Objective To analyze the influencing factors for postoperative anastomotic leak (AL) in carcinoma of the esophagus and gastroesophageal junction and construct a nomogram predictive model. Methods The patients who underwent radical esophagectomy at Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2018 to June 2020 were included in this study. Relevant variables were screened using univariate and multivariate logistic regression analyses. A nomogram was then developed to predict the risk factors associated with postoperative AL. The predictive performance of the nomogram was validated using the receiver operating characteristic (ROC) curve. Results A total of 468 patients with carcinoma of the esophagus and gastroesophageal junction were included in the study, comprising 354 males and 114 females, with a mean age of (62.8±7.2) years. The tumors were predominantly located in the middle or lower esophagus, and 51 (10.90%) patients experienced postoperative AL. Univariate logistic regression analysis indicated that age, body mass index (BMI), tumor location, preoperative albumin levels, diabetes mellitus, anastomosis technique, anastomosis site, and C-reactive protein (CRP) levels were potentially associated with AL (P<0.05). Multivariate logistic regression analysis identified age, BMI, tumor location, diabetes mellitus, anastomosis technique, and CRP levels as independent risk factors for AL (P<0.05). A nomogram was developed based on the findings from the multivariate logistic regression analysis. The area under the receiver operating characteristic (ROC) curve was 0.803, indicating a strong concordance between the actual observations and the predicted outcomes. Furthermore, decision curve analysis demonstrated that the newly established nomogram holds significant value for clinical decision-making. Conclusion The predictive model for postoperative AL in patients with carcinoma of the esophagus and gastroesophageal junction demonstrates strong predictive validity and is essential for guiding clinical monitoring, early detection, and preventive strategies.

Malignant pleural effusion (MPE) refers to the accumulation of pleural fluid caused by metastasis from primary pleural malignancies or tumors originating elsewhere. It is associated with a poor prognosis. Current treatment strategies primarily include systemic anti-tumor therapy and local management of MPE based on the primary tumor. Numerous studies have documented diverse approaches for the local control of MPE. This review summarizes recent advances in local treatment strategies for primary tumor-related MPE, highlighting emerging pharmacological agents and innovative techniques.
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Humans ; Pleural Effusion, Malignant/drug therapy*

Prostate cancer (PCa) is globally the most prevalent malignancy in the male genitourinary system, with a continuously ascending incidence in China. For the treatment of localized PCa, radical prostatectomy and radiotherapy have demonstrated effective suppression of the tumor, but with obvious complications that markedly compromise the life quality of the patients. Focal therapy, by targeting the principal tumor foci, can largely reduce the incidence of complications. In this context, irreversible electroporation represents an emerging modality of focal treatment capable of ablating the tumor as thoroughly as possible while sparing such critical structures as the urethra, rectum and neurovascular bundles from thermal damage, and thus offers a promising option for the management of localized PCa. This article presents an overview of the latest advances in the studies of irreversible electroporation.
Humans ; Male ; Prostatic Neoplasms/therapy* ; Electroporation/methods*

Acute respiratory distress syndrome (ARDS) is a common respiratory emergency, but current clinical treatment remains at the level of symptomatic support and there is a lack of effective targeted treatment measures. Our previous study confirmed that inhalation of hydrogen gas can reduce the acute lung injury of ARDS, but the application of hydrogen has flammable and explosive safety concerns. Drinking hydrogen-rich liquid or inhaling hydrogen gas has been shown to play an important role in scavenging reactive oxygen species and maintaining mitochondrial quality control balance, thus improving ARDS in patients and animal models. Coral calcium hydrogenation (CCH) is a new solid molecular hydrogen carrier prepared from coral calcium (CC). Whether and how CCH affects acute lung injury in ARDS remains unstudied. In this study, we observed the therapeutic effect of CCH on lipopolysaccharide (LPS) induced acute lung injury in ARDS mice. The survival rate of mice treated with CCH and hydrogen inhalation was found to be comparable, demonstrating a significant improvement compared to the untreated ARDS model group. CCH treatment significantly reduced pulmonary hemorrhage and edema, and improved pulmonary function and local microcirculation in ARDS mice. CCH promoted mitochondrial peripheral division in the early course of ARDS by activating mitochondrial thioredoxin 2 (Trx2), improved lung mitochondrial dysfunction induced by LPS, and reduced oxidative stress damage. The results indicate that CCH is a highly efficient hydrogen-rich agent that can attenuate acute lung injury of ARDS by improving the mitochondrial function through Trx2 activation.

Objective:To develop an artificial intelligence system using fully convolutional neural networks（FCN）to assist echocardiographers in the quantitative assessment of mitral regurgitation（MR）severity.Methods:From August 2021 to June 2024，echocardiographic images of 441 patients with MR were prospectively collected from Renmin Hospital of Wuhan University and the Central Hospital of Wuhan. After screening，a total of 269 patients（4 917 frames）were included in the study. Of these，3 644 frames（128 patients）of apical four-chamber color Doppler MR flow convergence images from Renmin Hospital of Wuhan University were selected as the training/validation set，while images from 121 patients（813 frames）were used as the internal test set. Additionally，images from 20 patients（460 frames）from the Central Hospital of Wuhan were selected as the external test set. The FCN algorithm was employed to capture features and segment the MR color region on the left atrial side，simultaneously outputting the regurgitant radius（r）for the calculation of the effective regurgitant orifice area and regurgitant volume. The severity of MR was then classified according to the 2017 guidelines of the American Society of Echocardiography. The segmentation and classification performance of the model was evaluated，and the measurement results of the AI system was compared with that of both senior and junior physicians.Results:In the internal test set，the accuracy of r identification for cases classified as Grade Ⅰ to Ⅳ was 0.48，0.81，0.86，and 0.87，respectively. In the external test set，the accuracy of r identification for cases classified as Grade Ⅰ to Ⅳ was 0.60，0.77，0.64，and 0.77，respectively. The average accuracy of MR classification in the internal and external test sets was 0.91 and 0.88，respectively.Conclusions:The FCN model is capable of segmenting the left atrial side regurgitant areas in apical four-chamber heart color Doppler images，aiding physicians in obtaining quantitative assessment parameters for MR，and assisting junior physicians in accurately assessing the severity of MR.

Objective To investigate the efficacy of Yiqi Wenyang Sanjie Decoction in the treatment of patients with pulmonary ground glass nodules and yang-deficiency constitution,and to observe its effect on serum inflammatory factors and immune function.Methods From January 2020 to June 2024,a total of 106 patients with pulmonary ground glass nodules and yang-deficiency constitution admitted to the Department of Respiratory Medicine and Preventive Treatment of Disease Center of Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine were selected.The patients were randomly divided into control group and Chinese medicine group by random number table method,with 53 cases in each group.The patients in the control group were only given follow-up without any intervention,and the patients in the Chinese medicine group were treated with Yiqi Wenyang Sanjie Decoction for 3 months.Before and after treatment,the two groups were observed in the changes of traditional Chinese medicine(TCM)syndrome scores,maximum diameter of pulmonary ground glass nodules,serum levels of inflammatory factors of interleukin-6(IL-6),interleukin-17A(IL-17A),and tumor necrosis factor-α(TNF-α),and levels of immune function indicators of peripheral blood CD3+,CD4+cell percentage and CD4+/CD8+ratio.After treatment,the efficacy and safety of the two groups were evaluated.Results(1)During the trial,5 cases fell off from the control group and 3 cases fell off from the Chinese medicine group.A total of 98 cases were eventually included,and 48 cases were in the control group and 50 cases were in the Chinese medicine group.(2)After 3 months of treatment,the total effective rate of the Chinese medicine group was 46.00%(23/50),and that of the control group was 10.42%(5/48).The intergroup comparison(tested by chi-square test)showed that the efficacy of the Chinese medicine group was significantly superior to that of the control group(P＜0.01).(3)After treatment,the TCM syndrome score and the maximum diameter of pulmonary ground glass nodules in the Chinese medicine group were lowered(P＜0.05),while the TCM syndrome score and the maximum diameter showed no obvious changes compared with those at enrollment(P＞0.05);the intergroup comparison showed that the reduction of TCM syndrome score and the maximum diameter of pulmonary ground glass nodules in the Chinese medicine group was significantly superior to that in the control group(P＜0.05).(4)After treatment,the levels of serum inflammatory factors of IL-6,IL-17A and TNF-α in the Chinese medicine group were significantly lowered compared with those at enrollment(P＜0.05),while there was no significant change in serum IL-6,IL-17A and TNF-α levels of the control group(P＞0.05);the intergroup comparison showed that the decrease of serum IL-6,IL-17A and TNF-α levels in the Chinese medicine group was significantly superior to that in the control group(P＜0.05).(5)After treatment,the percentage of T lymphocyte subset CD4+and the ratio of CD4+/CD8+in the Chinese medicine group were significantly increased compared with those at enrollment(P＜0.05),while there was no significant change in the percentage of CD3+,CD4+cells and the ratio of CD4+/CD8+of the control group and in the percentage of CD3+cells of the Chinese medicine group(P＞0.05).The intergroup comparison showed that the increase of CD4+percentage and CD4+/CD8+ratio in the Chinese medicine group was significantly superior to that in the control group(P＜0.05).(6)There were no obvious adverse reactions occurring in the Chinese medicine group during the treatment,showing relatively high safety.Conclusion Yiqi Wenyang Sanjie Decoction exerts certain effect in the treatment of patients with pulmonary ground glass nodules and yang-deficiency constitution.It can effectively promote the reduction of nodules,relieve clinical symptoms,decrease serum levels of inflammatory factors,improve immune function,and has good safety.

In recent years, robot-assisted esophagectomy has become increasingly widespread, but the esophagogastric anastomosis step remains relatively complex and cumbersome. Currently, commonly used gastrointestinal reconstruction anastomosis techniques include end-to-end anastomosis, end-to-side anastomosis, and side-to-side anastomosis. Depending on the anastomosis method, they can be further divided into manual anastomosis and mechanical anastomosis, with common instruments including circular staplers and linear staplers. In esophageal cancer surgery, the choice of esophagogastric anastomosis technique is typically based on the tumor’s location and size as well as the surgeon’s preference. Each anastomosis technique has its advantages and disadvantages. With continuous improvements in anastomosis techniques and updates in stapling instruments, the incidence of complications after esophagogastric anastomosis has been effectively reduced. However, safely and efficiently completing gastrointestinal reconstruction during surgery remains a significant challenge. Scholars have made extensive explorations in this field, actively proposing and achieving various reconstruction methods, leading to significant progress. This article reviews the research progress of robot-assisted esophagogastric anastomosis techniques from both the anastomosis techniques and methods perspectives.

Objective:To develop an artificial intelligence system using fully convolutional neural networks（FCN）to assist echocardiographers in the quantitative assessment of mitral regurgitation（MR）severity.Methods:From August 2021 to June 2024，echocardiographic images of 441 patients with MR were prospectively collected from Renmin Hospital of Wuhan University and the Central Hospital of Wuhan. After screening，a total of 269 patients（4 917 frames）were included in the study. Of these，3 644 frames（128 patients）of apical four-chamber color Doppler MR flow convergence images from Renmin Hospital of Wuhan University were selected as the training/validation set，while images from 121 patients（813 frames）were used as the internal test set. Additionally，images from 20 patients（460 frames）from the Central Hospital of Wuhan were selected as the external test set. The FCN algorithm was employed to capture features and segment the MR color region on the left atrial side，simultaneously outputting the regurgitant radius（r）for the calculation of the effective regurgitant orifice area and regurgitant volume. The severity of MR was then classified according to the 2017 guidelines of the American Society of Echocardiography. The segmentation and classification performance of the model was evaluated，and the measurement results of the AI system was compared with that of both senior and junior physicians.Results:In the internal test set，the accuracy of r identification for cases classified as Grade Ⅰ to Ⅳ was 0.48，0.81，0.86，and 0.87，respectively. In the external test set，the accuracy of r identification for cases classified as Grade Ⅰ to Ⅳ was 0.60，0.77，0.64，and 0.77，respectively. The average accuracy of MR classification in the internal and external test sets was 0.91 and 0.88，respectively.Conclusions:The FCN model is capable of segmenting the left atrial side regurgitant areas in apical four-chamber heart color Doppler images，aiding physicians in obtaining quantitative assessment parameters for MR，and assisting junior physicians in accurately assessing the severity of MR.

Objective:To evaluate the cardiac morphological and functional parameters of patients with persistent atrial fibrillation (per-AF) and paroxysmal atrial fibrillation (PAF) using two-dimensional speckle tracking echocardiography (2D-STE) and real-time three-dimensional echocardiography (RT-3DE), and to explore their predictive value for the occurrence and progression of atrial fibrillation.Methods:A retrospective study was conducted on 30 per-AF patients (per-AF group), 30 PAF patients (PAF group) and 25 non-AF subjects (control group) who underwent echocardiography at Wuhan University People′s Hospital from May 2022 to May 2023. The left/right atrial longitudinal strain of reservoir, conduct and contraction (LASr/RASr, LAScd/RAScd, LASct/RASct), and calculated left atrial stiffness (LASI) were assessed by 2D-STE. Three-dimensional left and right atrial maximum volume index (LAVImax/RAVImax), minimum volume index (LAVImin/RAVImin) and emptying fraction (LAEF/RAEF) were obtained by RT-3DE. Then, patients with atrial fibrillation were divided into the normal LAVI group and enlarged LAVI group, and the differences of atrial strain among each group were compared. ROC curve was used to evaluate the overall diagnostic efficiency and cutoff values of ultrasonic parameters in patients with normal volume of atrial fibrillation. Finally, a multivariate Logistic regression model was established to identify the ultrasonic parameters associated with the occurrence and progression of different types of atrial fibrillation.Results:①Structurally, LAD, RAD and RAVImin in control, PAF and per-AF groups increased gradually, while LAEF and RAEF decreased gradually (all P<0.05). ②In terms of strain, LASr in control, PAF and per-AF groups decreased gradually (all P<0.05); Compared with the control group, LAScd, RASr and RAScd in PAF and per-AF groups were significantly decreased, and LASct and RASct in PAF group were significantly decreased (all P<0.05). ③Compared with the normal LAVI group, the LASr, LAScd and LASct in the enlarged LAVI group were significantly decreased, while LASI was significantly increased (all P<0.05); Compared with control group, the left and right atrial strain parameters in LAVI normal group were decreased, and LASI was increased (all P<0.05). The atrial strain parameter ROC was constructed in all subjects with normal left atrial volume, and RASr was the most sensitive indicator.④Multi-factor Logistic regression analysis showed that LAVImin and RASr were the influence factors of PAF ( OR=1.521, 0.907; 95% CI=1.173-1.972, 0.825-0.998; P=0.002, 0.044), LASr was the influence factor of pre-AF ( OR=0.858, 95% CI=0.802-0.917, P<0.001). Conclusions:2D-STE and RT-3DE can be used to evaluate the structural and functional changes of both atria, especially LAVImin, LASr and RASr, which have certain predictive value for the occurrence and progression of atrial fibrillation.

Objective:To explore the impact of transcatheter edge-to-edge repair (TEER) devices on mitral valve regurgitant flow convergence post-procedure using computational fluid dynamics(CFD), and to seek solutions for accurately measuring effective regurgitant orifice area(EROA) after TEER.Methods:Multimodal fusion was conducted based on preoperative cardiac CT images and intraoperative three-dimensional transesophageal echocardiography(3DTEE) of 33 patients with mitral valve regurgitation undergoing TEER at Renmin Hospital of Wuhan University from January 2020 to August 2023. Using this data, CFD models of mitral valve regurgitation post-TEER, including with and without the TEER device, were constructed. The distance (D) from the midpoint of the mitral regurgitation orifice to the TEER device was measured. The proximal isovelocity surfice area(PISA) radius with and without the TEER device was measured, and the corresponding EROA1 and EROA2 based on this was calculated. The EROA correction factor CC=EROA2/EROA1 was calculated.Results:A total of 42 sets of CFD models with mild or greater residual mitral regurgitation, both with and without the TEER device, and 50 sets of PISA were obtained. Based on the relative position of PISA to the TEER device, four types of PISA were observed: Type 1: PISA away from the TEER device (D>R, 14 cases), with a CC of 0.93±0.07; Type 2: PISA adjacent to the TEER device (D