ObjectiveTo investigate the differential expression of integrin alpha-6（ITGA6） in abdominal wall endometriosis （AWE） tissues and its molecular mechanisms in regulating AWE. Methods36 AWE lesions were designated as the experimental group， while 36 cases of normal endometrial tissues served as the controls. Differential expression of ITGA6 between the two groups was assessed through immunohistochemical （IHC） staining. Human ITGA6 gene-specific interference sequences were designed， synthesized， and packaged into lentiviral vectors to establish the Ishikawa cell line with ITGA6-knockdown. Similarly， the ITGA6-overexpression cell line was constructed using the coding sequence （CDS） of the gene. Real-time PCR and Western blot were performed to detect changes in epithelial-mesenchymal transition（EMT）-related markers and angiogenesis-related indicators. Cell invasion and migration capabilities were assessed by Cell Scratch and Transwell assays. Furthermore， Western blot was conducted to profile PI3K/AKT pathway dynamics. ResultsEctopic endometrial tissues exhibited a marked increase in the number of ITGA6-positive cells and their expression intensity compared to eutopic endometrium （each P < 0.001）. Compared with the NC group， the ITGA6-knockdown group showed significantly reduced expression of N-cadherin， VEGF， and TGF-β1 （all P < 0.01）， while E-cadherin expression was markedly increased （P < 0.01）. Concomitantly， the invasion and migration capacities of ITGA6-low expression were significantly impaired （P < 0.001 for both）， accompanied by a marked reduction in AKT and phosphorylated AKT（p-AKT） levels （P < 0.001）. Conversely， overexpressing ITGA6 resulted in opposite effects. ConclusionITGA6 modulates EMT and angiogenesis in Ishikawa cells via the PI3K/AKT signaling pathway， thereby enhancing cell invasion and migration capabilities， which contributes to the pathogenesis of AWE.

AIM: To explore the application effect of eyelid margin incision combined with floating bridge technique in the treatment of ptosis patients, and to analyze its effects on the margin reflex distance 1(MRD1)and the aesthetic effect of the eyes. METHODS:Prospective study. This study enrolled patients with blepharoptosis treated at the Department of Ophthalmology of the hospital between January 2023 and July 2025, who were assigned to either an observation group or a control group. The patients in the control group received levator aponeurosis shortening surgery through conventional double-eyelid incision, while the patients in the observation group underwent levator aponeurosis shortening surgery using the eyelid margin incision combined with floating bridge technique. Subsequently, the surgical-related indicators,the correction effect of ptosis, the aesthetic effect, the ocular function indicators, the postoperative complication occurrence rate, and recurrence rate were compared and analyzed between two groups.RESULTS:A total of 100 patients(100 eyes)with blepharoptosis were enrolled in this study, with 50 patients(50 eyes)in the observation group and 50 patients(50 eyes)in the control group. The observation group had a mean age of 27.33±5.32 y, including 20 males and 30 females. The control group had a mean age of 27.64±4.66 y, including 24 males and 26 females. Compared with the control group, the operative time of the observation group was longer, the postoperative swelling resolution time and natural recovery time were shorter,and the correction rate was higher(P<0.05). Three months after the surgery, the VSS score and POSAS score of the observation group were lower than those of the control group, while the scores for eyelid curvature, symmetry of eyelid height, and the PFH, MRD1, palpebral fissure size, and upper eyelid levator muscle strength were all higher than those of the control group(all P<0.05). However, there was no significant difference in postoperative complication occurrence rate and recurrence rate between two groups(all P>0.05).CONCLUSION:The combined use of eyelid margin incision and floating bridge technique for treating ptosis results in slightly longer operation time, but it can shorten the postoperative recovery period, effectively ameliorate the MRD1 and ocular function of patients, and enhance the correction effect and aesthetic quality of the eyes. In addition, it has a low incidence of complications and guaranteed safety.

Objective To investige clinicopathological features and prognostic factors in patients with isocitrate dehydrogenase(IDH)wild-type glioblastoma(GBM).Methods A total of 137 patients with GBM diagnosed by surgical pathology at the General Hospital of Ningxia Medical University from January 2014 to July 2024 were retrospectively enrolled in this study.Clinical data,including age,gender,ethnicity,presence of epilepsy,neurological function status and Karnofsky Performance Status(KPS)score prior to radiotherapy,were collected.Tumor-related parameters,such as extent of resection,histological classification,tumor location,maximum tumor diameter,IDH mutation status,Ki-67 proliferation index,methylation status of the O6-methylguanine-DNA methyltransferase(MGMT)promoter and postoperative treatment regimens—including concurrent chemoradiotherapy and the number of adjuvant chemotherapy cycles were also recorded.Multivariate Cox proportional hazards regression analysis was conducted to identify independent prognostic factors.Kaplan-Meier survival curves were used to evaluate overall survival according to clinical characteristics.Results The median overall survival(OS)of the 137 GBM patients was 20.9 months,and their 1-year,2-year and 3-year survival rates were 79.7%,36.9%and 16.4%,respectively.Pre-radiotherapy KPS score,MGMT promoter methylation status,receipt of postoperative concurrent chemoradiotherapy and the number of adjuvant chemotherapy cycles were significantly associated with median survival of GBM patients(P＜0.05).Multivariate Cox analysis revealed that absence of MGMT promoter methylation,lack of postoperative concurrent chemoradiotherapy after surgery and the number of adjuvant chemotherapy cycles＜6 were independent risk factors for reduced survival in patients with GBM(P＜0.05).Patients with a pre-radiotherapy KPS score＜80,MGMT promoter unmethylation,lack of postoperative concurrent chemoradiotherapy and the number of adjuvant chemotherapy cycles＜6 demonstrated significantly lower cumulative overall survival rates compared to those with these characteristics(P＜0.05).Conclusion MGMT promoter unmethylation,lack of postoperative concurrent chemoradiotherapy and adjuvant chemotherapy cycles<6 are independent risk factors affecting overall survival in patients with IDH wild-type GBM.

Objective:To investigate the efficacy and safety of fluoroscopically-guided percutaneous gastrostomy (FGPG) for establishing enteral nutrition access in the treatment of esophageal fistula after radiotherapy for cervical esophageal cancer (CEC).Methods:A retrospective analysis was conducted on the clinical data of 54 patients who underwent FGPG due to esophageal fistula after radiotherapy for CEC at our department from November 2009 to August 2019. All patients received endoscopy before radiotherapy, and CEC was pathologically confirmed. Enteral nutrition support was offered through a gastrostomy tube postoperatively. The success rate of FGPG, complications, and healing of perforation were recorded and analyzed.Results:FGPG was successfully performed in all 54 patients (100%). During the 12-month follow-up, 50 patients (92.6) survived while four (7.4%) died. Among 36 patients with esophagomediastinal fistula, 32 (88.9%) healed in a median of 12 weeks; of 18 patients with esophagotracheal fistula, 8 (44.4%) healed in a median of 18 weeks. Thus, patients with esophagomediastinal fistula had a significantly higher healing rate ( P<0.01) and shorter healing time ( P=0.017). Gastrostomy tube-related complications were minimal, and no serious complication was noted. Conclusions:FGPG is effective for the treatment of esophageal fistula after CEC radiotherapy and may be an alternative treatment for esophageal fistula.

Objective:To explore the clinical effects and value for application of the tibial flap of the second toe with the vascular pedicle including a plantar vein on the reconstruction of fingertip soft tissue defects.Methods:From October 2020 to August 2022, retrospective analysis of 12 patients (12 digits) were treated at the Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital for small soft tissue defects of fingertip. The patients were 9 males and 3 females and aged 29-54 years, at 38 years in average. The fingertip defects were measured at approximately 1.2 cm × 0.8 cm to 1.2 cm × 1.2 cm. In the surgery, a tibial flap of second toe was designed to reconstruct the defect in fingertip. The flap were designed on the tibial of second toe without an extended incision in dorsal foot. The pedicle of the flap carried with the lateral proper digital artery, a nerve and the plantar vein of the second toe. At the recipient site, the artery, nerve and vein carried by the pedicle of the flap were end-to-end anastomosed with the digital artery, digital nerve and subcutaneous vein of the finger. The flaps were measured at 1.5 cm×1.0 cm - 1.5 cm×1.5 cm in size. All donor sites were reconstructed with skin grafts from the ipsilateral calf. Scheduled postoperative follow-ups were conducted at the outpatient clinic. The Michigan Hand Function Questionnaire (MHQ) evaluation criteria was employed to assess the recovery of hand function, and Total Active Movement (TAM) was used to evaluate the recovery of range of motion of the interphalangeal joints of the affected fingers.Results:All 12 flaps in the fingertips survived. Postoperative follow-ups lasted from 6 months to 2 years, with an average of 11 months. One flap was slightly bloated and a flap aesthetic surgery was followed at 3 months after the primary reconstructive surgery, and the rest of flaps were all in good appearance. TPD was found at 12 -14 mm for all flaps at 9 months after surgery. All donor sites in the feet and calfs had primary healing, without a contracture or rupture of skin graft or an obvious dysfunction at the donor sites. According to the evaluation criteria of the MHQ, 8 patients were very satisfied with the overall appearance of the hand, and 4 were satisfied. Finger movement was evaluated according to TAM criteria, all 12 fingers were rated excellent.Conclusion:Reconstruction of a fingertip defect with a tibial flap of the second toe with the vascular pedicle including a plantar vein of the second toe has a good clinical efficacy. It has advantages in flap harvest, avoids an extended incision on dorsal foot, and makes a minimal damage to the donor site.

Objective To develop and validate a nomogram prediction model for residual stone risk after flexible ureteroscopic lithotripsy(FURL)in patients with 2-3 cm renal calculi,so as to provide reference for treatment options.Methods Clinical data of 342 patients with renal calculi measuring 2-3 cm undergoing FURL in our hospital during Jun.2017 and Apr.2024 were retrospectively collected.At a 3∶1 randomization ratio,patients were allocated to the training cohort(n=257)and validation cohort(n=85).Patients in the training cohort were stratified into two subgroups based on postoperative stone-free status:residual stone group(n=63)and stone-free group(n=194).Logistic regression analysis was employed to identify factors influencing stone retention and construct the nomogram prediction model.Bootstrapped resampling was applied to validate the model internally,model performance was assessed with calibration curves,Hosmer-Lemeshow test was used to test the degree of fitting,receiver operating characteristic(ROC)curve was plotted to evaluate the predictive accuracy,and decision curve analysis was used to determine the clinical net benefit.The model's generalization capability was evaluated with 10-fold cross-validation of the training set.Results Multivariate logistic regression revealed that stone size,CT value,lower calyx stones,multiple stones,renal infundibulum length(RIL),and renal infundibulum width(RIW)were independent predictors of residual stones(P＜0.05).The nomogram based on the above mentioned parameters demonstrated excellent discrimination,with Bootstrap-validated concordance indices of 0.876(training cohort)and 0.948(validation cohort).Hosmer-Lemeshow tests showed good calibration in both cohorts(P＞0.05).ROC analysis yielded the area under the curve(AUC)of 0.876 and 0.948 for the training and validation cohorts,respectively.The optimal cutoff value was 0.253,with corresponding sensitivity of 84.13％,specificity of 78.35％,and total score of nomogram of 143.The decision curve analysis showed when the threshold probability of the training cohort and verification cohort was 0-0.81 and 0-0.97,respectively,the nomogram could obtain good clinical net benefit in predicting the risk of residual stones.The average accuracy of 10-fold cross-validation was 0.814,and the average AUC was 0.865.Conclusion The nomogram model effectively predicts residual stone risk following FURL for 2-3 cm renal calculi.It is suggested that patients with a total score of ≤143 may consider undergoing FURL.

Objective To compare the effects of remimazolam and propofol on postoperative nausea and vomiting(PONV)after pancreatic extracorporeal shock wave lithotripsy(P-ESWL),with the aim of optimizing the anesthesia regimen for this procedure.Methods Clinical data were retrospectively collected from patients who underwent P-ESWL for pancreatic stones under general anesthesia at The First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to December 2024.A total of 307 patients were recruited,with 103 in the remimazolam group and 204 in the propofol group.Inverse probability of treatment weighting(IPTW)based on propensity scores was used to balance baseline characteristics and confounding factors between the two groups.The incidence of PONV and anesthesia recovery time were compared between the two groups.Results Before IPTW,there were statistically significant differences between the remimazolam and propofol groups in gender[male/female:51/52 vs.155/49],smoking history(27.2％vs.42.6％),intraoperative sufentanil use[25(10)μg vs.30(10)μg],remifentanil use[429.00(177)μg vs.480.50(209)μg],rocuronium use[36(6)mg vs.38(7)mg],and intraoperative dexamethasone use(62.1％vs.49.0％)(all P＜0.05).After IPTW,the baseline characteristics and confounding factors were balanced and comparable between the two groups(P＞0.05).Before IPTW,the incidence of PONV was higher in the remimazolam group than in the propofol group(24.3％vs.14.7％,P=0.039).After IPTW,the two groups did not significantly differ in the incidence of PONV(21.5％vs.17.5％,P=0.215),and the anesthesia recovery time was significantly shorter in the remimazolam group than in the propofol group[3(3)min vs.9(4)min,P＜0.001].Conclusion Compared to propofol anesthesia,remimazolam does not increase the incidence of PONV in patients undergoing P-ESWL for pancreatic stones and can effectively reduce anesthesia recovery time.

Objective:To analyze the imaging features of primary leiomyosarcoma of the inferior vena cava (PLV).Methods:This study was a case series analysis. The clinical and imaging data of 17 patients with PLV confirmed by pathology who underwent CT, MRI and/or PET-CT examinations in the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2012 to September 2022 were retrospectively collected. The CT or MRI findings, including the number, location, size, shape, margin, density (signal), enhancement characteristics, surrounding invasion, and metastasis of the lesion were analyzed.Results:Among the 17 cases there were 7 males and 10 females, aged 32 to 78 years. All patients had single tumors, the maximum diameter of the mass was 3.8 to 19.0 cm, and in 12 cases it was consistent with the inferior venacava.There were 11 cases of "petal-like" necrosis cystic lesion, and 6 cases of "fissure" necrosis cystic lesion. Collateral circulation was found around the mass in 15 cases. There were 3 cases of intraluminal type, 2 cases of extraluminal type, and 12 cases of junctional type. The tumors of intraluminal type presented as "worm-like" appearance, while the extraluminal and junctional type tumors presented as lobulated shape, with local "umbilical depression sign". The margins were clear in 3 cases and unclear in 14 cases. Vascular invasion by the mass was observed in 7 cases. On CT plain scan, the solid component of PLV presented as isodense or slightly hypodense. On MRI T1-weighted images, the solid component presented as isodense or slightly hypodense, and on fat-suppressed T2-weighted images, it presented as isodense or slightly hyperdense. On MRI diffusion-weighted imaging, 12 cases showed high signal intensity, and the corresponding apparent diffusion coefficient map showed low signal intensity. On CT enhanced scan, 8 cases showed mild to moderate enhancement of the solid part of PLV in the arterial phase and 9 cases showed obvious enhancement. In the venous phase and delayed phase, 10 cases showed continuous enhancement and 7 cases showed progressive enhancement. On MRI enhanced scan, 8 cases showed moderate enhancement and 6 cases showed obvious enhancement of the solid part of PLV in the arterial phase. In the venous phase and delayed phase, continuous progressive enhancement was observed; no enhancement was seen in the necrotic and cystic areas.Conclusion:The imaging characteristics of PLV show that the maximum diameter of the masses are consistent with the direction of inferior vena cava, most masses exhibit a "petal-like" necrotic cyst morphology with collateral circulation, and a localized "umbilical concave sign", and some cases possess hemophilic tube features.

OBJECTIVE To investigate the targeting effect of folic acid-modified crebanine nanoparticles （FA-Cre@PEG- PLGA NPs， hereinafter referred to as “NPs”） combined with ultrasound irradiation on M109 cells in vitro and in vivo after administration， and explore the anti-tumor mechanism. METHODS CCK-8 assay was used to detect the inhibitory effect of NPs combined with ultrasound irradiation on the proliferation of M109 cells， and the best ultrasound time was selected. Using human lung cancer A549 cells as a control， the targeting of NPs combined with ultrasound irradiation to M109 cells was evaluated by free folic acid blocking assay and cell uptake assay. The effects of NPs combined with ultrasound irradiation on the migration， invasion， apoptosis， cell cycle and reactive oxygen species （ROS） levels of M109 cells were detected by cell scratch test， Transwell chamber test and flow cytometry at 1 h after 958401536@qq.com administration； the changes of mitochondrial membrane potential （MMP） were observed by fluorescence inverted microscope. A mouse subcutaneous tumor model of M109 cells was constructed， and the in vivo tumor targeting of NPs combined with ultrasound irradiation was investigated by small animal in vivo imaging technology. RESULTS NPs combined with ultrasound irradiation could significantly inhibit the proliferation of M109 cells， and the optimal ultrasound time was 1 h after administration. The free folic acid could antagonize the inhibitory effect of NPs on the proliferation of M109 cells， and combined with ultrasound irradiation could partially reverse this antagonism. Compared with A549 cells， the uptake rate of NPs in M109 cells was significantly higher （P＜0.01）， and ultrasound irradiation could promote cellular uptake. NPs combined with ultrasound irradiation could inhibit the migration and invasion of M109 cells and block the cell cycle in the G0/G1 and G2/M phases. Compared with control group， the apoptosis rate of M109 cells and ROS level were increased significantly （P＜0.01）， while the MMP decreased significantly （P＜0.01） in the different concentration （100， 200， 300 μg/mL） groups of M109 cells. Compared with the mice in non-ultrasound group， the fluorescence intensity and tumor-targeting index of the tumor site in the 0 h ultrasound group were significantly enhanced （P＜0.05 or P＜0.01）. CONCLUSIONS NPs combined with ultrasound irradiation have a strong targeting effect on M109 cells in vitro and in vivo， the anti-tumor mechanism includes inhibiting cell migration and invasion， blocking cell cycle， and inducing apoptosis.

Objective To investigate the suitable habitats of Phlebotomus chinensis in Gansu Province, so as provide insights into effective management of mountain-type zoonotic visceral leishmaniasis (MT-ZVL). Methods The geographical coordinates of locations where MT-ZVL cases were reported were retrieved in Gansu Province from 2015 to 2023, and data pertaining to 26 environmental variables were captured, including 19 climatic variables (annual mean temperature, mean diurnal range, isothermality, temperature seasonality, maximum temperature of the warmest month, minimum temperature of the coldest month, temperature annual range, mean temperature of the wettest quarter, mean temperature of the driest quarter, mean temperature of the warmest quarter, mean temperature of the coldest quarter, annual precipitation, precipitation of the wettest month, precipitation of the driest month, precipitation seasonality, precipitation of the wettest quarter, precipitation of the driest quarter, precipitation of the warmest quarter, and precipitation of the coldest quarter), five geographical variables (elevation, annual normalized difference vegetation index, vegetation type, landform type and land use type), and two population and economic variables (population distribution and gross domestic product). Twelve species distribution models were built using the biomod2 package in R project, including surface range envelope (SRE) model, generalized linear model (GLM), generalized additive model (GAM), multivariate adaptive regression splines (MARS) model, generalized boosted model (GBM), classification tree analysis (CTA) model, flexible discriminant analysis (FDA) model, maximum entropy (MaxEnt) model, optimized maximum entropy (MAXNET) model, artificial neural network (ANN) model, random forest (RF) model, and extreme gradient boosting (XGBOOST) model. The performance of 12 models was evaluated using the area under the receiver operating characteristic curve (AUC), true skill statistics (TSS), and Kappa coefficient, and single models with high performance was selected to build the optimal ensemble models. Factors affecting the survival of Ph. chinensis were identified based on climatic, geographical, population and economic variables. In addition, the suitable distribution areas of Ph. chinensis were predicted in Gansu Province under shared socioeconomic pathway 126 (SSP126), SSP370 and SSP585 scenarios based on climatic data during the period from 1991 to 2020, from 2041 to 2060 (2050s), and from 2081 to 2100 (2090s) . Results A total of 11 species distribution models were successfully built for prediction of potential distribution areas of Ph. chinensis in Gansu Province, and the RF model had the highest predictive accuracy (AUC = 0.998). The ensemble model built based on the RF model, XGBOOST model, GLM, and MARS model had an increased predictive accuracy (AUC = 0.999) relative to single models. Among the 26 environmental factors, precipitation of the wettest quarter (12.00%), maximum temperature of the warmest month (11.58%), and annual normalized difference vegetation index (11.29%) had the greatest contributions to suitable habitats distribution of Ph. sinensis. Under the climatic conditions from 1991 to 2020, the potential suitable habitat area for Ph. chinensis in Gansu Province was approximately 5.80 × 10⁴ km², of which the highly suitable area was 1.42 × 10⁴ km², and primarily concentrated in the southernmost region of Gansu Province. By the 2050s, the unsuitable and lowly suitable areas for Ph. chinensis in Gansu Province had decreased by varying degrees compared to that of 1991 to 2020 period, while the moderately and highly suitable areas exhibited expansion and migration. By the 2090s, under the SSP126 scenario, the suitable habitat area for Ph. chinensis increased significantly, and under the SSP585 scenario, the highly suitable areas transformed into extremely suitable areas, also showing substantial growth. Future global warming is conducive to the survival and reproduction of Ph. chinensis. From the 2050s to the 2090s, the highly suitable areas for Ph. chinensis in Gansu Province will be projected to expand northward. Under the SSP126 scenario, the suitable habitat area for Ph. chinensis in Gansu Province is expected to increase by 194.75% and 204.79% in the 2050s and 2090s, respectively, compared to that of the 1991 to 2020 period. Under the SSP370 scenario, the moderately and highly suitable areas will be projected to increase by 164.40% and 209.03% in the 2050s and 2090s, respectively, while under the SSP585 scenario, they are expected to increase by 195.98% and 211.66%, respectively. Conclusions The distribution of potential suitable habitats of Ph. sinensis gradually shifts with climatic changes. Intensified surveillance and management of Ph. sinensis is recommended in central and eastern parts of Gansu Province to support early warning of MT-ZVL.