Purpose: Due to the preservation of the entire stomach after endoscopic resection, the occurrence of metachronous gastric cancer (MGC) remains a possibility. In this study, we investigated the incidence and risk factors for MGC in patients with early gastric cancer who underwent endoscopic submucosal dissection (ESD) and successfully eradicatedHelicobacter pylori. Materials and Methods: A retrospective analysis was conducted of 1,191 patients who underwent ESD and successfully eradicated H. pylori at the Affiliated Drum Tower Hospital of Nanjing University. Endoscopic surveillance was performed at 3, 6, and 12 months post-resection, and annually thereafter. MGC was defined as the development of a new cancer at a site other than the primary gastric cancer site, at least 1 year after the initial endoscopic resection. Results: A total of 77 patients were diagnosed with MGC during a median follow-up of 41.5 months. Kaplan-Meier analysis showed a 5-year cumulative incidence of MGC of 9.4% after successful H. pylori eradication. Multivariate analysis of the training set using Cox proportional hazards models identified male sex, severe atrophic gastritis, multiple gastric cancers before H. pylori eradication, and smoking history as independent risk factors for MGC.The nomogram exhibited favorable discrimination, with area under the curves of 0.767 and 0.822 in the training set and 0.724 and 0.745 in the testing set at 3 and 5 years, respectively. Conclusions Patients with gastric cancer who undergo endoscopic resection, even after successful H. pylori eradication, should undergo annual and continuous endoscopic surveillance for MGC.

Albendazole-glucan particles(ABZ-GPS)and abendazole(ABZ)were used to treat secondary alveolar echinococ-cosis in mice.The therapeutic effects of ABZ-GPS on alveolar echinococcosis in vivo were evaluated,and the feasibility of using glucan particles as anti-hydatid drug carriers was further verified.Mice with echinococcosis were randomly divided into an ABZ group,glucan nanoparticle(GP)group,ABZ-GPS group,and control group.After four courses of administration with a final concentration of 50 mg/mL,the therapeutic effects of ABZ-GPS were evaluated on the basis of imaging,histopathological changes,ultrastructure,and immunology.After ABZ-GPS and ABZ administration,clear liver lesion tissue necrosis and large numbers of infiltrating lymphocytes were observed.Significant differences in the average cyst wet weight(t=7.83,P＜0.05),were observed between the ABZ-GPS group and ABZ group.Imaging revealed that ABZ-GPs were targeted to liver tissue.Pa-thology and ultrastructure analyses demonstrated that the alveolar hydatid cells in the liver in the control group and GP group grew well,and the vesicles were large,filled with cystic fluid,and translucent or transparent;the cyst wall tension was high;no calcification was observed;the stratum corneum and germinal layer were clear;and more fertile capsules and different num-bers of protocephalospora were present in the liver.In the ABZ group,the capsular cavity collapsed,and showed partial necro-sis and lymphocyte infiltration.In the ABZ-GP group,the corneum and germinal layer of echinococcus vesicles were difficult to identify,and we observed bulbous necrosis,central calcification,fibrous tissue hyperplasia,inflammatory cell infiltration,coarser,shorter or absent microvilli of the germinal layer,nuclear shrinkage,dissolution or disappearance,clear expansion of cytoplasmic microtubules,and myelin-like or vacuole-like changes.Therefore,ABZ-GPs showed good targeting and killing ac-tivity in vivo in mice with secondary alveolar coccosis.

Objective:To explore the research hotspots and emerging trends in the field of breast cancer-associated lymphedema, as reflected in the domestic and international literatures.Methods:The bibliometric method was used to retrieve literatures related to breast cancer-associated lymphedema from the Wanfang Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and the core collection of Web of Science, covering the time range from January 1, 2014, to December 31, 2023. CiteSpace 6.3.R3 software was employed for analysis, which involved statistical assessment of the publication volume, authors, countries, and institutions, as well as the identification of highly cited papers. A co-occurrence analysis of keywords was performed, followed by burst analysis and cluster analysis based on the results.Results:A total of 4 419 Chinese-language articles were retrieved from the three Chinese databases, of which 2 888 were included after duplicate removal. The Web of Science Core Collection yielded 2 142 English-language articles. Among the domestic authors, the top three with the highest publication counts were Zhang Lijuan (25 papers), Jia Jie (22 papers), and Zhong Qiaoling (21 papers). In the English-language literatures, the top three authors with the highest number of publications were Singhal D (32 papers), Devoogdt N (27 papers), and Boyages J (27 papers). A total of 76 countries worldwide had conducted research on breast cancer-associated lymphedema, with the United States contributing the most publications (748 papers), followed by China (227 papers). In total, 642 institutions worldwide had publications on this topic, with 385 domestic institutions. The leading domestic institution was Jiangxi Provincial Cancer Hospital (31 papers), while the top foreign institution was Harvard University (118 papers). The Top 10 most cited papers focused on key research areas in breast cancer-associated lymphedema. A total of 359 Chinese keywords and 513 English keywords were included for co-occurrence analysis. The five most frequent Chinese keywords were quality of life, nursing, complications, upper limb function, and risk factors. In the English literatures, the top five most frequent keywords were quality of life, women, survivors, risk factors, and surgery. Cluster analysis of the keywords revealed 16 clusters in the Chinese literatures, with the largest cluster "functional exercise", while 17 clusters were identified in the English literatures, with the largest cluster "lymph node transfer". The five most consistent clusters in Chinese literatures were lymphatic drainage, rehabilitation, functional impairment, evidence-based nursing, and circumferential lymphatics. In recent years, emerging topics in Chinese literatures included lymphatic drainage, breast reconstruction, and pathophysiology. In English literatures, the consistent top clusters were transplantation, node biopsy, morbidity, identification, and randomized trials, with recent emerging topics including obesity, adipose tissue, healing approaches, lymphatic microsurgical preventive healing approach, and anastomosis.Conclusion:The research on breast cancer-related lymphedema both domestically and internationally shows similarities and differences in direction and focus. Common research hotspots across both domestic and international studies include lymphatic drainage, functional exercise, health behaviors, and lymph node transfer. Recent emerging topics in Chinese literatures include lymphatic drainage, breast reconstruction, and pathophysiology. In contrast, English literatures focus more on the areas such as obesity, adipose tissue, healing methods, and lymphatic anastomosis.

Objective:To investigate the impact of fibroblast growth factor(FGF)on recurrence following segmen-tal mastectomy in patients with plasma cell mastitis.Methods:A total of 162 female patients diagnosed with plasma cell mastitis(PCM)were selected from our hospital from October 2021 to May 2023.All patients underwent segmental mastectomy.They were divided into recurrence group(n=28)and non-recurrence group(n=134)according to the follow-up survey on recurrence.Conduct a univariate analysis on the factors influencing recurrence in patients with PCM who undergo segmental mastectomy.After correcting for confounding factors,conduct a multiple linear regression analysis.Using a multivariate logistic regression model to explore the independent risk factors for recurrence in patients undergo-ing segmental mastectomy for PCM.Utilizing logistic regression analysis to explore the independent,multiplicative,or additive interaction between FGF and angiogenic factor in the management of recurrence in PCM patients undergoing segmental mastectomy.The Local Weighted Regression Scatter Method(LOWESS)is used to analyze the two-dimensional curve relationship of continuous variables.Evaluate the predictive efficacy of FGF for PCM recurrence fol-lowing segmental mastectomy using Receiver Operating Characteristic(ROC)curves.Results:The results of univariate analysis showed that the body mass index(BMI),estradiol,prolactin levels,nipple depression,and sinus phase propor-tion of patients in the recurrent group were significantly higher than those in the non recurrent group,and the differ-ences were statistically significant(P＜0.05).Before surgery and 1 and 3 months after surgery,the levels of FGF,vascu-lar endothelial growth factor(VEGF),endostatin(ES),and VEGF/ES in the recurrent group were higher than those in the non recurrent group,with statistically significant differences between the groups(P＜0.05).The intra group comparison results showed that compared with before surgery,all indicators in both groups of patients were significantly reduced at 1 month after surgery(P＜0.05),while in the recurrent group,all indicators were significantly increased at 3 months after surgery(P＜0.001).Logistic regression analysis showed that patients with elevated FGF had a higher risk of recurrence in PCM(P＜0.05).LOWESS analysis found that there is a certain non-linear relationship between PCM recurrence rate and FGF.FGF has good predictive performance for PCM recurrence.After further adjusting for various confounding fac-tors such as BMI,it was found that the angiogenic factor is related to FGF.The interaction results show that there is an additive or multiplicative interaction between FGF and VEGF/ES.Conclusion:FGF elevation increases the risk of re-currence after segmental mastectomy for PCM.FGF and VEGF/ES exhibit additive or multiplicative interactions.FGF has good predictive performance for PCM recurrence.

ObjectiveTo observe the clinical effect of garlic moxibustion with herbal medicinals in treating allergic rhinitis （AR） with latent heat in lung meridian and explore the potential mechanisms. MethodsA total of 70 AR patients with the latent heat in lung meridian were randomly divided into loratadine group （35 cases） and moxibustion group （35 cases）. The loratadine group was treated with loratadine tablets orally， 10mg each time， once a day， one week as a course for 4 courses. The moxibustion group received garlic moxibustion with herbal medicinals once a day， 7 times as one course， for a total of 4 courses. The primary outcome was total nasal symptom score （TNSS）， measured before and after treatment， and at the 1-month follow-up. Secondary outcomes included traditional Chinese medicine （TCM） syndrome score， immunoglobulin E （IgE） level and eosinophils （EOS） level before and after 4 weeks of treatment. Efficacy was evaluated based on the changes in TNSS after treatment. Adverse reactions and events during treatment were observed， and safety evaluation was performed. ResultsA total of 33 patients from each group were included in the final analysis. The moxibustion group had a total effective rate of 93.94% （31/33）， significantly higher than the 75.76% （25/33） of the loratadine group （P＜0.05）. After treatment， both groups showed a significant reduction in TNSS， TCM syndrome score， IgE and EOS levels （P＜0.05 or P＜0.01）， and more reductions were seen in the moxibustion group （P＜0.05）. During follow-up， the moxibustion group also had a lower TNSS than the loratadine group （P＜0.05）. During treatment， one patient in the moxibustion group experienced shortness of breath， and one patient in the loratadine group experienced headache. Both symptoms were mild and improved after symptomatic treatment， allowing them to continue the treatment. ConclusionGarlic moxibustion with herbal medicinals can alleviate nasal inflammatory symptoms， reduce allergic reactions in AR patients， and effectively control AR flare-ups and related inflammatory responses， superior to oral loratadine alone and of good safety.

Organophosphorus nerve agents are the most threatening chemical warfare agents and terrorist agents.The number of nerve agents and their related chemicals involved in the verification of Chemical Weapon Convention(CWC)exceeds ten million,with the majority being isomers.Accurate structural identification of these chemicals has always been one of the challenges in CWC related verification analysis.In this work,a total of 17 kinds of alkyl phosphonate isomers and structural analogs from 5 groups were designed and synthesized,and then analyzed by gas chromatography-mass spectrometry(GC-MS)and gas chromatography-infrared spectroscopy(GC-FTIR).The spectra of isomers or structural analogs obtained from two techniques as well as the structural information provided therein were compared and analyzed.The results showed that for isomers or structural analogs with similar MS spectra,FTIR spectra could provided more structural fingerprint information of compounds and had advantages in confirming structures.Combined with the excellent separation ability of GC,GC-FTIR can be used to assist GC-MS in the structural confirmation of alkyl phosphates,achieving rapid and accurate identification of isomers or structural analogues.

OBJECTIVE: To observe the clinical efficacy of 3D printing spinal external fixator combined with McKenzie therapy for patients with lumbar dics herniation (LDH). METHODS: Sixty patients with LDH between January 2022 and January 2023 were enrolled. Among them, 30 patients were given McKinsey training. According to different treatment methods, all patients were divided into McKenzie group and McKenzie + 3D printing group, 30 patients in each group. The McKenzie group provided McKenzie therapy. The McKenzie + 3D printing group were treated with 3D printing spinal external fixation brace on the basis of McKenzie therapy. Patients in both groups were between 25 and 60 years of age and had their first illness. In the McKenzie group, there were 19 males and 11 females, with an average age of (48.57±5.86) years old, and the disease duration was (7.03 ±2.39) months. The McKenzie + 3D printing group, there were 21 males and 9 females, with an average age of (48.80±5.92) years old, and the disease duration was(7.30±2.56) months. Pain was evaluated using the visual analogue scale (VAS), and lumbar spine function was assessed using the Oswestry disability index (ODI) and the Japanese Orthopaedic Association (JOA) score. VAS, ODI and JOA scores were compared between two groups before treatment and at 1, 3, 6, 9 and 12 months after treatment. RESULTS: All patients were followed up for 12 months. The VAS for the McKenzie combined with 3D printing group before treatment and at 1, 3, 6, 9, and 12 months post-treatment were(6.533±0.860), (5.133±1.008), (3.933±0.868), (2.900±0.759), (2.067±0.640), (1.433±0.504), respectively. In the McKenzie group, the corresponding scores were (6.467±0.860), (5.067±1.048), (4.600±0.968), (3.533±1.008), (2.567±0.728), (1.967±0.809), respectively. The ODI of the McKenzie group before treatment and at 1, 3, 6, 9, and 12 months post-treatment were (41.033±6.810)%, (37.933±6.209)%, (35.467±6.962)%, (27.567±10.081)%, (20.800±7.531)%, (13.533±5.158)%, respectively. For the McKenzie combined with 3D printing group, the corresponding ODI were(38.033±5.605)%, (33.000±6.192)%, (28.767±7.045)%, (22.200±5.517)%, (17.700±4.836)%, (11.900±2.771)%, respectively. The JOA scores of the McKenzie combined with 3D printing group before treatment and at 1, 3, 6, 9, and 12 months post-treatment were(8.900±2.074), (13.133±2.330), (15.700±3.583), (20.400±3.480), (22.267±3.084), (24.833±2.640), respectively. In the McKenzie group, the corresponding scores were(9.200±2.091), (12.267±2.406), (15.333±3.198), (18.467±2.240), (20.133±2.751), (22.467±2.849), respectively. Before the initiation of treatment, no statistically significant differences were observed in the VAS, ODI, and JOA scores between two groups (P>0.05). At 3, 6, 9, and 12 months post-treatment, the VAS in the McKenzie combined with 3D printing group was significantly lower than that in the McKenzie group, and the difference was statistically significant (P<0.05). The comparison of ODI between two groups at 1, 3, 6, 9, and 12 months post-treatment revealed statistically significant differences (P<0.05). At 6, 9, and 12 months post-treatment, the JOA score in the McKenzie combined with 3D printing group was significantly higher than that in the McKenzie-only group, and the difference was statistically significant (P<0.05). CONCLUSION The combination of 3D printed functional spinal external fixation brace with McKenzie therapy can significantly improve and maintain lumbar function in patients with LDH.
Humans ; Male ; Female ; Middle Aged ; Printing, Three-Dimensional ; Intervertebral Disc Displacement/surgery* ; External Fixators ; Lumbar Vertebrae/surgery* ; Adult ; Braces ; Treatment Outcome

BACKGROUND: Low serum albumin levels are established predictors of adverse outcomes in various cardiovascular conditions. However, the role of serum albumin in mortality among elderly patients with chronic aortic regurgitation (AR) has not been thoroughly investigated. This study aims to assess the relationship between serum albumin levels and mortality in this specific patient population. METHODS: Our analysis included 873 elderly AR patients from the China Valvular Heart Disease study, with baseline serum albumin measured at enrollment. Mortality outcomes were monitored for two years post-enrollment, employing a Cox proportional hazards model with a two-piecewise Cox proportional hazards framework to investigate the nonlinear relationship between serum albumin levels and all-cause mortality. RESULTS: During the 2-year follow-up period, we observed 63 all-cause deaths. The association between serum albumin levels and all-cause mortality displayed an approximating L-shaped curve, indicating a mortality threshold at 35 g/L. For serum albumin levels below 35 g/L, each 1 g/L decrease was associated with a 25% higher risk of all-cause mortality (HR = 1.25, 95% CI: 1.07-1.45). In contrast, no significant change in mortality risk was observed when serum albumin levels were greater than or equal to 35 g/L. Moreover, when serum albumin is classified as hypoproteinemia (serum albumin < 35 g/L), the higher risks of all-cause death were observed in hypoproteinemic patients (HR = 2.93, 95% CI: 1.50-5.74). More importantly, the association between serum albumin and death was significantly stronger in overweight/obese patients (≥ 24 kg/m² vs. < 24 kg/m², P _interaction = 0.006). CONCLUSIONS In elderly patients with AR, serum albumin levels showed an approximating L-shaped relationship with all-cause death, with thresholds of 35 g/L. Body mass index was significant effect modifiers of the association. These results suggest that serum albumin, as an inexpensive and readily available biochemical marker, may further improve the stratified risk of mortality in older AR patients.

BACKGROUND: Based on the China-VHD database, this study sought to develop and validate a Valvular Heart Disease- specific Age-adjusted Comorbidity Index (VHD-ACI) for predicting mortality risk in patients with VHD. METHODS & RESULTS: The China-VHD study was a nationwide, multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018. After excluding cases with missing key variables, 11,459 patients were retained for final analysis. The primary endpoint was 2-year all-cause mortality, with 941 deaths (10.0%) observed during follow-up. The VHD-ACI was derived after identifying 13 independent mortality predictors: cardiomyopathy, myocardial infarction, chronic obstructive pulmonary disease, pulmonary artery hypertension, low body weight, anaemia, hypoalbuminaemia, renal insufficiency, moderate/severe hepatic dysfunction, heart failure, cancer, NYHA functional class and age. The index exhibited good discrimination (AUC, 0.79) and calibration (Brier score, 0.062) in the total cohort, outperforming both EuroSCORE II and ACCI (P < 0.001 for comparison). Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694 (95% CI: 0.665-0.723) for 2-year mortality prediction. VHD-ACI scores, as a continuous variable (VHD-ACI score: adjusted HR (95% CI): 1.263 (1.245-1.282), P < 0.001) or categorized using thresholds determined by the Yoden index (VHD-ACI ≥ 9 vs. < 9, adjusted HR (95% CI): 6.216 (5.378-7.184), P < 0.001), were independently associated with mortality. The prognostic performance remained consistent across all VHD subtypes (aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid valve disease, mixed aortic/mitral valve disease and multiple VHD), and clinical subgroups stratified by therapeutic strategy, LVEF status (preserved vs. reduced), disease severity and etiology. CONCLUSION The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.

Objective:To investigate the method and clinical efficacy of simultaneous correction of sunken upper eyelid during double eyelid plasty.Methods:A retrospective analysis was conducted on patients with single eyelids and sunken upper eyelid treated at the Department of Plastic Surgery, the First People’s Hospital of Zhengzhou, from October 2022 to February 2024. All patients underwent incisional double eyelid plasty with individualized correction based on depression severity. For mild depression, a combination of pretarsal orbicularis oculi muscle flap folding and orbital septum fat flap transposition was performed for correction. For moderate depression, additional autologous stromal vascular fraction (SVF)-gel grafting would be performed if residual depression persisted after the aforementioned approach. For severe depression, if the orbital fat was sufficient, the orbicularis oculi muscle flap folding, orbital fat flap repositioning and autologous SVF-gel transplantation were used. If there was insufficient orbital fat, the correction involved the use of a orbicularis oculi muscle flap and SVF-gel transplantation. Postoperative follow-up was conducted regularly, and related complications were statistically analyzed. Six months after the surgery, two blinded plastic surgeons evaluated outcomes via visual analog scale (VAS), including five aspects: symmetry of palpebral folds(including width and curvature of the double eyelid fold), fold contour, depression improvement, scar quality, overall eyelid aesthetics. Each aspect was rated on a scale from 1 to 10, with higher scores indicating better outcomes. Patient satisfaction was scored separately (1-5 per item), with higher scores indicating greater satisfaction.Results:A total of 64 patients were enrolled, including 4 males and 60 females; the age ranged from 19 to 66 years[ (32.0±9.7) years]. The degree of sunken upper eyelid was mild in 33 cases, moderate in 19 cases and severe in 12 cases. All patients underwent double eyelid plasty and orbicularis oculi flap folding. Based on this, 45 cases (33 mild and 12 moderate cases) underwent orbital septum fat flap transposition, 11 severe cases underwent SVF-gel grafting, and 8 cases (7 moderate and 1 severe cases) required combined approaches to correct depression. During the procedure, 19 cases (38 sides) received (1.8±0.8) ml of SVF-gel injection. Among these cases, one case with severe sunken upper eyelid who did not receive orbital fat transfer was injected with high density fat (left side: 0.6 ml, right side: 0.8 ml) due to insufficient SVF-gel volume. Two cases with severe sunken upper eyelid who only had autologous SVF-gel transplantation did not fully correct the depression within 3 months post-surgery received a second SVF-gel injection[(1.0±0.1) ml]. Follow-up was conducted for 6 to 12 months after surgery. All patients experienced varying degrees of eyelid edema, which typically lasted 2 to 3 months. Ecchymosis (34 sides), conjunctival congestion (3 sides), and temporary ptosis (5 sides) all resolved within 2 weeks. Pigmentation (14 sides) and scar hyperplasia (3 sides) disappeared or stabilized within 6 months. No patients developed complications such as incision infection, hematoma, fat liquefaction, local skin unevenness, or induration. The surgeons’ VAS scores of the above five indicators were all > 8 points, and the satisfaction scores of patients for the five indicators were all > 4 points. In both scoring, the improvement of sunken upper eyelid scored the highest, which were (9.2 ± 0.9) points and (4.8 ± 0.6) points respectively.Conclusion:For patients with single eyelids and varying degrees of sunken upper eyelid, performing double eyelid plasty and orbicularis oculi muscle flap folding, individualized correction is achieved through autologous fat redistribution techniques, based on the severity of the sunken upper eyelid and the amount of orbital fat. This single procedure can restore upper eyelid volume and rejuvenate the appearance, resulting in a natural and aesthetically pleasing double eyelid with minimal complications and high patient satisfaction.