People's Liberation Army 401 Hospital

Colorectal cancer (CRC) exhibits high incidence and mortality rates, and current therapeutic approaches remain limited, underscoring the urgent need for novel treatment strategies. Astragali Radix, a traditional Chinese medicine with diverse pharmacological properties, has shown potential in cancer therapy; however, its anti-CRC mechanisms remain poorly understood. This study investigated the active components of A. Radix and their anti-CRC mechanisms using an integrated approach combining network pharmacology, molecular docking, and in vitro and in vivo experiments. Twenty active components of A. Radix with high oral bioavailability and drug-likeness were screened from databases, and relevant networks were constructed to identify core targets, including SRC, PIK3CA, and AKT1. Enrichment analysis revealed that these targets are primarily involved in the regulation of the PI3K-Akt signaling pathway. Molecular docking confirmed strong binding affinity between the active components of A. Radix and the core targets. In vitro experiments on HCT 116 and HT 29 cells demonstrated that A. Radix and quercetin inhibited cell proliferation in a concentration- and time-dependent manner, downregulating the mRNA expression of key genes (PIK3CA, PIK3R1, AKT1) in the PI3K-Akt pathway, and A. Radix showed superior efficacy compared with quercetin. Western blot analysis confirmed that the protein levels of PI3K, p-PI3K, AKT, p-AKT, PIK3CA, PIK3R1, and AKT1 were reduced in A. Radix-treated cells, as were the ratios of p-PI3K/PI3K and p-AKT/AKT. In vivo experiments on MC38 tumor-bearing mice further revealed that A. Radix significantly suppressed tumor growth and reduced pathway-related protein levels, outperforming quercetin. Additionally, acute toxicity experiments confirmed the favorable safety profile of A. Radix. This study demonstrates that A. Radix inhibits tumor cell proliferation through multi-component targeting of the PI3K-Akt signaling pathway, providing new therapeutic targets and theoretical evidence for CRC treatment. Furthermore, it establishes a methodological framework for the modern investigation of traditional Chinese medicine formulations.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital coronary anomaly. This case report describes an adult male with anomalous origin of the left coronary artery from the pulmonary artery, in whom transthoracic echocardiography revealed mitral valve prolapse without apparent anomalies of the coronary ostia. The definitive anatomical diagnosis was established using invasive coronary angiography and coronary computed tomography angiography. This case underscores the indispensable value of multimodality imaging in the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery.

To evaluate the clinical outcomes of intramedullary nailing and dual-plate fixation for the treatment of proximal humeral fractures in an indication-based retrospective cohort. A retrospective analysis was conducted on 69 patients with proximal humeral fractures admitted to our hospital from October 2022 to August 2024. Among them, 32 patients underwent fixation using Proximal humerus internal locking system (Philos) combined with a medial support plate (dual-plate group), while 37 patients underwent intramedullary nailing (intramedullary nailing group). All patients received early systematic rehabilitation therapy. Surgical parameters, hospital stay, fracture healing time, shoulder function scores, and postoperative complications were compared between the two groups. The intramedullary nailing group had shorter operative time, hospital stay, and fracture healing time compared to the dual-plate group (P < 0.05). The intraoperative blood loss was also lower in the intramedullary nailing group (P < 0.05). Postoperatively, the shoulder function scores in both groups improved significantly compared to preoperative values (P < 0.05), with significantly higher scores in the intramedullary nailing group than in the dual-plate group (P < 0.05). In this indication-based retrospective cohort, intramedullary nailing was associated with shorter operative time, less intraoperative blood loss, faster fracture healing and better shoulder function scores than double plating in proximal humeral fractures with relatively preserved medial support. Double-plate fixation remains an important option for complex fractures with severe medial column deficiency and poor bone quality, despite greater surgical trauma. These findings should not be interpreted as evidence that intramedullary nailing is superior for all proximal humeral fractures, and prospective randomized studies are needed to confirm the results.

To further explore relative biological effectiveness (RBE) variability, the RBE of different intracerebral cells at various irradiation (IR) dosages and time were determined in this study. A total of 120 rabbits were randomly divided into proton groups (0, 10, 20, 30, 40 Gy, RBE) (n = 3) and photon groups (0, 10, 20, 30, 40 Gy) (n = 3). The rabbits were sacrificed at 2, 4, 6, 8 weeks after brain IR. Neuronal survival, identified via Hematoxylin and Eosin (H&E) staining, and immunohistochemical detection of neurofilament (NF), Olig2, and CD68 in the hippocampus and thalamus, were analyzed. Dose- and time-dependent RBE curves were fitted using the LQ model. Proton IR showed higher neuronal survival at 4-, 6-, and 8-weeks post 10 Gy, 20 Gy, 30 Gy IR (p < 0.05) compared to photon IR. Oligodendrocyte populations in photon group at 4-, 6-, and 8-weeks post 10 Gy IR and 6-, 8-weeks post 20 Gy were consistently higher than proton subgroups (p < 0.05). While proton IR showed higher microglial activation which was observed only at 4-weeks post 30y IR. Proton RBE for neurons and oligodendrocytes remained below 1.1 but exceeded 1.1 for microglial activation. These findings demonstrate the dose- and time- dependent nature of proton RBE and suggest brain tissue tolerates higher proton IR doses compared to photon IR, which fully confirmed the biological advantages of proton IR. These will help clinicians more precisely set the organ limit at risk and tailor radiotherapy plans.

This study compares the diagnostic performance of ultrasound (US) and magnetic resonance imaging (MRI) in detecting abnormalities such as ligament tears, tendon injuries, or fractures in the ankle, while also evaluating their clinical utility and limitations. This study involved 83 patients with first-time ankle injuries. Surgical exploration served as the reference standard to compare and analyze US and MRI, evaluating sensitivity, specificity, positive predictive value (PPV, %), negative predictive value (NPV, %), accuracy (%), and area under the curve (AUC). US demonstrated significant diagnostic advantages for most ankle injuries, achieving 100% across all metrics for anterior talofibular ligament (ATFL) injury (κ = 1, AUC = 1). Moreover, US exhibited significantly higher overall diagnostic performance (AUC) compared to MRI for the calcaneofibular ligament (CFL), deltoid ligament (DL), peroneus longus tendon (PLT), and fracture detection. Conversely, MRI showed superior performance for syndesmotic (SDM) injury compared to US, with sensitivity rates of 46.67% versus 33.33% (AUC: 0.658 vs. 0.591), while maintaining 100% specificity for both ATFL injury and fracture. Both modalities demonstrated high sensitivity (100%) and excellent diagnostic value (AUC > 0.9) for tibialis posterior tendon (TPT) injury. This study confirms that US demonstrates superior performance in diagnosing superficial ligament injuries, specifically the ATFL and the CFL. In contrast, MRI is indispensable for evaluating deeper complex structures, such as the SDM and fracture lesions. Both modalities exhibit a complementary relationship in the diagnosis of ankle injuries.

An increasing amount of clinical evidence indicates that one-stage exchange arthroplasty provides outcomes comparable to those of two-stage exchange arthroplasty in the management of chronic periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). However, for cases complicated by a sinus tract, most specialists still advocate a two-stage exchange arthroplasty strategy. This study aims to evaluate the effectiveness of one-stage exchange arthroplasty in treating chronic PJI following TKA with sinus tract formation and to determine the feasibility of this approach in achieving infection control and restoring joint function. A retrospective analysis was conducted on 23 patients with PJI following TKA accompanied by a sinus tract, who were admitted between January 1, 2019 and December 31, 2023. All patients completed a minimum follow-up of 12 months. During this period, microbiological findings, individualized antimicrobial regimens, and incidences of infection recurrence were meticulously documented. To objectively evaluate infection control, serial measurements of serum inflammatory markers—including the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT)—were obtained preoperatively and on postoperative days 3, 7, 10, and 14, allowing for assessment of their dynamic changes. Furthermore, to assess functional recovery, the visual analog scale (VAS) score, knee range of motion (ROM), and Knee Society Score (KSS) were compared preoperatively and at postoperative day 14, 3 months, and the final follow-up. The mean follow-up duration was 14.0 ± 0.9 months. At the final follow-up, the infection-free survival rate was 95.65% (22/23) as defined by the International Consensus Meeting (ICM) criteria, with only one case of recurrence at two months postoperatively. All evaluated clinical outcomes—including the VAS score, ROM, and KSS—demonstrated statistically significant improvements compared to preoperative baseline values (P < 0.001). By the final follow-up, patients had achieved a nearly pain-free state. The mean knee ROM significantly increased from 64.8° ± 5.0° preoperatively to 120.0° ± 4.5°, while the mean KSS improved from 33.1 ± 5.3 points to 87.7 ± 5.2 points. For chronic PJI following TKA with a sinus tract, one-stage exchange arthroplasty, when performed in strict adherence to a standardized protocol, demonstrates favorable potential in infection control and significant functional restoration, with satisfactory medium-term outcomes. Therefore, under strictly standardized surgical protocols, one-stage exchange arthroplasty may be considered a viable treatment option for carefully selected cases of periprosthetic joint infection complicated by a sinus tract following thorough and prudent evaluation.

Chronic wounds, such as diabetic foot ulcers, are challenging to heal due to persistent inflammatory responses and imbalanced growth factors. Conventional microskin grafting techniques face limitations, including insufficient viability, orientation-dependent survival, and restricted paracrine functions. This study investigates the feasibility of using ultra-microskin grafts (approximately 0.3 mm thick, 0.4×0.4 mm in surface dimensions) at expansion ratios of 1:10 to enhance diabetic wound repair. Ultra-microskins were prepared using an automated skin-cutting device. Viability assessment of ultra-microskin and conventional microskins was performed using CCK-8 assay, LIVE/DEAD staining, transmission electron microscopy, and explant culture. Ultra-microskin was transplanted onto full-thickness defects at 1:10 and 1:20 expansion ratios; the optimal size was determined based on viability results and the "Inter-Graft Spacing Theory." Cytokine release from ultra-microskin was quantified by ELISA. The effects of cytokines in ultra-microskin extracts on the migration, proliferation, and tube formation capabilities of human foreskin fibroblasts (HFB), human umbilical vein endothelial cells (HUVECs), and HaCaT cells were assessed. Ultra-microskin (0.4 mm) was transplanted onto diabetic rat wounds at a 1:10 ratio. Wound healing was evaluated via gross photography, H&E staining, Masson's trichrome staining, and CD31/Ki-67 immunohistochemistry. Proteomic analysis of wound tissues was conducted on posttransplant days 7 and 14. Ultra-microskin sized ≥0.4 mm exhibited viability comparable to or exceeding that of conventional microskins. The optimal size for ultra-microskin was determined to be 0.4 mm. Ultra-microskin significantly enhanced the release of cytokines (TGF-α, EGF, MCP-1, TNF-α, IL-6, IL-10, VEGF-A, TGF-β1, IGF-1) and promoted the functions of wound healing-associated cells (HFB, HUVEC, HaCaT). Transplantation of ultra-microskin significantly attenuated inflammation, promoted vascularization and epithelialization, and accelerated the healing rate of diabetic wounds. Ultra-microskin (0.4 mm) dynamically accelerates diabetic wound healing via cytokine release, offering a novel therapeutic strategy for chronic wounds, including diabetic ulcers.