ABSTRACT Objective Precise and reproducible control of wedge resection remains challenging in osteotomy correction for ankylosing spondylitis–related rigid kyphosis, and reports of robotic stereotactic execution beyond pedicle screw placement are limited. This technical note describes the operative workflow of robot‐assisted stereotactic osteotomy (RASO), focusing on quantitative wedge planning and stereotactic execution feasibility. Methods The RASO technique and operative workflow are described. Patients with type II ankylosing spondylitis‐related thoracolumbar deformity who underwent single‐level three‐column RASO between May and November 2023 were analyzed. Preoperative planning was performed using Surgimap wedge simulation with ratio‐of‐closure–based prediction, and stereotactic osteotomy trajectories were executed using the Mazor X Stealth Edition system. Perioperative parameters and immediate postoperative radiographic findings were descriptively assessed to evaluate the feasibility and reliability of the proposed operative workflow. Results This technique was successfully implemented in 15 patients. The mean operative duration was 304.2 ± 51.4 min, and the mean intraoperative blood loss was 486.7 ± 229.5 mL. Planning–execution concordance demonstrated acceptable agreement, with a maximal ratio‐of‐closure–related deviation of ≤ 5.18° and a mean difference of 0.2° between planned and achieved osteotomy Cobb angles. The mean thoracolumbar kyphosis (TLK) improved from 50.2° to 13.2°, the chin‐brow vertical angle (CBVA) improved from 36.7° to 15.1°, the PT improved from 35.6° to 26.6°, and the sagittal vertical axis (SVA) improved from 207.6 to 93.7 mm. Three intraoperative durotomies occurred during the decompression phase; one patient developed delayed cerebrospinal fluid leakage. No neurological deficits, hardware failure, or mortality were observed. All patients achieved osseous fusion and demonstrated improvements in health‐related quality of life measures. Conclusions This technical note demonstrates the technical feasibility and workflow reliability of robot‐assisted stereotactic osteotomy for rigid ankylosing spondylitis–related thoracolumbar kyphotic deformity. Quantitative wedge planning can be reproducibly translated into robotic stereotactic intraoperative execution. Further studies are required to define the broader clinical role and potential applications of this technique. Trial Registration: Chinese Clinical Trial Registry: 2400090375.

OBJECTIVE:Subaxial cervical fracture-dislocation with bilateral locked facet joints represents a critical spinal injury. The management of this condition remains a subject of debate, particularly regarding the optimal surgical approach. This study aims to introduce a quantified indicator to guide surgical decision-making and to assess its safety in clinical practice. METHODS:We retrospectively compared 62 patients treated according to the Spinal Cord Buffer Space (SCBS) criteria with 63 patients treated before SCBS was introduced. Briefly, SCBS was measured on preoperative MRI to quantitatively assess whether sufficient buffer space exists for the spinal cord, ensuring that a posterior reduction can be performed without causing iatrogenic spinal cord injury. The neural status was assessed with the American Spinal Injury Association (ASIA) impairment scale. Local sagittal alignment was evaluated at the dislocation level. Fisher's exact test and independent t-test were used to compare the parameters between the two groups. RESULTS:Surgical planning according to SCBS is relatively safe, with no patient experiencing neurologic deterioration after operation (p = 0.014). Forty-two patients with preoperative grade E on ASIA had no postoperative changes. Thirteen patients with preoperative grade D recovered to grade E after surgery, while 7 patients remained grade D but reported improved limb function. In comparison, 63 patients were treated before SCBS was introduced. Among 47 patients with preoperative grade E, 43 patients remained grade E while 4 patients were downgraded to grade D. For 16 patients with preoperative grade D, there were 2 patients with postoperative grade C, 6 patients with postoperative grade D, and 8 patients with postoperative grade E. No loosening, displacement, or breakage of the implants was observed in both groups during the follow-up. CONCLUSIONS:SCBS is a reliable and quantified indicator for surgical planning, and can significantly reduce the incidence rate of iatrogenic neurologic deterioration. For patients with a positive SCBS, posterior reduction can be safely performed. In contrast, for patients with a negative SCBS, anterior decompression should be prioritized.

There is insufficient attention to the pathogenesis of abnormal radiological changes and molecular mechanism in the paraspinal muscles in AIS patients. Proteomics of plasma exosomes were applied for identification of differentially expressed proteins (DEPs) in AIS patients through liquid chromatography mass spectrometry (LC–MS/MS). Bioinformatic analysis were performed to explore biomarkers. The muscle density (HU value) of the concave and convex sides of paravertebral muscles in AIS patients was compared. HE staining were applied for investigation of pathological changes of paravertebral muscles. Cartilage intermediate layer protein-1 (CILP-1), TGF-β1/Smad pathway and the downstream proteins were compared between the concave and convex side of paraspinal muscle. C2C12 cells were incubated with TGF-β1 or Smad3 phosphorylation inhibitor (SIS3) to further clarify the correlation between CILP-1 and TGF-β1/Smad pathway. A total of 2437 proteins were identified, among which DEPs were enriched in immune response and extracellular matrix-receptor interaction, while CILP-1 was screened out. HU value of concave multifidus muscle (MF) in apical vertebrae area was significantly lower when compared with both convex MF and control group. Muscle fibrosis, increased CILP-1, TGF-β1 phosphorylation of Smad2/3 and downstream proteins could be observed in the concave side of paraspinal muscle. TGF-β1 stimulation resulted in upregulation of CILP-1 and ECM related proteins, which could be partially inhibited by SIS3. We confirmed the asymmetric expressions of CILP-1 and TGF-β1/Smad signaling pathways in the paravertebral muscles of AIS patients. In C2C12 cells, TGF-β1 induced up-regulation of CILP-1 expression via Smad3 phosphorylation.

Background:Percutaneous coronary intervention (PCI) is a cornerstone treatment for coronary artery disease (CAD), yet opportunities remain to improve clinical outcomes, symptom management, and long-term prognosis. Traditional Chinese Medicine (TCM), with its multi-target and multi-pathway mechanisms, offers a promising complementary approach to enhance PCI efficacy. Methods:A systematic search was conducted in PubMed and Web of Science using the terms: ("Percutaneous Coronary Intervention" AND "Traditional Chinese Medicine") and ("Percutaneous Coronary Intervention" AND "Chinese Herbal Drugs"). Randomized controlled trials (RCTs) with ≥100 participants were included to evaluate TCM's clinical efficacy in PCI. Pharmacological studies were also reviewed to explore underlying mechanisms. Results:A review of 20 RCTs showed that TCM plays multiple roles in CAD treatment during PCI. Specific interventions such as Danhong Injection, Tongxinluo Capsule, and Shenzhu Guanxin Granule were found to alleviate angina symptoms, restore cardiac function, reduce cardiac biomarkers, prevent no-reflow/slow-flow phenomena, inhibit in-stent restenosis, and improve prognosis while reducing complications. Mechanistically, TCM exerts its effects through antiplatelet action, anti-inflammation, inhibition of smooth muscle proliferation, vasodilation, microcirculation improvement, and endothelial protection. Conclusion:This systematic review highlights the complementary benefits of TCM in PCI for CAD patients. Effective interventions such as Danhong Injection and Tongxinluo Capsule contribute to symptom relief, cardiac function restoration, restenosis inhibition, and prognosis improvement. These benefits are linked to TCM's multi-target mechanisms, including anti-inflammatory and antiplatelet effects. Future high-quality studies are needed to further validate these findings and refine clinical applications.

BackgroundFemoral nonunion after intramedullary nailing (IMN) of a diaphyseal long bone fracture is a severe complication that requires effective management. The IMN dynamization has been used to treat hypertrophic nonunions previously. However, routine nail dynamization has only a low success rate and the risk of limb shortening.MethodsTwo patients with femoral shaft fracture hypertrophic nonunion at 4 or 5 months after intramedullary nailing were treated with the therapeutic paradigm named “controlled nail dynamization”. In this paradigm, the interlocking nails are removed but the dynamic hole nails are retained. At the same time, four Poller screws were used to limit the movement of the intramedullary nail in the coronal and sagittal planes. The intramedullary nail can only generate compressive stress along the axial direction of the femoral shaft, thereby promoting fracture healing. So this technique was named “controlled nail dynamization”.ResultsHere, we describe two cases of delayed healing of the femoral diaphysis, which were successfully treated through controlled nail dynamization. Followed up for more than 12 months. Bone union was achieved in both patients, and there were no complications such as nonunion and internal fixation failure.ConclusionThe controlled nail dynamization is feasible for safe and effective treatment for femoral shaft hypertrophic nonunion.

Background: Statin treatment can reduce atherosclerotic plaque as detected via invasive intracoronary methods. However, few studies have evaluated the effect of moderate-intensity statin therapy on carotid intraplaque neovascularization (IPN) using semiquantitative indices. This study thus aimed to assess the effect of statin on the carotid IPN of coronary artery disease with contrast-enhanced ultrasound (CEUS). Methods: In this noncontrol, retrospective, cohort study, 35 inpatients who underwent coronary angiography, serial CEUS, and laboratory evaluations were consecutively enrolled from June 2020 to December 2022 at the Department of Cardiology, Chinese PLA General Hospital. All patients were administered moderate-intensity statin during serial CEUS, and continuous and categorical assessment of IPN and maximum plaque height (MPH) of carotid plaque was performed. Patients with a target low-density lipoprotein cholesterol (LDL-C) <1.8 mmol/L at 12-month follow-up were compared with those who did not reach the LDL-C 1.8 mmol/L target. Results: From baseline to 12-month follow-up, there were significant differences in the LDL-C levels between patients (2.71 +/- 1.29 vs. 1.35 +/- 0.83 mmol/L), those with 12-month follow-up LDL-C <1.8 mmol/L (2.58 +/- 1.24 vs. 1.08 +/- 0.52 mmol/L), and those with 12-month follow-up LDL-C >= 1.8 mmol/L (3.24 +/- 1.44 vs. 2.56 +/- 0.85 mmol/L) all P values <0.05, with decreases of 41%, 49%, and 11% from baseline, respectively. The mean MPH (12 months to baseline) decreased from 2.47 +/- 0.63 to 2.22 +/- 0.60 mm (P<0.05), and the IPN also decreased from 1.15 +/- 0.62 to 0.58 +/- 0.56, representing a reduction of 0.57 +/- 0.59 from baseline (P<0.001). In the LDL-C <1.8 mmol/L patients, there were significant differences between baseline and 12 months in MPH (2.37 +/- 0.56 vs. 2.03 +/- 0.52 mm; P<0.05) and IPN (1.32 +/- 0.77 vs. 0.54 +/- 0.63; P<0.05) compared with those with a follow-up LDL-C >= 1.8 mmol/L. Patients with a follow-up LDL-C <1.8 mmol/L, compared with those with a follow-up LDL-C >= 1.8 mmol/L, showed a significantly greater reduction in MPH (-0.34 +/- 0.46 vs. -0.13 +/- 0.39; P<0.05) and IPN (-0.79 +/- 0.63 vs. -0.57 +/- 0.79; P<0.05). Additionally, patients with carotid IPN regression showed a higher percent change in LDL-C compared with those without carotid IPN regression (-53.31 +/- 23.20 vs. -29.55 +/- 19.47; P<0.05). Conclusions: Controlling the LDL-C to <1.8 mmol/L under moderate-intensity statin can stabilize and reduce carotid IPN as detected by the semiquantitative noninvasive CEUS.

BackgroundLaminotomy and laminar replantation have emerged as novel treatment modalities for intraspinal tumors, aiming to minimize postoperative complications and retain spinal mobility. However, existing research predominantly emphasizes their application in the thoracolumbar spine. The unique anatomy of the atlantoaxial segments necessitates surgical techniques that differ from those used in other spinal regions, and the clinical effect of such procedure remains unknown.Case presentationA 61-year-old male patient with intradural schwannoma at the atlantoaxial level was operated on. The patient underwent posterior laminectomy, as well as a combined replantation of the posterior arch of the atlas and bilateral axial laminae. Postoperatively, the patient experienced significant neurological improvement, with no deformities or instability on the radiological assessments during the follow-up.ConclusionLaminotomy with combined replantation of the posterior arch of the atlas and bilateral axial lamina emerges as an effective approach for managing intraspinal tumors at the atlantoaxial level. This technique not only offers ample operating space but also restores the stability of the spinal canal. Moreover, it preserves the mobility of the atlantoaxial segment, minimizes impact on adjacent segments, and mitigates the formation of postoperative fibrosis.

OBJECTIVES:The aim of this study is to investigate the safety and efficacy of excimer laser coronary angioplasty (ELCA) combined with drug-coated balloons (DCBs) in the treatment of in-stent restenosis (ISR), and to explore whether the contrast injection technique would improve the neointimal tissue ablation of ELCA. METHODS:We studied patients diagnosed with ISR between January 2019 and October 2022 at two medical centers. These patients underwent DCB angioplasty guided by optical coherence tomography (OCT). Based on whether ELCA was performed before DCB treatment, patients were categorized into two groups: the ELCA + DCB group and the DCB group. All patients underwent clinical follow-up 1 year after the procedure. The primary endpoint was the 1-year rate of target lesion revascularization (TLR), which was defined as any repeat percutaneous intervention or bypass surgery on the target vessel conducted to address restenosis or other complications related to the target lesion. The secondary endpoints including immediate luminal gain (ΔMLA, defined as the difference in minimum lumen area before and after the intervention). RESULTS:A total of 85 lesions in 75 patients were included. The mean age of the study population was 64.2 ± 12.0 years, with 81.3% male. Baseline clinical characteristics were well-balanced, and procedural success was 100% in both groups. The ELCA + DCB group (n = 24) exhibited a greater ΔMLA compared to the DCB group (n = 61) (3.57 ± 0.79 mm² vs. 2.50 ± 1.06 mm², [95% confidence interval, CI: 0.57-1.69], p < 0.001), The reduction in 1-year TLR was more frequently observed in patients from the ELCA + DCB group compared to the DCB group (hazard ratio 0.33 [95% CI: 0.11-0.99]; log-rank p = 0.048). The exploratory analysis showed that ELCA with contrast infusion is associated with greater acute lumen gain compared to ELCA with saline infusion (p < 0.001). CONCLUSIONS:The combination of ELCA and DCB is a safe and effective treatment strategy for in-stent stenosis. Additionally, compared with saline injection, ELCA with contrast injection is associated with greater acute lumen gain. However, the optimal contrast agent concentration and long-term outcome of the contrast injection technique need confirmation through larger sample sizes and prospective studies.

Background and aims To explore the effect of PCSK9 inhibitor based on the background of statin on carotid intraplaque neovascularization (IPN) assessed by serial contrast-enhanced ultrasound (CEUS) analysis in Chinese patients with premature coronary artery disease (PCAD). Methods 41 patients were included to receive treatments with biweekly evolocumab (n = 22) or placebo (n = 19) in addition to statin therapy for 52 weeks. All patients were newly diagnosed with PCAD and treatments were initiated at baseline of the observations. The baseline and 52-week CEUS were acquired to measure the max plaque height (MPH) and IPN. The primary outcome was the 52-week IPN changes, the secondary endpoints included the 52-week MPH changes and major adverse cardiovascular events. Results The mean ± SD age of the participants was 46.76 ± 8.56 years, and 61% (25/41) of patients were on statins before the start of the study. There was no statistically significant difference in the history of statins treatment and the initiated lipid-lowering therapy of Atorvastatin and Rosuvastatin between groups (p > 0.05). At 52 weeks, the evolocumab group showed a lower LDL level (0.84 ± 0.45 mmol/L vs. 1.58 ± 0.51 mmol/L, p < 0.001) and a greater decrease in percent reduction of LDL-C level (−65% vs. −32%) and a higher percent of achieving lipid-lowering target (95% vs. 53%, p < 0.05) compared with the placebo group. At 52 weeks, IPN (evolocumab group: 0.50 ± 0.60 vs. 1.50 ± 0.80, p < 0.001; placebo group: 0.79 ± 0.54 vs. 1.26 ± 0.65, p < 0.05) and MPH (evolocumab group: 2.01 ± 0.44 mm vs. 2.57 ± 0.90 mm, p < 0.05, placebo group: 2.21 ± 0.58 mm vs. 2.92 ± 0.86 mm, p < 0.05) reduced significantly in both groups from baseline to 52-week follow-up. IPN and MPH were decreased by both treatments. Still, there was no significant difference in delta (52 weeks - baseline) MPH by an ANOVA analysis between two groups [evolocumab group: −0.56 mm (2.01 mm–2.57 mm); placebo group: −0.71 mm (2.21 mm–2.92 mm), p > 0.05]. In the evolocumab group, the change in the mean reduction of IPN from baseline [-1.00 (0.50–1.50) vs. −0.47 (0.79–1.26), p < 0.05] and the incidence of patients with carotid IPN decrease were significantly greater reduction (90% vs. 58%, p < 0.05). Conclusions If compared to the placebo, the PCSK9 inhibitor evolocumab combined with statins resulted in a greater decrease in LDL-C and plaque neovascularization in Chinese patients with PCAD.

Objective: To compare the clinical efficacy of anterior column reconstruction using single or double titanium mesh cage (TMC) after total en bloc spondylectomy (TES) of thoracic and lumbar spinal tumors.Methods: A retrospective cohort study was performed involving 39 patients with thoracic or lumbar spinal tumors. All patients underwent TES, followed by anterior reconstruction and screw-rod instrumentation via a posterior-only procedure. Twenty-two patients in group A were treated with a single TMC to reconstruct the anterior column, whereas 17 patients in group B were reconstructed with double TMCs.Results: The overall follow-up is 20.5 ± 4.6 months. There is no significant difference between the 2 groups regarding age, sex, body mass index, tumor location, operative time, and intraoperative blood loss. The time for TMC placement was significantly shortened in the double TMCs group (5.2 ± 1.3 minutes vs. 15.6 ± 3.3 minutes, p = 0.004). Additionally, postoperative neural complications were significantly reduced with double TMCs (5/22 vs. 0/17, p = 0.046). The kyphotic Cobb angle and mean intervertebral height were significantly corrected in both groups (p ≤ 0.001), without obvious loss of correction at the last follow-up in either group. The bone fusion rates for single TMC and double TMCs were 77.3% and 76.5%, respectively.Conclusion: Using 2 smaller TMCs instead of a single large one eases the placement of TMC by shortening the time and avoiding nerve impingement. Anterior column reconstruction with double TMC is a clinically feasible, and safe alternative following TES for thoracic and lumbar tumors.

Background Atherosclerosis may be linked to morphological defects that lead to variances in coronary artery hemodynamics. Few objective strategies exit at present for generalizing morphological phenotypes of coronary arteries in terms of hemodynamics. We used unsupervised clustering (UC) to classify the morphology of the left main coronary artery (LM) and looked at how hemodynamic distribution differed between phenotypes. Methods In this study, 76 LMs were obtained from 76 patients. After LMs were reconstructed with coronary computed tomography angiography, centerlines were used to extract the geometric characteristics. Unsupervised clustering was carried out using these characteristics to identify distinct morphological phenotypes of LMs. The time-averaged wall shear stress (TAWSS) for each phenotype was investigated by means of computational fluid dynamics (CFD) analysis of the left coronary artery. Results We identified four clusters (i.e., four phenotypes): Cluster 1 had a shorter stem and thinner branches ( n = 26); Cluster 2 had a larger bifurcation angle ( n = 10); Cluster 3 had an ostium at an angulation to the coronary sinus and a more curved stem, and thick branches ( n = 10); and Cluster 4 had an ostium at an angulation to the coronary sinus and a flatter stem ( n = 14). TAWSS features varied widely across phenotypes. Nodes with low TAWSS (L-TAWSS) were typically found around the branching points of the left anterior descending artery (LAD), particularly in Cluster 2. Conclusion Our findings demonstrated that UC is a powerful technique for morphologically classifying LMs. Different LM phenotypes exhibited distinct hemodynamic characteristics in certain regions. This morphological clustering method could aid in identifying people at high risk for developing coronary atherosclerosis, hence facilitating early intervention.

Background: The ideal treatment for giant cell tumor of bone (GCTB) is still controversial. Various surgical adjuvants have been introduced following intralesional curettage to improve local control rates. However, findings from relevant studies are inconsistent, and no consensus has been reached. The purpose of this study is to determine what intraoperative adjuvant is effective in decreasing the recurrence of GCTB. Methods: We performed a systematic review and meta-analysis of articles published in the PubMed electronic database which assessed the recurrence rate of GCTB following intralesional curettage with or without various surgical adjuvants. Two authors independently evaluated all publications. Meta-analysis was performed with Stata/MP (Version 17.0, StataCorp LLC, TX, USA) and Review Manager (RevMan, Version 5.4.1, The Cochrane Collaboration, 2020). Pooled risk ratio (RR) was used for analysis, with P values less than 0.05 considered statistically significant. Results: Twenty-four studies involving 2,579 patients were included in this analysis. The overall recurrence rates for patients treated with or without high-speed burring (HSB) are 11.9% (26/218) and 47.7% (92/193), respectively. The pooled RR for tumor recurrence is 0.33 (95% CI: 0.22 to 0.49, P<0.001). In the meanwhile, the overall recurrence rates for patients treated with or without chemical adjuvants are 23.5% (77/328) and 26.1% (73/280), respectively, with a pooled RR of 0.84 (95% CI: 0.63 to 1.10, P=0.89). Additionally, the overall recurrence rates for patients treated with or without polymethyl methacrylate (PMMA) are 20.4% (205/1,006) and 33.4% (314/939), respectively, with a pooled RR of 0.59 (95% CI: 0.50 to 0.69, P<0.001). Conclusions: Intraoperative application of HSB or PMMA has an additional antitumor effect, while the use of phenol or H2O2 fails to make any significant difference (PROSPERO: CRD42022344262).

Background Acute mountain sickness (AMS) is the most prevalent condition resulting from hypobaric hypoxia (HH) at high altitudes. Although evidence suggests the involvement of inflammatory cytokines in AMS development, there is currently a lack of reports on variations in cytokine levels between individuals susceptible to AMS and those resistant to AMS prior to ascending to high altitude. Thus our current study aims to assess the predictive capability for AMS occurrence by evaluating differences in cytokine levels at low altitudes. Methods The present study recruited 48 participants, who ascended from low altitude to middle high-altitude (3700 m) and further to extreme high-altitude (5000 m). Based on Lake Louise Score (LLS) at the two high altitudes, participants were categorized into severe AMS-susceptible (sAMS), moderate AMS-susceptible (mAMS), and non-AMS groups. The Bio-Plex MAGPIX System was employed to measure plasma levels of 11 inflammatory cytokines. Cytokines at low altitude and middle high-altitude were analyzed through receiver operating characteristic (ROC) analysis to obtain area under the ROC curve (AUROC), sensitivity, and specificity. Results Based on LLS at 3700 m, we initially categorized the study subjects into the sAMS group (n = 8) and the Non-AMS group (n = 40). Among individuals in the non-AMS group (n = 40) at the altitude of 3700 m, those who developed AMS at the altitude of 5000 m were assigned to the mAMS group (n = 17), whereas those who did not experience AMS were included into the non-AMS group (n = 23). The concentration of TNF-α at low altitude exhibited robust predictive performance for predicting AMS occurrence at the altitude of 3700 m. Among the non-AMS group at the altitude of 3700 m, we identified that the concentration of IL-2 and IL-17A demonstrated high efficacy in predicting the onset of AMS following ascent to 5000 m. In addition, differentially expressed cytokines including IL-17A, TNF-α and IL-2 at low altitude possessed discriminatory potential among the three groups at 5000 m.. Conclusion We posited that the levels of TNF-α, IL-2, IL-17A in serum of low altitude could be considered as potential biomarkers to predict the occurrence of AMS at high altitude. New & noteworthy Through the two comparisons at different two altitudes (baseline level and 3700 m), we provided a model to progressively screen individuals who are susceptible and resistant to different high altitudes (3700 m and 5000 m). TNF-α could firstly screen out the AMS susceptible individuals at the altitude of 3700 m. And through its combination with IL-2 and IL-17A, we could further screen out AMS susceptible individuals at the altitude of 5000 m.

Objective To propose a novel free-hand pedicle screw placement technique in the lumbar spine and investigate its accuracy and safety in clinical practice. Methods 110 patients with herniation of a single lumbar disc were recruited for our study. All patients were consistently treated with posterior discectomy, interbody fusion, and transpedicular internal fixation. For 54 patients in the observation group, the pedicle screws were placed with our technique, which is located at 4 mm below the superior edge of the transverse process in line with the lateral margin of the superior articular process. For 56 patients in the control group, pedicle screws were placed according to the traditional crista lambdoidalis method. Comparisons were made in terms of the operation time, blood loss, time for exposure, the accuracy of placement, and postoperative complications. In addition, we prospectively applied our method to 64 patients with indistinguishable crista lambdoidalis and evaluated the accuracy of screw placement and clinical outcomes. Results There was no significant difference in intraoperative bleeding, accuracy of placement, and postoperative complications between our technique and the traditional crista lambdoidalis method (P > 0.05). However, the exposure time before screw placement (12.8 ± 0.3 vs 17.4 ± 0.3, p = 0.001) and the total surgery time (97.2 ± 1.9 vs 102.3 ± 0.9, p = 0.020) were significantly shortened with our method. Additionally, in cases of indistinguishable crista lambdoidalis, our technique showed satisfying accuracy, with 97.6% screws placed in appropriate trajectory on the first attempt and all screws eventually positioned in the safe zone according to the Gertzbein Robbins grading. All patients experienced steady improvement after surgery, as assessed with the visual analog pain scale and the Japanese Orthopaedic Association (JOA) score. Conclusion This study highlights a safe and effective technique for pedicle screw placement in the lumbar spine, which is particularly useful in cases of vertebral fracture and severe hyperplasia or degeneration of the facet joint.

Aim: To investigate the correlation between carotid plaque parameters detected on contrast-enhanced ultrasound (CEUS) and the plaque progression in non-culprit coronary lesions (NCCLs) after percutaneous coronary inter-vention (PCI).Methods: In this retrospective cross-sectional study, we analyzed 173 patients who underwent PCI. Patients were stratified into two groups (progression and non-progression groups) by comparing the coronary angiography (CAG) results at baseline and follow-up. The correlation between carotid plaque parameters and plaque pro-gression in NCCLs was analyzed by multivariate logistic regression analysis. A logistic regression model was established to predict NCCLs progression.Results: Overall, 55 of 173 patients exhibited NCCLs progression (31.79%). Univariate comparisons showed that plaque thickness, plaque length, and IPN score were significantly higher in the progressive group than in the non-progressive group (P < 0.01). Multivariate logistic regression analysis revealed that carotid plaque length (OR = 3.418, 95% CI =1.101-10.610) and IPN score (OR = 7.395, 95% CI =3.154-17.342) were strongly associated with plaque progression in NCCLs. After adjusting for confounders, the history of previous PCI, plaque length, and IPN score were independent predictors of the NCCLs progression (P < 0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the logistic regression model in predicting the NCCLs progression were 62.50%, 90.53%, 81.12%, 76.92%, and 82.69%, respectively, and the area under the receiver operating characteristic (ROC) curve was 0.882 (95% CI: 0.826-0.939). Conclusions: Carotid plaque length and IPN score were strongly correlated with plaque progression in NCCLs. Combining the history of previous PCI can reasonably predict the NCCLs progression.

Background: It is thought that the progression of vulnerable plaque is due in part to neovascularization, and plaque vulnerability is a useful approach for classifying cardiovascular risk. The aim of this retrospective study was to evaluate the correlation between carotid intraplaque neovascularization (IPN) detected on contrast -enhanced ultrasound and the progression of coronary lesions in patients undergoing percutaneous coronary intervention (PCI).Methods: Contrast-enhanced ultrasound and angiography were performed in 131 patients undergoing PCI. All patients had angiograms obtained $12 months after PCI, and progression was defined using those angio-grams. On the basis of angiographic images, patients were divided into progression and nonprogression groups. IPN was graded from 0 to 3 according to each plaque's microbubble appearance and extent, detected using contrast-enhanced ultrasound. The plaque with the highest IPN was used for analysis. Logistic regres-sion and receiver operating characteristic analyses were applied to evaluate risk factors for predicting the progression of coronary lesions in patients undergoing PCI.Results: In the progression group, the numbers of patients with IPN values of 0, 1, 2, and 3 were one (3.3%), nine (30.0%), 16 (53.3%), and four (13.3%), respectively. Significant differences were found in maximum pla-que height and IPN between groups. IPN and maximum plaque height were independent risk contributors to coronary lesion progression in patients undergoing PCI. The sensitivity, specificity, positive predictive value, and negative predictive value of IPN of 1.5 and to predict the progression of coronary lesions were 67%, 91%, 68%, and 89%, respectively. The area under the curve was 0.822.Conclusions: Carotid plaque neovascularization was correlated with the progression of coronary lesions in pa-tients undergoing PCI. IPN is a clinically useful tool for detecting the progression of coronary lesions and for risk stratification, especially in patients >60 years old. (J Am Soc Echocardiogr 2023;36:216-23.)

OBJECTIVE:To assess the safety and effectiveness of intravascular lithotripsy (IVL) treatment for de novo coronary lesion involving severely calcified vessels in a Chinese population.METHODS:The Clinical Trial of the ShOckwave Coronary IVL System Used to Treat CalcIfied Coronary ArtEries (SOLSTICE) was a prospective, single-arm, multicentre trial. According to the inclusion criteria, patients with severely calcified lesions were enrolled in the study. IVL was used to perform calcium modification prior to stent implantation. The primary safety endpoint was freedom from major adverse cardiac events (MACEs) at 30 days. The primary effectiveness endpoint was procedural success, defined as successful stent delivery with residual stenosis < 50% by core lab assessment without in-hospital MACEs. The morphological changes of calcium modification were assessed by optical coherence tomography (OCT) before and after IVL treatment.RESULTS:Patients (n = 20) were enrolled at three sites in China. Severe calcification by core lab assessment was present in all lesions, with a mean calcium angle and thickness of 300 ± 51° and 0.99 ± 0.12 mm (by OCT), respectively. The 30-day MACE rate was 5%. Both primary safety and effectiveness endpoints were achieved in 95% of patients. The final in-stent diameter stenosis was 13.1% ± 5.7% with no patient had a residual stenosis < 50% after stenting. No serious angiographic complications (severe dissection grade D or worse, perforation, abrupt closure, slow flow/no-reflow) observed at any time during the procedure. OCT imaging demonstrated visible multiplane calcium fracture in 80% of lesions with a mean stent expansion of 95.62% ± 13.33% at the site of maximum calcification and minimum stent area (MSA) of 5.34 ± 1.64 mm2.CONCLUSIONS:The initial coronary IVL experience for Chinese operators resulted in high procedural success and low angiographic complications consistent with prior IVL studies, reflecting the relative ease of use of IVL technology.

Background:Ascending to high altitude can induce a range of physiological and molecular alterations, rendering a proportion of lowlanders unacclimatized. The prediction of acute mountain sickness (AMS) prior to ascent to high altitude remains elusive.Methods:A total of 40 participants were enrolled for our study in the discovery cohort, and plasma samples were collected from all individuals. The subjects were divided into severe AMS-susceptible (sAMS) group, moderate AMS-susceptible (mAMS) group and non-AMS group based on the Lake Louise Score (LLS) at both 5000m and 3700m. Proteomic analysis was conducted on a cohort of 40 individuals to elucidate differentially expressed proteins (DEPs) and associated pathways between AMS-susceptible group and AMS-resistant group at low altitude (1400m) and middle high-altitude (3700m). Subsequently, a validation cohort consisting of 118 individuals was enrolled. The plasma concentration of selected DEPs were quantified using ELISA. Comparative analyses of DEPs among different groups in validation cohort were performed, followed by Receiver Operating Characteristic (ROC) analysis to evaluate the predictive efficiency of DEPs for the occurrence of AMS.Results:The occurrence of the AMS symptoms and LLS differed significantly among the three groups in the discovery cohort (p<0.05), as well as in the validation cohort. Comparison of plasma protein profiles using GO analysis revealed that DEPs were primarily enriched in granulocyte activation, neutrophil mediated immunity, and humoral immune response. The comparison of potential biomarkers between the sAMS group and non-AMS group at low altitude revealed statistically higher levels of AAT, SAP and LTF in sAMS group (p=0.01), with a combined area under the curve(AUC) of 0.965. Compared to the mAMS group at low altitude, both SAP and LTF were found to be significantly elevated in the sAMS group, with a combined AUC of 0.887. HSP90-α and SAP exhibited statistically higher levels in the mAMS group compared to the non-AMS group at low altitude, with a combined AUC of 0.874.Conclusion:Inflammatory and immune related biological processes were significantly different between AMS-susceptible and AMS-resistant groups at low altitude and middle high-altitude. SAP, AAT, LTF and HSP90-α were considered as potential biomarkers at low altitude for the prediction of AMS.

目的:基于光电容积脉搏波描记法(PPG)和人工智能算法的智能血压监测设备预测血压的两种模式准确性比较.方法:使用智能血压监测设备(O2Ring指环)采集患者PPG信号后上传至深度卷积神经网络(DCNN)系统,用于提取患者PPG信号的自身特征,并构建回归网络连接其特征,通过不断采集临床数据和机器学习来优化算法.O2Ring指环预测血压有直接预测和标定预测两种算法模式,采集41例临床高血压患者446个时间点的血压数据,将两种模式的预测血压值与动态血压计实测的血压值进行比较,对比两种预测血压模式的准确性.结果:41例患者的收缩压O2Ring指环的直接预测值和标定预测值与动态血压计的实测值比较,差异无统计学意义(t=-0.237,t=1.738;P>0.05);舒张压的O2Ring指环的直接预测值与动态血压计的实测值比较,差异有统计学意义(t=-6.332,P<0.001),舒张压的O2Ring指环的标定预测值与动态血压计的实测值比较,差异无统计学意义(t=-1.371,P>0.05).Pearson相关分析,收缩压的实测值与直接预测值和标定预测值均有显著相关性(r=0.5195,r=0.8828;P<0.001);舒张压的实测值与直接预测值和标定预测值亦都有显著相关性(r=0.4333,r=0.7544;P<0.001).标定预测值与实测值的一致性亦好于直接预测.结论:基于PPG信号和人工智能算法的标定预测模式与直接预测模式相比,能够更准确预测血压,可为临床应用提供参考.