Objective To explore the safety and efficacy of thoracoscopy-guided thoracic paravertebral block (TPVB) in thoracoscopic pulmonary resection, and to provide strategies for enhanced recovery after surgery (ERAS) in thoracoscopic lung resection. Methods Patients who underwent thoracoscopic pulmonary resection (including sublobar resection and lobectomy) in the 987th Hospital of Joint Logistics Support Force of People's Liberation Army, General Hospital of Central Theater Command of the People’s Liberation Army, and the First Affiliated Hospital with Nanjing Medical University between May 2021 and June 2023 were prospectively enrolled. The patients were randomly allocated into three groups in a single-blind manner using a random number table. Group A (incisional nerve block group) received a subcutaneous injection of ropivacaine (0.375%, 2 mg/kg) around the incision during chest closure. Group B (ultrasound-guided TPVB group) received an ultrasound-guided injection of ropivacaine (0.375%, 2 mg/kg) at the paravertebral space after chest closure. Group C (thoracoscopy-guided TPVB group) received a thoracoscopy-guided intrathoracic injection of ropivacaine (0.375%, 2 mg/kg) at the paravertebral space during chest closure. Perioperative adverse drug reactions, pain scores, postoperative analgesic consumption, and postoperative length of hospital stay were compared among the three groups. Results A total of 180 patients were included, comprising 108 females and 72 males, with a mean age of (62.15±7.36) years. There were no statistical differences among the three groups in baseline characteristics, including age, weight, gender, prevalence of comorbidities, operative time, number of surgical incisions, number of chest tubes, or intraoperative dosages of sufentanil and propofol (P>0.05). No adverse anesthesia events occurred during surgery in any of the groups. The pressing frequency of the patient-controlled intravenous analgesia (PCIA) pump, Visual Analogue Scale (VAS) pain scores, the rate of postoperative rescue analgesic use, and the incidences of postoperative cough and dizziness in the group C were significantly lower than those in the other two groups (P<0.05). The postoperative length of hospital stay in the group B and group C was significantly shorter than that in the group A (P<0.05). Conclusion Thoracoscopy-guided TPVB during chest closure can effectively alleviate postoperative pain without increasing postoperative side effects, which facilitates the enhanced recovery after thoracoscopic lung surgery.

To investigate the feasibility and advantages of "Axis Coordinate Localization Method" combined with total endoscopic technique for parotid surgery. A total of 31 patients with parotid gland tumors who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2022 to August 2024 were included in this study. The cohort comprised 11 males and 20 females, with age of (38.9±13.9) years and a maximum tumor diameter of (19.34±6.89) mm. Among these cases, 93.5% (29/31) involved the superficial lobe and 6.5%(2/31) the deep lobe of the parotid gland. The "axial" localization method was utilized to plan the surgical approach: establishing a coordinate system with the earlobe as the origin, the surface projection of the parotid duct as the x-axis, and a perpendicular line through the origin as the y-axis. The incision type-pre-tragal, retroauricular groove, or postauricular hairline-was selected according to the position of the tumor′s surface projection center within this coordinate system. All operations were performed using a complete endoscopic technique for tumor and glandular tissue resection. Postoperative facial nerve function was assessed with the House-Brackmann grading scale, while patient incision satisfaction, impact on work and daily life, and facial symmetry were quantitatively evaluated using a Numerical Rating Scale (10-point system).　All 31 patients successfully underwent the procedure. Short-term postoperative complications included temporary facial paralysis in 1 case (3.2%), periauricular numbness in 1 case (3.2%), surgical site effusion in 1 case (3.2%), and subcutaneous hematoma in 1 case (3.2%). All complications resolved after appropriate management. During follow-up, there were no instances of sialocele, Frey syndrome, incision infection, or tumor recurrence. Patient ratings were as follows: incision satisfaction (9.42±0.78), impact of surgery on daily life (1.32±0.60), and facial symmetry (9.29±0.78). The one case of temporary facial paralysis recovered 3 months after surgery. The combination of the "Axial" localization method and fully endoscopic technique demonstrates clear clinical feasibility in parotid tumor resection. This approach enables rapid and personalized incision selection based on tumor location, while the endoscopic minimally invasive technique reduces tissue trauma, improves cosmetic outcomes, and enhances surgical safety. It provides a new minimally invasive treatment pathway for patients with benign parotid tumors.

Objective To investigate the factors influencing pathologic complete response(pCR)after neoadjuvant chemotherapy(NAC)and its correlation with prognosis in patients with human epidermal growth factor receptor 2(HER2)-low breast cancer.Methods A retrospective analysis was conducted on patients with HER2-low breast cancer who underwent NAC at the Second Affiliated Hospital of Jiujiang College from February 28,2018 to February 28,2021.Patients were divided into pCR group(achieved pCR,n=143)and non-pCR group(did not achieve pCR,n=300)based on pCR status.General clinicopathological data were collected and compared between the two groups,including age,surgical method,NAC regimen,postoperative radiotherapy,clinical tumor stage,tumor cT stage,tumor cN stage,pathological type,tumor Nottingham grade,hormone receptor(HR)status,Ki-67 status,menopausal status,and endocrine therapy.Binary logistic regression analysis was used to identify factors influencing pCR after NAC.Propensity score matching(1:1)was employed to balance baseline characteristics between the two groups.The matched groups'baseline data were compared.Kaplan-Meier method was used for survival analysis of the matched cohorts.Multivariate Cox proportional hazards regression models were used to analyze the independent influence of pCR on disease-free survival(DFS)and overall survival(OS)in HER2-low breast cancer after matching.Results A total of 443 patients with HER2-low breast cancer receiving NAC were included,with a mean age of(49.5±8.0)years.Binary logistic regression analysis identified clinical tumor stage(OR=0.498,95%CI 0.267-0.930),HR status(OR=0.513,95%CI 0.328-0.801),Ki-67 status(OR=2.580,95%CI 1.366-4.874),tumor Nottingham grade Ⅲ(OR=3.197,95%CI 1.147-8.910),and endocrine therapy(OR=0.513,95%CI 0.328-0.801)as independent factors influencing pCR after NAC(P<0.05).After propensity score matching,80 patients remained in each group(PCR and non-PCR).No significant differences were found in clinicopathological characteristics between the matched groups(P>0.05).The median follow-up time was 45.0 months(95%CI 43.1-46.9)for pCR group and 43.0 months(95%CI 41.0-45.0)for non-pCR group.The DFS rate was significantly higher in pCR group than that in non-pCR group(87.5%vs.70.0%,P=0.004),but there was no significant difference in OS rate(88.8%vs.85.0%,P=0.438).Multivariate Cox regression analysis showed that pCR was an independent factor influencing on DFS(HR=0.312,95%CI 0.142-0.688,P=0.004),but not OS in HER2-low breast cancer patients.Conclusions Patients with HER2-low breast cancer who have a lower clinical tumor stage,HR-negative status,high Ki-67 expression,high tumor Nottingham grade,and absence of endocrine therapy are more likely to achieve pCR.Achieving pCR prolongs DFS significantly but does not significantly improve OS in these patients.

To investigate the feasibility and advantages of "Axis Coordinate Localization Method" combined with total endoscopic technique for parotid surgery. A total of 31 patients with parotid gland tumors who were admitted to the First Affiliated Hospital of Zhengzhou University from January 2022 to August 2024 were included in this study. The cohort comprised 11 males and 20 females, with age of (38.9±13.9) years and a maximum tumor diameter of (19.34±6.89) mm. Among these cases, 93.5% (29/31) involved the superficial lobe and 6.5%(2/31) the deep lobe of the parotid gland. The "axial" localization method was utilized to plan the surgical approach: establishing a coordinate system with the earlobe as the origin, the surface projection of the parotid duct as the x-axis, and a perpendicular line through the origin as the y-axis. The incision type-pre-tragal, retroauricular groove, or postauricular hairline-was selected according to the position of the tumor′s surface projection center within this coordinate system. All operations were performed using a complete endoscopic technique for tumor and glandular tissue resection. Postoperative facial nerve function was assessed with the House-Brackmann grading scale, while patient incision satisfaction, impact on work and daily life, and facial symmetry were quantitatively evaluated using a Numerical Rating Scale (10-point system).　All 31 patients successfully underwent the procedure. Short-term postoperative complications included temporary facial paralysis in 1 case (3.2%), periauricular numbness in 1 case (3.2%), surgical site effusion in 1 case (3.2%), and subcutaneous hematoma in 1 case (3.2%). All complications resolved after appropriate management. During follow-up, there were no instances of sialocele, Frey syndrome, incision infection, or tumor recurrence. Patient ratings were as follows: incision satisfaction (9.42±0.78), impact of surgery on daily life (1.32±0.60), and facial symmetry (9.29±0.78). The one case of temporary facial paralysis recovered 3 months after surgery. The combination of the "Axial" localization method and fully endoscopic technique demonstrates clear clinical feasibility in parotid tumor resection. This approach enables rapid and personalized incision selection based on tumor location, while the endoscopic minimally invasive technique reduces tissue trauma, improves cosmetic outcomes, and enhances surgical safety. It provides a new minimally invasive treatment pathway for patients with benign parotid tumors.

Objective:To study the effects of parenteral nutrition containing ω-3 fish oil fat emulsion on the inflammatory status of patients with intestinal fistula at the early stage.Methods:A retrospective analysis was conducted on 28 patients with intestinal fistula who were admitted to the Sixth Department of General Surgery of Anhui Provincial Second People's Hospital from November 2023 to May 2024.The patients were either divided into control group(n=15,parenteral nutrition alone group)or study group(n=13,parenteral nutrition plus ω-3 fish oil fat emulsion)according to whether ω-3 fish oil fat emulsion was added to parenteral nutrition.Both groups of patients received parenteral nutrition support treatment,and the study group was given ω-3 fish oil fat emulsion during treatment.The general information,inflammatory factors in the blood,nutrition,and immune status of two groups of patients were collected and compared.The feces samples on the first and 14th day of admission were collected and analyzed by 16S rRNA high-throughput sequencing of gut microbiota.Results:There was no statistically significant difference in the general information,inflammation,nutrition,immune status,and gut microbiota between the two groups of patients on the first day of admission(P>0.05),indicating comparability between the two groups.After two weeks of parenteral nutrition support,the counts of red blood cells,white blood cells,platelets,lymphocytes,and levels of C-reactive protein,glutamate-pyruvate transaminase,aspartate aminotransferase,total bilirubin,direct bilirubin,total protein,albumin,and creatinine in the research group were similar to those in the control group without statistically significant differences(P>0.05).However,the counts of neutrophils and levels of blood urea nitrogen in the study group were significantly lower than those in the control group(P=0.03 and P=0.01).In addition,the abundance of intestinal flora in the study group was significantly higher than that in the control group(P<0.05).At the genus level,the abundance of Bacteroides_uniformis,Parabacteroides_merdae,Alistipes_finegoldii,Streptococcus_constellatus,Christensenella_minuta were different between the two groups after two weeks of treatment(P<0.05).Conclusion:Parenteral nutrition containing ω-3 fish oil fat emulsion can reduce the counts of neutrophils,which may alleviate inflammatory responses for patients with intestinal fistula at the early stage.

With the growing emphasis on maternal and child oral health, the significance of managing oral health across preconception, pregnancy, and infancy stages has become increasingly apparent. Oral health challenges extend beyond affecting maternal well-being, exerting profound influences on fetal and neonatal oral development as well as immune system maturation. This expert consensus paper, developed using a modified Delphi method, reviews current research and provides recommendations on maternal and child oral health management. It underscores the critical role of comprehensive oral assessments prior to conception, diligent oral health management throughout pregnancy, and meticulous oral hygiene practices during infancy. Effective strategies should be seamlessly integrated across the life course, encompassing preconception oral assessments, systematic dental care during pregnancy, and routine infant oral hygiene. Collaborative efforts among pediatric dentists, maternal and child health workers, and obstetricians are crucial to improving outcomes and fostering clinical research, contributing to evidence-based health management strategies.
Humans ; Pregnancy ; Female ; Infant ; Consensus ; Mouth Diseases/therapy* ; Pregnancy Complications/therapy* ; Oral Health ; Infant, Newborn ; Delphi Technique ; Oral Hygiene

Objective:To observe the clinical efficacy of immediate repair of extracranial branch defects in the facial nerve through transplantation of the great auricular nerve.Methods:A retrospective inclusion was carried out on 17 patients with extracranial branch defects of the facial nerve caused by parotid malignant tumors and neurogenic tumors in the Department of Stomatology of Xuzhou Central Hospital from June 2021 to January 2023, including 10 males and 7 females, with the age ranged from 28 to 68 (42.4±11.4) years old. All patients underwent immediate transplantation of the greater auricular nerve during the operation. The facial nerve function was evaluated according to the House-Brackmann (HB) facial paralysis grading standard at the last follow-up. Grade Ⅰ-Ⅲ was considered effective, and grade Ⅳ-Ⅵ was considered ineffective. The quality of life was evaluated using the physical function score (FDIP) and social function score (FDIS).Results:The follow-up time was 6-30 (18.3 ±6.6) months. The facial nerve function was classified as grade Ⅰ in four cases, grade Ⅱ in six cases, grade Ⅲ in four cases, and grade Ⅳ in three cases. This resulted in an effective rate of 14/17. The FDIP score at the final follow-up was (84.7 ±9.1) points, which was higher than the (54.1 ±20.6) points recorded at the immediate moment of repair ( P<0.001). In contrast, the FDIS score was (11.8 ±8.9) points, which was lower than the (57.5 ±11.7) points recorded at the immediate moment of repair ( P<0.001). Conclusion:The transplantation of the auricular great nerve can effectively enhance facial nerve function and improve the life quality in the immediate repair of defects in the extracranial branches of the facial nerve.

AIM To investigate the ameliorative effects of Compound Fufangteng Mixture(CFM)on cyclophosphamide(CTX)-induced immunosuppression in mice.METHODS Forty-eight male C57BL/6J mice were randomly divided into the blank control group,the model group,the levamisole hydrochloride group(40 mg/kg)and the low-dose,medium-dose and high-dose CFM groups(3.75,7.5,10 g/kg),with 8 mice in each group,and given respective intervention orally once daily for 14 days.On the 5th to 7th day of administration,with the blank control group given normal saline intraperitoneally,the other groups underwent intraperitoneal CTX injections(80 mg/kg).24 hours after the last administration,organ indices of thymus and spleen were calculated;splenic histopathological alterations were assessed by HE staining;serum levels of IL-2,IL-6 and IgG were quantified using ELISA;splenic CD4+,CD8+T lymphocytes,alongside CD86+and CD206+macrophages populations were analyzed by flow cytometry;and splenic expression of CD4,CD8 and F4/80 was evaluated by immunohistochemical staining.RESULTS In CTX-treated mice,CFM administration mitigated body weight loss;enhanced thymus weight and thymic index;ameliorated splenic immune cell populations,elevated serum levels of cytokines IL-2,IL-6 and IgG in serum;and upregulated splenic levels of CD45+CD3+T lymphocytes and F4/80+CD11b+macrophages,alongside increasing the expression of CD4,CD8 and F4/80 surface markers.CONCLUSION CFM alleviates CTX-induced immunosuppression state in mice by modulating immune cells,restoring immune function and enhancing anti-inflammatory and tissue repair capabilities.

Bladder cancer is a common malignant tumor in the urinary system.At present,the main treatment methods include surgery and drug therapy.Although surgical treatment has shown remarkable effects,the prognosis and quality of life of patients still need to be improved.In recent years,immunotherapy has developed rapidly,with programmed cell death-1(PD-1)/programmed cell death-ligand-1(PD-L1)emerging as particularly prominent targets.In order to deeply understand the potential of PD-1/PD-L1 inhibitors in the treatment of bladder cancer and provide new ideas for the treatment of bladder cancer,this study reviewed the research progress of PD-1/PD-L1 inhibitors in the field of bladder cancer.

Objective To explore the application of goal-directed fluid therapy based on pulse pressure variation rate(PPV)combined with low central venous pressure(LCVP)technique in liver surgery.Methods A total of 86 patients who underwent liver lobe/segment resection in our hospital from January 2022 to December 2023 were included,and randomly divided into two groups by random sequence method.Patients in the conventional group were treated with LCVP technique,while patients in the test group were given PPV goal-directed intervention on the basis of the conventional group.The surgical indicators,hemodynamic indicators,cognitive function,adverse reactions and recovery of gastrointestinal function of patients in the two groups were compared.Results There was no statistically significant difference in the operation time,Pringle maneuver time,first postoperative exhausting time or first postoperative defecation time of patients between the two groups(P>0.05).However,the intraoperative blood loss,intraoperative fluid infusion volume and hospital stay of patients in the test group were all less/shorter than those in the conventional group(P<0.05).Compared with the time point of T0,patients in the two groups showed increased heart rate(HR)but decreased mean arterial pressure(MAP)and central venous pressure(CVP)at time points of T1 and T2(P<0.05).There was no statistically significant difference in the HR or MAP of patients between the two groups at time points of T0,T1,T2 and T3(P>0.05).At time points of T1 and T2,the CVP of patients in the test group was lower than that in the conventional group(P<0.05).One day after operation,the mini-mental state examination(MMSE)score of patients in the test group was higher than that in the conventional group(P<0.05).The MMSE scores 7 days after operation of patients in the two groups were higher than those 1 day after operation(P<0.05).Patients in the test group had a lower total incidence of adverse reactions and a shorter recovery time of gastrointestinal function than those in the conventional group(P<0.05).Conclusion The goal-directed fluid therapy based on PPV combined with LCVP technique has a good application effect in liver surgery,which can reduce intraoperative blood loss and fluid infusion volume of patients,shorten hospital stay,increase hemodynamic stability,improve postoperative cognitive dysfunction,and promote the recovery of gastrointestinal function,with a relatively high treatment safety.