Objective To compare the effect of transcranial direct current stimulation(tDCS)combined with seated Taijiquan Yun-shou in different sequences on brain functional activation in healthy youths.Methods From September to December,2024,14 healthy young medical interns or probationers were recruited from the Fifth Hospital of Xiamen.They randomly completed three interventions in a crossover design:Yunshou training followed immediately by tDCS(Y-S group),tDCS intervention followed immediately by Yunshou training(S-Y group),and simultaneous implementation of tDCS intervention and Yunshou training(Sim group).Yunshou was practiced in a seated position.For tDCS,the anode was placed over the left primary motor cortex(M1),and the cathode over the right M1.Changes in oxyhemoglobin(HbO2)concentration in the regions of interest were mea-sured using functional near-infrared spectroscopy.Results Three cases dropped down.The brain regions with significant differences before and after intervention included:CH3,CH7 and CH23 of right prefrontal cortex(PFC)in Y-S group;CH12 of left PFC in S-Y group;and CH9,CH10 and CH25 of the left PFC,CH13 and CH14 of the left sensorimotor cortex(SMC),CH15 of the right pre-motor and supplementary motor cortex(PMC),and CH16 of the right SMC in Sim group(P<0.05).After inter-vention,HbO2 concentration was the highest in the bilateral PFC,bilateral PMC and left SMC in the Y-S group(P<0.05);and it was almost the same between Sim group and S-Y group(P>0.05),except that of the right PFC decreased in Sim group.Conclusion The sequential combination of brain-limb integrated regulation is a key factor influencing the immediate cor-tical activation pattern.

Objective:To investigate the expression and clinical significance of zinc finger protein Kruppel-like factor 4 (KLF4) and topoisomeraseⅡalpha (TOP2A) in breast cancer.Methods:From Jan. 2022 to Jun. 2023, 126 patients with breast cancer were selected for examination in the clinical Laboratory of the First Affiliated Hospital of Inner Mongolia Medical University. Breast cancer tissues and adjacent tissues of all patients were collected. The expressions of KLF4 and TOP2A were detected by immunohistochemical staining, and the relationship of the expressions of KLF4 and TOP2A with the pathological features of patients was analyzed. Patients were divided into recurrence group and non-recurrence group according to whether they had recurrence after surgery. The expression of KLF4 and TOP2A in the two groups were compared. Spearman correlation analysis was used to analyze the relationship of KLF4 and TOP2A with breast cancer recurrence, and multivariate Cox risk regression was used to analyze the risk factors of breast cancer recurrence after surgery.Results:The positive expression rate of KLF4 in tumor tissues was lower than that in paracancer tissues, and the positive expression rate of TOP2A was higher ( χ 2=35.24, 53.89, P<0.001) ; The levels of KLF4 and TOP2A in tumor tissues were correlated with TNM stage, differentiation degree, borderline state and lymph node metastasis ( χ 2=10.98, 8.49, 4.28, 7.28, P=0.001, 0.004, 0.039, 0.007; χ 2=8.15, 8.78, 6.39, 7.20, P=0.004, 0.003, 0.011, 0.007), and the expression of TOP2A was correlated with the pathological type ( χ 2=4.31, P=0.04) ; The recurrence rate in KLF4 negative expression group and TOP2A positive expression group was higher than that in KLF4 positive expression group and TOP2A negative expression group ( χ 2=4.53, 5.92, P=0.033, 0.015) ; Spearman correlation analysis showed that positive expression of KLF4 was negatively correlated with breast cancer recurrence ( r=-0.43, P<0.001), and positive expression of TOP2A was positively correlated with breast cancer recurrence ( r=0.51, P<0.001) ; Multivariate Cox regression analysis showed that TNM stage, lymph node metastasis, negative KLF4 expression and positive TOP2A expression were independent risk factors for breast cancer recurrence ( P<0.05) . Conclusion:KLF4 is negatively expressed in breast cancer tissues, while TOP2A is positively expressed, and its expression level is closely related to pathological characteristics and has certain evaluation value for postoperative recurrence of breast cancer.

Background and purpose:Approximately 30%of patients with metastatic colorectal cancer(CRC)develops pulmonary metastasis,yet less than 10%are eligible for surgical resection.Radiofrequency ablation(RFA)serves as an alternative therapy for non-surgical candidates,but the relationship between its efficacy and tumor diameter remains controversial.This study aimed to investigate the impact of tumor size on survival outcomes and local progression risk in CRC patients with pulmonary metastasis after RFA,and to validate the clinical utility of a 3 cm threshold for prognosis.Methods:This retrospective study included CRC patients with pulmonary metastasis who underwent RFA at Fudan University Shanghai Cancer Center between January 2016 and December 2024.Patients were stratified into two groups based on maximum lesion diameter:≤3 cm(Small group)and 3-5 cm(Large group).Patient inclusion criteria:⑴ pathologically confirmed lung metastases originating from CRC,with metastases limited to the lungs or extra-pulmonary metastatic lesions having been radically treated;⑵ maximum lesion diameter<5 cm;⑶complete clinical data available;⑷ complete imaging data available,including computed tomography(CT)images during ablation and contrast-enhanced CT images during postoperative follow-up;⑸ follow-up time of at least＞6 months after RFA;⑹ technical complete ablation;⑺ fewer than 3 pulmonary metastatic lesions.Exclusion criteria:⑴ target lesions previously treated with local therapies such as RFA or radiotherapy;⑵ patients unable to tolerate RFA;⑶ patients with follow-up time＜6 months after RFA.Three senior interventional physicians performed percutaneous RFA under guidance of a 64-slice spiral CT scanner.Chest contrast-enhanced CT scans obtained 1 month after RFA were used as the baseline,followed by contrast-enhanced CT scans every 3 months for 1 year,then every 6 months for subsequent follow-up.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(ethical approval number:2108241-11).Primary endpoints included overall survival(OS),progression-free survival(PFS),and local tumor progression(LTP).Kaplan-Meier analysis and multivariate COX regression were employed to evaluate the independent prognostic value of tumor size.Results:A total of 134 patients who met the inclusion criteria were ultimately enrolled,including 77 in the Small group and 57 in the Large group.With a median follow-up of 35 months,the≤3 cm group demonstrated superior 1-,3-,and 5-year OS rates(100.0%,95.1%,74.2%)compared to the 3-5 cm group(94.7%,36.8%,27.0%,P＜0.0001),and the≤3 cm group demonstrated superior 1-,3-,and 5-year PFS rates(90.9%,34.4%,23.3%)compared to the 3-5 cm group(13.8%,0.0%,0.0%,P＜0.000 1).The≤3 cm group also exhibited significantly lower 1-,3-,and 5-year LTP rates(0.0%,19.7%,33.6%)compared to the 3-5 cm group(46.0%,75.5%,75.5%,P＜0.000 1).Multivariable analysis identified tumor diameter＞3 cm as an independent predictor of worse OS[hazard ratio(HR)=6.49,95%CI:3.18-13.24,P＜0.001],while elevated preoperative carcinoembryonic antigen(CEA)(≥5 ng/mL)correlated with shorter OS(HR=1.82,P=0.033).Conclusion:CRC patients with pulmonary metastasis and tumor diameters of 3-5 cm exhibited significantly inferior survival outcomes after RFA compared to the≤3 cm group.A tumor diameter of 3 cm can serve as a critical threshold for selecting RFA indications,and combining preoperative CEA levels can optimize patient stratification.

Purpose To investigate the impact of patient positioning deviation on CT image quality and radiation dose in chest CT scans.Materials and Methods A retrospective analysis was conducted on all patients who underwent chest high-resolution CT plain scans from January 22 to 26,2024,at the Second Affiliated Hospital,Zhejiang University School of Medicine.The distance between the gantry center and patient center was measured.Patients were divided into three groups based on the magnitude of deviation from the isocenter:negative deviation group,isocenter group and positive deviation group.Compared the signal to noise ratio(SNR),CT dose index volume(CTDIvol),dose length product(DLP)and SNR/CTDI distribution among the three patient groups.Results Among the 965 patients studied,29.95%(289 cases)were accurately positioned,while 70.05%(676 cases)deviated from the center.The frequency of positive deviation(31.81%,307/965)was lower than that of negative deviation(38.24%,369/965).Compared with the isocenter group,patients in the negative deviation group received higher CTDIvol and DLP but superior SNR,while those in the positive deviation group received lower CTDIvol and DLP with inferior SNR(H=213.783,187.595,59.247,all P<0.05).The SNR/CTDI ratio in the isocenter group 0.84(0.50)was significantly higher than that in the negative deviation group 0.72(0.54)and the positive deviation group 0.71(0.38)(H=13.257,P<0.05).There was a significant association between gender and deviation direction.Patients with higher body weight and taller stature,particularly male patients,demonstrated negative deviation,while those with lower body weight and shorter stature tended to positive deviation.Conclusion Accurate positioning in chest CT scans can ensure diagnostic accuracy while minimizing radiation exposure and achieving the best image quality-to-radiation dose ratio.However,as a population-based preliminary study,the findings should be complemented by phantom experiments to further validate the correlation between anthropometric parameters and positional deviations in clinical CT practice.

This is a case report of bilateral Gustilo ⅢC fracture with tibial defects in both legs and combined with defects of soft tissue. The injury was treated by emergency surgery in November 2021 in the Hand and Foot Microsurgery Hospital, Xi'an Fengcheng Hospital. It was found that annular avulsion injury with partial defect of soft tissue in left leg from under the knee to ankle (10.0 cm × 4.0 cm, 14.0 cm × 8.0 cm), distal tibia-fibula fractures and partial bone defect of tibia (6.0 cm), anterior tibial artery and posterior tibial artery rupture, and posterior tibial nerve and foot were both intact. Of the right leg, it was found that there was an annular avulsion injury with partial defect of soft tissue between 1/3 of proximal leg and above ankle (25.0 cm × 10.0 cm), distal tibia-fibula fractures and partial tibial defect (4.0 cm), anterior tibial artery was ruptured and the posterior tibial artery was embolised, but posterior tibial nerve and foot were both intact. There was no blood supply in both feet. A chimeric fibular flap of right peroneal artery (15.0 cm × 6.0 cm, and the excised fibula was 13.0 cm long) was harvested and further divided into 2 chimeric flaps for reconstruction of the defects of bilateral tibia and soft tissue. A chimeric flap pedicled with descending branch of left lateral circumflex femoral artery (29.0 cm × 8.0 cm) was harvested and further divided into 2 chimeric tissue flaps pedicled with the descending branch of lateral circumflex femoral artery to cover the remaining wounds of both calves. The proximal peroneal artery was anastomosed with anterior tibial artery, and the distal peroneal artery was anastomosed with the lateral circumflex femoral artery carried by chimeric flap, and bilateral posterior tibial arteries were bridge anastomosed with the great saphenous veins. All patients were entered in the scheduled follow-up at 4, 8 and 12 weeks after surgery. The walking and the movement of ankles and toes were gradually recovered. At 1 year after surgery, the patient was able to get of the bed by himself. Plantar sensation regained to S 4 and there was a slight limb in walking, but without pain, wear or ulceration in feet.

Objective To compare the effect of transcranial direct current stimulation(tDCS)combined with seated Taijiquan Yun-shou in different sequences on brain functional activation in healthy youths.Methods From September to December,2024,14 healthy young medical interns or probationers were recruited from the Fifth Hospital of Xiamen.They randomly completed three interventions in a crossover design:Yunshou training followed immediately by tDCS(Y-S group),tDCS intervention followed immediately by Yunshou training(S-Y group),and simultaneous implementation of tDCS intervention and Yunshou training(Sim group).Yunshou was practiced in a seated position.For tDCS,the anode was placed over the left primary motor cortex(M1),and the cathode over the right M1.Changes in oxyhemoglobin(HbO2)concentration in the regions of interest were mea-sured using functional near-infrared spectroscopy.Results Three cases dropped down.The brain regions with significant differences before and after intervention included:CH3,CH7 and CH23 of right prefrontal cortex(PFC)in Y-S group;CH12 of left PFC in S-Y group;and CH9,CH10 and CH25 of the left PFC,CH13 and CH14 of the left sensorimotor cortex(SMC),CH15 of the right pre-motor and supplementary motor cortex(PMC),and CH16 of the right SMC in Sim group(P<0.05).After inter-vention,HbO2 concentration was the highest in the bilateral PFC,bilateral PMC and left SMC in the Y-S group(P<0.05);and it was almost the same between Sim group and S-Y group(P>0.05),except that of the right PFC decreased in Sim group.Conclusion The sequential combination of brain-limb integrated regulation is a key factor influencing the immediate cor-tical activation pattern.

Objective To investigate the prognostic value of thrombin-antithrombin III complex(TAT),plasmin-α2-plasmin inhibitor complex(PIC),thrombomodulin(TM)and tissue plasminogen activator-inhibitor complex(t-PAIC)in patients with myelodysplastic syndrome(MDS).Methods Selected 88 primary MDS patients diagnosed at the 521 Hospital of Ordnance Industry from January 2018 to January 2021.Plasma levels of TAT,PIC,TM,t-PAIC,fibrin degradation products(FDP)and D-dimer(D-D)were measured.A multivariate approach was used to analyze the association between overall survival(OS)and the levels of each coagulation marker.Coagulation markers significantly associated with OS were used to construct a coagulation prognostic scoring system.Based on the median coagulation marker score,MDS patients were divided into high and low score groups.Kaplan-Meier analysis was used to plot survival curves.Results TAT(OR=1.667),PIC(OR=0.734),TM(OR=1.294)and t-PAIC(OR=1.523)were independent factors influencing OS in MDS patients(Wald χ2=0.671～10.751,all P<0.05).The β-values were integrated as statistical weights to construct a coagulation marker score,calculated as follows:[TAT]×0.502-[PIC]×1.013+[TM]×0.181+[t-PAIC]×0.381.The OS(median 14.6 months)and leukemia free survival(LFS)(median 10.3 months)of patients in the high coagulation marker score group were significantly lower than those in the low score group(33.6 months,35.2 months)(Log rank=20.57,26.84,all P<0.001).Subgroup analysis indicated that in both the low-risk IPSS-R subgroup(very low,low,and intermediate risk)and the high-risk IPSS-R subgroup(high and very high risk),the OS(Log rank=9.12,4.30)and LFS(Log rank=4.54,8.51)of the high coagulation marker score group were lower than those of the low score group(all P<0.05).Bivariate analysis showed a moderate correlation between the coagulation marker score and Revise International Prognostic Scoring System(IPSS-R)(PCC=0.536,P<0.001).Multivariate analysis indicated that IPSS-R and high coagulation marker scores were independent risk factors for OS and LFS in MDS patients(P<0.05).Conclusion The coagulation marker score,based on TAT,PIC,TM and t-PAIC,can serve as an independent prognostic factor for OS and LFS in MDS patients.

This is a case report of bilateral Gustilo ⅢC fracture with tibial defects in both legs and combined with defects of soft tissue. The injury was treated by emergency surgery in November 2021 in the Hand and Foot Microsurgery Hospital, Xi'an Fengcheng Hospital. It was found that annular avulsion injury with partial defect of soft tissue in left leg from under the knee to ankle (10.0 cm × 4.0 cm, 14.0 cm × 8.0 cm), distal tibia-fibula fractures and partial bone defect of tibia (6.0 cm), anterior tibial artery and posterior tibial artery rupture, and posterior tibial nerve and foot were both intact. Of the right leg, it was found that there was an annular avulsion injury with partial defect of soft tissue between 1/3 of proximal leg and above ankle (25.0 cm × 10.0 cm), distal tibia-fibula fractures and partial tibial defect (4.0 cm), anterior tibial artery was ruptured and the posterior tibial artery was embolised, but posterior tibial nerve and foot were both intact. There was no blood supply in both feet. A chimeric fibular flap of right peroneal artery (15.0 cm × 6.0 cm, and the excised fibula was 13.0 cm long) was harvested and further divided into 2 chimeric flaps for reconstruction of the defects of bilateral tibia and soft tissue. A chimeric flap pedicled with descending branch of left lateral circumflex femoral artery (29.0 cm × 8.0 cm) was harvested and further divided into 2 chimeric tissue flaps pedicled with the descending branch of lateral circumflex femoral artery to cover the remaining wounds of both calves. The proximal peroneal artery was anastomosed with anterior tibial artery, and the distal peroneal artery was anastomosed with the lateral circumflex femoral artery carried by chimeric flap, and bilateral posterior tibial arteries were bridge anastomosed with the great saphenous veins. All patients were entered in the scheduled follow-up at 4, 8 and 12 weeks after surgery. The walking and the movement of ankles and toes were gradually recovered. At 1 year after surgery, the patient was able to get of the bed by himself. Plantar sensation regained to S 4 and there was a slight limb in walking, but without pain, wear or ulceration in feet.

Objective:To investigate the expression and clinical significance of zinc finger protein Kruppel-like factor 4 (KLF4) and topoisomeraseⅡalpha (TOP2A) in breast cancer.Methods:From Jan. 2022 to Jun. 2023, 126 patients with breast cancer were selected for examination in the clinical Laboratory of the First Affiliated Hospital of Inner Mongolia Medical University. Breast cancer tissues and adjacent tissues of all patients were collected. The expressions of KLF4 and TOP2A were detected by immunohistochemical staining, and the relationship of the expressions of KLF4 and TOP2A with the pathological features of patients was analyzed. Patients were divided into recurrence group and non-recurrence group according to whether they had recurrence after surgery. The expression of KLF4 and TOP2A in the two groups were compared. Spearman correlation analysis was used to analyze the relationship of KLF4 and TOP2A with breast cancer recurrence, and multivariate Cox risk regression was used to analyze the risk factors of breast cancer recurrence after surgery.Results:The positive expression rate of KLF4 in tumor tissues was lower than that in paracancer tissues, and the positive expression rate of TOP2A was higher ( χ 2=35.24, 53.89, P<0.001) ; The levels of KLF4 and TOP2A in tumor tissues were correlated with TNM stage, differentiation degree, borderline state and lymph node metastasis ( χ 2=10.98, 8.49, 4.28, 7.28, P=0.001, 0.004, 0.039, 0.007; χ 2=8.15, 8.78, 6.39, 7.20, P=0.004, 0.003, 0.011, 0.007), and the expression of TOP2A was correlated with the pathological type ( χ 2=4.31, P=0.04) ; The recurrence rate in KLF4 negative expression group and TOP2A positive expression group was higher than that in KLF4 positive expression group and TOP2A negative expression group ( χ 2=4.53, 5.92, P=0.033, 0.015) ; Spearman correlation analysis showed that positive expression of KLF4 was negatively correlated with breast cancer recurrence ( r=-0.43, P<0.001), and positive expression of TOP2A was positively correlated with breast cancer recurrence ( r=0.51, P<0.001) ; Multivariate Cox regression analysis showed that TNM stage, lymph node metastasis, negative KLF4 expression and positive TOP2A expression were independent risk factors for breast cancer recurrence ( P<0.05) . Conclusion:KLF4 is negatively expressed in breast cancer tissues, while TOP2A is positively expressed, and its expression level is closely related to pathological characteristics and has certain evaluation value for postoperative recurrence of breast cancer.

Objective To investigate the expression levels and clinical significance of type Ⅰ innate lymphoid cells(ILC1s),T-box transcription factor(T-bet),interleukin(IL)-12,IL-18 and interferon-gamma(IFN-γ)in peripheral blood of patients with primary immune thrombocytopenia(ITP).Methods Thirty-five ITP patients with their first episode were selected as the initial treatment group.Thirteen of these patients were followed up after receiving treatment.Additionally,20 healthy individuals underwent routine physical examinations during the same period were recruited as the control group.Peripheral blood samples were collected for analysis.The proportion of ILC1s was determined by flow cytometry.T-bet mRNA expression was measured using quantitative real-time PCR(qRT-PCR).Serum levels of IL-18,IL-12 and IFN-γ were quantified by enzyme-linked immunosorbent assay(ELISA).The differences in ILC1s proportion,T-bet mRNA expression and cytokine levels were compared between groups.Correlations between ILC1s proportion,T-bet mRNA,cytokine levels and platelet(PLT)counts were also analyzed.Results Compared with the control group,the initial treatment group exhibited significantly elevated levels of peripheral ILC1s,T-bet mRNA and serum IL-18,IL-12 and IFN-γ(P＜0.05).Among the 13 patients who were followed up,all these indices decreased significantly after treatment(P＜0.05).Correlation analysis revealed that the proportion of ILC1s in the initial treatment group was positively correlated with IL-12,IL-18,IFN-γ and T-bet mRNA levels(rs=0.666,0.647,0.677,and 0.750,respectively,P＜0.01),and negatively correlated with PLT count(rs=-0.637,P＜0.01).Conclusion Innate immunity may play a role in the pathogenesis and progression of ITP by regulating the expression levels of ILC1s,T-bet,IL-12,IL-18 and IFN-γ.