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.

Objective To introduce a modified technique of right ventricular outflow tract (RVOT) reconstruction using a handmade bicuspid pulmonary valve crafted from expanded polytetrafluoroethylene (ePTFE) and to summarize the early single-center experience. Methods Patients with complex congenital heart diseases (CHD) who underwent RVOT reconstruction with a handmade ePTFE bicuspid pulmonary valve due to pulmonary regurgitation at Guangdong Provincial People’s Hospital from April 2021 to February 2022 were selected. Postoperative artificial valve function and right heart function indicators were evaluated. Results A total of 17 patients were included, comprising 10 males and 7 females, with a mean age of (18.18±12.14) years and a mean body weight of (40.94±19.45) kg. Sixteen patients underwent reconstruction with a handmade valved conduit, with conduit sizes ranging from 18 to 24 mm. No patients required mechanical circulatory support, and no in-hospital deaths occurred. During a mean follow-up period of 12.89 months, only one patient developed valve dysfunction, and no related complications or adverse events were observed. The degree of pulmonary regurgitation was significantly improved post-RVOT reconstruction and during follow-up compared to preoperative levels (P<0.001). Postoperative right atrial diameter, right ventricular diameter, and tricuspid regurgitation area were all significantly reduced compared to preoperative values (P<0.05). Conclusion The use of a 0.1 mm ePTFE handmade bicuspid pulmonary valve for RVOT reconstruction in complex CHD is a feasible, effective, and safe technique.

OBJECTIVE: To compare the effectiveness of ultrasound-guided closed reduction with Kirschner wire fixation and open reduction with Kirschner wire fixation in the treatment of humeral lateral condyle fracture (HLCF) in children. METHODS: A clinical data of 53 children with HLCF admitted between May 2020 and April 2023 and met selective criteria was retrospectively analyzed. Of these, 25 cases were managed with closed reduction and Kirschner wire fixation under ultrasound guidance (closed group), while 28 cases underwent open reduction and Kirschner wire fixation (open group). There was no significant difference between the two groups in terms of gender, age, cause of injury, fracture side, fracture classification, and time from injury to operation ( P>0.05). The following variables were recorded and compared between the two groups: operation time, intraoperative fluoroscopy frequency, fracture healing time, incidence of complications, and the Flynn elbow function score at last follow-up. RESULTS: In the closed group, the fractures were successfully reduced under ultrasound guidance, with no nerve damage reported in either group. The operation time and intraoperative fluoroscopy frequency were significantly less in the closed group than in the open group ( P<0.05). One case of infection (Kirschner wire irritation) was observed in the closed group, while 3 cases in the open group (2 of Kirschner wire irritation and 1 of incision infection). However, the difference in the incidence of infection between the two groups was not significant ( P>0.05). All patients in both groups were followed up 6-18 months (mean, 10.2 months). X-ray examinations confirmed that fractures had healed in both groups, with no significant difference in healing time ( P>0.05). During follow-up, 5 cases of lateral humeral process formation were observed in the closed group, compared to 12 cases in the open group, although this difference was not significant ( P>0.05). At last follow-up, the excellent and good rate of elbow joint function was evaluated as 96.0% (24/25) in the closed group and 92.9% (26/28) in the open group according to the Flynn scoring criteria, with no significant difference between the two groups ( P>0.05). Both groups showed no occurrence of ossifying myositis or elbow internal/external rotation. CONCLUSION The effectiveness of ultrasound-guided closed reduction and Kirschner wire fixation in the treatment of HLCF in children is comparable to open reduction and Kirschner wire fixation, but the former can reduce operation time and intraoperative fluoroscopy frequency, and obtain lower the incidence of complications.
Humans ; Humeral Fractures/diagnostic imaging* ; Bone Wires ; Male ; Female ; Child ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Treatment Outcome ; Child, Preschool ; Open Fracture Reduction/methods* ; Fracture Healing ; Elbow Joint/surgery* ; Adolescent ; Closed Fracture Reduction/methods* ; Fluoroscopy ; Operative Time

OBJECTIVE: To investigate the surgical technique and preliminary effectiveness of closed reduction and internal fixation (CRIF) using antegrade elastic intramedullary nailing (ESIN) via a novel approach through the proximal radius for treating distal radius metaphyseal-diaphyseal junction (DRMDJ) fractures in children. METHODS: A retrospective analysis was conducted on 34 children with DRMDJ fractures who met the selection criteria and were treated between January 2020 and June 2023. There were 21 boys and 13 girls, aged 6-14 years (mean, 8.2 years). Injury causes included falls in 11 cases and sports-related trauma in 23 cases. Twenty-six cases were associated with ipsilateral distal ulnar fractures. All patients had failed initial closed reduction in the outpatient clinic. The time from injury to operation ranged from 1 to 15 days (mean, 4 days). All patients underwent CRIF using antegrade ESIN inserted via a novel approach at the proximal one-third of the radius. The operation time, intraoperative fluoroscopy frequency, fracture healing time, and complications were recorded. Fracture reduction was assessed immediately after operation on anteroposterior and lateral X-ray films for residual translation and angulation. Wrist function was evaluated using the modified Mayo wrist score. RESULTS: Surgery was successfully completed in all 34 children. CRIF with ESIN failed in 2 cases with associated ipsilateral distal ulnar fractures, requiring conversion to open reduction of the ulna. Operation time ranged from 15 to 56 minutes (mean, 21 minutes). Intraoperative fluoroscopy frequency ranged from 5 to 21 times (mean, 7 times). Immediate postoperative X-ray films showed residual translation of 0-15% on anteroposterior view and 0-10% on lateral view, and residual angulation of 0°-5° on both anteroposterior and lateral views. All children were followed up 6-18 months (mean, 12 months). There was no complication such as neurovascular injury, incision infection, or limitation of forearm rotation. Follow-up X-ray films showed no fracture displacement, implant loosening, delayed union, or nonunion. Fracture healing time ranged from 4 to 8 weeks (mean, 6 weeks). Implants were removed at 4-6 months postoperatively (mean, 5 months). At last follow-up, all fractures had achieved anatomic or near-anatomic healing. The modified Mayo wrist score ranged from 80 to 100 (mean, 94), with 27 excellent and 7 good results, yielding an excellent and good rate of 100%. CONCLUSION CRIF using antegrade ESIN via a novel approach through proximal radius is a safe and effective treatment for pediatric DRMDJ fractures, associated with few postoperative complications and excellent restoration of wrist function.
Humans ; Child ; Female ; Male ; Fracture Fixation, Intramedullary/instrumentation* ; Adolescent ; Radius Fractures/diagnostic imaging* ; Retrospective Studies ; Bone Nails ; Treatment Outcome ; Fracture Healing ; Diaphyses/surgery* ; Radius/surgery* ; Operative Time ; Closed Fracture Reduction/methods* ; Ulna Fractures/surgery*

Peptide-based radiopharmaceuticals targeting integrin α5β1 show promise for precise tumor diagnosis and treatment. However, current peptide-based radioligands that target α5β1 demonstrate inadequate in vivo performance owing to limited tumor retention. The use of PEGylation to enhance the tumor retention of radiopharmaceuticals by prolonging blood circulation time poses a risk of increased blood toxicity. Therefore, a PEGylation strategy that boosts tumor retention while minimizing blood circulation time is urgently needed. Here, we developed a PEGylation-enabled peptide multidisplay platform (PEGibody) for PR_b, an α5β1 targeting peptide. PEGibody generation involved PEGylation and self-assembly. [⁶⁴Cu]QM-2303 PEGibodies displayed spherical nanoparticles ranging from 100 to 200 nm in diameter. Compared with non-PEGylated radioligands, [⁶⁴Cu]QM-2303 demonstrated enhanced tumor retention time due to increased binding affinity and stability. Importantly, the biodistribution analysis confirmed rapid clearance of [⁶⁴Cu]QM-2303 from the bloodstream. Administration of a single dose of [¹⁷⁷Lu]QM-2303 led to robust antitumor efficacy. Furthermore, [⁶⁴Cu]/[¹⁷⁷Lu]QM-2303 exhibited low hematological and organ toxicity in both healthy and tumor-bearing mice. Therefore, this study presents a PEGibody-based radiotheranostic approach that enhances tumor retention time and provides long-lasting antitumor effects without prolonging blood circulation lifetime. The PEGibody-based radiopharmaceutical [⁶⁴Cu]/[¹⁷⁷Lu]QM-2303 shows great potential for positron emission tomography imaging-guided targeted radionuclide therapy for α5β1-overexpressing tumors.

Triple-negative breast cancer is therapeutically challenging due to the low expression of tumor markers and 'cold' tumor immunosuppressive microenvironment. Here, we present a dual-targeting peptide-drug conjugate (PDC) for tumor inhibition. Our PDC efficiently and selectively delivers cytotoxic Monomethyl Auristatin E (MMAE) into tumor cells via C-X-C chemokine receptor type 4 (CXCR4) and folate receptor 1 (FOLR1) for synergistic inhibition of growth and metastasis. Our results show that the dual-targeting PDC has potent antitumor activity in cultured human cells and several murine transplanted tumor models without apparent toxicity. The combination of dual-targeting PDC and radiotherapy modulates the tumor immunosuppressive microenvironment by increasing CD8⁺ T cell infiltration and attenuating the proportion of myeloid-derived suppressor and regulatory T cells. Therefore, our dual-targeting PDC represents a promising new strategy for cancer therapy that rebalances the immune system and promotes tumor regression.

ObjectiveTo explore the effects of modified Danggui Beimu Kushen pills on tumor growth and T-cell subsets in H22 hepatocellular carcinoma-bearing mice and to provide an experimental basis for the treatment of hepatocellular carcinoma with modified Danggui Beimu Kushen pills combined with immune checkpoint antibodies. MethodA H22 hepatocellular carcinoma-bearing mouse model was established. The modeled mice were randomized into model， cisplatin， low- （4 g·kg^-1·d^-1）， medium- （8 g·kg^-1·d^-1）， and high-dose （16 g·kg^-1·d^-1） modified Danggui Beimu Kushen pills groups. After continuous administration for 14 days， the mice were sacrificed on day 15. The tumor volume was measured on days 0， 4， 8， 12， 15 of drug administration. Tumors were weighed and thymus index and spleen index were calculated. Spleen lymphocytes were co-cultured with H22 hepatoma cells， and the tumor cell-killing rate was detected by the cell counting kit-8 （CCK-8）. Real-time polymerase chain reaction was carried to determine the mRNA levels of programmed cell death protein-1 （PD-1） and lymphocyte activation gene-3 （LAG-3） in spleen and tumor tissues. The number of CD4⁺ and CD8⁺ T cells and the expression of PD-1 and LAG-3 were detected by immunohistochemistry （IHC）. ResultOn day 8 of drug administration， tumor volumes in all treatment groups decreased compared with that in the model group. On day 15， both tumor volume and tumor weight were significantly lower in the treatment groups than in the model group （P<0.01）， with the cisplatin group showing the most pronounced reduction. Compared with the model and cisplatin groups， medium- and high-dose modified Danggui Beimu Kushen pills increased the thymus index （P<0.01）. Compared with the model group， all treatment groups showed increased spleen index （P<0.05， P<0.01）， with the cisplatin group showing the most significant increase. Compared with the model and cisplatin groups， all the groups of modified Danggui Beimu Kushen pills demonstrated increased number of CD4⁺ and CD8⁺ T cells and tumor cell-killing rate in the spleen and tumor tissues （P<0.01） and down-regulated mRNA and protein levels of LAG-3 （P<0.05， P<0.01）. The high-dose group of modified Danggui Beimu Kushen pills had lower mRNA level of PD-1 in the tumor tissue than the model and cisplatin groups （P<0.01）. ConclusionModified Danggui Beimu Kushen pills may promote the proliferation and tumor microenvironment infiltration of CD4⁺ and CD8⁺ T cells in H22 tumor-bearing mice by down-regulating LAG-3 expression， thereby improving T-cell immune activity and inhibiting tumor growth. This study provides an experimental basis for the combination of modified Danggui Beimu Kushen pills and immune checkpoint antibodies in the treatment of hepatocellular carcinoma.

Objective:To investigate the effect of total saponins of Panax japonicus(TSPJ) on ferroptosis of myocardial cells in diabetic cardiomyopathy(DCM) rats and underlying mechanism.Methods:Experiment 1: SD rats were divided into control group, DCM group, low-dose TSPJ group, high-dose TSPJ group, and metformin(Met) group, with 10 rats in each group. Experiment 2: SD rats were divided into control group, DCM group, TSPJ group, adenosine monophosphate-activated protein kinase(AMPK) inhibitor Compound C group, and TSPJ+ AMPK agonist AICAR group, with 10 rats in each group. Except for the control group, all rats were intraperitoneally injected with streptozotocin to construct a DCM model. After 8 weeks of corresponding drug intervention, the body weight as well as glucose and lipid metabolism of rats in each experimental group were assessed, and the cardiac function indicators were detected with echocardiography. The levels of serum lactate dehydrogenase(LDH), cardiac troponin I(cTnI) and creatine kinase isoenzyme MB(CK-MB) were detected by ELISA technique. The pathological changes of myocardial tissue were observed using hematoxylin-eosin(HE) staining. The levels of dismutase(SOD), glutathione(GSH), malondialdehyde(MDA), reactive oxygen species(ROS) and Fe 2+ in myocardial tissue were detected. Western blot was used to detect ferroptosis, ferritinophagy, and the AMPK/mammalian target of rapamycin/UNC-51-like kinase 1(mTOR/ULK1) signaling pathway related proteins expression in myocardial tissue. Results:Compared with control group, left ventricular ejection fraction(EF), left ventricular short axis shortening rate(FS), peak blood velocity ratio(E/A) between early and late diastolic periods were significantly decreased in DCM group, left ventricular inner diameter(LVEDd) was increased, and the serum LDH, cTnI, CK-MB were increased, the levels of SOD, GSH were decreased, MDA, ROS, Fe 2+ were increased in myocardial tissue, the expressions of TFR1, NCOA4 LC3-II/LC3-I, Beclin-1, phosphorylated AMPK and phosphorylated ULK1 were increased, the expressions of GPX4, SLC7A11 and phosphorylated mTOR were decreased. Compared with DCM group, the above indicators of rats were significantly improved in each treatment group. Compared with the TSPJ group, the AMPK agonist AICAR reversed the effects of TSPJ on ferroptosis and ferritinophagy mediated by the AMPK/mTOR/ULK1 pathway in DCM rat cardiomyocytes. Conclusion:TSPJ can inhibit ferroptosis in DCM rat cardiomyocytes and improve myocardial injury by regulating AMPK/mTOR/ULK1 mediated ferritinophagy.

Lung cancer， the most common malignant tumor， is characterized by a complex pathogenesis and high malignancy， and poses a significant threat to the health and lives of affected individuals. p53 signaling pathway plays a crucial role in the progression of lung cancer and is considered one of the potential targets for targeted therapy. In recent years， multiple studies have indicated that traditional Chinese medicine （TCM） can exert anticancer effects by modulating the p53 signaling pathway. Based on this， this article systematically summarizes the current status and progress of research on TCM intervening in lung cancer by regulating p53 signaling pathway. It was found that TCM formula and preparations， such as Qingjin desheng tablet， Tiaoqi xiaoji decoction， Bufei tongluo jiedu formula， Jianpi bushen formula and Yiqi fuzheng jiedu formula， can promote autophagy and apoptosis of lung cancer cells， inhibit the growth and metastasis of lung cancer cells and strengthen the immune function of the body by activating p53 signaling pathway， thereby inhibiting lung cancer. TCM monomers， such as pseudoginsenoside-Rh2， saikosaponin D， polyphyllin Ⅶ， dendrobiine， sophoridine， gambogic acid， triptolide and triptolide succinate monoester YJ-4， can accelerate cell apoptosis， inhibit the proliferation of lung cancer cells and regulate cell cycle by activating p53 signaling pathway， thereby inhibiting lung cancer.

Lung cancer， the most common malignant tumor， is characterized by a complex pathogenesis and high malignancy， and poses a significant threat to the health and lives of affected individuals. p53 signaling pathway plays a crucial role in the progression of lung cancer and is considered one of the potential targets for targeted therapy. In recent years， multiple studies have indicated that traditional Chinese medicine （TCM） can exert anticancer effects by modulating the p53 signaling pathway. Based on this， this article systematically summarizes the current status and progress of research on TCM intervening in lung cancer by regulating p53 signaling pathway. It was found that TCM formula and preparations， such as Qingjin desheng tablet， Tiaoqi xiaoji decoction， Bufei tongluo jiedu formula， Jianpi bushen formula and Yiqi fuzheng jiedu formula， can promote autophagy and apoptosis of lung cancer cells， inhibit the growth and metastasis of lung cancer cells and strengthen the immune function of the body by activating p53 signaling pathway， thereby inhibiting lung cancer. TCM monomers， such as pseudoginsenoside-Rh2， saikosaponin D， polyphyllin Ⅶ， dendrobiine， sophoridine， gambogic acid， triptolide and triptolide succinate monoester YJ-4， can accelerate cell apoptosis， inhibit the proliferation of lung cancer cells and regulate cell cycle by activating p53 signaling pathway， thereby inhibiting lung cancer.