Objective:To investigate the endoscopic and pathological characteristics of metachronous early gastric cancer (EGC) after endoscopic submucosal dissection (ESD) for EGC.Methods:Data of 451 consecutive EGC patients treated with ESD at the Department of Gastroenterology, Peking University Third Hospital between 1 January, 2005 and 31 December, 2022 were retrospectively collected, of which 252 patients who met the criteria and had endoscopic follow-up ≥ 1 year were enrolled in the retrospective dynamic cohort. Multivariate Cox regression analysis was used to identify independent risk factors for metachronous EGC after ESD. Pearson's contingency coefficient was applied to analyze endoscopic correlation between the index and metachronous lesions. T-test, χ2 test, and Fisher exact test were used to compare endoscopic pathological features between index and metachronous lesions, the proportion of lesions meeting absolute ESD indication and their maximum diameters between patients undergoing annual vs bi-annual follow-up. Kaplan-Meier analysis assessed the cumulative incidence of metachronous EGC. Results:During a median follow-up of 40 months, 26 patients [10.3% (26/252)] developed metachronous EGC, with a mean interval of 43.9 months. Multivariate Cox regression identified the independent risk factors of index lesions including location in the middle third of the stomach ( HR=3.783, 95% CI: 1.300-11.011, P=0.015), in the anterior wall ( HR=3.934, 95% CI: 1.113-13.904, P=0.033), and the maximum diameter <15 mm ( HR=3.034, 95% CI: 1.074-8.571, P=0.036). Pearson's contingency coefficient showed no significant concordance between index and metachronous lesions for vertical location (C=0.375, P=0.372), horizontal location (C=0.508, P=0.434), gross morphology (C=0.287, P=0.675), or ulcer presence (C=0.194, P=0.313). Compared to index lesions, metachronous lesions were more frequently located on the posterior wall (lesser curvature/greater curvature/anterior wall/posterior wall: 11/2/1/12 VS 96/49/46/61, P=0.031), more often differentiated (differentiated/undifferentiated: 26/0 VS 214/38, P=0.032), and smaller in maximum diameter (8.08±5.99 mm VS 13.95±10.26 mm, t=4.383, P<0.001). No significant differences were observed between patients undergoing annual vs bi-annual follow-up in the proportion of metachronous lesions meeting absolute ESD indication (14/16 VS 9/9, P=0.520) or in maximum diameter (8.11±6.94 mm VS 6.67±4.35 mm, t=-0.275, P=0.535). The cumulative incidence curve of metachronous EGC plateaued after 10 years. Conclusion:Patients with EGC located in the middle third of the stomach, in the anterior wall, or of smaller diameter need intensive endoscopic surveillance after ESD. Posterior wall deserves particular attention during follow-up, with annual endoscopy recommended for at least 10 years post-ESD.

Interventional therapy for liver cancer is often regarded as palliative.However,clinical evidence demonstrates that interventional therapy can sometimes achieve radical treatment outcomes.For a long period,the radical potential and thoroughness of interventional therapy for liver cancer have not been objectively or fairly assessed,and the updating of its concepts and basic research lags behind clinical practice,this situation is not conducive to the improvement of interventional therapy level,nor is it conducive to the development of interventional radiology discipline.The proposal of the concept of curative intervention therapy is conducive to the common development with other disciplines.Therefore,it is necessary to fully understand and explore the feasibility and importance of radical interventional therapy for liver cancer,as well as to emphasize the implementation of curative interventional therapy for liver cancer.

Objective:To explore the therapeutic strategy for laryngeal cysts in infants. Methods:A retrospective analysis of the clinical data of 19 children with laryngeal cysts treated in Kunming Children's Hospital from January 2020 to January 2023. All patients were diagnosed through electronic laryngoscopy examination. Twelve neonates were admitted to the neonatal intensive care unit. Five of them received mechanical ventilation with tracheal intubation before surgery due to severe respiratory distress, and seven received oxygen therapy with a head mask. The remaining seven children were admitted to Department of Otolaryngology Head and Neck Surgery, of which three cases were treated with oxygen therapy through a mask during sleep due to frequent shortness of breath during sleep. All patients underwent low-temperature plasma radiofrequency ablation under general anesthesia to remove the cysts. Results:Three newborns were unable to have their tracheal tubes removed due to complications with pneumonia after surgery, while the rest of the children were able to have their tubes successfully removed after complete anesthesia, and no gastric tubes were placed. All postoperative respiratory difficulties in the children disappeared, and there were no complications such as bleeding, hoarseness, or laryngeal stenosis. Five pediatric patients had incomplete relief of laryngeal ringing symptoms one month after surgery, and electronic laryngoscopy diagnosed laryngeal softening. Regular follow-up is recommended. One child relapsed 4 months after surgery and underwent a follow-up surgery six months later without recurrence. Conclusion:Endoscopic low-temperature plasma radiofrequency ablation is an effective surgical method for treating laryngeal cysts, with a low postoperative recurrence rate. Laryngeal cysts may be accompanied by laryngeal softening, which may be a possible reason for the postoperative symptoms not improving.
Humans ; Retrospective Studies ; Cysts/surgery* ; Laryngeal Diseases/surgery* ; Infant ; Laryngoscopy ; Infant, Newborn ; Male ; Female ; Radiofrequency Ablation

OBJECTIVES: To evaluate preterm white matter injury (PWMI) in neonatal rats using multimodal magnetic resonance imaging (MRI) combined with histological assessments and to explore its underlying mechanisms. METHODS: Healthy 3-day-old Sprague-Dawley neonatal rats were randomly divided into a sham operation group and a PWMI group (n=12 in each group). A PWMI model was established in neonatal rats through hypoxia-ischemia. Laser speckle imaging was used to observe changes in cerebral oxygen saturation and blood flow at different time points post-modeling. Multimodal MRI was employed to assess the condition of white matter injury, while hematoxylin-eosin staining was utilized to observe morphological changes in the striatal area on the injured side. Immunofluorescence staining was performed to detect the proliferation and differentiation of oligodendrocyte precursor cells. RESULTS: At 0, 6, 12, 24, and 72 hours post-modeling, the relative blood flow and relative oxygen saturation on the injured side in the PWMI group were significantly lower than those in the sham operation group (P<0.05). At 24 hours post-modeling, T2-weighted imaging showed high signals in the white matter of the injured side in the PWMI group, with relative apparent diffusion coefficient values and Lorenz differential values being lower than those in the sham operation group (P<0.001); additionally, the arrangement of nerve cells in the PWMI group was disordered, and the number of EdU⁺PDGFR-α⁺ cells was higher than that in the sham operation group (P<0.001). At 28 days post-modeling, the relative fractional anisotropy values, the number of EdU⁺Olig2⁺ cells, and the fluorescence intensity of myelin basic protein and neurofilament protein 200 in the white matter region of the PWMI group were all lower than those in the sham operation group (P<0.001). CONCLUSIONS Multimodal MRI can evaluate early and long-term changes in PWMI in neonatal rat models in vivo, providing both imaging and pathological evidence for the diagnosis and treatment of PWMI in neonates. Hypoxia-ischemia inhibits the proliferation and differentiation of oligodendrocyte precursor cells in neonatal rats, leading to PWMI.
Animals ; Rats, Sprague-Dawley ; Magnetic Resonance Imaging/methods* ; Rats ; White Matter/injuries* ; Animals, Newborn ; Female ; Multimodal Imaging ; Male ; Hypoxia-Ischemia, Brain/pathology*

OBJECTIVES: To investigate the characteristics and clinical significance of anorectal manometry measurements in children with tethered cord syndrome (TCS) before and after surgery. METHODS: A retrospective study was conducted on 44 children with TCS treated at the Children's Hospital of Zhejiang University School of Medicine from January 2022 to September 2023. These patients were divided into effective subgroup (n=34) and non-effective subgroup (n=10) based on postoperative symptom improvement. Additionally, 34 children with functional constipation were selected as a control group. Baseline data and manometry measurements were compared between the preoperative TCS group and the control group, as well as between the non-effective and effective subgroups. RESULTS: The TCS group had lower short contraction time and defecation relaxation rate compared to the control group (P<0.05), while defecation residual pressure and maximum rectal tolerable threshold were higher than the control group (P<0.05). The length of the anal canal in the high-pressure zone in the effective subgroup was greater postoperatively than preoperatively (P<0.05), and the initial rectal sensation threshold decreased postoperatively (P<0.05). The non-effective subgroup had lower preoperative maximum rectal expulsion pressure compared to the effective subgroup (P<0.05). Postoperative rectal anal inhibition reflex values in the effective subgroup were higher than those in the non-effective subgroup (P<0.05). CONCLUSIONS There are some differences in anorectal dynamics between children with TCS and those with functional constipation. Maximum rectal expulsion pressure may be a key predictor of surgical outcomes. Surgery can alter certain defecation functions in some children.
Humans ; Male ; Anal Canal/physiopathology* ; Female ; Rectum/physiopathology* ; Child ; Child, Preschool ; Retrospective Studies ; Manometry ; Neural Tube Defects/physiopathology* ; Infant ; Defecation ; Adolescent ; Constipation/physiopathology* ; Clinical Relevance

Objective:To investigate whether malignant tumors affect the laboratory outcomes of patients in their first controlled ovarian hyperstimulation (COH) cycle.Methods:This study was a retrospective case-control study that analyzed the clinical and laboratory data of patients who underwent fertility preservation before chemotherapy and radiotherapy due to malignant tumors, as well as patients with infertility caused by tubal factors who first underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from January 2020 to May 2024. Patients who underwent fertility preservation were designated as the research group, while patients who underwent assisted reproduction due to tubal factors during the same period were designated as control group. After 1∶3 propensity score matching (PSM), 40 patients were included in the research group and 118 patients were included in control group. The ovarian response, oocyte retrieval outcomes, and embryonic development after fertilization in the first COH cycle were compared between the two groups. Results:After PSM, the research group and control group showed statistically significant differences in the gonadotropin (Gn) starting dosage [225.00 (162.50, 300.00) U vs. 193.75 (150.00, 225.00) U, P=0.002], duration of Gn used [10.00 (8.00, 11.00) d vs. 12.00 (10.00, 13.00) d, P<0.001], and average estradiol levels on human chorionic gonadotropin trigger day [2 487.00 (1 461.25, 4 090.25) pmol/L vs. 10 738.50 (8 400.00, 16 507.25) pmol/L, P<0.001]. However, no statistically significant difference was found in the total dosages of Gn used between the two groups ( P>0.05). There were no significant differences between the groups in terms of the number of oocytes retrieved, the number of metaphase Ⅱ oocytes, two pronuclei (2PN) rate, 2PN cleavage rate, available embryo rate, high-quality embryo rate, blastocyst formation rate, and available blastocyst formation rate (all P>0.05). Conclusion:Compared with infertility patients with tubal factors, there is no significant difference in the laboratory outcomes of malignant tumor patients undergoing COH for fertility preservation prior to chemotherapy and radiation.

Objective To identify the potential categories and influencing factors of apathy in stroke patients,providing a basis for precise typing and individualized interventions by healthcare professionals.Methods Using the convenience sampling method,stroke patients from 2 tertiary hospitals in Xinjiang Uggur Automous Region were selected from November 2023 to August 2024,and were surveyed using the General Information Questionnaire,Apathy Evaluation Scale-Informant,Perceived Autonomy Scale,and Stroke Self-Efficacy Questionnaire.The latent profile analysis was used to identify potential categories of apathy,and logistic regression analysis was used to explore the differences in the characteristics of patients in different categories.Results The apathy symptoms of 521 stroke patients could be divided into 3 potential categories:mild apathy group(23.6％),moderate apathy-low interest-low behavioral group(46.5％),and heavy apathy-low interest-low cognitive group(29.9％).Logistic regression showed that age 45～＜60 years,duration of the disease＜6 months,and high rehabilitation self-efficacy were the common protective factors of the moderate apathy-low interest-low behavioral group and the heavy apathy-low interest-low cognitive group.The dependence on activities of daily living was a risk factor for the moderate apathy-low interest-low behavioral group,and high perception of autonomy was a protective factor for the heavy apathy-low interest-low cognitive group.Conclusion Apathy symptoms in stroke patients are characterized by distinct categories,which are influenced by age,stroke duration,ADL,rehabilitation self-efficacy,and perception of autonomy.Healthcare professionals should adopt effective strategies to precisely intervene based on different potential categories of protective factors and risk factors to alleviate their apathy.

Objective:To investigate whether malignant tumors affect the laboratory outcomes of patients in their first controlled ovarian hyperstimulation (COH) cycle.Methods:This study was a retrospective case-control study that analyzed the clinical and laboratory data of patients who underwent fertility preservation before chemotherapy and radiotherapy due to malignant tumors, as well as patients with infertility caused by tubal factors who first underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from January 2020 to May 2024. Patients who underwent fertility preservation were designated as the research group, while patients who underwent assisted reproduction due to tubal factors during the same period were designated as control group. After 1∶3 propensity score matching (PSM), 40 patients were included in the research group and 118 patients were included in control group. The ovarian response, oocyte retrieval outcomes, and embryonic development after fertilization in the first COH cycle were compared between the two groups. Results:After PSM, the research group and control group showed statistically significant differences in the gonadotropin (Gn) starting dosage [225.00 (162.50, 300.00) U vs. 193.75 (150.00, 225.00) U, P=0.002], duration of Gn used [10.00 (8.00, 11.00) d vs. 12.00 (10.00, 13.00) d, P<0.001], and average estradiol levels on human chorionic gonadotropin trigger day [2 487.00 (1 461.25, 4 090.25) pmol/L vs. 10 738.50 (8 400.00, 16 507.25) pmol/L, P<0.001]. However, no statistically significant difference was found in the total dosages of Gn used between the two groups ( P>0.05). There were no significant differences between the groups in terms of the number of oocytes retrieved, the number of metaphase Ⅱ oocytes, two pronuclei (2PN) rate, 2PN cleavage rate, available embryo rate, high-quality embryo rate, blastocyst formation rate, and available blastocyst formation rate (all P>0.05). Conclusion:Compared with infertility patients with tubal factors, there is no significant difference in the laboratory outcomes of malignant tumor patients undergoing COH for fertility preservation prior to chemotherapy and radiation.

Objective:To explore the application value of positive Selvester QRS score in the treatment and prognosis of pa-tients with stable coronary artery disease(SCAD).Methods:A total of 101 SCAD patients admitted in Jiangsu Province Hospital of Chinese Medicine between January 2021 and January 2023 were enrolled.The patients were followed up for 6 to 12 months.Another 100 healthy people who received physical examination in our hospital simultaneously were selected as the control group.All patients underwent percutaneous coronary intervention(PCI)and were examined using standard 12-lead ECG and analyzed for positive Selvester QRS score(≥1point).SCAD patients were divided into PCI success group(n=65)and PCI failure group(n=36)according to the results of coronary angiography.According to prognosis,the pa-tients were divided into favorable outcome group(n=60)and unfavorable outcome group(n=41).The percentage of posi-tive Selvester QRS score were compared among above-mentioned groups.Influencing factors for unfavorable outcome in SCAD patients were analyzed.Results:Compared with participants in control group,those in the SCAD group had signifi-cant higher Selvester QRS score positive rate(24.75％vs.3.00％,P＜0.001);Compared with patients in PCI success group,those in the PCI failure group had significant higher Selvester QRS score positive rate(55.56％vs.7.69％,P＜0.001);Compared with those in favorable outcome group,those in unfavorable outcome group had significant higher pro-portions of age＞60 years(56.10％ vs.25.00％),diabetes history(36.59％ vs.13.33％)and Selvester QRS score positiverate(43.90％ vs.11.67％)(P＜0.01 all).Multivariate Logistic regression analysis showed that age＞60 years old,history of diabetes and positive Selvester QRS score were independent risk factors for the unfavorable outcome of SCAD patients after PCI(OR=3.368～3.961,P＜0.05 or＜0.01).Conclusion:The positive rate of Selvester QRS score in PCI failure group is significantly higher than that in PCI success group,and positive Selvester QRS score is closely associ-ated with the unfavorable outcome of SCAD patients after PCI,which could be used as an important indicator for clinical treatment and prognosis detection of SCAD patients.

Objective:To investigate the current situation of rehabilitation motivation of middle-aged and elderly stroke patients and analyze its influencing factors, so as to provide reference for formulating targeted rehabilitation plans and intervention strategies.Methods:A convenience sampling method was used to select middle-aged and elderly stroke patients from (the First Affiliated Hospital of Shihezi University, the People's Hospital of Shihezi, and the People's Hospital of Xinjiang Uygur Autonomous Region from November 2023 to April 2024 as the study subjects. A cross-sectional survey was conducted using a general information questionnaire, the Motivation in Stroke Patients for Rehabilitation Scale, Perceived Social Support Scale, and and Apathy Evaluation Scale-Informant Version.Results:The 328 middle-aged and elderly stroke patients were ultimately included, including 223 males and 105 females, aged (63.63 ± 12.00) years. The total score of rehabilitation motivation, perceived social support and apathy symptoms of middle-aged and elderly stroke patients was ( 86.14 ± 11.28 ), (63.23 ± 6.31), (43.66 ± 4.63) points. LASSO regression screened 8 factors. Multiple linear regression analysis showed that age, education level, stroke duration, neurological deficits, activities of daily living, perceived social support and apathy symptoms were the influencing factors of rehabilitation motivation in middle-aged and elderly stroke patients ( t values were -6.52 to 7.56, all P<0.05), accounting for 72.6% of the total variation. The importance of random forest was ranked as follows: perceived social support, Activity of Daily Living, education level, stroke course, age, apathy symptoms, and neurological deficit. Conclusions:The rehabilitation motivation of middle-aged and elderly stroke patients is at a medium level. Clinical workers should focus on the rehabilitation motivation of stroke patients with insufficient social support, poor self-care ability and low education level, and regularly evaluate the level of rehabilitation motivation and the subjective initiative of rehabilitation exercise.