Persistent left superior vena cava is a rare venous variant that is often combined with cardiovascular malformations. In thoracic surgery, especially mediastinal tumor resection, neglect of this variant may make the surgery difficult and risky, and careful preoperative imaging interpretation and adequate preoperative evaluation play an important role in the perioperative safety of the patient. In this paper, we reported a case of a 17-year-old female patient with a persistent left superior vena cava combined with mediastinal tumors. She was successfully discharged 5 days after thoracoscopic surgery, and after 3 years of postoperative follow-up, no tumor recurrence was observed.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

PURPOSE: The rate of complications among patients undergoing surgery has increased due to infection with SARS-CoV-2 and other variants of concern. However, Omicron has shown decreased pathogenicity, raising questions about the risk of postoperative complications among patients who are infected with this variant. This study aimed to investigate complications and related factors among patients with recent Omicron infection prior to undergoing orthopedic surgery. METHODS: A historical control study was conducted. Data were collected from all patients who underwent surgery during 2 distinct periods: (1) between Dec 12, 2022 and Jan 31, 2023 (COVID-19 positive group), (2) between Dec 12, 2021 and Jan 31, 2022 (COVID-19 negative control group). The patients were at least 18 years old. Patients who received conservative treatment after admission or had high-risk diseases or special circumstances (use of anticoagulants before surgery) were excluded from the study. The study outcomes were the total complication rate and related factors. Binary logistic regression analysis was used to identify related factors, and odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the impact of COVID-19 infection on complications. RESULTS: In the analysis, a total of 847 patients who underwent surgery were included, with 275 of these patients testing positive for COVID-19 and 572 testing negative. The COVID-19-positive group had a significantly higher rate of total complications (11.27%) than the control group (4.90%, p < 0.001). After adjusting for relevant factors, the OR was 3.08 (95% CI: 1.45-6.53). Patients who were diagnosed with COVID-19 at 3-4 weeks (OR = 0.20 (95% CI: 0.06-0.59), p = 0.005), 5-6 weeks (OR = 0.16 (95% CI: 0.04-0.59), p = 0.010), or ≥7 weeks (OR = 0.26 (95% CI: 0.06-1.02), p = 0.069) prior to surgery had a lower risk of complications than those who were diagnosed at 0-2 weeks prior to surgery. Seven factors (age, indications for surgery, time of operation, time of COVID-19 diagnosis prior to surgery, C-reactive protein levels, alanine transaminase levels, and aspartate aminotransferase levels) were found to be associated with complications; thus, these factors were used to create a nomogram. CONCLUSION Omicron continues to be a significant factor in the incidence of postoperative complications among patients undergoing orthopedic surgery. By identifying the factors associated with these complications, we can determine the optimal surgical timing, provide more accurate prognostic information, and offer appropriate consultation for orthopedic surgery patients who have been infected with Omicron.
Humans ; COVID-19/complications* ; Male ; Female ; Middle Aged ; Postoperative Complications/epidemiology* ; SARS-CoV-2 ; Orthopedic Procedures/adverse effects* ; Aged ; Nomograms ; Adult ; Retrospective Studies ; Risk Factors

Objective:To explore the value of a model based on 18F-FDG PET/CT radiomics features in assessing the prognosis of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer undergoing neoadjuvant targeted chemotherapy. Methods:This retrospective analysis included 132 female patients (age (50±11) years) diagnosed with HER2-positive breast cancer who underwent 18F-FDG PET/CT prior to treatment between January 2016 and August 2022 in Tianjin Medical University Cancer Institute and Hospital. Data were split into training (105 cases) and validation (27 cases) cohorts using stratified sampling (8∶2). Clinical pathological data and progression-free survival (PFS) were recorded. PET and CT images were annotated for lesion delineation and radiomics features extraction. The least absolute shrinkage and selection operator (LASSO) algorithm was used to select features in the training cohort, and the radiomics score (Rad-score) was calculated. Cox proportional hazards regression analysis was performed to identify risk factors for PFS. A nomogram model was constructed, and the concordance index (C-index) was calculated to assess predictive performance. Results:Univariate Cox regression showed that N stage (hazard ratio ( HR)=2.36, 95% CI: 1.04-5.37, P=0.040) and Rad-score ( HR=14.50, 95% CI: 3.39-62.13, P<0.001) were related to PFS in patients with HER2-positive breast cancer after neoadjuvant therapy. Multivariate analysis indicated the Rad-score as an independent risk factor for PFS ( HR=13.32, 95% CI: 3.10-57.20, P<0.001). The nomogram model combining N stage and Rad-score predicted PFS more accurately than the Rad-score model alone, with C-indexes of 0.80 vs 0.74 in the training cohort, and 0.77 vs 0.71 in the validation cohort. Conclusions:Radiomics based on pre-treatment 18F-FDG PET/CT can predict PFS in patients with HER2-positive breast cancer undergoing neoadjuvant targeted chemotherapy. The nomogram model combining radiomics features and clinical risk factor improves prognostic prediction.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To explore the networked association among the dimensions of self-efficacy in patients with rheumatoid arthritis(RA)and to identify core efficacy and bridge efficacy,and provide a basis for formulating precise nursing intervention strategies.Methods A total of 652 RA patients admitted in our hospital from September 2024 to January 2025 were enrolled with convenience sampling.The general information questionnaire and Rheumatoid Arthritis Self-Efficacy Scale(RASE)were used for assessment.Exploratory factor analysis was used to extract efficacy symptom clusters.With aid of R project,network analysis was employed to construct an association network among efficacy dimensions to calculate centrality indicators(strength,closeness,betweenness)to identify core efficacy and bridge efficacy.Results Exploratory factor analysis extracted 7 efficacy symptom clusters,with a cumulative variance contribution rate of 64.539%(P<0.001).Network analysis showed that the network density was 0.143,suggesting that there were moderate correlations among the self-efficacy dimensions."Relaxation efficacy 1(r1)"and"pain efficacy 1(a1)"had the strongest correlation(r=0.73).Interpersonal efficacy 2(i2)had the highest intensity centrality(6.88),and relaxation efficacy 3(r3)had the highest tightness(0.0125),and medication efficacy 1(m1)had the highest mediation(116),which were the core efficacy and bridge efficacy in this network group.Conclusion There are complex network-like correlations among the various dimensions of self-efficacy in RA patients.Interpersonal efficacy is the core driving factor,while relaxation and medication efficacies play the bridging role,jointly influencing the overall level of patients'self-management ability.

Objective To explore factors affecting blood pressure control in chronic disease patients in China's na-tional basic public health service chronic disease patient management program and to find their relationships with Bayesian network(BN)model,in order to provide a scientific basis for comprehensive hypertension management.Methods 5 577 Hypertensive patients were selected from eight provinces(including autonomous regions)covering eastern,central and western parts of China during a survey from 2021 to 2022.Researchers collected individual and community-management data to screen influencing factors by Logistic regression,and to describe factor dependencies and to identify key determinants of blood pressure control with BN in.blood pressure control.Results Logistic regression revealed that urban/rural status,education,alcohol use,exercise,overweight/obesity and com-munity-doctor advice on salt reduction,smoking cessation were significantly associated with blood pressure control(P＜0.05).The BN model identified 22 directed edges showing that urban residence and good hypertension knowl-edge were more correlated with better control,while community-doctor management and services directly affected patient lifestyle habits but not blood pressure control.Conclusions Research should focus more on urban-rural dis-parities and hypertension education.Additionally,improving patient habits and community-doctor services is essen-tial for better blood pressure control.

Uncontrolled hemorrhage is the leading cause of potentially survivable combat casualty death,dominated by non-compressible hemorrhage in the torso and junctional areas.Rapid hemostasis using war trauma dressings is the mainstay of treatment for such casualties.The article reviews the research progress of novel hemostatic dressings for war trauma,including novel improved dressings,multifunctional dressings,electrospinning wound dressings,and smart dressings in order to provide references for the research on war trauma dressings.

Intraoperative cell salvage (IOCS) has been widely applied as an important blood conservation measure in surgical operations. However, there is currently a lack of clinical practice guidelines for the implementation of IOCS in patients with malignant tumors. This report aims to provide clinicians with recommendations on the use of IOCS in patients with malignant tumors based on the review and assessment of the existed evidence. Data were derived from databases such as PubMed, Embase, the Cochrane Library and Wanfang. The guideline development team formulated recommendations based on the quality of evidence, balance of benefits and harms, patient preferences, and health economic assessments. This study constructed seven major clinical questions. The main conclusions of this guideline are as follows: 1) Compared with no perioperative allogeneic blood transfusion (NPABT), perioperative allogeneic blood transfusion (PABT) leads to a more unfavorable prognosis in cancer patients (Recommended); 2) Compared with the transfusion of allogeneic blood or no transfusion, IOCS does not lead to a more unfavorable prognosis in cancer patients (Recommended); 3) The implementation of IOCS in cancer patients is economically feasible (Recommended); 4) Leukocyte depletion filters (LDF) should be used when implementing IOCS in cancer patients (Strongly Recommended); 5) Irradiation treatment of autologous blood to be reinfused can be used when implementing IOCS in cancer patients (Recommended); 6) A careful assessment of the condition of cancer patients (meeting indications and excluding contraindications) should be conducted before implementing IOCS (Strongly Recommended); 7) Informed consent from cancer patients should be obtained when implementing IOCS, with a thorough pre-assessment of the patient's condition and the likelihood of blood loss, adherence to standardized internally audited management procedures, meeting corresponding conditions, and obtaining corresponding qualifications (Recommended). In brief, current evidence indicates that IOCS can be implemented for some malignant tumor patients who need allogeneic blood transfusion after physician full evaluation, and LDF or irradiation should be used during the implementation process.

Immunometabolism studies focus on the relationships between immune cell functions and cellular energy metabolism pathways.Immunometabolism plays an important regulatory role in immune-related diseases.Mycobacterium tuberculosis(M.tb),an important intracellular pathogenic bacterium,enters alveolar macrophages after infection.The confrontation between M.tb and the host is a complex and dynamic process involving multiple aspects and mechanisms,such as the immune response,granuloma formation,and immune evasion.M.tb effector proteins play key roles in maintaining bacterial virulence and regulating host cell metabolism.This article reviews the reprogramming process of glucose metabolism,lipid metabolism,and immunometabolism,as well as changes in mi-tochondrial function in M.tb-infected host cells,thereby revealing the relationship between M.tb pathogenicity and host metabolic regu-lation,which is important for understanding tuberculosis.