ObjectiveTo investigate the efficacy and safety of lenvatinib combined with sintilimab versus atezolizumab combined with bevacizumab in patients with unresectable hepatocellular carcinoma （uHCC）， aims to provide real-world evidence for clinical personalized treatment. MethodsA retrospective analysis was performed for 78 patients with uHCC who were admitted to Beijing Ditan Hospital， Capital Medical University， from January 1， 2023， to May 31， 2025， and according to the treatment modality， they were divided into lenvatinib+sintilimab group （L+S group with 49 patients） and atezolizumab+bevacizumab group （A+T group with 29 patients）. The primary endpoints were progression-free survival （PFS） and overall survival （OS）， and the secondary endpoints included objective response rate （ORR）， disease control rate （DCR）， and the incidence rate of adverse events. The independent-samples t test was used for comparison of normally distributed continuous data between groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups； the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used for survival analysis， and the log-rank test was used for comparison between groups. ResultsThe 78 patients had a median PFS of 9 months and a median OS of 15 months. The median PFS was 11 months in the L+S group and 7 months in the A+T group， with no significant difference between the two groups （χ²=0.247， P=0.619）； the median OS was 19 months in the L+S group and 12 months in the A+T group， with a significant difference between the two groups （χ²=6.565， P=0.010）. There were no significant differences between the two groups in complete remission， partial remission， stable disease， disease progression， DCR， and ORR （all P>0.05）. The L+S group had a significantly higher incidence rate of adverse events than the A+T group （95.9% vs 75.9%， P=0.007）， and there was a significant difference in the incidence rate of grade ≥3 adverse events between the L+S group and the A+T group （65.3% vs 34.5%， P=0.008）. ConclusionCompared with atezolizumab combined with bevacizumab， lenvatinib combined with sintilimab can improve the OS of patients with uHCC， while atezolizumab combined with bevacizumab has a better safety profile.

Objective:To investigate the efficacy of a 3D printed guide plate in the placement of a hinged external fixator for treatment of elbow terror triad.Methods:A retrospective study was conducted to analyze the data of 10 patients with elbow terror triad who had been treated at Department of Orthopedics, Northern Jiangsu People's Hospital Affiliated to Yangzhou University from July 2021 to July 2023 by the hinged external fixator placement assisted by a 3D printed guide plate. There were 6 males and 4 females, aged (48.2±19.7) years. The range of elbow motion and visual analogue scale (VAS) pain score in the patients were recorded and compared between preoperation and the last follow-up. Mayo elbow performance score (MEPS) and complications were also recorded at the last follow-up.Results:The central axis of the elbow rotation was successfully located at one time under the assistance of the 3D printed guide plate in the 10 patients. Intraoperative fluoroscopy and postoperative CT computer simulation verified that the rotation center of the hinged external fixator was consistent with that of the elbow joint. All patients were followed up for 12.0 (5.5, 13.5) months. The elbow flexion and extension at the last follow-up in the 10 patients were 126.2°±6.1° and 153.2°±5.9°, respectively, significantly better than those before operation (23.3°±6.7° and 121.2°±5.7°) ( P<0.05). Their VAS pain score was 1 (0, 1) point at the last follow-up, significantly lower than that before operation [3 (2, 3) points] ( P<0.05). Their MEPS score at the last follow-up was (88.0±6.8) points, giving 6 excellent and 4 good cases. No patient experienced such complications as pin tract infection, loosening or breakage of fixation needles, or radial nerve injury. Ectopic ossification occurred in 2 patients, and 1 patient underwent a secondary nerve release due to ulnar nerve symptoms. Conclusion:In the surgical treatment of elbow terror triad, application of a 3D printed guide plate to assist the placement of an external fixator can quickly and accurately locate the central axis of the elbow rotation, which promotes the early functional exercise of the patients to obtain a satisfactory functional prognosis.

Objective:To evaluate the clinical value of three-dimensional(3D) printing-assisted fenestrated/branched endovascular aortic repair (F/B-TEVAR) for the treatment of endoleak after open surgery for type A aortic dissection.Methods:A multi-center retrospective case series analysis was conducted on 16 patients with anastomotic leakage following Stanford type A aortic dissection open repair, admitted to 12 medical centers between January 2019 and December 2023. All surgeries were led by the vascular surgery team from Department of Vascular Surgery, Nanjing Drum Tower Hospital. The study included 12 males and 4 females, with an age of (58.1±8.2) years (range: 42 to 75 years). Preoperative patient-specific 3D-printed models or 3D parametric surface topological guides were created based on aortic CT angiography data. These models assisted intraoperative external positioning of fenestration sites, combined with stent diameter selection and inner branch techniques to complete endovascular repair. Surgical procedures, complications, and clinical outcomes were evaluated, with follow-up CT imaging to assess efficacy.Results:All patients successfully underwent surgery without conversion to open repair. One patient had distal stent migration from a prior open repair, requiring intraoperative coverage of the main stent window and conversion to an in situ fenestration procedure. The mean operative time was (332.6±111.2)minutes (range: 80 to 460 minutes). No renal failure, paraplegia, or branch artery loss occurred. Postoperative follow-up ( M(IQR)) was 18(18) months(range: 6 to 36 months), with follow-up rates of 16/16 at 6 months, 10/16 at 12 months, 8/16 at 24 months, and 2/16 at 36 months. During follow-up, endoleak occurred in 3 patients, cerebral infarction in 1 patient, and death in 1 patient. The remaining patients demonstrated stable stent positioning, patent branches, and no endoleak. Conclusion:3D technology-guided F/B-TEVAR shows favorable mid-to short-term outcomes in treating anastomotic leakage after open repair of type A aortic dissection.

Background and purpose:Single-week ultra-hypofractionated whole breast irradiation(WBI)after breast-conserving surgery could shorten the treatment duration while ensuring efficacy and safety,making it a viable option for WBI.However,ultra-hypofractionated WBI requires daily image-guided radiotherapy(IGRT),and its impact on setup errors remains unclear.This study aimed to identify factors associated with set-up errors in ultra-hypofractionated WBI guided with daily cone-beam computed tomography(CBCT)and calculate margin expanded from clinical target volume(CTV)to planning target volume(PTV).Methods:This study included patients enrolled in a prospective trial that explored the safety of single-week ultra-hypofractionated WBI(NCT04926766)in Shanghai Ruijin Hospital,which was approved by Shanghai Ruijin Hospital Ethics Committee(No.2020-352).All patients received CBCT1 after positioning.After correcting errors,patients received CBCT2.CBCT3 was conducted after radiotherapy was completed.The translational errors between CBCT1,CBCT2,and plan CT were initial and residual inter-fractional errors.The translational error between CBCT2 and CBCT3 was an intra-fractional error.The PTV margin was calculated according to the van Herk formula.Results:A total of 34 patients were enrolled in this study,and 510 CBCT images were collected.Daily CBCT significantly reduced set-up error in anterior-posterior(AP),superior-inferior(SI)and right-left(RL)directions(initial inter-fractional error vs residual inter-fractional error:AP,2.8 mm vs 0.4 mm;SI,1.6 mm vs 0.5 mm;RL,1.8 mm vs 0.3 mm,all P＜0.001).Higher CTV volume(＞402.5 cm3 vs≤402.5 cm3)was associated with larger residual inter-fractional error(0.5 mm vs 0.3 mm,P=0.023)and intra-fractional error(0.5 mm vs 0.2 mm,P=0.001)in AP direction.Higher CTV volume was also associated with larger residual inter-fractional error in the SI direction(0.6 mm vs 0.5 mm,P=0.037).Higher BMI(＞23.2 kg/m2 vs≤23.2 kg/m2)and larger weight(＞60.0 kg vs≤60.0 kg)were associated with larger intra-fractional error in AP direction:0.7 mm vs 0.2 mm(P＜0.001)and 0.5 mm vs 0.2 mm(P=0.033),respectively.Under guidance with daily CBCT,the recommended margins were 2.3 mm in AP direction,2.8 mm in SI direction,and 2.0 mm in RL direction.However,in patients with CTV volume＞402.5 cm3 and BMI＞23.2 kg/m2,a larger margin was recommended in SI direction:3.1 mm and 3.4 mm,respectively.Conclusion:The 3 mm margin was feasible under guidance with daily CBCT.The CTV to PTV margin should be larger in patients with higher BMI or CTV volume.

Background and purpose:Single-week ultra-hypofractionated whole breast irradiation(WBI)after breast-conserving surgery could shorten the treatment duration while ensuring efficacy and safety,making it a viable option for WBI.However,ultra-hypofractionated WBI requires daily image-guided radiotherapy(IGRT),and its impact on setup errors remains unclear.This study aimed to identify factors associated with set-up errors in ultra-hypofractionated WBI guided with daily cone-beam computed tomography(CBCT)and calculate margin expanded from clinical target volume(CTV)to planning target volume(PTV).Methods:This study included patients enrolled in a prospective trial that explored the safety of single-week ultra-hypofractionated WBI(NCT04926766)in Shanghai Ruijin Hospital,which was approved by Shanghai Ruijin Hospital Ethics Committee(No.2020-352).All patients received CBCT1 after positioning.After correcting errors,patients received CBCT2.CBCT3 was conducted after radiotherapy was completed.The translational errors between CBCT1,CBCT2,and plan CT were initial and residual inter-fractional errors.The translational error between CBCT2 and CBCT3 was an intra-fractional error.The PTV margin was calculated according to the van Herk formula.Results:A total of 34 patients were enrolled in this study,and 510 CBCT images were collected.Daily CBCT significantly reduced set-up error in anterior-posterior(AP),superior-inferior(SI)and right-left(RL)directions(initial inter-fractional error vs residual inter-fractional error:AP,2.8 mm vs 0.4 mm;SI,1.6 mm vs 0.5 mm;RL,1.8 mm vs 0.3 mm,all P＜0.001).Higher CTV volume(＞402.5 cm3 vs≤402.5 cm3)was associated with larger residual inter-fractional error(0.5 mm vs 0.3 mm,P=0.023)and intra-fractional error(0.5 mm vs 0.2 mm,P=0.001)in AP direction.Higher CTV volume was also associated with larger residual inter-fractional error in the SI direction(0.6 mm vs 0.5 mm,P=0.037).Higher BMI(＞23.2 kg/m2 vs≤23.2 kg/m2)and larger weight(＞60.0 kg vs≤60.0 kg)were associated with larger intra-fractional error in AP direction:0.7 mm vs 0.2 mm(P＜0.001)and 0.5 mm vs 0.2 mm(P=0.033),respectively.Under guidance with daily CBCT,the recommended margins were 2.3 mm in AP direction,2.8 mm in SI direction,and 2.0 mm in RL direction.However,in patients with CTV volume＞402.5 cm3 and BMI＞23.2 kg/m2,a larger margin was recommended in SI direction:3.1 mm and 3.4 mm,respectively.Conclusion:The 3 mm margin was feasible under guidance with daily CBCT.The CTV to PTV margin should be larger in patients with higher BMI or CTV volume.

Objective:To investigate the efficacy of a 3D printed guide plate in the placement of a hinged external fixator for treatment of elbow terror triad.Methods:A retrospective study was conducted to analyze the data of 10 patients with elbow terror triad who had been treated at Department of Orthopedics, Northern Jiangsu People's Hospital Affiliated to Yangzhou University from July 2021 to July 2023 by the hinged external fixator placement assisted by a 3D printed guide plate. There were 6 males and 4 females, aged (48.2±19.7) years. The range of elbow motion and visual analogue scale (VAS) pain score in the patients were recorded and compared between preoperation and the last follow-up. Mayo elbow performance score (MEPS) and complications were also recorded at the last follow-up.Results:The central axis of the elbow rotation was successfully located at one time under the assistance of the 3D printed guide plate in the 10 patients. Intraoperative fluoroscopy and postoperative CT computer simulation verified that the rotation center of the hinged external fixator was consistent with that of the elbow joint. All patients were followed up for 12.0 (5.5, 13.5) months. The elbow flexion and extension at the last follow-up in the 10 patients were 126.2°±6.1° and 153.2°±5.9°, respectively, significantly better than those before operation (23.3°±6.7° and 121.2°±5.7°) ( P<0.05). Their VAS pain score was 1 (0, 1) point at the last follow-up, significantly lower than that before operation [3 (2, 3) points] ( P<0.05). Their MEPS score at the last follow-up was (88.0±6.8) points, giving 6 excellent and 4 good cases. No patient experienced such complications as pin tract infection, loosening or breakage of fixation needles, or radial nerve injury. Ectopic ossification occurred in 2 patients, and 1 patient underwent a secondary nerve release due to ulnar nerve symptoms. Conclusion:In the surgical treatment of elbow terror triad, application of a 3D printed guide plate to assist the placement of an external fixator can quickly and accurately locate the central axis of the elbow rotation, which promotes the early functional exercise of the patients to obtain a satisfactory functional prognosis.

Objective:To evaluate the clinical value of three-dimensional(3D) printing-assisted fenestrated/branched endovascular aortic repair (F/B-TEVAR) for the treatment of endoleak after open surgery for type A aortic dissection.Methods:A multi-center retrospective case series analysis was conducted on 16 patients with anastomotic leakage following Stanford type A aortic dissection open repair, admitted to 12 medical centers between January 2019 and December 2023. All surgeries were led by the vascular surgery team from Department of Vascular Surgery, Nanjing Drum Tower Hospital. The study included 12 males and 4 females, with an age of (58.1±8.2) years (range: 42 to 75 years). Preoperative patient-specific 3D-printed models or 3D parametric surface topological guides were created based on aortic CT angiography data. These models assisted intraoperative external positioning of fenestration sites, combined with stent diameter selection and inner branch techniques to complete endovascular repair. Surgical procedures, complications, and clinical outcomes were evaluated, with follow-up CT imaging to assess efficacy.Results:All patients successfully underwent surgery without conversion to open repair. One patient had distal stent migration from a prior open repair, requiring intraoperative coverage of the main stent window and conversion to an in situ fenestration procedure. The mean operative time was (332.6±111.2)minutes (range: 80 to 460 minutes). No renal failure, paraplegia, or branch artery loss occurred. Postoperative follow-up ( M(IQR)) was 18(18) months(range: 6 to 36 months), with follow-up rates of 16/16 at 6 months, 10/16 at 12 months, 8/16 at 24 months, and 2/16 at 36 months. During follow-up, endoleak occurred in 3 patients, cerebral infarction in 1 patient, and death in 1 patient. The remaining patients demonstrated stable stent positioning, patent branches, and no endoleak. Conclusion:3D technology-guided F/B-TEVAR shows favorable mid-to short-term outcomes in treating anastomotic leakage after open repair of type A aortic dissection.

Objective To identify the N6-methyladenosine (m6A)-related characteristic genes analyzed by gene clustering and immune cell infiltration in myocardial ischemia-reperfusion injury (MI/RI) after cardiopulmonary bypass through machine learning. Methods The differential genes associated with m6A methylation were screened by the dataset GSE132176 in GEO, the samples of the dataset were clustered based on the differential gene expression profile, and the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of the differential genes of the m6A cluster after clustering were performed to determine the gene function of the m6A cluster. R software was used to determine the better models in machine learning of support vector machine (SVM) model and random forest (RF) model, which were used to screen m6A-related characteristic genes in MI/RI, and construct characteristic gene nomogram to predict the incidence of disease. R software was used to analyze the correlation between characteristic genes and immune cells, and the online website was used to build a characteristic gene regulatory network. Results In this dataset, a total of 5 m6A-related differential genes were screened, and the gene expression profiles were divided into two clusters for cluster analysis. The enrichment analysis of m6A clusters showed that these genes were mainly involved in regulating monocytes differentiation, response to lipopolysaccharides, response to bacteria-derived molecules, cellular response to decreased oxygen levels, DNA transcription factor binding, DNA-binding transcription activator activity, RNA polymerase Ⅱ specificity, NOD-like receptor signaling pathway, fluid shear stress and atherosclerosis, tumor necrosis factor signaling pathway, interleukin-17 signaling pathway. The RF model was determined by R software as the better model, which determined that METTL3, YTHDF1, RBM15B and METTL14 were characteristic genes of MI/RI, and mast cells, type 1 helper lymphocytes (Th1), type 17 helper lymphocytes (Th17), and macrophages were found to be associated with MI/RI after cardiopulmonary bypass in immune cell infiltration. Conclusion The four characteristic genes METTL3, YTHDF1, RBM15B and METTL14 are obtained by machine learning, while cluster analysis and immune cell infiltration analysis can better reveal the pathophysiological process of MI/RI.

Objective To explore the effects of isogenous micro-grafting(MG)technology and the combined use of botulinum toxin type A(BTX-A)on hair regeneration in mice.Methods Forty-five C57BL/6 mice were randomly divided into five groups:normal saline group(NS group),MG group(MB-0 group),MG+low-dose BTX-A group(MB-2 group),MG+medium dose BTX-A group(MB-10 group),MG+high-dose BTX-A group(MB-50 group).The growth of hair on the backs of the mice was observed after the administration of the drugs,and the hair follicles were evaluated by hematoxylin-eosin(HE)staining on the 7th,14th,and 21st days of the experiment,and the expression of vascular endothelial growth factor(VEGF)and β-catenin was evaluated by immunohisto-chemical staining on day 21.Results After treatment with micrograft and botulinum toxin type A,the skin darke-ning time was shortened(P＜0.05),and the coverage rate of new hair increased on the 14 th day(P＜0.05).Compared with the NS group,the number of hair follicles increased(P＜0.05)and the expression of VEGF andβ-catenin increased in each other group.Conclusion Isogenous micro-grafting technology combined with botuli-num toxin type A has a promotional effect on hair regeneration in mice,and the mechanism may be related to the promotion of vascular growth and activation of β-catenin signaling.