Definitive chemoradiotherapy (dCRT) has become a cornerstone in the treatment of locally advanced esophageal cancer; however, local control remains suboptimal, and persistent lesions or locoregional recurrences after treatment are not uncommon. For patients without distant metastases but with local failure, whether surgical intervention can still offer curative potential remains a major clinical dilemma. Salvage esophagectomy (SE) offers potential long-term survival for selected patients, but this procedure is performed in the context of severe fibrosis, impaired local blood supply, and obscured anatomical planes following chemoradiotherapy, resulting in significantly higher perioperative risk compared to primary esophagectomy. Consequently, controversies exist regarding patient selection, preoperative restaging, choice of surgical approach, extent of lymphadenectomy, gastrointestinal reconstruction, and perioperative management. In recent years, with the refinement of restaging modalities such as PET/CT, the accumulation of experience in high-volume centers, and emerging evidence from clinical studies, the clinical role of SE has gradually shifted from a "high-risk salvage measure" to a "selective curative strategy aimed at achieving long-term survival in carefully selected patients". Nevertheless, standardized guidelines for patient selection, technical approaches, and perioperative management are still lacking. Based on current evidence and clinical experience, experts organized by the Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association systematically reviewed key issues regarding SE, including its definition, indications, preoperative evaluation, choice of surgical approach, lymphadenectomy, gastrointestinal reconstruction, and perioperative management, and formulated a Chinese expert consensus. This consensus aims to provide guidance for standardized assessment, appropriate referral, individualized surgical decision-making, and optimized perioperative management of patients with locoregional failure after dCRT. Ultimately, this will increase the likelihood of R0 resection, reduce the risk of severe complications, and promote the safer, more judicious, and standardized implementation of SE in high-risk scenarios.

Objective To analyze the international research hotspots and development trends of social work intervention in chronic disease management,providing reference for domestic research on social work intervention in chronic disease manage-ment.Methods The research literature was retrieve on the core collection of Web of Science,articles published from the estab-lishment of the database from 2000 to 2024.CiteSpace were used to present the keyword co-occurrence,keyword clustering,au-thor collaboration network,and institutional collaboration network of social work intervention in chronic disease management.Results The post-documentation situation showed a fluctuating upward trend as a whole.The keywords that appeared frequently were"social support""management""quality of life""chronic disease"and"Care".There was multi-agency and multi-author collaboration.Conclusion Internationally,social work intervention in chronic disease management focuses on social support and quality of life.The research cooperation system in related fields is diversified,and social workers play an active role in the inter-disciplinary teams for chronic disease management.

Objective To analyze the international research hotspots and development trends of social work intervention in chronic disease management,providing reference for domestic research on social work intervention in chronic disease manage-ment.Methods The research literature was retrieve on the core collection of Web of Science,articles published from the estab-lishment of the database from 2000 to 2024.CiteSpace were used to present the keyword co-occurrence,keyword clustering,au-thor collaboration network,and institutional collaboration network of social work intervention in chronic disease management.Results The post-documentation situation showed a fluctuating upward trend as a whole.The keywords that appeared frequently were"social support""management""quality of life""chronic disease"and"Care".There was multi-agency and multi-author collaboration.Conclusion Internationally,social work intervention in chronic disease management focuses on social support and quality of life.The research cooperation system in related fields is diversified,and social workers play an active role in the inter-disciplinary teams for chronic disease management.

This paper elaborated the structural principles,structures and working principles of the A5 type passive training system for hand function through discussed the clinical application of passive training system for hand function in the rehabilitation of patients with stroke.It analyzed a series of occurring common faults during system operation,such as system errors caused by missing components,improper sensitivity settings for spasticity,abnormal connections for equipment,motor failures,jam and pause of robotic hand,and faults of lifting table,and conducted fault analysis for them.After that,this paper proposed corresponding handling strategies and solutions for faults,which included software configuration,calibration and detection of robotic hand sensors,repair of connection fault,and regular maintenance and replacement of system's components.It provided theoretical basis for the maintenance and optimization of the passive training system for hand function.Thus,it can rapid remove troubles,and reduce the equipment's failure rate of passive training system for hand function,and improve the equipment's normal utilization rate,and ensure favorable performance of equipment in long-term use.

Objective To evaluate the risk of right heart failure after heart transplantation by establishing nomogram based on preoperative pulmonary artery pressure.Methods A total of 184 patients undergoing heart transplantation were retrospectively collected and divided into the training group(126 cases)and the verification group(58 cases).Patients in the training set were divided into the right heart failure group(60 cases)and the non-right heart failure group(66 cases)according to whether right heart failure occurred after operation.The differences of clinical data between the two groups were compared,and the influencing factors of right heart failure occurred after operation in the training set were screened by Lasso-Logistic regression.According to the screened influencing factors,nomograms were drawn,and the predictive efficiency of the model was evaluated by using the receiver's operating characteristic(ROC)curve,calibration curve,receiver's operating characteristic(ROC)curve and clinical decision curve.Further vertification of the clinical application effect of centralized evaluation model was conducted.Results The Lasso-Logistic regression analysis identified the following independent risk factors for right heart failure after heart transplantation:elevated total bilirubin(OR=2.649,95％CI:1.339-5.239),increased mean pulmonary artery pressure(OR=3.082,95％CI:1.608-5.910),elevated pulmonary artery resistance(OR=3.171,95％CI:1.710-5.879),and widened right ventricular outflow tract diameter(OR=2.681,95％CI:1.361-5.281),all of which demonstrated statistical significance(P＜0.05).The nomogram model was constructed accordingly.The AUC of the nomogram model was 0.846(95％CI:0.813-0.947).The calibration curve demonstrated good fit via the goodness-of-fit test(Hosmer-Lemeshow x2=0.862,P=0.361).Clinical decision curve analysis revealed that the net benefit rate remained＞0 when the high-risk threshold probability ranged from 1％to 95％,indicating favorable clinical utility of this nomogram model.Based on the model predictions,among 58 heart transplant patients in the validation cohort,34 were classified as high-risk for right heart failure and 24 as low-risk.Actual diagnosis results showed 29 cases with right heart failure and 29 without.The Kappa coefficient reached 0.483(95％CI:0.261-0.705),demonstrating high consistency between model predictions and actual clinical outcomes.Conclusion Preoperative pulmonary systolic pressure increase is an independent risk factor for right heart failure after heart transplantation.A nomogram prediction model for right heart failure after heart transplantation is established by combining other clinical risk factors,and it has good prediction efficiency.

Objective To compare the differences in intraoperative radiation exposure between leadless and transvenous pacemaker implantation. Methods Cumulative dose (CD), dose area product (DAP), and fluoroscopy time during procedure were recorded and analyzed in 21 patients with leadless pacemaker implantation (Micra group), 55 patients with transvenous single-chamber pacemaker implantation (VVI group), and 216 patients with transvenous dual-chamber pacemaker implantation (DDD group). Results The fluoroscopy times of the Micra group, VVI group, and DDD group were 5.0 ± 1.9, 4.8 ± 1.4, and 7.6 ± 1.9 min, respectively (P < 0.001). Their CD values were 203.5 ± 76.1, 147.0 ± 41.0, and 249.6 ± 58.2 mGy, respectively (P < 0.001). Their DAP values were 18.6 ± 7.1, 13.4 ± 3.9, and 22.6 ± 5.6 Gy·cm², respectively (P < 0.001). Compared with the VVI group, the Micra group had similar fluoroscopy time (P=0.813) but higher CD (P=0.010) and DAP values (P = 0.012). Compared with the DDD group, the Micra group had reduced fluoroscopy time (P < 0.001), CD value (P = 0.033), and DAP value (P = 0.047). Conclusion Leadless pacemaker implantation is associated with increased radiation exposure compared to transvenous single-chamber pacemaker implantation. However, it offers a significant advantage in reducing radiation exposure for both medical staff and patients compared to transvenous dual-chamber pacemaker implantation.

This paper elaborated the structural principles,structures and working principles of the A5 type passive training system for hand function through discussed the clinical application of passive training system for hand function in the rehabilitation of patients with stroke.It analyzed a series of occurring common faults during system operation,such as system errors caused by missing components,improper sensitivity settings for spasticity,abnormal connections for equipment,motor failures,jam and pause of robotic hand,and faults of lifting table,and conducted fault analysis for them.After that,this paper proposed corresponding handling strategies and solutions for faults,which included software configuration,calibration and detection of robotic hand sensors,repair of connection fault,and regular maintenance and replacement of system's components.It provided theoretical basis for the maintenance and optimization of the passive training system for hand function.Thus,it can rapid remove troubles,and reduce the equipment's failure rate of passive training system for hand function,and improve the equipment's normal utilization rate,and ensure favorable performance of equipment in long-term use.

Objective To evaluate the risk of right heart failure after heart transplantation by establishing nomogram based on preoperative pulmonary artery pressure.Methods A total of 184 patients undergoing heart transplantation were retrospectively collected and divided into the training group(126 cases)and the verification group(58 cases).Patients in the training set were divided into the right heart failure group(60 cases)and the non-right heart failure group(66 cases)according to whether right heart failure occurred after operation.The differences of clinical data between the two groups were compared,and the influencing factors of right heart failure occurred after operation in the training set were screened by Lasso-Logistic regression.According to the screened influencing factors,nomograms were drawn,and the predictive efficiency of the model was evaluated by using the receiver's operating characteristic(ROC)curve,calibration curve,receiver's operating characteristic(ROC)curve and clinical decision curve.Further vertification of the clinical application effect of centralized evaluation model was conducted.Results The Lasso-Logistic regression analysis identified the following independent risk factors for right heart failure after heart transplantation:elevated total bilirubin(OR=2.649,95％CI:1.339-5.239),increased mean pulmonary artery pressure(OR=3.082,95％CI:1.608-5.910),elevated pulmonary artery resistance(OR=3.171,95％CI:1.710-5.879),and widened right ventricular outflow tract diameter(OR=2.681,95％CI:1.361-5.281),all of which demonstrated statistical significance(P＜0.05).The nomogram model was constructed accordingly.The AUC of the nomogram model was 0.846(95％CI:0.813-0.947).The calibration curve demonstrated good fit via the goodness-of-fit test(Hosmer-Lemeshow x2=0.862,P=0.361).Clinical decision curve analysis revealed that the net benefit rate remained＞0 when the high-risk threshold probability ranged from 1％to 95％,indicating favorable clinical utility of this nomogram model.Based on the model predictions,among 58 heart transplant patients in the validation cohort,34 were classified as high-risk for right heart failure and 24 as low-risk.Actual diagnosis results showed 29 cases with right heart failure and 29 without.The Kappa coefficient reached 0.483(95％CI:0.261-0.705),demonstrating high consistency between model predictions and actual clinical outcomes.Conclusion Preoperative pulmonary systolic pressure increase is an independent risk factor for right heart failure after heart transplantation.A nomogram prediction model for right heart failure after heart transplantation is established by combining other clinical risk factors,and it has good prediction efficiency.

OBJECTIVE To establish a method for determining the contents of clopidogrel(CLP),clopidogrel carboxylate(CLP-C),clopidogrel acyl-β-D-glucuronide(CLP-G)and contents of clopidogrel active metabolite(CAM)in rat plasma,and to investigate their in vivo pharmacokinetic characteristics.METHODS The Shisedo CAPCELL ADME column was used with a mobile phase consisting of water and acetonitrile(both containing 0.1%formic acid)in a gradient elution.The flow rate was 0.4 mL/min,and the column temperature was maintained at 20℃.The injection volume was 2 μL.The analysis was performed in positive ion mode using electrospray ionization with multiple reaction monitoring.The ion pairs for quantitative analysis were m/z 322.1→211.9(for CLP),m/z 308.1→197.9(for CLP-C),m/z 322.1→154.8(for CLP-G),m/z 504.1→154.9[for racemic CAM derivative(CAMD)].Six rats were administered a single intragastric dose of CLP(10 mg/kg).Blood samples were collected before medication and at 0.08,0.33,0.66,1,2,4,6,10,23 and 35 hours after medication.The established method was used to detect the serum contents of various components in rats.Pharmacokinetic parameters were then calculated using WinNonlin 6.1 software.RESULTS The linear ranges for CLP,CLP-C and CAMD were 0.08-20.00,205.00-8 000.00,and 0.04-25.00 ng/mL,respectively(r≥0.990).The relative standard deviations for both intra-day and inter-day precision tests were all less than 15%,and the relative errors for accuracy ranged from-11.68%to 14.40%.The coefficients of variation for the matrix factors were all less than 15%,meeting the requirements for bioanalytical method validation.The results of the pharmacokinetic study revealed that,following a single intagastric administration of CLP in rats,the exposure to the parent CLP in plasma was extremely low.Both the area under the drug concentration-time curve(AUC0-35 h)and the peak concentration of the parent CLP were lower than those of its metabolites.The AUC0-35 h of the active metabolite CAM was approximately 43 times that of CLP,though it had a shorter half-life(2.53 h).The inactive metabolite CLP-C exhibited the highest exposure level,but it reached its peak concentration the latest and was eliminated slowly.The AUC0-35 h of CLP-G was about four times that of CAM,and its half-life was similar to that of CLP-C.CONCLUSIONS This study successfully established an liquid chromatography-tandem mass spectrometry method for the determination of CLP and its three metabolites,and revealed their pharmacokinetic characteristics in rats.Specifically,the parent drug CLP was rapidly eliminated,while the inactive metabolites CLP-C and CLP-G exhibited long half-lives,and active metabolite CAM displayed a transient exposure pattern.

Objective To investigate the therapeutic effect and underlying mechanism of Qishishenshu Capsule on renal fibrosis in mice with early diabetic nephropathy(DN).Methods A DN mouse model was established by multiple injections of streptozotocin.The mice were randomly divided into a normal group(NC),model group(DN),and Qishi group(QS)(0.9 g/(kg·d)),with eight mice in each group.Mice were gavaged continuously for 4 weeks,and fasting blood glucose(FBG)was measured weekly.Four weeks later,urinary albumin/creatinine(UACR),serum creatinine,and blood urea nitrogen were measured.Hematoxylin-eosin,periodicacid-Schiff,and Sirius red staining were used to analyze renal pathological changes.Real-time fluorescence quantitative reverse-transcription polymerase chain reaction was used to detect the mRNA levels of fibronectin(FN),collagen type Ⅰ alpha 1(Col1a1),and α-smooth muscle actin(α-SMA).Immunohistochemistry and Western blot were performed to detect FN,collagen type Ⅰ(Collagen Ⅰ),collagen typeⅢ(Collagen Ⅲ),α-SMA,Podocin,Nephrin,and transforming growth factor-β1/SMAD family member2/3(TGF-β1/Smad2/3)pathway-related proteins.Results Compared with mice in the NC group,those in the DN group showed significantly higher levels of FBG and UACR(P＜0.001),and mesangial hyperplasia,basement membrane thickening,and collagen deposition in the renal tissue.The mRNA levels of FN,Col1a1,and α-SMA were increased(P＜0.05).Protein levels of Podocin and Nephrin were decreased(P＜0.05).The levels of FN,Collagen I,Collagen Ⅲ,α-SMA,and TGF-β1/Smad2/3 pathway proteins were increased(P＜0.05).Compared with the DN group,the QS group's level of UACR was decreased(P＜0.05),their renal pathological injury was alleviated,and mRNA levels of FN,Collagen Ⅰ,andα-SMA were attenuated(P＜0.05);whereas their protein levels of Podocin and Nephrin were elevated(P＜0.05).The levels of FN,Collagen Ⅰ,Collagen Ⅲ,α-SMA,and TGF-β1/Smad2/3 pathway proteins were also decreased(P＜0.05).Conclusions Qishishenshu Capsule improved renal fibrosis in DN mice,probably through the inhibition of the TGF-β1/Smad2/3 signaling pathway.