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To investigate the efficacy and safety of unilateral biportal endoscopy (UBE) for the treatment of thoracic myelopathy caused by thoracic ossification of the ligamentum flavum (TOLF).

A retrospective case series analysis was conducted on the clinical data of 80 patients with short-segment (≤2 levels) TOLF who underwent UBE surgery at our institution between January 2020 and December 2024. The cohort comprised 44 males and 36 females with an age of (55.8±10.7) years (range: 34 to 76 years). Fifty-nine cases involved a single segment, and 21 cases involved two segments; 27 cases had concomitant dural ossification. Intraoperatively, a diamond burr was used to perform full-thickness drilling of the ossified ligamentum flavum, and the “floating technique” was applied in cases with dural ossification. Operative time, length of hospital stays, and perioperative complications were recorded. Spinal canal area and sagittal diameter were measured preoperatively, at postoperative day 3, and at the final follow-up. The Oswestry disability index (ODI) and Japanese Orthopaedic Association (JOA) score were assessed preoperatively, at postoperative day 3 and 3 months, and at the final follow-up. Repeated measures ANOVA was used to compare pre- and postoperative data, with pairwise comparisons adjusted using Bonferroni post-hoc tests.

All procedures were completed successfully without conversion to open surgery. The operative time was (141.4±44.6) min (range: 80 to 220 min), and the length of hospital stay was (11.7±5.5) d (range: 7 to 28 d). The follow-up period was (33.5±13.1)months (range: 12 to 60 months). Postoperative cerebrospinal fluid leakage occurred in 20 cases (25.0%, 20/80), all of which were associated with concomitant dural ossification or severe dural adhesion, and after conservative treatment, no cerebrospinal fluid leakage occurred. Epidural hematoma occurred in 3 cases (3.8%, 3/80), all of which were successfully managed by emergency endoscopic hematoma evacuation with subsequent recovery of muscle strength. Neurological deterioration due to improper drain placement occurred in 4 cases (5.0%, 4/80), all of which recovered to preoperative muscle strength levels by the final follow-up. Compared with preoperative values, spinal canal area and sagittal diameter were significantly increased at postoperative day 3 and at the final follow-up (all P<0.05). ODI and JOA scores showed significant improvement at all postoperative time points compared with preoperative values (all P<0.05). No symptom recurrence or neurological deterioration was observed at the final follow-up.

UBE is an effective technique for the treatment of thoracic myelopathy caused by short-segment TOLF, achieving adequate spinal canal decompression and significant improvement in neurological function. Appropriate preoperative surgical approach planning and correct intraoperative decompression strategies are essential for ensuring surgical safety.

To investigate the predictive value of systemic immune inflammatory response index (SII) and interleukin-6 (IL-6) for postoperative hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH).

This is a retrospective cohort study. The clinical data of 209 aSAH patients who underwent surgical treatment at the People′s Hospital of Xinjiang Uygur Autonomous Region from June 2023 to June 2025 were enrolled, including 83 males and 126 females, with an age of (58.5±6.0) years (range: 29 to 78 years). Patients were divided into a hydrocephalus group and a non-hydrocephalus group based on the occurrence of hydrocephalus 3 months postoperatively. Preoperative baseline data, treatment modality, and SII and IL-6 levels on postoperative day 3 were collected. Intergroup comparisons were performed using the independent sample t-test or chi-square test. Multivariate logistic regression analysis was used to identify independent influencing factors for postoperative hydrocephalus in aSAH patients, and receiver operating characteristic (ROC) curves were used to evaluate the predictive efficacy of SII, IL-6, and their combination for hydrocephalus.

Among the 209 aSAH patients, 56 developed hydrocephalus 3 months postoperatively, with an incidence rate of 26.8%. There were no statistically significant differences between the two groups in sex distribution, smoking history, alcohol consumption history, diabetes history, treatment modality, or aneurysm location (all P>0.05). The proportions of hypertension history, Hunt-Hess grade Ⅲ to Ⅳ, and modified Fisher grade Ⅲ to Ⅳ in the hydrocephalus group were higher than those in the non-hydrocephalus group (all P<0.05). The Glasgow Coma Scale (GCS) score in the hydrocephalus group was lower than that in the non-hydrocephalus group ((8.12±1.09)points vs.(9.04±1.56) points, t=4.062,P<0.01), and the SII and IL-6 levels were higher than those in the non-hydrocephalus group (all P<0.05). Multicollinearity analysis showed that hypertension history (tolerance=0.075, VIF=12.136) and GCS score (tolerance=0.098, VIF=11.314) exhibited multicollinearity, and variables with multicollinearity were excluded. Age, Hunt-Hess grade, modified Fisher grade, SII, and IL-6 were included as independent variables in the multivariate Logistic regression model, with postoperative hydrocephalus in aSAH patients as the dependent variable (yes=1, no=0). The results indicated that Hunt-Hess grade, SII, and IL-6 were independent risk factors for postoperative hydrocephalus in aSAH patients (all P<0.05). ROC curve analysis showed that the area under the carve (AUCs) for SII, IL-6 alone, and their combination in predicting postoperative hydrocephalus in aSAH patients were 0.789, 0.743, and 0.859, respectively. The AUC of the combined prediction was greater than that of SII or IL-6 alone (Z=2.571, P=0.010; Z=3.149, P=0.002).

Elevated SII and IL-6 levels are independent risk factors for postoperative hydrocephalus in aSAH patients, and the combined detection of the two can enhance predictive efficacy.

To evaluate the mid-to long-term efficacy of drug-coated balloon (DCB) angioplasty for symptomatic intracranial atherosclerotic stenosis (sICAS), and to assess the predictive value of the Mori classification for post-procedural restenosis.

This retrospective case series study enrolled 56 patients with sICAS who underwent DCB angioplasty at Beijing Hospital between September 2018 and September 2024. The age was (62.2±10.2) years (range: 44 to 83 years), 36 patients (64.3%) were male and 20 (35.7%) were female. Patients were divided into a restenosis group and a non-restenosis group according to the presence of imaging restenosis after the procedure. Imaging restenosis was defined as recurrent stenosis≥50% of the target vessel diameter compared with the immediate post-procedural result. Between-group comparisons were performed using the independent-samples t test, Mann-Whitney U test, χ² test, or Fisher′s exact test. Multivariate binary logistic regression was used to identify independent factors associated with restenosis. A nomogram-based prediction model was constructed and internally validated by 1 000 bootstrap resamples, and decision curve analysis (DCA) was used to assess clinical net benefit.

Among the 56 patients, the residual stenosis after DCB angioplasty (M(IQR)) was 20.0 (30.0)%(range:0 to 50%), and 5 patients (8.9%) received bailout stenting. During the follow-up of 23.0(17.0) months (range: 12 to 82 months), imaging restenosis occurred in 9 patients (16.1%) and symptomatic restenosis in 1 patient (1.8%). The restenosis rates for Mori type A, B, and C lesions were 1/16, 12.1% (4/33), and 4/7, respectively. Univariate and multivariate analyses identified the Mori classification as an independent predictor of restenosis(OR=11.73, 95%CI: 2.02-68.18, P=0.006). DCA indicated that the model provided a high clinical net benefit within the threshold probability range of 0 to 0.55.

DCB angioplasty for sICAS demonstrated stable mid-to long-term efficacy and a favorable safety profile. The Mori classification is an independent risk factor for restenosis and may aid preoperative risk stratification and individualized management.

To investigate the impact of different extents of mediastinal lymph node dissection on postoperative survival in patients with cT1N0-1M0 non-small cell lung cancer (NSCLC).

A single-center retrospective cohort study was conducted. A total of 639 patients with cT1N0-1M0 primary NSCLC who underwent curative-intent surgical resection at the Fourth Hospital of Hebei Medical University between January 2015 and December 2017 were consecutively enrolled. The cohort included 340 males and 299 females, with an age of (61.0±8.4) years (range: 31 to 79 years). Based on the extent of mediastinal lymph node dissection, patients were divided into three groups: the lobe-specific lymph node dissection group (n=72), the extended lymph node dissection group (n=228, beyond lobe-specific stations), and the limited lymph node dissection group (n=339, failed to cover lobe-specific stations). Subgroup analyses were stratified by tumor size (≤1 cm vs.>1 to 3 cm), pathological type (adenocarcinoma vs. non-adenocarcinoma), tumor location (peripheral vs. central), and pathological N stage (N0 vs. N1-2). The primary endpoint was overall survival. The Kaplan-Meier method was used to plot survival curves, and comparisons between groups were performed using the Log-rank test with Bonferroni correction for multiple comparisons (adjusted α=0.017). Independent prognostic factors were identified using the Cox proportional hazards regression model.

The follow-up time (M(IQR)) was 66.7 (25.9) months, and the overall 5-year survival rate was 82.1%. The 5-year survival rates in the extended, lobe-specific, and limited groups were 84.9%, 92.9%, and 77.9%, respectively, with a statistically significant difference among the three groups (P=0.004). Pairwise comparisons showed significant differences between the extended and limited groups (P=0.015) and between the lobe-specific and limited groups (P=0.008), but no significant difference between the extended and lobe-specific groups (P=0.181). Multivariate Cox regression analysis identified age, lymph node dissection pattern, T stage, and N stage as independent prognostic factors for postoperative survival (all P<0.05). Subgroup analyses revealed that in patients with tumor size >1 to 3 cm, lung adenocarcinoma, and peripheral-type lung cancer, lobe-specific lymph node dissection (including both the lobe-specific and extended groups) was associated with significantly better survival compared with limited dissection (all P<0.01). However, in patients with tumor size ≤1 cm, non-adenocarcinoma, and central-type lung cancer, no significant survival differences were observed among the three groups (all P>0.05).

In curative-intent surgery for cT1N0-1M0 NSCLC, performing lobe-specific mediastinal lymph node dissection significantly improves postoperative survival compared with limited dissection. Further extension of lymph node dissection beyond the lobe-specific range does not confer additional survival benefit.

To evaluate the feasibility of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) for papillary thyroid carcinoma (PTC) with a tumor diameter>2 cm.

This is a retrospective case series study. Clinical data of 60 patients with PTC who underwent TOETVA were collected from the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University,the Department of General Surgery of Haicang Hospital Affiliated to Xiamen Medical College,and the Department of General Surgery of Zhongshan Hospital Affiliated to Xiamen University between January and December 2025. The study comprised 11 males (18.3%) and 49 females (81.7%),with an age of (30.2±9.0) years (range:8 to 59 years). Among them, 10 cases underwent bilateral thyroid lobectomy with bilateral central zone lymph node dissection, while 50 cases underwent unilateral thyroid lobectomy with ipsilateral central zone lymph node dissection. Postoperative follow-up was conducted via outpatient visits and telephone calls, with the cutoff date set at March 31,2026.

All 60 procedures were successfully completed under endoscopy,with no conversion to open surgery. Postoperative pathological examination confirmed PTC in all patients,including 50 cases of unilateral carcinoma and 10 cases of bilateral carcinoma. The maximum diameter (M(IQR) of the primary lesion was 25.6 (9.2) mm (range: 21 to 46 mm). Intraoperatively,recurrent laryngeal nerve invasion was observed in 4 cases,muscle invasion in 5 cases,and esophageal invasion in 1 case. The mean operative time was (94.1±16.4) min (range: 55 to 125 min). The postoperative serum calcium level was (2.17±0.17) mmol/L (range: 1.79 to 2.62 mmol/L),and the parathyroid hormone (PTH) level was 31.85 (13.46) pg/ml (range: 6.3 to 70.8 pg/ml). The drainage volume on the first postoperative day was 70.0 (55.0) ml (range: 4 to 130 ml), and the duration of drainage was 3 (1) d (range: 2 to 5 d). The number of harvested central compartment lymph nodes was 14 (6) (range: 2 to 37),with 3 (5) positive nodes (range: 0 to 32 positive nodes); the central compartment lymph node metastasis rate was (41.5±29.1)% (range:0 to 100%). The postoperative hospital stay was 6 (2) d (range: 4 to 10 d). No complications such as lymphatic leakage,choking on drinking water,or postoperative hemorrhage occurred. Two patients developed transient hypoparathyroidism,and their PTH levels normalized at the 1-month postoperative follow-up. Two patients experienced transient hoarseness,all of whom recovered within 6 months after surgery. During follow-up,1 patient was diagnosed with lateral cervical lymph node metastasis at 1-year postoperative re-examination and underwent lateral cervical lymph node dissection; no tumor residue or recurrence was detected in the remaining cases.

Transoral endoscopic thyroidectomy via the vestibular approach is feasible for PTC with a maximum tumor diameter>2 cm, and yields satisfactory preliminary outcomes.

To investigate the medium-to long-term outcomes of total hip arthroplasty (THA) for the treatment of sequelae of hip infection.

A retrospective case series analysis was conducted on 94 patients who underwent primary THA for sequelae of hip infection at the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University from January 2012 to January 2025. There were 43 males and 51 females, with an age of (43.5±14.5) years(range:18 to 77 years). The etiologies included 42 cases of sequelae of suppurative hip arthritis, 45 cases of sequelae of hip tuberculosis, and 7 cases of sequelae of hip osteomyelitis. The quiescent period of infection was (25.8±14.9) years (range:0.3 to 64.0 years). Based on pathoanatomical characteristics, patients were classified into three types: secondary osteoarthritis type (47 cases), dislocation type (21 cases), and ankylosis type (26 cases). Outcome measures included Harris hip score (HHS), complications, and prosthesis survival. Multivariable linear regression was used to identify factors influencing the improvement in HHS. Prosthesis survival was analyzed using the Kaplan-Meier method, and comparisons between groups were performed using the Log-rank test.

The follow-up duration was (68.3±42.1) months (range:0 to 160 months). The overall postoperative complication rate was 24.5% (23/94), including periprosthetic joint infection in 1 case (1.1%), aseptic loosening in 1 case (1.1%), prosthetic dislocation in 1 case (1.1%), and persistent hip pain in 2 cases (2.1%). Other complications included nerve injury in 3 cases (3.2%), acute liver injury in 3 cases (3.2%), and deep vein thrombosis in 9 cases (9.6%), all of which resolved with symptomatic treatment. At the final follow-up, the HHS increased from 42.1±10.9 preoperatively to 82.3±11.4 postoperatively (t=-29.492, P<0.01). Multivariable linear regression showed that pathoanatomical classification was independently associated with the degree of HHS improvement. Compared with the secondary osteoarthritis type, patients with the dislocation type (β=-7.900, 95%CI:-14.909 to-0.891, P=0.028) and the ankylosis type (β=-9.521, 95%CI:-15.540 to -3.502, P=0.002) had significantly less improvement in HHS after THA. Kaplan-Meier analysis revealed a prosthesis survival time of (153.1±3.4) months (95%CI: 146.4 to 159.7 months) and a 10-year survival rate of 94.7%. There was no significant difference in cumulative prosthesis survival among the dislocation type, ankylosis type, and secondary osteoarthritis type (P=0.078).

Under the premise of a long quiescent period of infection, THA for sequelae of hip infection can achieve satisfactory medium-to long-term functional improvement and prosthesis survival. The pathoanatomical classification of the hip provides some guidance for assessing surgical difficulty and predicting postoperative outcomes.

To introduce an acetabular reconstruction technique for total hip arthroplasty (THA) in patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH), and report its mid-term clinical outcomes.

This is a retrospective case series study. Clinical data of 231 patients (310 hips) with Crowe type Ⅳ DDH who consecutively underwent THA via the posterolateral approach at the First and the Fourth Medical Centers of the Chinese People′s Liberation Army General Hospital from August 2018 to April 2024 were retrospectively analyzed, and all patients had complete surgical and follow-up records. There were 17 males and 214 females, with an age of (43.9±9.8) years (range:18 to 60 years) and a body mass index of (24.0±3.1) kg/m² (range:17 to 30 kg/m²). Intraoperatively, the “ABCDE” method for true acetabulum identification (A: acetabular capsule; B: bone ridge; C: ligamentum capitis femoris; D: detect with index finger; E: exploration via ligamentum transversum) was adopted to precisely locate the true acetabulum, together with standardized operative essentials for acetabular reaming and acetabular cup implantation. All patients were followed up for no less than 1 year postoperatively. Preoperative and postoperative Harris Hip Score (HHS) and leg length discrepancy were measured and recorded, and perioperative complications were documented. The paired-sample t-test was used to compare preoperative and postoperative indicators.

All patients successfully received the surgery and completed follow-up. Among all hips, 223 were treated with robotic or navigation-assisted THA, and 87 with conventional THA. The operative time was (131.7±27.5) min (range:91 to 170 min). Intraoperatively, ceramic-on-ceramic bearing surfaces were used in 195 hips, ceramic-on-highly cross-linked polyethylene in 114 hips, and metal-on-polyethylene in 1 hip. Modular femoral stems were implanted in all hips, and subtrochanteric osteotomy was performed in 205 hips. The postoperative hospital stay was (5.2±2.8) d (range:3 to 9 d). The follow-up period was (28.8±14.2) months (range:12 to 46 months). Acetabulum-related complications occurred in 6 hips, including 3 cases of hip dislocation and 3 cases of acetabular fracture; secondary open reduction surgery was performed in 3 hips due to postoperative dislocation. The HHS significantly increased from preoperative (60.0±14.1) points (range:40 to 74 points) to postoperative (95.9±3.1) points (range:88 to 99 points) (t=32.45, P<0.01). The absolute value of postoperative leg length discrepancy was (6.5±3.3) mm (range:0 to 18 mm), which was significantly lower than the preoperative value of (17.6±11.2) mm (range:1 to 50 mm) (t=9.152, P<0.01).

The true acetabulum localization and acetabular reconstruction technique adopted in this study can accurately identify the native acetabulum, improve the stability of the acetabular component, and significantly restore hip function, which provides certain clinical references for acetabular reconstruction in patients with Crowe type Ⅳ DDH.

To evaluate the clinical effect of total hip arthroplasty through direct anterior approach in the lateral decubitus position combined with proximal femur osteotomy in the treatment of Hartofilakidis type C developmental dysplasia of the hip(DDH).

A retrospective case series analysis of 134 patients (163 hips) with Hartofilakidis type C developmental dysplasia of the hip who underwent total hip arthroplasty at the Department of Orthopaedics, the First Affiliated Hospital of University of Science and Technology of China from January 2017 to December 2024 was performed. There were 10 males (11 hips) and 124 females (152 hips), aged (44.5±12.3) years (range:22 to 81 years), with the body mass index of (22.6±3.5) kg/m² (range:13.9 to 34.2 kg/m²). Harris hip scores and lower limb length discrepancy were compared between preoperative and final follow-up. Imaging stability of the prosthesis was evaluated by X-ray, and postoperative complications were recorded. The paired sample t-test or Mann-Whitney U test was used to compare data before and after surgery.

All patients successfully completed the surgery. The operation time(M(IQR)) was 125(35) min (range:80 to 200 min) and intraoperative bleeding loss was 200(100)ml (range:100 to 1 000 ml). All the patients were followed up for 36(22)months (range:16 to 100 months). Harris hip score increased from preoperative (44.7±5.6) points to (85.2±5.2) points at the last follow-up, and the difference was statistically significant (t=65.677, P<0.01). Lower limb length discrepancy decreased from preoperative 5(2)cm to 1(2) cm, and the difference was statistically significant (Z=15.777, P<0.01). All acetabular components were stable and free of displacement on imaging during follow-up. In 2 hips, the femoral osteotomy fragment had loosening and displacement after surgery and underwent revision surgery. In 2 hips, Vancouver type C periprosthetic fracture occurred, and they underwent open reduction and internal fixation. In 6 hips, dislocation occurred after surgery and all prostheses were in good position after closed reduction. At the last follow-up, 4 hips had local sensory abnormality in the affected lower limb. No dislocation, loosening, fracture, infection or neurovascular injury occurred in other patients.

Total hip arthroplasty through direct anterior approach combined with proximal femur osteotomy for Hartofilakidis type C DDH can effectively improve hip joint function with satisfactory short-to-mid-term outcomes.

The pseudocapsule of renal cell carcinoma (RCC) is a fibromuscular interface structure formed by the compression of adjacent renal parenchyma during expansile tumor growth, which subsequently triggers fibrous connective tissue proliferation, inflammatory response, and tissue remodeling. In recent years, with advances in pathology, radiomics, and molecular biology, the pseudocapsule is no longer considered a mere passively formed fibrous encapsulation, but rather a dynamic tumor-host interface actively involving tumor cells, stromal cells, inflammatory cells, blood vessels, and the extracellular matrix. On one hand, the pseudocapsule can restrict tumor extension through its dense fibrous architecture; on the other hand, aberrant vascular remodeling, matrix degradation, and alterations in the immune microenvironment within the pseudocapsule may contribute to local invasion, nutrient supply, and potential metastasis. Therefore, the integrity, thickness, continuity, and tumor breakthrough of the pseudocapsule may carry important prognostic value. This review summarizes the pathological features, formation mechanisms, imaging evaluation, and molecular basis of the pseudocapsule in RCC, as well as their associations with tumor progression and prognosis. Furthermore, based on current pathological reporting standards, actionable recommendations for pseudocapsule reporting in clinical practice were proposed, aiming to provide references for preoperative assessment, surgical strategy selection, and prognostic prediction in patients with RCC.

Although the complications of complex total hip arthroplasty (THA) are decreasing with the progress of surgical technology, it is still a difficult clinical problem. Complex THA has a high risk of dislocation, vascular and nerve injury due to anatomical disorder, poor soft tissue condition, bone defect and other factors. Recent studies have shown that spinal-pelvic linkage, soft tissue protection and reconstruction, and the removal of impingement potential factors play an important role in maintaining hip joint stability. Minimally invasive interventional therapy has become an important means to deal with main vascular injury. There are still no clinical guidelines for the diagnosis and treatment of nerve injury, but in recent years, the principle of comprehensive management based on prevention has gradually been paid attention to. In the future, with the development of artificial intelligence(AI), AI-assisted preoperative planning and robot-assisted technology will be widely used in complex THA, which is expected to further improve the accuracy of surgery and reduce the risk of complications.