Currently, gastrectomy+D 2 lymph node dissection has become the standard treatment for advanced gastric cancer, but the 5-year survival rate of gastric cancer patients is still less than 50%. In order to improve the prognosis of patients with advanced gastric cancer, neoadjuvant therapy has emerged. Neoadjuvant chemotherapy has been widely used in the treatment of gastric cancer. At the same time, neoadjuvant immunotherapy (NAI) represented by PD-1 inhibitors has begun to emerge in the treatment of locally advanced gastric cancer. Whether neoadjuvant therapy, especially NAI, inflicts an increased complications after radical resection of gastric cancer is still a matter of sorne concern. Therefore, this article reviews the application of neoadjuvant therapy for gastric cancer, perioperative complications and influencing factors of surgical complications.

Objective:To investigate the effect of miR-199a on interstitial transdifferentiation (EMT) of human renal tubular epithelial cells stimulated by high glucose.Methods:Human renal tubular epithelial cells were cultured in vitro and divided into low glycemic group (LG), high osmotic group (HM) and high glycemic group (HG) according to different glucose concentrations. They were divided into miR-199a inhibition group (miR-199ai group), negative control group (miR-INC group) and liposome group (Mock group) according to whether they were transfected with miR-199a inhibitors (miR199ai). They were divided into si-hypoxia-inducible factor-1α (si-HIF-1α) group, miR-199ai group, miR-199ai+ si-HIF-1α group and negative control group (NC group) according to whether they converted to si-HIF-1α and miR-199ai. The expressions of miR-199a, HIF-1α, fibronectin (FN) and α-smooth muscle actin (α-SMA) in different groups of cells were detected by real-time quantitative fluorescent polymerase chain reaction (qRT-PCR) and Western blot. Dual luciferase target assay was used to verify the targeting relationship between miR-199a and HIF-1α gene.Results:The mRNA expression level of miR-199a in the HG group was significantly lower than that in the LG group and the HM group (all P<0.01), and the mRNA and protein expression levels of HIF-1α, FN and α-SMA in Hg group were significantly higher than those in LG group and HM group (all P<0.01). The mRNA and protein expression levels of HIF-1α, FN and α-SMA in the miR-199ai group were significantly higher than those in the miR-iNC group and the Mock group (all P<0.01). Target gene prediction by TargetScan and miRanda showed that miR-199a could target the 3′-untranslated region(3′-UTR) that binds HIF-1α. Dual luciferase reported results: Inhibition of miR-199a resulted in a significant increase in luciferase activity ( P<0.01), but there was no significant change in luciferase activity after 3 ′-UTR mutation of HIF-1α ( P>0.05). After transfection with si-HIF-1α, the mRNA and protein expression levels of HIF-1α, FN and α-SMA in si-HIF-1α group were significantly lower than those in NC group (all P<0.05). After transfection with miR-199ai, the mRNA and protein expression levels of HIF-1α, FN and α-SMA in miR-199ai group were significantly higher than those in NC group (all P<0.05). However, when co-transfected with si-HIF-1α and miR-199ai, the expression levels of mRNA and protein in miR-199AI group were significantly higher than those in NC group (all P<0.05). The mRNA and protein expression changes of HIF-1α, FN and α-SMA induced by transfection of si-HIF-1α or miR-199ai alone can be recovered. Conclusions:miR-199a can alleviate hyperglycemia-induced EMT in human renal tubular epithelial cells through targeted regulation of HIF-1α.

To promote the development of extracellular vesicles of herbal medicine especially the establishment of standardization, led by the National Expert Committee on Research and Application of Chinese Herbal Vesicles, research experts in the field of herbal medicine and extracellular vesicles were invited nationwide with the support of the Expert Committee on Research and Application of Chinese Herbal Vesicles, Professional Committee on Extracellular Vesicle Research and Application, Chinese Society of Research Hospitals and the Guangdong Engineering Research Center of Chinese Herbal Vesicles. Based on the collation of relevant literature, we have adopted the Delphi method, the consensus meeting method combined with the nominal group method to form a discussion draft of "Consensus statement on research and application of Chinese herbal medicine derived extracellular vesicles-like particles (2023)". The first draft was discussed in online and offline meetings on October 12, 14, November 2, 2022 and April and May 2023 on the current status of research, nomenclature, isolation methods, quality standards and research applications of extracellular vesicles of Chinese herbal medicines, and 13 consensus opinions were finally formed. At the Third Academic Conference on Research and Application of Chinese Herbal Vesicles, held on May 26, 2023, Kewei Zhao, convenor of the consensus, presented and read the consensus to the experts of the Expert Committee on Research and Application of Chinese Herbal Vesicles. The consensus highlights the characteristics and advantages of Chinese medicine, inherits the essence, and keeps the righteousness and innovation, aiming to provide a reference for colleagues engaged in research and application of Chinese herbal vesicles at home and abroad, decode the mystery behind Chinese herbal vesicles together, establish a safe, effective and controllable accurate Chinese herbal vesicle prevention and treatment system, and build a bridge for Chinese medicine to the world.

Cervical Bronchogenic cysts (BC) is a rare congenital abnormality caused by abnormal budding of the embryonic foregut diverticulum. Mediastinal and intrapulmonary types are the most common sites of occurrence, and thyroid BC is rare. This article aims to report a case of resection of thyroid BC with video-assistance technology to improve the understanding of the imaging, pathology and clinical aspects of this disease.

Objective To develop and validate a deep learning model for automatic identification of liver CT contrast-enhanced phases.Methods A total of 766 patients with liver CT contrast-enhanced images were retrospectively collected.A three-phase classification model and an arterial phase(AP)classification model were developed,so as to automatically identify liver CT contrast-enhanced phases as early arterial phase(EAP)or late arterial phase(LAP),portal venous phase(PVP),and equilibrium phase(EP).In addition,221 patients with liver CT contrast-enhanced images in 5 different hospitals were used for external validation.The annotation results of radiologists were used as a reference standard to evaluate the model performances.Results In the external validation datasets,the accuracy in identifying each enhanced phase reached to 90.50%-99.70%.Conclusion The automatic identification model of liver CT contrast-enhanced phases based on residual network may provide an efficient,objective,and unified image quality control tool.

Primary hyperthyroidism and thyroid cancer are usually considered as independent diseases,but recent studies suggest that these two diseases may share common pathogenic mechanisms.This article aims to emphasize the standardized diagnosis and treatment of primary hyperthyroidism patients with concomitant thyroid cancer.By comprehensively analyzing related domestic and foreign research,it provides useful reference and guidance for clinicians when dealing with patients with hyperthyroidism and concurrent thyroid cancer,to improve the level of diagnosis and treatment.

Parathyroid glands play an important role in calcium and phosphorus metabolism in human beings.The complete preservation of parathyroid glands during neck surgery is crucial in avoiding postoperative hypoparathyroidism and hypocalcemia.At present,most thyroid operations still rely on traditional visual identification or intraoperative freezing to identify parathyroid glands.The former depends on the experience of the surgeon,while the latter needs longer time and costs much.Recently,researchers have conducted relevant studies on intraoperative staining techniques and fluorescent-based imaging techniques that are helpful for the identification of parathyroid glands,such as methylene blue,carbon nanoparticles suspension,near-infrared autofluorescence,indocyanine green angiography,and laser speckle contrast imaging.The above-mentioned techniques all have significantly improved the identification and protection of parathyroid glands.This article reviews the progress in clinical research on intraoperative identification of parathyroid glands.

Papillary thyroid microcarcinoma(PTMC),which lacks lymph node metastasis,distant metastasis,extra-thyroid invasion,high-risk subtypes,and invasion of the trachea or recurrent laryngeal nerve,may be classified as low-risk PTMC based on clinical assessment.Surgical intervention such as lobectomy or total thyroidectomy is the primary treatment modality for PTMC.This study comprised 124 patients who underwent conformal thyroidectomy and revealed that this innovative surgical approach yielded long-term oncological outcomes comparable to those who received lobectomy or total thyroidectomy.The surgical intervention may play a significant role in the comprehensive management of PTMC,while the implementation of PTMC precision medicine necessitates the utilization of genetic testing,molecular typing,and other advanced technologies to detect early-stage high-risk factors like lymph node microinvasion and integrate biology-based surgery concept for optimal outcomes.

Background:Identifying missed diagnoses of polyps is significant in reducing the incidence of colorectal cancer.Until now,the role of repeat colonoscopy during colorectal polypectomy in reducing themissed diagnoses of polyps is sparsely studied.Aims:To analyze the value of repeat colonoscopy during colorectal polypectomy in reducing themissed diagnoses of polyps.Methods:One hundred and forty-six patients in the first affiliated hospital of Ningbo University who underwent polypectomy were consecutively recruited for repeat colonoscopy from January 2020 to January 2021.The number,size,and location of missed polyps were recorded and analyzed during colorectal polypectomy.Univariate logistic regression analysis was used to analyze the independent risk factors of missed polyps.Results:There were 86 males and 60 females among the 146 enrolled patients,which aged(55.54±10.51)years.The overall missed polyps'rate was 27.17%.We found that all missed polyps were sessile polyps and<10 mm in size,the difference was significant in the left colon.Univariate logistic regression analysis showed that the endoscopist' experience was an independent risk factor for missed polyps.Conclusions:Endoscopist'experience was an independent risk factor for missed polyps.Repeat colonoscopy could reduce the missed polyps.

ObjectiveTo assess the curative effects of Fangji Huangqi detumescence prescription （FHDP） on synovitis and polarization of synovial macrophages of knee osteoarthritis （KOA） model in rats induced by Hulth method. MethodThirty-six rats were randomly divided into sham operation group， model group， high-dose， medium-dose， and low-dose （29.16， 14.58， and 7.29 g·kg^-1） FHDP groups， and loxoprofen sodium （16.2 mg·kg^-1） group. KOA model in rats was induced by modified Hulth method. Six weeks after the operation， rats were given high， medium， and low concentrations of FHDP， normal saline （NS）， and loxoprofen sodium according to the group to intervene， and sacrificed after 2-week administration. Synovium and cartilage histopathological changes were observed after hematoxylin-eosin （HE） staining. Flow cytometry （FCM） and immunofluorescence （IF） test were used to evaluate the polarization of M1/M2 macrophages. Immunohistochemistry （IMC） and enzyme-linked immunosorbent assay （ELISA） were used to detect the related protein expression levels of macrophage polarization， such as interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， interleukin-10 （IL-10）， and matrix metalloproteinase-13 （MMP-13） in joint tissues and serum. ResultCompared with the sham operation group， Krenn and Mankin scores in the model group were significantly increased （P<0.01）. Compared with the model group， Krenn score was decreased in all administration groups （P<0.05， P<0.01）， but there was no significant difference in Mankin score in any administration groups. Compared with the sham operation group， M1/mø （CD38⁺） ratio in the model group was significantly increased （P<0.01）， and M2/mø （CD206⁺） ratio in the model group was decreased （P<0.05）. Compared with the model group， M1/mø ratio in the high， medium， and low-dose FHDP groups was decreased （P<0.05， P<0.01）， but M2/mø ratio was increased in all administration groups （the difference had no statistical significance）. Compared with the sham operation group， M1/M2 ratio in the model group was significantly increased （P<0.01）. Compared with the model group， M1/M2 ratio in all FHDP groups was significantly decreased （P<0.01）， and M1/M2 ratio in the high and medium-dose FHDP groups was lower than that in the loxoprofen sodium group （P<0.05）. Compared with the sham operation group， the levels of TNF-α， IL-1β， and MMP-13 in synovium and cartilage of the model group were significantly increased （P<0.01）， the level of IL-10 was significantly decreased （P<0.01）. Compared with the model group， the levels of TNF-α and IL-1β in synovium were decreased in all administration groups （P<0.05）， but the difference of the levels of MMP-13 and IL-10 in synovium had no statistical significance. The level of inflammatory mediators in cartilage was not affected in all administration groups. Compared with the sham operation group， the levels of TNF-α and IL-β in serum of the model group were significantly increased （P<0.01）， the level of IL-10 was decreased （P<0.05）. Compared with the model group， the level of TNF-α in the high-dose FHDP group was decreased （P<0.05）， and the level of IL-10 was increased in all administration groups （P<0.05， P<0.01）. The difference of the level of IL-β in all administration groups had no statistical significance. ConclusionFHDP attenuated the synovitis of KOA rats. FHDP exert the effect on the releasing of proinflammatory cytokines and MMP by inhibiting the polarization of M1 macrophages in synovium， and had no significant effect on the polarization of M2 macrophages. Modulating the imbalanced polarization of synovial macrophages was a possible mechanism of FHDP on attenuating synovitis and treating KOA.