Objective To compare the midterm outcomes of the Bentall procedure versus isolated aortic valve replacement(AVR)in patients with bicuspid aortic valve(BAV)complicated with severe stenosis and ascending aortic dilation in order to assess the therapeutic value of these surgical approaches for this complex cardiac condition.Methods A retrospective cohort study was conducted on 96 eligible patients who underwent surgical treatment in our institute between January 2018 and December 2022.According to surgical approaches,they were divided into an AVR group(65 cases)and a Bentall group(31 cases).Demographic features,comorbidities,preoperative status,and echocardiographic parameters were collected in all patients.Propensity score matching(PSM)was applied in a 1:1 ratio to balance baseline characteristics.Perioperative indicators and follow-up data were compared and analyzed between matched cohorts after control of cofounding factors.Results After PSM,25 matched pairs were screened out and analyzed with comparable baseline data(all P>0.05).The Bentall group demonstrated significantly more superior intraoperative effective orifice area(EOA,2.69±0.47 vs 2.35±0.47 cm2,P=0.013)and EOA index(EOAI,1.69±0.30 vs 1.47±0.29 cm2/m2,P=0.010),and obviously longer cardiopulmonary bypass time[190.00(147.00,257.00)vs 101.00(88.50,124.50)min,P<0.01]and aortic cross-clamp time[141.00(120.00,166.00)vs 66.00(55.00,81.50)min,P<0.01]when compared with the AVR group.During a median follow-up of 28 months,the AVR group had notably larger aortic sinus diameter[32.00(30.00,34.00)vs 26.80(26.00,28.00)mm,P<0.01]and ascending aortic diameter[38.00(34.50,42.00)mm vs 26.00(26.00,28.00)mm,P<0.01],with ongoing dilation in the ascending aorta,while the Bentall group maintained stable dimensions.The Bentall group also showed statistically lower peak aortic valve pressure gradients[21.00(15.50,27.00)vs 25.00(19.50,31.00)mmHg,P=0.049].Conclusion Both Bentall procedure and AVR are effective in treatment of BAV complicated with severe stenosis and ascending aortic dilation.But,Bentall procedure offers advantages in hemodynamic optimization and aortic stability.

Peritoneal metastasis in gastric cancer is associated with rapid disease progression. Hyperthermic intraoperative peritoneal chemotherapy (HIPEC) done immediately after cytoreductive surgery (CRS) has become an important treatment for peritoneal metastasis in gastric cancer patients. However, different treatment options for HIPEC exist with potential influence on survival rates and prognosis in patients, exist. These treatment options include open or closed abdomen technique, perfusion solution, number of catheters, temperature, duration, and drug regimens. This paper aims to provide more evidence on standardization of HIPEC treatment options and technologies by systematically reviewing different drug regimens and technical approaches. The study included 2 randomized controlled trials, 3 phase I/II clinical trials, 2 prospective cohort studies, and 34 retrospective cohort studies, involving 1511 patients. The most common HIPEC option is to dissolve 50-75 mg/m 2 of Cisplatin and 30-40 mg/m 2 of Mitomycin C in 3-4 L saline solution at 42-43℃. After gastrointestinal anastomosis, 2-3 catheters are used in the HIPEC system with a perfusion flow rate of 500 ml/min. The duration is 60-90 minutes. Anastomotic leakage was low in studies where HIPEC was performed after gastrointestinal anastomosis. The utilization of open HIPEC and a two-drug regimen resulted in improved overall survival rates. The future development of HIPEC aims to enhance tumor-specific therapy by optimizing various aspects, such as identifying the safest and most effective chemotherapy regimens, refining patient selection criteria, and improving perioperative care.

Peritoneal metastasis in gastric cancer is associated with rapid disease progression. Hyperthermic intraoperative peritoneal chemotherapy (HIPEC) done immediately after cytoreductive surgery (CRS) has become an important treatment for peritoneal metastasis in gastric cancer patients. However, different treatment options for HIPEC exist with potential influence on survival rates and prognosis in patients, exist. These treatment options include open or closed abdomen technique, perfusion solution, number of catheters, temperature, duration, and drug regimens. This paper aims to provide more evidence on standardization of HIPEC treatment options and technologies by systematically reviewing different drug regimens and technical approaches. The study included 2 randomized controlled trials, 3 phase I/II clinical trials, 2 prospective cohort studies, and 34 retrospective cohort studies, involving 1511 patients. The most common HIPEC option is to dissolve 50-75 mg/m 2 of Cisplatin and 30-40 mg/m 2 of Mitomycin C in 3-4 L saline solution at 42-43℃. After gastrointestinal anastomosis, 2-3 catheters are used in the HIPEC system with a perfusion flow rate of 500 ml/min. The duration is 60-90 minutes. Anastomotic leakage was low in studies where HIPEC was performed after gastrointestinal anastomosis. The utilization of open HIPEC and a two-drug regimen resulted in improved overall survival rates. The future development of HIPEC aims to enhance tumor-specific therapy by optimizing various aspects, such as identifying the safest and most effective chemotherapy regimens, refining patient selection criteria, and improving perioperative care.

Hearing loss is one of the common radiotherapy-induced complications of head and neck tumors, including nasopharyngeal carcinoma. These side reactions can be classified into acute or delayed types, which affect all structures of the auditory organs, resulting in conductive, sensorineural or mixed hearing loss. Up to 40% of patients develop acute middle ear side effects during radical radiotherapy, while approximately 1/3 develop late sensorineural hearing loss. The total radiation dose and tumor site appear to be the most important factors associated with the risk of hearing loss. The mechanisms of conductive and sensorineural hearing impairment are different. New radiotherapy techniques (three-dimensional conformal radiotherapy, intensity modulated radiotherapy, proton therapy) enable better dose distribution, lower dose to non-target organs, and gradually increase the feasibility of protecting normal tissues. The present article illustrates recent progress in radiotherapy-induced hearing loss, specially focusing on the occurrence, the mechanisms and related factors of ear toxicity, detection and diagnosis, and treatment.

Dysphagia is the main complication of chemoradiotherapy for head and neck cancer. Recently, the advancement of multidisciplinary treatment has achieved a higher tumor control rate, but also a higher incidence of late radiation-induced dysphagia in head and neck cancer. Radiation-induced dysphagia leads to prolonged unnatural feeding, nutritional deficiency, weight loss, and also has a major risk for silent aspiration and aspiration pneumonia, which significantly reduces the quality of life of patients. Besides, late radiation-induced dysphagia is the main reason for limiting the intensity of treatment. Therefore, it is of great significance to deeply understand the pathogenesis of radiation-induced dysphagia and actively explore effective prevention and treatment measures to improve the survival rate and quality of life in head and neck cancer. This paper summarizes the pathogenesis, occurrence, risk factors of radiation-induced dysphagia in head and neck cancer, as well as the progress in the measurement and reporting methods, prevention and treatment strategies.

Cardiotoxicity is traditionally regarded as the late toxic side effect of radiotherapy. Classical radiobiology suggests that non-proliferative and highly-differentiated tissues, such as the heart, should exhibit robust resistance to ionizing radiation. However, in-depth analyses of radiation-induced heart disease (RIHD) have discovered that radiation can induce a range of physiological changes in the heart. These changes, which include endothelial dysfunction, inflammation, thrombosis, and cardiac fibrosis, may be significantly accelerated as radiation doses increase. At present, multidisciplinary team treatment modalities have substantially enhanced curative effects for cancer patients. However, the resulting prolongation of survival time exposes a larger patient population to the risks of treatment-related cardiotoxicity, establishing RIHD as a pressing research concern. This article offers a systematic review of recent insights into the incidence of RIHD, the relationship between radiotherapy and RIHD, methods for its detection and diagnosis, as well as its pathogenesis and potential treatment strategies.

Surgery, radiotherapy and chemotherapy are currently the principal modalities for oncological treatment. Approximately 70% of patients with malignant tumors require radiotherapy. However, the damage induced by radiation on normal human tissues remains an unavoidable issue in clinical practice. When radiotherapy is applied to abdominal and pelvic tumors such as liver cancer, colorectal cancer, cervical cancer, and prostate cancer, the anatomical proximity of these organs to the small intestine inevitably leads to some degree of intestinal damage. This type of injury, induced by radiotherapy, is referred as radiation-induced small intestine injury. Clinically, a high incidence of radiation-induced small intestine injury is observed among patients receiving pelvic and abdominal radiotherapy, which not only impacts the quality of life of cancer patients, but also limits the effectiveness of the treatment. This article reviews the research progress in radiation-induced small intestine injury.

Radiotherapy is one of the main treatment methods for malignant tumors, which can cause the radiation damage to normal tissues. Radiation-induced skin injury (RISI) is one of the main adverse reactions caused by radiotherapy. The main clinical manifestations of RISI are dermatitis, ulcer, erosion and necrosis, which seriously affect the quality of life and treatment effect of tumor radiotherapy patients, and even affect the overall survival of patients. The pathological mechanism of RISI is still unclear. Some studies have shown that inflammation and oxidative stress are the main causes of RISI. RISI can be divided into acute and chronic RISI according to the different onset time, and different treatment strategies can be formulated according to the severity of the injury. In this article, clinical manifestations, classification, pathogenesis, prevention and treatment of RISI are comprehensively summarized.

Objective To discuss the application value of video health education mode in patient's self-maintenance of totally implantable venous access port(TIVAP).Methods A total of 208 patients,who received implantation of TIVAP at the Second Affiliated Hospital of Naval Military Medical University of China From September 2021 to December 2022,were enrolled in this study.The patients were divided into control group(n=108)and observation group(n=100).Traditional health education was conducted for the patients of the control group,while on the basis of traditional health education an additional video health education based on visual communication theory was carried out for the patients of the observation group.Evaluation of self-care ability(ESCA)was used to evaluate the self-care ability before the intervention and 6 months after the implantation of TIVAP in the two groups.The complications,the incidence of adverse events,and the indwelling duration of the infusion port were compared between the two groups.Results Before intervention,the differences in each dimension score and total score of ESCA table between the two groups were not statistically significant(all P＞0.05).After intervention,the each dimension score and total score of ESCA table in the observation group were significantly higher than those in the control group(all P＜0.05).After intervention,both the total incidence of complications and the total incidence of adverse events in the observation group were remarkably lower than those in the control group(both P＜0.05),besides,the indwelling duration of the infusion port in the observation group was obviously longer than that in the control group.Conclusion The use of video health education mode can significantly improve the self-care ability of patients carrying a TIVAP,reduce the incidence of complications and adverse events,and extend the effective duration of TIVAP.Therefore,it is an effective health education mode.

Robotics ; Robotic Surgical Procedures ; Kidney Transplantation