The benefit of postoperative adjuvant therapy for patients with resectable esophageal squamous cell carcinoma (ESCC) is not yet supported by high-level evidence. This review analyzes the role of adjuvant therapy by examining the discrepancy between clinical needs and guidelines, its historical evolution, recent advances in high-risk factors, and future outlooks. We provide a detailed discussion of high-risk factors used for patient selection, including lymph node positivity, and for node-negative patients, features such as tumor length, location, T stage, extent of lymph node dissection, differentiation, vascular and neural invasion, laboratory indices, and molecular markers. The goal is to inform the development of individualized precision treatment strategies for resectable ESCC.

Epilepsy is a chronic neurological disorder caused by an imbalance between excitation and inhibition in the central nervous system.Recently,the role of the orexin system in the pathogenesis of epilepsy has garnered significant attention.Orex-in primarily regulates arousal states and enhances neuronal excit-ability through activation of OX1-R/OX2-R receptors.Studies have shown that elevated orexin levels lower the seizure thresh-old,while orexin receptor antagonists(ORAs)exhibit potential antiepileptic effects.ORAs suppress epileptiform discharges by reducing glutamate release,enhancing GABAergic inhibitory effects,and modulating the thalamocortical circuit.Animal ex-periments and preliminary clinical studies demonstrate that OX1R antagonists decrease excitatory synaptic transmission,whereas OX2 R antagonists primarily strengthen GABA-mediated inhibition.With the widespread application of ORAs in sleep disorders,exploring their clinical value as antiepileptic drugs will become a key focus for future research.This review summa-rizes the role of the orexin system in epileptogenesis and discus-ses the research progress and future directions of ORAs as poten-tial antiepileptic agents.

Objective:To investigate postoperative analgesic effects of transversus abdominis plane block (TAPB) versus local infiltration analgesia (LIA) after laparotomy for cytoreductive surgery in patients with ovarian cancer. Methods:This study used a randomized controlled design. Ninety patients with ovarian cancer who underwent laparotomy for cytoreductive surgery at Jilin Cancer Hospital from June 2022 to June 2023 were prospectively included. The patients were randomly assigned to either the TAPB group or the LIA group ( n = 45 per group) using the random number table method. The TAPB group received TAPB postoperatively, while the LIA group received LIA. Postoperative pain in both groups was assessed, and the number of presses on the patient-controlled intravenous analgesia device, as well as the incidence of postoperative adverse reactions, were recorded. Results:At 6, 12, and 24 hours after surgery, the Visual Analog Scale (VAS) scores in the TAPB group were significantly lower than those in the LIA group [(2.91 ± 0.64) vs. (3.35 ± 0.82), t = -2.84, P = 0.006; (3.42 ± 0.96) vs. (4.27 ± 1.14), t = -3.83, P<0.001; (2.28 ± 0.51) vs. (2.86 ± 0.83), t = -3.99, P<0.001]. The number of presses on the patient-controlled intravenous analgesia device and the number of rescue treatments in the TAPB group were significantly lower than those in the LIA group [(10.24 ± 2.52) counts vs. (16.79 ± 4.38) counts, t = -8.70, P<0.001; (1.82 ± 0.46) counts vs. (2.68 ± 0.84) counts, t = -6.02, P<0.001]. There was no significant difference in incidence of postoperative adverse reactions including nausea, vomiting, and chills between the two groups [4.44% (2/45) vs. 6.67% (3/45), P>0.05]. Conclusions:In patients with ovarian cancer undergoing laparotomy for cytoreductive surgery, postoperative analgesia using TAPB demonstrates greater efficacy compared with LIA. TAPB more effectively alleviates postoperative pain and reduces the number of presses on the patient-controlled intravenous analgesia device, while also offering higher safety than LIA.

Objective·To detect the expression level of Fas-associated protein with death domain(FADD)in head and neck squamous cell carcinoma(HNSCC)and to explore the molecular mechanisms by which FADD promotes the proliferation of HNSCC cells.Methods·The GEPIA 2 database was utilized to analyze the expression level of FADD in tumor tissues and to evaluate its association with prognosis.Immunohistochemistry staining(IHC)was performed on HNSCC tissues to investigate the changes in FADD expression levels in normal,dysplastic,and tumor tissues.Stable FADD-knockdown Fadu and HSC3 cell lines were constructed and validated using Western blotting and quantitative real-time PCR(qRT-PCR).The regulatory effect of FADD on the proliferation of HNSCC cells was explored using the LiveCyte live-cell tracking system,colony formation assay,and cell viability assay.Proteins interacting with FADD were identified by co-immunoprecipitation mass spectrometry(Co-IP/MS),and further mechanistic studies were conducted using CRISPR/Cas9 technology,LiveCyte live-cell tracking system,and Western blotting.Results·Analysis of the GEPIA2 database indicated that FADD was significantly overexpressed in head and neck cancer and was associated with poor prognosis.IHC staining showed that FADD expression levels progressively increased from normal to dysplastic to tumor tissues in HNSCC patients.Knockdown of FADD in HNSCC cells resulted in significantly reduced proliferation and colony formation compared to the control group.Co-IP/MS results showed that FADD interacted with the CUX1 protein,and FADD knockdown led to increased CUX1 expression.Moreover,CUX1 knockdown significantly promoted HNSCC cell proliferation and reversed the anti-proliferative phenotype caused by FADD knockdown.Conclusion·FADD plays a significant pro-carcinogenic role in HNSCC and is associated with poor prognosis.FADD can further regulate tumor cell proliferation by interacting with CUX1 and suppressing its expression level.

This study aims to innovate a homogeneous outpatient service management system across multiple hospital campuses to enhance service quality.Based on the practical experience of a tertiary general hospital in Guangdong Province and in accordance with the"Interim Regulations on Outpatient Quality Management in Healthcare Institutions,"we constructed a"6+1"homogeneous outpatient service management system.This system includes:① a multi-stakeholder co-governance outpa-tient management system,②a vertical and cross-hierarchical management network,③ a democratic-centralized clinical coordina-tion strategy,④ a guidance-encouragement performance evaluation standard,⑤a collaborative dynamic supervision mechanism,⑥a spiral retrospective evaluation and improvement method,and ⑦ an integrated outpatient diagnosis and treatment system.Af-ter over two years of implementation,the hospital's outpatient volume has grown by an average of over 15％annually,patient waiting time after appointment has been reduced to 20 minutes,and patient satisfaction in the tertiary public hospital performance evaluation achieved full marks.The electronic medical record system functionality reached Level 6,significantly improving healthcare service efficiency and quality while enhancing homogeneous management across campuses.

Objective:To investigate the changes of relevant subcortical regions in patients with dysphagia after stroke by diffusion tensor imaging.Methods:This study prospectively selected six patients with dysphagia early after stroke who were admitted to The Second Hospital of Jiaxing from January 2020 to March 2021 (stroke group). During the same period, 15 healthy volunteers were selected as a control group (volunteer group). Both groups underwent diffusion tensor imaging scans. The mean diffusivity, axial diffusivity, fractional anisotropy, and radial diffusivity were compared between the stroke group and the volunteer group, as well as between the affected and unaffected sides within the stroke group.Results:The mean diffusivity did not pass calibration, and no results were obtained. Axial diffusivity differed significantly between the two groups in fiber bundles located in the middle cerebellar peduncle, the transverse pontine tract, the splenium of the corpus callosum, the right corticospinal tract, the left superior cerebellar peduncle, the right cerebral peduncle, the right external capsule, and the right cingulate gyrus [(1.38 ± 0.06) ×10 -3 mm 2/s vs. (1.50 ± 0.05) × 10 -3 mm 2/s, (1.17 ± 0.05) × 10 -3 mm 2/s vs. (1.08 ± 0.04) × 10 -3 mm 2/s, (1.84 ± 0.04) × 10 -3 mm 2/s vs. (1.90 ± 0.06) ×10 -3 mm 2/s, (1.28 ± 0.04) × 10 -3 mm 2/s vs. (1.41 ± 0.03) ×10 -3 mm 2/s, (2.16 ± 0.06) × 10 -3 mm 2/s vs. (2.30 ± 0.07) × 10 -3 mm 2/s, (1.59 ± 0.04) × 10 -3 mm 2/s vs. (1.78 ± 0.05) × 10 -3 mm 2/s, (1.39 ± 0.05) × 10 -3 mm 2/s vs. (1.13 ± 0.04) × 10 -3 mm 2/s, (1.27 ± 0.04) × 10 -3 mm 2/s vs. (1.20 ± 0.03) × 10 -3 mm 2/s, t = 4.70, 4.34, 2.24, 8.17, 4.29, 8.26, 12.55, 4.40, all P < 0.05)]. Furthermore, significant differences in fractional anisotropy were observed in fiber bundles located in the knee of the corpus callosum, the right and left corticospinal tracts, the right superior cerebellar peduncle, the right and left cerebral peduncles, the left anterior limb of the internal capsule, the right and left posterior limbs of the internal capsule, the posterior portion of the right internal capsule around the lentiform nucleus, the right and left anterior corona radiata, the right and left superior corona radiata, the right and left posterior corona radiata, the right external capsule, and the left uncinate fasciculus ( t = 3.86, 7.54, 3.62, 3.77, 7.72, 3.77, 3.77, 10.86, 6.26, 5.17, 5.03, 3.77, 8.79, 5.03, 5.52, 3.62, 6.91, 4.14, all P < 0.05). Additionally, radial diffusivity differed significantly between the two groups in fiber bundles located in the middle cerebellar peduncle, the left medial lemniscus, the right and left anterior limbs of the internal capsule, the right and left posterior limbs of the internal capsule, the posterior part of the right internal capsule surrounding the lentiform nucleus, the right superior corona radiata, the left sagittal stratum, the right external capsule, and the left external capsule ( t = 4.34, 3.14, 15.71, 7.54, 19.49, 6.91, 12.07, 11.31, 8.69, 17.87, 10.68, all P < 0.05). Conclusions:White matter integrity in subcortical structures is extensively impaired in patients with dysphagia following a stroke.

Objective To evaluate the efficacy and safety of a novel intravascular lithotripsy(IVL)balloon—Vesscrack shockwave balloon—for vascular preparation before stent implantation in patients with severe coronary artery calcification(CAC).Methods This was a prospective,single-arm,multicenter study conducted in China from June 2022 to October 2022.Patients with severe CAC were treated with the Vesscrack shockwave balloon for lesion preparation,followed by drug-eluting stent(DES)implantation.Of these,33 patients underwent optical coherence tomography(OCT).The primary endpoint was procedural success,defined as successful stent implantation with residual stenosis≤30％and the absence of in-hospital major adverse events,including cardiac death,target vessel-related myocardial infarction,or target lesion revascularization.Results A total of 170 patients[mean age:(65.9±7.9)years,116 males]were enrolled.After treatment with IVL and DES,the minimum lumen diameter increased significantly compared to baseline[(2.34±0.40)mm vs.(0.95±0.33)mm,P＜0.001],the degree of stenosis was significantly reduced[(13.24±6.60)％vs.(65.18±10.59)％,P＜0.001].Procedural success was achieved in 100％of cases,and device success was 98.8％.The 30-day patient-related cardiovascular clinical composite endpoint(POCE)rate was 0.0,with no target lesion failure,no confirmed or potential thrombotic events were observed.The shockwave energy generator demonstrated excellent stability and ease of use.Among the 33 patients assessed with OCT,after IVL intervention,the maximum calcified area of the lumen[(3.51±1.51)mm2 vs.(2.85±1.80)mm2,P＜0.001],and the minimum lumen area within the target lesion[(3.08±1.04)mm2 vs.(2.02±0.75)mm2,P＜0.001],and after DES intervention,the luminal area of the largest calcified site[(6.59±1.64)mm2 vs.(2.85±1.80)mm2,P＜0.001]and the minimum luminal area within the target lesion[(6.19±1.45)mm2 vs.(2.02±0.75)mm2,P＜0.001]were significantly increased,and the differences were statistically significant.Conclusions The Vesscrack shockwave balloon is effective and safe for vascular preparation in patients with severe CAC prior to stent implantation.It achieves significant calcified plaque modification,high procedural success rates,and minimal complications.

OBJECTIVE To explore the distribution of pathogens isolated from the thoracoscopic lobectomy patients with postoperative pulmonary infections and observe the expressions of maternal expression gene 3(MEG3)/microribonucleic acid-223(miR-223)/nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)axis in peripheral blood.METHODS Totally 48 lung cancer patients who underwent thoracoscopic lobec-tomy and had postoperative pulmonary infections in the First Affiliated Hospital of Guangzhou University of Chi-nese Medicine from Jun.2021 to Jun.2024 were assigned as the infection group,meanwhile,31 lung cancer pa-tients who underwent thoracoscopic lobectomy but did not have postoperative infections were chosen as the no in-fection group.The sputum specimens were collected from the infection group,the distribution of isolated patho-gens was analyzed.The clinical data and the expression MEG3,miR-223 and NLRP3 were observed and compared between the two groups.The values of MEG3,miR-223 and NLRP3 in prediction of the postoperative infections were analyzed by receiver operating characteristic(ROC)curves.RESULTS Totally 63 strains of pathogens were i-solated from the 48 thoracoscopic lobectomy patients with postoperative pulmonary infections,33(52.38％)of which were gram-negative bacteria,25(39.68％)were gram-positive bacteria,and 5(7.94％)were fungi.There were significant differences in age,diabetes mellitus,chronic obstructive pulmonary disease(COPD),operation duration,and expression levels of MEG3,miR-223 and NLRP3 between the infection group and the no infection group(P＜0.05).ROC curve analysis showed that the areas under the curves of MEG3,miR-223 and NLRP3 and the joint detection of the three indexes were 0.861,0.760,0.912 and 0.968,respectively,in prediction of the post-operative pulmonary infections,and the predictive efficiency of the joint detection was highest(P＜0.05).CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated from the thoracoscopic lo-bectomy patients with postoperative pulmonary infections,the occurrence and progression of the infections may be closely associated with the activation of MEG3/miR-223/NLRP3 axis.The joint detection of the three indexes can effectively predict the postoperative pulmonary infections in the thoracoscopic lobectomy patients.

Objective To investigate the effects of blade outlet angle,impeller channel slope and impeller draft angle on hemolytic performance and hydraulic performance in a magnetically levitated centrifugal blood pump using computational fluid dynamics,aiming to optimize these parameters for improving blood compatibility.Methods Numerical simulations of a magnetically levitated centrifugal blood pump were performed using Fluent to calculate the shear stress and head on blood cells during blood pump flow and to predict the hemolytic performance of the centrifugal blood pump.Results With the increase of the blade outlet angle to 60°,the percentage of the low shear stress from 0 to 150 Pa increased to 98.9%,and the percentage of the shear stress from 150 to 300 Pa decreased to 0.6%.The maximum reduction of hemolysis index of the blood pump was 28.89%with different combinations of the impeller channel slope and the impeller draft angle.Conclusion The increase of the blade outlet angle will effectively improve the shear stress distribution in the pump,thus reducing the hemolysis index.Comparing the positive effects of impeller draft angle and channel slope on the blood pump,the optimization of the channel slope can be prioritized.