Volume 106 ·  Issue 13 ·  2026

To explore the correlation between serum transforming growth factor-β stimulated clone 22 domain family member 4 (TSC22D4) and type 2 diabetes mellitus (T2DM) combined with metabolic associated fatty liver disease (MAFLD).

Prospectively, 257 patients with T2DM who were hospitalized at Gansu Provincial Hospital from April 2024 to April 2025 were included in this study, comprising 168 males and 89 females, with the age of [M(Q₁, Q₃)] 53(47, 58) years. Based on their disease status, the patients were divided into the simple T2DM group (n=127) and the T2DM+MAFLD group (n=130). Additionally, healthy individuals from the physical examination center during the same period were enrolled as the normal control group (n=132), including 80 males and 52 females, with the age of 51(47, 57) years. Clinical data were collected, and differences in clinical indicators among the three groups were compared. Spearman correlation analysis was employed to examine the correlations between TSC22D4 and metabolic and inflammatory indicators. A multivariate logistic regression model was employed to analyze the influencing factors of T2DM complicated with MAFLD.

The body mass index (BMI), visceral fat area (VFA), fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance index (HOMA-IR), glycated hemoglobin (HbA1c), TSC22D4, interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) levels were all higher in both the simple T2DM group and the T2DM+MAFLD group compared to the normal control group. Moreover, all these indicators were significantly elevated in the T2DM+MAFLD group compared to the simple T2DM group (all P<0.05). Conversely, high-density lipoprotein cholesterol levels were lower in both the simple T2DM group and the T2DM+MAFLD group compared to the normal control group, with the T2DM+MAFLD group exhibiting even lower levels than the simple T2DM group (all P<0.05). Among the 257 T2DM patients, Spearman correlation analysis revealed that TSC22D4 was positively correlated with BMI, VFA, FBG, FINS, HOMA-IR, HbA1c, triglycerides, total cholesterol, low-density lipoprotein cholesterol, IL-6, and hs-CRP (all P<0.05). The results of the multivariate logistic regression model analysis revealed that elevated BMI (OR=1.286, 95%CI:1.128-1.465), longer duration of diabetes (OR=1.098, 95%CI:1.036-1.163), and elevated TSC22D4 levels (OR=1.031, 95%CI:1.021-1.040) were associated factors contributing to the increased risk of T2DM complicated with MAFLD.

Elevated TSC22D4 is a relevant factor contributing to the increased risk of developing T2DM complicated with MAFLD. Serum TSC22D4 may contribute to the development and progression of MAFLD in T2DM patients by exacerbating insulin resistance and inflammatory responses.

To investigate the causes of failure following arthroscopic anterior cruciate ligament (ACL) reconstruction and to evaluate the outcomes of revision surgery.

A total of 102 patients who underwent revision surgery due to failed ACL reconstruction between January 2017 and December 2022 at Shengjing Hospital of China Medical University were included in this study. All the patients included in the study underwent single-bundle, stage Ⅰ arthroscopic revision ACL reconstruction. Knee function was evaluated using the International Knee Documentation Committee (IKDC) score, Tegner activity scale, Lysholm score, and knee laxity. These parameters were assessed preoperatively and postoperatively at 6, 12, 18, 24, and 30 months to compare the clinical outcomes.

Among the patients, there were 70 males and 32 females, with a mean age of (33.2±3.6) years. The primary cause of ACL reconstruction failure was abnormal bone tunnel placement, observed in 56 cases (54.9%). Additionally, 37 failures (36.3%) were attributed to secondary trauma postoperatively, 8 cases (7.8%) resulted from graft fixation failure, and 1 case (1.0%) was due to graft disappearance caused by rejection. Medial compartment cartilage damage was the most frequently observed intraarticular lesion (35 cases, 34.3%). The mean follow-up duration was (26.8±4.0) months. At 6 months post-revision, no significant improvements were observed in IKDC or Tegner scores [(37.3±3.2) vs (36.3±5.8) points, (4.0±0.4) vs (4.0±0.7) points, respectively, both P>0.05], whereas the Lysholm score improved from (56.2±7.2) points to (83.2±4.1) points (P<0.001), and the KT-3000 side-to-side difference at 30° of knee flexion decreased from (6.6±1.3) mm to (2.3±0.2) mm (P<0.001) when compared with those before the revision operation. From 12 months onward, all functional scores and stability parameters continued to improve. At the final follow-up, the IKDC, Lysholm, and Tegner scores reached (82.2±3.3), (87.2±3.5) and (7.2±2.3) points, respectively, while the KT-3000 difference at 30° and 90° flexion was (2.2±0.7) mm and (1.8±0.5) mm, respectively; all showing significant improvement when compared with those preoperative values (all P<0.001).

Malpositioned bone tunnels represent the leading cause of failure after arthroscopic ACL reconstruction. Revision surgery significantly improves knee function and stability during follow-up.

To investigate the radiographic characteristics of lumbar disc herniation (LDH) associated with sciatic scoliosis and to compare coronal and sagittal alignment parameters between adolescent and adult patients.

A retrospective analysis was conducted on patients with LDH who underwent unilateral endoscopic discectomy or unilateral laminotomy with discectomy at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, between January 2017 and July 2025. A total of 86 adolescents with LDH complicated by sciatic scoliosis were included as the adolescent group. Using a random number table, 172 adult patients who met the identical diagnostic and treatment criteria during the same period were selected and matched in a 1∶2 ratio to form the adult group. Based on sagittal balance status, patients were further classified into a balanced group [sagittal vertical axis (SVA)≤40 mm] and an imbalanced group (SVA>40 mm). Spinopelvic sagittal parameters were evaluated. Differences in sagittal and coronal alignment between groups were compared. Furthermore, the associations among the side of disc herniation, the direction of scoliotic curvature, and trunk shift were analyzed.

In patients with LDH complicated by sciatic scoliosis, the mean lumbosacral curve was 15.3°±5.8°, the thoracic/thoracolumbar curve was 16.9°±5.4°, apical vertebral translation was (2.9±1.6) cm, and trunk shift was (3.0±1.5) cm. Overall, 79.8% (206/258) of the patients exhibited lumbosacral curve convexity on the same side as the disc herniation, while 81.0% (209/258) demonstrated trunk shift toward the side contralateral to the herniation (both P<0.01). Compared with the imbalanced group, the balanced group showed smaller trunk shift and apical vertebral translation [(2.8±1.2) vs (3.3±1.7) cm and (2.7±1.4) vs (3.1±1.7) cm, respectively, both P<0.05]. Further analysis revealed that adolescents had lower thoracic kyphosis (TK), lumbar lordosis (LL), lower lumbar lordosis, and sacral slope (SS) than adults (13.2°±9.8° vs 17.4°±11.0°, 19.5°±14.2° vs 30.3°±15.6°, 16.7°±11.9° vs 23.8°±11.6°, and 23.4°±6.4° vs 26.7°±8.3°, respectively); while, the SVA and pelvic tilt (PT) were significantly greater than those in adults [(70.5±58.4) vs (41.8±52.6) mm, and 25.7°±10.5° vs 20.8°±9.3°, respectively] (all P<0.05).

Patients with LDH complicated by sciatic scoliosis typically exhibit characteristic imaging features, including trunk tilt toward the side contralateral to the herniation, herniation predominantly on the convex side of the lumbosacral curve, and sagittal imbalance. Sagittal imbalance is coupled with coronal deformity and more pronounced in adolescent patients.

To evaluate the efficacy of the endotherapy rob-assistant (ERA) system in treating gastrointestinal polyps in beagle dogs.

Sixteen beagle dogs, aged 10-20 months and weighing 8-15 kg, were enrolled. They were randomly divided into an experimental group (ERA-assisted, n=8) and a control group (assisted by an instrument nurse, n=8) using a random number table. Artificial polyps were created in the gastric antrum, gastric body, gastric fundus, and colon using high-frequency electrocoagulation marking. Endoscopic mucosal biopsy and endoscopic mucosal resection were then performed. Procedural success rate, operation time, and complications were compared between the groups. Wound healing was assessed two weeks postoperatively.

All the artificial polyp models were successfully established, success rate: 100% (16/16). All procedures were completed without intraoperative complications, and postoperative wound healing was favorable. Compared with the control group, the experimental group showed no statistically significant difference in EMR operation time[M (Q₁, Q₃)] [344 (330, 388) vs 372 (330, 422) s, P>0.05]. Both the instrument transfer time [upper endoscopy: 9 (8, 9) vs 10 (8, 13) s; colonoscopy: 8 (8, 9) vs 11 (10, 13) s, all P<0.05] and the biopsy operation time [upper endoscopy: 67 (53, 79) vs 79 (73, 87) s; colonoscopy: 64 (51, 72) vs 77 (71, 81) s, all P<0.05] were significantly shorter in the experimental group, compared to the control group. Furthermore, the incidence of risky maneuvers was significantly lower than that of the control group [43% (100/233) vs 0, P<0.05].

The ERA system is safe and effective for treating gastrointestinal polyps in beagle dogs.

A retrospective study was conducted to include patients with genetically confirmed pseudohypoparathyroidism (PHP) type 1 at the First Affiliated Hospital of Zhengzhou University from August 2016 to April 2025, aiming to analyze their clinical and genetic characteristics. A total of 15 patients with PHP type 1 were enrolled, including 7 males and 8 females, with a median age of onset at 12.0 years (range: 3.5-40.0 years). Among them, 4 cases were PHP 1A and 11 cases were PHP 1B. All patients exhibited elevated parathyroid hormone levels, and 14 had hypocalcemia. Hyperphosphatemia was observed in all pediatric patients, while serum phosphate levels were normal in adult patients. Six patients had hypokalemia. Two patients had hypertension (including one with idiopathic hyperaldosteronism). Three patients had concurrent autoimmune thyroid diseases. There was significant clinical phenotypic overlap between PHP 1A and PHP 1B. In addition to the typical features of parathyroid hormone resistance and hypocalcemia, patients with PHP type 1 could also present with age-related serum phosphate abnormalities, hypokalemia, hypertension, autoimmune thyroid diseases, and other atypical phenotypes. Regarding genetic characteristics, 4 cases of PHP 1A exhibited maternally inherited inactivating variants in the GNAS gene. Among the 11 PHP 1B cases, 10 had methylation defects in the GNAS gene imprinting control region (including 3 familial cases and 7 sporadic cases), while the remaining 1 case had a copy number variation [20(chr20:?_44996182-62737512_?)*2 ROH], representing paternal uniparental disomy of chromosome 20q, consistent with sporadic PHP1B. In clinical practice, precise classification requires the integration of clinical phenotypes with molecular genetic findings, along with systematic evaluation and long-term follow-up.