Objective:To investigate the changes in the narrow band imaging (NBI) phenotypes of oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma after neoadjuvant immunochemotherapy, and to explore the clinical value of NBI endoscopy in re-evaluation and follow-up of pharyngeal and laryngeal squamous cell carcinoma after neoadjuvant immunochemotherapy.Methods:Twenty-nine patients diagnosed with locally advanced pharyngeal or laryngeal squamous cell carcinoma in the First Affiliated Hospital of Xiamen University from November 2021 to January 2024 and receiving 2 cycles of neoadjuvant immunochemotherapy were selected, including 26 males and 3 females, aged 43-80 years. Regular NBI and white light (WL) endoscopy examinations, as well as imaging examinations such as CT scans, were performed. After the neoadjuvant immunochemotherapy, 36 specimens from suspected lesions of the pharynx or the larynx were obtained through surgical resection. The NBI findings of the pharyngeal or laryngeal lesions and their relationships with corresponding pathological and imaging results were analyzed with kappa test, Pearson correlation analysis, McNemar test, and Wilcoxon Signed Rank Test.Results:After neoadjuvant immunochemotherapy, primary lesions showed pathological complete response (pCR) in 9 cases, partial response (PR) in 19 cases, and progressive disease (PD) in one case. The NBI phenotypes of pharyngeal and laryngeal malignant tumors after treatment showed high consistency (kappa=0.818, P<0.01) and significant correlations ( r=0.852, P<0.01) with their pathological results. WL endoscopic examinations showed inconsistency (kappa=0.239, P=0.12) with their pathological results. NBI endoscopy was more effective in identifying benign lesions after treatment than WL endoscopy ( P=0.031). In cases of both PR and pCR of the primary lesion, there were significant differences in NBI phenotypes before and after neoadjuvant immunochemotherapy (all P<0.05), with phenotypes transitioning to lower malignancy and benign lesions, respectively. Among 19 cases with PR, 16 showed concentric/eccentric regression, and 3 showed multipoint focal regression. NBI endoscopy was more accurate in diagnosing benign or malignant lesions, pCR or PR after treatment compared to CT (all P<0.05). Conclusions:The present NBI microvascular classification of the pharyngeal and laryngeal lesions is still applicable for the diagnosis and evaluation in pharyngeal and laryngeal squamous cell carcinoma after neoadjuvant immunochemotherapy. The changes in NBI phenotypes and ranges can indicate tumor regression, progression, and recurrence. NBI is more accurate in diagnosing pharyngeal and laryngeal squamous cell carcinoma after neoadjuvant immunochemotherapy compared to WL endoscopy and imaging examinations such as CT.

Objective: Randomized controlled trials (RCTs) of Chinese patent medicines and classic traditional Chinese medicine prescriptions were systematically reviewed from both Chinese and English journals published in 2023. A preliminary summary and evaluation were conducted on the generation and translation of clinical evidence for these treatments. This analysis aims to inform future research on clinical efficacy evaluation and guide the rational application of evidence. Methods: RCTs of Chinese patent medicines and classic traditional Chinese prescriptions published in 2023 were comprehensively retrieved from the Artificial Intelligence Clinical Evidence Database for Chinese Patent Medicine (AICED-CPM), with supplementary searches conducted in China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (SinoMed), Cochrane Library, PubMed, Embase, and Web of Science. The study characteristics and methodological quality of these RCTs were systematically analyzed and evaluated. Results: A total of 1 443 RCTs of Chinese patent medicines were included, comprising 1 399 Chinese articles and 44 English articles. Additionally, 334 RCTs of classic traditional Chinese medicine prescriptions were found, with 331 published in Chinese and 3 in English. 196 567 participants were included, covering 585 types of Chinese patent medicines (487 oral, 61 injectable, and 37 topical) and 179 classic traditional Chinese medicine prescriptions. The involved studies encompassed 22 types of diseases, with research primarily focusing on diseases of the circulatory system, the respiratory system, and the genitourinary system. The sample sizes ranged from 18 to 3 777 participants, and most studies were conducted at a single center. Methodologically, the implementation of allocation concealment and blinding remained insufficiently emphasized. Conclusion Overall, compared with 2022, both the number of RCT publications and their methodological quality have improved in 2023, with heightened attention to research on diseases of the genitourinary system. However, quality control and standardized management in the design and implementation processes still require enhancement to produce more high-quality clinical evidence and accelerate the translation and application of this evidence.

Objective:To explore the predictive value of hepatitis B surface antibody (HBsAb) quantitative level for achieving hepatitis B surface antigen (HBsAg) seroclearance and serological conversion in patients with chronic hepatitis B (CHB) treated with nucleos(t)ide analogs (NAs) or interferon (IFN).Methods:A two-center prospective cohort study was conducted, including CHB patients from Nanfang Hospital Southern Medical University and Eastern Theater General Hospital treated with NAs and IFN. All patients were followed up once every three to six months. Basic clinical information and test results were collected at each follow-up. The presence or absence of HBsAg seroclearance and serological conversion rate was evaluated. HBsAg serological conversion was defined as HBsAg quantification continuously below the detection limit (<0.05 IU/mL) at two detection time points at least six months apart. HBsAg serological conversion was defined as HBsAb positivity (≥10 IU/L) at the same time as the first HBsAg seroclearance. The Kruskal-Wallis test was used to compare the quantitative data of multiple groups, and the Wilcoxon rank-sum test was used to compare the data between groups. The chi-square test was used for the count data, and the Fisher exact test was used when the chi-square test was not met. Univariate and multivariate Cox analysis was used to determine the predictors of the study endpoints, and stepwise regression was used for variable screening.Results:A total of 2 266 CHB cases were included, of which 86.5% (1 959/2 266) were NA antiviral-received population. The median treatment duration before baseline was 10.5 (2.5, 37.6) months, and the baseline HBsAg quantification was 3.1 (2.6, 3.5) log 10 IU/mL. A total of 68 cases (3.0%) had HBsAg seroclearance, and 44 cases (1.9%) achieved serological conversion after 85.0 (62.7, 97.3) months of prospective follow-up. The level and positivity rate of HBsAb showed a progressive increase 36 months before and significantly after HBsAg seroclearance. Cox regression analysis results showed that baseline HBsAb level was an independent predictor of HBsAg serological conversion ( HR=2.26, P=0.002) in the overall population, especially in the subgroup with HBsAg between 100 and 1 000 IU/mL, suggesting HBsAb level had important predictive value. In addition, the serological conversion development rate was significantly higher in the GOLDEN model favourable patients than in the unfavourable patients (11.5% vs. 0, P<0.001). Conclusion:The baseline HBsAb quantitative level can predict HBsAg seroclearance and serological conversion for patients with CHB receiving antiviral treatment, which is of significant value in long-term treatment monitoring.

Purpose To investigate the clinicopathological features,differential diagnosis and prognosis of atypical fibroxanthoma(AFX).Methods Pathological features of 15 cases of AFX and 3 cases of pleomorphic dermal sarcoma(PDS)misdiagnosed as AFX were retrospectively analyzed by hematoxylin and eosin staining and immunohistochemical EnVision staining technology.Clinical information was collected and analyzed,and the relevant literatures were re-viewed.Results The age of the 15 patients with AFX ranged from 18 to 78 years,with an average age of 57 years.4 cases occurred in the head and neck,and 11 cases occurred in the trunk and limbs.3 patients with PDS misdiagnosed as AFX were aged from 56 to 60 years,with an average age of 58 years.The tumors were located in the trunk and limbs.Microscopically,15 cases of AFX and 3 cases of PDS misdiagnosed as AFX were composed of proliferative pleo-morphic and atypical spindle cells interspersed with a varying number of multinucleated cells.15 cases of AFX tumors were superficial and located in the dermis.In 3 cases of PDS misdiagnosed as AFX,1 case was located in subcutane-ous adipose tissue,1 case had superficial subcutaneous extension,and the third case had positive basal margin.Immu-nohistochemically,the immunophenotypes of the two groups were consistent.CD10 was expressed in all cases,CD68 was positive in most cases,SMA was expressed in a few cases,desmin was focal expressed in a very few cases,and S-100,SOX10,CD34,HMB-45,Melan A,STAT6 and CK(AE1/AE3)were not expressed in all cases.Ki67 prolifera-tion index ranged from 2％to 30％.15 patients with AFX were followed up from 12 to 108 months.One patient had tumor recurrence 1 year and 3 years after operation due to positive basal margin.Most of the other patients underwent extended resection after diagnosis and were in good condition without tumor recurrence and metastasis.3 cases of PDS misdiagnosed as AFX were followed up for 31 to 78 months.One patient had lung metastasis after 2 years,one patient recurred 4 times after operation,and the other patient died after 4 times of recurrence.Conclusion AFX is a rare dis-ease with similar pathological characteristics and immunophenotype to PDS.AFX can be diagnosed only when the tumor is small and completely confined to the dermis.When the maximum diameter of the tumor is more than 3 cm,or the presence of any form of subcutaneous extension requires a high level of vigilance for PDS.Careful differentiation and correct classification of AFX and PDS are very important for the treatment and prognosis of the disease.

Objective To analyze the practical value of spiral CT three-dimensional reconstruction techniquein evaluating triplane fractures of the distal tibia.Methods A retrospective analysis was conducted on183 patients with triplane fractures of the distal tibia admitted to Sichuan Orthopedic Hospital from January 2021 to March 2023.All patients underwent both X-ray and spiral CT examinations.Taking surgical reduction results as the gold standard for diagnosis,the diagnostic accuracies of X-ray examination and spiral CT three-dimensional reconstruction technique for triplane fractures of the distal tibia were analyzed.Results Fracture classification according to the number of fracture fragments showed that among the 183 patients with triplane fractures of the distal tibial,there were 44 cases of four-part fractures,62 cases of three-part fractures,and 77 cases of two-part fractures.The classification by the location of epiphyseal injury in the distal tibia showed 175 cases of lateral type and 8 cases of medial type.According to whether the fracture line involved the articular surface,they were categorized into 94 cases of type I,60 cases of type II,and 29 cases of type III.For the classification of the number of fracture fragments,X-ray misdiagnosed 9 cases of four-part fractures as three-part or two-part fractures,and 21 cases of three-part fractures as two-part fractures,resulting in a diagnostic accuracy of 83.60%.For theclassification of fracture line and articular surface position,X-ray led to misdiagnosis or inaccurate diagnosis in 39 cases,with a diagnostic accuracy of 78.69%.When spiral CT three-dimensional reconstruction technique was used to classify the number of fracture fragments,only 1 case of four-part fracture was misdiagnosed as three-part fracture,and 2 cases of three-part fractures were misdiagnosed as four-part fractures or two-part fractures,yielding a diagnostic accuracy of 98.36%.For the diagnosis of the positional relationship of the fracture line to the articular surface,spiral CT three-dimensional reconstruction technique had 8 misdiagnoses,with a corresponding diagnostic accuracy of 95.63%.Conclusion Spiral CT three-dimensional reconstruction technique can stereoscopically display the spatial information of the triplane fractures of the distal tibia,such as the location,shape,type,and articular surface,exhibiting high accuracy for classification diagnosis and significant application value in the reduction and treatment of triplane fractures of the distal tibia.

Biomimetic wet-adhesive hydrogels mimic the adhesive properties of biological organisms to achieve strong bonding in moist environments.Compared to conventional medical adhesives,these materials are characterized by enhanced biocompatibility,robust ad-hesion,and adjustable physicochemical properties.Although biomimetic wet-adhesive hydrogels have been applied in oral mucosal drug delivery,intraoral wound management,and implant surgery,a systematic review is currently lacking.This article aims to summarize the wet-adhesion mechanisms of bio-inspired materials and their applications in various scenarios and to provide insights and methodolo-gies for the design of novel intraoral dressings.

Objective To explore the longitudinal changes of symptoms after discharge in patients with daytime lung cancer surgery by factor analysis,in order to strengthen nursing countermeasures and improve the quality of life of patients.Methods Patients who underwent day surgery in the thoracic surgery department of a tertiary general hospital in Zhejiang Province from October 2023 to January 2024 were selected using convenience sampling.On the 1st,3rd,14th and 30th day after discharge,the general information questionnaire and the postoperative symptom inventory for patients with lung cancer were used for investigation.Exploratory factor analysis was performed to extract the symptom clusters.Results A total of 227 patients were followed up in this study,including 19 shed cases and 2 excluded cases,and 206 patients were finally included.The percentage of the 9 major symptoms of patients with daytime lung cancer surgery after discharge showed dynamic changes.The highest percentage symptom on the 1st day after discharge was pain in 197 cases(95.63％).The highest percentage on the 30th day after discharge was cough in 129 cases(62.62％).The results of exploratory factor analysis were P＜0.001 and KMO＞0.500 for Bartlett's test of sphericity on days 1,3,and 14 after discharge,except for P=0.874 and KMO=0.495 on day 30,with digestive and respiratory symptom clusters on day 1;respiratory,digestive,and fatigue symptom clusters on day 3;fatigue and respiratory symptom clusters on day 14.Conclusion The single symptom and symptom clusters of patients with daytime lung cancer surgery after discharge showed dynamic changes at different time points.Therefore,in clinical work,targeted intervention strategies should be adopted,and precise symptom management should be implemented according to the characteristics of symptom clusters in different periods of discharge of patients undergoing daytime lung cancer surgery,so as to reduce the symptom burden of patients.

Purpose To investigate the clinicopathological features,differential diagnosis and prognosis of atypical fibroxanthoma(AFX).Methods Pathological features of 15 cases of AFX and 3 cases of pleomorphic dermal sarcoma(PDS)misdiagnosed as AFX were retrospectively analyzed by hematoxylin and eosin staining and immunohistochemical EnVision staining technology.Clinical information was collected and analyzed,and the relevant literatures were re-viewed.Results The age of the 15 patients with AFX ranged from 18 to 78 years,with an average age of 57 years.4 cases occurred in the head and neck,and 11 cases occurred in the trunk and limbs.3 patients with PDS misdiagnosed as AFX were aged from 56 to 60 years,with an average age of 58 years.The tumors were located in the trunk and limbs.Microscopically,15 cases of AFX and 3 cases of PDS misdiagnosed as AFX were composed of proliferative pleo-morphic and atypical spindle cells interspersed with a varying number of multinucleated cells.15 cases of AFX tumors were superficial and located in the dermis.In 3 cases of PDS misdiagnosed as AFX,1 case was located in subcutane-ous adipose tissue,1 case had superficial subcutaneous extension,and the third case had positive basal margin.Immu-nohistochemically,the immunophenotypes of the two groups were consistent.CD10 was expressed in all cases,CD68 was positive in most cases,SMA was expressed in a few cases,desmin was focal expressed in a very few cases,and S-100,SOX10,CD34,HMB-45,Melan A,STAT6 and CK(AE1/AE3)were not expressed in all cases.Ki67 prolifera-tion index ranged from 2％to 30％.15 patients with AFX were followed up from 12 to 108 months.One patient had tumor recurrence 1 year and 3 years after operation due to positive basal margin.Most of the other patients underwent extended resection after diagnosis and were in good condition without tumor recurrence and metastasis.3 cases of PDS misdiagnosed as AFX were followed up for 31 to 78 months.One patient had lung metastasis after 2 years,one patient recurred 4 times after operation,and the other patient died after 4 times of recurrence.Conclusion AFX is a rare dis-ease with similar pathological characteristics and immunophenotype to PDS.AFX can be diagnosed only when the tumor is small and completely confined to the dermis.When the maximum diameter of the tumor is more than 3 cm,or the presence of any form of subcutaneous extension requires a high level of vigilance for PDS.Careful differentiation and correct classification of AFX and PDS are very important for the treatment and prognosis of the disease.

Objective To explore the longitudinal changes of symptoms after discharge in patients with daytime lung cancer surgery by factor analysis,in order to strengthen nursing countermeasures and improve the quality of life of patients.Methods Patients who underwent day surgery in the thoracic surgery department of a tertiary general hospital in Zhejiang Province from October 2023 to January 2024 were selected using convenience sampling.On the 1st,3rd,14th and 30th day after discharge,the general information questionnaire and the postoperative symptom inventory for patients with lung cancer were used for investigation.Exploratory factor analysis was performed to extract the symptom clusters.Results A total of 227 patients were followed up in this study,including 19 shed cases and 2 excluded cases,and 206 patients were finally included.The percentage of the 9 major symptoms of patients with daytime lung cancer surgery after discharge showed dynamic changes.The highest percentage symptom on the 1st day after discharge was pain in 197 cases(95.63％).The highest percentage on the 30th day after discharge was cough in 129 cases(62.62％).The results of exploratory factor analysis were P＜0.001 and KMO＞0.500 for Bartlett's test of sphericity on days 1,3,and 14 after discharge,except for P=0.874 and KMO=0.495 on day 30,with digestive and respiratory symptom clusters on day 1;respiratory,digestive,and fatigue symptom clusters on day 3;fatigue and respiratory symptom clusters on day 14.Conclusion The single symptom and symptom clusters of patients with daytime lung cancer surgery after discharge showed dynamic changes at different time points.Therefore,in clinical work,targeted intervention strategies should be adopted,and precise symptom management should be implemented according to the characteristics of symptom clusters in different periods of discharge of patients undergoing daytime lung cancer surgery,so as to reduce the symptom burden of patients.

Objective To analyze the practical value of spiral CT three-dimensional reconstruction techniquein evaluating triplane fractures of the distal tibia.Methods A retrospective analysis was conducted on183 patients with triplane fractures of the distal tibia admitted to Sichuan Orthopedic Hospital from January 2021 to March 2023.All patients underwent both X-ray and spiral CT examinations.Taking surgical reduction results as the gold standard for diagnosis,the diagnostic accuracies of X-ray examination and spiral CT three-dimensional reconstruction technique for triplane fractures of the distal tibia were analyzed.Results Fracture classification according to the number of fracture fragments showed that among the 183 patients with triplane fractures of the distal tibial,there were 44 cases of four-part fractures,62 cases of three-part fractures,and 77 cases of two-part fractures.The classification by the location of epiphyseal injury in the distal tibia showed 175 cases of lateral type and 8 cases of medial type.According to whether the fracture line involved the articular surface,they were categorized into 94 cases of type I,60 cases of type II,and 29 cases of type III.For the classification of the number of fracture fragments,X-ray misdiagnosed 9 cases of four-part fractures as three-part or two-part fractures,and 21 cases of three-part fractures as two-part fractures,resulting in a diagnostic accuracy of 83.60%.For theclassification of fracture line and articular surface position,X-ray led to misdiagnosis or inaccurate diagnosis in 39 cases,with a diagnostic accuracy of 78.69%.When spiral CT three-dimensional reconstruction technique was used to classify the number of fracture fragments,only 1 case of four-part fracture was misdiagnosed as three-part fracture,and 2 cases of three-part fractures were misdiagnosed as four-part fractures or two-part fractures,yielding a diagnostic accuracy of 98.36%.For the diagnosis of the positional relationship of the fracture line to the articular surface,spiral CT three-dimensional reconstruction technique had 8 misdiagnoses,with a corresponding diagnostic accuracy of 95.63%.Conclusion Spiral CT three-dimensional reconstruction technique can stereoscopically display the spatial information of the triplane fractures of the distal tibia,such as the location,shape,type,and articular surface,exhibiting high accuracy for classification diagnosis and significant application value in the reduction and treatment of triplane fractures of the distal tibia.