ObjectiveTo explore the influencing factors of tumor regression patterns after neoadjuvant chemotherapy （NACT） in breast cancer， construct and validate a predictive model for tumor regression patterns. MethodsA total of 1 314 breast cancer patients who received NACT between March 1， 2019， and March 1， 2024， were selected as study subjects and randomly divided into a validation cohort （n=301） and a study cohort （n=603）. Within the study cohort， patients were further stratified based on post-NACT tumor regression patterns into a concentric regression group（case group）（n=387） and a non-concentric regression group（control group）（n=216）. General clinicopathological data were collected and compared between the two groups. Unconditional logistic regression was used to analyze the influencing factors of tumor regression patterns post-NACT and establish a predictive model. The Hosmer-Lemeshow test and receiver operating characteristic （ROC） curve were employed to evaluate the model's goodness-of-fit and predictive performance， followed by external validation. ResultsAmong all subjects in the study cohort， 174 patients （28.9%） achieved pathological complete response （pCR）， 213 （35.3%） showed unifocal regression， 92 （15.3%） had multifocal regression， 78 （12.9%） presented main residual lesions with satellite lesions， 43 （7.1%） had stable disease， and 3 （0.5%） experienced disease progression. Significant differences were observed between the two groups in age， estrogen receptor（ER）， progesterone receptor（PR）， Ki-67， human epidermal growth factor receptor 2（HER2）， histological grade， prognostic nutritional index（PNI）， and chemotherapy regimen （all P ＜ 0.05）. Logistic regression analysis revealed that age （OR=0.563， 95% CI： 0.358–0.885）， ER （OR=0.521， 95% CI： 0.350–0.773）， PR（OR=0.552， 95% CI： 0.379–0.806）， HER2（OR=3.729， 95% CI： 2.488–5.590）， Ki-67 （OR=1.804， 95% CI： 1.071–3.039）， PNI （OR=2.285， 95% CI： 1.307–3.997） and histological grade （Ⅲ） （OR=2.194 95% CI： 1.283–3.751） were independent influencing factors for concentric regression post-NACT （all P ＜ 0.05）. The Hosmer-Lemeshow test for the logistic regression model yielded a P-value of 0.927， and the area under the ROC curve was 0.731 （95%CI： 0.690-0.772， P ＜ 0.001）. External validation demonstrated that the area under the ROC curve of this prediction model was 0.764 （95% CI： 0.709–0.820， P＜0.001）， with a sensitivity of 75.0% and a specificity of 65.7%. The Youden's index was 0.407. ConclusionThis logistic regression model exhibits high predictive value and provides a reference for clinicians to predict tumor regression patterns in breast cancer patients after NACT.

Twelve derivatives of asiatic acid were synthesized through acylation, alkylation, oxidative dehydrogenation and other reactions using asiatic acid from usoxane-type pentacyclic triterpenoids as the parent compound. Their structures were confirmed by 1H NMR and 13C NMR, and determined to be novel compounds never reported in literature. Through the MTT method, high-expression human cancer cells (A549 and SGC-7901) were selected for a preliminary in vitro anti-tumor activity study on these compounds. Among them, the IC50 of compound I1 were 11.39 and 9.08 μmol/L respectively, and those of compound I2 were 12.64 and 9.15 μmol/L respectively, which were close to those of sorafenib, a common drug for clinical use. The experimental results show that the synthesized asiatic acid derivatives have certain anti-proliferative effects on the two types of human cancer cells, A549 and SGC-7901, significantly higher than those of asiatic acid. Compounds I1 and I2 show quite strong anti-proliferative effects on human cancer cells A549 and SGC-7901.

Objective To determine whether an intelligerct cloud platform follow-up model demonstrates superiority over conventional methods in enhancing follow-up quality,reducing costs,and improving functional recovery following total knee arthroplasty(TKA).Methods A retrospective cohort study was conducted on 260 patients undergoing TKA at our hospital from October 2022 to September 2023.According to the different postoperative follow-up methods,they were divided int a cloud platform group(n=130)and a traditional group(n=130).The baseline data,pre-and postoperative knee function scores,and follow-up costs were collected and compared between the 2 groups.Results The cloud platform group exhibited significantly higher rate of follow-up satisfaction,reduced resource utilization,shorter per-follow-up duration,fewer accompanying persons per visit,lower total follow-up expenditures,and decreased cumulative follow-up time when compared with the traditional group(P<0.05).At 6 weeks,3,6,and 12 months postoperatively,better range of motion(ROM)was observed in the cloud-based group than the traditional group(P<0.05),but no intergroup differences were seen in other knee function scores.Conclusion Cloud platform follow-up enhances early postoperative ROM(6 weeks to 12 months)and demonstrates marked cost-effectiveness when compared to the conventional mode.It represents a viable alternative for post-TKA rehabilitation surveillance.

BACKGROUND: Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear. This study aimed to investigate associations of individual and combined lifestyle factors (LFs) with the incidence risk and long-term prognosis of pneumonia hospitalization. METHODS: Using data from the China Kadoorie Biobank study, we used the multistate models to investigate the role of five high-risk LFs, including smoking, excessive alcohol drinking, unhealthy dietary habits, physical inactivity, and unhealthy body shape, alone or in combination in the transitions from a generally healthy state at baseline to pneumonia hospitalization or cardiovascular disease (CVD, regarded as a reference outcome), and subsequently to mortality. RESULTS: Most of the five high-risk LFs were associated with increased risks of transitions from baseline to pneumonia and from pneumonia to death, but with different risk estimates. The greater the number of high-risk LFs, the higher the risk of developing pneumonia and long-term mortality risk after pneumonia, with the strength of associations comparable to that of LFs and CVD. Compared to participants with 0-1 high-risk LF, the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for transitions from baseline to pneumonia and from pneumonia to death in those with five high-risk LFs were 1.43 (1.28-1.60) and 1.98 (1.61-2.42), respectively. Correspondingly, the respective HRs (95% CIs) for transitions from baseline to CVD and from CVD to death were 2.00 (1.89-2.11) and 1.44 (1.30-1.59), respectively. The risk estimates changed slightly when further adjusting for the presence of major chronic diseases. CONCLUSION In this Chinese population, unhealthy LFs were associated with an increased incidence and long-term mortality risk of pneumonia.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Cardiovascular Diseases/etiology* ; China/epidemiology* ; Life Style ; Pneumonia/etiology* ; Prognosis ; Risk Factors ; Smoking

To investigate the characteristics and differences of immune cell infiltration between different SDHx gene expression and pheochromocytoma/paraganglioma(PPGL).

Objective:To investigate the efficacy and safety of percutaneous trans-hepatic choledochoscopic lithotripsy (PTCSL) in the treatment of recurrent hepatobiliary calculi under enhanced recovery after surgery (ERAS) mode.Methods:Clinical data of 88 patients with recurrent hepatobiliary calculi, who were treated with PTCSL at Zhengzhou Central Hospital Affiliated to Zhengzhou University and the First Affiliated Hospital of Xi'an Jiaotong University between June 2022 and June 2024 were retrospectively analyzed, including 34 males and 54 females, aged (52.0±13.8) years. The scheme includes preoperative education, prophylactic antibiotic application, ensuring the quality of surgery, early postoperative feeding and activity, etc. The operation can be divided into two fashions: percutaneous transhepatic cholangial drainage and PTCSL, which can be completed in one stage (one-stage expansion method) or in two stages (staged expansion method). Clinical data such as gender, age, operative time, intraoperative blood loss, residual stone, and surgical complications were recorded.Results:All 88 patients underwent PTCSL under ERAS mode successfully, including 52 cases using one-stage expansion method and 36 cases using staged expansion method. The operative time was (53±20) min, the intraoperative blood loss was (9.7±3.8) ml, the postoperative hospital stay was (3.6±1.7) d, and the hospitalization cost was (17 500±4 700) yuan. Sixty-nine patients (78.4%, 69/88) had one-time stone removal in the first PTCSL. A total of 19 cases of residual stones were managed again by percutaneous sinus soft choledochoscopy, of which 12 cases were managed by one-time choledochoscopy, five cases by two-time choledochoscopy, and two cases by three-time choledochoscopy. The rate of residual stone was significantly higher in one-stage expansion method compared to staged expansion method [28.8% (15/52) vs. 11.1% (4/36), P=0.040]. No death, conversion to open surgery, or severe complications such as intra-abdominal hemorrhage or bile leakage occurred in the patients. No residual stones or recurrence were found during the follow-ups of (7.5±2.1) months after discharge. Conclusion:PTCSL under ERAS mode is safe and effective in the treatment of recurrent hepatobiliary calculi.

Objective:To retrieve, summarize and evaluate the best evidence for the non-pharmacological management of patients with cancer pain, so as to provide an evidence-based basis for the scientific management of cancer pain by healthcare professionals.Methods:A systematic search of the national and international literature on the non-pharmacological management of cancer pain was conducted, with a timeframe of January 2017 to January 2024. The quality of the included literature was evaluated, and evidence was extracted and summarized for those that met the quality criteria.Results:A total of 18 papers were included, including one clinical decision, seven guidelines, three expert consensus, and seven systematic reviews. Twenty-eight pieces of evidence were summarized around six themes of pain assessment, cognitive-behavioral interventions, physical therapy, interventional therapy and surgery, and self-management education and follow-up.Conclusions:Healthcare professionals should develop a patient-centered, appropriate and feasible non-pharmacological management plan for cancer pain with multiple agreements with patients and families, taking into account the clinical context and individual differences of patients in China, in order to improve the quality of life.

Objective:Committee of Minimally Invasive Cardiovascular Surgery(CMICS) conducts an annual summary of minimally invasive cardiovascular surgery procedures performed throughout the country, which includes a comprehensive survey of the total number of minimally invasive procedures by region and the distribution of minimally invasive procedures by hospital. Since CMICS first published the 2018-2019 China Minimally Invasive Cardiovascular Surgery Data White Paper in 2020, the report has received great attention from peers within and outside the industry. In this statistical report, CMICS will focus on publishing the data related to minimally invasive cardiovascular surgery in China from 2021 to 2023 for reference and use by industry peers.

Objective:To analyze the efficacy of distal tibial osteotomy and bone transport in the treatment of infected bone defects at the proximal tibia.Methods:A retrospective study was conducted to analyze the clinical data of 25 patients with infected bone defects at the proximal tibia who had been treated by distal osteotomy and bone transport at Department of Microprosthetic Surgery, The First Hospital Affiliated to Xinjiang Medical University from May 2015 to June 2023. There were 20 males and 5 females with an age of (45.9±7.1) years. The length of bone defects was (7.5±3.9) cm, the number of operations 3 (2, 4) times, the distance from bone defects to the tibial plateau (4.1±1.9) cm, and the length of bone defects (7.5±3.9) cm. Six patients finished debridement and osteotomy in one operation. Staged surgery was conducted in 19 patients. At first, the original fixator was removed, followed by debridement and injection of the antibiotic bone cement. Next, the bone cement was removed to clean the lesion completely, and then the medullary cavity was penetrated by an electric drill to install an external fixator after flushing. Bone transport started 7 to 10 days later, at a speed of 1 mm/d, and was carried out in 4 times. The healing index, external fixation time, and external fixation index were recorded. The visual analog scale (VAS) for pain, knee range of motion (ROM), and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were compared between preoperation, 1-month postoperation, and the last follow-up. Fracture healing was evaluated using the Paley criteria, and complications were documented.Results:In this cohort, the healing index was (68.9±35.6) points, the external fixation time 13.0 (8.5, 21.8) months, and the external fixation index (2.43±1.24) points. All patients were followed up for 13.0 (8.5, 21.7) months. The VAS score, knee ROM, and AOFAS ankle-hindfoot score at the last follow-up were significantly improved compared with preoperation and 1-month postoperation ( P<0.05). According to the Paley criteria, fracture healing was excellent in 14, good in 9 and poor in 2 cases, giving an excellent and good rate of 92.0%. The incidences of ankle and knee movement limitations were 92.0% (23/25) and 76.0% (19/25), respectively, being the highest. The incidences of foot drop, clubfoot and claw toe were 68.0% (17/25), 24.0% (6/25) and 20.0% (5/25), respectively. The incidences of pin tract infection and nonunion at the junction were 56.0% (14/25) and 60.0% (15/25), respectively. All these complications were improved by dressing change or surgery. Conclusions:Distal tibial osteotomy and bone transport can effectively treat infected bone defects at the proximal tibia, and the complications during the treatment need to be treated accordingly.

Objective:To retrieve, summarize and evaluate the best evidence for the non-pharmacological management of patients with cancer pain, so as to provide an evidence-based basis for the scientific management of cancer pain by healthcare professionals.Methods:A systematic search of the national and international literature on the non-pharmacological management of cancer pain was conducted, with a timeframe of January 2017 to January 2024. The quality of the included literature was evaluated, and evidence was extracted and summarized for those that met the quality criteria.Results:A total of 18 papers were included, including one clinical decision, seven guidelines, three expert consensus, and seven systematic reviews. Twenty-eight pieces of evidence were summarized around six themes of pain assessment, cognitive-behavioral interventions, physical therapy, interventional therapy and surgery, and self-management education and follow-up.Conclusions:Healthcare professionals should develop a patient-centered, appropriate and feasible non-pharmacological management plan for cancer pain with multiple agreements with patients and families, taking into account the clinical context and individual differences of patients in China, in order to improve the quality of life.