Objective:To investigate the efficacy of radiotherapy in postoperative metastatic human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer treated with pyrotinib, and to identify potential subgroups that may benefit from this strategy.Methods:The clinical data of 187 patients with postoperative distant metastatic HER2-overexpressing breast cancer who received pyrotinib at the First Affiliated Hospital of Bengbu Medical University from January 2018 to July 2022 were retrospectively analyzed. The Kaplan-Meier method was used to assess changes in survival outcomes in patients undergoing radiotherapy. Univariate and multivariate analyses were conducted to identify prognostic factors, and the log-rank test was used to determine potential subgroups that may benefit from radiotherapy.Results:Among the 187 patients, 76 received radiotherapy. The median follow-up duration for the entire population was 16.9 months (range: 3.1-37.9 months), and the 2-year overall survival (OS) was 75.0%. Multivariate analysis showed that age, metastatic status, and radiotherapy were independent factors affecting OS (3.86-6.76, P<0.05). Further subgroup analysis showed that radiotherapy significantly improved OS in patients aged ≥50 years, those with oligometastases or bone metastases, those not receiving endocrine therapy, and those resistant to trastuzumab ( P<0.05). Conclusions:Radiotherapy, in addition to pyrotinib, can enhance the survival rate of patients with postoperative metastatic HER2-overexpressing breast cancer. The benefits of radiotherapy may be more pronounced in patients with a low tumor burden, inadequate systemic treatment, and drug resistance.

Objective:To investigate the efficacy of radiotherapy in postoperative metastatic human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer treated with pyrotinib, and to identify potential subgroups that may benefit from this strategy.Methods:The clinical data of 187 patients with postoperative distant metastatic HER2-overexpressing breast cancer who received pyrotinib at the First Affiliated Hospital of Bengbu Medical University from January 2018 to July 2022 were retrospectively analyzed. The Kaplan-Meier method was used to assess changes in survival outcomes in patients undergoing radiotherapy. Univariate and multivariate analyses were conducted to identify prognostic factors, and the log-rank test was used to determine potential subgroups that may benefit from radiotherapy.Results:Among the 187 patients, 76 received radiotherapy. The median follow-up duration for the entire population was 16.9 months (range: 3.1-37.9 months), and the 2-year overall survival (OS) was 75.0%. Multivariate analysis showed that age, metastatic status, and radiotherapy were independent factors affecting OS (3.86-6.76, P<0.05). Further subgroup analysis showed that radiotherapy significantly improved OS in patients aged ≥50 years, those with oligometastases or bone metastases, those not receiving endocrine therapy, and those resistant to trastuzumab ( P<0.05). Conclusions:Radiotherapy, in addition to pyrotinib, can enhance the survival rate of patients with postoperative metastatic HER2-overexpressing breast cancer. The benefits of radiotherapy may be more pronounced in patients with a low tumor burden, inadequate systemic treatment, and drug resistance.

Objective:To evaluate the curative effect of Sun's procedure using sutureless artificial blood vessel replacement technique on acute type A aortic dissection.Methods:Retrospective analysis was performed on 40 patients with acute type A aortic dissection who underwent Sun's procedure in The First People's Hospital of Nanning from May 2019 to April 2023. According to the surgical method, the patients were divided into sutureless group (20 cases) and traditional group (20 cases).The time of stopping circulation, cardiopulmonary bypass, recovery time, intubation time, blood loss 12 h after operation, cerebral infarction and acute renal failure were compared between the two groups.Patients older than 70 years, patients with preoperative malperfusion syndrome, or patients who did not undergo Sun's procedure were excluded.Results:The time of stopping circulation[( 13.6±3.3)min vs. ( 28.2±5.6)min, P<0.001] and the time of cardiopulmonary bypass[(116.0±34.8)min vs.(219.1±46.3 )min, P<0.001]and blood loss at 12 h after operation[( 474.5±301.0)ml vs. (422.7±389.8)ml, P<0.001] in the sutureless group were significantly lower than those in the traditional group.All patients survived and were discharged from hospital. There were no significant differences in recovery time, intubation time, cerebral infarction and acute renal failure between the two groups. Conclusion:Sutureless artificial blood vessel replacement technique can significantly shorten the time of stopping circulation and cardiopulmonary bypass, effectively protect the function of the whole body organs, and reduce the occurrence of postoperative complications.Moreover, it is easy to carry out in primary hospitals, and it is a safe and effective new surgical strategy for treating acute type A aortic dissection with Sun's surgery.

BACKGROUND:Mesenchymal stem cell-derived exosomes may play a crucial role in tissue damage repair,and miRNA is an important component of exosomes for therapeutic effects.Among them,miR-29b-3p has the effect of reducing cell apoptosis,promoting axonal regeneration,and angiogenesis. OBJECTIVE:To study the protective effect of adipose-derived mesenchymal stem cell-derived exosome via miR-29b-3p on a neural cell injury model simulated by H2O2-treated PC12 cells,and explore the relevant mechanisms. METHODS:(1)First,the collagenase digestion method was used to extract rat adipose-derived mesenchymal stem cells.Adipose-derived mesenchymal stem cells were transfected with miR-29b-3p mimics and inhibitors.Exosomes were extracted from the culture supernatant by ultracentrifugation and identified so as to construct adipose-derived mesenchymal stem cell-derived exosomes with high expression and knockdown miR-29b-3p.(2)By constructing a neural cell injury model simulated by PC12 cells treated with H2O2,the relevant mechanisms of the protective effect of adipose-derived mesenchymal stem cell-derived exosome via miR-29b-3p on the simulated neuronal cell injury model were studied. RESULTS AND CONCLUSION:(1)Adipose-derived mesenchymal stem cell-derived exosome had a typical cup-shaped shape and a diameter distribution in the range of 50-140 nm,expressed membrane proteins Alix,CD63,and TSG101,which were specific markers on the surface of exosomes,and could be successfully ingested by PC12 cells.(2)Adipose-derived mesenchymal stem cell-derived exosome pretreatment could reduce cell apoptosis induced by H2O2 treatment in PC12 cells,and this protective effect was enhanced with the increase of miR-29b-3p expression in the exosomes and weakened with the decrease of miR-29b-3p expression in the exosomes.The mechanism of its effect was related to adipose-derived mesenchymal stem cell-derived exosome via miR-29b-3p promoting the expression of anti-apoptotic protein Bcl-2 and inhibiting the expression of apoptotic protein Bax.

New drug discovery is under growing pressure to satisfy the demand from a wide range of domains, especially from the pharmaceutical industry and healthcare services. Assessment of drug efficacy and safety prior to human clinical trials is a crucial part of drug development, which deserves greater emphasis to reduce the cost and time in drug discovery. Recent advances in microfabrication and tissue engineering have given rise to organ-on-a-chip, an in vitro model capable of recapitulating human organ functions in vivo and providing insight into disease pathophysiology, which offers a potential alternative to animal models for more efficient pre-clinical screening of drug candidates. In this review, we first give a snapshot of general considerations for organ-on-a-chip device design. Then, we comprehensively review the recent advances in organ-on-a-chip for drug screening. Finally, we summarize some key challenges of the progress in this field and discuss future prospects of organ-on-a-chip development. Overall, this review highlights the new avenue that organ-on-a-chip opens for drug development, therapeutic innovation, and precision medicine.

ObjectiveTo evaluate the effect of Astragali Radix （AR）-Angelicae Sinensis Radix （ASR） drug pair on supplementing Qi and activating blood circulation in rats with Qi deficiency and blood stasis and provide a theoretical basis for clinical rational medication and identification and quality control of compound pharmacodynamic substances from the three aspects of characteristic map， identification of pharmacodynamic substances， and comparison of blood components. MethodHigh-performance liquid chromatography （HPLC） was employed to establish the fingerprint of AR∶ASR （3∶1）， and ultra-high performance liquid chromatography-Q-Exactive Orbitrap-mass spectrometry （UPLC-Q-Exactive Orbitrap-MS） was employed to analyze the ingredients of the decoction. Adult male Wistar rats with SPF grades were selected and randomly divided into a blank group， a model group， a 3∶1 group， and a 5∶1 group. The rat model of Qi deficiency and blood stasis syndrome was prepared by controlling food intake and swimming in cold water every day. In parallel， each group was given medicine （or water） once a day. The dose of drug groups was 10.2 g∙kg^-1， and the model group and blank group were given the same amount of distilled water for 15 d. Animal behavior， body weight， whole blood and plasma viscosity， thymus index， spleen index， the levels of adenosine triphosphate （ATP）， adenosine diphosphate（ADP）， von willebrand factor （vWF）， and ATP/ADP value in serum of rats were recorded. The morphology of vascular endothelium was observed by hematoxylin-eosin （HE） staining and scanning electron microscopy. UPLC-Q-Exactive Orbitrap-MS was used to analyze prototype and metabolic components in serum. ResultThe fingerprint of AR-ASR drug pair （AR-ASR 3∶1） was established. UPLC-Q-Exactive Orbitrap MS identified 49 chemical components in vitro and preliminarily identified 11 prototype components absorbed into blood in vivo. As compared with the blank group， the body mass decreased significantly （P<0.01）， the whole blood （high shear， middle shear， and low shear） viscosity and plasma viscosity were significantly increased （P<0.05， P<0.01）， the thymus index and spleen index decreased significantly （P<0.05， P<0.01）， serum ATP content decreased significantly （P<0.01）， ADP content increased significantly （P<0.01）， ATP/ADP value decreased significantly （P<0.01）， and vWF content increased significantly （P<0.01）. The results of HE staining and scanning electron microscopy showed that the vessels were partially damaged， showing the structural disorder of the intima， the bulge， defect， and roughness of the endothelium， and the obvious cell adhesion and migration in the model group. As compared with the model group， the body mass also increased significantly （P<0.01）. The results of whole blood and plasma viscosity showed that the whole blood low shear viscosity was significantly decreased in the 3∶1 group （P<0.05）. The results of thymus index and spleen index showed that 5∶1 group significantly increased the thymus index of rats （P<0.05）. The results of serum ATP and ADP levels showed that the 5∶1 group had more significant effects on ATP and ADP levels （P<0.05）， and both groups significantly reduced ATP/ADP values （P<0.01）. The results of serum vWF level showed that the vWF content in the 3∶1 group decreased significantly （P<0.05）. The results of HE staining and scanning electronic microscopy showed that the damage of vascular endothelium was improved in the treatment group and the structure of intima was neat. ConclusionAR-ASR drug pair can improve the macro and micro indexes of rats with qi deficiency and blood stasis in the 3∶1 and 5∶1 groups. Overall， the 5∶1 ratio has a better effect on supplementing Qi but 3∶1 ratio has a better effect on promoting blood circulation.

Objective:To investigate the safety and dose of 4D template (real-time adjustable angle template) in the treatment of advanced malignant tumors with 125I seeds. Methods:98 patients with advanced malignant tumors admitted to Department of Thoracic Surgery of Shaanxi Provincial Tumor Hospital were treated with 4D template-navigated radioactive 125I seed implantation from June 2018 to December 2019. Preoperative TPS plan, intraoperative optimization, postoperative verification of immediate dose and postoperative evaluation of implantation dose were performed. The treatment results were observed. Results:All 98 patients completed the seed implantation. The implantation dose of GTV of implantation site receiving external irradiation was (12 489±414) cGy and the dose of no external irradiation was (15 036±514) cGy. V 100% was 84.7%-94.1%, and 88.2%-93.7%. The implantation dose of CTV was (7 450±621) cGy, and (9 080±761) cGy. The quality of dose implantation was evaluated as: excellent in 89 cases (91%, 89/98), good in 7 cases (7%, 7/98), fair in 2 cases (2%, 2/98), and poor in 0 case, respectively. The symptom relief rate of patients with pain was 92%(36/39). The 1-and 2-year local control rates were 61%, 36% and 82%, 54% in patients treated with and without external irradiation, respectively. The difference was statistically significant ( P=0.02). The incidence rates of pneumothorax and hemoptysis were 19%(9/48) and 10%(5/48). No corresponding complications were observed in other parts of the patients. Conclusion:4D template-assisted 125I seed therapy is safe and effective for malignant tumors, and intraoperative adjustment of needle angle and dose optimization can realize the precise control of implantation dose.

Objective:To explore the relationship among maximal oxygen uptake (VO 2max), heart rate recovery after exercise (HRR) and anti-G ability of fighter pilots. Methods:A total of 90 fighter pilots were selected by cluster sampling method, and the +G z tolerance that devoted by anti-G staining manoeuvre performing was predicted by anti-G and anti-hypoxia ability detector and G tolerance empirical formula. The values of VO 2max and HRR were collected under 25 W/min power increasing rate scheme. According to the level of VO 2max, pilots were divided into 3 groups: low level (the bottom third), intermediate level (the middle third) and high level (the top third). The differences of HRR value and +G z tolerance increment among the first, second and third minutes after exercise were compared among the pilots of different level of VO 2max. The correlation among the values of HRR, VO 2max and +G z tolerance increment were analyzed. Results:There were significant differences in the values of HRR and +G z tolerance increment at the second and the third minutes of exercise among the pilots with different VO 2max levels in 3 groups ( F=7.65, 10.64, 10.28, all P≤0.001). There was no obvious correlation between the values of HRR, VO 2max and +G z tolerance increment at the first minute after exercise ( r=0.020, -0.017, P=0.852, 0.871). The value of HRR at the second minute after exercise was positively correlated with VO 2max ( r=0.288, P=0.006), but not obviously with the +G z tolerance increment ( r=-0.017, P=0.150). The value of HRR value at the third minute was positively correlated with the increase of VO 2max and +G z tolerance increment ( r=0.433, 0.240, P<0.001, =0.023). VO 2max was positively correlated with the increase of +G z tolerance increment ( r=0.436, P<0.001). Conclusions:The increase of pilots′ VO 2max is conducive to the improvement of anti-G ability. The value of HRR at the third minute after exercise can be used as a sensitive monitoring index to predict pilot′s G-tolerance.

Objective:To explore the relationship between neck muscle strength and elastic strain of flying personnel by comparing the changes of neck muscle elastic strain values and neck muscle strength before and after neck muscle training in flying personnel with neck pain.Methods:By using CME-1 neck muscle strength trainer, 56 flying personnel were trained under isometric and changeable velocity and resistant (CVR) training mode for 2 weeks. The neck muscle strength and neck muscle elastic strain values before and after training were compared.Results:The elastic strain values of longus colli, splenius capitis and levator scapula were significantly increased by neck muscle training ( t=4.154, 2.348, 2.745, P<0.001, P=0.040, 0.006). The relative growth rate of the average elastic strain values of longus colli, splenius capitis and levator scapula after training was 13.75%, 4.18% and 2.8%, respectively. After neck muscle training, the average maximum neck muscle strength and average 10 s maximum impulse in the directions of forward flexion, backward extension, left flexion and right flexion were higher than those before training, and the difference was statistically significant ( t=3.364-8.284, all P<0.01); The relative growth rate of the average maximum neck muscle strength in each direction was 39.3%, 34.6%, 35.2% and 28.4%, respectively, and the relative growth rate of the average 10 s maximum impulse was 51.4%, 33.6%, 42.7% and 34.5%, respectively. The elastic strain values of levator scapula and longus colli were negatively correlated with the average maximum muscle strength of anterior flexor ( r=-0.281, -0.387, P=0.036, 0.004). Conclusions:Neck muscle training can effectively improve the strength of neck muscle groups and the elastic strain of some muscle groups. The elastic strain values of levator scapula and longus colli are negatively correlated with the average maximum muscle strength of anterior flexor, those suggesting that neck muscle training has a certain effect on enhancing the activity of anterior flexor muscle groups and maintaining the physiological lordosis of cervical spine.

Objective:To explore the relationship between neck muscle strength and elastic strain of flying personnel by comparing the changes of neck muscle elastic strain values and neck muscle strength before and after neck muscle training in flying personnel with neck pain.Methods:By using CME-1 neck muscle strength trainer, 56 flying personnel were trained under isometric and changeable velocity and resistant (CVR) training mode for 2 weeks. The neck muscle strength and neck muscle elastic strain values before and after training were compared.Results:The elastic strain values of longus colli, splenius capitis and levator scapula were significantly increased by neck muscle training ( t=4.154, 2.348, 2.745, P<0.001, P=0.040, 0.006). The relative growth rate of the average elastic strain values of longus colli, splenius capitis and levator scapula after training was 13.75%, 4.18% and 2.8%, respectively. After neck muscle training, the average maximum neck muscle strength and average 10 s maximum impulse in the directions of forward flexion, backward extension, left flexion and right flexion were higher than those before training, and the difference was statistically significant ( t=3.364-8.284, all P<0.01); The relative growth rate of the average maximum neck muscle strength in each direction was 39.3%, 34.6%, 35.2% and 28.4%, respectively, and the relative growth rate of the average 10 s maximum impulse was 51.4%, 33.6%, 42.7% and 34.5%, respectively. The elastic strain values of levator scapula and longus colli were negatively correlated with the average maximum muscle strength of anterior flexor ( r=-0.281, -0.387, P=0.036, 0.004). Conclusions:Neck muscle training can effectively improve the strength of neck muscle groups and the elastic strain of some muscle groups. The elastic strain values of levator scapula and longus colli are negatively correlated with the average maximum muscle strength of anterior flexor, those suggesting that neck muscle training has a certain effect on enhancing the activity of anterior flexor muscle groups and maintaining the physiological lordosis of cervical spine.