Objective:To investigate the changes of lymphocyte to monocyte ratio (LMR), matrix metalloproteinase-2 (MMP-2), hypoxia inducible factor-1 (HIF-1 α) in patients with breast cancer undergoing surgical resection before and after radiotherapy and their relationship with short-term prognosis.Methods:106 patients with breast cancer who underwent surgical resection and radiotherapy from Jan. 2021 to Jan. 2024 were analyzed as the study subjects. All patients received the same scheme of radiotherapy. The changes of LMR, MMP-2, and HIF-1 α levels at different time points before and after radiotherapy were recorded, and the clinical efficacy of the two groups of patients after radiotherapy was compared. According to the short-term efficacy after radiotherapy, the patients were divided into 31 patients with poor efficacy (progression+deterioration) and 75 patients with good efficacy (complete remission+effective remission+partial remission). The basic clinical data of the two groups were compared. The binary regression analysis was used to analyze the factors that affect the short-term prognosis of patients with breast cancer who had undergone surgery after radiotherapy. A risk prediction model was constructed, and the ROC analysis model was used to predict the value.Result:Compared with before radiotherapy, LMR decreased and MMP-2 and HIF-1 α increased after one week of radiotherapy ( t=2.68, -2.76, -1.96, P=0.008, 0.006, 0.052); After one course of radiotherapy and three courses of radiotherapy, LMR increased and MMP-2 and HIF-1 α decreased ( t=-3.02, 5.14, 5.86, all P<0.05; t=-7.95, 19.80, 21.36, all P<0.001). Low expression of LMR, high expression of MMP-2 and high expression of HIF-1 α are independent risk factors for poor short-term prognosis of breast cancer patients after radiotherapy. LMR、MMP-2、HIF-1α、The prediction model can predict the poor short-term prognosis of breast cancer patients after radiotherapy. The AUC values were 0.780 (95% CI: 0.674~0.887), 0.759 (95% CI: 0.659~0.859), 0.840 (95% CI: 0.748~0.931), and 0.887 (95% CI: 0.808~0.965), respectively. When taking the cut-off values, the sensitivities were 0.853, 0.903, 0.677, and 0.920, and the specificities were 0.677, 0.533, 0.933, and 0.774, respectively. Bootstrap method (B=1000) was used to perform internal validation on the prediction model of poor short-term prognosis of breast cancer patients after radiotherapy. The results showed that the prediction curve after deviation correction was close to the ideal state, and the C-index reached 0.774, indicating that the model had strong prediction ability. In addition, the decision curve of the model shows that the net profit is always positive and better than the two invalid reference lines within the threshold probability range of 0.1 to 1.0. Conclusion:LMR of postoperative radiotherapy patients with breast cancer decreased first and then increased, MMP-2 and HIF-1 α increased first and then decreased, all of which are independent predictors of short-term prognosis. The combined model has a significant predictive effect on poor efficacy and can be used as an important reference for clinical prognosis evaluation.

Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

Objective:The aim of this study is to analyze the clinical characteristics and genetic variants of a late-onset auditory neuropathy pedigree caused by maternally inherited- mitochondrial mutation.Methods:A male proband who presented with bilateral sensorineural hearing loss at Henan Children′s Hospital in September 2023 was chosen, along with his family members (4 generations, 20 individuals) as the study subjects. Data from this pedigree were collected, organized, and analyzed for clinical genetic characteristics. Medical histories were obtained from family members, pedigree charts were drawn, audiological, imaging, and physical examinations were conducted. Pathogenic genes and mutations were screened using high-throughput sequencing. Sanger sequencing was employed for variant confirmation and segregation validation in the family.Results:In this family, a total of 12 members (10 members collected) had sensorineural hearing loss, characterized by late-onset hearing impairment with an onset age ranging from 9 to 30 years. The patients exhibited poor speech recognition rates, and audiometric examinations are consistent with auditory neuropathy. There was no history of ototoxic drug use. High-throughput sequencing identified the variant NC_012920.1:m.7471dup in the mitochondrial MT-TS1 gene as the pathogenic variant. Sanger sequencing results confirmed that the pathogenic gene mutation site perfectly co-segregated with the auditory neuropathy phenotype in this family. According to the classification criteria and guidelines for genetic variations by the American College of Medical Genetics and Genomics, the variant was classified as a pathogenic mutation. Conclusion:The mitochondrial MT-TS1 gene mutation m.7471dup is considered to be the pathogenic cause in this late-onset auditory neuropathy pedigree.

Objective:To investigate the changes of lymphocyte to monocyte ratio (LMR), matrix metalloproteinase-2 (MMP-2), hypoxia inducible factor-1 (HIF-1 α) in patients with breast cancer undergoing surgical resection before and after radiotherapy and their relationship with short-term prognosis.Methods:106 patients with breast cancer who underwent surgical resection and radiotherapy from Jan. 2021 to Jan. 2024 were analyzed as the study subjects. All patients received the same scheme of radiotherapy. The changes of LMR, MMP-2, and HIF-1 α levels at different time points before and after radiotherapy were recorded, and the clinical efficacy of the two groups of patients after radiotherapy was compared. According to the short-term efficacy after radiotherapy, the patients were divided into 31 patients with poor efficacy (progression+deterioration) and 75 patients with good efficacy (complete remission+effective remission+partial remission). The basic clinical data of the two groups were compared. The binary regression analysis was used to analyze the factors that affect the short-term prognosis of patients with breast cancer who had undergone surgery after radiotherapy. A risk prediction model was constructed, and the ROC analysis model was used to predict the value.Result:Compared with before radiotherapy, LMR decreased and MMP-2 and HIF-1 α increased after one week of radiotherapy ( t=2.68, -2.76, -1.96, P=0.008, 0.006, 0.052); After one course of radiotherapy and three courses of radiotherapy, LMR increased and MMP-2 and HIF-1 α decreased ( t=-3.02, 5.14, 5.86, all P<0.05; t=-7.95, 19.80, 21.36, all P<0.001). Low expression of LMR, high expression of MMP-2 and high expression of HIF-1 α are independent risk factors for poor short-term prognosis of breast cancer patients after radiotherapy. LMR、MMP-2、HIF-1α、The prediction model can predict the poor short-term prognosis of breast cancer patients after radiotherapy. The AUC values were 0.780 (95% CI: 0.674~0.887), 0.759 (95% CI: 0.659~0.859), 0.840 (95% CI: 0.748~0.931), and 0.887 (95% CI: 0.808~0.965), respectively. When taking the cut-off values, the sensitivities were 0.853, 0.903, 0.677, and 0.920, and the specificities were 0.677, 0.533, 0.933, and 0.774, respectively. Bootstrap method (B=1000) was used to perform internal validation on the prediction model of poor short-term prognosis of breast cancer patients after radiotherapy. The results showed that the prediction curve after deviation correction was close to the ideal state, and the C-index reached 0.774, indicating that the model had strong prediction ability. In addition, the decision curve of the model shows that the net profit is always positive and better than the two invalid reference lines within the threshold probability range of 0.1 to 1.0. Conclusion:LMR of postoperative radiotherapy patients with breast cancer decreased first and then increased, MMP-2 and HIF-1 α increased first and then decreased, all of which are independent predictors of short-term prognosis. The combined model has a significant predictive effect on poor efficacy and can be used as an important reference for clinical prognosis evaluation.

Objective:To evaluate the outcomes of intensive conservative treatment compared to conventional conservative treatment in patients with acute aortic syndrome(AAS).Methods:The study prospectively enrolled consecutive patients with AAS who were admitted to Beijing Anzhen Hospital, affiliated with Capital Medical University, and Beijing Dawanglu Emergency Rescue Hospital from January 2024 to December 2024. These patients with surgical contraindications or refused surgery for various reasons opted for conservative treatment. A total of 282 patients were included, and 15 patients with missing data or those who died without any treatment were excluded. Finally, 267 patients were enrolled, of whom 94 received intensive conservative treatment, and 173 received conventional conservative treatment, the inverse probability of treatment weighting (IPTW) was used to reduce the influence of confoundings. After adjusting of baseline datas via IPTW, the survival outcomes of the two groups were compared at 14 days, 30 days, and at the end of follow-up.Results:The results showed significant differences in acute phase survival rates between the enhanced conservative treatment group and the conventional conservative treatment group at 14 days(82.40%vs.53.20%, P<0.0001). Significant survival differences were also observed at 30 days and at 276-day mid-term follow-up (96.29% vs.51.60%, P<0.0001; 78.50% vs.48.50%, P<0.0001). In the subgroup analysis, for type A aortic dissection, the enhanced conservative treatment group had higher survival rates compared to the conventional conservative treatment group at 14, 30 and 276 days (63.46% vs.41.35%, P<0.05; 52.17% vs.37.90%, P<0.05; 50.00% vs. 31.97%, P<0.05). However, for type B aortic dissection, although the enhanced conservative treatment group had higher survival rates than the conventional conservative treatment group, no statistically significant differences were observed (96.29% vs. 80.00%, P=0.054; 95.65% vs.78.37%, P=0.067; 94.12% vs.74.20%, P=0.088). Conclusion:For patients diagnosed with AAS are forced to choose conservative treatment if emergency surgery is not possible in the first place, intensive conservative treatment strategies can significantly reduce the mortality in the acute phase compared with conventional conservative treatment. Mid-term follow-up, intensive conservative treatment still has a significant survival advantage.

Objective:The aim of this study is to analyze the clinical characteristics and genetic variants of a late-onset auditory neuropathy pedigree caused by maternally inherited- mitochondrial mutation.Methods:A male proband who presented with bilateral sensorineural hearing loss at Henan Children′s Hospital in September 2023 was chosen, along with his family members (4 generations, 20 individuals) as the study subjects. Data from this pedigree were collected, organized, and analyzed for clinical genetic characteristics. Medical histories were obtained from family members, pedigree charts were drawn, audiological, imaging, and physical examinations were conducted. Pathogenic genes and mutations were screened using high-throughput sequencing. Sanger sequencing was employed for variant confirmation and segregation validation in the family.Results:In this family, a total of 12 members (10 members collected) had sensorineural hearing loss, characterized by late-onset hearing impairment with an onset age ranging from 9 to 30 years. The patients exhibited poor speech recognition rates, and audiometric examinations are consistent with auditory neuropathy. There was no history of ototoxic drug use. High-throughput sequencing identified the variant NC_012920.1:m.7471dup in the mitochondrial MT-TS1 gene as the pathogenic variant. Sanger sequencing results confirmed that the pathogenic gene mutation site perfectly co-segregated with the auditory neuropathy phenotype in this family. According to the classification criteria and guidelines for genetic variations by the American College of Medical Genetics and Genomics, the variant was classified as a pathogenic mutation. Conclusion:The mitochondrial MT-TS1 gene mutation m.7471dup is considered to be the pathogenic cause in this late-onset auditory neuropathy pedigree.

Objective To investigate the clinical effect of acupotomology combined with Bushenzhuanggu prescription in the treatment of residual lumbar pain after percutaneous kyphoplasty(PKP)for osteoporotic vertebral compression fractures.Methods A total of 77 patients with PKP postoperative residual lumbar pain admitted to the Department of Orthopedics,Ningbo Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from January 2018 to December 2021 were randomly divided into control group and observation group.Patients in control group were treated with calcitriol soft capsules and calcium carbonate D3 tablets,and patients in observation group were treated with acupotomy combined with Bushenzhuanggu prescription.The pain degree,lumbar function and self-care ability of the two groups were compared.Results After treatment,the pain level,lumbar function,and self-care abilityof the two groups of patients improved compared to before treatment.Compared with control group,the visual analogue score(VAS)score and Oswestry disability index(ODI)index of observation group decreased more significantly,and the difference was statistically significant(P<0.05);The Barthel index of observation group increased more significantly in the early stage(3 days and 1 month after treatment),with a statistically significant difference(P<0.05).However,there was no statistically significant difference in Barthel index between the two groups at 3 months after treatment(P>0.05).Conclusion Acupotomy combined with Bushenzhuanggu prescription has satisfactory clinical efficacy in the treatment of residual lumbar pain after PKP operation of osteoporotic vertebral compression fracture.It can significantly reduce pain,improve lumbar function,shorten the improvement time of patients'self-care ability,improve patients'quality of life,and effectively promote patients'rapid recovery.

Objective:To investigate the clinical significance of intraoperative prepositioning of dual mediastinal drains in elderly patients developing anastomotic leakage(AL)after a total endoscopic Ivor-Lewis procedure.Methods:This retrospective case-control study analyzed the clinical data of 500 elderly patients who underwent total endoscopic Ivor-Lewis surgery for esophageal or cardia cancer from January 2020 to December 2022.In the control group, one mediastinal drainage tube was placed intraoperatively, while in the study group, two mediastinal drainage tubes were placed.Both groups had a chest tube placed conventionally.The study compared the incidence of anastomotic leak(AL)at 1 month postoperatively, inflammatory indexes in patients with AL, grading of AL, rate of nasal fistula placement, incision infection, anastomotic stenosis, and incidence of hoarseness.Additionally, it compared ICU occupancy, ventilator use, and ICU length of stay between the two groups.Results:The analysis included clinical data from 455 elderly patients.Among the patients who developed AL, the study group had significantly lower peak body temperature[(39.58±1.03)℃ vs.(38.05±0.56)℃, t=4.298, P<0.05], white blood cell count[(18.63±3.35)×10 9/L vs.(14.28±2.78)×10 9/L, t=3.450, P<0.05], and C-reactive protein(CRP)levels[(154.66±41.64)mg/L vs.(122.19±31.29)mg/L, t=2.131, P<0.05]. The study group also had a significantly lower grading of AL and rate of nasal fistula placement(82.4% vs.30.0%, P<0.05). In terms of ICU indicators, the study group had a significantly lower ICU admission rate(64.7% vs.10.0%, P<0.05), shorter period of ventilator use[(6.47±8.15)days vs.(0.90±2.23)days, t=2.62, P<0.05], and shorter ICU stay[(11.70±8.89)days vs.(4.70±6.27)days, t=2.184, P<0.05]. Conclusions:Double mediastinal drainage tubes, have been found to significantly alleviate inflammation, decrease the rate of nasal fistula placement and ICU admission, and shorten the length of ICU stay in elderly patients.Therefore, they are considered safe and deserving of clinical promotion.

Objective:To analyze the expression of sequence similarity family 3 member C (FAM3C) in pancreatic cancer and its effects on pancreatic cancer cell proliferation, migration, invasion and the underlying mechanisms.Methods:Tissue samples from four pancreatic cancer patients undergoing surgical resection at Affiliated Hospital of Jiangnan University from July 2022 to June 2023 were collected. Expression of FAM3C was assessed in both cancer and adjacent tissues using polymerase chain reaction and Western blot techniques. High FAM3C-expressing pancreatic cancer cells PANC-1 and MIA PaCa-2 were selected for further experiments involving FAM3C-siRNA and methyltransferase-like protein 3 (METTL3)-siRNA groups, alongside a negative control group. Cell counting, Transwell assays, and co-immunoprecipitation with methylation antibodies were utilized to evaluate the proliferation, migration, invasion, and methylation status of FAM3C.Results:The relative expression of FAM3C mRNA in cancer tissues of the four patients with pancreatic cancer was higher than that in adjacent tissues (1.29±0.19 vs 0.47±0.17, t=-6.48, P=0.001). Compared with the negative control group A, the proliferation ability of the FAM3C-siRNA interference group decreased, and the number of migrating and invasive cells decreased (all P<0.05). In the negative control group B of PANC-1 cells, the relative expression of FAM3C mRNA in IgG-treated cells was lower than that in the methylated antibody-treated group (1.05±0.53 vs 30.57±1.09, t=-42.04, P=0.001). After PANC-1 cells were treated with methylated antibodies, the relative expression of FAM3C mRNA in the negative control group B was higher than that in the METTL3-siRNA interference group (30.57±1.09 vs 18.17±0.50, t=17.89, P=0.001). Compared with the negative control group B, the proliferation ability, migration and invasion cell numbers of PANC-1 cells in the METTL3-siRNA interference group were reduced (all P<0.05). The results of MIA PaCa-2 and PANC-1 cells were consistent. Conclusions:FAM3C is highly expressed in pancreatic cancer and promotes the proliferation, migration and invasion of pancreatic cancer cells. METTL3 affects FAM3C expression by methylation and proliferation, migration and invasion of pancreatic cancer cells.

Objective:To analyze the optical coherence tomography (OCT) imaging characteristics in patients with Coats disease and their value in predicting macular fibrosis.Methods:A nested case-control study was performed.A total of 43 patients (43 eyes) diagnosed with Coats disease through color fundus photography, ocular B-scan ultrasonography, fundus fluorescein angiography, and spectral-domain OCT examination were enrolled from January 2008 to October 2021 at the Xijing Hospital.Among them, there were 40 males and 3 females, aged from 2 to 60 years old, with a median age of 13 years.Macular fibrosis was used as an indicator of poor prognosis, and patients were divided into two groups based on whether macular fibrosis occurred at the end of follow-up.The differences in OCT characteristics between two groups were compared and logistic regression analysis was used to identify the risk factors for macular fibrosis.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Xijing Hospital of Fourth Military Medical University (No.KY20202009-C-1).Results:The OCT clinical features of 43 cases of Coats disease included intraretinal hard exudates in 43 eyes (100%), subretinal fluid in 21 eyes (48.8%), macular cysts in 17 eyes (27.9%), subretinal exudates in 9 eyes (20.9%), anterior retinal hyperreflective dots in 7 eyes (16.3%), epiretinal membrane in 21 eyes (48.8%), and intraretinal fluid in 22 eyes (51.2%).In color fundus photos of 41 eyes, 38 eyes (93.0%) had hard exudates distributed in the posterior pole and 27 eyes (65.9%) had the mid-peripheral region.OCT examination showed that hard exudates were distributed in the inner nuclear layer in 35 eyes (81.4%) and the outer nuclear layer in 33 eyes (76.7%).Among 21 eyes with exudative retinal detachment detected by OCT, 9 eyes (42.9%) were detected by fundus photography and 18 eyes (85.7%) were detected by B-scan ultrasonography.The proportions of eyes with subretinal fluid and subretinal exudates were higher in the macular fibrosis group than in the non-macular fibrosis group, and the differences were statistically significant ( χ2=20.755, P<0.001; χ2=6.133, P=0.013).Logistic regression analysis showed that the presence of subretinal fluid was a risk factor for macular fibrosis (odds ratio=48.345, 95% confidence interval: 4.272-547.066, P=0.002). Conclusions:OCT examination can detect subretinal fluid, subretinal exudates, macular cysts, macular exudates, and hyperreflective spots in the retina of patients with Coats disease.Subretinal fluid is a risk factor for macular fibrosis.