Objective    To observe the morphological characteristics of the communicating branches between accessory nerve, vagus nerve, and cervical nerve roots, as well as the adjacent position of accessory nerve at the jugular foramen.    Methods   The specimens of head and neck were dissected to observe the adjacent structures in the jugular foremen, the communicating branches between accessory nerve and vagus nerve below the jugular foramen, and the communicating branches between the spinal root of accessory nerve and the cervical nerve root.    Results    The area of the left vagal tract was (6.99±0.74) mm2, and the area of the right vagal tract was (5.02±0.37) mm2 at the jugular foramen, with significant difference statistically (P<0.05). Under the jugular foramen, 29 sides (76.3%) had communicating branches between the vagus nerve and accessory nerve. There were four types of communicating branches, with the length of the left communicating branch was (5.82±1.18) mm and the length of the right communicating branch was (6.60±1.17) mm. There was no statistical difference between the left and right sides. There were 17 sides (77.27%, 17/22) to be observed to have communicating branches between the spinal root of accessory nerve and the posterior branch of the cervical nerve (C1 and C2).    Conclusions    Accessory nerve and vagus nerve have communicating branches below the jugular foramen, which provides anatomical basis for avoiding damage to accessory nerve in clinical practice. The presence of communicating branches between accessory nerve and the posterior root of the cervical nerve indicates that accessory nerve contains sensory fibers, which may originate from posterior root of cervical nerve, and its function may be related to the maintenance of the head posture.

Objective    To study the anatomical basis of the percutaneous pedicle screw fixation technique in transverse process root approach and analyze the feasibility of the screw placement method. Methods     In this study, 3D CT reconstruction images of 100 adult lumbar spine from L1 to L5 were analyzed by using the PACS system. The imaging anatomical parameters of the screw cross section, including the insertion angle, width of the pedicle, length of the ideal screw tract and length of the ideal screw tract within the pedicle were measured.    Results   There was no statistical difference between the left and right sides of the same vertebral level (P>0.05). Additionally, there was no significant difference in angle measurements between different genders (P>0.05). However, there were significant differences in most length indicators between genders (P<0.05), with males having larger measurements compared with females. The minimum inner inclination angles from L1 to L5 were as follows: 15.40°, 16.63°, 14.74°, 11.82°, and 6.82°, respectively. The maximum inner inclination angles were: 36.22°, 38.86°, 42.99°, 49.05°, and 54.70°, respectively. The ideal inclination angles were: 23.67°, 24.30°, 25.08°, 27.10°, and 29.96°, respectively, exceeded the internal inclination angle of the traditional insertion point and fell within a safe range of 20.83° to 47.88°. In the cross-section where the screw  placed, the average pedicle width from L1 to L5 in males was: 6.82, 6.96, 8.38, 10.31 and 13.65 mm, while in females it was: 5.39, 5.78, 7.24, 9.09 and 13.21 mm. The length of the ideal screw tract in males was: 54.90, 55.19, 55.75, 54.87 and 56.27 mm, whereas in females it was: 51.04, 51.31, 52.68, 52.11 and 54.71 mm. The length of the ideal screw tract within the pedicle in males was: 20.85, 19.87, 18.41 mm, 15.87 and 15.02 mm, while in females it was: 20.18, 19.02, 17.00, 15.19 and 15.05 mm.  Conclusions   The imaging results indicate that the transverse process root approach at a specific anatomical location is a safe and reliable insertion point for pedicle screws. This finding provides new reference for selecting the appropriate insertion point of pedicle screws in percutaneous pedicle screw techniques.

Objective　To explore the feasibility of the novel C2 spinous lamina screw by using anatomical measurements on CT images and digital three-dimensional reconstruction.　Methods　Cervical CT data from 120 adults (59 males and 61 females) were collected and imported into Mimics 21.0 software using Dicom format for slicing and data measurement, 3D reconstruction and simulated screw placement. The thickness of C2 lamina, the height of C2 lamina, the length of C2 lamina, the width of the spinous root, the length of the simulated screw trajectory, the angle of inversion of the screw, the angle of inclination of the screw head, and the angle between the lamina and the sagittal plane were measured. The feasibility of the novel C2 spinous lamina screw placement was analyzed.　Results　There was no statistical difference between the measured data on both  sides (P>0.05). There were significant differences in the height, thickness, and length of the C2 lamina, as well as the width of the spinous process and the length of the screw path between males and females (P<0.05). There were no significant differences in the uptilt angle of the screw, the medial tilt angle of the screw, and angle between lamina and sagittal plane of screws between male and female (P>0.05). The screw path length of the novel C2 spinous lamina screw was (27.16±3.92) mm for males and (23.90±4.25) mm for females, the medial tilt angle of the screw was (61.88±6.93) °, and the uptilt angle of the screw was (28.26±5.95) °.  The length of the screw path of the novel C2 spinous lamina screw was moderately positively correlated with the height of the lamina and the thickness of the lower part of the lamina, and strongly positively correlated with the thickness of the upper and middle lamina.　Conclusions The novel C2 spinous lamina screw is feasible in the study of imaging anatomy, and the results of CT measurement and computer simulation provide theoretical support for the subsequent biomechanical research and clinical application.

Objective   To explore the classification and anatomical variation characteristics of adult abdominal trunk through the dissection of the recorded population samples, which providing reference for clinical surgery.    Methods    Abdominal stem dissections were performed on 44 embalmed cadavers. The shape of the branches of the celiac trunk was observed, and they were further quantified and described according to the Panagouli typing method and at the level of the vertebral body of origin.    Results    There were 5 types of celiac trunk in the anatomical specimens of our institute according to the Panagouli classification method. 36 cases (83%) had typical anatomical structure of the celiac trunk (type Ⅰ), and 8 cases (17%) had anatomical variations, of which 5 cases (11%) were classified as type Ⅲ, 1 case (2%) was classified as type IV, 1 case (2%) was classified as type Ⅴ, and 1 case (2%) was classified as type Ⅸ.    Conclusions There are many variations in the celiac trunk in adults, so it is necessary to fully evaluate them in combination with imaging before surgery to avoid injury.

Objective    To investigate the role of macrophage depletion in functional regeneration after peripheral nerve injury.     Methods    Adult mice in the experimental group were intraperitoneally injected with the clodronate liposome to exhaust the macrophages and then were subjected a sciatic nerve crush injury model. The mice in the control group were administrated with the control liposome to replace the clodronate. Seven days post injury (dpi), immunofluorescence staining was performed to illustrate the F4/80 positive macrophages and the GAP43 positive regenerating axons. At 28 dpi, immunofluorescence staining was used to detect the F4/80 positive macrophages, behavior tests and neuroelectrophysiology were conducted to assay the motor function and nerve conduction. The wet weight of gastrocnemius muscle and their myofiber’s size were measured to reflex the myoatrophy in the target muscles.    Results    The macrophages in the injured nerves were exhausted more than 70% at both 7 dpi and 28 dpi, and GAP43-positive regenerating axons in length at 7dpi were less and shorter in the experimental group than those of the control group. At 28 dpi, compared with the control group, the motor ability and nerve conduction intensity were significantly decreased, the latency of nerve conduction was prolonged, and the wet weight ratio and myofiber size were significantly reduced in the experimental group.    Conclusions   The clodronate liposome can alleviate the functional regeneration after peripheral nerve injury through exhausting macrophages.

 Objective    To investigate the modulatory effects of Angelica Sinensis Polysaccharide (ASP) on intestinal microbiota and its subsequent influence on cerebral ischemia/reperfusion (I/R) injury in murine models.    Methods    A cohort of 64 SPF level mice was stratified into four groups: sham operation group (Sham group), middle cerebral artery occlusion group (MCAO group), ASP gavage group (ASP group), and fecal microbiota transplantation group (ASP-FMT group), each comprising 16 subjects. Following a 7-day regimen of the respective interventions, the MCAO model was established. Neurological function deficits were quantified 24 hours post-MCAO using the modified Neurological Severity Scores (mNSS); cerebral infarct size was assessed via 2,3,5-triphenyltetrazolium chloride (TTC) staining; concentrations of superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione (GSH) in the ischemic penumbra were determined using assay kits. Additionally, the expression levels of inflammatory cytokines IL-1β, IL-5, IL-6, and IL-10 in brain tissues were quantified via Western blot, while 1 the diversity of intestinal microbiota was analyzed by 6s rRNA sequencing of cecal contents.   Results   Compared with the MCAO group, neurological function was markedly ameliorated after ASP intervention (P<0.001), cerebral infarct size was significantly reduced (P<0.01), and oxidative stress levels were attenuated (P<0.05). Compared with the MCAO group, the expression of pro-inflammatory cytokines IL-1β, IL-5, and IL-6 were substantially decreased by ASP intervention, while concurrently upregulated the anti-inflammatory cytokine IL-10 (P<0.05). Post-MCAO, a notable depletion in the richness of intestinal microbiota and a reduction in probiotic strains were observed. However, ASP administration or fecal microbiota transplantation partially restored microbiota richness and enhanced the proportion of probiotics. A correlation was established between the modulation of intestinal microbiota and the degree of brain tissue damage.    Conclusions   Angelica Sinensis Polysaccharide ameliorates intestinal microbiota, mitigates oxidative stress, modulates inflammatory cytokine profiles, and thereby attenuates neurological dysfunction and reduces infarct size following cerebral ischemia/reperfusion injury.

Objective   To investigate the mechanism by which cannabidiol (CBD) inhibits neuro-inflammation and protects neural tissue in a rat model of multiple cerebral concussions.    Methods  Rat models of multiple cerebral concussions (MCC) were established, and Hematoxylin-eosin(HE) and immunohistochemical staining were used to assess changes in neurons and microglial cells after multiple cerebral concussions and the protective effects of CBD. Western blot was performed to measure the expression of microglial cell marker Iba-1 and pro-inflammatory factors IL-1β and TNFα in different brain regions. Results    HE staining revealed significant pathological changes in neurons following MCC in rats compared to the Sham group. CBD intervention led to a restoration of normal neuronal morphology, with a more pronounced effect observed in the high-dose group. Immunohistochemical staining showed that microglial cells in the Sham group were in a resting state, while their numbers increased and exhibited an activated state after MCC. CBD intervention resulted in a shift of microglial cells towards a resting state, with a more significant effect observed in the high-dose group. Western blot demonstrated a significant upregulation of Iba-1, IL-1β, and TNFα protein levels in different brain regions after MCC (P<0.05). CBD intervention led to a downregulation of Iba-1, IL-1β, and TNFα expression in these brain regions (P<0.05).  Conclusions  Cannabidiol could alleviate inflammatory response in the cortex and hippocampus of rats with multiple cerebral concussions and exhibit neuroprotective effects.

Objective    To investigate the effect of Fasudil in improving axon and myelin regeneration and functional recovery after peripheral nerve injury.   Methods   Thirty SD rats weighing (200±30) g were randomly divided into two groups: control group and Fasudil group. Normal saline and 10 mg/kg hydrochloride Fasudil were intraperitoneal given, respectively. The right sciatic nerve was transected and sutured. Two weeks after operation, the density of NF-200 positive axons at the distal end of the injury was evaluated. Four weeks after operation, the number of neurons in the L4-6 dorsal root ganglia (DRG) and sacrolumbar enlargement that sent axons to the nerve distal to the transection site was evaluated by retrograde tracing using Fluoro-gold. Twelve weeks after operation, the wet weight ratio of gastrocnemius muscle and the cross-sectional area of muscle fibers were measured; and immunohistochemistry using primary NF-200 and MPZ antibodies and transmission electron microscopy were used to measure the diameter and thickness of axons and myelin sheaths. The footprints of rats at 4, 6, 8, 10, and 12 weeks after operation were collected to evaluate the sciatic function index (SFI) of rats in the two groups. In addition, rat embryonic dorsal root ganglion (DRG) and spinal motor neurons (SMN) were cultured to evaluate the effect of Fasudil on axon growth.   Results   At 14 days after operation, the density of NF-200 positive axons at the distal end of the Fasudil group was significantly higher than that of control group (P=0.034). Four weeks after operation, the number of L4-6 DRG and spinal ventral horn motor neurons retrogradely labeled by Fluoro-gold in Fasudil group was significantly higher than that in control group (P<0.05). Twelve weeks after operation, the number of myelinated axons, diameter of myelinated axons, and thickness of myelin sheaths in Fasudil group was higher than those in control group (P<0.05), while G-ratio value was lower than that in control group (P<0.05). The SFI data showed that at 6, 8, 10, and 12 weeks after operation, the SFI values in Fasudil group were significantly better than those in control group (P<0.05). Twelve weeks after operation, the wet weight ratio of gastrocnemius muscle and cross-sectional area of myofibrils in control group were significantly smaller than those in Fasudil group (P<0.01). After culturing for 5 days, the axons of DRG and SMN in Fasudil group were significantly longer than those in control group (P<0.01).    Conclusions    Fasudil can promote axon and myelin regeneration after sciatic nerve injury in rats and improve their motor function recovery.

Objective    To establish a three-dimensional finite element model of the wrist joint and investigate the stress distribution and deformation of the wrist joint and prosthesis at different angles of motion after partial replacement prosthesis of scaphoid with personalized 3D printing,  so as to provide basis for design and optimization of prosthesis for clinical application.   Methods   The CT data of the wrist joint of a patient with left scaphoid fracture and bone defect and the data of a personalized 3D-printed titanium alloy scaphoid prosthesis were imported into finite element analysis software. Relevant material properties were assigned. The overall deformation, stress distribution of the wrist joint, and stress distribution of the prosthesis and screws under different motion directions were analyzed.   Results    With the increasing of motion angle, the overall deformation and stress of the wrist joint increased correspondingly, but there were no obvious stress concentration and shielding. The stress of the prosthesis was concentrated at the scaphoid junction, reaching a maximum value during extreme palmar flexion (264.45 MPa), the stress of the screw was concentrated in the waist, reaching a maximum value during extreme ulnar deviation (116.13 MPa), but did not exceed the material strength.   Conclusions   After the partial replacement of the personalized 3D-printed titanium alloy scaphoid prosthesis, the overall deformation of the wrist joint was small, and the stress distribution was reasonable, without excessive concentration or shielding. The maximum stress was much lower than the yield strength of the prosthesis material. This surgical method can match the anatomical characteristics of the patient, has good biomechanical properties, and is a suitable choice for the treatment of scaphoid nonunion with osteonecrosis of the wrist. 

 Objective   To explore the application effect of NiTi shape memory ally four-corner arthrodesis concentrator (NT-FCAC) in the treatment of wrist collapse, and to report the efficacy of 9-10 years follow-up.    Methods    Thirty-two patients with four-corner arthrodesis and navicular osteotomy with NT-FCAC were selected for treatment of wrist collapse due to navicular osteogenesis imperfecta and navicular-moon-progressive wrist collapse. Goniometer was used to measure the wrist joint mobility. Jammar dynamometer was used to measure the grip strength. Quick DASH (Quick Arm, Shoulder, Hand Dysfunction Score) was used to observe the recovery of the limb function before and after the operation, and Visual Analogue Score (VAS) was used to assess the degree of the patients' wrist pain. Anteroposterior and lateral radiographs of the wrist joint were taken to observe the rate of carpal arthrodesis.    Results   Bone healing was obtained in all 32 carpal bones at 3 months postoperatively. At 9-10 years of follow-up, all patients had no serious surgical complications, the range of motion of the wrist joint reached more than 60% of the healthy side, and the grip strength of the affected hand was restored to 80.78% of that of the healthy side. The VAS score was reduced from the preoperative score (5.97±0.86) to the final follow-up (0.16±0.37), the Quick DASH score was reduced from the preoperative score (70.00±4.76) to the final follow-up (6.16±0.37). There were statistical differences in the preoperative  VAS and Quick DASH scores and  the VAS and Quick DASH scores at each follow-up.    Conclusions    The application of NT-FCAC for four-corner arthrodesis of the carpal bones has a high rate of carpal fusion, preserves most of the functions of the carpal joints, and has a good long-term efficacy, which is suitable for carpal collapse that requires four-corner arthrodesis.

Objective    To explore the short-term clinical study of unilateral biportal endoscopic (UBE) technique in the treatment of adjacent segment disease (ASD) after posterior lumbar interbody fusion. Methods   The clinical data and follow-up of patients admitted to the department of spine surgery using UBE for the treatment of ASD after posterior lumbar interbody fusion from May 2020 to January 2022 were retrospectively analyzed.   Results    A total of 12 patients who met the criteria were successfully completed the surgery, and the follow-up time ranged from 16 to 36 months, with a mean of (24.3±4.6) months. Surgical time ranged from 47 min to 83 min, with a mean of (62.9±9.8) min. One case developed nerve root irritation symptoms, which were treated with hormones, dehydration and other symptomatic treatments, and the patient's symptoms were relieved after 2 days. No other complications occurred. The length of hospitalization ranged from 5 days to 10 days, with a mean of (6.9±1.6) days. At 3 days, 3 months, 6 months, 12 months and the final follow-up after surgery, the VAS score of low back pain, VAS score of lower limb pain and ODI score were significantly decreased compared with those before surgery, and the difference was statistically significant (P<0.001). At the 6-month postoperative follow-up, the excellent rate was 91.67% (11/12) as assessed by the modified MacNab criteria. In terms of imaging: complete nerve decompression was seen on review MRI at 3 days postoperatively. Review lumbar spine CT showed that the range of osteotomy of the inferior articular eminence to the articular facet distance was (3.84~6.93) mm, with an average of (5.07±1.03) mm. Isthmus bone retention preservation ranged from 4.85 mm to 7.94 mm, with an average of (5.96±0.81) mm. Lumbar spine power position was reviewed at 3 months postoperatively and at the final follow-up visit, and there was no vertebral instability and no responsible segmental recurrence.   Conclusions   Unilateral biportal endoscopic technique for treating adjacent segment disease after posterior lumbar interbody fusion is less traumatic, shorter operation time, higher patient satisfaction, and clear short-term efficacy.

Objective    To evaluate the clinical effect of arthroscopic “Chinese way” in the treatment of shoulder dislocation combined with massive rotator cuff tear in the elderly by using long head of biceps tendon (LHBT) transfer for superior capsule reconstruction.    Methods    From May 2019 to January 2022, 36 patients of shoulder dislocation with massive rotator cuff tear treated in the second affiliated hospital of Soochow University were retrospectively analyzed. Total of 16 males and 20 females were involved, with an average age of (62.3±4.7) years (range, 52 to 73). Arthroscopic repair of massive rotator cuff tear was augmented by LHBT transposition. The difference of the VAS scores, range motion and the shoulder function scores between before operation and the last follow-up were analyzed. The rate of cuff re-tear  was evaluated by MR.   Results   All patients were followed up data for (17.6±4.5) months. The motion of shoulder joint flexion, abduction, lateral rotation and lateral rotation at the last follow-up were significantly improved compared to those of before operation (P<0.05). The VAS, ASES , Constant-Murley and UCLA scores of the last follow-up were also improved compared to those before operation (P<0.05). There were no shoulder re-dislocation occurred.  According to the Sugaya standard, 5 cases (13.9%) of rotator cuff re-tear were indicated by MR. UCLA score was excellent in 9 cases, good in 23 cases, poor in 4 cases, and the excellent and good rate was 88.9%.    Conclusions    In the arthroscopic treatment of elderly shoulder dislocation combined with massive rotator cuff injury, the "Chinese way" technique is used to reconstruct the rotator cuff tissue, which can effectively avoid rotator cuff retearing, relieve shoulder pain, restore shoulder joint function and prevent re-dislocation. 

Objective    To investigate the efficacy of applying the three-step method of full laryngeal recurrent nerve visualization to prevent laryngeal recurrent nerve injury during laparoscopic thyroidectomy via anterior chest approach.   Methods  The 78 surgical videos performed by the author's surgical team, from July 2021 to July 2023, as well as clinical data of the patients were retrospectively analyzed to observe intraoperative full laryngeal recurrent nerve visualization and postoperative occurrence of nerve injury symptoms or other adverse reactions.  Results   All the 78 surgical operations were successfully completed without intermediate open surgery, and altogether 117 recurrent laryngeal nerves were exposed throughout the operation, with intraoperative bleeding of 20-100 mL (average 37.8 mL). No symptoms of recurrent laryngeal nerve damage, such as hoarseness of voice or dysphagia, were observed in all 78 patients after the operation.  Conclusions   The three-step method of full laryngeal recurrent nerve visualization in laparoscopic thyroidectomy via anterior chest approach  contributes to the protection of the functional integrity of the recurrent laryngeal nerve and reduces the recurrent laryngeal nerve injury by latent heat, and this method can be operated conveniently with easy learning, which is worth to be popularized in the clinic.

Objective   To investigate the three-dimensional CT features and differential points of chondroblastoma (CB) and primary aneurysmal bone cyst (ABC).    Methods   The three-dimensional CT findings and clinical data of 22 patients of simple CB, 5 patients of CB secondary aneurysmal bone cyst and 24 patients of primary ABC confirmed by surgical pathology and immunohistochemistry were retrospectively analyzed.    Results    The three groups showed single osteolytic bone destruction with clear boundary on three-dimensional CT. The maximum diameters of lesions in CB group and CB secondary aneurysmal bone cyst group were smaller than that in ABC group (P<0.05). The incidences（54.5%,86.4%,50%,77.3%,54.5%）of irregular bone, eccentricity, calcification, adjacent articular surface, and penetration of cortical bone in CB group were higher than those in ABC group（20.8%,29.2%,8.3%,4.2%,25.0%）(P<0.05), and the incidences(40.9%,18.2%) of expansion growth and pathological fracture were lower than those of ABC group(75.0%,45.8%) (P<0.05). However, there was no significant difference in the incidence of sign of lobulation, marginal sclerosis, bone crest and cortical involvement between CB group and ABC group (P>0.05).    Conclusions    The anatomical location of the lesions and the CT three-dimensional signs are of great value in the differential diagnosis of CB and ABC.

Objective    To observe and analyze the therapeutic effect of pirfenidone on pulmonary interstitial fibrosis secondary to COVID-19. Methods Clinical data of 2 patients with pulmonary interstitial fibrosis after severe COVID-19 were collected and followed up after discharged from our hospital, and the therapeutic effect of pirfenidone on anti-fibrosis secondary to COVID-19 was analyzed.   Results    After the two patients were treated with pirfenidone for 15 weeks and 9 weeks respectively, dynamic review of chest CT showed that the degree of pulmonary fibrosis in both patients was significantly reduced.   Conclusions Pirfenidone may be effective in improving pulmonary fibrosis after COVID-19, but it still needs to be confirmed by longer duration of follow-up and clinical studies with more samples.

Objective 　To investigate the etiology, clinical characteristics, and therapeutic approaches of ankle-derived hallux tendon sheath cysts based on the clinical and anatomical findings from four cases of ankle-derived hallux tendon sheath cysts, in conjunction with a review of relevant literature.　Methods　The diagnosis of ankle-derived hallux tendon sheath cysts in all four cases was confirmed through clinical symptoms, physical signs, imaging studies, and intraoperative angiography. The treatment involved the excision of the hallux tendon sheath cysts combined with ankle joint capsule repair. Analysis and summary were conducted in light of the related literature.　Results　In this study, three patients experienced favorable healing, timely suture removal, and functional exercises post-surgery. One patient encountered the infection at the plantar incision site, which resolved after 14 days of diligent wound care. Follow-up periods ranged from 3 to 13 months (average 7.5 months), with no recurrences up to the time of manuscript submission. The outcomes, as indicated by AOFAS and VAS scores, were excellent.　Conclusions　The hypothesis proposed regarding the etiology of ankle-derived hallux tendon sheath cysts, based on the analysis of four cases from this study and eighteen cases from other literature, provides a plausible explanation for the clinical features of this condition. Accurate diagnosis before and during surgery is crucial for selecting the appropriate surgical strategy.