Objective    To provide clinical anatomical evidence to optimize index finger pollicization for congenital thumb hypoplasia in children.    Methods    Twenty hands from healthy children aged 5-8 years were dissected. Macroscopic and microscopic analyses were performed to study the morphology and innervation of first palmar and dorsal interosseous muscles, focusing on anatomical features associated with common surgical deficiencies. The resection and reattachment points of interosseous muscle and extrinsic muscle tendons were observed. Simulated pollicization procedures were conducted to determine optimal techniques for muscle reattachment and nerve preservation.   Results   The first palmar interosseous muscle was small, approximately half size of dorsal interosseous muscle, and primarily inserted into the ulnar side of dorsal capsule of proximal interphalangeal joint. The radial bundle of first dorsal interosseous muscle originated from the ulnar side of the first metacarpal, and the ulnar bundle from the radial side of the second metacarpal, converging to insert into the radial side of the second metacarpophalangeal joint capsule and dorsal aponeurosis. The deep branches of ulnar nerve entered the muscles from palmar side, nearly perpendicular to the direction of the incision on second metacarpal periosteum. Optimal reattachment points for interosseous muscles were located adjacent to the flexor aspect of the reconstructed thumb's interphalangeal joint capsule, consistent with their original insertions. The proximal segments of the flexor and extensor tendons were shortened by approximately 2 cm and sutured end-to-end to the corresponding tendons of the reconstructed thumb, preserving the original line of pull.    Conclusions     Anatomical reconstruction using the first palmar and dorsal interosseous muscles as intrinsic dynamic muscles, fixed near the flexor aspect of the reconstructed thumb's interphalangeal joint capsule, is recommended. Securing the periosteum containing interosseous muscles to the newly created metacarpal and performing proximal tendon shortening with end-to-end repair align force transmission and tendon tension with native anatomy, promoting ideal functional outcomes.

Objective   To investigate the anatomical characteristics of posterior cruciate ligament (PCL) and meniscofemoral ligament (MFL), so as to provide useful information for PCL reconstructions.   Methods    A total of 112 human lower limbs were dissected and variations of the PCL, MFL were noted. The length and width of PCL and MFL were measured using a vernier caliper.    Results   PCL was divided into two main bundles: anterolateral bundle (ALB) and posteromedial bundle (PMB). In some cases, ALB could be further subdivided into two or three bundles: a central bundle and an anterior bundle in 63 cases; or two central bundles and an anterior bundle in 9 cases. PMB could also be divided into two bundles, which included an oblique bundle and a longitudinal bundle in 29 cases; or two parallel bundles in 41 cases. There was statistically significant difference in the type composition of ALB between males and females (P<0.05). The frequencies of anterior meniscofemoral ligament (AMFL)and posterior meniscofemoral ligament (PMFL) were 9.8% and 67.9%, respectively. The average length and width of PCL were (34.96±4.52) mm, (10.28±2.03) mm; and the average length and width of PMFL were (20.31±5.70) mm, (4.05±1.07) mm, respectively. There was significant difference in the length of PMFL between male and female (P<0.05). Conclusions    This study complements previous research on the morphological characteristics and variational patterns of PCL. Understanding the complex anatomical structure of PCL is crucial for assessing PCL injuries and planning related surgical procedures.  

Objective   To locate of position of the ventricle system by rat ventriculography, which is used as anatomic localization mark to identify structure of positron emission tomography (PET) images of rat brain.    Methods    The rats were subjected to food deprivation prior to receiving tail vein injection of 18F-FDG. After an uptake period of 30 min, rats were placed in gantry and performed PET/CT scan in prone position. After the scan was completed, the rats were sacrificed under isoflurane anesthesia. A contrast agent was then perfused through the ascending aorta, and a head CT scan was performed again. The brain CT images after contrast agent injection were reconstructed. The PET and second scanned CT images were registrated and fused using PMOD software to observe the imaging of the ventricles and related structures, as well as the anatomical location of the activated brain regions in the PET images.   Results   The lateral ventricles, 3rd ventricle, aqueduct of midbrain and the 4th ventricle, the related structure to ventricles were clearly visualized in CT images. These structures could be used as landmark to locate the rat brain structure of PET images, such as A24a, A24a', caudate putamen, globus pallidus, accumbens nucleus, paratenial nucleus of thalamus. Conclusions    Clear ventriculography plays a crucial role in the anatomical localization of PET images of the rat brain.

Objective    Peripheral nerve injury leads to various degrees of functional defects. Nerve guidance conduits are considered as a new promising scaffold for peripheral nerve repair. However, conventional single-material nerve conduits have shown limited efficacy in protecting cells from posttraumatic inflammation. This study aims to develop a single-process PLGA-based nerve conduit loaded with melatonin to enhance the biological performance of pure PLGA materials by suppressing oxidative stress and inflammatory responses.   Methods   The PLGA conduit is prepared with dry-jet wet spinning methods. The melatonin is integrated into PLGA conduits directly with the single-step process. Scanning electrical microscope observation, FTIR test, degradation test and drug releasing test were performed to characterize the morphology and physical properties of the nerve conduits. Schwann cells were cultured to test the biocompatibility of the prepared nerve conduits. Oxidative stress was applied on Schwann cell using hydrogen peroxide. Then the protecting effects of the nerve conduits were tested on the hydrogen peroxide-treated cells. SD rat sciatic model was applied to test the conduit in vivo.    Results    The melatonin is successfully integrated into the nerve conduit with the dry-jet wet spinning method. Cell adhesion and proliferation test of the Schwann cell indicated that the nerve conduits exhibit excellent biocompatibility. While the mitochondrial morphology observation and JC-1 potential detection also showed protecting effects on Mitochondria. The q-PCR analysis showed nerve conduits reduced cellular oxidative stress and inflammatory responses while enhancing cellular proliferation. A marked enhancement on SD rat sciatic nerve regeneration was also observed on melatonin loaded conduits.    Conclusions    By integrating melatonin into PLGA using the dry-jet wet-spinning technique, the conduit is endowed with multiple functional advantages, including anti-inflammatory, antioxidant, and neuroprotective properties. This approach is expected to create a favorable microenvironment for nerve tissue regeneration and provide a new perspective for the treatment of peripheral nerve injuries.

Objective    To explore the mechanism of the new double-layer chitosan membrane combined with platelet-rich fibrin (PRF) on the repair of bone defects around implants in rats.   Methods   Forty clean-grade male SD rats were selected to establish skull defect models and were randomly divided into a control group, a platelet-rich fibrin group (PRF group), a new double-layer chitosan membrane group (N-CTS group) and a combined group, 10 rats in each group. The defect area of control group was not filled, PRF group was filled with platelet-rich fibrin (PRF), N-CTS group was filled with a new double-layer chitosan membrane (N-CTS), the bone defect area of combined group was filled with a new double-layer chitosan membrane combined with PRF. After 8 weeks, peripheral blood T lymphocyte subsets CD4+, CD8+, and CD4+ /CD8+ were measured by flow cytometry. Micro-CT was used to analyze the bone volume fraction (BV/TV), trabecular number (Tb. N), trabecular thickness (Tb. Th), and trabecular space (Tb. Sp) of new bone tissue. The multi-functional grid test system and micrometer were used to measure the width of the combined bone plate, the thickness of coated bone wall and the coating rate under the microscope. The pathological changes were observed by HE staining. Western blot was used to detect osteopontin (OPN), Runt-related transcription factor 2 (Runx2) and osteocalcin (OCN).   Results   Compared with control group, CD4+, CD4+/CD8+, Tb.TH, Tb.N, BV/TV, width of bone plate, thickness of coated bone wall, coating rate, OPN, Runx2, and OCN increased, CD8+, Tb.Sp decreased in PRF group and N-CTS group (P<0.05). Compared with PRF group and N-CTS group, CD4+, CD4+/ CD8+, Tb.TH, Tb.N, BV/TV, width of bone plate, thickness of coated bone wall, coating rate, OPN, Runx2 and OCN increased, CD8+ and Tb.Sp decreased in combined group (P<0.05). HE staining showed that the degradation of tissue fibers in control group was slow and the integration with bone defects was poor. The materials in each treatment group were well degraded, and osteoblasts and neovascularization were observed with new bone formation, among which combined group had the most significant effect.  Conclusions   The new double-layer chitosan membrane combined with PRF can significantly promote the repair of bone defects around rats and accelerate the formation of new bone in defect area.

Objective     To investigate the changes in bone microstructure of female C57BL/6J mice after 4-, 8-, and 12-week ketogenic diet (KD) interventions, aiming to determine the optimal time window for establishing a KD-induced osteoporosis (OP) model. The findings will provide theoretical insights for preventing the adverse effects of KD therapy on bone microstructure, thereby promoting the clinical translation and broader application of KD therapeutic strategies.   Methods    Experimental animals were divided into groups with normal diet for 4 weeks (Con+1), 8 weeks (Con+2), and 12 weeks (Con+3); KD for 4 weeks (KD+1), 8 weeks (KD+2), and 12 weeks (KD+3); and bilateral ovariectomy for 4 weeks (OVX+1), 8 weeks (OVX+2), and 12 weeks (OVX+3). Body weight, blood ketones, and blood glucose were monitored. Micro-CT scanning and HE staining were performed to observe changes in femoral bone microstructure and morphology at each time point.   Results   There were no significant differences in bone microstructure between Con+1, KD+1, and OVX+1. The trabecular mineral density (TMD) of KD+2 was significantly reduced compared to Con+2. The TMD, bone volume fraction (BV/TV), trabecular number (Tb.N), connectivity density (Conn.D), cortical thickness (Ct.Th), bone area (Barea), and bone area/total area (BA/TA) of KD+3 were significantly lower than those of Con+3, while trabecular separation (Tb.Sp) was significantly increased. The BV/TV of the KD group at the three time points was 5.8%, 5.0%, and 3.6%, respectively. The BV/TV of the OVX group at the three time points was 4.4%, 2.9%, and 3.0%, respectively. The HE results confirmed the Micro-CT findings.    Conclusions   Short-term ketogenic diet (KD) interventions within 4 weeks exhibited minimal impact on bone microstructure in mice, suggesting a relatively safe therapeutic window. In contrast, a 12-week KD regimen successfully induced an osteoporosis (OP) model in mice, serving as a critical phase for investigating the pathological mechanisms of KD-induced OP and exploring preventive/therapeutic strategies. KD has "time-dependent bone damage", and this discovery has significant translational value for promoting the precise and safe application of KD therapy. 

Objective    To explore the expression of YTH domain-containing family protein 3 (YTHDF3) in pulmonary hypertension (PH) and evaluate its potential clinical significance.   Methods   The expression levels of YTHDF3 in human pulmonary arterial smooth muscle cells (HPASMCs) and lung tissues from patients with PH were detected using cellular immunofluorescence and Western blot analysis. Histopathological staining and tissue-wide fluorescence imaging was employed to evaluate the extent of pulmonary arterial wall remodeling and the expression and localization of YTHDF3 in rat models. Bioinformatic analysis was further conducted to explore the downstream regulatory pathways of YTHDF3 in PH.    Results   YTHDF3 expression upregulated in the pulmonary arterial tissues of patients with PH and in hypoxia-treated HPASMCs in vitro. More importantly, concomitant with the pathological remodeling of pulmonary arteries in a rat model of PH, YTHDF3 expression increased within the medial layer of these vessels. Consistent with these findings, human bulk omics data further confirmed the upregulation of YTHDF3 in PH samples and suggested its potential role in influencing the pathogenesis and progression of pulmonary hypertension, possibly through the regulation of apoptosis-related pathways.   Conclusions YTHDF3 is enriched in the remodeled medial layer of pulmonary arteries in PH, where it contributes to the pathogenesis and progression of PH by regulating pathways such as smooth muscle cell apoptosis, demonstrating significant clinical application potential.

Objective    To investigate the effect of apolipoprotein C1 (APOC1) overexpression on drug resistance of liver cancer drug-resistant cells HepG2/SR and its possible mechanism.    Methods    The sorafenib resistant cells HepG2/SR were established by inducing the liver cancer HepG2 cells with a gradually increasing concentration of sorafenib. HepG2/SR cells were divided into a control and an APOC1 overexpression groups. CCK-8 assay and EdU labeling technique were used to detect cell proliferation activities and proliferation rates. Cell scratch assay was used to detect cell migration rates. Flow cytometry was used to detect cell apoptotic rates, and Western blotting to detect the expression levels of E-cadherin, N-cadherin and Vimentin proteins in the cells.    Results    Compared with the control cells, the proliferation activity, proliferation rate and migration rate of the HepG2/SR cells in APOC1 overexpression group were significantly decreased, the apoptotic rate of the cells was significantly increased, and the expression level of E-cadherin protein in the cells was significantly increased, while the expression levels of N-cadherin and Vimentin proteins were significantly decreased.   Conclusions    APOC1 overexpression can inhibit the proliferation, migration and promote the apoptosis of liver cancer drug resistant HepG2/SR cells. The mechanism may be related to the inhibition of protein expression involved in the epithelial-mesenchymal transition (EMT) process.

Objective    To investigate the effects of Bushen Zhuangjin Decoction on cartilage injury and the long-chain acyl-CoA synthase 4 (ACSL4) pathway in rabbits with knee osteoarthritis (KOA).  Methods   Rabbits were randomly divided into the normal, the KOA, the low-dose and high-dose Bushen Zhuangjin Decoction, the celecoxib, and the high-dose Bushen Zhuangjin Decoction + rosiglitazone groups, with 12 rabbits in each group. The levels of serum interleukin (IL) -18, IL-6 and tumor necrosis factor -α (TNF-α) were monitored; The pathology of articular cartilage was detected by safranin O-green staining. The mitochondrial structure of articular cartilage was observed by transmission electron microscopy. Prussian blue staining was used to detect iron deposition in articular cartilage. The levels of Fe2+, reactive oxygen species (ROS), malondialdehyde (MDA), glutathione (GSH) in articular cartilage, as well as glutathione peroxidase 4 (GPX4), plasma vector family 7 member 11 (SLC7A11), and ACSL4 proteins were analyzed respectively. Results    Compared with KOA group, the pathological and mitochondrial damage of articular cartilage tissue in the low-dose and high-dose Bushen Zhuangjin Decoction groups and cecoxib group were alleviated, iron deposition reduced, the levels of serum IL-6, IL-18, and TNF-α decreased, and the levels of Fe2+ and MDA, the average fluorescence intensity of ROS, and the ACSL4 protein in articular cartilage tissue decreased. The levels of GSH and the proteins of GPX4 and SLC7A11 increased (P<0.05); Rosiglitazone reversed the inhibitory effect of high-dose Bushen Zhuangjin Decoction on ferroptosis in KOA rabbits.   Conclusions Bushen Zhuangjin Decoction may inhibit ferroptosis in KOA rabbits by suppressing the ACSL4 pathway, thereby regulating articular cartilage injury.

Objective    To explore the impact of the postoperative anatomical changes in distal radioulnar joint (DRUJ) congruence in patients with ulnar impaction syndrome on clinical efficacy and functional recovery, and to provide clinical evidence for optimizing surgical strategies.  Methods  A retrospective analysis was conducted on the perioperative data of 10 patients who underwent ulnar shortening osteotomy in the hand surgery department of our hospital between July 2023 and March 2025. Based on the preoperative and postoperative imaging evaluations of the distal radioulnar joint Tolat classification changes, the operative time, postoperative pain duration, return-to-work time, and functional outcomes (pain score, wrist joint range of motion, grip strength, QuickDASH score, and modified Mayo Wrist Score) were recorded.  Results   The follow-up period was 3 to18 months. After operation, the distribution of DRUJ classification shifted, with transitions from Tolat type 3 to Tolat types 1 and Tolat type 2. The postoperative pain scores, Quick DASH scores, range of flexion and extension, grip strength, and modified Mayo Wrist Scores all improved compared to the preoperative values (P<0.05). Those with greater variability in the distal radioulnar joint had a longer duration of postoperative pain compared to those with less variability(P<0.05).    Conclusions   Postoperative pain after ulnar shortening osteotomy is closely associated with alterations in the congruence state of the distal radioulnar joint. Maintaining the anatomical congruence of the DRUJ may facilitate faster functional recovery. Under the concept of enhanced recovery after surgery, preservation of DRUJ congruence can positively influence clinical outcomes. 

Objective    To investigate the clinical efficacy and safety of three-dimensional reconstruction technique-assisted radiofrequency ablation (REA) of lung tumors in the treatment of patients with non-small cell lung cancer with with spinal invasion (NSLCL).   Methods   A total of 110 patients with NSLCL were divided into a three-dimensional reconstruction planning group (51 cases, three-dimensional reconstruction technique-assisted REA) and a two-dimensional CT planning group (59 cases, two-dimensional CT planning-assisted REA) based on different treatment regimens. The surgery-related indicators, pain visual analogue scale (VAS) score, tumor markers, functional recovery, quality of life, tumor ablation target volume at 3 months after surgery and incidence rates of surgery-related complications were compared between the two groups.   Results   Compared with two-dimensional CT planning group, the CT scan frequency and intraoperative blood loss volume in three-dimensional reconstruction planning group were less, and the needle insertion time, surgical time and postoperative hospital stay were shorter (P<0.05). The VAS scores in three-dimensional reconstruction planning group at 6 and 24 hours after surgery were lower than those in two-dimensional CT planning group (P<0.05). At 1 month and 3 months after surgery, the levels of serum carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC-Ag) in three-dimensional reconstruction planning group were lower than those in two-dimensional CT planning group (P<0.05), and the Karnofsky performance status (KPS) score and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) score were better compared with two-dimensional CT planning group (P<0.05). At 3 months after surgery, the tumor ablation target volume in three-dimensional reconstruction planning group was smaller than that in two-dimensional CT planning group (P<0.05). The incidence rates of complications were significantly lower in three-dimensional reconstruction planning group than those in two-dimensional CT planning group (P<0.05). Conclusions   Three-dimensional reconstruction technique-assisted REA in the treatment of NSLCL can effectively control tumor progression, promote postoperative recovery, improve the quality of life and reduce the risk of complications, with important clinical application value.

Objective   To examine the alterations in the shape of the sacrum and investigate its correlation with the presence of a third sacral segment sacroiliac screw pathway.    Methods   In a retrospective analysis involving 1,264 patients who underwent pelvic X-rays and CT scans between December 2013 and December 2023, comprising 539 males and 725 females aged 18 to 70 years with an average age of was (46.71±15.58) years, the patients were categorized into distinct groups based on their pelvic anatomy, and the presence or absence of related passages was examined within each group.   Results   The probability of the existence of the 3rd sacral segment channel in each group was as follows: normal sacrum was 40.30 %, acute lateral tilt of the sacral wings was 74.94 %, 79.84 % of the L5-S1 was intervertebral disk being parallel to the iliac crest, 93.64 % of the upper sacral foramen deviating from regularity, 57.21 % residual L5-S1 intervertebral disk, 81.73 % cleft of the tongue fossa, 72.82 % transitional vertebrae of the lumbar-sacral region, 89.13 % of the mastoid process, and 58.97 % of the sacral vertebral column defect.   Conclusions   In this study, various abnormal sacral morphologies all affect the existence of the S3 sacroiliac screw trajectory. When these morphological variations are present in the sacrum, the possibility of the presence of a bony canal in the third sacral segment is greater. 

Objective    To investigate the clinical, imaging and pathological features of nephronophthisis (NPH) associated with NPHP3 gene in pediatric patients and their relationships with disease progression. Methods The clinical, imaging and pathological characteristics of 13 genetically confirmed pediatric patients from 10 families with NPHP3-associated NPH were retrospectively analyzed and the associations between these features and disease progression were examined.    Results    The median age at onset of the 13 patients was 1.9 years, and the median age at progression to end-stage renal disease (ESRD) was 3.3 years. The most common initial clinical manifestations were anemia (46.2%) and abnormal renal ultrasound findings (38.5%). Imaging result showed bilateral renal enlargement (69.2%) and renal cysts (61.5%). Renal cyst could emerge at the early stage of the disease and reside on corticomedullary, as well as cortex. There was no significant difference in age at progression to ESRD between the groups with normal renal size and those with enlarged kidneys at onset (P>0.05). Maximum cyst diameter was not significantly associated with progression to ESRD (P>0.05). Renal pathology uniformly demonstrated chronic tubulointerstitial nephropathy, thickness of tubular basement membrane was absent in some patient, in a few patients without cysts on imaging, renal cysts were nevertheless observed pathologically. Hepatic involvement was significantly more common in the infantile form than in the juvenile form (P<0.05), while cardiac involvement occurred only in infantile patients.   Conclusions In this study, NPHP3-associated NPH predominantly presented in the infantile form, with early onset and rapid progression. Renal enlargement, absence of thickening of tubular basement membrane, early emerging of renal cysts and its distribution on the renal cortex, distinguish NPHP3-associated NPH from classic NPH. Extrarenal manifestations mainly involved the liver and heart and were predominantly observed in infantile patients. This finding offers early diagnostic clues for rapidly progressive cases and provides a basis for guiding clinical monitoring (for example, emphasizing assessment of hepatic and cardiac function) and genetic counseling.

Objective   To explore the value of CT radiomics in differentiating pulmonary nodular mucinous adenocarcinoma (PNMA) from inflammatory pulmonary nodules (PIN).    Methods   A total of 51 PNMA cases and 60 PIN cases who visited our hospital from January 2016 to July 2023 were selected. Multi-slice spiral computed tomography (MSCT) scans were performed to compare the imaging features and clinical data of two groups. Imaging radiomics features were extracted from both groups, and logistic regression analysis was used to identify clinical factors associated with PNMA and construct a Clinic model. An optimal feature model (Rad model) was built using a support vector machine (SVM). Based on Python 3.6 and the Softmax strategy, an artificial neural network model (Combine model) was constructed.   Results   PNMA group had higher lesion size, IL-6, CRP, CEA, and multiple imaging features (fine spiculation, lobulation, heterogeneous density, cavitation, pleural retraction, and vascular convergence) compared to the PIN group (all P<0.05). Lobulation, CRP, cavitation, vascular convergence, and pleural retraction were independent predictors of PNMA (all P<0.05). The Combine model, which integrates clinical independent factors and radiomics features, demonstrated the best diagnostic performance, with AUCs of 0.955 and 0.940 in the training and validation sets, respectively, significantly higher than single clinical or radiomics models (Delong test, P<0.05), and showed better calibration and clinical net benefit.    Conclusions    Radiomics analysis based on multi-slice spiral CT shows that Combine model, which integrates independent clinical factors and radiomics features, demonstrates the best diagnostic performance in distinguishing PNMA from PIN, exhibiting high accuracy, and clinical applicability.

Objective   To explore the age and gender differences in CT signs of acute appendicitis at different disease courses.   Methods   235 patients with acute appendicitis treated in our hospital from June 1, 2021 to June 30, 2024 were included as study objects, which were divided into simple group （acute simple appendicitis, n=32）, suppurative group （acute suppurative appendicitis, n=185） and gangrene group （acute gangrenous appendicitis, n=18）, respectively. The imaging findings of patients at different disease courses of different age and gender were compared by multi-slice spiral CT plain scan.   Results   The age and the time from onset to treatment in pyogenic group and gangrene group were higher than that in simple group （P<0.05）. The incidence of appendiceal thickening and peri appendiceal exudation in pyogenic group was higher than that in simple group （P<0.05）, and the proportion of alcohol consumption in gangrene group was higher than that in simple group （P<0.05）. Among the disease courses <24 h and 24~48 h, the incidence of endovascular gas in the ≥65 years old group were lower than that in the 45~64 years old group （P<0.05）, while there were no statistically significant differences in the other comparisons （P>0.05）. There was no statistically significant difference in CT signs among patients with different disease courses and genders （P>0.05）. Gender was a predictor of appendiceal thickening, and disease course was a predictor of peri appendiceal exudation, extraluminal free gas （P<0.05）.    Conclusion   Age was closely related to the severity of acute appendicitis and the signs of endovascular gas, while gender had a predictive effect on the appendiceal thickening, and the disease course had a predictive effect on peri appendiceal exudation, extraluminal free gas.

Pancreatic anatomical research is shifting from static description to dynamic, multidimensional analysis. At the macroanatomical level, the redefinition of the pancreatic mesentery and retroperitoneal fascial planes continues to drive advances in precision surgery. At the microanatomical level, spatial transcriptomics reveals cellular heterogeneity and spatial architecture of the pancreas under inflammatory and tumor conditions. In imaging, iterative advances in photon-counting CT and endoscopic ultrasound enhance visualization of fine structures, while AI enables automated lesion segmentation and benign-malignant classification. In applied technology, augmented reality and fluorescence-guided navigation are accelerating the seamless integration of digital models with the operative field. Looking ahead, multimodal data fusion, deeper AI integration, individualized (patient specific) anatomy, and three-dimensional organoid technologies will further propel precision diagnosis and treatment of pancreatic diseases, offering new perspectives and avenues for both basic research and clinical practice.

Muscle spasticity, frequently occurring after stroke or spinal cord injury, severely compromises motor function and quality of life. Botulinum neurotoxin A, a targeted neuromuscular junction blocker, serves as a first line treatment for focal spasticity. Its classic mechanism involves cleaving synaptosomal-associated protein 25, thereby inhibiting acetylcholine release. Recent research has unveiled its multi-level central modulatory effects. BoNT-A exerts systemic therapeutic benefits by reducing muscle spindle sensitivity, restoring spinal inhibitory balance, disrupting the “pain-spasm cycle,” and driving functional reorganization in the cerebral cortex. Clinically, it has proven effective in significantly improving muscle tone, range of motion, and pain. Current treatment is advancing toward greater precision. The use of imaging and electrophysiological guidance has enhanced injection accuracy. Research on novel targets, such as the nerve entry point and Intramuscular nerve dense region, aims to achieve "enhanced efficacy with reduced dosage." Furthermore, multimodal approaches combining BoNT-A with rehabilitation or extracorporeal shockwave therapy demonstrate synergistic advantages. However, long-term safety profiles, particularly concerning muscle structure and immunogenicity, require continued scrutiny. Future directions should integrate artificial intelligence-based prediction models, novel BoNT formulations, and multimodal strategies to advance treatment toward a higher standard of personalization and functional restoration.

Chronic Ankle Instability (CAI) is a complex pathological condition triggered by acute ankle sprains, characterized by recurrent joint instability, functional impairments, and activity limitation. Although the clinical manifestations of CAI are widely acknowledged, its specific pathogenesis have not been fully clarified. This review systematically examines the pathogenesis of CAI, with a particular emphasis on its anatomical foundations, primary injuries due to ligamentous injury, pathomechanical impairments, sensory-perceptual impairments s, motor- behavioral impairments,. Additionally, it contrasts traditional classification approaches with emerging multidimensional models, highlighting the clinical significance of the comprehensive instability theory in assessment. This review offers valuable insights for advancing future research and optimizing clinical practice.