Objective To systematically evaluate the efficacy and safety of video-assisted thoracoscopic surgery (VATS) with different numbers of ports in the treatment of spontaneous pneumothorax. Methods We conducted a comprehensive search of CNKI, PubMed, The Cochrane Library, Web of Science, EMbase, Wanfang Data, and the Chinese Medical Journal Full-text Database for clinical controlled trials on VATS with different port numbers for spontaneous pneumothorax, from their inception to March 2023. Two researchers independently screened the literature and assessed its quality.The Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of cohort and case-control studies, and the Cochrane risk-of-bias tool was used to evaluate randomized controlled trials (RCT). Meta-analysis was performed using RevMan 5.4.1 software. Results A total of 107 studies were included, comprising 35 RCT, 2 cohort studies, and 70 case-control studies. All cohort and case-control studies included in the analysis had NOS scores≥7. The meta-analysis revealed that compared to two-port VATS (2P-VATS) and three-port VATS (3P-VATS), single-port thoracoscopic surgery (SPTS) was associated with less intraoperative blood loss (SMD=–1.58, 95%CI: –1.93 to –1.22, P<0.001; and SMD=–1.59, 95%CI: –2.03 to –1.14, P<0.001, respectively), shorter postoperative hospital stay (SMD=–1.05, 95%CI: –1.29 to –0.82, P<0.001; and SMD=–1.08, 95%CI: –1.39 to –0.77, P<0.001), shorter duration of postoperative chest tube drainage (SMD=–0.75, 95%CI: –1.00 to –0.50, P<0.001; and SMD=–1.23, 95%CI: –1.72 to –0.75, P<0.001), fewer postoperative complications (OR=0.34, 95%CI: 0.26 to 0.45, P<0.001; and OR=0.47, 95%CI: 0.33 to 0.68, P<0.001), and lower pain scores at 24, 48, and 72 hours after surgery (P<0.05). The operative time for SPTS was shorter than that for 2P-VATS (SMD=–0.53, 95%CI: –0.90 to –0.16, P=0.005) but showed no significant difference compared to 3P-VATS (P=0.21). When comparing 2P-VATS with 3P-VATS, 2P-VATS demonstrated less intraoperative blood loss (SMD=–1.02, 95%CI: –1.81 to –0.22, P=0.01), shorter postoperative hospital stay (SMD=–0.59, 95%CI: –1.11 to –0.06, P=0.03), shorter duration of chest tube drainage (SMD=–0.46, 95%CI: –0.85 to –0.08, P=0.02), fewer postoperative complications (OR=0.36, 95%CI: 0.22 to 0.59, P<0.001), and lower pain scores at 24, 48, and 72 hours after surgery (P≤0.05). Conclusion Both SPTS and 2P-VATS are effective and safe surgical options for spontaneous pneumothorax, deserving further promotion and application in clinical practice. However, due to limitations in the quantity and quality of the included studies, more large-sample, high-quality research is needed to validate these findings.

Objective To systematically evaluate the efficacy of immune checkpoint inhibitors (ICIs) in treating esophageal cancer patients of different genders. Methods Computer searches were conducted on PubMed, Cochrane Library, and Embase databases to collect randomized controlled trial (RCT) on ICIs treatment for esophageal cancer patients from the establishment of the databases to January 25, 2024. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. The outcome indicators were overall survival (OS) and progression-free survival (PFS), and RevMan 5.4 software was used for meta-analysis. The modified Jadad scoring scale was used to evaluate the quality of the included literature. Results A total of 10 RCT involving 5364 esophageal cancer patients were included in this study, with 2684 patients in the trial group and 2680 patients in the control group. The Jadad scores of the included literature were all ≥6 points, indicating high-quality RCT. Meta-analysis results showed that female esophageal cancer patients receiving ICIs treatment [HR=0.72, 95%CI (0.59, 0.87), P<0.001] had a more significant median OS prolongation than male patients [HR=0.73, 95%CI (0.68, 0.78), P<0.001]; while male patients [HR=0.57, 95%CI (0.52, 0.64), P<0.001] had a more significant PFS prolongation than female patients [HR=0.72, 95%CI (0.55, 0.94), P=0.01]. Female patients treated with ICIs alone [HR=0.66, 95%CI (0.50, 0.87), P=0.003] had a more significant median OS prolongation than male patients [HR=0.79, 95%CI (0.72, 0.87), P<0.001]; while male patients receiving ICIs combined with chemotherapy [HR=0.67, 95%CI (0.61, 0.74), P<0.001] had a more significant median OS prolongation than female patients [HR=0.77, 95%CI (0.59, 1.01), P=0.06]. Conclusion Female patients receiving ICIs have a slight advantage in OS compared to male patients, while male patients have an advantage in PFS. Male patients receiving ICIs combined with chemotherapy have better survival benefits than female patients, while female patients using ICIs monotherapy have better survival benefits than male patients.

Colorectal cancer (CRC) is a common malignant tumor. The treatment of patients with advanced disease still faces severe challenges. Among patients with metastatic colorectal cancer (mCRC), most of those with microsatellite stable (MSS)/proficient mismatch repair (pMMR) tumors are highly insensitive to monotherapy with immune checkpoint inhibitors. With in-depth investigations into the mechanisms of the tumor immune microenvironment in MSS/pMMR CRC, the combination strategies of immunotherapy and targeted therapy have become a key direction to break through the treatment bottleneck in this population. These strategies include combinations of immunotherapy with antiangiogenic agents, epidermal growth factor receptor inhibitors, histone deacetylase inhibitors, and MAPK pathway inhibitors. Although the current relevant evidence is mainly derived from early-phase clinical trials, a number of studies demonstrated that immunotherapy combined with targeted therapy can improve the objective response rate and survival benefit in patients with MSS/pMMR mCRC and shows remarkable efficacy advantages in specific subgroups. This article systematically reviews the biological basis and clinical research progress of relevant combination therapeutic strategies, discusses potential beneficiary subgroups, and prospects future research directions. It aims to provide theoretical evidence and clinical references for optimizing the individualized treatment paradigm for this large patient population.

Objective To systematically investigate the effects of Dangmu extract syrup on the growth and development of 4-day-old(postnatal day 4,PND4)Sprague-Dawley(SD)rats and its toxic reactions.Methods According to the whole litter design method,128 young mice(PND2)were randomly divided into negative control group and low,medium and high dose groups.From PND4,the animals were orally given pure water,31 g/kg,93 g/kg and 280 g/kg(calculated as raw herb material)of Dangmu extract syrup,respectively,once daily for 18 consecutive days,with a 15 d of recovery phase.During the study period,the general state,growth and development,nerve reflex function,spontaneous behavior,hematology,coagulation,blood biochemistry,immune function,growth hormone and histopathology of the animals in each group were observed or examined.Results After 18 d of continuous administration,compared with the negative control group,GLU(male and female)in the medium and high dose groups increased(P＜0.05 or P＜0.01),LDH(male and female)and AST(male)in the medium and high dose groups,ALT,AST(female)in the high dose group decreased(P＜0.05 or P＜0.01),RET and percentage of RET(male and female)in the low and high dose groups,RET(male)in the medium dose group increased(P＜0.05 or P＜0.01),spleen mass and the organ-to-body mass ratio(male and female)in the low and high dose groups and female in the medium dose group increased(P＜0.05 or P＜0.01).Splenic nodule structures were formed in all dose groups with large size and number,and there was a dose relationship in the degree of changes.After 15 d recovery period,compared with the negative control group,GLU(female)in the low dose group increased(P＜0.05),ALT,AST,ALP,TG(female)in the medium and high dose groups,GGT,TG,TCHO(male)in the medium dose groups,AST,ALP,TG,LDH(male)in the high dose group decreased(P＜0.05 or P＜0.01),RET(female)and percentage of RET(male)in the high dose group increased(P＜0.05).compared with the 18 d of continuous administration,the spleen structures of the animals in each group were more completely developed and the splenic nodule structures were obvious,but no significant difference was noted in the comparison between groups.No significant drug-related changes were observed in other test result.Conclusions Dangmu extract syrup advanced the development of complete spleen structure in 4-day-old SD rats,accompanied by the enhancement of its hematopoietic function,and at the same time,it caused the animals,blood glucose to rise,the enhancement of glucose metabolism function led to the increase of related enzyme consumption,and led to the decrease of some liver function parameters,and showed a dose correlation.There was no gender difference in the changes,which were reversible after stop administration,and the mechanism of the changes needs to be further explored and confirmed.In the clinical trials,attention should be paid to the control of the dose of the test article,and regular monitoring of the spleen and related blood and clinical chemistry parameters.

Objective To investigate the effects of the polymer pharmaceutical excipient methoxy poly-ethylene glycol poly-lactic acid(mPEG-PLA)in Sprague-Dawley(SD)rats and Beagle dogs and its toxicological reactions,to provide a reference for its safe clinical use.Methods SD rats and Beagle dogs(male∶female ratios,1∶1)were divided randomly into control group and low,medium,and high dose mPEG-PLA groups(70,210,700 mg/kg).Animals received intravenous mPEG-PLA once a day for 90 days,followed by a 28-day recovery period.Indicators including clinical observations,food intake,body weight,hematology,blood biochemistry,immune function,and pathological examination were recorded.Results Compared with the control group,(1)food intake was decreased(P＜0.01)and body weight was increased(P＜0.05 or P＜0.01)after 90 days of continuous administration,with similar changes in the medium and high dose groups in both rats and dogs.In addition,MONO/MONO％,RBC,MCH,MCHC,HCT,HGB,PLT,TP,ALB,GLB,and Fbg were all decreased(P＜0.05 or P＜0.01)and coagulation indexes(e.g.,APTT)were increased(P＜0.05 or P＜0.01).Organ weights and the organ-to-body/brain weight ratios of the liver and spleen were increased(P＜0.05 or P＜0.01),and histopathology indicated numerous foam-like macrophages in the hepatic sinuses,red spleen pulp,and lymph node medulla.DBIL and TBIL also increased in rats in the high dose group(P＜0.05 or P＜0.01),while the dogs experienced skin swelling or scabs,abdominal swelling,vomiting,decreased activity,high albuminuria,and ascites,and the renal glomerular cells showed vacuoles.(2)After 28 days of recovery,rats and dogs in the medium and high dose groups showed a few foam-like macrophages in the hepatic sinuses,red spleen pulp,and lymph node medulla,as well as decreased of food intake in dogs.The MCHC,PLT,and TP decreased in dogs in the high dose group(P＜0.05),and the liver and spleen weights and organ coefficients in rats increased(P＜0.05 or P＜0.01),while the MONO％decreased in male rats in the medium dose group(P＜0.05).Conclusions Administration of mPEG-PLA 210 and 700 mg/kg for 90 days caused blood mononuclear cells to enter and aggregate in the liver,spleen,lymph nodes,and other tissues in SD rats and Beagle dogs,leading to secondary tissue structural damage.Protein and fibrinogen synthesis and bilirubin metabolism in the liver decreased,leading to abnormal coagulation function,and decreased intravascular colloid osmotic pressure resulted in edema and bleeding.The result suggest that the liver,spleen,kidney,and lymph nodes are target organs for mPEG-PLA toxicity,with dose-dependent and reversible effects and species differences,but no significant sex differences.Clinical monitoring of related organ functions is needed to avoid secondary damage.

Objective:To summarize the best available evidence for exercise interventions in patients with systemic lupus erythematosus (SLE) .Methods:The PIPOST model from the Joanna Briggs Institute (JBI) Centre for Evidence-Based Healthcare in Australia was used to construct the evidence-based nursing question. A top-down approach based on the "6S" evidence pyramid model was employed to search for relevant evidence, including clinical guidelines, consensus statements, systematic reviews, best practices, and evidence summaries. The search was conducted across BMJ Best Practice, UpToDate, guideline repositories, professional association websites, and Chinese and international databases. Eligible literature was screened for quality assessment, and high-quality evidence was extracted. The search timeframe covered publications from database inception to June 15, 2024.Results:A total of 15 studies were included, comprising 1 clinical decision-making article, 3 guidelines, 6 systematic reviews, and 5 randomized controlled trials. A total of 25 evidence statements were synthesized across 6 key aspects: exercise principles, exercise assessment, exercise modalities, exercise intensity, exercise frequency and duration, and exercise monitoring.Conclusions:The best evidence summarized in this study provides a valuable reference for clinical healthcare professionals implementing exercise interventions for patients with systemic lupus erythematosus.

Houpo Qiwutang originated from the Synopsis of the Golden Chamber， and it consists of seven medicines： Magnoliae Officinalis Cortex， Rhei Radix et Rhizoma， Aurantii Fructus Immaturus， Cinnamomi Ramulus， Zingiberis Rhizoma Recens， Glycyrrhizae Radix et Rhizoma， and Jujubae Fructus. It is a basic formula for the treatment of abdominal fullness. Through the bibliometric method， the historical history， drug base， preparation and dosage， decoction method， and ancient and modern applications of Houpu Qiwu Tang were analyzed by means of textual research. The research finds that Houpu Qiwu Tang has been passed down through the generations in an orderly manner with fewer changes. The drug base of this formula is basically clear， and the base of Magnoliae Officinalis Cortex， Rhei Radix et Rhizoma， Cinnamomi Ramulus， Zingiberis Rhizoma Recens， and Jujubae Fructus is consistent with the 2020 edition of Chinese Pharmacopoeia. The mainstream base of Aurantii Fructus Immaturus is the dried young fruit of Citrus aurantium of Rutaceae family， and the historical mainstream base of Glycyrrhizae Radix et Rhizoma is the dried root of Glycyrrhiza uralensis of Leguminosae family. The modern dosage of this formula is 110.40 g of Magnoliae Officinalis Cortex， 41.40 g of Rhei Radix et Rhizoma， 69 g of Aurantii Fructus Immaturus， 27.60 g of Cinnamomi Ramulus， 69 g of Zingiberis Rhizoma Recens， 41.40 g of Glycyrrhizae Radix et Rhizoma， and 30 g of Jujubae Fructus. In addition， the decoction method is to add 2 000 mL of water with the above seven flavors of the medicine， boil it to 800 mL， and then take 160 mL in a warm state each time. The amount of the medicine taken for each time is 22.08 g of Magnoliae Officinalis Cortex， 8.28 g of Rhei Radix et Rhizoma， 13.80 g of Aurantii Fructus Immaturus， 5.52 g of Cinnamomi Ramulus， 13.80 g of Zingiberis Rhizoma Recens， 8.28 g of Glycyrrhizae Radix et Rhizoma， and 6 g of Jujubae Fructus. The modern application of this formula involves the digestive system， respiratory system， and urinary system. It is more advantageous in digestive system diseases such as early postoperative inflammatory bowel obstruction， functional dyspepsia， gastric pain， functional abdominal distension， and gastric reflux esophagitis. By comprehensively examining the key information of Houpu Qiwu Tang， this paper aims to provide literature support for the development and clinical application of this formula.

In proton therapy,prompt gamma-ray imaging is considered as one of the most promising methods for assessing proton beam range.Prompt gamma-ray imaging detector evaluates the proton beam range based on the prompt gamma-ray distribution obtained by the prompt gamma-ray imaging system,which enables high-precision measurement of the proton beam range.Herein a proton beam range verification algorithm is designed for the newly developed prototype of the range verification detector(pixelated prompt gamma-ray imaging detector),which verifies the range estimation accuracy of the prototype for different phantoms and different energies of homogeneous media through Monte Carlo simulation.The results show that the accuracy of the proton beam range verification algorithm is within 0.5 mm of the safety margin error of the Bragg peak,and the measurement accuracy is significantly improved with the increase of the number of protons,indicating that the prototype algorithm is feasible for proton beam range verification.

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objective To systematically investigate the effects of Dangmu extract syrup on the growth and development of 4-day-old(postnatal day 4,PND4)Sprague-Dawley(SD)rats and its toxic reactions.Methods According to the whole litter design method,128 young mice(PND2)were randomly divided into negative control group and low,medium and high dose groups.From PND4,the animals were orally given pure water,31 g/kg,93 g/kg and 280 g/kg(calculated as raw herb material)of Dangmu extract syrup,respectively,once daily for 18 consecutive days,with a 15 d of recovery phase.During the study period,the general state,growth and development,nerve reflex function,spontaneous behavior,hematology,coagulation,blood biochemistry,immune function,growth hormone and histopathology of the animals in each group were observed or examined.Results After 18 d of continuous administration,compared with the negative control group,GLU(male and female)in the medium and high dose groups increased(P＜0.05 or P＜0.01),LDH(male and female)and AST(male)in the medium and high dose groups,ALT,AST(female)in the high dose group decreased(P＜0.05 or P＜0.01),RET and percentage of RET(male and female)in the low and high dose groups,RET(male)in the medium dose group increased(P＜0.05 or P＜0.01),spleen mass and the organ-to-body mass ratio(male and female)in the low and high dose groups and female in the medium dose group increased(P＜0.05 or P＜0.01).Splenic nodule structures were formed in all dose groups with large size and number,and there was a dose relationship in the degree of changes.After 15 d recovery period,compared with the negative control group,GLU(female)in the low dose group increased(P＜0.05),ALT,AST,ALP,TG(female)in the medium and high dose groups,GGT,TG,TCHO(male)in the medium dose groups,AST,ALP,TG,LDH(male)in the high dose group decreased(P＜0.05 or P＜0.01),RET(female)and percentage of RET(male)in the high dose group increased(P＜0.05).compared with the 18 d of continuous administration,the spleen structures of the animals in each group were more completely developed and the splenic nodule structures were obvious,but no significant difference was noted in the comparison between groups.No significant drug-related changes were observed in other test result.Conclusions Dangmu extract syrup advanced the development of complete spleen structure in 4-day-old SD rats,accompanied by the enhancement of its hematopoietic function,and at the same time,it caused the animals,blood glucose to rise,the enhancement of glucose metabolism function led to the increase of related enzyme consumption,and led to the decrease of some liver function parameters,and showed a dose correlation.There was no gender difference in the changes,which were reversible after stop administration,and the mechanism of the changes needs to be further explored and confirmed.In the clinical trials,attention should be paid to the control of the dose of the test article,and regular monitoring of the spleen and related blood and clinical chemistry parameters.