Objective To explore the impact of number of positive regional lymph nodes (nPRLN) in N1 stage on the prognosis of non-small cell lung cancer (NSCLC) patients. Methods Patients with TxN1M0 stage NSCLC who underwent lobectomy and mediastinal lymph node dissection from 2010 to 2015 were screened from SEER database (17 Regs, 2022nov sub). The optimal cutoff value of nPRLN was determined using X-tile software, and patients were divided into 2 groups according to the cutoff value: a nPRLN≤optimal cutoff group and a nPRLN>optimal cutoff group. The influence of confounding factors was minimized by propensity score matching (PSM) at a ratio of 1 : 1. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate overall survival (OS) and lung cancer-specific survival (LCSS) of patients. Results A total of 1316 patients with TxN1M0 stage NSCLC were included, including 662 males and 654 females, with a median age of 67 (60, 73) years. The optimal cutoff value of nPRLN was 3, with 1165 patients in the nPRLN≤3 group and 151 patients in the nPRLN>3 group. After PSM, there were 138 patients in each group. Regardless of before or after PSM, OS and LCSS of patients in the nPRLN≤3 group were superior to those in the nPRLN>3 group (P<0.001). N1 stage nPRLN>3 was an independent prognostic risk factor for OS [HR=1.52, 95%CI (1.22, 1.89), P<0.001] and LCSS [HR=1.72, 95%CI (1.36, 2.18), P<0.001]. Conclusion N1 stage nPRLN>3 is an independent prognostic risk factor for NSCLC patients in TxN1M0 stage, which may provide new evidence for future revision of TNM staging N1 stage subclassification.

Objective:To explore and analyze the expression levels of serum transthyretin（TTR）and Survivin in children with Mycoplasma pneumoniae pneumonia（MPP），and to further analyze the effect of the combination of the two in the predictive of pulmonary consolidation.Methods:A total of 142 children with MPP admitted to Qinhuangdao First Hospital from April 2022 to April 2024 were selected as the MPP group，and they were grouped into consolidation group（ n=58）and non-consolidation group（ n=84）according to the chest imaging examination.In addition，135 healthy children were selected as the control group.The ELISA was used to test serum TTR and Survivin levels on admission to the hospital.The general clinical data were collected and analyzed.Multivariate Logistic regression was used to analyze the influencing factors of pulmonary consolidation in children with MPP.Receiver operating characteristic（ROC）curves were plotted to analyze the value of TTR and Survivin in predicting pulmonary consolidation in children with MPP.Pearson method was used to analyze the correlation between TTR，Survivin and inflammation-related indicators. Results:Compared with the control group，the serum TTR[（261.25±28.06）mg/L vs.（296.33±31.28）mg/L] and Survivin[（1.53±0.18）pg/mL vs.（1.86±0.20）pg/mL] levels in the MPP group greatly decreased（ P<0.05）.Compared with the non-consolidation group，the serum TTR[（235.62±25.76）mg/L vs.（278.95±29.65）mg/L] and Survivin[（1.39±0.16）pg/mL vs.（1.62±0.19）pg/mL] levels in the consolidation group were greatly lower（ P<0.05），and the neutrophil percentage，white blood cell count and C-reactive protein（CRP）levels in the consolidation group were greatly higher than those in the non-consolidation group（ P<0.05）.Elevated neutrophil percentage，white blood cell count and CRP levels were risk factors for pulmonary consolidation in children with MPP（ P<0.05），while Elevated TTR and Survivin level were protective factors（ P<0.05）.The cutoff values for TTR and Survivin to diagnose solid lung lesions in children with MPP were 262.38 mg/L and 1.54 pg/mL,respectively.The area under ROC curve of TTR，Survivin and combined prediction for pulmonary consolidation were 0.855，0.866 and 0.940，respectively，and the area under ROC curve of combined prediction was greatly better than those of TTR（ Z=3.281， P=0.001）and Survivin（ Z=3.211， P=0.001）alone.TTR and Survivin were negatively correlated with neutrophil percentage，white blood cell count and CRP（ P<0.05）. Conclusion:The serum TTR and Survivin levels of children with MPP combined pulmonary consolidation are reduced，which have certain auxiliary predictive value for the occurrence of pulmonary consolidation in patients.

AIM:To elucidate the mechanism by which Polygonatum sibiricum polysaccharides(PSP)miti-gate high-sugar diet-induced neuroinflammation through the gut microbiota-serum metabolome axis.METHODS:Fifty male ICR mice were divided into 5 groups:control group,model group,low-dose(250 mg/kg)PSP group,high-dose(500 mg/kg)PSP group,and donepezil hydrochloride(3 mg/kg)group.The neuroinflammation model was established through administration of high-sugar chow and 10%sucrose water for 12 weeks.Cognitive function assessment was per-formed utilizing the Morris water maze.Hippocampal histopathology was examined by hematoxylin-eosin(HE)staining,activated microglia were assessed via immunofluorescence,and neuronal apoptosis was evaluated by TUNEL assay.Serum and hippocampal levels of interleukin-6(IL-6),IL-1β,tumor necrosis factor-α(TNF-α)and nitric oxide(NO)were quantified using ELISA and Western blot.Gut microbiota diversity and serum untargeted metabolomics analyses were car-ried out employing 16S rRNA sequencing and LC-MS/GC-MS,respectively.Differential metabolites were screened,and key metabolic pathways were enriched using MetaboAnalyst 6.0.Spearman correlation analysis established relationships between gut microbiota,metabolites,and inflammatory factors.RESULTS:Model mice demonstrated increased escape latency(P<0.05 or P<0.01)and decreased platform crossings(P<0.01)compared with controls,which were reversed by PSP treatment(P<0.05 or P<0.01).Treatment with PSP substantially reduced IL-6,IL-1β,TNF-α and NO levels in se-rum and hippocampus(P<0.05 or P<0.01),diminished inflammatory infiltration,inhibited microglial activation,and re-duced neuronal damage.Gut microbiota analysis demonstrated that PSP increased Lactobacillus and Bacteroides abun-dance while reducing Alistipes(P<0.05).Metabolomics identified 15 differential metabolites(including betaine,kyotor-phin and ε-caprolactam)and highlighted the significance of alanine,aspartate and glutamate metabolism pathways.Spear-man analysis revealed that abundance of Alistipes and Bacteroides were positively correlated with IL-1β(P<0.05),while abundance of Lactobacillus was negatively correlated with inflammatory factors(P<0.05 or P<0.01).Key metabolites(be-taine,kyotorphin,ε-caprolactam,trans-cinnamate,cis-zeatin and galactitol)showed strong associations with inflamma-tion factors(P<0.05 or P<0.01).CONCLUSION:Treatment with PSP attenuates neuroinflammation through modula-tion of gut microbiota(Lactobacillus,Bacteroides and Alistipes),regulation of metabolites(betaine,kyotorphin and so on),and targeting amino acid metabolism pathways.

Postmenopausal osteoporosis (PMOP), a bone metabolic imbalance disorder induced by estrogen deficiency, necessitates novel prevention and treatment strategies that transcend the constraints of conventional therapeutic approaches. Melatonin, a signaling molecule secreted by the pineal gland, plays a key role in maintaining circadian rhythms and regulating bone metabolism. In recent years, numerous studies both domestically and internationally have demonstrated that melatonin can promote the generation of osteoblasts and osteoclasts, thereby increasing bone density and improving symptoms of osteoporosis. This article reviews the role of melatonin in the prevention of PMOP, aiming to provide new ideas for the diagnosis and treatment of PMOP.

Objective:To explore the characteristics and influencing factors of risk perception related to additional injury during motor rehabilitation in stroke patients with hemiplegia, and to provide a foundation for the development of assessment tools and prevention strategies.Methods:A purposive sampling strategy combined with maximum variation sampling was employed to select 15 stroke patients with hemiplegia who were hospitalized in the Department of Neurology and Department of Rehabilitation at Northern Jiangsu People's Hospital between January and April 2024. Face-to-face, semi-structured in-depth interviews were conducted. Data were analyzed and thematically extracted using Colaizzi seven-step method.Results:Each interview lasted between 25 and 47 minutes, totaling 547 minutes of interview time and approximately 92 000 words of transcription. A total of 3 major themes were identified: characteristics of risk perception regarding additional injury during motor rehabilitation, multidimensional influencing factors of risk perception, and perceived severity of additional injury.Conclusions:Stroke patients with hemiplegia exhibit diverse and dynamic risk perception characteristics regarding additional injury during motor rehabilitation, which are influenced by multiple interrelated factors. A generally low and inaccurate level of risk perception was observed. Medical staff should pay greater attention to improving the accuracy of patients' risk perception, enhancing risk assessment mechanisms, and developing targeted prevention strategies to help patients avoid additional injuries and maximize the benefits of motor rehabilitation.

OBJECTIVE: To compare the biomechanical properties of personalized Y-shaped plates with horizontal plates, vertical plates, and traditional Y-shaped plates in the treatment of distal humeral intra-articular fractures through finite element analysis, and to evaluate their potential for clinical application. METHODS: The study selected a 38-year-old male volunteer and obtained a three-dimensional model of the humerus by scanning his upper limbs using a 64-slice spiral CT. Four types of fracture-internal fixation models were constructed using Mimics 19.0, Geomagic Wrap 2017, Creo 6.0, and other software: horizontal plates, vertical plates, traditional Y-shaped plate, and personalized Y-shaped plate. The models were then meshed using Hypermesh 14.0 software, and material properties and boundary conditions were defined in Abaqus 6.14 software. AnyBody 7.3 software was used to simulate elbow flexion and extension movements, calculate muscle strength, joint forces, and load torques, and compare the peak stress and maximum displacement of the four fixation methods at different motion angles (10°, 30°, 50°, 70°, 90°, 110°, 130°, 150°) during elbow flexion and extension. RESULTS: Under dynamic loading during elbow flexion and extension, the personalized Y-shaped plate exhibits significant biomechanical advantages. During elbow flexion, the peak internal fixation stress of the personalized Y-shaped plate was (28.8±0.9) MPa, which was significantly lower than that of the horizontal plates, vertical plates, and traditional Y-shaped plate ( P<0.05). During elbow extension, the peak internal fixation stress of the personalized Y-shaped plate was (18.1±1.6) MPa, which was lower than those of the other three models, with significant differences when compared with horizontal plates and vertical plates ( P<0.05). Regarding the peak humeral stress, the personalized Y-shaped plate model showed mean values of (10.9±0.8) and (13.1±1.4) MPa during elbow flexion and extension, respectively, which were significantly lower than those of the other three models ( P<0.05). Displacement analysis showed that the maximum displacement of the humerus with the personalized Y-shaped plate during elbow flexion was (2.03±0.08) mm, slightly higher than that of the horizontal plates, but significantly lower than that of the vertical plates, showing significant differences ( P<0.05). During elbow extension, the maximum displacement of the humerus with the personalized Y-shaped plate was (1.93±0.13) mm, which was lower than that of the other three models, with significant differences when compared with vertical plates and traditional Y-shaped plates ( P<0.05). Stress contour analysis showed that the stress of the personalized Y-shaped plate was primarily concentrated at the bifurcation of the Y-shaped structure. Displacement contour analysis showed that the personalized Y-shaped plate effectively controlled the displacement of the distal humerus during both flexion and extension, demonstrating excellent stability. CONCLUSION The personalized Y-shaped plate demonstrates excellent biomechanical performance in the treatment of distal humeral intra-articular fractures, with lower stress and displacement, providing more stable fixation effects.
Humans ; Male ; Adult ; Healthy Volunteers ; Finite Element Analysis ; Tomography, Spiral Computed ; Models, Anatomic ; Biomechanical Phenomena ; Humeral Fractures, Distal/surgery* ; Fracture Fixation, Internal/instrumentation* ; Bone Plates ; Computer Simulation ; Precision Medicine/methods* ; Elbow Joint/surgery* ; Elbow/surgery* ; Humerus/surgery* ; Torque ; Stress, Mechanical ; Intra-Articular Fractures/surgery* ; Prosthesis Design/methods* ; Imaging, Three-Dimensional ; Range of Motion, Articular

Objective:To evaluate the efficacy and safety of immunotherapy combined with chemotherapy as conversion therapy for initially unresectable locally advanced esophageal squamous cell carcinoma.Methods:This retrospective case series study analyzed clinical and pathological data of 32 patients with initially unresectable locally advanced esophageal squamous cell carcinoma who received immunotherapy combined with chemotherapy at the Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, from June 2020 to December 2024. The cohort included 27 males and 5 females, with an age ( M(IQR)) of 61(9)years (range:46 to 73 years). Five patients were diagnosed with stage Ⅲ, 27 with stage ⅣA. All patients received PD-1 inhibitor sintilimab combined with nedaplatin and albumin-bound paclitaxel. Radiological evaluations were performed every two cycles, the multidisciplinary team evaluation was conducted to determine conversion to resectable status, and patients with successful conversion underwent radical esophagectomy. Follow-up was conducted via telephone or outpatient visits every 3 to 6 months after the last treatment. The primary endpoint was R0 resection rate, secondary endpoints included objective response rate (ORR), pathological complete response (pCR) rate, major pathological response (MPR) rate, event-free survival (EFS), disease-free survival (DFS) in patients with R0 resection, overall survival (OS) and safety. Kaplan-Meier method was used to plot survival curves and estimate median EFS, DFS, OS rates and their 95% CI. The 95% CI for ORR, pCR rate, MPR rate, and downstaging rate were calculated using the Clopper-Pearson method. Results:The median treatment cycle of 2(1) (range:2 to 8). As of June 2025, the median follow-up was 32.5(13.5)months (range:6.4 to 59.1 months). Among the 32 patients, 9 experienced progression or recurrence, including 2 with liver and lymph node metastases, 2 with lung metastases, 2 with thoracic vertebral metastases, and 3 with mediastinal lymph node metastases. After conversion therapy, 29 patients underwent surgery, achieving an R0 resection rate of 84.4% (95% CI:67.2% to 94.7%), a pCR rate of 27.6% (95% CI:12.7% to 47.2%), and an MPR rate of 55.2% (95% CI:35.7% to 73.6%). Grade 3 or higher surgical complications occurred in 6.9%(2/29) of patients, and grade 3 or higher treatment-related adverse events were observed in 15.6%(5/29). Among the 32 patients, the ORR was 56.3% (95% CI:37.7% to 73.6%),the 3-year EFS rate and OS rate was 59.4% (95% CI:40.8% to 86.4%) and 59.7% (95% CI:40.0% to 89.0%) respectively. Conclusion:Immunotherapy combined with chemotherapy demonstrates high conversion rates and favorable safety in the conversion therapy of initially unresectable locally advanced esophageal squamous cell carcinoma, representing a promising treatment strategy.

Postmenopausal osteoporosis (PMOP), a bone metabolic imbalance disorder induced by estrogen deficiency, necessitates novel prevention and treatment strategies that transcend the constraints of conventional therapeutic approaches. Melatonin, a signaling molecule secreted by the pineal gland, plays a key role in maintaining circadian rhythms and regulating bone metabolism. In recent years, numerous studies both domestically and internationally have demonstrated that melatonin can promote the generation of osteoblasts and osteoclasts, thereby increasing bone density and improving symptoms of osteoporosis. This article reviews the role of melatonin in the prevention of PMOP, aiming to provide new ideas for the diagnosis and treatment of PMOP.

Objective To observe the effect of numerical simulation technique for predicting effect of self-expanding prosthetic valve(SEV)stents for treating type 0 bicuspid aortic valve(BAV)stenosis with different implantation strategies.Methods Based on CT angiography data from a patient with type 0 BAV stenosis and asymmetric calcification,three-dimensional models of aortic root wall,aortic valve calcification,native valve and SEV were reconstructed.ABAQUS/Explicit dynamic analysis module was used to observe the interaction between SEV stents and aortic root including root stress and stent deformation under different implantation strategies(implantation depths of high,medium or low,and implantation centers of central or eccentric position).Results When SEV was implanted centrally at low depth and central position,the Von Mises stress on aortic root wall was the highest,with mean and peak value of 2.28 and 45.30 kPa,respectively.When SEV was implanted at medium depth and central position,the average eccentricity of stent across all planes was the highest(0.254),while when implanted at high depth and eccentric position,the average ellipticity in planes S1-S3 was the minimal(0.124).Conclusion Different SEV implantation strategies resulted in varying interactions between stent and aortic root.Numerical simulation technique could be used to determine the implantation center and depth based on the size and location of type 0 BAV calcification,which was helpful to reducing rupture risk of aortic annulus,increasing durability and improving prognosis of SEV stent.

Objective:To investigate the effects of Xingnao Yisui Decoction on the behaviour of vascular dementia (VaD) rats and the apoptosis of neurons in the CA1 region of the hippocampus; To explore its mechanism of action.Methods:Totally 60 adult SD rats with similar levels of cognitive function were selected and divided into Xingnao Yisui Decoction high-, medium- and low-dosage groups, donepezil group, model group and sham-operation group according to the random number table method, with 10 rats in each group. Except for the sham-operation group, the VaD model was prepared using a modified bilateral common carotid artery ligation method in all the groups. Xingnao Yisui Decoction high-, medium- and low-dosage groups were gavaged with 19.62, 9.81, 4.91 g/(kg·d) of Xingnao Yisui Decoction respectively, the donepezil group was gavaged with 0.5 mg/(kg·d) of donepezil solution, and the sham-operation group and the model group were given equal amount of saline gavage, 1 time/d for 4 weeks. Morris water maze experiment was used to observe the behavioral changes in each group, TUNEL staining was used to observe the apoptosis of neurons in CA1 area of hippocampus. Realtime PCR was used to detect the mRNA expression of NF-κB and MMP-9. ELISA was used to detect the changes of serum NF-κB, MMP-9, p53, Bcl-2 and Bax protein levels.Results:Compared with the model group, the escape latency of rats in the donepezil group and Xingnao Yisui Decoction high-, medium- and low-dosage groups was shortened ( P<0.05); the times of crossing the platform and the stay time in the target quadrant increased ( P<0.05); the number of apoptotic cells in hippocampal CA1 region decreased ( P<0.01); the number of apoptotic cells in hippocampal CA1 region decreased ( P<0.01); the mRNA expression of NF- κB and MMP-9 in hippocampal mRNA level decreased ( P<0.01); the content of NF-κB, MMP-9, p53 and Bax decreased ( P<0.01), while the content of Bcl-2 increased ( P<0.01). Conclusion:Xingnao Yisui Decoction can effectively mediate the NF-κB-MMP-9 pathway to improve the permeability of the blood-brain barrier and regulate p53-Bcl-2-Bax to reduce apoptosis of neurons in CA1 area of hippocampus, thus significantly improve the learning and memory ability of VaD rats.