Youth forum

• Artificial intelligence in gynecological surgery: current situation,challenges and prospects

  SUN Hao, LIU Xiaojun*

  2025,46(12):1519-1524 ,DOI: 10.16781/j.CN31-2187/R.20250346

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  The rapid development of artificial intelligence（AI） provides new technical support for the precision and personalized of gynecological surgery. This paper systematically reviews the application of AI in the whole process of gynecological surgery, including preoperative planning and simulation based on image and clinical data, real-time intraoperative navigation and robot-assisted decision making, postoperative complication prediction and prognosis assessment, and virtual surgical training. Studies have shown that AI significantly improves surgical accuracy and patient safety, but still faces challenges such as data privacy, algorithm generalization, and insufficient clinical validation. In the future, it is necessary to promote the deep integration of AI, robotics and biosensing through multidisciplinary collaboration to further improve the intelligent development of gynecological surgery.

人工智能＋医学科研

• Artificial intelligence-assisted CT diagnosis of lymph node metastasis: integrated models,multi-cancer applications,and interpretability challenges

  XING Wanting, BIAN Yun, SHAO Chengwei*

  2025,46(12):1525-1531 ,DOI: 10.16781/j.CN31-2187/R.20250456

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  Accurate diagnosis of lymph node metastasis is critical for cancer staging, treatment selection, and prognostic evaluation. Computed tomography（CT）, as a conventional imaging modality, plays a significant role in diagnosing lymph node metastasis. However, it remains limited in the identification of nodes with short-axis diameter ＜1 cm and micrometastases. In recent years, artificial intelligence（AI） technology has advanced rapidly in the field of medical image analysis, offering novel technical pathways to improve the accuracy of CT-based diagnosis of lymph node metastasis. This article reviews the research progress in AI-assisted CT diagnosis of lymph node metastasis, with a focus on the technical characteristics, diagnostic performance, and clinical applications of radiomics, deep learning, and their integrated models across various cancer types. Future directions and existing challenges are also discussed.

Monographic report: Diagnosis, treatment, and nursing of cerebrovascular diseases

• Bevacizumab for chronic subdural hematoma: research progress

  YIN Lugang, TAN Yuhao, LIU Jianmin*, ZUO Qiao*

  2025,46(12):1532-1537 ,DOI: 10.16781/j.CN31-2187/R.20250168

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  Chronic subdural hematoma（CSDH）, a common neurosurgical condition, is closely associated with inflammation and angiogenesis. Vascular endothelial growth factor（VEGF） plays a pivotal role in its development and progression. Bevacizumab（BCZ）, an anti-VEGF monoclonal antibody, exerts therapeutic effects on CSDH by inhibiting VEGF activity and suppressing pathological angiogenesis. This article reviews the mechanisms underlying CSDH formation and recent advances in animal experiments and clinical trials of BCZ for CSDH treatment, summarizes the current state of drug treatment of CSDH and the pharmacokinetic characteristics of BCZ through different routes of administration, and highlights the long-term benefits of intravascular use of BCZ in the treatment of CSDH, aiming to improve clinical management.

• Imaging research progress on hemorrhagic transformation in acute ischemic stroke

  SONG Yuting, TIAN Bing*

  2025,46(12):1538-1546 ,DOI: 10.16781/j.CN31-2187/R.20250478

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  Hemorrhagic transformation（HT） following acute ischemic stroke（AIS） refers to the pathological process of secondary bleeding in the cerebral infarction area. It is a common complication after AIS treatment and is also an inherent part of the natural course of disease. HT is considered closely related to poor prognosis, particularly in symptomatic intracranial hemorrhage, with a mortality rate of 40%-50%. In recent years, rapid advances in imaging technology and artificial intelligence have led to significant breakthroughs in HT research. This article reviews recent progress in multimodal computed tomography and magnetic resonance imaging, radiomics, and artificial intelligence-based prediction models. Radiomics, deep learning, and their integrated models have been proven superior to conventional methods in predictive performance and are robust assisting tools for clinical precision decision-making.

• Diagnostic value of fibrinogen for acute ischemic stroke due to large artery atherosclerosis in ultra-acute phase

  CHEN Lei, ZHANG Minmin, HUYAN Meihua, HUANG Qi, DENG Benqiang, ZHANG Ping, LIU Jianmin

  2025,46(12):1547-1552 ,DOI: 10.16781/j.CN31-2187/R.20250092

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  Objective To compare the fibrinogen level among patients with acute ischemic stroke of different etiologies and to evaluate the correlation between fibrinogen and large artery atherosclerosis（LAA） stroke. Methods Clinical data and coagulation indexes in ultra-acute phase（within 4.5 h of symptom onset） were retrospectively analyzed in patients with acute ischemic stroke treated at the Neurovascular Center of The First Affiliated Hospital of Naval Medical University from Oct. 2018 to Jul. 2021. Based on the Trial of Org 10172 in Acute Stroke Treatment, the etiological diagnosis was made. The clinical characteristics and coagulation indexes were compared between LAA, small artery occlusion（SAO） and cardioembolism（CE） groups. Multivariate logistic regression model was used to analyze the independent predictive factors of LAA. Results A total of 221 patients with acute ischemic stroke were enrolled, including 58（26.2%） cases of LAA, 110（49.8%） SAO, and 53（24.0%） CE. There were significant differences in prothrombin time, fibrinogen and D-dimer levels among the 3 groups（all P＜0.05）. Multivariate logistic regression analysis showed that fibrinogen was an independent predictor of LAA when compared with CE（odds ratio [OR] =3.199, 95% confidence interval [CI] 1.562-6.553, P=0.001） and with SAO（OR=1.610, 95%CI 1.072-2.418, P=0.022） after adjusting for confounding factors（age, diabetes mellitus, hypercholesterolemia, and smoking）. Conclusion Fibrinogen is associated with acute ischemic stroke due to LAA, and it can be beneficial for etiological diagnosis of acute ischemic stroke in ultra-acute phase.

• DSA measurement and analysis of diameter difference of middle meningeal artery in chronic subdural hematoma

  TAN Yuhao, YIN Lugang, ZHANG Renkun, ZHANG Yongwei, ZHAO Rui, LI Qiang, XU Yi, YANG Pengfei, ZUO Qiao*, LIU Jianmin*

  2025,46(12):1553-1557 ,DOI: 10.16781/j.CN31-2187/R.20250140

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  Objective To quantitatively evaluate the difference in the diameter of the middle meningeal artery（MMA） in patients with chronic subdural hematoma（CSDH） using digital subtraction angiography（DSA）. Methods We retrospectively enrolled 32 patients with CSDH who underwent MMA embolization at our department between May 2018 and May 2023. The cohort included 28 males and 4 females, with a mean age of（66.38±10.54） years. The diameter of the intracranial segment of the MMA trunk was measured on anteroposterior and lateral DSA images. The Wilcoxon signed-rank test was used to analyze the diameter difference of bilateral MMA. Results In the 29 patients with unilateral CSDH, the mean diameter of the affected MMA was significantly greater than that of the healthy MMA（2.10 [2.00, 2.25] mm vs 1.95 [1.80, 2.05] mm, P＜0.001）. In the 3 patients with bilateral hematomas, no significant difference in MMA diameter was observed between the 2 sides（P=0.724）. Conclusion MMA is significantly enlarged on the side of the hematoma in patients with CSDH, suggesting that MMA enlargement may be related to the pathogenesis of CSDH.

• Construction and validation of a risk prediction model for peripherally inserted central catheter occlusion in intensive care unit stroke patients

  XIE Shan△, PENG Jin△, ZHA Yi, YAO Gaoling, SHA Sai, WANG Qin, YU Longjuan*

  2025,46(12):1558-1565 ,DOI: 10.16781/j.CN31-2187/R.20250022

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  Objective To identify risk factors of peripherally inserted central catheter（PICC） occlusion in intensive care unit（ICU） patients with stroke and to construct and validate a corresponding risk prediction model. Methods A total of 289 stroke patients who underwent PICC placement and were admitted to the ICU of the Neurovascular Center in our hospital from Jan. 2022 to Aug. 2024 were retrospectively enrolled. Among them, 202 patients admitted between Jan. 2022 and Sep. 2023 were included in modeling group, and 87 patients admitted between Oct. 2023 and Aug. 2024 were included in validation group. According to the occurrence of PICC occlusion, the patients were assigned to occlusion group or non-occlusion group. Multivariate logistic regression analysis was used to identify risk factors for PICC occlusion and to construct a risk prediction model. The discriminative performance of the model was evaluated using receiver operating characteristic curve analysis. Results Multivariate logistic regression analysis revealed that puncture on the affected side, diabetes mellitus, and elevated D-dimer were independent risk factors for PICC occlusion in ICU stroke patients. The constructed prediction model was: LogitP=-4.733+1.324×site of puncture+1.185×diabetes mellitus+0.618×D-dimer. Hosmer-Lemeshow test indicated good model calibration（P=0.761）. In the modeling group, the area under curve（AUC） value was 0.840（95% confidence interval [CI] 0.747-0.933）, with a sensitivity of 0.731 and a specificity of 0.875. In the validation group, the AUC value was 0.873（95%CI 0.759-0.987）, with a sensitivity of 0.833 and a specificity of 0.867. Conclusion Puncture on the affected side, diabetes mellitus, and elevated D-dimer are independent risk factors for PICC occlusion in ICU stroke patients. The developed risk prediction model has good discriminative ability and may serve as a basis for clinical prevention and management of PICC occlusion in ICU stroke patients.

• A safe nursing management program for infusion in critically ill stroke patients based on 4R crisis management theory: development and implementation

  LI Shan, XU Fei, GAN Lifen*

  2025,46(12):1566-1572 ,DOI: 10.16781/j.CN31-2187/R.20250100

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  Objective To construct a safe infusion nursing management program for critically ill stroke patients based on the 4R crisis management theory and analyze its application. Methods A total of 90 critically ill stroke patients admitted to the Neurovascular Center of The First Affiliated Hospital of Naval Medical University from Mar. to Dec. 2024 were included. Among them, 45 patients admitted from Mar. to Jun. 2024 served as control group, and 45 patients admitted from Jul. to Dec. 2024 as observation group. The control group received perioperative routine infusion nursing, while the observation group was implemented with the safe infusion nursing management program based on the 4R crisis management theory in addition to the routine infusion nursing. The incidence of intravenous infusion-related adverse events, quality of life（score of 36-item short form health survey） before intervention（within 24 h after initial catheterization） and after intervention（30 d after discharge）, and nursing satisfaction（evaluated by a self-made satisfaction survey form） were compared between the 2 groups. Results The incidence of intravenous infusion-related adverse events in the observation group was significantly lower than that in the control group（8.89% [4/45] vs 28.89% [13/45], P＜0.05）. After intervention, the total score of quality of life and the scores of physical and mental health dimensions in both groups were improved compared with those before intervention（all P＜0.05）, and the improvement was greater in the observation group than that in the control group（all P＜0.001）. The nursing satisfaction in the observation group was significantly higher than that in the control group（97.78% [44/45] vs 80.00% [36/45], P＜0.05）. Conclusion Implementing the safe infusion nursing management program based on the 4R crisis management theory for critically ill stroke patients can effectively reduce the incidence of intravenous infusionrelated adverse events and improve patients’ quality of life and nursing satisfaction, showing important clinical application value.

Original article

• Burden of retinoblastoma among children ＜10 years in China and globally during 1990-2021

  ZHOU Yu, AI Bin, PAN Jiahao, LIU Hangyu, ZHANG Yu

  2025,46(12):1573-1581 ,DOI: 10.16781/j.CN31-2187/R.20250293

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  Objective To investigate the burden of retinoblastoma (RB) among children ＜10 years globally, in China and in different sociodemographic index (SDI) regions from 1990 to 2021, and to analyze its patterns by gender and age group. Methods Using the 2021 Global Burden of Disease (GBD) database, we estimated the number of incident cases, number of deaths, and disability-adjusted life year (DALY) of RB among children ＜10 years from 1990 to 2021, along with the corresponding age-standardized rates. Further descriptive analyses were conducted by gender, SDI region, and age group. Finally, Bayesian age-period-cohort model was used to predict the number of incident cases, number of deaths, DALY, and the corresponding age-standardized rates globally and in China from 2022 to 2040. Results In 2021, the number of incident cases of RB among children ＜10 years worldwide increased by 34.27% compared with 1990, while the number of deaths and DALY decreased by 13.14% and 12.85%, respectively. The number of incident cases, number of deaths and DALY of RB among children ＜10 years in China were 1 102.43, 70.74 and 6 765.72, respectively. The number of incident cases increased by 99.73% compared with 1990, while the number of deaths and DALY decreased by 77.51% and 75.59%, respectively. Among children ＜10 years, there were significant age and gender differences in the burden of RB. Globally, the burden of RB in newborns aged 0-6 d was the highest, while for Chinese children, the disease burden was the highest between 12 and 23 months. Moreover, the number of incident cases, number of deaths, and DALY reached their peaks at the age of 2-4 years globally and in China. It was predicted that by 2040, the incident cases and deaths of RB in China would drop to 890 and 57, respectively, decreased by 19.24% and 19.72% compared with 2021; however, DALY would show an upward trend. Conclusion Significant progress has been made in the prevention and control, early screening and treatment of RB among children in China. However, the impact of RB on the long-term quality of life of patients is still considerable, suggesting that we need to further increase the screening coverage rate, optimize the treatment regimens, and strengthen the management and support of patients during their recovery period.

• Comparison of large language models for perioperative lung-protective ventilation recommendations

  WU Qi, LU Jun, ZHANG Yanlin, WANG Xiaolin, YANG Tao, BIAN Jinjun, BO Lulong*

  2025,46(12):1582-1589 ,DOI: 10.16781/j.CN31-2187/R.20250542

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  Objective To evaluate the professional adaptability of different large language models（LLMs） in generating recommendations for perioperative lung-protective ventilation. Methods A cross-sectional study was conducted using Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations published in 2019 as the standard. Eight LLMs were selected to generate ventilation strategy recommendations via standardized prompts. Outcomes were calibrated through assessment by the 8 LLMs and anesthesiologists based on total disagreement score（TDS） and quality assessment of medical artificial intelligence（QAMAI）. Results Recommendations generated by LLMs showed strong alignment with the expert consensus but failed to achieve full concordance across all items. Assessment results by LLMs indicated that Chat GPT o1 performed best（TDS 1.5 [1.0, 2.0], QAMAI score 25.5 [22.2, 27.8]）, while Gemini 2.0 pro showed the poorest performance（TDS 3.0 [2.0, 5.0], QAMAI score 21.0 [16.8, 23.8]）. Among domestic LLMs, DeepSeek R1 achieved the best scores（TDS 2.0 [1.5, 2.8], QAMAI score 25.5 [19.2, 28.2]）. Peer review results by anesthesiologists were consistent with LLM assessment findings. Conclusion The recommendations of LLMs for perioperative lung-protective ventilation strategies exhibit heterogeneity, with Chat GPT o1 and DeepSeek R1 demonstrating relatively higher accuracy and potential clinical utility.

• Subcellular localization analysis of MYCT1 in hepatocellular carcinoma and its clinical significance

  MENG Hanyu, CAO Ruixue, XIN Xuan, WANG Cuicui, WANG Yanmei, LIU Xiaohong

  2025,46(12):1590-1596 ,DOI: 10.16781/j.CN31-2187/R.20250340

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  Objective To investigate the expression of Myc target 1（MYCT1） in hepatocellular carcinoma（HCC） and its clinicopathological significance. Methods The expression characteristics of MYCT1 in HCC were analyzed using UALCAN platform and Gene Set Cancer Analysis（GSCA） database. A total of 103 tissue samples from HCC patients at No. 960 Hospital of Joint Service Support Force of PLA from Oct. 2015 to Dec. 2024 were retrospectively collected. The expression of MYCT1 was detected using immunohistochemical staining, and the relationship between its expression patterns and clinical pathological parameters was analyzed. Kaplan-Meier survival analysis and Cox regression model were applied to evaluate the value of MYCT1 in predicting the prognosis of HCC patients. Results Database analysis revealed that MYCT1 was lowly expressed in HCC tissue and showed differential expression across different clinical stages. HCC patients with high MYCT1 expression had significantly better overall survival than those with low MYCT1 expression（P＜0.05）. Immunohistochemical staining results showed that the high expression rate of MYCT1 in the cytoplasm of cancer tissue（39.8%, 41/103） was significantly lower than that in the adjacent non-tumor tissue（60.2%, 62/103; P＜0.01）, and the positive expression rate in the nucleus of HCC tissue（70.9%, 73/103） was significantly higher than that in the adjacent non-tumor tissue（20.4%, 21/103; P＜0.01）. Clinicopathologic characteristic analysis showed that cytoplasmic expression of MYCT1 was associated with α-fetoprotein（AFP） level（P=0.046） and TNM stage（P=0.006）, whereas nuclear expression of MYCT1 was associated with age（P=0.048）, AFP level（P=0.049）, and tumor differentiation（P=0.003）. Kaplan-Meier survival analysis showed that HCC patients with high cytoplasmic expression of MYCT1 had significantly better overall survival than those with low expression of MYCT1（P=0.035）. Multivariable Cox regression analysis revealed that low cytoplasmic expression of MYCT1 in cancer tissue was an independent risk factor for the overall survival of HCC patients（hazard ratio=0.40, 95% confidence interval 0.19-0.85, P=0.017）. Conclusion MYCT1 shows a down-regulation of cytoplasmic expression and a change in nuclear-cytoplasmic distribution in HCC, suggesting that it may exert a tumor-suppressing effect by regulating subcellular localization. This distinctive expression pattern provides a novel molecular marker for the diagnosis and prognosis assessment of HCC.

• Development and clinical validation of a quantitative evaluation model for stroma ratio in pancreatic ductal adenocarcinoma based on magnetic resonance T1 mapping radiomics

  ZHANG Xinyue, CHEN Chengwei, YUAN Xiaohan, SHEN Yixuan, CHEN Shiyue, BIAN Yun, LU Jianping

  2025,46(12):1597-1603 ,DOI: 10.16781/j.CN31-2187/R.20250069

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  Objective To develop a noninvasive assessment model for stromal content in pancreatic ductal adenocarcinoma（PDAC） based on magnetic resonance imaging（MRI） T1 mapping radiomics. Methods A total of 157 patients with PDAC confirmed by postoperative pathology at The First Affiliated Hospital of Naval Medical University from Jun. 2023 to Dec. 2024 were prospectively enrolled. From the T1 mapping images, 12 442 features were extracted and 10 key features were screened. With least absolute shrinkage and selection operator（LASSO） regression, the 10 key features were linearly combined and weighted to construct radiomics score（Rad_Score）. Spearman rank correlation was used to test the correlation between Rad_Score and stromal content. With the stromal content diagnosed by pathology as the gold standard, the diagnostic performance of Rad_Score was evaluated by receiver operating characteristic curve. Multivariate linear regression was used to develop a stromal content prediction equation（including Rad_Score and maximum tumor diameter）; the Bland-Altman method was used to test the consistency between predicted and actual values. Results In PDAC patients, Rad_Score was correlated with stromal content（r_s=0.52, P＜0.001）. For discriminating stromal content＞0.5, the area under the curve value of Rad_Score was 0.936（95% confidence interval 0.885-0.987）, with a sensitivity of 91.7% and a specificity of 88.0%. The linear regression prediction model based on Rad_Score and maximum tumor diameter was: stromal content=0.592+0.037×Rad_Score-0.025×maximum tumor diameter（cm）; Bland-Altman method analysis showed good consistency between predicted and actual values（mean bias 0.00, 95% limits of agreement-0.33 to 0.33）. Conclusion The PDAC stromal assessment model based on MRI T1 mapping radiomics has high discriminatory value for high and low stromal content.

• Moderating role of physical exercise on relationship between sleep quality and depressive symptoms in college students: evidence from electroencephalogram-specific frequency bands and brain functional connectivity

  ZHU Yongguo, LI Xinmo, WANG Zixian, JIA Shuqi, GUO Zhaohui, LIU Hairong

  2025,46(12):1604-1613 ,DOI: 10.16781/j.CN31-2187/R.20250589

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  Objective To examine the independent and combined effects of depressive symptoms and sleep problems on brain functional connectivity（δ and θ bands）, and to evaluate interactive mechanisms between depressive symptoms, sleep quality, electroencephalogram（EEG） indicator（T6 δ）, and physical exercise. Methods Using an observational design,we recruited 325 college students who completed Beck depression inventory-Ⅱ（BDI-Ⅱ）, Pittsburgh sleep quality index（PSQI）, and physical activity rating scale-3（PARS-3）. Resting-state EEG was recorded and brain functional connectivity was analyzed. The participants were classified into 4 groups by BDI-Ⅱ and PSQI scores: depressive symptom with sleep problem group（n=73）, depressive symptom without sleep problem group（n=67）, non-depressive symptom with sleep problem group（n=87）, and non-depressive symptom without sleep problem group（n=98）. Mediation and moderation effect tests were conducted using a moderated-mediation framework（PROCESS; Bootstrap）. Physical exercise was the moderator, simpleslope test was performed at low（mean-1 standard deviation [SD], 0.459）, medium（mean, 18.529）, and high（mean+1SD, 36.600） PARS-3 levels. Results Across the 4 groups, multiple electrode sites showed significant differences in δ and θ band power（all P＜0.05）. Brain δ and θ band functional connectivity also differed markedly: the depressive symptom with sleep problem group exhibited the strongest parietal/occipital connectivity with weakened prefrontal connectivity; the depressive symptom without sleep problem group showed a pronounced reduction in prefrontal connectivity; the non-depressive symptom with sleep problem group showed relatively stronger parietal/occipital and weaker prefrontal connectivity; and the non-depressive symptom without sleep problem displayed a more balanced pattern. Path analysis identified a single significant mediating pathway: sleep quality→T6 δ →depressive symptom（indirect effect=-0.099, 95% confidence interval-0.177 to-0.014）. Physical exercise significantly moderated the primary path: sleep quality →depressive symptom; the effect size was increased across exercise level, and the effect sizes at the low, medium, and high levels were 0.781, 1.024, and 1.266, respectively（all P＜0.001）. Conclusion Depressive symptoms and sleep problems exert region-and band-specific effects on brain functional connectivity; their combined influence may represent a key mechanism of network dysfunction, with T6 δ emerging as a putative neurophysiological node in sleep quality-depressive symptom pathway. Physical exercise significantly moderates the association between sleep quality and depressive symptoms; at different exercise levels, improvements in sleep quality covary with reductions in depressive symptoms, providing a theoretical basis for prevention and intervention in mental health problems among college students.

Review

• Protective mechanism of tanshinone ⅡA against myocardial ischemia-reperfusion injury

  LI Yunle, LONG Chenyuanying, TAN Xing, CONG Binhai

  2025,46(12):1614-1618 ,DOI: 10.16781/j.CN31-2187/R.20240170

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  Tanshinone ⅡA is a lipid-soluble compound extracted from the roots of Salvia miltiorrhiza, a traditional Chinese medicine. It is commonly used to prevent and treat cardiovascular diseases, with coronary atherosclerotic heart disease being the prime clinical indication. Studies have demonstrated that tanshinone ⅡA can alleviate myocardial injury by regulating multiple processes involved in myocardial ischemia-reperfusion injury. This article reviews the cardioprotective mechanism of tanshinone ⅡA, focusing on its roles in inhibiting calcium overload, alleviating mitochondrial damage, inhibiting inflammatory response, regulating autophagy, and inhibiting ferroptosis, providing a theoretical basis and new perspectives for the clinical application of tanshinone ⅡA.

• Molecular mechanisms and treatment strategies for recurrence of isocitrate dehydrogenase mutation glioma

  TAO Wanru, Lü Lei, WANG Zijun, SHEN Feng, BAO Leilei

  2025,46(12):1619-1626 ,DOI: 10.16781/j.CN31-2187/R.20240708

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  Isocitrate dehydrogenase mutation（m IDH） influences the treatment and prognosis of glioma. Compared with the wild type, the glioma patients with m IDH have better prognosis, but they are also accompanied by challenges of treatment resistance and disease recurrence. The recurrence mechanism involves multiple aspects such as genomic instability, subtype transformation, stem cell renewal, changes in metabolic patterns, and dynamic adjustments of the immune microenvironment. An in-depth understanding of the recurrence resistance mechanism of glioma with m IDH is crucial for formulating and optimizing treatment strategies, such as synthetic lethal, chemoradiotherapy sensitization, and combination of targeted therapy and immunotherapy. This article reviews the recurrence mechanism of m IDH glioma and the corresponding coping strategies, so as to provide new perspectives and ideas for related research.

Short article

• Unilateral biportal endoscopic decompression for elderly patients with lumbar spinal stenosis and osteoporosis: an analysis of clinical efficacy and safety

  LU Chunwen, GUO Chao, WU Hongri, DU Shiyao, WANG Zhenwei, WANG Hui, XU Tianming*

  2025,46(12):1627-1632 ,DOI: 10.16781/j.CN31-2187/R.20250343

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  Objective To evaluate the clinical efficacy and safety of unilateral biportal endoscopic（UBE） decompression for lumbar spinal stenosis（LSS） in elderly patients with osteoporosis. Methods A retrospective analysis was conducted on 67 elderly patients with LSS and osteoporosis who underwent UBE decompression in our hospital between May 2020 and Oct. 2023. General characteristics, perioperative parameters, clinical outcomes, and complications were recorded, and the clinical efficacy indexes, including pain visual analogue scale（VAS） score, Oswestry disability index（ODI）, and Euro-quality of life-5 dimensions（EQ-5D） index, were compared and analyzed before and after operation. Results All 67 patients（32 males and 35 females; mean age [72.9±5.1] years） successfully underwent UBE decompression. The operative time was（88.2±18.4） min, visible blood loss was（82±18） mL, and hospital stay was（5.8±1.3） d. The pain VAS score was significantly decreased from 7.3±1.0 preoperatively to 2.6±0.7 12 months postoperatively（P＜0.01）; ODI was decreased from（56.5±8.2）% to（25.4±5.8）%（P＜0.01）; and EQ-5D index was increased from 0.53±0.07 to 0.79±0.05（P＜0.01）. Postoperative complications, including dural tear（n=3）, epidural hematoma（n=1）, infection（n=1）, and nerve root irritation（n=1）, occurred in 6（9.0%） patients, and all were resolved after symptomatic treatment. One（1.5%） patient required revision surgery within 12 months. Conclusion UBE decompression can relieve postoperative pain, and lead to function improvement and better quality of life in elderly LSS patients with osteoporosis, with a low incidence of postoperative complications, suggesting that it has good clinical indications and safety.

• Randomized controlled trial of Kanglaite soft capsules in treating chronic prostatitis/chronic pelvic pain syndrome

  ZHOU Tie, ZHU Baohua, QIN Shengfei

  2025,46(12):1633-1637 ,DOI: 10.16781/j.CN31-2187/R.20250544

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  Objective To evaluate the efficacy of Kanglaite soft capsule（KLTc） in treating patients with chronic prostatitis/chronic pelvic pain syndrome（CP/CPPS） and its effects on immunological parameters. Methods After providing written informed consent, patients were randomly assigned to KLTc group or terazosin group. The KLTc group received KLTc（1 800 mg, 3 times daily） and the terazosin group received terazosin（2 mg, once daily） for a 3-month course of treatment. Patients with abnormal white blood cell counts in expressed prostatic secretions received levofloxacin for 1 month. The results were assessed in the 3^rd month of treatment. The primary outcomes were changes from baseline in the total score of National Institutes of Health chronic prostatitis symptom index（NIH-CPSI） and its subdomain scores（pain, urinary symptom, and quality of life）. The secondary outcomes were changes in peripheral blood immunological parameters. Results A total of 81 patients completed the trial（KLTc group: n=41; terazosin group: n=40）. The KLTc group demonstrated significantly greater reductions in NIH-CPSI pain score（-2.78±3.32 vs-1.05±4.13）, urinary symptom score（-2.10±2.91 vs-0.50±2.54）, quality of life score（-2.24±2.36 vs-0.20±4.11）, and total NIH-CPSI score （-7.12±6.10 vs-2.30±6.91） compared with the terazosin group（all P＜0.05）. An increase in serum immunoglobulin A（Ig A） was observed in the KLTc group and the change was significant compared with the terazosin group（P＜0.05）. The KLTc group showed increased numbers of CD3⁺ and CD8⁺ T cells, whereas the terazosin group exhibited reductions; the changes in the numbers of CD3⁺ and CD8⁺ T cells were significant between the 2 groups（both P＜0.05）. No serious adverse reactions were observed in any patients. Conclusion KLTc can significantly improve urinary symptoms and quality of life in patients with CP/CPPS. Its mechanism of action may be associated with upregulation of serum Ig A levels and increased CD3⁺ and CD8⁺ immune cells.

• Association between frailty index and risk of incident type 2 diabetes mellitus in middle-aged and elderly individuals

  WANG Nan, JIANG Guanhua, HAN Xiangdong, CHEN Yueying

  2025,46(12):1638-1643 ,DOI: 10.16781/j.CN31-2187/R.20240683

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  Objective To explore the impact of frailty on the risk of type 2 diabetes mellitus（T2DM） in middle-aged and elderly Chinese individuals. Methods Data were obtained from the China Health and Retirement Longitudinal Study（CHARLS） from 2011 to 2015, and frailty was evaluated with frailty index. Logistic regression was employed to investigate the association between the frailty index and incident T2DM. Restricted cubic spline（RCS） regression analysis was used to explore possible non-linear associations. The predictive performance of the frailty index for incident T2DM was evaluated using receiver operating characteristic（ROC） curve. Results A total of 8 144 participants were enrolled, with 821（10.08%） incident T2DM cases over the 4-year follow-up period. Logistic regression analysis results indicated that for each quartile increase in the frailty index, the probability of developing T2DM increased by 29%（odds ratio=1.29, 95% confidence interval 1.19-1.41） after adjusting for confounding factors such as age, gender, sleep duration, and body mass index. RCS regression analysis results showed a non-linear dose-response relationship between the frailty index and incident T2DM(P_{non-linearity}= 0.004). When the frailty index exceeded 10.192, the risk of developing T2DM showed a gradually cumulative trend with an increase in the frailty index. The ROC curve analysis showed that the frailty index has certain predictive value for incident T2DM（area under curve=0.570）. Conclusion The frailty index is associated with incident T2DM. Routine screening, dynamic monitoring, and targeted interventions for frailty may reduce the incidence of T2DM in middle-aged and elderly individuals.

• Da Vinci robotic surgery across pediatric age groups: current situation and patient selection strategy

  YUAN Fei, QIN Xinke, YU Shengjun, DUAN Xufei, YAN Xueqiang, BIAN Hongqiang, YANG Jun, HE Xiaoqiong

  2025,46(12):1644-1648 ,DOI: 10.16781/j.CN31-2187/R.20250138

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  Objective To analyze the current use of da Vinci robotic surgery（DVRS） across pediatric age groups and propose a patient selection strategy for DVRS. Methods The surgical data of 794 children who underwent noncombined DVRS in the Department of Pediatric Surgery of our hospital from Oct. 2020 to Dec. 2023 were retrospectively analyzed. Results Among the 794 children who underwent non-combined DVRS, 433 were males and 361 were females, aged 1 d to 16 years 10 months（median 3.33 [1.00, 6.47] years）; the cohort comprised 17 neonates, 182 infants, 174 toddlers, 202 preschoolers, 194 school-aged children and 25 adolescents. The preoperative preparation time, operative time, hospital stay, and hospitalization cost for DVRS in neonates were the highest across pediatric age groups, whereas intraoperative blood loss was the lowest（all P＜0.05）. There were no significant differences in conversion rate, major-complication incidence or unplanned re-operation rate across pediatric age groups（all P＞0.05）. Among the 107 children with congenital biliary dilatation who underwent DVRS, neonates had the longest preoperative preparation time and operative time across pediatric age groups, whereas intraoperative blood loss was the lowest（all P＜0.05）. Among the 117 children with congenital biliary dilatation, the proportion of DVRS increased significantly with age（P=0.017）. Conclusion DVRS is safe and feasible across all pediatric age groups; however, the younger the children, the higher the technical difficulty, the greater the cost, and the lower the acceptance of DVRS. A stepwise implementation starting with older children and proceeding cautiously to neonates is therefore recommended.

• Comparison of abdominal unicentric Castleman’s disease and paraganglioma on computed tomography

  CHANG Jinke, LI Pengcheng, BAO Zihan, HAO Qiang, ZHANG Qianwen

  2025,46(12):1649-1654 ,DOI: 10.16781/j.CN31-2187/R.20240613

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  Objective To explore the differences in computed tomography（CT） features between abdominal unicentric Castleman’s disease（UCD） and paraganglioma（PGL）. Methods The clinical data and CT features of 28 abdominal UCD patients and 48 abdominal PGL patients confirmed by surgical pathology were retrospectively analyzed and compared. Results Patients in the PGL group were significantly older（52.0 [45.5, 63.5] years vs 38.5 [32.0, 44.0] years, P＜0.001） and had a significantly higher prevalence of hypertension（60.4% [29/48] vs 17.9% [5/28], P＜0.001） than those in the UCD group. There were no significant differences between UCD and PGL lesions in size, calcification, hemorrhage intratumoral or peritumoral vessels, degree of enhancement, enhancement pattern, or CT values of each period（all P＞0.05）; in contrast, significant differences were observed in lesion location, morphology, boundary, peritumoral fat space, cystic necrosis, fissured non-enhanced areas, and enlarged lymph nodes around the tumor（all P＜0.05）. The PGL lesions were all located in the posterior peritoneum, and the proportions of lesions with irregular shape, unclear boundary, and cystic necrosis were higher than the UCD lesions; while the UCD lesions were all round like, some were located in the mesentery, and the proportions of lesions with fuzzy peritumoral fat spaces, branching calcification, fissured non-enhanced areas, and enlarged lymph nodes around the tumor were higher than the PGL lesions. Conclusion Abdominal UCD and PGL exhibit distinct CT characteristics that can facilitate their differentiation.