Objective:To investigate the distribution characteristics of CTLA-4 on the surface of CD4+T cells in patients with breast cancer at different stages,and to evaluate its predictive value for the efficacy of radical mastectomy.Methods:A retrospective study was conducted on 200 breast cancer patients admitted between January 2020 and December 2022.Patients were divided into four groups based on clinical staging:stage Ⅰ(64 cases),stage Ⅱ(57 cases),stage Ⅲ(43 cases),and stage Ⅳ(36 cases).The clinical pathological characteristics of the four groups were compared,and the expression level of CTLA-4 on the surface of CD4+T cells in peripheral venous blood(CTLA-4+CD4+)was detected.Patients were divided into a poor prognosis group(52 cases)and a good prognosis group(148 cases)based on their prognosis,and the clinical pathological characteristics of the two groups were compared.A stratified regression model was used to analyze the relationship between CTLA-4+CD4+expression levels and different clinical characteristics.Logistic regression analysis was employed to evaluate the independent correlation between CTLA-4+CD4+expression levels and the risk of poor prognosis.An unconditional logistic regression model was used to analyze the multiplicative interaction effect of CTLA-4+CD4+expression levels and clinical staging on prognosis prediction.Restricted cubic spline analysis was used to investigate the relationship between CTLA-4+CD4+expression levels and poor patient prognosis.Results:Significant differences were observed in tumor diameter,ECOG score,lesion multiplicity,lymph node metastasis,tumor differentiation degree,ER,PR,HER2,Ki-67,CA125,CA153,and CEA among patients with different clinical stages(P<0.05).Significant differences were also observed in CD3+,CD4+,CD8+,and CTLA-4+CD4+(P<0.05).As the clinical stage increased,the proportions of CD3+,CD4+,and CD8+decreased,while the proportion of CTLA-4 on the surface of CD4+T cells increased(P<0.05).Significant differences were observed in clinical stage,tumor diameter,lymph node metastasis,tumor differentiation degree,ECOG score,ER,PR,HER2,and CTLA-4+CD4+among patients with different prognosis groups(P<0.05).Hierarchical regression analysis indicated that clinical stage,tumor diameter,lymph node metastasis,tumor differentiation degree,ECOG score,and HER2 had a significant positive impact on CTLA-4+CD4+(P<0.05),while ER and PR had a significant negative impact on CTLA-4+CD4+(P<0.05).Logistic regression analysis showed that CTLA-4+CD4+was positively correlated with poor prognosis(P<0.05).CTLA-4+CD4+and clinical stage had multiplicative and additive interactions on prognosis.Regardless of the clinical stage,CTLA-4+CD4+on the surface of CD4+T cells was significantly positively correlated with poor prognosis.Conclusion:The expression level of CTLA-4+CD4+in patients with advanced breast cancer is significantly elevated,playing a crucial role in the clinical pathological characteristics of breast cancer.An elevated level may indicate a poor prognosis.

Obejective Based on the Citespace software,this study aims to comb the research hotspots and core contents of the development process of the TMD field in China,and carefully understand the research evolution process of the Temporo-mandibular Disorders(TMD)related fields in China,clarify its development timeline.Methods Using CNKI as the database source,through CiteSpace 6.1R6,we completed keyword co-occurrence,keyword clustering and emergence,and timeline knowledge mapping,and conducted a retrospective analysis of TMD-related literature published in China.Results A total of 2,034 domestic articles related to TMD were counted,and the development characteristics were obtained through data analysis:the treatment methods of TMD had evolved from combining traditional Chinese and Western medicine to Western medicine taking the dominant position,the research population had evolved from special populations to the general population,the focus had shifted from TMD itself to TMD-related and concurrent diseases,and the scope of research had continued to expand.Conclusions The development of literature on TMD disease has gone through three different periods,and there has been a significant shift in the research hotspots of TMD in China.The popularization rate of disease knowledge in TMD is not high,and further education needs to be provided to the general public.

Objective:To investigate the distribution characteristics of CTLA-4 on the surface of CD4+T cells in patients with breast cancer at different stages,and to evaluate its predictive value for the efficacy of radical mastectomy.Methods:A retrospective study was conducted on 200 breast cancer patients admitted between January 2020 and December 2022.Patients were divided into four groups based on clinical staging:stage Ⅰ(64 cases),stage Ⅱ(57 cases),stage Ⅲ(43 cases),and stage Ⅳ(36 cases).The clinical pathological characteristics of the four groups were compared,and the expression level of CTLA-4 on the surface of CD4+T cells in peripheral venous blood(CTLA-4+CD4+)was detected.Patients were divided into a poor prognosis group(52 cases)and a good prognosis group(148 cases)based on their prognosis,and the clinical pathological characteristics of the two groups were compared.A stratified regression model was used to analyze the relationship between CTLA-4+CD4+expression levels and different clinical characteristics.Logistic regression analysis was employed to evaluate the independent correlation between CTLA-4+CD4+expression levels and the risk of poor prognosis.An unconditional logistic regression model was used to analyze the multiplicative interaction effect of CTLA-4+CD4+expression levels and clinical staging on prognosis prediction.Restricted cubic spline analysis was used to investigate the relationship between CTLA-4+CD4+expression levels and poor patient prognosis.Results:Significant differences were observed in tumor diameter,ECOG score,lesion multiplicity,lymph node metastasis,tumor differentiation degree,ER,PR,HER2,Ki-67,CA125,CA153,and CEA among patients with different clinical stages(P<0.05).Significant differences were also observed in CD3+,CD4+,CD8+,and CTLA-4+CD4+(P<0.05).As the clinical stage increased,the proportions of CD3+,CD4+,and CD8+decreased,while the proportion of CTLA-4 on the surface of CD4+T cells increased(P<0.05).Significant differences were observed in clinical stage,tumor diameter,lymph node metastasis,tumor differentiation degree,ECOG score,ER,PR,HER2,and CTLA-4+CD4+among patients with different prognosis groups(P<0.05).Hierarchical regression analysis indicated that clinical stage,tumor diameter,lymph node metastasis,tumor differentiation degree,ECOG score,and HER2 had a significant positive impact on CTLA-4+CD4+(P<0.05),while ER and PR had a significant negative impact on CTLA-4+CD4+(P<0.05).Logistic regression analysis showed that CTLA-4+CD4+was positively correlated with poor prognosis(P<0.05).CTLA-4+CD4+and clinical stage had multiplicative and additive interactions on prognosis.Regardless of the clinical stage,CTLA-4+CD4+on the surface of CD4+T cells was significantly positively correlated with poor prognosis.Conclusion:The expression level of CTLA-4+CD4+in patients with advanced breast cancer is significantly elevated,playing a crucial role in the clinical pathological characteristics of breast cancer.An elevated level may indicate a poor prognosis.

Objective:To study the correlation between spontaneous cerebrospinal fluid rhinorrhea and increased intracranial pressure.Methods:Clinical data of patients with spontaneous cerebrospinal fluid rhinorrhea treated in the Department of Otorhinolaryngology of the Provincial Hospital of Shandong First Medical University from January 2019 to December 2023 and their epidemiology, clinical symptoms and signs, preoperative cerebrospinal fluid pressure, imaging data, leakage site, repair method and the presence or absebce of increased intracranial pressure were analysed. SPSS 23.0 software was used for statistical analysis.Results:Of the 57 patients with cerebrospinal fluid nasolacrimal leakage, 84.2%(48/57) were females and 15.8%(9/57) were males; 80.7%(46/57) were between 40 and 60 years old; and overweight and obese patients accounted for 75.4%(43/57). Of 57 patients, 35 patients received cranial MRI+magnetic resonance venography, and among them, 12(34.3%) patients were clinically with headache symptoms; the incidences of empty pterygoid and venous sinus stenosis were 40.0%(14/35) and 51.4%(18/35), respectively; and 33 patients underwent preoperative lumbar puncture examination, of whom 25(75.8%) patients had the increased cerebrospinal fluid pressure and 1 patient had idiopathic intracranial hypertension. All 57 patients underwent dural repair of the skull base, the postoperative follow-up period ranged from 3 to 60 months, and the success rate of surgery was 94.7%. The success rate was 100% in female patients and 33.3%(3/9) in male patients, including one with surgical failure receiving reoperation and two with postoperative recurrence in other areas of the skull base, with significant difference in the success rate of surgery between males and females (χ 2=16.890, P<0.001). Conclusions:Most patients with spontaneous cerebrospinal fluid rhinorrhea have the increased cerebrospinal fluid pressures, but very few fulfil the diagnosis of idiopathic intracranial hypertension. The success rate of surgical repair alone is high, but some recurrences still exist, especially in male patients.

Objective: To analyze the method and effect of reconstruction of the orbital floor defect with preserved orbital contents after advanced maxillary sinus cancer resection. Methods: Thirty-three patients of T3/T4 stage maxillary sinus cancer with orbital invasion who were treated in Shandong Provincial Hospital from January 2010 to October 2016 were retrospectively analyzed, including 20 males and 13 females, aged from 12 to 80 years old. Patients were treated with appropriate surgical methods according to their clinical manifestation, imaging finding, invasion range, preoperative and intraoperative pathology. Surgical approaches such as maxillectomy, expanded maxillectomy and superstructure maxillectomy were used for patients with Medpor orbit floor repairment. Patients were followed up regularly after surgery, and the surgical efficacy was discussed by descriptive statistical method. Results: Of those 33 cases, 19 were squamous cell carcinoma, 8 were adenoid cystic carcinoma, 5 were inverted papilloma malignant transformation, and 1 was myoepithelial carcinoma in our study. After tumor resection and orbital floor repair, the orbital contents and eyeball function of all patients remained intact. During follow-up time ranged from 3 to 8 years, a total of 6 patients relapsed at 3 years and died of ineffective treatment. The survival rate was 81.8% (27/33). Conclusion Tumor resection and Medpor orbital floor repair in maxillary sinus cancer patients with orbital invasion can preserve the function of the eyeball well, greatly improve the quality of patient′s life.

Objective To compare the effects of high negative pressure drainage and conventional drainage on postoperative blood loss and wound healing in patients with calcaneal fracture. Methods A prospective randomized controlled single-blinded trial was conducted on the 66 patients with closed calcaneal facture who had been treated from June 2012 to March 2016 in our hospital. They were randomized by coin into 2 groups: 36 patients (aged from 21 to 65 years with a mean age of 38.1 years) were treated with a high vacuum drainage system while the other 30 (aged from 19 to 66 years with a mean age of 37.5 years) with a conventional silicone tube and a drainage vessel. The 2 groups were treated by the same team of surgeons and the same surgical procedures. The 2 groups were compared in terms of postoperative drainage volume, hemoglobin (HGB), bleeding volume, wound healing time, incision complications and wound infection. Results The high negative pressure group incurred significantly greater drainage volume (516.7 ± 138.8 mL) and bleeding volume (612.9 ± 179.5 mL) than the conventional drainage group (305.8 ± 95.4 mL and 437.8 ± 102.0 mL) (P <0.05). The former incurred significantly less HGB (116.8 ± 6.9 g/L) and wound healing time (15.2 ± 3.1 d) than the latter (124.1 ± 7.8 g/L and 18.5 ± 4.2 d) (P <0.05). The rate of incision complications for the high negative pressure group (5.6%, 2/36) was significantly lower than that for the conventional drainage group (26.7%, 8/30) (χ2=4.150, P=0.042). There was no significant difference between the 2 groups in the rate of wound infection (0 versus 3.3%) (P=0.927). Conclusion After surgery for calcaneal fractures, high negative pressure drainage may lead to faster wound healing and fewer postoperative wound complications but greater blood loss and lower HGB than conventional drainage.

Objective To observe the effect of remifentanil combined with propofol to induce and sustain controlled hypotension in children during endoscopic sinus surgery(ESS). Methods Forty ASA Ⅰ children undergoing adenoidectomy in ESS were divided into control group and controlled hypotension group by random digits table with 20 cases in each group. No controlled hypotension in control group. Anesthesia was induced with propofol,remifentanil and atracurium, and maintained with continuous infusion of propofol 2 min until the target mean arterial pressure (MAP)(55 - 60 mm Hg, 1 mm Hg = 0.133 kPa) was reached,and MAP was maintained at this level during operation in controlled hypotension group. During 15 min before surgical procedure pharynx nasalis blood flow was measured and recorded with laser Dopper flowmetry continuously. The quality of the surgical field in term of blood loss and dryness was established at 15 min after operation starting. Results Controlled hypotension was induced within (2.5 ± 0.3 ) min, the infusion rate ofMAP and heart rate at 15 min after controlled hypotension and 15 min after operation starting were significantly lower than those at controlled hypotension instantly in controlled hypotension group and control group (P ＜ 0.05 ). The pharynx nasalis blood flow decreased at 15 min after controlled hypotension from baseline [(68.3 ± 8.3 )% vs. (99.8 ± 7.9 )%] (P ＜ 0.05 ). The operation time and the quality of the surgical field in term of blood loss and dryness in controlled hypotension group were better than those in control group [(21 ± 4) min vs. (32 ± 6) min and ( 1.8 ± 0.1 ) scores vs. (3.5 ± 0.5) scores] (P ＜ 0.05 ). The awakeextubate time was within 10 min in two groups, and there were no anesthesia related complications.Conclusion Remifentanil combined with propefol can induce and sustain controlled hypotension,reduce pharynx nasal is blood flow and provide good surgical conditions in children for ESS.

OBJECTIVE: To investigate the clinical and pathological characteristics of sinonasal neoplasms. METHOD: A cohort of 333 patients with sinonasal neoplasm, which were confirmed by surgical pathology, were enrolled in this study. The clinicopathological characteristics, in terms of age, sex, location, and disease constituent ratio were retrospectively reviewed. RESULT: (1) In this series of patients, there were 200 males and 133 females, aged from 2 to 84 years, with a median of 54 years. The benign to malignant ratio was 1.1:1. As for their origination, 144 tumors arose from the nasal cavity, while, 191 tumors derived from sinus, including 90 from maxillary sinus, 31 from frontal sinus, 46 from ethmoid sinus, and 24 from sphenoidal sinus. (2) Disease constituent ratio decreased in order of epithelial tissue, soft tissue, lymphohematopoietic tissue, bone and cartilaginous tissue, ectopic intracranial tumors. The five most frequent malignant tumors were squamous carcinoma, lymphoma, adenoid cystic carcinoma, malignant melanoma and esthesioneuroblastoma, while, benign tumors ranked in the top five were papilloma, fibroma, osteoma, angioma and ectopic intracranial tumors,respectively. (3) Of 200 cases arising from epithelium, 118 were benign, 82 were malignant, and the benign to malignant ratio was 1.4:1. Of 68 cases from soft tissue, 37 were benign and 31 were malignant tumors (ratio, 1.2:1). Among the 22 cases from bone and cartilaginous tissue, 17 were benign and 5 were malignant (ratio, 3.4:1). With respect to the 29 cases from lymphohematopoietic tissue, the majority of tumors were malignant (28 cases), with only one benign case. In addition, ectopic intracranial tumors were also observed. Besides the above all, 12 cases of other types were found in this work. CONCLUSION Neoplasms from different parts of nasal cavity and paranasal sinus have specific clinical characteristics. The pathological types of these tumors may be highly diverged. The diagnosis and differential diagnosis depend mainly on pathological examination. Comprehensive treatment, which employs surgery in combination with other modalities, is the main strategy for these tumors.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Nose Neoplasms ; diagnosis ; pathology ; surgery ; Papilloma, Inverted ; diagnosis ; pathology ; surgery ; Paranasal Sinus Neoplasms ; diagnosis ; pathology ; surgery ; Retrospective Studies ; Young Adult

Objective To valuate different effects in hepatectomy of three inflow occlusion methods including pringle maneuver, hemihepatic occlusion and portal venous occlusion. Methods 180 patients undergoing hepatectomy were randomly assigned to pringle group (group A), hemehepatic occlusion group (group B)or PV occlusion group (group C). The amount of blood lost, measurements of liver enzymes alanine aminotransferase (ALT), aspirate aminotransferase (AST), total bilirubin (TB), Serum albumin (ALB) and postoperative complication were also recorded. Results There was no operative mortality. One patient in group B changed into pringle maneuver due to the difficulties in dissecting the hemi-hepatic portal and was excluded. The amount of hemorrhage of three groups had no statistical difference. The ALT, AST, ALB and TB level of 1,3,7 days after operation had significant differences in three groups. The pringle group had a higher level ALT,AST,TB and lower ALB level than the other two groups. Conclusions All techniques of occlusion are effective and feasible for patients undergoing hepatectomies. However, compared with pringle maneuver, PV clamping and hemihepatic occlusion can relieve the liver function damage after hepatectomy.