To investigate the risk factors for early relapse after curative resection of Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction (AEG) and construct a visual predictive model.

Objective:To evaluate the clinical effect of modified posterior pharyngeal flap surgery in the treatment of velopharyngeal insufficiency.Methods:Clinical data of patients with cleft lip and palate diagnosed with velopharyngeal insufficiency and undergoing modified posterior pharyngeal flap surgery in Peking University School and Hospital of Stomatology from January 2018 to May 2022 were retrospectively analyzed. The traditional posterior pharyngeal flap surgery was improved by combining the modern concept and method of soft palate muscle reconstruction, and performed modified posterior pharyngeal flap surgery to correct velopharyngeal insufficiency. Preoperative and postoperative follow-up were performed including speech evaluation (classifying as none, mild, moderate, moderate to severe hypernasality and nasal emission), nasopharyngeal fiberscope (classifying velopharyngeal insufficiency as mild, moderate, or severe), lateral cephalometric radiographs (resting position and /i/ position), and the Nasal Obstruction Symptom Evaluation (NOSE) scale. The recovery of velopharyngeal function and nasal ventilation after the operation were statistically analyzed. The difference of resting velar length (RVL), effective working length (EWL) and angel of velar lifting (AVL) before and after the operation was compared by paired t-test to evaluate the clinical effect of surgery. P<0.05 indicates a statistically significant difference. Results:A total of 83 patients with velopharyngeal insufficiency were enrolled, including 44 males and 39 females, aged (13.04±11.31) years (4-53 years). 83 patients were followed up for 6-18 months after surgery, and all patients had primary wound healing without postoperative bleeding, perforation, or posterior pharyngeal flap detachment; 78 cases achieved complete velopharyngeal closure, the surgical success rate was 94%, three patients still had mild hypernasality and nasal emission after surgery, one patient still had moderate hypernasality and nasal emission after surgery, and one patient had severe hypernasality after surgery. The RVL was (29.27±6.01) mm before the operation and (36.88±6.51) mm after the operation.The EWL of the soft palate was (18.53±5.04) mm before the operation and (25.76±5.17) mm after the operation.The angel of velar lifting was 11.42°±11.65° before the operation and 15.91°±8.54° after operation. The differences were statistically significant ( P<0.01). 98%(81/83) patients had subjective nasal obstruction symptom in the short period after surgery (within one month), the nasal obstruction symptom evaluation (NOSE) score was 8.61±3.64. The long-term postoperative follow-up showed that the NOSE score was 3.06±2.92, and the difference was statistically significant ( P<0.01). Conclusion:Modified posterior pharyngeal flap surgery can significantly increase the resting velar length and effective working length, improve the movement ability of the soft palate, acquire functional reconstruction of velopharyngeal closure, improve speech function and achieve effectively surgical results.

Objective:To evaluate the clinical effect of modified posterior pharyngeal flap surgery in the treatment of velopharyngeal insufficiency.Methods:Clinical data of patients with cleft lip and palate diagnosed with velopharyngeal insufficiency and undergoing modified posterior pharyngeal flap surgery in Peking University School and Hospital of Stomatology from January 2018 to May 2022 were retrospectively analyzed. The traditional posterior pharyngeal flap surgery was improved by combining the modern concept and method of soft palate muscle reconstruction, and performed modified posterior pharyngeal flap surgery to correct velopharyngeal insufficiency. Preoperative and postoperative follow-up were performed including speech evaluation (classifying as none, mild, moderate, moderate to severe hypernasality and nasal emission), nasopharyngeal fiberscope (classifying velopharyngeal insufficiency as mild, moderate, or severe), lateral cephalometric radiographs (resting position and /i/ position), and the Nasal Obstruction Symptom Evaluation (NOSE) scale. The recovery of velopharyngeal function and nasal ventilation after the operation were statistically analyzed. The difference of resting velar length (RVL), effective working length (EWL) and angel of velar lifting (AVL) before and after the operation was compared by paired t-test to evaluate the clinical effect of surgery. P<0.05 indicates a statistically significant difference. Results:A total of 83 patients with velopharyngeal insufficiency were enrolled, including 44 males and 39 females, aged (13.04±11.31) years (4-53 years). 83 patients were followed up for 6-18 months after surgery, and all patients had primary wound healing without postoperative bleeding, perforation, or posterior pharyngeal flap detachment; 78 cases achieved complete velopharyngeal closure, the surgical success rate was 94%, three patients still had mild hypernasality and nasal emission after surgery, one patient still had moderate hypernasality and nasal emission after surgery, and one patient had severe hypernasality after surgery. The RVL was (29.27±6.01) mm before the operation and (36.88±6.51) mm after the operation.The EWL of the soft palate was (18.53±5.04) mm before the operation and (25.76±5.17) mm after the operation.The angel of velar lifting was 11.42°±11.65° before the operation and 15.91°±8.54° after operation. The differences were statistically significant ( P<0.01). 98%(81/83) patients had subjective nasal obstruction symptom in the short period after surgery (within one month), the nasal obstruction symptom evaluation (NOSE) score was 8.61±3.64. The long-term postoperative follow-up showed that the NOSE score was 3.06±2.92, and the difference was statistically significant ( P<0.01). Conclusion:Modified posterior pharyngeal flap surgery can significantly increase the resting velar length and effective working length, improve the movement ability of the soft palate, acquire functional reconstruction of velopharyngeal closure, improve speech function and achieve effectively surgical results.

Mismatch repair-deficient/microsatellite instability-high(dMMR/MSI-H)gastric cancer represents a distinct molecular subtype of tumors characterized by pronounced sensitivity to immune checkpoint inhibitors(ICIs)attributed to its unique immune microenvironment and elevated mutation burden.Various clinical studies underscore the efficacy of ICIs in treating dMMR/MSI-H gastric cancer;however,chal-lenges such as primary and acquired resistance persist.Overcoming resistance and identifying optimal ICIs for its treatment remain critical clinical issues.This review delineates the mechanisms of ICIs,recent advances in their therapeutic application for dMMR/MSI-H gastric can-cer,and ongoing challenges in combating resistance,aiming to guide clinical practice effectively.

At present, many treatment options for colorectal cancer, including chemotherapy, targeted therapy and immunotherapy, have poor efficacy due to resistance variation and patient individualization. It is urgent to find new precise and effective treatment measures at this stage. Studies have shown that the pathogenesis and progression of colorectal cancer involve multiple processes such as inflammation, immunity, and cholesterol metabolism, and there are many types of potential interactive reactions. Clarifying the regulatory mechanism of various factors is helpful to provide new ideas for colorectal cancer treatment.

BACKGROUND: The aryl hydrocarbon receptor (AhR) is commonly known as an environmental sensor. Polymorphisms in AhR gene have been implicated in susceptibility to cancer. However, the results were controversial. This study was conducted to quantitatively summarize the association between AhR polymorphisms and cancer risk by meta-analysis. METHODS: Relevant reports were searched in four databases (Embase, PubMed, Wanfang, and China National Knowledge Infrastructure). We used pooled odds ratio (OR) and 95% confidence interval (95% CI) to evaluate the strength of the association in both standard and cumulative meta-analysis. Subgroup and sensitivity analysis was also performed, and between-study heterogeneity and publication bias were checked. RESULTS: A total of seventeen studies referring to three AhR polymorphisms (rs2066853, rs7796976, and rs2074113) were identified, and 9557 cases and 10038 controls were included. There was no statistically significant association of AhR rs2066853 polymorphism with cancer risk in the overall population, and the negative results were repeated in subgroup analysis by the ethnicity and cancer type. Concerning AhR rs7796976 or rs2074113 polymorphism, no significant correlation was detected. Moreover, these non-significant findings were stable in sensitivity analysis, and the cumulative meta-analysis indicated a trend of no significant link between this three AhR polymorphisms and cancer risk as more data accumulated over time. CONCLUSION This meta-analysis provides evidence that the rs2066853, rs7796976, or rs2074113 polymorphism in AhR gene is not a susceptible predictor of cancer. Further clinical and functional investigation between AhR polymorphisms and cancer susceptibility are needed.
Basic Helix-Loop-Helix Transcription Factors/genetics* ; Confidence Intervals ; Genetic Predisposition to Disease/epidemiology* ; Humans ; Neoplasms/genetics* ; Odds Ratio ; Polymorphism, Genetic ; Receptors, Aryl Hydrocarbon/genetics*

OBJECTIVE: To analyze and compare the hidden blood loss of minimally invasive percutaneous plate osteosynthesis(MIPPO) combined with locking plate fixation and intramedullary nail fixation in the treatment of tibial shaft fracture. METHODS: One hundred and ninety-one cases of tibial shaft fracture treated from January 2017 to January 2019 were analyzed retrospectively. The patients were all treated with closed reduction and divided into two groups:group A (110 cases) and group B (81 cases). In group A, 78 males and 32 females were treated with MIPPO combined with locking plate. The age ranged from 19 to 74 (45.32±11.79) years old. According to AO classification, 42cases were type 42-A, 45 were type 42-B and 23 were type 42-C fractures. Group B was treated with intramedullary nail, including 65 males and 16 females, aged 19 to 84 (45.44± 14.32) years old. According to AO classification, there were 39 cases of type 42-A, 29 cases of type 42-B and 13 cases of type 42-C. The operation time, intraoperative blood loss and hidden blood loss were observed and compared between the two groups. RESULTS: On the first day, the hidden blood loss was (155.27±47.89) ml in group A and (160.43±131.42) ml in group B, the difference was statistically significant (<0.001);on the third day, the hidden blood loss was (102.70±94.79) ml in group A and (338.23±85.24) ml in group B, the difference was statistically significant (<0.001). There was no significant difference between the two groups in gender, age, height, weight, fracture type and preoperative Hct (>0.05). CONCLUSION In the treatment of tibial shaft fracture with intramedullary nail, there is obvious hidden blood loss, which is much higher than expected.
Adult ; Aged ; Aged, 80 and over ; Bone Nails ; Bone Plates ; Female ; Fracture Fixation, Internal ; Fracture Fixation, Intramedullary ; Fracture Healing ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tibial Fractures ; Treatment Outcome ; Young Adult

Objective:To evaluate the effects of supra-arch branches bypass on cerebral oxygen saturation and hemodynamics in patients with Stanford type B aortic dissection.Methods:From January to December 2018, consecutive 27 patients with Stanford type B aortic dissection were enrolled in the study. All patients received hybrid treatment, including supra-arch branches bypass(right axillary artery-left common carotid artery-left subclavian artery) and thoracic endovascular aortic repaire(TEVAR). All the operations were performed by the same surgical team. The left and right cerebral oxygen saturation were measured after anesthesia(T1), left carotid artery occlusion(T2) and after operation(T3); peak systolic velocity(PSV) and resistance index(RI) of left and right carotid arteries were measured before(t1) and after operation(t2).Results:The left cerebral oxygen saturation was 0.62 ±0.01, 0.54±0.01 and 0.62±0.01 at T1, T2 and T3, respectively. There was significant difference between T2 and T1 and T3( P=0.002, P=0.001), but there was no significant difference between T1 and T3. The PSV of left carotid artery at t1 and t2 were(0.91±0.11)m/s and(0.76±0.09)m/s respectively, with no significant difference( P= 0.191). The RI of left carotid artery at t1 and t2 were 0.83±0.06 and 0.93±0.13 respectively, with no significant difference( P= 0.575). Conclusion:If one side of carotid artery was blocked for a short time during supra-arch branches bypass, the cerebral oxygen saturation would be decreased temporarily, but the changes of cerebral oxygen metabolism could be completely restored after operation. However, the hemodynamics of carotid artery would not change significantly. In the hybrid treatment strategy for the patients with aortic dissection Stanford type B, blocking bilateral carotid arteries can be avoided. Making the right axillary artery-left common carotid artery-left subclavian artery shunt is a safe and effective choice.

Objective: To explore the effects of vascular risk factors on cognitive function among the elderly in community. Methods: A cross-sectional study was conducted in 1 269 elderly people (aged 65 and over) who were randomly selected from three communities.Through face-to-face interview, cognitive function was assessed by mini-mental state examination(MMSE), and blood samples were collected for laboratory examination.Logistic regression analysis was used to analyze the vascular risk factors affecting cognitive function. Results: Age ((73.1±6.6), (71.3±4.9), t=4.603, P<0.05), education level (χ²=12.727, P<0.05), hypertension (χ²=9.106, P<0.05) and LDL-C (χ²=5.157, P<0.05) were significantly different in the elderly with or without mild cognitive impairment(MCI). After controlling age, gender and education, the logistic regression analysis showed that hypertension(β=0.378, P=0.006, OR(95%CI)=1.44(1.10-1.91)), systolic blood pressure ≥140 mmHg(β=0.350, P=0.011, OR(95%CI)=1.42(1.08-1.86), 1 mmHg=0.133 kPa), and high LDL-C(β=0.355, P=0.014, OR(95%CI)=1.43(1.08-1.89)) were the risk factors of MCI in the elderly in the community.Hypertension alone or high LDL-C (β=0.365, P=0.029, OR(95%CI)=1.44(1.04-2.00)) alone was risk factor for mild cognitive impairment in the elderly in the community.The risk of mild cognitive impairment in the elderly with hypertension and high LDL-C was 2.00 times higher than that in the healthy elderly (β=0.696, P<0.05, OR(95%CI)=2.00(1.36-2.97)). Conclusion Mild cognitive impairment in the elderly is closely related to hypertension and elevated LDL-C levels.Multiple vascular risk factors can further increase the risk of cognitive impairment.

Objective To explore the effects of vascular risk factors on cognitive function among the elderly in community. Methods A cross-sectional study was conducted in 1 269 elderly people ( aged 65 and over) who were randomly selected from three communities. Through face-to-face interview, cognitive function was assessed by mini-mental state examination(MMSE),and blood samples were collected for labo-ratory examination. Logistic regression analysis was used to analyze the vascular risk factors affecting cogni-tive function. Results Age (( 73. 1 ± 6. 6), ( 71. 3 ± 4. 9),t=4. 603,P<0. 05),education level ( χ2=12. 727,P<0. 05),hypertension (χ2=9. 106,P<0. 05) and LDL-C (χ2=5. 157,P<0. 05) were significantly different in the elderly with or without mild cognitive impairment(MCI). After controlling age,gender and ed-ucation,the logistic regression analysis showed that hypertension(β=0. 378,P=0. 006,OR(95%CI)=1. 44 (1. 10-1. 91)),systolic blood pressure ≥140 mmHg( β=0. 350,P=0. 011,OR( 95% CI)= 1. 42( 1. 08-1. 86),1 mmHg=0. 133 kPa),and high LDL-C( β=0. 355,P=0. 014,OR(95%CI)=1. 43( 1. 08-1. 89)) were the risk factors of MCI in the elderly in the community. Hypertension alone or high LDL-C (β=0. 365, P=0. 029,OR(95%CI)=1. 44(1. 04-2. 00)) alone was risk factor for mild cognitive impairment in the eld-erly in the community. The risk of mild cognitive impairment in the elderly with hypertension and high LDL- C was 2. 00 times higher than that in the healthy elderly ( β=0. 696,P<0. 05,OR( 95%CI)= 2. 00( 1. 36-2. 97)). Conclusion Mild cognitive impairment in the elderly is closely related to hypertension and elevat-ed LDL-C levels. Multiple vascular risk factors can further increase the risk of cognitive impairment.