Objective To investigate the risk factors for postoperative recurrence and metastasis in patients with T1 stageⅢ/Ⅳ clear cell renal cell carcinoma(ccRCC), and to analyze the influence of surgical methods on prognosis, so as to provide prognostic evaluation and treatment guidance for clinical practice. Methods A retrospective analysis was conducted on 398 patients diagnosed with T1 stage Ⅲ/Ⅳ ccRCC who underwent either partial nephrectomy(PN)or radical nephrectomy(RN)at Jiangsu Province Hospital during Jan. 2008 and Sep. 2022. The patients were divided into recurrence group(n=49)and non-recurrence group(n=349)according to whether the tumor recurred during the follow-up period. The general, clinical data and prognosis were compared between the two groups. Univariate and multivariate Cox regression analyses were used to explore the factors influencing disease-free survival(DFS)and overall survival(OS)after surgery. Subgroup analysis using Kaplan-Meier curves was performed for T1a and T1b patients. Results During the median follow-up of 67(42, 98)months, the recurrence group was characterized by older age, larger tumor diameter, higher proportion of T1b stage, and more complex tumor anatomy. Univariate and multivariate Cox regression analyses showed that age ≥55 years and R.E.N.A.L. score ≥7 were independent risk factors for poorer DFS and OS(P＜0.05). Subgroup analysis revealed that PN or RN did not significantly affect DFS or OS in T1a patients and OS in T1b patients, while RN significantly improved DFS in T1b patients(P＜0.05). Conclusion Age ≥55 years and R.E.N.A.L. score ≥7 are independent risk factors for poor DFS and OS in highgrade T1 ccRCC patients. For T1b patients, RN may improve DFS.

Objective To compare the smile incision combined with indirect reduction technique with traditional ORIF technique and systematically evaluate the advantages of this innovative surgical method in terms of functional recovery and postoperative cosmetic effects.Methods A total of 60 patients with midshaft clavicle fractures were enrolled between October 2022 and August 2024.The patients were randomly assigned to either ORIF group(open reduction and internal fixation,n=30)or MIPPO group(MIPPO combined with smile incision,n=30).Outcomes assessed included surgical trauma,functional recovery,and cosmetic outcomes.Results The MIPPO group exhibited significantly reduced intraoperative blood loss[(32.9±7.6)mL vs.(90.2±14.0)mL,P＜0.05],shorter incision length[(3.0±0.5)cm vs.(8.5±1.2)cm,P＜0.05],and reduced operative time compared to the ORIF group.Functional recovery indicators such as bone healing time[(10.1±1.7)weeks vs.(12.8±2.0)weeks,P＜0.05],initial and complete self-care time,and weight-bearing recovery were all significantly improved in the MIPPO group.The Constant-Murley score was higher in the MIPPO group(91.5±5.1 vs.82.4±6.0,P＜0.05).Cosmetic outcomes also favored the MIPPO group,with a superior SBSES score(9.2±0.4 vs.3.0±0.7,P＜0.05)and better results in scar visibility,pigmentation,thickness,and elasticity.Conclusion The smile incision combined with indirect reduction technique significantly reduces surgical trauma,accelerates postoperative recovery,and provides substantially better cosmetic outcomes compared to conventional methods,making it particularly suitable for patients with high aesthetic expectations.

OBJECTIVE To retrospectively analyze the clinical efficacy of Qingchi San in the treatment of mild-to-moderate ul-cerative colitis.METHODS A retrospective analysis was conducted on 221 ulcerative colitis patients treated at the Gastroenterology Department of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from December 2014 to February 2024.Participants were divided into an observation group(n=121)and a control group(n=100).The control group received oral me-salazine,while the observation group received Qingchi San enema in addition to the control group's treatment.Both groups received a 4-week course of treatment.The two groups were compared in terms of clinical efficacy,clinical remission rate,TCM syndrome score,time to intestinal bleeding remission,and changes in inflammatory markers(C-reactive protein,erythrocyte sedimentation rate,and white blood cells)and coagulation markers(platelets and D-dimer).RESULTS After treatment,the total effective rate and clinical remission rate in the observation group were significantly higher than those in the control group(P<0.05,P<0.01).The TCM syn-drome scores for each item(diarrhea,abdominal pain,bloody stools with mucus,and tenesmus)in the observation group were signifi-cantly improved compared with those in the control group(P<0.01).The time to intestinal bleeding remission in the observation group was significantly shorter than that in the control group(P<0.01).C-reactive protein,erythrocyte sedimentation rate,and white blood cell count in the observation group were significantly decreased compared with those in the control group(P<0.05,P<0.01).There was no statistically significant difference in coagulation markers(platelets and D-dimer)between the two groups(P>0.05).No signif-icant treatment-related adverse reactions,such as liver and kidney damage,were observed during treatment.CONCLUSION Qing-chi San enema can improve the clinical efficacy of patients with mild-to-moderate ulcerative colitis,improve clinical symptoms,short-en bleeding time,and reduce inflammatory markers.

Objective:To investigate the association between blood selenium levels and sex hormones in Chinese men aged 18-79 years.Methods:Data were derived from the China National Human Biomonitoring survey conducted in 2017-2018, with a final sample size of 5 414 men. General demographic characteristics, behavioral habits, and dietary frequency were collected through questionnaires and physical examinations. Fasting blood samples were collected to measure blood lead, serum testosterone, and estradiol levels. Complex sampling linear regression models were used to analyze the associations between blood selenium levels and testosterone, estradiol, and the testosterone/estradiol ratio, adjusting for confounding factors including age, education level, marital status, smoking status, alcohol consumption, seafood intake, soy product intake, protein supplement intake, BMI, and diabetes status.Results:The mean age of the 5 414 participants was (46.85±27.91) years; 4 774 (91.65%) were of Han ethnicity and 4 505 (86.68%) were married. The median ( Q1, Q3) blood selenium concentration in men was 97.80 (80.64, 116.99) μg/L. After adjusting for confounding factors, the complex sampling linear regression model revealed negative associations between blood selenium levels and both testosterone levels and the testosterone/estradiol ratio, with a significant linear trend ( Ptrend<0.05). Compared with the Q1 group, the β (95% CI) values for testosterone in the Q2, Q3, and Q4 groups were -0.02 (-0.06 to 0.02), -0.03 (-0.08 to 0.01), and -0.06 (-0.09 to -0.02), respectively. Similarly, the β (95% CI) values for the testosterone/estradiol ratio in the Q2, Q3, and Q4 groups were -0.01 (-0.03 to 0.02), -0.01 (-0.04 to 0.04), and -0.03 (-0.06 to -0.01), respectively. Subgroup analysis indicated stronger associations between blood selenium levels and testosterone/estradiol levels in non-smoking and obese men (BMI≥28 kg/m2). Conclusion:Blood selenium levels are negatively associated with testosterone levels and the testosterone/estradiol ratio in Chinese adult males.

Background and purpose:Polo-like kinase 4(PLK4)is a cell cycle regulatory protein,which is closely related to the occurrence and development of a variety of malignant tumors.The aim of this study was to investigate the role of PLK4 in the proliferation,invasion and apoptosis of oral squamous cell carcinoma(OSCC).Methods:Gene Expression Profiling Interactive Analysis 2(GEPIA2)and the University of Alabama at Birmingham Cancer Data Analysis Portal(UALCAN)were used to analyze the expression of PLK4 in head and neck squamous cell carcinoma and surrounding normal tissues.Real-time fluorescence quantitative polymerase chain reaction(RTFQ-PCR)and Western blot were employed to evaluate the mRNA and protein expression of PLK4 in OSCC cells.We further analyzed PLK4,phosphoinositide 3-kinase(PI3K),phosphorylated phosphoinositide 3-kinase(p-PI3K),protein kinase B(AKT),phosphorylated protein kinase B(p-AKT),survivin,and cyclin D1 protein expression.The effects of PLK4 on cell proliferation,apoptosis and invasion were analyzed by cell counting kit-8(CCK-8)assay,flow cytometry and transwell assay.In addition,12 4-week-old SPF BALB/c female nude mice were divided into sh-NC group(n=6)and sh-PLK4 group(n=6)by random number table method.The sh-NC/sh-PLK4 cells were injected into the right anterior armpit of nude mice for subcutaneous tumor formation.The body weight,tumor volume and tumor weight of the two groups of nude mice were observed,and the stripped tumor tissues were analyzed by H-E staining.The animal experiments were approved by the Animal Experiment Center of Shandong Second Medical University(No:2024SDL840).Results:The results of GEPIA2 and UALCAN online databases showed that PLK4 was highly expressed in OSCC compared with normal tissues.In addition,PLK4 was highly expressed in OSCC cell lines(HN6,Cal-27,SCC-4,SCC-9,SCC-25)compared with oral mucosal epithelial cells(P＜0.05).Western blot results showed that the expression levels of PI3K/AKT signaling pathway proteins p-PI3K,p-AKT,cyclin D1 and survivin were decreased after PLK4 knockdown and increased after PLK4 overexpression in OSCC cells(P＜0.05).The cell proliferation activity and the number of transmembrane cells were positively correlated with the decrease and increase of PLK4 expression(P＜0.05),while the cell apoptotic rate was negatively correlated(P＜0.05),indicating that cell proliferation and apoptosis were both affected.In addition,compared with the sh-NC group,the tumor volume and weight of the nude mice in the sh-PLK4 group were decreased(P＜0.05),while there was no significant difference in the body weight of the nude mice between the two groups(P＞0.05).Moreover,the nuclear atypia of tumor tissues in sh-PLK4 group was lower than that in sh-NC group(P＜0.05).Conclusion:PLK4 can regulate the invasion,proliferation and apoptosis of OSCC cells,potentially through the activation of PI3K/AKT signaling pathway.

Objective:To explore the association of blood and urinary cadmium levels with lipid profile levels and dyslipidemia in Chinese adults aged 18 to 79 years.Methods:Based on the China National Human Biomonitoring (CNHBM) program, a cross-sectional survey was conducted from 2017 to 2018 using a multi-stage stratified random sampling method, including a total of 10 713 adults aged 18 to 79 years. Data was obtained through questionnaires, physical examinations, biological sample collection, and laboratory testing. Multiple linear mixed effect model (MLMM) and generalized linear mixed effect model (GLMM) were used to analyze the association of blood and creatinine-corrected urinary cadmium levels with lipid profile levels as well as dyslipidemia among adults.Results:The age of 10 713 participants was (47.23±0.24) years, with 5 372 males accounting for 61.3% of the national population. The weighted mean±standard error (SE) of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) was (5.21±0.03), (1.86±0.03), (2.96±0.03), and (1.43±0.01) mmol/L, respectively. The prevalence rate of hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, low HDL-C, and high LDL-C was 16.0%, 21.6%, 6.6%, 13.5%, and 10.0%, respectively. MLMM showed that, after adjusting for relevant confounders, log-transformed blood cadmium levels were positively associated with increased levels of TC, TG and LDL-C ( P<0.05). When blood cadmium levels were categorized into quartiles, compared to the lowest exposure group ( Q1), participants in the highest blood cadmium exposure group ( Q4) had increases of 0.19 (95% CI: 0.06, 0.32) mmol/L in TC and 0.25 (95% CI: 0.08, 0.43) mmol/L in TG. GLMM indicated that, after adjusting for confounders, higher blood cadmium exposure levels were associated with increased risks of hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, and high LDL-C ( P<0.05). Further analysis by quartiles showed that, compared to the blood cadmium Q1 exposure group, the OR value (95% CI) for the Q4 group was 1.53 (1.12, 2.08) for hypercholesterolemia, 1.54 (1.09, 2.17) for hypertriglyceridemia, 2.24 (1.47, 3.40) for mixed hyperlipidemia, and 1.49 (1.07, 2.09) for high LDL-C. Conclusion:The cadmium internal exposure levels are associated with blood lipid profile levels as well as the incidence of dyslipidemia in Chinese adults aged 18 to 79.

Objective To explore the clinical features,treatment and prognosis of traumatic subdural effusion(TSE)in infants.Methods Data of 51 cases of traumatic subdural effusion in infants admitted to the single center of Dalian Women and Children Medical Center(Group)from February 2013 to February 2020 were retrospectively analyzed,and their clinical manifestations,imaging features,treatment methods and prognosis were summarized and analyzed.Results Fifty-one cases(26 males and 25 females),ranging in age from 1 month to 3 years old of traumatic subdural effusion in infants were reviewed in our hospital,all cases were confirmed by Computed Tomography(CT)examination.31 cases were treated conservatively,29 cases were cured,and 2 cases were treated surgically due to poor conservative treatment.Surgical treatment was performed in 22 cases(including 2 cases who received surgical treatment due to poor conservative treatment).One patient underwent puncture and continuous drainage at the lateral Angle of the anterior fontanelle and was cured.Twenty-one cases underwent cranial drilling,subdural space catheterization for external drainage,and 17 cases(80.95％,17/21)were cured at one time.There were 4 cases(19.05％,4/21)of recurrence after external drainage with catheterization.Two cases were cured by external drainage with Ommaya capsule insertion and intermittent aspiration and fluid drainage.It was changed to subdural peritoneal shunt surgery,and 2 cases were cured after the operation.There was no surgical infection or death in all the children in the group.The median follow-up time ranged from 3 months to 60 months,and the conditions were all stable.Conclusion Traumatic subdural effusion is a common complication after craniocerebral injury in infants and young children.Due to its lack of self-expression,the hidden condition is often ignored.Moreover,the brain tissue of infants and young children is in the growth and development stage,which will affect the development of brain tissue after its onset.

Objective To investigate the value of CT perfusion imaging (CTP) combined with serum eicosapentaenoic acid (EPA)/arachidonic acid (AA) in predicting hemorrhage transformation and short-term prognosis after thrombolysis in acute ischemic stroke (AIS) patients with leukoaraiosis. Methods Ninety-eight AIS patients with leukoaraiosis admitted to the department of neurology of our hospital from January 2021 to December 2022 were selected and divided into the hemorrhage transformation group and non-hemorrhage transformation group according to whether hemorrhage transformation occurred after thrombolysis. The Fazekas scale was used to evaluate the leukoaraiosis of the patients. CTP parameters and EPA/AA were compared between patients in the two groups and patients with different degrees of leukoaraiosis in the hemorrhage transformation group. The predictive value of CTP parameters and EPA/AA on the occurrence of hemorrhage transformation was evaluated by receiver operating characteristic (ROC) curve. The prognosis was assessed according to the modified Rankin scale (mRS) score 1 month after thrombolysis;the linear and linear combinations are used to evaluate the linear relationship between variables;the ROC curve was used to evaluate the predictive value of CTP parameters and EPA/AA in the short-term prognosis of patients. Results The reactive cerebral blood flow (rCBF),reactive cerebral blood volume (rCBV),CTP integration index and EPA/AA in the hemorrhage transformation group were significantly lower than those in the non-hemorrhage transformation group (P<0.05),while the relative time to peak (rTTP) was significantly longer than that in the non-hemorrhage transformation group (P<0.05). The incidence of hemorrhage transformation increased with the increase of leukoaraiosis degree (P<0.05). In the hemorrhage transformation group,rCBF,rCBV,CTP integration index and EPA/AA of patients with mild leukoaraiosis were higher than those of patients with moderate-severe leukoaraiosis (P<0.05). In patients with mild leukoaraiosis,the area under the curve (AUC) of rCBF and EPA/AA in predicting hemorrhage transforma-tion were 0.712 and 0.720,respectively (P<0.05);in patients with moderate-severe leukoaraiosis,the AUC of rCBF,rCBV,rTTP,CTP integration index and EPA/AA in predicting hemorrhage transformation were 0.738,0.714,0.717,0.739 and 0.742,respectively (P<0.05). Among the 98 patients received thrombolysis,35 patients had a poor prognosis. The AUC of rCBF,rCBV,CTP integration index and EPA/AA in predicting short-term prognosis were 0.742,0.732,0.704 and 0.738,respectively,and the AUC of the four combined prediction was 0.968. Conclusion CTP parameters and EPA/AA have a certain predictive value for the occurrence of hemorrhage transformation after thrombolysis in AIS patients with leukoaraiosis,and rCBV,rCBF,CTP integration index and EPA/AA are important influencing factors of the short-term prognosis for these patients.

Objective:To introduce the research and innovations around the application of aquatic rehabilitation techniques in the treatment of lumbago, and to summarize specific methods and applications in aeromedicine. Literature resource and selection Literature on the prevention and treatment of lumbago using aquatic rehabilitation techniques as well as on the rehabilitation of lumbago in pilots was retrieved and selected. Literature quotation Sixty-one references were cited. Literature synthesis Aquatic rehabilitation techniques can be classified into shower therapy, immersion therapy, and aquatic exercise therapy according to treatment regimens. Among them, immersion therapy and aquatic exercise therapy are commonly used in the treatment of lumbago. Aquatic rehabilitation techniques can effectively alleviate patients′ lumbago, improve their functional disorders, and enhance their quality of life. Prior to aquatic therapy, patients with lumbago need to have their motor function assessed to tailor the treatment protocol based on diagnostic findings and specific therapeutic objectives. Aquatic rehabilitation techniques, when used to prevent and treat lumbago in pilots under convalescence, are not only more effective than land-based training, but also more accessible to pilots due to their comfort and compliance. Many of our military rehabilitation and convalescent centers in China have integrated modern aquatic rehabilitation techniques into rehabilitation treatment by drawing on their rich water resources so as to improve the physical and mental health, social adaptability and military adaptability of pilots. Conclusions:When used for the prevention and treatment of lumbago, aquatic rehabilitation techniques are highly effective, safe and enjoyable, so they should be made more accessible to pilots during convalescence.

Objective To compare the smile incision combined with indirect reduction technique with traditional ORIF technique and systematically evaluate the advantages of this innovative surgical method in terms of functional recovery and postoperative cosmetic effects.Methods A total of 60 patients with midshaft clavicle fractures were enrolled between October 2022 and August 2024.The patients were randomly assigned to either ORIF group(open reduction and internal fixation,n=30)or MIPPO group(MIPPO combined with smile incision,n=30).Outcomes assessed included surgical trauma,functional recovery,and cosmetic outcomes.Results The MIPPO group exhibited significantly reduced intraoperative blood loss[(32.9±7.6)mL vs.(90.2±14.0)mL,P＜0.05],shorter incision length[(3.0±0.5)cm vs.(8.5±1.2)cm,P＜0.05],and reduced operative time compared to the ORIF group.Functional recovery indicators such as bone healing time[(10.1±1.7)weeks vs.(12.8±2.0)weeks,P＜0.05],initial and complete self-care time,and weight-bearing recovery were all significantly improved in the MIPPO group.The Constant-Murley score was higher in the MIPPO group(91.5±5.1 vs.82.4±6.0,P＜0.05).Cosmetic outcomes also favored the MIPPO group,with a superior SBSES score(9.2±0.4 vs.3.0±0.7,P＜0.05)and better results in scar visibility,pigmentation,thickness,and elasticity.Conclusion The smile incision combined with indirect reduction technique significantly reduces surgical trauma,accelerates postoperative recovery,and provides substantially better cosmetic outcomes compared to conventional methods,making it particularly suitable for patients with high aesthetic expectations.