Table of Content

25 May 2026 Volume 44 Issue 3

  

Anatomical study of the triceps aponeurosis and its clinical significance

Wang Jing, Yao Yushan, Hou Fanli, Li Chengyang, Yu Shuangfei, Meng Xiaotong, Gao Xin, Li Jing

Chinese Journal of Clinical Anatomy. 2026, 44(3):  245-249.  doi:10.13418/j.issn.1001-165x.2026.3.01

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 Objective    To observe the anatomical characteristics of the triceps aponeurosis (TA) and explore the relationship between TA and radial nerve (RN), so as to provide useful information for the localization of RN during humeral fracture surgeries.    Methods    A total of 63 adult upper limbs were dissected and the characteristics of the TA were noted. The length and width of the TA, the distance from the proximal apex and lateral border of the TA to the RN were measured, respectively.    Results    (1) TA was divided into the following 4 anatomical types according to its morphology: ①Classical type: TA had a proximal apex and a distal apex in 49 cases (77.8%); ②Single apex type: TA had only one proximal apex and no distal apex in 5 cases (7.9%); ③Three apexes type: TA had two proximal apexes and one distal apex in 6 cases (9.5%); ④Step type: TA showed a stepwise shape in 3 cases (4.8%). (2) There were significant differences in the length (P<0.05) and width (P<0.05) of TA between genders. There were significant differences in the length (P<0.05) of TA, and the distance between RN and the lateral edge of TA (P<0.05) in the four types.   Conclusions   The anatomical classification of TA is a supplement to previous studies. Analyzing the relationship between TA and RN can more accurately locate the radial nerve, providing positive reference when performing surgical procedures on humeral fractures.

Morphological observation and clinical application research of Hasner's valve variation

Zhao Boyun, Yang Zhixin, He Yongqian, Chen Haoyin, Liang Jingjing, Liu Minjie, Xu Dazheng, Jiang Mei Hua

Chinese Journal of Clinical Anatomy. 2026, 44(3):  250-255.  doi:10.13418/j.issn.1001-165x.2026.3.02

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Objective   To observe the morphological parameters of the Hasner valve and to propose a morphological classification system that will serve as a reference for clinical surgical decision-making. Methods    The presence rate, shape, inclination angle, coverage angle, thickness, opening area, and distance of the Hasner valve in 45 adult specimens were anatomically measured, followed by K-means cluster analysis. Results    Among the 45 adult specimens, the Hasner valve was present in 88%. Clustering was identified three types:  Type A: Largest valve area (mean pre-/post-resection opening area ratio [S1]/[S2] was 0.533) and widest coverage of the nasolacrimal duct orifice (mean membrane-directed coverage angle was 166°).  Type B: Most horizontally oriented valve opening (mean nasolacrimal duct orifice inclination angle θ was 47.6°) and greatest valve thickness (mean plica thickness T was 0.745 mm).  Type C: Smallest valve area (mean [S1]/[S2] was 0.66), narrowest coverage (mean membrane-directed coverage angle was 149°), and thinnest valve (mean plica thickness T was 0.298 mm).    Conclusions    The Hasner valve can be classified into Types A, B, and C. This new classification provides anatomical basis for selecting surgical approaches: Type A is suitable for laser lacrimal canaliculoplasty and endoscopic intranasal Hasner valve resection, type B is appropriate for bypass procedures such as dacryocystorhinostomy and canaliculotomy, type C is optimal for lacrimal balloon dacryoplasty.

Digital study of sagittal balance parameters in adolescent idiopathic scoliosis: a comparative study with normal adolescents

Zhang Ruofan, Kang Zhijie, Jin Feng, Zhang Yunfeng, Zhang Kai, Li Xiaohe, Wang Haiyan

Chinese Journal of Clinical Anatomy. 2026, 44(3):  256-264.  doi:10.13418/j.issn.1001-165x.2026.3.03

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Objective    To explore the differences in sagittal balance parameters between normal adolescents and adolescent idiopathic scoliosis, and to analyze the influencing factors of the disease.   Methods   A total of 242 full-spine sagittal X-ray images of adolescents were collected from three different tertiary hospitals. After screening, 100 images with complete imaging data were included in the study, comprising 50 healthy adolescents and 50 patients with adolescent idiopathic scoliosis (AIS). The imaging data were imported into Mimics 21.0 for the measurement of sagittal morphological parameters, including cervical Cobb Angle (CCA), Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Thoracolumbar Kyphosis (TLK), Sagittal Vertical Axis (SVA), Spinal Tilt (ST), Spinosacral Angle (SSA), Spinopelvic Angle (SPA), T1 Spinopelvic Inclination (T1-SPI), T9 Spinopelvic Inclination (T9-SPI), T1 Pelvic Angle (TPA), Lumbar Pelvic Angle (LPA), Sacral Slope (SS), Pelvic Incidence (PI), and Pelvic Tilt (PT). Differences in these parameters were compared between healthy adolescents and AIS patients, as well as between male and female AIS patients. Correlations among parameters were also analyzed. Binary logistic regression analysis was performed to investigate the association between sagittal morphological parameters and the presence of AIS.   Results   Comparing the sagittal parameters between healthy adolescents and AIS patients showed statistically significant differences in TK, LL, PT, PI, SVA, SSA, SPA, and T9-SPI (Z=-3.712, P=0.000; t=16.648, P=0.000; Z=-2.203, P=0.028; Z= -2.147, P=0.032; Z=-3.812, P=0.000; Z=-3.381, P=0.001; Z=-3.723, P=0.000; Z=-3.550, P=0.000), while the remaining parameters showed no statistical significance (P>0.05). Comparing the gender differences within AIS patients, TK, LL, SS, SVA, ST, SPA, and T9-SPI showed statistically significant differences (Z=-2.367, P=0.018; t=6.317, P=0.015; t=6.480, P=0.014; Z=-2.319, P=0.020; Z=-2.377, P=0.017; Z=-2.843, P=0.004; Z=-2.464, P=0.014), while the remaining parameters showed no statistical significance (P>0.05). In AIS patients, the sagittal parameters showed that TK was weakly positively correlated with LL (r=0.282, P=0.047), significantly positively correlated with SVA (r=0.641, P=0.000), and weakly negatively correlated with TLK (r=-0.326, P=0.021). LL was significantly positively correlated with SS (r=0.772, P=0.000), moderately positively correlated with PI (r=0.435, P=0.002), and weakly positively correlated with SPA (r=0.324, P=0.022). PT was moderately positively correlated with PI (r=0.508, P=0.000). SS was moderately positively correlated with PI (r=0.548, P=0.000) and weakly positively correlated with SPA (r=0.289, P=0.042). SVA was weakly positively correlated with SSA (r=0.313, P=0.027) and weakly negatively correlated with TLK and T9-SPI (r=-0.324, P=0.022; r=-0.299, P=0.035). ST was significantly positively correlated with SPA (r=0.744, P=0.000). LPA was moderately positively correlated with TPA (r=0.5, P=0.000) and weakly negatively correlated with T9-SPI (r=-0.33, P=0.019). Binary logistic regression analysis revealed that there were statistically significant in TK, LL, SSA, SPA, and T9-SPI (P=0.007; P=0.025; P=0.005; P=0.012; P=0.018), while the remaining parameters showed no statistical significance (P>0.05).   Conclusions   In patients with AIS, TK, LL, SSA, and SPA were significantly increased, and T9-SPI was significantly decreased, indicating that AIS may lead to an increase in the overall inclination of the spine, accompanied by changes in the segmental curvature of the vertebral body and pelvic morphology. Therefore, the changes of the above parameters should be focused on in the preoperative evaluation, so as to fully grasp the overall balance of the spine and pelvis, and provide a reference for the formulation of individualized treatment plans.

Analysis on the mechanism of spastic sarcomere remodeling after stroke based on omics changes of the ubiquitin proteasome system and related proteins

Liu Guangrun, He Yun, Jiang Xiaolin, Yang Shengbo

Chinese Journal of Clinical Anatomy. 2026, 44(3):  265-273.  doi:10.13418/j.issn.1001-165x.2026.3.04

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Objective     To analyze the changes of the ubiquitin proteasome system and related proteins in the gastrocnemius muscle of rats with post-stroke spasm through quantitative proteomics, and to elucidate the mechanism of sarcomere remodeling.    Methods    Sixteen Sprague Dawley rats were divided into a normal group and a post-stroke muscle spasm group. A stroke muscle spasm model was created by using the nylon thread embolization. Neurological function damage was evaluated using the Zea Longa score. Gastrocnemius muscle tone was measured using a biological signal analyzer, and the length, number, and width of gastrocnemius muscle segments were measured by using Mallory phosphotungstic acid hematoxylin staining. The changes in the ubiquitin protease system and related proteins were quantitatively analyzed by using proteomics.    Results    Compared with the normal group, the Zea Longa score and gastrocnemius muscle tone were significantly increased in the post-stroke spasticity group, with an increased sarcomere length and decreased sarcomere number and decreased width, P<0.05, the difference was statistically significant. Bioinformatics analysis revealed that the expression of Ube2b and Ube2n, Trim63 and Fbxo32, as well as 32 proteasome subunits, were upregulated in the post-stroke muscle spasm group, while their related proteins Myh1 and Des were significantly downregulated.    Conclusions    After stroke, the muscle remodeling in the spastic gastrocnemius muscle of rats may be due to the upregulation of the ubiquitin proteasome system leading to increased hydrolysis of Myh1 and desmin.

Neural pathways from the thalamic reticular nucleus to hippocampal subregions

Liu Yao, Ma Wenqian, Huang Haiyue, Peng Hairong, Ma Chang, Zhang Rui, Zhang Lianxiang, Wen Yujun

Chinese Journal of Clinical Anatomy. 2026, 44(3):  274-280.  doi:10.13418/j.issn.1001-165x.2026.3.05

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Objective    To clarify the neural pathways from the thalamic reticular nucleus (TRN) to subregions of the hippocampus (HPC).    Methods    The anterograde tracer biotinylated dextran amine (BDA) was injected into the unilateral TRN of the mouse brain, and the anterograde projections originating from the TRN were observed in the thalamus and hippocampus. The retrograde tracer cholera toxin subunit B (CTb) was injected into the CA3 region or dentate gyrus (DG) of the unilateral hippocampus in mice, and the distribution of retrogradely labeled neuronal somata was examined in the thalamus.    Results    Seven days after BDA injection, BDA-positive nerve fibers were detected in the ipsilateral anterodorsal thalamic nucleus (AD), anteroventral thalamic nucleus (AV), and paraventricular thalamic nucleus (PV). Among these fibers, those projecting to the AD and AV expressed vesicular glutamate transporter 2 (vGluT2), and BDA-positive fibers were also observed in the hippocampal DG region. Seven days after CTb injection, CTb-positive neuronal somata originating from the hippocampal CA3 region were found in the ipsilateral AD, AV, and PV, while CTb-positive neuronal somata from the DG region were identified in the ipsilateral TRN.    Conclusion An indirect pathway exists between the TRN and the hippocampal CA3 region, with the projection route being TRN→AD/AV/PV→CA3. A direct pathway is present between the TRN and the hippocampal DG region, where nerve fibers from the TRN directly project to the hippocampal DG region.

Salidroside alleviates sevoflurane-induced mouse hippocampal neuronal injury by inhibiting ferroptosis 

Mao Ke, Du Silong, Liu Pengsen, Yang Jiansheng, Zhao Yanfen, Wang Can, Guo Yunliang

Chinese Journal of Clinical Anatomy. 2026, 44(3):  281-289.  doi:10.13418/j.issn.1001-165x.2026.3.06

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Objective   To explore the effect and mechanism of salidroside (SAL) on sevoflurane (SEVO)-induced ferroptosis in mouse hippocampal HT22 cells.   Methods   The safe concentration of salidroside (50 μmol/L) was screened by MTT assay, and a SEVO-induced HT22 cell injury model was established with 4 groups: control, SEVO, SEVO+SAL and SEVO+SAL+Erastin (a ferroptosis activator).  FerroOrange probe was used to detect intracellular iron levels, immunofluorescence was employed to examine GPX4 protein expression, and commercial assay kits were applied to measure GSH, MDA and 4-HNE contents. Lipid ROS levels were detected using C11-BODIPY 581/591. Based on target pathway prediction from SwissTargetPrediction and FerrDb databases, Western blot was performed to detect p-EGFR protein expression to validate pathway activity. Finally, the regulatory role of this pathway in HT22 cell ferroptosis was clarified using the EGFR inhibitor AG1478 and agonist EGF.   Results  Salidroside significantly improved SEVO-induced reduction in cell viability, inhibited iron accumulation, upregulated GPX4 and GSH levels, and decreased lipid ROS, MDA, and 4-HNE contents (P<0.05). The addition of Erastin partially reversed the protective effect of salidroside (P<0.05). Bioinformatics and experimental verification confirmed that salidroside could inhibit SEVO-induced activation of the EGFR pathway in HT22 cells. AG1478 produced protective effects similar to those of salidroside, whereas activation of this pathway through treatment with EGF significantly attenuated the neuroprotective effects of salidroside (P<0.05).   Conclusions Salidroside may attenuate SEVO-induced HT22 cell ferroptosis and neuronal damage by inhibiting EGFR pathway activation, which providing a potential strategy for anesthesia-related neuroprotection.

Effect of rat superior cervical ganglionectomy on relieving vasospasm in the facial artery area

Cai Zili, Ren Zhenyu, Zhou Shujun, Zhuang Yuehong, Wu Jiwen

Chinese Journal of Clinical Anatomy. 2026, 44(3):  290-295.  doi:10.13418/j.issn.1001-165x.2026.3.07

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Objective    To investigate the effects of superior cervical ganglionectomy on relieving facial artery vasospasm and improving blood perfusion.    Methods    A total of 20 rats were randomly divided into an experimental group (n=10) and a control group (n=10). The experimental group underwent right superior cervical ganglionectomy, and the resected specimens were harvested to immunofluorescent staining. The control group received sham surgery. For the vasospasm model: mechanical induction of facial artery vasospasm was performed on rats from two groups (n=20) immediately after surgery and at 1h post-surgery. Laser speckle imaging was used to measure facial artery blood flow and vessel diameter at both time points. At 1w post-surgery, rats in the experimental group underwent Horner's syndrome evaluation, facial artery blood flow and diameter measurements, which were compared with pre-spasm measurements taken immediately after surgery. Finally, facial artery specimens were harvested from both groups for immunofluorescence staining.    Results    (1) Immediately after surgery, before and after vasospasm, there were no statistical differences in ipsilateral facial artery blood flow and vessel diameter between the experimental and control groups (P>0.05). (2) At 1h post-surgery, before and after vasospasm, the experimental group showed significantly higher ipsilateral facial artery blood flow and vessel diameter compared to the control group (P<0.0001). (3) At 1week post-surgery, all rats in the experimental group developed ipsilateral Horner's syndrome. Ipsilateral facial artery blood flow and vessel diameter were both significantly higher than pre-spasm measurements taken immediately after surgery (P<0.0001). Immunofluorescence results indicated that the resected specimens were rich in tyrosine hydroxylase (TH)-positive neurons. The density of TH-positive fibers in the facial artery region of the experimental group was significantly lower than that in the control group.   Conclusions   Superior cervical ganglionectomy can effectively relieve facial artery vasospasm and improve blood perfusion.

Modelling of autophagy-related genes in microcirculatory damage at the extremities of patients with diabetic foot ulcers based on bioinformatics analysis

Song Xiaoyi, Tang Zhangfeng, Gui Liang

Chinese Journal of Clinical Anatomy. 2026, 44(3):  296-304.  doi:10.13418/j.issn.1001-165x.2026.3.08

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Objective    To construct a model of autophagy-related genes (ATGs) in the microcirculatory damage of extremities in patients with diabetic foot ulcers (DFU) based on bioinformatics analysis, and explore the related mechanisms and diagnostic/therapeutic targets.   Methods   Datasets GSE 134431, GSE 80178, and GSE 68183 were obtained from the GEO database, serving as training and validation sets, respectively. After data preprocessing, normalization, and batch correction, cluster analysis, GO and GSVA enrichment analysis, and WGCNA module identification were performed. Multiple machine learning methods were used to build prediction models, and performance was evaluated using nomograms, calibration curves, and decision curve analysis.   Results   A total of 20 differentially expressed genes were identified. Cluster analysis divided patients into 2 groups based on the presence or absence of microcirculatory damage. GO analysis revealed significant enrichment of genes in autophagosome-related structures, ubiquitin ligase binding, and cellular stress response processes. GSVA indicated significant enrichment in autophagy, mitophagy, and FoxO signaling pathways. The SVM model performed best (AUC=1.000), with an AUC of 0.929 in the validation set. Key genes included BNIP3, HEPHL1, and KLK10.   Conclusions   ATGs are involved in DFU microcirculatory damage by regulating mitophagy and the FoxO pathway. The SVM model demonstrates strong predictive ability, providing a basis for clinical diagnosis and targeted therapy.

The effects of bone marrow mesenchymal stem cells on motor function, neurotrophic factors and the PI3K/AKT/GSK-3β/β-catenin pathway in rats with spinal injury

Wu Cairong, Su Ruilong, Xu Zunying, Cai Taoyi

Chinese Journal of Clinical Anatomy. 2026, 44(3):  305-310.  doi:10.13418/j.issn.1001-165x.2026.3.09

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Objective    To explore effects of bone marrow mesenchymal stem cells (BMSCs) on motor function, neurotrophic factors and PI3K/AKT/GSK-3β/β-catenin pathway in rats with spinal cord injury.    Methods    30 SPF-grade male SD rats were selected and randomly divided into the normal (NO), the model (MO), and the BMSCs (BM) groups, with 10 rats in each group. Spinal injury rat models were established in the MO and the BM group, but NO model was established in the NO group. After successful modeling, 10μL of 1×106 BMSCs were injected into the injury sites of the BM group. The NO and the MO group were injected with the same volume of normal saline. The motor function was evaluated by BBB score and inclined plate test. The pathology of spinal cord tissue was detected by HE staining. Serum neurotrophic factor was detected by enzyme-linked immunosorbent assay. The expression of PI3K/AKT/GSK-3β/β-catenin pathway molecules in spinal cord tissue was detected by immunoblotting.    Results    Compared with the NO group, the BBB score of the MO group decreased (P<0.05), and compared with the MO group, the BBB score of the BM group increased (P<0.05). Compared with the NO group, the inclined plate test Angle in the MO group decreased (P<0.05), while that in the BM group increased (P<0.05). The spinal cord tissue morphology and structure in group NO were normal, cells were arranged regularly, and there were no obvious pathological changes. In group MO, the spinal cord tissue structure was disordered, with cell edema, necrosis, inflammatory cell infiltration, and injury pathological manifestations such as cavities. Compared with group MO, the pathological structure in group BM was significantly improved. Compared with the NO group, the levels of serum NT-3, NGF and BDNF in the MO group increased (P<0.05), and compared with the MO group, the levels of serum NT-3, NGF and BDNF in the BM group increased (P<0.05). Compared with the NO group, the protein expression of PI3K/AKT/GSK-3β/β-catenin in the spinal cord tissue of the MO group decreased (P<0.05), while compared with the MO group, the protein expression of pathway molecules in spinal cord tissue of the BM group increased (P<0.05).    Conclusions    BMSCs have a significant therapeutic effect on rats with spinal cord injury. They can effectively improve motor function, promote the secretion of neurotrophic factors, and activate the PI3K/AKT/GSK-3β/β-catenin pathway.

Research on the mechanism of POSTEN promoting keloid formation via endoplasmic reticulum stress and proliferation

Wang Guohe, Feng Peng, Zhang Yue, Li Ziyin, Du Aoyu

Chinese Journal of Clinical Anatomy. 2026, 44(3):  311-316.  doi:10.13418/j.issn.1001-165x.2026.3.10

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Objective     To reveal the mechanism of periostin (POSTEN) in the formation of keloids and its influence on the nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) signaling pathway, endoplasmic reticulum stress (ER Stress) regulation, and cell proliferation behavior. Methods Venn analysis and STRING/Cytoscape protein interaction network construction were performed using the GSE44270 dataset and Genecards database. Western blot and qRT-PCR were used to detect POSTEN expression. Immunofluorescence was used for localization. Transwell and EdU assays were used to evaluate migration and proliferation. Western blot was used to detect the levels of key proteins in the NFκB pathway (p-NFκB) and endoplasmic reticulum stress markers (GRP78, CHOP).    Results   Compared with normal human dermal fibroblasts (NF), the expression levels of POSTEN protein and mRNA in human keloid fibroblasts (KF) were significantly increased (P<0.05). After POSTEN knockdown, POSTEN expression was significantly decreased (P<0.05), accompanied by a significant reduction in EdU positive cell rate and the number of migrating and invasive cells (P<0.05), and the levels of p-NFκB, GRP78, and CHOP proteins were also significantly decreased (P<0.05).    Conclusions    POSTEN is highly expressed in keloid fibroblasts. It can induce endoplasmic reticulum stress by activating the NFκB signaling pathway, thereby promoting the proliferation, migration and invasion of keloid fibroblasts, and ultimately facilitating the formation of keloids; Targeted inhibition of POSTEN may become a potential strategy for the treatment of keloids.

Exploring the effects of breviscapine on coronary artery injury in Kawasaki disease mice based on Keap1/Nrf2/ARE signaling 

Guo Wei, Xu Zhenxing, Lei Hao

Chinese Journal of Clinical Anatomy. 2026, 44(3):  317-322.  doi:10.13418/j.issn.1001-165x.2026.3.11

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Objective    To investigate the effects of breviscapine (Bre) on coronary artery injury in Kawasaki disease (KD) mice based on the Kelch-like epichlorohydrin related protein 1 (Keap1)/nuclear factor erythroid 2 related factor 2 (Nrf2)/antioxidant response element (ARE) signaling pathway.   Methods   KD mice were constructed and randomly divided into the KD , the L-Bre, the M-Bre, the H-Bre groups (intraperitoneal injection of 20, 50, and 100 mg/kg of Bre), and the Bre + ML385 group (intraperitoneal injection of 100 mg/kg of Bre and 30 mg/kg Nrf2 inhibitor ML385). HE staining was applied to observe pathological changes in coronary artery tissue. TUNEL staining was used to observe apoptosis of artery tissue cells. ELISA was used to detect the expressions of cardiac injury factors in the blood [myoglobin (Mb), creatine kinase (CK), creatine kinase isoenzyme (CK-MB)], oxidative stress indicators [reactive oxygen species (ROS), superoxide dismutase (SOD)], and inflammatory factors [tumor necrosis factor (TNF-α), interleukin-1β (IL-1β)]. Western blot was applied to detect the expression of Keap1, Nrf2, HO-1, and NQO1 proteins in artery tissue.   Results   The Mb, CK, CK-MB, apoptosis rate, expression of TNF-α, IL-1β, ROS, and Keap1 in the KD group were higher than that in Control group, while the expression of SOD, Nrf2, HO-1 and NQO1 was lower than that in Control group (P<0.05). The Mb, CK, CK-MB, apoptosis rate, expression of TNF-α, IL-1β, ROS, and Keap1 in the L-Bre, M-Bre, and H-Bre groups were lower than that in KD group, while the expression of SOD, Nrf2, HO-1, and NQO1 was higher than that in KD group (P<0.05). The changes in the above indicators in the Bre+ML385 group were in the opposite direction compared to those in H-Bre group.   Conclusions   Bre can inhibit coronary artery injury in KD mice, which may be achieved by regulating the Keap1/Nrf2/ARE signaling pathway.

Transfer strategies for POR patients undergoing antagonist protocol in assisted  pregnancy

Liu Yan, Li Tao, Gao Jing, Sun Li

Chinese Journal of Clinical Anatomy. 2026, 44(3):  323-328.  doi:10.13418/j.issn.1001-165x.2026.3.12

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Objective    To explore the optimal embryo transfer strategy for poor ovarian response (POR) patients with embryos of different quality.    Methods    A retrospective analysis was performed on 411 POR patients (≤3 oocytes retrieved) treated with the antagonist protocol and IVF/ICSI at the Reproductive Center of the Third Affiliated Hospital of Sun Yat-sen University from January 2018 to May 2024. Cycles were divided into fresh transfer (Group A, n=234) and frozen transfer (Group B, n=177), all with Day 3 cleavage-stage embryo transfer. Subgroups were categorized by embryo quality: good-quality embryos (A1=95, B1=50), good plus fair/poor-quality embryos (A2=54, B2=74), and fair/poor-quality embryos only (A3=85, B3=53). Baseline characteristics and clinical outcomes (pregnancy rate, implantation rate, live birth rate, miscarriage rate) were compared.    Results    The patients in transferring good-quality embryos or good plus fair/poor-quality embryos groups, there were no significant differences in clinical pregnancy, implantation, live birth or miscarriage rates between fresh and frozen cycles. The patients in fair/poor-quality embryos group, the clinical pregnancy rate in the frozen transfer group was significantly higher than that of the fresh transfer group (30.19% vs. 14.12%, P=0.022) and the implantation rate was also higher than that of the fresh transfer group (22.33% vs. 10.62%, P=0.009), with no significant differences in live birth or miscarriage rates (P>0.05). Multivariate logistic regression showed that transfer mode (fresh vs. frozen) was not an independent factor affecting clinical pregnancy.     Conclusions    For POR patients (≤3 oocytes retrieved) under the antagonist protocol, fresh and frozen transfer show comparable outcomes when good-quality embryos are available. Frozen transfer is associated with higher clinical pregnancy and implantation rates when only fair/poor-quality embryos are transferred. These findings require verification in larger-sample studies.

Finite element analysis of new retrograde intramedullary femoral nails for the treatment of AO/OTA 33A3 type of distal femoral fractures

Xu Weizhen, Liu Hui, Zhang Jinhui, Xiong Yuanfei, Chen Hangping, Wu Jin

Chinese Journal of Clinical Anatomy. 2026, 44(3):  329-337.  doi:10.13418/j.issn.1001-165x.2026.3.13

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Objective   To compare the biomechanical properties of multi-dimensional locking retrograde intramedullary nail (new nail), traditional single plane locking retrograde intramedullary nail (traditional nail), and locking plate fixation for AO/OTA 33A3 distal femoral fractures using three-dimensional finite element method.    Methods    Models of AO/OTA 33A3 distal femoral fractures and 3D models of internal fixation devices were established using Creo 5.0 software. Then the finite element models were created and the same boundary conditions and three types of loads were applied for computation. The stress distribution of the internal fixation, as well as the overall and localized deformation of the femur, were analyzed under different loading conditions to evaluate the stability of the three fixation methods for treating distal femoral fractures.   Results   (1) Under vertical load conditions, the maximum stress values of femur internal fixation, as well as the overall displacement of the femur, interfragmental gap, and fracture angle, were significantly higher than those of traditional and new nails. Although the maximum stress value of the new nail was higher than that of the traditional nail, its femoral stress value, overall femoral displacement, interfragmental gap, and fracture angle were all smaller than those of the traditional nail. (2) Under load conditions, the maximum stress value of internal fixation of the locking plate was not significantly different from that of the new nail. However, its maximum stress value of the femur, overall displacement of the femur, interfragmental gap, and fracture angle were all much greater than those of traditional and new nails. The maximum stress values of the femur and internal fixation of the new nail were both greater than those of the traditional nail, but its overall displacement, interfragmental gap, and fracture angle were all smaller than those of the traditional intramedullary nail. (3) Under torsional load conditions, the new nail had significantly lower maximum stress values for internal fixation and overall torsional displacement of the femur compared with traditional nails and locking plate, except for the maximum stress value of the femur, which is greater than that of traditional nails.    Conclusions    Compared with the locking plate and traditional nail, the new nail provides better stability in the treatment of AO/OTA 33A3 distal femoral fractures under vertical, horizontal, or rotational loads. This demonstrates certain advantages and lays theoretical foundation for further clinical application and promotion.

Clinical application of posterior interosseous artery perforator flap with distalized rotation point for repairing skin defects of the dorsum of hand reconstruction 

Huang Chengwei, Huo Yongxin, Bai Weifei, Fu Jiansong, Zhai Jingxiu, Bao Qiying, Gao Yuan

Chinese Journal of Clinical Anatomy. 2026, 44(3):  338-342.  doi:10.13418/j.issn.1001-165x.2026.3.14

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Objective   To investigate the design of a modified posterior interosseous artery (PIOA) perforator chain flap with a low rotation point based on the angiosome and perforasome theory, and to evaluate its anatomical basis and clinical efficacy in repairing skin defects of the dorsum of hand, dorsal fingers, and first web space.    Methods    A retrospective analysis was performed on 9 patients with complex soft tissue defects of the hand admitted between March 2024 and June 2025. There were 8 males and 1 female, aged 18-57 years. The causes of injury included machine crush injuries in 6 cases and blunt injuries in 3 cases. Defects were located on the dorsum of hand in 8 cases and on the ulnar side of the palm in 1 case. Fractures were combined in 8 cases, and isolated soft tissue defects in 1 case. All were severe acute hand trauma patients, with wound areas ranging from 2.5 cm×3.0 cm to 6.0 cm×11.0 cm. All wounds underwent secondary repair using the modified surgical technique. The rotation point was set at the level of the base of the 3rd and 4th metacarpals, and the flap was supplied by the perforator chain between the terminal cutaneous branches of the PIOA and the dorsal carpal arterial arch. Dissection was performed at the superficial layer of the deep fascia without isolating the main vascular trunk. The flap size ranged from 3.0 cm×3.5 cm to 6.5 cm×11.5 cm. The donor site was closed primarily or covered with full-thickness skin grafts.   Results   All 9 flaps survived completely, and all wounds achieved primary healing. The follow-up period was 5-12 months (mean 8.5 months). The texture and appearance of the flaps were satisfactory. The mean DASH score was 9.2. Suprafascial dissection ensured no injury to the PIN.   Conclusions   The modified low-rotation-point PIOA perforator chain flap utilizes the network blood supply of the perforator chain, and distalizing the rotation point effectively overcomes the reconstructive bottleneck for distal hand defects while avoiding the risk of posterior interosseous nerve injury, making it an ideal surgical method for repairing complex soft tissue defects of the distal hand.

Effect of different approaches on recovery of joint function in elderly patients with hip replacement

Wang Lin, An Jilong, Liu Ming, Li Zhengqiang, Li Jing, Wang Qi

Chinese Journal of Clinical Anatomy. 2026, 44(3):  343-350.  doi:10.13418/j.issn.1001-165x.2026.3.15

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Objective    To explore the effect of Direct Anterior Approach (DAA) and SuperPATH approach on elderly patients with hip arthroplasty and the recovery of joint function.    Methods    A total of 87 elderly patients with hip arthroplasty in our hospital were collected in the research. They were randomly divided into 43 cases in a control group (DAA scheme) and 44 cases in an observation group (SuperPATH approach scheme). The selected period was from July 2023 to August 2024. The surgical indicators, inflammatory factors, postoperative complications, hip indicators, muscle injury markers, bone metabolism, imaging, postoperative efficacy, VAS, BBS, JPS and pain media levels were compared between the two groups.    Results    Compared with the control group, the observation group had lower postoperative hospital stay, postoperative ambulation time, incision length, anesthesia time, intraoperative blood loss and total incidence, and higher postoperative drainage volume, external expansion Angle of acetabular prosthesis and excellent and good rate (P<0.05). One week after the operation, compared with the control group, the levels of TRACP-5b, CK, PGE2, interleukin-6, 5-HT, ALD, NO, erythrocyte sedimentation rate, LDH, C-reactive protein, CKMB, tumor necrosis factor -α, and β-CTx in observation group were lower, while the levels of ALP and PINP were higher (P<0.05). Six months after the operation, compared with the control group, the VAS score, the actual length of the lower extremities, the JPS score and the BBS score of observation group were worse (P<0.05).   Conclusions   SuperPATH approach in elderly patients with hip replacement can promote the recovery of hip function, with significant effect and fewer complications.

Application of VBN in thoracoscopic partial lobectomy and wedge resection and the impact on traumatic stress indicators

Dou Ting, Luo Dong, Liu Dan, Qi Wen

Chinese Journal of Clinical Anatomy. 2026, 44(3):  351-357.  doi:10.13418/j.issn.1001-165x.2026.3.16

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Objective    To investigate the application effects of virtual bronchoscopic navigation (VBN) in thoracoscopic partial lobectomy and wedge resection, and analyze the impact on traumatic stress indicators.   Methods   A total of 322 patients with early-stage non-small cell lung cancer (NSCLC) who underwent thoracoscopic partial lobectomy or wedge resection at the hospital from January 2022 to December 2024 were selected. Based on the localization method, patients were divided into a VBN group (n=158) and a control group (n=164). The control group received CT-guided dye marker injection for localization, while the VBN group received VBN-assisted localization. Surgery-related indicators, stress indicators, inflammatory factors, pulmonary function, blood gas analysis indicators, and surgical complications were compared between the two groups.    Results    Compared with the control group, the VBN group showed reductions in the duration of surgery, intraoperative blood loss, thoracic drainage volume, thoracic drainage days, and postoperative hospital stay (P<0.05). Postoperative serum cortisol (Cor) and norepinephrine (NE) levels, and surgical stress index (SSI) in the VBN group were lower than those in the control group (P<0.05). The VBN group exhibited lower postoperative serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and eosinophil cationic protein (ECP) compared with the control group (P<0.05). The VBN group demonstrated higher postoperative peak expiratory flow (PEF), forced expiratory volume in one second to vital capacity ratio (FEV1%), tidal volume (TV) per kilogram, inspiratory-to-expiratory time (Ti/Te) ratio, time to peak tidal expiratory flow to expiratory time ratio (TPTEF/TE), and volume to peak expiratory flow to total expiratory volume ratio (VPEF/VE) than the control group (P<0.05). After surgery, the VBN group had higher PaO2 and SaO2 and lower PaCO2 compared with the control group (P<0.05). The total complication rate in the VBN group (3.80%) was lower than that in the control group (9.76%) (P<0.05).   Conclusion   Using VBN in thoracoscopic partial lobectomy and wedge resection can significantly shorten operation time, reduce intraoperative trauma, stress and inflammatory response, improve respiratory function, reduce complications, and promote recovery.

Application of magnetic resonance diffusion tensor imaging, multi-slice spiral CT, and serum serotonin levels in the diagnosis of lumbar disc herniation

Guo Zhoushuai, Zhao Tao, Zhang Chunhao

Chinese Journal of Clinical Anatomy. 2026, 44(3):  358-367.  doi:10.13418/j.issn.1001-165x.2026.3.17

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Objective    To investigate the use of serum serotonin (5-Hydroxytryptamine, 5-HT) levels, multi-slice spiral CT (MSCT), and diffusion tensor imaging (DTI) in the diagnosis of lumbar disc herniation (LDH).    Methods    A retrospective analysis was conducted on 73 LDH patients diagnosed with L3/L4~L5/S1 lumbar disc herniation causing nerve root compression in our hospital from September 2022 to August 2024 (study group), and 80 healthy volunteers (control group) were selected during the same period. All subjects underwent lumbar DTI and MSCT examinations to detect serum 5-HT levels. The lumbar DTI imaging measurement indicators [anisotropy score (FA), apparent diffusion coefficient (ADC)] and MSCT parameters [sagittal flexion angle (SCA), endplate flexion depth (ECD)] of L3/L4~L5/S1 intervertebral disc segments with different Pfirrmann grades in the research group were compared, and the correlation was analyzed. The imaging parameters and serum 5-HT levels between the study group and the control group were compared, logistic regression analysis was performed, and plot receiver operating characteristic (ROC) curves to analyze the diagnostic value of each indicator for LDH.    Results    There were statistically significant differences (P<0.05) in the FA, ADC, SCA, and ECD values of L3/L4~L5/S1 intervertebral disc segments with different Pfirrmann grades. Pfirrmann grading was positively correlated with FA intervertebral disc and SCA values (P<0.05), and negatively correlated with ADC intervertebral disc and ECD values (P<0.05). The mean values of FA nerve roots and ECD in the L3/L4~L5/S1 segment of the study group were lower than those in the control group. The mean values of ADC nerve roots, SCA, and serum 5-HT levels in the L3/L4~L5/S1 segment of the study group were higher than those in the control group, and the differences were statistically significant (P<0.05). Logistic regression analysis showed that FA nerve roots (OR=0.000, 95% CI 0.000~0.690), ADC nerve roots (OR=20.151, 95% CI 0.209~1940.734), SCA (OR=1.745, 95% CI 1.321~2.305), ECD (OR=0.056, 95% CI 0.005~0.619), and serum 5-HT (OR=1.084, 95% CI 1.039~1.130) were independent risk factors for LDH (P<0.05). Logit (P)=-92.885-20.925FA nerve root+3.003ADC nerve root+0.557SCA-2.890 ECD+0.081 5-HT. The ROC analysis results showed that the mean values of FA nerve roots, ADC nerve roots, SCA, and ECD, serum 5-HT levels, and joint prediction in the L3/L4~L5/S1 segment were statistically significant for the diagnosis of LDH (P<0.05), indicating high predictive value of joint prediction, AUC=0.985, the sensitivity was 94.5% and the specificity was 95.0%. Conclusions   The lumbar DTI imaging measurement indicators, including intervertebral disc FA and ADC values, as well as MSCT parameters SCA and ECD, can effectively diagnose lumbar degeneration in the L3/L4~L5/S1 segment of LDH. The nerve root FA and ADC values measured by lumbar DTI show significant changes in LDH patients with nerve root compression injury. The combination of MSCT parameters SCA, ECD, and 5-HT has diagnostic value for LDH.

The improved design and application of an immunohistochemical label

Dong Xingmei, Wang Ruiwu, Li Mingxian

Chinese Journal of Clinical Anatomy. 2026, 44(3):  368-370.  doi:10.13418/j.issn.1001-165x.2026.3.18

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Objective   This study explores the redesign of immunohistochemical (IHC) labels to incorporate concise prompts that serve as effective reference information across multiple workflow stages, thereby streamlining processes and improving efficiency and quality.   Methods    Distinct coding systems were added to specific sections of IHC labels to represent different IHC instruments, tissue microarrays, and pathologists. Time consumption and accuracy were compared between control and experimental groups by referencing relevant codes at respective workflow stages.   Results   Technicians were able to complete label application and slide sorting for IHC slides with improved speed and accuracy.   Conclusion   Optimized IHC labels enhance technicians’ operational efficiency and quality of work.

Intestinal obstruction caused by congenital partial absence of mesentery of small intestine and right mesocolon：a case report

Yang Jiguang, Liu Haijun, Guan Fang, Zhang Ruifeng

Chinese Journal of Clinical Anatomy. 2026, 44(3):  337.  doi:10.13418/j.issn.1001-165x.2026.3.19

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