ObjectiveTo observe clinical effectiveness and safety of lumbar oscillatory manipulation in the treatment of patients with lumbar disc herniation. MethodsThis study recruited 90 lumbar disc herniation patients who were randomly divided into 45 cases each in the treatment group and the control group. The treatment group was given lumbar oscillatory manipulation， while the control group was given traditional lumbar obliquely pulling manipulation， and both groups were treated twice a week for 4 weeks. The Oswestry dysfunction index （ODI） score， lumbar spine mobility， and the absolute values of difference in hardness between the left and right sides of the lumbar erector spinae muscle were compared between groups of patients before treatment and after 2 and 4 weeks of treatment； the shear wave elastic modulus of multifidus muscle and abdominal muscle thickness were compared between groups before treatment and after 4 weeks of treatment； the clinical effectiveness of the treatment was compared， and the safety evaluation was carried out. ResultsCompared with the group before treatment， the ODI scores and the the absolute values of difference in hardness between the left and right sides of the lumbar erector spinae muscle decreased after 2 and 4 weeks treatment in both groups， and the mobility of the lumbar vertebrae in all directions of anterior flexion， posterior extension， left lateral flexion， and right lateral flexion increased； the shear wave elastic modulus of bilateral multifidus muscles of the fourth lumbar vertebral segments decreased， and the thickness of abdominal muscle increased after 4 weeks of treatment in both groups （P＜0.05）. Compared with the control group， the ODI score of the treatment group decreased after 2 weeks of treatment， and the shear wave elastic modulus value of bilateral multifidus muscle of the fourth lumbar vertebral segment decreased and the thickness of abdominal muscle increased after 4 weeks of treatment （P＜0.05）. The total effective rate was 90.48% （38/42） in the treatment group and 71.43% （30/42） in the control group， and the clinical effectiveness of the treatment group was better than that of the control group （P＜0.05）. No adverse events occurred in both groups during the study. ConclusionLumbar oscillatory manipulation is superior to traditional lumbar obliquely pulling manipulation in relieving symptoms of lumbar disc herniation and improving lumbar spine function， which may be related to its improvement in the elasticity of the multifidus muscle.

The spatio-temporal heterogeneity of breast cell subsets forms the fundamental biological basis for physiological development and pathological progression, including tumorigenesis; however, its complex regulatory mechanisms are not yet fully elucidated. With its high-resolution capabilities, single-cell RNA sequencing (scRNA-seq) technology offers a powerful tool for dissecting this cellular heterogeneity. This technology enables the construction of high-precision breast cell atlases, the accurate identification of distinct cell subsets, and the reconstruction of differentiation trajectories from stem/progenitor cells to functional epithelial cells. By resolving the transcriptional regulatory networks that govern cell fate determination, intercellular communication patterns, and dynamic microenvironmental interactions, scRNA-seq has unveiled the molecular foundations of breast development and provided new perspectives on the pathogenesis of related diseases such as breast cancer and macromastia. Furthermore, scRNA-seq demonstrates significant potential for discovering early molecular markers of disease, deciphering tumor heterogeneity, and elucidating mechanisms of therapeutic resistance. The continued application of scRNA-seq for dissecting breast cell heterogeneity, combined with its integration with multi-modal data such as spatial omics, promises to provide critical evidence and new insights for revealing the molecular mechanisms of breast development-related diseases and for formulating precision therapeutic strategies.
Humans ; Single-Cell Analysis/methods* ; Female ; Breast Neoplasms/pathology* ; Sequence Analysis, RNA/methods* ; Breast/cytology*

OBJECTIVES: To investigate the risk factors of overall postoperative complications in elderly patients undergoing gastrointestinal surgeries. METHODS: This study was conducted among a total of 1388 elderly patients, who underwent elective gastrointestinal surgeries at 17 centers across China between April, 2020 and April, 2022. The primary outcome was the incidence of postoperative complications within 30 days, including procedure-related, neuropsychiatric, respiratory, cardiovascular, and gastrointestinal complications as well as acute kidney injury. Baseline characteristics, preoperative psychological and functional status, intraoperative anesthesia and surgical factors, intraoperative medication, use of nerve block, and postoperative analgesia methods were compared between the patients experiencing one or more postoperative complications and those without complications. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for postoperative complications. The relationship between postoperative acute pain and each type of complication were explored. RESULTS: The incidence of overall postoperative complications was 50.8% (705/1388) in these patients. Multivariate analysis showed that age (OR: 1.026; 95% CI: 1.006-1.046), prognostic nutritional index (OR: 0.998; 95% CI: 0.997-1.000), preoperative EuroQol-5 dimensions score (OR: 0.094; 95% CI: 0.018-0.500), blood loss (OR: 1.002; 95% CI: 1.001-1.003), and acute postoperative pain (OR: 1.308; 95% CI: 1.033-1.657) were significantly associated with the occurrence of postoperative complications. Specifically, patients experiencing severe postoperative pain had a significantly higher incidence of neuropsychiatric (27.2% vs 19.8%), procedure-related (17.3% vs 10.2%), and cardiovascular complications (3.6% vs 1.7%). CONCLUSIONS An advanced age, a low preoperative nutritional index, a poor quality of life score, a greater volume of intraoperative blood loss, and acute postoperative pain are independent risk factors for postoperative complications in elderly patients undergoing gastrointestinal surgeries. There is a significant association between acute postoperative pain and multi-system complications.
Humans ; Postoperative Complications/etiology* ; Aged ; Risk Factors ; Digestive System Surgical Procedures/adverse effects* ; Male ; Female ; China/epidemiology* ; Pain, Postoperative/epidemiology* ; Incidence ; Aged, 80 and over

ObjectiveTo investigate the association between estimated glucose disposal rate （eGDR） and the severity of coronary heart disease. MethodsWe conducted a hospital-based cross-sectional study that included 1258 patients （mean age： 62（53-68） years） who underwent coronary angiography for suspected coronary artery disease （53.9% were male）. Insulin resistance level （IR） was calculated according to eGDR formula： eGDR = 21.158 - （0.09 × WC） - （3.407 × hypertension） - （0.551 × HbA1c） ［hypertension （yes = 1 / no = 0）， HbA1c = HbA1c （%）］. Subjects were grouped according to the eGDR quantile. CAD severity was determined by the number of narrowed vessels： no-obstructive CAD group （all coronary stenosis were<50%， n=704）， Single-vessel CAD group （only one involved major coronary artery stenosis≥50%， n=205）， Multi-vessel CAD group （two or more involved major coronary arteries stenosis≥50%， n=349）； Multivariate logistic regression model was used to analyze the association between eGDR and CAD severity. The linear relationship between eGDR and CAD in the whole range of eGDR was analyzed using restricted cubic spline. Subgroup analyses were used to assess the association between eGDR and CAD severity in different diabetic states. Receiver operating characteristic （ROC） curve analysis were used to evaluate the value of eGDR in improving CAD recognition. ResultsA decrease in the eGDR index was significantly associated with an increased risk of CAD severity （OR： 2.79； 95%CI： 1.72~4.55； P<0.001）. In multivariate logistic regression models， individuals with the lowest quantile of eGDR （T1） were 2.79 times more likely to develop multi-vessel CAD than those with the highest quantile of eGDR （T3） （OR： 2.79； 95%CI： 1.72~4.55； P<0.001）. Multivariate restricted cubic spline analysis showed that eGDR was negatively associated with CAD and multi-vessel CAD （P-nonlinear>0.05）. In non-diabetic patients， compared with the reference group （T3）， the T1 group had a significantly increased risk of CAD （OR： 1.42； 95% CI： 1.00~2.01； P<0.05） and multi-vessel CAD （OR： 1.86； 95%CI： 1.21~2.86； P<0.05）. No statistical association was found between eGDR and CAD in diabetic patients. In ROC curve analysis， when eGDR was added to traditional model for CAD， significant improvements were observed in the model's recognition of CAD and multi-vessel CAD. ConclusionOur study shows eGDR levels are inversely associated with CAD and CAD severity. eGDR， as a non-insulin measure to assess IR， could be a valuable indicator of CAD severity for population.

Objective:To investigate psychological resilience of inpatients with extracranial arteriovenous malformation (AVM) and analyze the related factors, in order to provide scientific basis for improving the psychological resilience of patients.Methods:A cross-sectional study was conducted to include patients with extracranial AVM who were hospitalized in the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from October 2020 to December 2021. The general information questionnaire, Cornor-Davidon resilience scale, Herth hope index, medical coping modes questionnaire and family APGAR scale were used to investigate them. SPSS 21.0 software was used. The t-test, one-way ANOVA, Pearson correlation analysis and multiple linear regression analysis were used for statistical analysis. Results:In total, 177 patients with extracranial AVM were included in our study. The total mean score of the resilience scale was 65.94±13.90, and the mean scores of the three dimensions of resilience, optimism and strength were 33.02±7.67, 10.38±2.75 and 22.54±4.67. The mean scores of Herth hope index was 37.50±3.56, positive coping style was 24.89±6.65, and family APGAR scale was 8.19±2.41. In univariate analysis, gender, ethnicity and family relationship had significant differences in psychological resilience (all P<0.05). Among these patients, female’s mental resilience score was significantly lower than that of male’s. Correlation analysis showed that the scores of the Herth hope index, positive coping style, and family APGAR scale were positively correlated with the total scores of resilience and the scores of each dimension (all P<0.01). Multiple linear regression analysis showed that gender, the scores of Herth hope index, positive coping mode, family APGAR scale were main influencing factors of resilience ( P<0.05). Conclusion:Female patients with extracranial AVM need more attention to their psychological problems and psychological reactions. Herth hope, positive coping mode, family-centered care are the protective factors of resilience of patients with extracranial AVM.

Objective:To conduct a network meta-analysis comparing the efficacy and safety of various drug injections for treating keloids.Methods:The search terms of "triamcinolone acetonide, 5-fluorouracil, verapamil, botulinum toxin, platelet rich plasma, keloid, scar, drug injection" were retrieved in PubMed, Embase, Web of Science, CNKI and Wanfang database to obtain the publicly published randomized controlled trials comparing single or combined drug injection for treating keloid from January 2010 to February 2023. The outcome index was the effective proportion of treatment, incidence proportion of adverse reactions, and recurrence proportion. NoteExpress, RevMan 5.4, and Stata 16.0 statistical software were utilized to perform a network meta-analysis of eligible studies that met the inclusion and exclusion criteria.Results:A total of 1 679 patients were enrolled in 21 studies that evaluated nine treatment modalities: triamcinolone (TAC), 5-fluorouracil (5-FU), botulinum toxin type A (BTA), platelet-rich plasma (PRP), Verapamil, BTA+ 5-FU, TAC+ 5-FU, TAC+ BTA, and TAC+ PRP. The network diagram revealed that there were 36 pairwise comparisons among the 9 treatment measures, with direct comparisons in 13 of them. The funnel plot demonstrated a symmetrical distribution of effect size points, and both Beggs test and Eggers test yielded P values greater than 0.05, indicating a low likelihood of publication bias. Nine treatment measures formed five closed loops with good consistency. The result of the network meta-analysis indicated that BTA+ 5-FU was more effective than TAC, 5-FU, or PRP alone; TAC+ 5-FU was more effective than TAC, 5-FU, or PRP alone; TAC+ BTA was more effective than TAC, 5-FU, BTA, or PRP alone; Verapamil was more effective than 5-FU and BTA was more effective than 5-FU. All result were found to be statistically significant ( P<0.05). A surface under the cumulative ranking area (SUCRA) map was generated, displaying the efficacy ranking and corresponding SUCRA values for each treatment: BTA+ 5-FU (85.6%)>TAC+ 5-FU (84.8%)>BTA+ TAC (76.7%)>Verapamil (48.9%)>BTA (45.0%)>TAC+ PRP (43.8%)>PRP (32.1%)>TAC (24.7%)>5-FU(8.3%). In terms of recurrence rate, the incidence of recurrence was higher with 5-FU compared to BTA or TAC+ 5-FU, and the incidence of recurrence was higher with TAC compared to TAC+ 5-FU; these differences were statistically significant ( P<0.05). A SUCRA map was generated with the ranking and SUCRA value for each treatment as follows: 5-FU (80.4%)>TAC (73.5%)>Verapamil (65.7%)>TAC+ BTA (52.5%)>PRP (34.8%)>BTA+ 5-FU (33.7%)>TAC+ 5-FU (30.2%)>BTA (29.3%). The qualitative analysis revealed a significantly lower incidence of systemic and local adverse reactions following combined drug injection compared to single drug injection. Conclusion:In the treatment of keloids using drug injection, combination therapy utilizing multiple drugs has demonstrated superior efficacy, lower recurrence rates, and fewer adverse reactions in comparison to single-drug therapy. Notably, the utilization of BAT, 5-FU, and TAC in combination may yield the most favorable outcomes.

Objective:To investigate psychological resilience of inpatients with extracranial arteriovenous malformation (AVM) and analyze the related factors, in order to provide scientific basis for improving the psychological resilience of patients.Methods:A cross-sectional study was conducted to include patients with extracranial AVM who were hospitalized in the Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from October 2020 to December 2021. The general information questionnaire, Cornor-Davidon resilience scale, Herth hope index, medical coping modes questionnaire and family APGAR scale were used to investigate them. SPSS 21.0 software was used. The t-test, one-way ANOVA, Pearson correlation analysis and multiple linear regression analysis were used for statistical analysis. Results:In total, 177 patients with extracranial AVM were included in our study. The total mean score of the resilience scale was 65.94±13.90, and the mean scores of the three dimensions of resilience, optimism and strength were 33.02±7.67, 10.38±2.75 and 22.54±4.67. The mean scores of Herth hope index was 37.50±3.56, positive coping style was 24.89±6.65, and family APGAR scale was 8.19±2.41. In univariate analysis, gender, ethnicity and family relationship had significant differences in psychological resilience (all P<0.05). Among these patients, female’s mental resilience score was significantly lower than that of male’s. Correlation analysis showed that the scores of the Herth hope index, positive coping style, and family APGAR scale were positively correlated with the total scores of resilience and the scores of each dimension (all P<0.01). Multiple linear regression analysis showed that gender, the scores of Herth hope index, positive coping mode, family APGAR scale were main influencing factors of resilience ( P<0.05). Conclusion:Female patients with extracranial AVM need more attention to their psychological problems and psychological reactions. Herth hope, positive coping mode, family-centered care are the protective factors of resilience of patients with extracranial AVM.

Objective:To conduct a network meta-analysis comparing the efficacy and safety of various drug injections for treating keloids.Methods:The search terms of "triamcinolone acetonide, 5-fluorouracil, verapamil, botulinum toxin, platelet rich plasma, keloid, scar, drug injection" were retrieved in PubMed, Embase, Web of Science, CNKI and Wanfang database to obtain the publicly published randomized controlled trials comparing single or combined drug injection for treating keloid from January 2010 to February 2023. The outcome index was the effective proportion of treatment, incidence proportion of adverse reactions, and recurrence proportion. NoteExpress, RevMan 5.4, and Stata 16.0 statistical software were utilized to perform a network meta-analysis of eligible studies that met the inclusion and exclusion criteria.Results:A total of 1 679 patients were enrolled in 21 studies that evaluated nine treatment modalities: triamcinolone (TAC), 5-fluorouracil (5-FU), botulinum toxin type A (BTA), platelet-rich plasma (PRP), Verapamil, BTA+ 5-FU, TAC+ 5-FU, TAC+ BTA, and TAC+ PRP. The network diagram revealed that there were 36 pairwise comparisons among the 9 treatment measures, with direct comparisons in 13 of them. The funnel plot demonstrated a symmetrical distribution of effect size points, and both Beggs test and Eggers test yielded P values greater than 0.05, indicating a low likelihood of publication bias. Nine treatment measures formed five closed loops with good consistency. The result of the network meta-analysis indicated that BTA+ 5-FU was more effective than TAC, 5-FU, or PRP alone; TAC+ 5-FU was more effective than TAC, 5-FU, or PRP alone; TAC+ BTA was more effective than TAC, 5-FU, BTA, or PRP alone; Verapamil was more effective than 5-FU and BTA was more effective than 5-FU. All result were found to be statistically significant ( P<0.05). A surface under the cumulative ranking area (SUCRA) map was generated, displaying the efficacy ranking and corresponding SUCRA values for each treatment: BTA+ 5-FU (85.6%)>TAC+ 5-FU (84.8%)>BTA+ TAC (76.7%)>Verapamil (48.9%)>BTA (45.0%)>TAC+ PRP (43.8%)>PRP (32.1%)>TAC (24.7%)>5-FU(8.3%). In terms of recurrence rate, the incidence of recurrence was higher with 5-FU compared to BTA or TAC+ 5-FU, and the incidence of recurrence was higher with TAC compared to TAC+ 5-FU; these differences were statistically significant ( P<0.05). A SUCRA map was generated with the ranking and SUCRA value for each treatment as follows: 5-FU (80.4%)>TAC (73.5%)>Verapamil (65.7%)>TAC+ BTA (52.5%)>PRP (34.8%)>BTA+ 5-FU (33.7%)>TAC+ 5-FU (30.2%)>BTA (29.3%). The qualitative analysis revealed a significantly lower incidence of systemic and local adverse reactions following combined drug injection compared to single drug injection. Conclusion:In the treatment of keloids using drug injection, combination therapy utilizing multiple drugs has demonstrated superior efficacy, lower recurrence rates, and fewer adverse reactions in comparison to single-drug therapy. Notably, the utilization of BAT, 5-FU, and TAC in combination may yield the most favorable outcomes.

Objective:To investigate the similarities and differences in clinical manifestations, lesion features, treatment options and prognosis in patients with kaposiform hemangioendothelioma (KHE) and tufted angioma (TA).Methods:The clinical data of KHE patients and TA patients diagnosed and treated in West China Hospital of Sichuan University from August 2016 to June 2020 were retrospectively analyzed. The similarities and differences in gender, the age of onset, clinical features, complications, histopathology, imaging manifestations, treatment and prognosis of the two diseases were compared. The χ2 test or Fisher’s exact test were used to analyze the qualitative data. The Mann-Whitney U test was used to analyze the quantitative data of the two groups that did not conform to the normal distribution. P<0.05 was considered to be statistically significant. Results:A total of 217 patients were included, including 183 patients with KHE and 34 patients with TA. There was no significant difference between KHE and TA in male to female ratio ( χ2=0.44, P=0.510), the age of onset ( U=2 757.00, Z=-1.09, P=0.278) and the sites of lesion ( χ2=3.64, P=0.162). The mixed type of KHE was the most common, reaching 63.39% (116/183), while the superficial type of TA was the most common, reaching 88.24% (30/34). The lesion diameter of KHE patients was 6.30(4.40, 9.70) cm, which was larger than that of TA patients 2.95(2.05, 4.03) cm, and the difference was statistically significant ( U=967.50, Z=-6.38, P<0.001). KHE is more likely to involve skeletal muscle, and cause thrombocytopenia and severe fibrinogenopenia. KHE mainly involved the dermis, subcutaneous tissue and even deep muscles, and manifested as an infiltrative mass. Magnetic resonance imaging (MRI) showed mass diffuse with high signal on T 2 phase. TA was often a superficial lesion that only involved the subcutaneous fat layer and was lumpy. MRI showed that the high signal was confined to the subcutaneous fat layer. The total effective rate of KHE [KHE(85.79%) vs. TA(91.18%)] and the total effective rate of drug therapy [KHE(85.32%) vs. TA(95.65%)] were lower than those of TA. Conclusions:Compared with TA, KHE has a larger tumor diameter, higher invasiveness, higher risk of complications. In addition, treatment plan was more complicated and treatment response rate was lower in patients with KHE compared with those in patients with TA.

Objective:To investigate the similarities and differences in clinical manifestations, lesion features, treatment options and prognosis in patients with kaposiform hemangioendothelioma (KHE) and tufted angioma (TA).Methods:The clinical data of KHE patients and TA patients diagnosed and treated in West China Hospital of Sichuan University from August 2016 to June 2020 were retrospectively analyzed. The similarities and differences in gender, the age of onset, clinical features, complications, histopathology, imaging manifestations, treatment and prognosis of the two diseases were compared. The χ2 test or Fisher’s exact test were used to analyze the qualitative data. The Mann-Whitney U test was used to analyze the quantitative data of the two groups that did not conform to the normal distribution. P<0.05 was considered to be statistically significant. Results:A total of 217 patients were included, including 183 patients with KHE and 34 patients with TA. There was no significant difference between KHE and TA in male to female ratio ( χ2=0.44, P=0.510), the age of onset ( U=2 757.00, Z=-1.09, P=0.278) and the sites of lesion ( χ2=3.64, P=0.162). The mixed type of KHE was the most common, reaching 63.39% (116/183), while the superficial type of TA was the most common, reaching 88.24% (30/34). The lesion diameter of KHE patients was 6.30(4.40, 9.70) cm, which was larger than that of TA patients 2.95(2.05, 4.03) cm, and the difference was statistically significant ( U=967.50, Z=-6.38, P<0.001). KHE is more likely to involve skeletal muscle, and cause thrombocytopenia and severe fibrinogenopenia. KHE mainly involved the dermis, subcutaneous tissue and even deep muscles, and manifested as an infiltrative mass. Magnetic resonance imaging (MRI) showed mass diffuse with high signal on T 2 phase. TA was often a superficial lesion that only involved the subcutaneous fat layer and was lumpy. MRI showed that the high signal was confined to the subcutaneous fat layer. The total effective rate of KHE [KHE(85.79%) vs. TA(91.18%)] and the total effective rate of drug therapy [KHE(85.32%) vs. TA(95.65%)] were lower than those of TA. Conclusions:Compared with TA, KHE has a larger tumor diameter, higher invasiveness, higher risk of complications. In addition, treatment plan was more complicated and treatment response rate was lower in patients with KHE compared with those in patients with TA.