Objective To explore the feasibility of the endoscopic occipital transtentorial transpineal-recess (EOTT-TR) approach for treatment of craniopharyngiomas within the third ventricle. Methods The clinical and imaging data of a 54-year-old female patient with craniopharyngioma was reviewed. The patient was presented with progressive visual impairment and headache for six months. Endocrine evaluation indicated mild impairment of the pituitary-hypothalamic axis function. Imaging revealed a large solid tumor was entirely confined within the third ventricle, maximal diameter of approximately 4.7 cm. The lesion was resected via right EOTT-TR approach, which involved upward retraction of the pineal gland under the 3D endoscopy, and accessing the third ventricle through the pineal recess. Following resection, pathological diagnosis was performed, and postoperative complications were observed. Results Subtotal resection was achieved. Postoperatively, central diabetes insipidus, diplopia and upward gaze dysfunction occurred, but improved after 3 months of follow-up. MRI confirmed subtotal resection of the tumor, and the vision of the patient was improved, and the Karnofsky performance status (KPS) score increased from 80 points to 90 points at 3 months after operation. The pathological diagnosis was papillary craniopharyngioma (WHO grade Ⅰ). Conclusions The EOTT-TR approach provides a unique postero-superior to antero-inferior perspective, allowing full exposure of the third ventricle. It is particularly advantageous for treating craniopharyngiomas originating from the antero-inferior wall of the third ventricle, enabling tumor resection while preserving hypothalamic function without affecting visual acuity or visual fields. Therefore, for craniopharyngiomas strictly confined within the third ventricle, the EOTT-TR approach is a feasible surgical approach.

ObjectiveTo investigate the effects of Yifei Zhuji formula （YFZJF） on epithelial-mesenchymal transition （EMT） in non-small cell lung cancer （NSCLC） through regulation of phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway. MethodsThe Lewis lung carcinoma mouse model and human lung adenocarcinoma PC-9 cell model were used in this study. In the animal experiments， 60 C57BL/6 mice were randomized into a blank group and a Lewis lung carcinoma modeling group. The modeled mice were further randomized into model， low-， medium-， and high-dose （7.475， 14.95， 29.9 g·kg^-1·d^-1， respectively） YFZJF， and cisplatin groups， with 10 mice in each group. Mice in YFZJF groups were administrated with YFZJF at different doses by gavage， and those in the cisplatin group received intraperitoneal injection of cisplatin at 6 mg·kg^-1. Mice in the blank group and model group were administrated with equal volumes of normal saline by gavage every day. All the groups were treated for 14 consecutive days， and samples were collected for analysis after completion of treatment. Changes in body mass， tumor volume， and tumor mass were measured. Hematoxylin-eosin （HE） staining was performed to observe pathological changes in the lung tissue. Immunohistochemistry， Real-time PCR， and Western blot were employed to determine the expression of proliferating cell nuclear antigen （Ki-67）， PI3K/Akt/mTOR signaling pathway-related molecules， and EMT-related molecules in the tumor tissue. In the cell experiments， human lung adenocarcinoma PC-9 cells were allocated into control， YFZJF-containing serum， and cisplatin groups， which were treated with 20% blank rat serum， 20% YFZJF-containing rat serum， and 5.4 μmol·L^-1 cisplatin for 48 h， respectively. The cell counting kit-8 （CCK-8） assay was adopted to detect cell proliferation and determine drug concentration. Cell scratch assay and Transwell assay were employed to evaluate cell migration and invasion. Immunofluorescence staining and Real-time PCR were used to analyze changes in expression of EMT markers. ResultsCompared with those in the model group， the tumor volume and tumor mass were reduced in the high-dose YFZJF group （P<0.01）. Immunohistochemical results showed that compared with the model group， the medium- and high-dose YFZJF groups exhibited reduced Ki-67 expression in the tumor tissue （P<0.01）. HE staining results showed that YFZJF alleviated the pathological injury of the lung tissue to different degrees. Real-time PCR results in the tumor tissue showed that compared with the model group， the high-dose YFZJF group displayed downregulated mRNA levels of protein kinase B1 （Akt1） and N-cadherin （P<0.05）， phosphatidylinositol 3-kinase p85 regulatory subunit （p85） （P<0.01）， mTOR （P<0.01）， and Vimentin （P<0.01）， and an upregulated mRNA level of E-cadherin （P<0.01）. Western blot results showed that compared with the model group， the high-dose YFZJF group exhibited downregulated protein levels of phosphorylated （p）-PI3K/PI3K， p-Akt/Akt， p-mTOR/mTOR， Vimentin， and N-cadherin （P<0.01）， and an upregulated protein level of E-cadherin （P<0.01） in the tumor tissue. The cell experiment results showed that compared with the blank serum group， YFZJF-containing serum inhibited the proliferation， migration， and invasion of PC-9 cells （P<0.05， P<0.01）. Immunofluorescence results showed that compared with the control group， YFZJF-containing serum downregulated the protein levels of N-cadherin and Vimentin and upregulated the protein level of E-cadherin （P<0.01）. Real-time PCR results showed that compared with the control group， YFZJF-containing serum upregulated the mRNA level of E-cadherin （P<0.05） and downregulated the mRNA levels of N-cadherin， Vimentin， P85， Akt1， and mTOR （P<0.05， P<0.01）. ConclusionYFZJF can significantly inhibit the progression of non-small cell lung cancer and reduce the migration and invasion of tumor cells by inhibiting the abnormal activation of PI3K/Akt/mTOR signaling pathway and reversing EMT.

Empty follicle syndrome (EFS), defined by the failure to retrieve oocytes despite normal follicle development following controlled ovarian stimulation, is a multifactorial condition in assisted reproductive treatment and categorized into genuine EFS (GEFS) and false EFS (FEFS). The etiology of GEFS is complex, involving genetic factors and ovarian dysfunction, with mutations in LHCGR and ZP genes being the major causes. However, the underlying cause remains unknown in most patients. Targeted therapies based on specific etiologies are crucial in GEFS management. Oocyte donation is considered as a final viable option when other precision treatments prove ineffective. The etiology of FEFS is relatively clear, primarily associated with inappropriate administration of ovulation-triggering drugs, which can be rescued by a second injection of human chorionic gonadotropin or change the medication regimen. This review summaries current advances in the diagnosis and treatment of EFS, aiming to provide guidance for clinical management and further etiology research.

Objective:To compare the clinical outcomes of arthroscopic Y-shaped suture suspension fixation and those of open reduction and internal fixation in the treatment of tibial insertion avulsion fractures of the posterior cruciate ligament (PCL).Methods:A retrospective study was conducted to analyze the clinical data from the 23 patients with PCL tibial avulsion fracture who had been admitted to Department of Sports Medicine, The Affiliated Changsha Central Hospital, University of South China, from May 2018 to May 2024. There were 15 males and 8 females with an age of (39.0±15.6) years. By the Meyers-McKeever classification, there were 20 cases of type Ⅱ and 3 cases of type Ⅲ. All patients were divided into 2 groups based on their different surgical schemes: an arthroscopic group of 11 cases treated with Y-shaped suture suspension fixation under arthroscopy and an open group of 12 cases treated with open reduction and internal fixation. The surgical time, intraoperative blood loss, and visual analog scale (VAS) pain scores, Lysholm knee function scores, and International Knee Documentation Committee (IKDC) subjective scores at 1 month after surgery and the last follow-up were recorded and compared between the 2 groups.Results:There was no statistically significant difference in the preoperative general information between the 2 groups, indicating comparability ( P>0.05). The 23 patients were followed up for (13.7±3.8) months after surgery. None of the patients experienced complications like incision infection, neurovascular damage, nonunion or delayed union of fracture. In the arthroscopic group, the surgical time was (97.1±11.1) min, significantly shorter than that in the open group [(64.7±9.0) min], and the intraoperative blood loss (14.9±6.6) mL, significantly less than that in the open group [(29.4±13.2) mL] ( P<0.05). At 1 month after surgery, the VAS pain score, Lysholm knee function score, and IKDC subjective score in the arthroscopic group were, respectively, 3.0 (2.0, 3.0) points, (72.0±4.8) points, and (67.3±2.9) points, all significantly better than those in the open group [5.0 (4.0, 5.0) points, (66.9±4.0) points, and (63.1±2.4) points] ( P<0.05). There was no statistically significant difference in the VAS pain score, Lysholm knee function score, or IKDC subjective score at the last follow-up between the 2 groups ( P>0.05). Conclusions:Both arthroscopic Y-shaped suture suspension fixation and open reduction and internal fixation can achieve satisfactory treatment outcomes for PCL tibial avulsion fractures. The latter shows an advantage in shorter surgical time, but the former advantages in less bleeding volume and better early efficacy.

Empty follicle syndrome (EFS), defined by the failure to retrieve oocytes despite normal follicle development following controlled ovarian stimulation, is a multifactorial condition in assisted reproductive treatment and categorized into genuine EFS (GEFS) and false EFS (FEFS). The etiology of GEFS is complex, involving genetic factors and ovarian dysfunction, with mutations in LHCGR and ZP genes being the major causes. However, the underlying cause remains unknown in most patients. Targeted therapies based on specific etiologies are crucial in GEFS management. Oocyte donation is considered as a final viable option when other precision treatments prove ineffective. The etiology of FEFS is relatively clear, primarily associated with inappropriate administration of ovulation-triggering drugs, which can be rescued by a second injection of human chorionic gonadotropin or change the medication regimen. This review summaries current advances in the diagnosis and treatment of EFS, aiming to provide guidance for clinical management and further etiology research.

BACKGROUND:Repetitive trans-spinal magnetic stimulation(rTSMS)can inhibit inflammatory responses following spinal cord injury.rTSMS applies magnetic field stimulation to the spinal cord region to modulate neuronal excitability and synaptic transmission,thereby promoting plasticity and repair of the nervous system. OBJECTIVE:To observe the effects of rTSMS on the Toll-like receptor 4(TLR4)/nuclear factor(NF)-κB/NLRP3 signaling pathway after spinal cord injury and explore its mechanism in promoting motor function recovery. METHODS:Male C57BL/6J mice,SPF grade,were randomly divided into sham surgery group,spinal cord injury group,and rTSMS group.The latter two groups of mice were anesthetized and the T9 vertebral plate was removed using rongeur forceps to expose the spinal cord,and the spinal cord was clamped using a small aneurysm clip for 20 seconds to establish the spinal cord injury model.Mice in the rTSMS group underwent a 21-day rTSMS intervention starting on day 1 after spinal cord injury.The stimulation lasted 10 minutes per day,5 days per week with an interval of 2 days.Basso Mouse Scale scores were used to assess motor function recovery in mice after spinal cord injury at 1,3,7,14,and 21 days after spinal cord injury.Western blot was employed to detect the expression of AQP4,apoptotic factors Bax,Bcl-2,CL-Caspase-3,inflammatory factors tumor necrosis factor-α,interferon-γ,interleukin-6,interleukin-4,and the TLR4/NF-κB/NLRP3 signaling pathway related proteins in the injured spinal cord.Oxidative stress assay kit was used to measure the activity of superoxide dismutase,glutathione peroxidase,and malondialdehyde content at the site of spinal cord injury.Immunofluorescence staining was performed to detect the expression of neuronal nuclei(NeuN). RESULTS AND CONCLUSION:The Basso Mouse Scale score in the rTSMS group was significantly higher than that in the spinal cord injury group(P<0.05).Compared with the spinal cord injury group,the rTSMS group showed a reduction in spinal cord water content.The expression of AQP4 protein,malondialdehyde content,and expression of Bax,Bcl-2,CL-Caspase-3,tumor necrosis factor-α,interferon-γ,interleukin-6,and TLR4/NF-κB/NLRP3 signaling pathway related proteins were all decreased in the rTSMS group,while the activities of superoxide dismutase and glutathione peroxidase,as well as the expression of Bcl-2,interleukin-4,and NeuN,were all increased(P<0.05).These results suggest that rTSMS downregulates the expression of proteins related to the TLR4/NF-κB/NLRP3 signaling pathway,alleviating symptoms after spinal cord injury such as spinal cord edema,oxidative stress,apoptosis,and inflammation,exerting neuroprotective effects,and thereby promoting the recovery of hindlimb motor function after spinal cord injury.

Objective To systematically evaluate the efficacy and safety of proximal gastrectomy (PG) versus total gastrectomy (TG) for the treatment of Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction (AEG). Methods PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang, and VIP databases were searched for literature comparing the efficacy and safety of PG and TG for the treatment of Siewert type Ⅱ/Ⅲ AEG. The search period was from database inception to March 2023. Meta-analysis was performed using Review Manager 5.4 software. Results A total of 23 articles were included, including 16 retrospective cohort studies, 5 prospective cohort studies, and 2 randomized controlled trials. The total sample size was 2 826 patients, with 1 389 patients undergoing PG and 1 437 patients undergoing TG. Meta-analysis results showed that compared with TG, PG had less intraoperative blood loss [MD=−19.85, 95%CI (−37.20, −2.51), P=0.02] and shorter postoperative hospital stay [MD=−1.23, 95%CI (−2.38, −0.08), P=0.04]. TG had a greater number of lymph nodes dissected [MD=−6.20, 95%CI (−7.68, −4.71), P<0.001] and a lower incidence of reflux esophagitis [MD=3.02, 95%CI (1.24, 7.34), P=0.01]. There were no statistically significant differences between the two surgical approaches in terms of operative time, postoperative survival rate (1-year, 3-year, 5-year), and postoperative overall complications (P>0.05). Conclusion PG has advantages in terms of intraoperative blood loss and postoperative hospital stay, while TG has advantages in terms of the number of lymph nodes dissected and the incidence of reflux esophagitis. There is no significant difference in long-term survival between the two surgical approaches.

Objective:To compare the clinical outcomes of arthroscopic Y-shaped suture suspension fixation and those of open reduction and internal fixation in the treatment of tibial insertion avulsion fractures of the posterior cruciate ligament (PCL).Methods:A retrospective study was conducted to analyze the clinical data from the 23 patients with PCL tibial avulsion fracture who had been admitted to Department of Sports Medicine, The Affiliated Changsha Central Hospital, University of South China, from May 2018 to May 2024. There were 15 males and 8 females with an age of (39.0±15.6) years. By the Meyers-McKeever classification, there were 20 cases of type Ⅱ and 3 cases of type Ⅲ. All patients were divided into 2 groups based on their different surgical schemes: an arthroscopic group of 11 cases treated with Y-shaped suture suspension fixation under arthroscopy and an open group of 12 cases treated with open reduction and internal fixation. The surgical time, intraoperative blood loss, and visual analog scale (VAS) pain scores, Lysholm knee function scores, and International Knee Documentation Committee (IKDC) subjective scores at 1 month after surgery and the last follow-up were recorded and compared between the 2 groups.Results:There was no statistically significant difference in the preoperative general information between the 2 groups, indicating comparability ( P>0.05). The 23 patients were followed up for (13.7±3.8) months after surgery. None of the patients experienced complications like incision infection, neurovascular damage, nonunion or delayed union of fracture. In the arthroscopic group, the surgical time was (97.1±11.1) min, significantly shorter than that in the open group [(64.7±9.0) min], and the intraoperative blood loss (14.9±6.6) mL, significantly less than that in the open group [(29.4±13.2) mL] ( P<0.05). At 1 month after surgery, the VAS pain score, Lysholm knee function score, and IKDC subjective score in the arthroscopic group were, respectively, 3.0 (2.0, 3.0) points, (72.0±4.8) points, and (67.3±2.9) points, all significantly better than those in the open group [5.0 (4.0, 5.0) points, (66.9±4.0) points, and (63.1±2.4) points] ( P<0.05). There was no statistically significant difference in the VAS pain score, Lysholm knee function score, or IKDC subjective score at the last follow-up between the 2 groups ( P>0.05). Conclusions:Both arthroscopic Y-shaped suture suspension fixation and open reduction and internal fixation can achieve satisfactory treatment outcomes for PCL tibial avulsion fractures. The latter shows an advantage in shorter surgical time, but the former advantages in less bleeding volume and better early efficacy.

The COVID-19 epidemic has spread to the whole world for three years and has had a serious impact on human life, health and economic activities. China's epidemic prevention and control has gone through the following stages: emergency unconventional stage, emergency normalization stage, and the transitional stage from the emergency normalization to the "Category B infectious disease treated as Category B" normalization, and achieved a major and decisive victory. The designated hospitals for prevention and control of COVID-19 epidemic in Tianjin has successfully completed its tasks in all stages of epidemic prevention and control, and has accumulated valuable experience. This article summarizes the experience of constructing a hospital infection prevention and control system during the "Category B infectious disease treated as Category A" period in designated hospital. The experience is summarized as the "Cluster" hospital infection prevention and control system, namely "three rings" outside, middle and inside, "three districts" of green, orange and red, "three things" before, during and after the event, "two-day pre-purification" and "two-director system", and "one zone" management. In emergency situations, we adopt a simplified version of the cluster hospital infection prevention and control system. In emergency situations, a simplified version of the "Cluster" hospital infection prevention and control system can be adopted. This system has the following characteristics: firstly, the system emphasizes the characteristics of "cluster" and the overall management of key measures to avoid any shortcomings. The second, it emphasizes the transformation of infection control concepts to maximize the safety of medical services through infection control. The third, it emphasizes the optimization of the process. The prevention and control measures should be comprehensive and focused, while also preventing excessive use. The measures emphasize the use of the least resources to achieve the best infection control effect. The fourth, it emphasizes the quality control work of infection control, pays attention to the importance of the process, and advocates the concept of "system slimming, process fattening". Fifthly, it emphasizes that the future development depends on artificial intelligence, in order to improve the quality and efficiency of prevention and control to the greatest extent. Sixth, hospitals need to strengthen continuous training and retraining. We utilize diverse training methods, including artificial intelligence, to ensure that infection control policies and procedures are simple. We have established an evaluation and feedback mechanism to ensure that medical personnel are in an emergency state at all times.

Objective To systematically evaluate the efficacy and safety of single and bilateral lung transplantation in the treatment of end-stage chronic obstructive pulmonary disease (COPD). Methods Chinese and English databases were searched by computer, including PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, Wanfang database, VIP database and CBM. Case-control studies on single lung transplantation or bilateral lung transplantation for COPD were collected from the inception to July 31, 2022. We evaluated the quality of the literature via Newcastle-Ottawa Scale (NOS). All results were analyzed using Review Manager V5.3 and STATA 17.0. Results A total of 8 studies were included covering 14076 patients, including 8326 patients in the single lung transplantation group and 5750 patients in the bilateral lung transplantation group. NOS scores were≥6 points. The results of meta-analysis showed that there was no statistical difference in the postoperative 1-year survival between the two groups (P=0.070). The 2-year survival rate (P=0.002), 3-year survival rate (P<0.001), 5-year survival rate (P<0.001), overall survival rate (P＜0.001), postoperative forced expiratory volume in one second/predicted value (P<0.001), postoperative forced vital capacity (P<0.001), and postoperative 6-minute walking distance (P=0.002) were lower or shorter than those in the bilateral lung transplantation group, the postoperative intubation time (P=0.030) was longer than that in the bilateral lung transplantation group. Bilateral lung transplantation group showed better surgical results. There was no statistical difference in the mortality, obliterative bronchiolitis, length of hospitalization, primary graft dysfunction, or postoperative adverse events (P>0.05). Conclusion Bilateral lung transplantation is associated with better long-term survival and postoperative lung function compared with single lung transplantation. In-hospital mortality and postoperative complications are similar between them.