Objective To investigate the expression of carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6) in esophageal squamous cell carcinoma (ESCC) and analyze its correlation with immune cell infiltration and patient prognosis. Methods Three ESCC datasets (GSE161533, GSE26886, and GSE23400) from the GEO database were analyzed to identify differentially expressed genes. CEACAM6 was identified as a key gene through survival analysis. Its expression, prognostic value, and relationship with immune cell infiltration were further explored using databases, such as TIMER. Tissue samples were collected from 162 patients with ESCC. Immunohistochemistry was performed to detect the expression of CEACAM6, immune cell markers (CD4, CD8, CD20, and CD56), and immune checkpoint molecules (HHLA2 and CD40LG). Correlations between CEACAM6 expression and clinicopathological features, immune cell infiltration, and immune checkpoints were analyzed. Results Bioinformatic analysis and clinical sample validation confirmed that CEACAM6 expression was significantly upregulated in ESCC tissues compared with adjacent nontumor tissues (P<0.05). High CEACAM6 expression was closely associated with advanced clinical stage (AJCC Ⅲ-Ⅳ), high T stage (T3-T4), lymph node metastasis, nonulcerative type, and poor prognosis. Furthermore, CEACAM6 expression levels were positively correlated with the infiltration density of CD8⁺ T cells, CD4⁺ T cells, and CD20⁺ B cells within the tumor microenvironment and with the expression of the immune checkpoint molecules HHLA2 and CD40LG (all P<0.05). Conclusion CEACAM6 serves as an independent poor prognostic factor for ESCC. Its high expression is implicated in the modulation of the tumor immune microenvironment by correlating with specific immune cell infiltration and immune checkpoint molecules, suggesting its potential as a novel prognostic biomarker and immunotherapeutic target for ESCC.

Objective To explore the clinical efficacy of robot-assisted coronary artery bypass grafting through a small incision in the left intercostal space in the treatment of multivessel coronary disease. Methods A retrospective analysis was conducted on the clinical data of patients who underwent coronary artery bypass grafting through a small incision in the left intercostal space at Central China Fuwai Hospital of Zhengzhou University from January 1, 2023 to October 15, 2024. Patients were divided into a robotic group and a minimally invasive group based on whether the surgery was assisted by the Da Vinci robot. Results A total of 81 patients were included, with 57 in the minimally invasive group, including 41 males and 16 females, with a median age of 65.0 (57.5, 69.5) years; and 24 in the robotic group, including 17 males and 7 females, with a median age of 61.0 (56.0, 69.0) years. There was no statistically significant difference in baseline data between the two groups (P>0.05). The robotic group had less intraoperative bleeding [300 (200, 438) mL vs. 500 (375, 600) mL, P=0.006], shorter postoperative mechanical ventilation time [15.0 (13.3, 23.5) h vs. 22.0 (15.5, 39.5) h, P=0.037], and lower incidence of postoperative pain [8 (33.3%) vs. 33 (57.9%), P=0.043]. The hospitalization cost in the robotic group was higher than that in the minimally invasive group [130491 (123298, 135691) yuan vs. 123892 (115543, 133449) yuan, P=0.023]. There was no statistical difference in postoperative laboratory indicators between the two groups (P>0.05). There was also no statistical difference in the duration of surgery, postoperative 24 h drainage volume, ICU stay time, postoperative hospital stay or incidences of perioperative compications including pleural effusion, transfusion, new-onset atrial fibrillation, acute kidney injury, non-union of incision, major cardiovascular and cerebrovascular adverse events, and reoperation between the two groups (P>0.05). Conclusion Compared with the minimally invasive group, the robotic group shows satisfactory efficacy and can effectively reduce postoperative pain and intraoperative bleeding, and shorten postoperative mechanical ventilation time.

BACKGROUND:Studies have shown that ischemia-induced cellular autophagy dysfunction is a key factor in brain injury.Autophagy related genes 6(ATG6),microtubule-associated protein 1 light chain(LC3),p62,and other autophagy key proteins are involved in the processes such as neuronal axonal degeneration,death,and intracellular homeostasis maintenance,playing an important role in the recovery of neural function. OBJECTIVE:To review the research progress in the role of cellular autophagy in cerebral ischemic injury and the regulatory mechanism of traditional Chinese medicine. METHODS:The first author used"ischemic stroke,brain tissue injury,cellular autophagy,signaling pathways,traditional Chinese medicine compounds,terpenoids,alkaloids,flavonoids,saponins,lignans,phthalates"as Chinese and English keywords respectively to search for literature on autophagy,cerebral ischemic injury,and the regulatory mechanisms of traditional Chinese medicine from China National Knowledge Infrastructure(CNKI)and PubMed databases from January 2016 to February 2024.Literature that is not highly relevant,repetitive,or outdated was excluded.A total of 1 746 relevant literature were retrieved,and 92 articles were ultimately included. RESULTS AND CONCLUSION:Numerous studies have confirmed that autophagy plays an important role in cerebral ischemic injury.Moderate autophagy can promote cell survival,while excessive autophagy exacerbates brain injury.Traditional Chinese medicine can regulate the expression of autophagy related proteins,inhibit neuronal necrosis and apoptosis,and exert neuroprotective effects at different stages of cerebral ischemia by regulating signaling pathways such as PI3K/Akt/mTOR,AMPK-mTOR,and mitogen activated protein kinase.

Objective:To evaluate the role of silent information regulator factor 2-related enzyme 1 (SIRT1)/Klotho signaling pathway in renal injury induced by myocardial ischemia-reperfusion (I/R) in diabetic rats.Methods:Forty SPF healthy male rats, aged 6-8 weeks, weighing 140-170 g, were divided into 5 groups ( n=8 each) by the random number table method: non-diabetic sham operation group (NS group), non-diabetic I/R group (NIR group), diabetic sham operation group (DS group), diabetic I/R group (DIR group), and diabetic I/R + SIRT1 inhibitor EX-527 group (DIR+ EX-527 group). Diabetes mellitus was induced by intraperitoneal streptozotocin 60 mg/kg. The myocardial I/R was produced by temporary ligation of the left anterior descending branch of coronary artery for 30 min followed by 120 min reperfusion. EX-527 5 mg/kg was intraperitoneally injected before ischemia and at 10 min before reperfusion in DIR+ EX-527 group. Serum levels of lactic dehydrogenase (LDH), cardiac troponin I (cTnI), malondialdehyde (MDA), superoxide dismutase (SOD), blood urea nitrogen (BUN) and creatinine (Cr) were determined at the end of reperfusion. Renal tissues were collected for observation of the pathological changes and for detection of the expression of SIRT1, Klotho, and interleukin-1 β (IL-1β) by Western blot. Results:Compared with NS group, the serum levels of LDH, cTnI, BUN and MDA were significantly increased, the serum levels of SOD were decreased, the expression of Klotho and SIRT1 was down-regulated, the expression of IL-1β was up-regulated ( P<0.05), and the pathological damage to renal tissues was marked in NIR group and DS group. Compared with DS group and NIR group, the serum levels of LDH, cTnI, BUN, Cr and MDA were significantly increased, the serum levels of SOD were decreased, the expression of Klotho and SIRT1 was down-regulated, the expression of IL-1β was up-regulated ( P<0.01), and the pathological damage to renal tissues was aggravated in DIR gruop. Compared with DIR gruop, the serum levels of LDH, cTnI, BUN, Cr and MDA were significantly increased, the level of serum SOD was decreased, the expression of Klotho and SIRT1 was down-regulated, the expression of IL-1β was up-regulated ( P<0.01), and the pathological damage to renal tissues was aggravated in DIR+ EX-527 group. Conclusions:Weakened activation of SIRT1/Klotho signaling pathway may be involved in the mechanism of myocardial I/R-induced renal injury in diabetic rats.

Objective To investigate the relationship between stationing years of personnel on an island and their traditional Chinese medicine(TCM)constitution,thus providing a reference for adjusting the health status of stationed personnel,preventing and treating diseases.Methods Based on The Scale of Constitution in Chinese Medicine Questionnaire,TCM constitution of 734 personnel stationed on an island was investigated.Pearson χ2 method was used for data analysis.Results Of the 734 personnel stationed on an island 345(47.0%)were of the balanced constitution type and 389(53.0%)were of the biased constitution types.Among the people with biased constitution types,composite constitution accounted for 80.5%(313 people)and the simple accounted for the rest(19.5%,76 people).The top three types of the biased were dampness heat(15.2%),qi deficiency(14.0%),and yin deficiency(10.7%).The distribution of TCM constitution types was significantly different in terms of stationing years on the island(P<0.05).There was a significant difference in the balanced type and yin deficiency type between people with stationing time≤2 years and>8 years(P<0.05).There was a significant difference in qi deficiency type and qi depression type between people with stationing time≤2 years and>5 years(P<0.05).Compared to people with stationing time≤2 years,significant difference was found in yang deficiency type in people with stationing time ranging from 2 to 5 years and those with>8 years(P<0.05).There were significant differences in the phlegm dampness type,blood stasis type,and specific diathesis type between people with stationing time≤2 years and people with stationing time ranging from>2～5 years and>8 years(P<0.05).There were significant differences in the dampness heat type between people with stationing time≤2 years and people with stationing time ranging from>5～8 years and>8 years,between pepole with stationing time ranging from>2～5 years and people with stationing time>8 years(P<0.05).Conclusion The dampness heat type,qi deficiency type and yin deficiency type are common biased TCM constitution in personnel stationed on islands.The longer the time spent on islands,the greater the possibility of forming biased constitution.

Objective To compare and analyze the early- to mid-term outcomes of transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) combined with coronary artery bypass grafting (CABG) for the treatment of significant aortic stenosis (AS) and coronary artery disease (CAD). Methods The data of patients with significant AS and CAD who underwent surgical treatment at Central China Fuwai Hospital of Zhengzhou University from January 2018 to July 2023 were collected. These patients were divided into a TAVR+PCI group and a SAVR+CABG group according to the operation method. Propensity score matching (PSM) was used to select patients with close clinical baseline characteristics, and the early- to mid-term outcomes of the two groups were compared. Results A total of 272 patients were enrolled, including 208 males and 64 females, with a mean age of (64.16±8.24) years. There were 47 patients in the TAVR+PCI group and 225 patients in the SAVR+CABG group. After 1 : 1 PSM, 32 pairs were selected. There was no statistical difference in baseline data between the two groups (P>0.05). Compared with the SAVR+CABG group, the TAVR+PCI group had significantly shorter operative time, mechanical ventilation time, ICU stay, postoperative hospital stay, and less intraoperative bleeding, and significantly lower postoperative transfusion and complete revascularization rates (P<0.05). The differences in the rates of postoperative in-hospital death, myocardial infarction, stroke, or other complications between the two groups were not statistically significant (P>0.05), and the differences in the rates of moderate-to-severe perivalvular leakage, death, or readmission in the mid-term follow-up were not statistically significant (P>0.05). Conclusion In patients with significant AS and CAD, the early- and mid-term rates of death and complications are similar between those treated with TAVR+PCI and SAVR+CABG, and TAVR+PCI is a safe alternative to SAVR+CABG.

Objective To compare perioperative outcomes of minimally invasive aortic valve surgery by a right anterior minithoracotomy (RAMT) and conventional sternotomy. Methods A retrospective analysis of patients who underwent isolated aortic valve surgeries in Central China Fuwai Hospital of Zhengzhou University between May 2021 and August 2023 with a minimal incision via the RAMT approach (a RAMT group) or conventional incision via the full sternotomy approach (a conventional group). A propensity score matching analysis was performed to balance preoperative data and compare perioperative data of the two groups. Results There were 58 patients in the RAMT group, including 46 males and 12 females with an average age of (52.0±14.1) years; 128 patients were enrolled in the conventional group, including 87 males and 41 females with an average age of (60.0±12.4) years. After propensity-score matching, there were 51 patients in each group. The RAMT group had a longer average operation time, cross-clamping time and cardiopulmonary bypass time compared to the conventional group (all P<0.05). However, ICU length of stay, ventilator-assisted time and postoperative hospital stay were significantly shorter in the RAMT group (all P<0.05). Patients in the RAMT group had lower 24 hour chest drain output (P<0.05). RAMT was associated with a trend towards a lower blood transfusion rate in comparison to the sternotomy group, although this was not statistically significant (P>0.05). The occurrence of all-cause death, and perioperative complications was also similar in both groups (P>0.05). Conclusion RAMT has less trauma, faster recovery, less postoperative drainage, and shorter hospital stay than conventional approach. RAMT in patients undergoing isolated aortic valve surgery is a safe approach.

Objective:To evaluate the role of silent information regulator factor 2-related enzyme 1 (SIRT1)/Klotho signaling pathway in renal injury induced by myocardial ischemia-reperfusion (I/R) in diabetic rats.Methods:Forty SPF healthy male rats, aged 6-8 weeks, weighing 140-170 g, were divided into 5 groups ( n=8 each) by the random number table method: non-diabetic sham operation group (NS group), non-diabetic I/R group (NIR group), diabetic sham operation group (DS group), diabetic I/R group (DIR group), and diabetic I/R + SIRT1 inhibitor EX-527 group (DIR+ EX-527 group). Diabetes mellitus was induced by intraperitoneal streptozotocin 60 mg/kg. The myocardial I/R was produced by temporary ligation of the left anterior descending branch of coronary artery for 30 min followed by 120 min reperfusion. EX-527 5 mg/kg was intraperitoneally injected before ischemia and at 10 min before reperfusion in DIR+ EX-527 group. Serum levels of lactic dehydrogenase (LDH), cardiac troponin I (cTnI), malondialdehyde (MDA), superoxide dismutase (SOD), blood urea nitrogen (BUN) and creatinine (Cr) were determined at the end of reperfusion. Renal tissues were collected for observation of the pathological changes and for detection of the expression of SIRT1, Klotho, and interleukin-1 β (IL-1β) by Western blot. Results:Compared with NS group, the serum levels of LDH, cTnI, BUN and MDA were significantly increased, the serum levels of SOD were decreased, the expression of Klotho and SIRT1 was down-regulated, the expression of IL-1β was up-regulated ( P<0.05), and the pathological damage to renal tissues was marked in NIR group and DS group. Compared with DS group and NIR group, the serum levels of LDH, cTnI, BUN, Cr and MDA were significantly increased, the serum levels of SOD were decreased, the expression of Klotho and SIRT1 was down-regulated, the expression of IL-1β was up-regulated ( P<0.01), and the pathological damage to renal tissues was aggravated in DIR gruop. Compared with DIR gruop, the serum levels of LDH, cTnI, BUN, Cr and MDA were significantly increased, the level of serum SOD was decreased, the expression of Klotho and SIRT1 was down-regulated, the expression of IL-1β was up-regulated ( P<0.01), and the pathological damage to renal tissues was aggravated in DIR+ EX-527 group. Conclusions:Weakened activation of SIRT1/Klotho signaling pathway may be involved in the mechanism of myocardial I/R-induced renal injury in diabetic rats.

Objective To understand the research status and development trend in the field of molecular and cell biology of thyroid cancer.Methods Relevant literature published in the field of molecular and cell biology of thyroid cancer from January 1,2013 to December 31,2022 was obtained in the web of science core collection(WoSCC)according to the search conditions,and bibliometric and visual analysis were performed using the bibliometric software VOSviewer and Excel.Results A total of 1 627 literatures were included.Among them,113 papers were published in 2013,and 214 were published in 2022.The annual number of publications was on the rise.There were 9 274 authors in total,of whom 6 published no less than 10 literatures.There were a total of 2 042 institutions,of which the top 10 institutions were mostly Chinese universities.There were 68 countries in total,and the largest number of publications was China,followed by the United States.There were 513 journals in total,and the top 10 journals with the largest number of literatures were mainly in the field of oncology,followed by the field of endocrinology and metabolism.A total of 62 563 references from 5 887 journals were cited.The most co-cited journal was Journal of Biological Chemistry(1 608 times),and the most co-cited references was Molecular Pathogenesis and Mechanisms of Thyroid Cancer(89 times).Conclusion The field of molecular and cell biology of thyroid cancer is currently developing steadily.Ferroptosis,glycosylation,telomerase reverse transcriptase and oxidative stress are the research frontiers in this field.

OBJECTIVE To explore the effects of posaconazole combined with proton pump inhibitors （PPI） on the blood concentration and the risk of invasive fungal disease （IFD） in patients with malignant hematological disorder. METHODS In accordance with the random number table method， 40 patients with malignant hematological disorders who were admitted to the hematology department of our hospital between December 2020 and December 2021 were chosen and divided into control group （20 cases） and observation group （20 cases）. The control group received Posaconazole oral suspension alone， while the observation group received Posaconazole oral suspension combined with PPI. The incidence of IFD， attainment rate of blood concentration， the time from the start of prophylaxis to IFD onset， the fatality associated with IFD， treatment of infected patients， and blood concentrations of posaconazole on 7th， 14th， 21st， and 28th day after posaconazole application were compared between 2 groups； the occurrence of adverse events during drug administration in the two groups was recorded. RESULTS The study was stopped because 2 patients in the observation group and 9 patients in the control group received hospital departures after taking posaconazole for fewer than 7 days. The incidence of IFD in the observation group was significantly higher than control group， and the attainment rate of blood concentration in the observation group was significantly lower than control group （P＜0.05）. There was no significant difference in the time from the start of prophylaxis to IFD onset， the fatality associated with IFD， treatment of infected patients and the incidence of adverse events （P＞ 0.05）. The blood concentration of posaconazole in the observation group was significantly lower than control group on 7th day of medication （P＜0.05）； there was no significant in blood concentration of posaconazole between 2 groups on the 14th day of medication （P＞0.05）. CONCLUSIONS Posaconazole combined with PPI can reduce the blood concentration of patients with malignant hematological disorders， increase the risk of IFD. Clinical practice should try to avoid the combination of the two or use them under the guidance of therapeutic drug monitoring.