score （5.13 ± 2.25 vs. 5.72 ± 2.19， P < 0.05）， and significantly lower multiple pregnancy rate （1.33% vs. 28.57%， P < 0.05）， but significantly higher quality embryo rate （90.66% vs. 46.24%， P < 0.05）， implantation rate （50.00% vs. 34.41%， P < 0.05）， and live infant mass （g） （3 236.84 ± 565.35 vs. 2 976.44 ± 692.79， P < 0.05） compared to the double blastocyst transfer group. Binary logistic regression analysis showed that the number of high?quality embryos transferred and AFS score were independent influencing factors for clinical pregnancy （P < 0.05）. Conclusions The number of high?quality embryos transferred and the AFS score are independent influencing factors for clinical pregnancy in patients undergoing frozen?thawed cycle blastocyst transfer after hysteroscopic adhesiolysis for intrauterine adhesions. Single high?quality blastocyst transfer is a preferred treatment for patients after hysteroscopic adhesiolysis， and double blastocyst transfer is favorable for patients with a poor prognosis to achieve better pregnancy outcomes.

Objective To observe the clinical efficacy of closed-loop rehabilitation therapy by brain-computer interface （BCI） combined with exoskeleton robotic hand in patients with hand dysfunction after cerebral infarction and analyze the influence of patients' cognitive function and implicit motor imagery ability on the recognition rate of BCI. Methods A total of 50 patients with cerebral infarction were randomly assigned to the observation group and the control group， 25 patients in each group. Both groups received routine rehabilitation programs. In addition to the conventional rehabilitation treatment， the observation group received the closed-loop BCI rehabilitation trainingby brain-computer interface （BCI） combined with exoskeleton robotic hand. The scores of Fugl-Meyer Assessment of the Upper Extremity （FMA-UE）， Action Research Arm Test （ARAT）， Wolf Motor Function Test （WMFT）， and Modified Ashworth scale （MAS） of the wrist flexors were compared between the two groups before and after treatment. Before intervention， the mental rotation test and Montreal Cognitive Assessment （MoCA） were used to assess the baseline implicit motor imagery ability and cognitive level of patients in the observation group. The correlation analysis between these scores and the recognition rate of BCI was conducted to analyze the relevant factors affecting the closed-loop rehabilitation effects of BCI. Results The two groups showed no significant difference in all outcomes before treatment （both P > 0.05）. After intervention， the observation group exhibited the significantly higher scores of FMA-UE， ARAT， and WMFT （all P < 0.05）， and significantly lower MAS scores of wrist and finger flexors compared with the control group （all P < 0.05）. In addition， the recognition rate of BCI was positively correlated with the accuracy of mental rotation test and MoCA score （P < 0.05）， and negatively correlated with the reaction time of mental rotation test （P < 0.05）. Conclusions Closed-loop rehabilitation training with BCI combined with exoskeleton robot hand can promote the recovery of upper limbs and hand motor function in patients with cerebral infarction. Additionally， the implicit motor imagery ability and cognitive function of patients are suggested to be used for screening the patients suitable for BCI training before the implementation of BCI treatment.

Objective This study aimed to explore the changes of interhemispheric functional homotopy in patients with different course of temporal lobe epilepsy based on voxel-mirrored homotopic connectivity （VMHC）. Methods Twenty temporal lobe epilepsy patients with a short disease course （TLE-SD）， twenty-seven temporal lobe epilepsy patients with a long disease course （TLE-SD） and thirty healthy controls （HC） matched with demographic data were enrolled. All participants finished functional MRI scans and neuropsychological assessment. Brain regions with significant changes between the TLE-SD/TLE-LD group and the healthy controls group were obtained based on the VMHC analysis， and the two-samples t-test was performed in the different brain regions of VMHC values between the two comparisons. The VMHC values of abnormal brain regions in the patient group were extracted and used for correlation analysis with the scale scores. Results Compared with HC， the VMHC values of the putamen and anterior cingulate gyrus were reduced in the TLE-SD group， while the VMHC values of the putamen， anterior cingulate gyrus， superior temporal gyrus and superior frontal gyrus were reduced in the TLE-LD group. Compared with the TLE-SD group， the VMHC values of the superior temporal gyrus in the TLE-LD group was significantly reduced （t = 2.918， P = 0.033）. Correlation analysis showed that the VMHC values of the putamen was positively correlated with the Montreal Cognitive Assessment （MoCA） scores （r = 0.442， P = 0.021）. Conclusions The interhemispheric functional homotopy was impaired in patients with temporal lobe epilepsy and the impairment may be more severe in patients with a long course of disease. Cognitive impairment in patients with temporal lobe epilepsy may be related to the abnormalities of interhemispheric functional homotopy.

Objective To assess the viability and efficacy of employing automated segmentation for whole breast radiotherapy with simultaneous integrated boost to the medial tumor beds， a comparative analysis was conducted on the disparities in geometry， dosimetry， and working time between the auto-segmentation （AS） and manual segmentation （MS） groups. Methods A total of 30 patients with early breast cancer， who had undergone conserving surgery and received hypofractionated radiotherapy with a boost to the medial tumor bed， were enrolled from the First People's Hospital of Zunyi. AccuContour software was used in the AS group to obtain the whole breast planning target volume and cardiopulmonary structure. Geometric differences between AS and MS groups were assessed using Dice similarity coefficient （DSC） and 95% Hausdorff distance （95HD）. Subsequently， a comparison was made between the two groups regarding target and cardiopulmonary dosimetry for PlanA and PlanM. Additionally， the time spent by each group was also compared. Results The DSC of PGTV， PTV， lung， and heart were 0.94（0.91，0.96）， 0.88（0.86，0.91）， 0.98（0.97，0.98） and 0.94（0.93，0.95）， respectively. And the 95 HD（cm） were 0.25（0.20，0.33）， 0.99（0.56，1.20）， 0.29（0.25，0.35） and 0.50（0.50，0.59） respectively. The dosimetric results showed that the V95， D95， and Dmean of PGTV and PTV in the AS group were significantly lower than those in the MS group （P < 0.05）； while the V₂₀ and MLD of the left lung were significantly higher （P < 0.05）. No significant difference was observed in cardiac dose between the two groups. The mean absolute differences of PGTV and cardiopulmonary dose parameters between the two groups were less than 1 Gy/1%， respectively. In terms of work efficiency， the AS approach substantially reduced contouring and planning time with over 70% of cases approved within two days. Conclusions The differences in geometric and dosimetric parameters between the auto-segmentation and manual segmentation groups were found to be negligible for whole breast radiotherapy with medial tumor bed boost patients. It is recommended that the PTV be manually modified prior to plan optimization， leading to a significant improvement in work efficiency.

Objective To analyze the expression of miR-4524a-3p in peripheral blood mononuclear cells （PBMCs） and major immune cell subsets of patients with systemic lupus erythematosus （SLE）， and evaluate its clinical application. Methods Peripheral blood samples were collected from SLE patients and healthy controls， followed by isolation of PBMCs， CD3⁺ T lymphocytes， CD19⁺ B lymphocytes， and CD14⁺ monocytes using human peripheral blood lymphocyte isolation solution （Ficoll） and immunomagnetic bead cell sorting. The expression level of miR-4524a-3p was quantified using fluorescence quantitative PCR. Pearson's linear correlation analysis was performed to assess the relationship between miR-4524a-3p expression and the disease activity score in SLE patients （SLEDAI）. Additionally， the diagnostic efficacy of miR-4524a-3p for SLE was evaluated by constructing a receiver operating characteristic curve （ROC）. Results The expression of miR-4524a-3p was significantly decreased in PBMCs （P < 0.05）， CD3⁺T cells （P < 0.001）， and CD14⁺ monocytes （P < 0.001） from patients with SLE compared to healthy controls. Furthermore， it exhibited a negative correlation with SLEDAI score （r = -0.406，P < 0.01）. Notably， the expression level of miR-4524a-3p was significantly lower in patients with moderate or severe active stage than those in mild and inactive stages （P < 0.01）. In addition， the SLE subgroup with lupus nephritis and joint involvement displayed lower levels of miR-4524a-3p compared to the subgroup without such manifestations （P < 0.01）. Importantly， ROC analysis demonstrated that miR-4524a-3p holds promising diagnostic value for SLE. Conclusion The expression of miR-4524a-3p was significantly diminished in CD3⁺ T cells and CD14⁺ monocytes derived from patients with SLE， exhibiting a close association with disease activity and demonstrating potential clinical diagnostic value for SLE.

Objective To develop a prognostic model that integrates preoperative imaging， pathological features， and tumor marker indexes for predicting metastasis in sentinel lymph nodes（SLN）. Methods The preoperative examination data of 232 breast cancer patients admitted to the First Affiliated Hospital of Zhengzhou University between January 2022 and April 2023 were retrospectively analyzed. The dataset was randomly divided into a training set （174 cases） and a validation set （58 cases） at a ratio of 3∶1. Univariate and multivariate logistic regression analyses were performed to identify independent predictors influencing SLN metastasis. A nomogram was constructed， and its accuracy and clinical applicability were evaluated using receiver operating characteristic （ROC curve） analysis， calibration curve analysis， and decision curve analysis. Results The multivariate analysis revealed that palpability， CA153， calcification， and ALN blood flow signal were identified as independent risk factors for SLN metastasis （P < 0.05）. These four variables were integrated into a nomogram and plotted on the ROC curve. The area under the curves （AUCs） for the training set and validation set were 0.810 （95%CI： 0.744 ~ 0.876） and 0.737 （95%CI： 0.606 ~ 0.867）， respectively， indicating good predictive accuracy as demonstrated by the calibration curve. Conclusion Revised sentence： "Developing a nomogram for preoperative prediction of SLN metastasis in breast cancer patients offers a non-invasive approach for clinical application and serves as a reliable tool to identify breast cancer patients who may not require SLN biopsy， thereby facilitating decisions regarding further axillary lymph node dissection （ALND） and adjuvant therapy.

Objective The clinical value of serum VILIP-1 and Hepc25 in predicting the prognosis of patients with Acute ischemic stroke （AIS） from intravenous thrombolysis was analyzed. Methods A total of 225 patients with acute ischemic stroke diagnosed and treated in the hospital from January 2022 to November 2023 were selected. According to Rankin Scale （mRS） grouping study， 97 patients with mRS ≥ 3 were divided into poor prognosis group and 128 patients with mRS < 3 were divided into good prognosis group. The serum levels of VILIP-1 and Hepc25 were compared and their prognostic value for intravenous thrombolysis. Results After logistic regression analysis， age， admission blood glucose， LYM， NIHSS score， PLT， WBC， VILIP-1， and Hepc25 were all factors affecting the prognosis of AIS patients （P < 0.05）； VILIP-1 and Hepc25 levels increased in patients with moderate and severe defects compared with mild defects. VILIP-1 and Hepc25 levels were higher in patients with severe defects than those with moderate defects. Compared with the poor prognosis group， the VILIP-1 and Hepc25 levels in the good prognosis group were decreased， with statistical difference （P < 0.05）. ROC curve analysis showed that single diagnosis of VILIP-1 and Hepc25 was lower than combined diagnosis （P < 0.05）. Conclusion The elevated levels of VILIP-1 and Hepc25 participate in the process of intravenous thrombolysis and affect the prognosis of patients， and can be used as clinical indicators for the prognosis of AIS patients.

Objective To investigate the difference in visual quality between oval and round corneal flaps in femtosecond excimer laser in situ keratomileusis （FS-LASIK）. Methods In a prospective randomized controlled clinical study， patients who voluntarily underwent FS-LASIK surgery in Wuhan University Affiliated Aier Ophthalmology Hospital from June 2022 to February 2023 were randomly divided into oval valve group and round valve group， with 36 patients （72 eyes） in each group. During FS-LASIK， oval and round corneal flaps were made， and excimer laser surgery was performed in parallel. Observe intraoperative and postoperative complications. The unaided visual acuity （UCVA） and spherical equivalent （SE） at 1 day， 1 week， 1 month and 3 months after surgery were compared between the two groups at 3 months after surgery， and the modulation transfer function （MTF）， Strel ratio （SR） and total higher-order aberration at 3 months after surgery were compared between the two groups. Results All patients had successfully completed the surgery without serious complications. There was no significant difference between the oval valve group and the round valve group in UCVA at 1 day， 1 week after surgery， 1 month after surgery， 3 months after surgery. There was no significant difference between the two groups on the postoperative SE at 1 day， 1 week after surgery， 1 month after surgery， and 3 months after surgery. There was no significant difference in MTF， SR and total higher-order aberration between the two groups at 3 months after surgery. Conclusion Ideal visual acuity can be achieved with either oval or round corneal flap during FS-LASIK， and there is no significant difference in visual quality between the two in the early postoperativeperiod.

Objective To assess the feasibility of utilizing the ExacTracDynamic surface monitoring system （ETD） for setup and body surface monitoring in patients with thoracic tumors undergoing intensity?modulated radiotherapy （IMRT）. Methods Patients receiving IMRT for thoracic tumors were included in this study. The enrolled patients were alternatively assigned to either conventional cross curve positioning （control group） or surface monitoring system?assisted positioning （experimental group）. ETD X?ray images were utilized for calibration purposes prior to radiotherapy， enabling the determination of setup errors. A region of interest （ROI） was delineated on the body surface above the sternum， and real?time body surface monitoring was performed based on this ROI during radiotherapy. Post?radiotherapy X?ray images were obtained to verify patient position. Data regarding left?right （X）， head?foot （Y）， abdomen?back （Z）， pitch， roll， and yaw directions were recorded and analyzed. Results A total of 60 patients were enrolled， with 754 fractions of radiotherapy in the control group and 718 fractions in the experimental group. The setup errors in the X and Z directions were significantly smaller in the experimental group compared to the control group （P < 0.05）. Moreover， there was a significant reduction in the number of setup errors ≤ 0.50 cm for X， Y， and Z directions， as well as ≤ 1.00° for Roll angle in the experimental group compared to the control group （P < 0.05）. Additionally， differences were observed between surface monitoring and X?ray image verification regarding position deviation along Y and Z directions （P < 0.05）， although these deviations remained within submillimeter levels on average. Conclusion Surface monitoring system?assisted positioning can enhance radiotherapy setup accuracy among thoracic tumor patients， particularly along X and Z directions. Furthermore， when setting ROI above sternum on body surface area， surface monitoring provides better reflection of target area's position deviation.

Objective To evaluate the efficacy of Schroth PSSE combined with 3D printing braces in the treatment of adolescent idiopathic scoliosis. Method Forty patients were included and divided into a support group （3D printing support group） and a support + exercise therapy group （3D printing support + Schroth PSSE group）. Excluding outliers and lost follow-up data， 32 patients were ultimately included， with 16 patients in each group. Wearing time ≥ 18 h for both groups of 3D printing supports. The intervention period of Schroth PSSE is 12 weeks， and exercise is maintained after 12 weeks until the end of follow-up. The longest follow-up time for the brace group was 25 months， with an average follow-up time of （15.00 ± 1.29） months. The longest follow-up time for the brace+exercise therapy group was 24 months， with an average follow-up time of （16.59 ± 1.01） months. Relevant indicators were evaluated after follow-up. Results The support and exercise therapy group showed better improvement in Cobb angle and trunk rotation angle （ATR） than the support group， with statistically significant differences （P < 0.05）； The distance between the midpoint of the C₇ vertebral body and the midline of the sacrum （C₇-CSVL） in the support and exercise therapy group showed a statistically significant difference before and after treatment （P < 0.05）， while there was a significant difference before and after Apical Vertebral Translation（AVT ）treatment （P < 0.01）. There was no statistically significant difference compared to the support group （P < 0.05）； In terms of SRS-22 score， the brace + exercise therapy group can comprehensively improve the SRS-22 score. Conclusion The combination of Schroth PSSE and 3D printing braces has a better effect on improving Cobb angle and torso rotation angle， improving coronary imbalance， increasing patient satisfaction， and improving quality of life compared to using 3D printing braces alone.

Objective To evaluate the clinical efficacy of a rapid 3D-printed patient-specific osteotomy guide in knee replacement surgery， and provide guidance for its widespread clinical application. Methods A total of 80 patients with end-stage knee osteoarthritis who had undergone Total Knee Arthroplasty （TKA） were selected and randomly divided into two groups. The first group comprised 40 cases （40 knees） that underwent traditional TKA， while the second group consisted of 40 patients （40 knees） in the 3D-printed osteotomy guide group. Various parameters， including surgery duration， intraoperative blood loss， time to ambulation after surgery， mechanical axis angle between femur and tibia post-surgery， Visual Analog Scale （VAS） score， Hospital for Special Surgery （HSS） knee score， Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC） score， range of motion （ROM） of the knee， and other indicators were analyzed separately for both groups. Statistical analyses were conducted. Results All the patients underwent surgery smoothly and were followed up for 3 ~ 12 months. In comparison to the traditional osteotomy guide group， the 3D-printed osteotomy guide group demonstrated significantly shorter surgery duration （P < 0.05）， reduced intraoperative blood loss， earlier time to first ambulation after surgery （P < 0.05）， lower postoperative VAS score， and smaller mechanical axis angle between the femur and tibia after surgery （P < 0.01）. At 6 months post-surgery， both groups showed significantly improved KSS scores compared to preoperative values （P < 0.01）. The KSS score of the 3D-printed guide group was higher than that of the traditional surgical guide group at 6 months after surgery （P < 0.05）， but there was no statistical difference in KSS scores between the two groups （P > 0.05）. WOMAC scores for both groups decreased over time at 3 and 6 months post-surgery compared to preoperative scores （P < 0.05）. At these time points， WOMAC scores were lower in the 3D-printed guide group than in the traditional osteotomy guide group （P < 0.05）. One case of hematocele and infection occurred in the traditional osteotomy guide group； however， successful discharge was achieved following re-debridement while preserving the prosthesis. None of the surgical patients experienced complications such as neurovascular injury， deep vein thrombosis， prosthesis loosening or periprosthetic fractures. Conclusion Compared to conventional total knee arthroplasty （TKA） surgery， the utilization of a rapid 3D-printed osteotomy guide for knee replacement presents several advantages， including reduced surgical operation duration， minimal intraoperative blood loss， precise and expeditious osteotomies， accelerated postoperative recovery， and heightened patient satisfaction during medical consultations. Notably， its clinical efficacy surpasses that of traditional approaches.

Objective To observe and compare of the effects of esketamine and sufentanil induction for general anesthesia on postoperative analgesia in obese patients undergoing laparoscopic sleeve gastrectomy. Methods Patients scheduled for elective laparoscopic sleeve gastrectomy between March 2023 and March 2024， irrespective of gender， aged between 20 and 50 years， with a BMI ranging from 30.0 to 50.0 kg/m² and ASA Ⅰ or Ⅱ classification， were randomly allocated into two groups： the esketamine group （Group E） and the sufentanil group （Group S）， each consisting of 32 cases. During anesthesia induction， Group E received a dose of esketamine at 0.5 mg/kg while Group S received sufentanil at a dosage of 0.5 μg/kg； the remaining protocol remained unchanged. Heart rate （HR）， mean arterial pressure （MAP）， and SpO₂ were recorded at various time points： upon arrival （T0）， prior to anesthesia induction （T1）， immediately after induction （T2）， during intubation （T3）， at the conclusion of anesthesia administration（T4）， and during extubation（T5）. Postoperative pain scores using the Numeric Rating Scale（NRS） were assessed at specific intervals following surgery： one hour post?surgery（P0）， six hours post?surgery（P1）， twelve hours post?surgery（P2）， twenty?four hours post?surgery（P3）and forty?eight hours post?surgery（P4）. Additionally， intraoperative remifentanil consumption as well as the number of presses on the analgesic pump within forty?eight hours after surgery in both patient groups were documented along with any occurrences of adverse reactions. Results During the surgery， there was no statistically significant difference in mean arterial pressure （MAP） and heart rate （HR） between the two patient groups at T0 ~ T5 （P > 0.05）. At T2， both groups exhibited lower MAP and HR compared to T0； specifically， group S had a MAP of （91.81±8.94） mmHg and HR of （81.75 ± 13.37） beats/min， while group E had a MAP of （93.69 ± 9.96） mmHg and HR of （80.38 ± 13.2） beats/min， with group E showing values closer to baseline levels. At T3， both groups experienced a transient increase in MAP and HR （P < 0.05）； specifically， group S had a MAP of （97.56 ± 8.96） mmHg and HR of （86.47 ± 13.84） beats/min， while group E had a MAP of （101.03 ± 8.29） mmHg and （89.41 ± 15.32） times/min， with S group closer to baseline values. There was no statistically significant difference in the amount of remifentanil used during surgery between group S and group E （P > 0.05）， which were （2 071.88 ± 717.63） μg and （2 093.75 ± 718.39） μg， respectively. Compared with the postoperative conditions of the two groups， the NRS scores of group E （0.41 ± 0.61 ± 1.870.75， 2.47 ± 0.62） at P0， P1 and P2 were lower than those in group S （0.88 ± 0.71， 2.47 ± 0.72， 2.97 ± 0.54）， and the difference was statistically significant （P < 0.05）. The number of intravenous analgesia pump presses was significantly reduced in group E after surgery （P < 0.05）， with the postoperative analgesic pump compressions occurring 11.25±2.70 times in group S and 8.56 ± 2.23 times in group E. The incidence of postoperative nausea and vomiting （PONV） and hypotension in Group E （21.88%， 15.63%） was lower than that observed in group S （46.88%， 37.50%）， demonstrating statistical significance （P < 0.05）. Conclusion In comparison to sufentanil induction， the utilization of esketamine anesthesia induction is deemed safe for laparoscopic sleeve gastrectomy in obese patients， effectively mitigating postoperative acute pain and reducing the incidence of PONV.

Objective To compare the impact of continuous profound neuromuscular blockade versus conventional neuromuscular blockade on postoperative shoulder pain in patients undergoing robot?assisted laparoscopic surgery during steep Trendelenburg position. Methods This study was a single?center， randomized， double?blind clinical trial. The inclusion criteria encompassed individuals aged between 18 and 80 years， with an American Society of Anesthesiologists status of Ⅰ or Ⅱ， and a body mass index ranging from 18 kg/m² to 30 kg/m². A total of one hundred patients were randomly assigned to either the deep neuromuscular blockade group （D group） or the conventional neuromuscular blockade group （C group）， with equal distribution of fifty cases in each group. Rocuronium dosage was titrated to achieve post?tetanic count values of 1 ~ 2 and train?of?four stimulation levels of 1 ~ 2 during surgery for D and C groups respectively. At the end of surgery， sugammadex was administered for reversal of neuromuscular blockade. The primary endpoint assessed the incidence of postoperative shoulder pain within three days after surgery. Secondary endpoints included Leiden score evaluation during intraoperative period， number of additional neuromuscular blockers required by the surgeon， recovery time for muscle relaxation postoperatively， nausea and vomiting scores during recovery phase， visual analog scale （VAS） scores in Post?Anesthesia Care Unit （PACU） as well as within three days after surgery， incidence rate for postoperative pulmonary complications， length of hospital stay duration and patient satisfaction score. Results The incidence of postoperative shoulder pain was significantly lower in group D compared to group C （D group 32% vs. C group 56%；P < 0.05）. However， there were no significant differences in postoperative shoulder pain VAS scores between the two groups （P > 0.05）. No significant differences were observed between the groups in terms of Leiden score， surgeon's requirement for additional neuromuscular blockers， nausea and vomiting in PACU， and VAS score （P > 0.05）. Group D exhibited better early postoperative activity pain scores than group C （P < 0.05）. There were no significant differences in VAS scores between the groups at other time points （P > 0.05）. Furthermore， there were no significant differences in the incidence of postoperative pulmonary complications， length of stay， and satisfaction scores between the two groups. Conclusion The implementation of continuous deep neuromuscular blockade in patients undergoing robot?assisted laparoscopic surgery with steep Trendelenburg position can effectively mitigate the occurrence of postoperative shoulder pain.

Objective To investigate the value of electrocardiographic parameters in assessing severe coronary artery lesions in patients with coronary artery disease. Methods A total of 364 patients with coronary heart disease admitted to the Second Affiliated Hospital， Zhengzhou University from January 2022 to September 2023 were selected as the subjects. The patients were divided into severe lesion group （n = 123） and non-severe lesion group （n = 241） based on the Gensini score. The two groups were compared in terms of baseline data and electrocardiographic parameters. Logistic regression was used to analyze the factors affecting severe lesions and the efficacy of ECG parameters assessment. A column-line plot of ECG parameters to assess severe lesions was created. The joint incremental value of ECG parameters and the area under the ROC curve for assessing severe lesions were calculated. Results The patients in the severe lesion group were elder in age and they showed significantly higher rates in creatine kinase isoenzyme， amino-terminal brain natriuretic peptide precursor， QRS time frame， frontal QRS-T pinch angle， smoking， hypertension， diabetes mellitus， pathologic Q waves， left ventricular hyper voltage， fragmented QRS waves， and significantly lower rates in low HDL cholesterol and ejection fraction， as compared to the non-severe lesion group（all P < 0.05）. Logistic regression analysis showed that pathological Q waves （OR= 3.71， 95%CI： 1.93 ~ 7.15， P < 0.001）， left ventricular hyper voltage （OR= 5.05， 95%CI：1.66 ~ 15.41， P = 0.004）， fragmented QRS waves （OR= 2.17， 95%CI： 1.14 ~ 4.11， P = 0.018）， and frontal QRS-T pinch angle （OR= 1.01， 95%CI：1.00 ~ 1.02， P = 0.023） were the factors for assessing severe lesions. The incremental value of combined ECG parameters for severe lesions： C-statistic 0.09 （95% CI： 0.02 ~ 0.16， P = 0.009）， NRI 0.37 （95%CI： 0.20 ~ 0.55， P < 0.001）， and IDI 0.12 （95%CI： 0.08 ~ 0.17， P < 0.001）. The ROC curves showed an AUC of 0.79 （95%CI： 0.74 ~ 0.84， P < 0.001）， a sensitivity of 63.41%， and a specificity of 85.89% for the combined assessment of severe lesions by ECG parameters. Conclusion The combined observations of electrocardiographic parameters such as pathologic Q waves， left ventricular hyper voltage， fragmented QRS waves， and frontal QRS-T pinch angle have an affirmativeclinical value in the assessment of severe lesions.

Objective To investigate the role and clinical significance of fine-needle aspiration combined with next-generation sequencing 18 genes detection in the diagnosis of thyroid cancer. Methods The samples were tested by liquid-based cytology and next-generation sequencing. Cytological diagnosis was based on the 3rd edition Bethesda system for reporting thyroid cytopathology. Histological diagnosis was based on the fifth WHO classification criteria for thyroid neoplasms. Results Among 97 thyroid specimens， 8 cases （8.25%） were unsatisfied， 44 cases （45.36%） had benign lesions， 9 cases （9.28%） had atypical cells of unknown significance， 4 cases （4.12%） had suspected follicular or oncocytic tumors. Suspected papillary carcinoma was found in 10 cases （10.31%） and papillary carcinoma in 22 cases （22.68%）. A total of 52 cases （53.61%） were mutated， and 10 gene mutations were detected， among which BRAF gene mutation had the highest detection rate 63.46% （33/52）. BRAF gene mutation was associated with gender， age and cytological diagnosis（P < 0.05）. Cytology combined with next-generation sequencing improved the diagnostic accuracy （97.0% vs. 81.8%）， having higher diagnostic efficiency. Conclusion Thyroid fine-needle aspiration cytology combined with next-generation sequencing can promote early diagnosis of thyroid cancer and provide basis for individual treatment of patients.

Objective To investigate the utility of dual?energy CT combined with musculoskeletal ultrasonography in differentiating between calcium pyrophosphate deposition disease and gouty arthritis. Methods A retrospective analysis was conducted on the medical records of 102 patients diagnosed with gouty arthritis and 102 patients diagnosed with calcium pyrophosphate deposition disease. These patients were categorized into the Gout group and Calcium Deposition group， respectively， based on their respective diagnoses. All patients underwent dual?energy CT and musculoskeletal ultrasonography examinations， while joint fluid aspiration results or intra?articular crystal material served as the gold standard for diagnosis. The diagnostic efficacy of dual?energy CT and musculoskeletal ultrasonography in discriminating between calcium pyrophosphate deposition disease and gouty arthritis was evaluated. Results In the gout group， the proportion of male patients and serum uric acid levels were significantly higher compared to those in the calcium deposition group （P < 0.05）. The prevalence rates of knee joint， first metatarsophalangeal joint， and ankle joint involvement were higher in the gout group， while knee joint， wrist joint， and shoulder joint involvement rates were higher in the calcium deposition group. The proportions of irregular bone cortex， cartilage injury， and degenerative meniscus changes were lower in the gout group compared to the calcium deposition group （P < 0.05）. The proportions of double contour sign， tophus formation， hyperechoic band within ligaments or tendons， and bone erosion were higher in the gout group compared to the calcium deposition group （P < 0.05）， whereas cartilage calcification was lower in the gout group （P < 0.05）. The sensitivities for diagnosing calcium pyrophosphate deposition disease and gouty arthritis using dual?energy CT scan alone， musculoskeletal ultrasound alone， and their combined use were 86.27%， 83.33%， and 94.12% respectively. The specificities for diagnosing these conditions using dual?energy CT scan alone，musculoskeletal ultrasound alone，and their combined use were 89.22%，88.24%， and 86.27% respectively. The positive predictive values were 88.89%， 87.63%， and 87.27%， respectively. The negative predictive values were 86.67%， 84.11%， and 93.63%， respectively. The accuracies were 87.75%， 85.78%， and 90.20% respectively. The agreement Kappa values were 0.755， 0.716， and 0.804 respectively. Conclusions The integration of dual?energy CT and musculoskeletal ultrasonography exhibits promising diagnostic efficacy in discriminating between calcium pyrophosphate deposition disease and gouty arthritis. This combined approach serves as a valuable adjunctive tool for the diagnosis of both conditions.

Objective To investigate the value of serum aquaporin 1 （AQP1） level combined with extravascular lung water index （EVLWI） in assessing the severity and prognosis of sepsis causing acute respiratory distress syndrome （ARDS）. Methods 268 patients with sepsis-induced ARDS （ARDS group） and 55 patients with sepsis alone （sepsis alone group） admitted to our hospital from January 2020 to December 2023 were selected. Patients with sepsis-induced ARDS were divided into 89 mild， 109 moderate， and 70 severe groups according to the oxygenation index （OI）， and 104 deaths and 164 survivors according to the 28 d prognosis. Detection of serum AQP1 levels and calculation of EVLWI. Using Spearman's method， the correlation between serum AQP1 level， EVLWI and OI in patients with sepsis-induced ARDS； the establishment of a logistic regression model to determine the factors of sepsis-induced mortality in patients with ARDS； and the plotting of ROC curves to evaluate the value of serum AQP1 level in combination with EVLWI for its assessment. Results Compared with the simple sepsis group， serum AQP1 level was reduced and EVLWI was increased in the ARDS group （P < 0.05）. AQP1 levels were sequentially lower and EVLWI sequentially higher in the mild， moderate， and severe groups （P < 0.05）. Serum AQP1 levels were positively correlated with OI in patients with sepsis-induced ARDS， and EVLWI was negatively correlated with OI in patients with sepsis-induced ARDS （P < 0.05）. The 28 d mortality rate in 268 patients with ARDS due to sepsis was 38.81% （104/268）. The independent protective factors for death in ARDS patients with sepsis were elevated OI （OR= 0.984， 95%CI： 0.976 ~ 0.992） and elevated AQP1 （OR= 0.761， 95%CI： 0.677 ~ 0.854）， and the independent risk factors were increased SOFA score （OR= 1.367， 95%CI： 1.142 ~ 1.636） and elevated blood lactate （OR= 2.515， 95%CI： 1.689 ~ 3.745）， and elevated EVLWI （OR= 1.559， 95%CI： 1.290 ~ 1.885） （P < 0.05）. The AUC predicted by serum AQP1 level combined with EVLWI was 0.887 （95%CI： 0.843 ~ 0.923）， which was greater than the AUC predicted by serum AQP1 level， and EVLWI alone， which was 0.792 （95%CI： 0.738 ~ 0.839）， and 0.807 （95%CI： 0.754 ~ 0.852） （P < 0.05）. Conclusion Decreased serum AQP1 levels and elevated EVLWI were associated with increased severity and poor prognosis in patients with sepsis-induced ARDS， and serum AQP1 levels in combination with EVLWI were of high value in assessing the prognosis of patients with sepsis-induced ARDS.

Objective To investigate the relationship between coronary artery plaque AI quantitative parameter and FFR-CT in coronary computed tomography angiography. Methods A total of 84 patients suspected of having CAD ［52 males and 32 females， aged 27 to 81 years with a mean age of （58.1 ± 11.9） years］ were enrolled in this study. All patients underwent coronary computed tomography angiography. The CCTA data was processed using shukun（SK） software for labeling and analysis of the coronary arteries， as well as obtaining quantitative parameters of coronary artery plaque AI and corresponding FFR-CT values. The quantitative parameters included plaque length， total volume， minimum lumen area （MLA）， minimal lumen degree （MLD）， lipid composition volume and proportion， fibrous-lipid composition volume and proportion， fibrous composition volume and proportion， calcified composition volume and proportion. Coronary artery hemodynamic abnormality or myocardial ischemia was defined as an FFR-CT value ≤ 0.8. Correlational analysis was performed to evaluate the association between AI plaque quantitative parameters and FFR-CT values. Univariate and multivariate binary logistic regression analyses were conducted to identify independent risk factors for predicting FFR-CT ≤ 0.8. The predictive performance of the model based on AI plaque quantitative parameters was assessed using receiver operating characteristic （ROC） curve analysis and calculation of the area under the curve （AUC）. Sensitivities， specificities， diagnostic test accuracy rates were also calculated. Results The predominant symptoms observed in the cohort of 84 patients were chest pain （n = 39， 46.4%） and distress （n = 27， 32.1%）. Spearman analysis results revealed a weak positive correlation between FFR-CT and MLA （r = 0.49， P < 0.000 1）， while weak negative correlations were found for plaque length， total volume， lipid composition volume， fibrous-lipid composition volume， fibrous composition volume， and calcified composition volume （r = -0.44， -0.56， -0.40， -0.36， -0.42， -0.40； all P < 0.05）. Additionally， MLD exhibited a moderate negative correlation with FFR-CT （r = -0.60， P < 0.000 1）. In the univariate binary logistic regression analysis， several variables including plaque length， total volume， MLA， MLD， lipid composition volume， fibrous-lipid composition volume， fibrous composition volume， and calcified composition volume were found to be independently associated with FFR-CT ≤ 0.8 （All P < 0.05）. The adjusted multivariate binary logistic regression analysis model revealed that MLD was the sole independent predictor （OR= 1.082， 95%CI：1.034 ~ 1.133， P = 0.001）. The logistics regression model expression was logit（P）=0.079X₁ - 4.052， where X₁ represents the value of MLD and achieved a predictive accuracy of 85.2%. The ROC AUC of plaque length， total volume， MLA， MLD， lipid composition volume， fibrous-lipid composition volume， fibrous composition volume and calcified composition volume were 0.796， 0.886， 0.711， 0.754 and 0.698 respectively， and the coresponding sensitivities and specificities were 47.83%， 73.91%， 73.90%， 52.17%， 60.87% and 92.11%， 73.68%， 60.53%， 84.21%， 89.47%. The five indexes combined diagnostic model possessed the largest AUC of 0.906， and 73.91%， 71.05% of sensitivity and specificity. Conclusion The AI quantitative parameters of coronary artery plaque exhibited varying degrees of correlation with FFR-CT， while MLD emerged as the sole independent predictor of FFR-CT ≤ 0.8， demonstrating high diagnostic efficiency.

Objective To observe the clinical effect of traditional Chinese medicine bone-setting technique using spinal， pelvi-lower extremity line to treat patients with knee osteoarthritis （KOA）. Methods 426 patients with KOA were all from the First Affiliated Hospital of Hebei University of Traditional Chinese Medicine. They were randomly divided into experimental group （384 cases， 57 cases of elimination， shedding and termination） by computer generated sequence. Traditional Chinese bone setting techniques were applied with spinal-pelvic-lower limb force line （divided into three parts： lumbar fixed point reduction method， hip joint push-pull and extension method and knee peripheral tendon recovery method every 3 days. 2 weeks） treatment； The control group was the waiting treatment group （48 cases， 6 cases were eliminated， abscission， termination）， which was only used for clinical observation for 2 weeks. The main outcome index was WOMAC pain score. Secondary outcome measures were WOMAC stiffness score， functional score， standardized score and quality of life score （SF-12）. The test time points were baseline， 2 weeks after enrollment， and follow-up （14 weeks after enrollment）. The control group was at baseline and 2 weeks after enrollment. Results Compared with baseline， WOMAC pain score， stiffness score， functional score and standardized score were all decreased in 2 groups 2 weeks after enrollment （P < 0.05）， but the experimental group was significantly decreased compared with the control group （P < 0.001）. SF-12 quality of life scores were all higher than before （P < 0.001）， but the experimental group was significantly higher than the control group （P < 0.001）. At follow-up， compared with 2 weeks after enrollment， WOMAC pain scores were increased （P < 0.001）， WOMAC stiffness， joint function and standardized scores were decreased （P < 0.001）， and SF-12 scores were increased （P < 0.001）. Conclusion The use of spinal - pelvi-lower extremity line of traditional Chinese medicine bone-setting technique in the treatment of KOA is effective in improving the knee joint function and improving the quality of life of patients， but the short-term effect of pain relief is good， and the long-term effect is not good. Its safety is good， and it can be considered in clinical application for KOA patients with joint dysfunction as the main manifestation.

With the acceleration of population aging and the continuous growth of the elderly population， frailty has become a global public health problem. At the same time， an increasing number of elderly people require surgical treatment， and people are paying more attention to the possible postoperative neurocognitive disorder. Frailty and neurocognitive disorder interact with each other， forming a vicious cycle. Improving one of them can improve the prognosis of the elderly. As one of the commonly used anesthetic drugs in clinical practice， dexmedetomidine has neuroprotective effects.This article reviews the relationship between frailty and neurocognitive disorder， as well as the research progress of dexmedetomidine in improving perioperative neurocognitive disorder in frail elderly patients.

Anterior cruciate ligament （ACL） injury is caused by strong violence， which can destabilize the knee joint， cause joint cartilage degeneration， meniscus injury， and in severe cases， develop osteoarthropathy. The gold standard for the treatment of ACLR injuries at this stage is arthroscopic anterior cruciate ligament reconstruction （ACLR）.In clinical practice， the LARS （Ligament advanced reinforcement system） artificial ligament made of polyethylene terephthalate （PET） as the material has a good effect in the short and medium term， but the long-term biological healing between the graft and the host bone is poor， and the real "ligamentization" requirement of the postoperative graft cannot be met. Coating-modified modification of artificial ligaments can improve their hydrophilicity and biocompatibility， which in turn can promote the healing of graft-bone tunnels. Tendon bone healing is a bone-derived progressive process from indirect insertion to direct insertion， which takes a relatively long time and is closely related to the prognosis and early rehabilitation effect of patients. This article reviews the progress of superficial modification of artificial ligaments to promote ACLR tendon bone healing.