Objective To compare the benefits and drawbacks of primary patch expansion versus pericardial tube right ventricular-pulmonary artery connection in patients diagnosed with pulmonary atresia with ventricular septal defect (PA/VSD). Methods A retrospective study was conducted on patients diagnosed with PA/VSD who underwent primary right ventricular-pulmonary artery connection surgery at our center between 2010 and 2020. Patients were categorized into two groups based on the type of right ventricular-pulmonary artery connection: a pericardial tube group and a patch expansion group. Clinical data and imaging findings were compared between the two groups. Results A total of 51 patients were included in the study, comprising 31 males and 20 females, with a median age of 12.57 (4.57, 49.67) months. The pericardial tube group included 19 patients with a median age of 17.17 (7.33, 49.67) months, while the patch expansion group consisted of 32 patients with a median age of 8.58 (3.57, 52.72) months. In both groups, the diameter of pulmonary artery, McGoon index, and Nakata index significantly increased after treatment (P<0.001). However, the pericardial tube group exhibited a longer extracorporeal circulation time (P<0.001). The reoperation rate was notably high, with 74.51% of patients requiring further surgical intervention, including 26 (81.25%) patients in the patch expansion group and 12 (63.16%) patients in the pericardial tube group. No statistical differences were observed in long-term cure rates or mortality between the two groups (P＞0.005). Conclusion In patients with PA/VSD, both patch expansion and pericardial tube right ventricular-pulmonary artery connection serve as effective initial palliative treatment strategies that promote pulmonary vessel development and provide a favorable foundation for subsequent radical operations. However, compared to the pericardial tube approach, the patch expansion technique is simpler to perform and preserves some intrinsic potential for pulmonary artery development, making it the preferred procedure.

AIM: To compare the effects of different nucleus chopping methods on the central corneal thickness, corneal endothelial cell(CEC)count and tear inflammatory indicators in patients with hard nucleus cataract.METHODS: Retrospective study. Totally 89 patients(89 eyes)with hard nucleus cataract who treated in our hospital were included from January 2020 to December 2022. According to different intraoperative nucleus chopping methods, the patients were divided into reverse prechop group(46 eyes)and phaco-chop group(43 eyes). The total effective rate of surgery and visual acuity recovery were compared between the two groups. Corneal related indicators(central corneal thickness, CEC count, CEC area), tear inflammatory indicators and tear film function [tear film break-up time(BUT), Chinese Dry Eye Questionnaire(CDEQ), Schirmer Ⅰ test(SⅠt)] were observed before and after surgery in both groups, and the degree of corneal edema was evaluated.RESULTS: The effective phaco time, phaco energy and cumulative complex energy parameters in the phaco-chop group were longer or higher than those in the reverse prechop group(P<0.05). The macular retinal thickness in the reverse prechop group at 7 d and 1 mo after surgery was thinner than that in the phaco-chop group, the central corneal thickness at 3 and 7 d after surgery was also thinner than that in the phaco-chop group, the CEC count at 3 mo after surgery was more than that in the phaco-chop group, the CEC loss rate was lower than that in the phaco-chop group, and the CEC area at 3 mo after surgery was smaller than that in the phaco-chop group(P<0.05). The levels of tear TNF-α and IL-6 at 7 d and 1 mo after surgery in the reverse prechop group were lower than those in the phaco-chop group(P<0.05). The BUT at 1 and 3 mo after surgery was longer in the reverse prechop group than that in the phaco-chop group(P<0.05). The CDEQ score in the reverse prechop group was lower than that in the phaco-chop group at 1 and 3 mo after surgery(P<0.05). The SⅠt at 1 and 3 mo after surgery was higher in the reverse prechop group compared with that in the phaco-chop group(P<0.05). The degree of corneal edema at 1 d after surgery was milder in the reverse prechop group than that in the phaco-chop group(P<0.05). CONCLUSION: Compared with phaco-chop, the application of reverse-chopper prechop combined with phacoemulsification can better reduce the ultrasonic energy in the treatment of hard nuclear cataract, and it is more conducive to reducing the postoperative inflammatory degree, improving the tear film function and relieving the corneal edema degree.

Background/Aims: Transmembrane 4 L six family member 1 (TM4SF1) is highly expressed and contributes to the progression of various malignancies. However, how it modulates hepatocellular carcinoma (HCC) progression and senescence remains to be elucidated. Methods: TM4SF1 expression in HCC samples was evaluated using immunohistochemistry and flow cytometry. Cellular senescence was assessed through SA-β-gal activity assays and Western blot analysis. TM4SF1-related protein interactions were investigated using immunoprecipitation-mass spectrometry, co-immunoprecipitation, bimolecular fluorescence complementation, and immunofluorescence. Tumor-infiltrating immune cells were analyzed by flow cytometry. The HCC mouse model was established via hydrodynamic tail vein injection. Results: TM4SF1 was highly expressed in human HCC samples and murine models. Knockdown of TM4SF1 suppressed HCC proliferation both in vitro and in vivo, inducing non-secretory senescence through upregulation of p16 and p21. TM4SF1 enhanced the interaction between AKT1 and PDPK1, thereby promoting AKT phosphorylation, which subsequently downregulated p16 and p21. Meanwhile, TM4SF1-mediated AKT phosphorylation enhanced PD-L1 expression while reducing major histocompatibility complex class I level on tumor cells, leading to impaired cytotoxic function of CD8+ T cells and an increased proportion of exhausted CD8+ T cells. In clinical HCC samples, elevated TM4SF1 expression was associated with resistance to anti-PD-1 immunotherapy. Targeting TM4SF1 via adeno-associated virus induced tumor senescence, reduced tumor burden and synergistically enhanced the efficacy of anti-PD-1 therapy. Conclusions Our results revealed that TM4SF1 regulated tumor cell senescence and immune evasion through the AKT pathway, highlighting its potential as a therapeutic target in HCC, particularly in combination with first-line immunotherapy.

Background/Aims: Transmembrane 4 L six family member 1 (TM4SF1) is highly expressed and contributes to the progression of various malignancies. However, how it modulates hepatocellular carcinoma (HCC) progression and senescence remains to be elucidated. Methods: TM4SF1 expression in HCC samples was evaluated using immunohistochemistry and flow cytometry. Cellular senescence was assessed through SA-β-gal activity assays and Western blot analysis. TM4SF1-related protein interactions were investigated using immunoprecipitation-mass spectrometry, co-immunoprecipitation, bimolecular fluorescence complementation, and immunofluorescence. Tumor-infiltrating immune cells were analyzed by flow cytometry. The HCC mouse model was established via hydrodynamic tail vein injection. Results: TM4SF1 was highly expressed in human HCC samples and murine models. Knockdown of TM4SF1 suppressed HCC proliferation both in vitro and in vivo, inducing non-secretory senescence through upregulation of p16 and p21. TM4SF1 enhanced the interaction between AKT1 and PDPK1, thereby promoting AKT phosphorylation, which subsequently downregulated p16 and p21. Meanwhile, TM4SF1-mediated AKT phosphorylation enhanced PD-L1 expression while reducing major histocompatibility complex class I level on tumor cells, leading to impaired cytotoxic function of CD8+ T cells and an increased proportion of exhausted CD8+ T cells. In clinical HCC samples, elevated TM4SF1 expression was associated with resistance to anti-PD-1 immunotherapy. Targeting TM4SF1 via adeno-associated virus induced tumor senescence, reduced tumor burden and synergistically enhanced the efficacy of anti-PD-1 therapy. Conclusions Our results revealed that TM4SF1 regulated tumor cell senescence and immune evasion through the AKT pathway, highlighting its potential as a therapeutic target in HCC, particularly in combination with first-line immunotherapy.

Objective To analyze the application effect of size-specific dose estimate(SSDE)in radiation dose and images quality of coronary CT angiography(CCTA).Methods A retrospective study was conducted on 56 patients undergoing CCTA at the First Affiliated Hospital of Chongqing Medical University between February 2022 and February 2025.These patients were assigned to observation group(SSDE injection),while another 56 patients undergoing CCTA during the same period were enrolled as routine group(traditional injection).The two groups were compared for coronary enhancement value,images quality score,objective parameters of images quality[image noise,CT value,contrast to noise ratio(CNR),signal to noise ratio(SNR)],radiation dose parameters[dose-length product(DLP),CT dose index volume(CTDIvol),effective dose(ED)],anteroposterior diameter,left-right diameter and fsize.Results The CCTA image quality score and coronary enhancement value in observation group were significantly higher than those in routine group(P<0.05).Compared with routine group,observation group had higher CT value,CNR,and SNR,as well as lower image noise(P<0.05).The CTDIvol,ED,DLP and SSDE of observation group were lower than those of routine group(P<0.05).The?size in observation group was smaller,while anteroposterior diameter and left-right diameter were longer than those in routine group(P<0.05).Conclusion The application of SSED protocol in CCTA scanning can effectively improve radiation dose and images quality.

Objective:To assess the effect of joint exposure to multiple air pollutants on sleep structure in patients with stable chronic obstructive pulmonary disease (COPD), identify key air pollutants, and analyze potential influencing factors.Methods:In this panel study, 92 stable COPD patients were recruited. From March 2021 to September 2023 in Beijing, all participants completed 254 nights of sleep monitoring. The total sleep duration, light sleep duration, deep sleep duration and rapid eye movement sleep duration and their respective proportions in total sleep duration were recorded. The exposure levels of fine particulate matter (PM 2.5), inhalable particulate matter (PM 10), nitrogen dioxide (NO 2), ozone (O 3), sulfur dioxide (SO 2), and carbon monoxide (CO) were estimated based on the infiltration factor method and time-activity logs of participants. To assess the lag effect of air pollutants, moving average concentrations of air pollutants from 0-1 day to 0-3 months were calculated. The linear mixed-effect model and Bayesian kernel machine regression (BKMR) model were used to assess the single and joint effects of air pollutants on sleep structure parameters in COPD patients, respectively. Results:All six types of air pollutants were associated with changes in sleep structure, manifesting as an increase in total sleep duration and light sleep proportion and a reduction in deep sleep proportion. The effects of O 3 were strongest at lag 0-6 days, while other air pollutants were at lag 0-3 months. Joint exposure to multiple air pollutants exerted significant joint effects on sleep structure, and NO 2 was identified as the dominant pollutant. NO 2 had a posterior inclusion probability (PIP) greater than 0.5 for light sleep proportion (PIP=0.691) and deep sleep proportion (PIP=0.957). With an interquartile range (IQR) increase of 8.6 μg/m 3 in NO 2 at lag 0-3 months, the light sleep proportion increased by 10.5% (95% CI: 2.2%-19.4%), and the deep sleep proportion decreased by 19.5% (95% CI:-30.6%- -6.8%). Conclusion:Joint exposure to air pollutants is associated with changes in sleep structure in stable COPD patients, and NO 2 may be a key pollutant.

Objective To analyze the application effect of size-specific dose estimate(SSDE)in radiation dose and images quality of coronary CT angiography(CCTA).Methods A retrospective study was conducted on 56 patients undergoing CCTA at the First Affiliated Hospital of Chongqing Medical University between February 2022 and February 2025.These patients were assigned to observation group(SSDE injection),while another 56 patients undergoing CCTA during the same period were enrolled as routine group(traditional injection).The two groups were compared for coronary enhancement value,images quality score,objective parameters of images quality[image noise,CT value,contrast to noise ratio(CNR),signal to noise ratio(SNR)],radiation dose parameters[dose-length product(DLP),CT dose index volume(CTDIvol),effective dose(ED)],anteroposterior diameter,left-right diameter and fsize.Results The CCTA image quality score and coronary enhancement value in observation group were significantly higher than those in routine group(P<0.05).Compared with routine group,observation group had higher CT value,CNR,and SNR,as well as lower image noise(P<0.05).The CTDIvol,ED,DLP and SSDE of observation group were lower than those of routine group(P<0.05).The?size in observation group was smaller,while anteroposterior diameter and left-right diameter were longer than those in routine group(P<0.05).Conclusion The application of SSED protocol in CCTA scanning can effectively improve radiation dose and images quality.

Objective To explore the impact of factors such as economic level,regional differences,and healthcare policies on the medical costs and the clinical treatment behaviors for benign prostatic hyperplasia(BPH)using big data technology.Methods A combination of qualitative and quantitative approaches was employed,including descriptive statistical analysis,central tendency analysis,comparative analysis,and structural analysis to explore regional differences in the treatment of BPH and the underlying causes.Results The mean medical cost per case in the provincial capital city(19 502 yuan)was significantly higher than that in the prefecture-level city(16 526 yuan),with a difference of 2 976 yuan(+18%).Moreover,the cost distribution was more dispersed in the provincial capital([8 370 yuan-26 344 yuan]vs.[9 687 yuan-21 974 yuan]in the prefecture-level city).However,the provincial capital demonstrated better hospitalization efficiency,with a significantly shorter mean length of stay(9.24 days vs 10.21 days,-10.5%).All these differences were statistically significant(P<0.01).Payment methods influenced surgical choices.In the provincial capital,43.99%of patients underwent transurethral resection of the prostate(TURP),with no cases of holmium laser enucleation of the prostate(HOLEP).In contrast,the prefecture-level city reported 22.71%of patients receiving plasmakinetic resection of the prostate(PKRP)and 19.19%undergoing HoLEP.Significant differences were observed in antibiotic utilization patterns.The most commonly used antibiotic in the provincial capital was piperacillin-tazobactam(19.96%),while cefotaxime dominated in the prefecture-level city(21.11%).Notably,ertapenem was frequently used in the provincial capital but rarely in the prefecture-level city,potentially due to cost considerations(P<0.05).Regional preferences were evident in antispasmodic medication;phloroglucinol injection was used in 80%of cases in the prefecture-level city,while anisodamine hydrobromide injection predominated in the provincial capital(P<0.05).For BPH-specific medications,although tamsulosin hydrochloride sustained-release capsules were the primary choice in both regions,the prefecture-level city showed significantly higher usage(80.11%vs 49.17%).Finasteride tablets were more commonly prescribed in the provincial capital(39.03%vs.14.14%,P<0.05).Conclusion Economic levels,healthcare policies,and different hospitals significantly influence clinical decision-making and medical expenses.Hospitals should enhance refined management,while healthcare policy reforms need to advance from multiple perspectives and levels to improve the efficiency and equity of healthcare services.