Objective:To explore the factors associated with the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of neuropathic pain (NP) following spinal cord injury (SCI).Methods:This was a retrospective study of 89 SCI survivors with NP receiving high-frequency rTMS. Those with a ≥30% reduction in their Numeric Rating Scales (NRS) scores after 2 weeks of treatment were termed Responders ( n=36), with the others classified as non-responders ( n=53). Demographic data (gender, education level, age), SCI characteristics (injury etiology, injury severity, neurological injury level, injury duration), NP characteristics (pain type, pain intensity, analgesic use), functional assessment (Modified Ashworth Scale score, Spinal Cord Independence Measure score, Modified Barthel Index score, American Spinal Injury Association motor/sensory score) were collected. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection, followed by binary logistic regression to identify factors associated with treatment efficacy. Results:Among the 89 patients, 36 (40.4%) were Responders to high-frequency rTMS. Binary logistic regression revealed that those with a cervical spinal cord injury and/or spasticity and women were more likely to respond to high-frequency rTMS.Conclusions:Female gender, cervical spinal cord injury, and spasticity are independent factors predicting rTMS efficacy in treating SCI, with spasticity demonstrating the strongest association.

Gastric cancer has relatively high disease burden worldwide. With the advancement of endoscopic technology and increased public health awareness, the detection rate of early gastric cancer has gradually risen globally. Conventional total or distal gastrectomy frequently results in postoperative complications, including malnutrition and digestive disorders, which can significantly impair the patient's quality of life. Function-preserving gastrectomy (FPG), which aims to minimize the extent of resection and preserve the functional anatomy of the stomach while ensuring radical removal of the tumor, has shown significant advantages in improving postoperative quality of life. This review summarizes the indications for various FPG techniques and the challenges currently faced, emphasizing the necessity of cautious promotion of FPG to improve treatment outcomes and the quality of life for patients with gastric cancer.

To investigate the role of the DPP4-nestin axis in liver fibrosis induced by alveolar cyst infection,a murine model was established using C57BL/6 mice via hepatic portal vein injection.Liver histopathological changes were assessed using HE staining,while immunohistochemistry and immunofluorescence were employed to evaluate the expression levels of nestin and DPP4 in infected mouse livers.In vitro,J S1 cell line was stimulated with recombinant DPP4 protein to es-tablish a cellular model,and qPCR,Western blot,and shRNA lentivirus interference techniques were utilized to examine the involvement of the DPP4-nestin axis in hepatic stellate cell activation.The findings demonstrated that compared to the Sham group,liver tissue structure disruption and collagen deposition were evident along with significantly increased expressions of nestin and DPP4(P＜0.050 0),which colocalized with nesin and α-SMA.Furthermore,stimulation with recombi-nant DPP4 protein significantly enhanced JS1 cell activation(P＜0.050 0)as well as upregulated nestin expression(P＜0.050 0)when compared to control group cells.Notably,shRNA lentivirus-mediated inhibition of nestin expression effectively suppressed the activating effects exerted by re-combinant DPP4 protein on JS1 cells(P＜0.050 0).Collectively,these results highlight the crucial regulatory role played by the DPP4-nestin axis in hepatic stellate cell activation triggered by alveo-lar infection;thus,targeting this axis may represent a novel therapeutic strategy for treating alveo-lar infection-induced liver fibrosis.

Objective The aim of this study was to investigate the key genes that regulate colorectal cancer(CRC)metasta-sis,evaluate the effects of exosomal miR-151A-3P derived from CRC on the proliferation and migration,and explore the possibility of exosomal miR-151A-3P as a prognostic biomarker for CRC patients.Methods High-throughput sequencing was performed to screen the differentially expressed miRNAs in serum exosomes of metastatic CRC patients.RT-qPCR was used to verify the expression of differentially expressed miRNAs in CRC specimens.After mimics overexpression or knockdown of miR-151A-3P,CCK-8 and EdU assays were used to detect cell proliferation,and Scratch wound healing and Transwell assays were used to detect cell migration and in-vasion capability.A BALB/c nude mouse model was used to evaluate the effect of exosomal miR-151A-3P on the metastatic ability of CRC cells.Results The sequencing results showed that compared with non-metastatic CRC patients,the expression of miR-151A-3P was significantly increased in serum exosomes of metastatic CRC patients(P<0.001).The results were validated by RT-qPCR and found that miR-151A-3P was highly expressed in both serum exosomes and tumor tissues of metastatic CRC patients(P<0.001).The overall survival of CRC patients with high expression of serum exosomal miR-151A-3P was shorter than that of CRC pa-tients with low expression(P=0.029).After silencing miR-151A-3P,the cell proliferation,migration,and invasion abilities of CRC cells were decreased(P<0.05),while overexpression of miR-151A-3P could promote the proliferation,migration and invasion of CRC cells(P<0.05).In the BALB/c nude mouse colorectal cancer model,the administration of exosomal miR-151A-3P led to an increase in the number of lung metastases in BALB/c nude mice(P<0.05).Conclusion CRC-derived exosomal miR-151A-3P promotes the proliferation and migration of CRC cells,and is associated with poor prognosis of CRC patients.

Objective:To explore the factors associated with the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of neuropathic pain (NP) following spinal cord injury (SCI).Methods:This was a retrospective study of 89 SCI survivors with NP receiving high-frequency rTMS. Those with a ≥30% reduction in their Numeric Rating Scales (NRS) scores after 2 weeks of treatment were termed Responders ( n=36), with the others classified as non-responders ( n=53). Demographic data (gender, education level, age), SCI characteristics (injury etiology, injury severity, neurological injury level, injury duration), NP characteristics (pain type, pain intensity, analgesic use), functional assessment (Modified Ashworth Scale score, Spinal Cord Independence Measure score, Modified Barthel Index score, American Spinal Injury Association motor/sensory score) were collected. Least absolute shrinkage and selection operator (LASSO) regression was used for variable selection, followed by binary logistic regression to identify factors associated with treatment efficacy. Results:Among the 89 patients, 36 (40.4%) were Responders to high-frequency rTMS. Binary logistic regression revealed that those with a cervical spinal cord injury and/or spasticity and women were more likely to respond to high-frequency rTMS.Conclusions:Female gender, cervical spinal cord injury, and spasticity are independent factors predicting rTMS efficacy in treating SCI, with spasticity demonstrating the strongest association.

Objective The aim of this study was to investigate the key genes that regulate colorectal cancer(CRC)metasta-sis,evaluate the effects of exosomal miR-151A-3P derived from CRC on the proliferation and migration,and explore the possibility of exosomal miR-151A-3P as a prognostic biomarker for CRC patients.Methods High-throughput sequencing was performed to screen the differentially expressed miRNAs in serum exosomes of metastatic CRC patients.RT-qPCR was used to verify the expression of differentially expressed miRNAs in CRC specimens.After mimics overexpression or knockdown of miR-151A-3P,CCK-8 and EdU assays were used to detect cell proliferation,and Scratch wound healing and Transwell assays were used to detect cell migration and in-vasion capability.A BALB/c nude mouse model was used to evaluate the effect of exosomal miR-151A-3P on the metastatic ability of CRC cells.Results The sequencing results showed that compared with non-metastatic CRC patients,the expression of miR-151A-3P was significantly increased in serum exosomes of metastatic CRC patients(P<0.001).The results were validated by RT-qPCR and found that miR-151A-3P was highly expressed in both serum exosomes and tumor tissues of metastatic CRC patients(P<0.001).The overall survival of CRC patients with high expression of serum exosomal miR-151A-3P was shorter than that of CRC pa-tients with low expression(P=0.029).After silencing miR-151A-3P,the cell proliferation,migration,and invasion abilities of CRC cells were decreased(P<0.05),while overexpression of miR-151A-3P could promote the proliferation,migration and invasion of CRC cells(P<0.05).In the BALB/c nude mouse colorectal cancer model,the administration of exosomal miR-151A-3P led to an increase in the number of lung metastases in BALB/c nude mice(P<0.05).Conclusion CRC-derived exosomal miR-151A-3P promotes the proliferation and migration of CRC cells,and is associated with poor prognosis of CRC patients.

Gastric cancer has relatively high disease burden worldwide. With the advancement of endoscopic technology and increased public health awareness, the detection rate of early gastric cancer has gradually risen globally. Conventional total or distal gastrectomy frequently results in postoperative complications, including malnutrition and digestive disorders, which can significantly impair the patient's quality of life. Function-preserving gastrectomy (FPG), which aims to minimize the extent of resection and preserve the functional anatomy of the stomach while ensuring radical removal of the tumor, has shown significant advantages in improving postoperative quality of life. This review summarizes the indications for various FPG techniques and the challenges currently faced, emphasizing the necessity of cautious promotion of FPG to improve treatment outcomes and the quality of life for patients with gastric cancer.

Objective:This study aimed to compare postoperative pain between minimally invasive coronary artery bypass grafting (MICS-CABG) and conventional CABG for multivessel coronary artery disease, comparing baseline characteristics and perioperative data between the two groups, and analyzing risk factors influencing postoperative pain.Methods:A total of 545 patients undergoing elective off-pump coronary artery bypass grafting (OPCABG) for multivessel coronary artery disease at Beijing Anzhen Hospital from July 2022 to July 2023 were included. There were 397 patients in the conventional CABG group (289 males, 108 females, aged 35-77 years) and 148 patients in the minimally invasive CABG group (121 males, 27 females, aged 37-84 years), with 148 patients in each group after propensity score matching. Pain levels were assessed using the Numeric Rating Scale (NRS) at the first 5 days postoperatively (acute postoperative pain, APP) and at 3, 6, and 12 months postoperatively (chronic post-surgical pain, CPSP). Logistic regression was used to analyze risk factors for CPSP at 3 months postoperatively in both groups. Results:Within 48 hours postoperatively, both groups reported maximum NRS pain intensities at rest (NRS 4.0 vs. 6.0) and during activity (NRS 5.2 vs. 7.5). From the third day after surgery, there were no significant differences in resting pain intensity between the two groups, and from the fourth day after surgery, there were no significant differences in pain intensity during movement. With 60.2% in the conventional group and 92.6% in the minimally invasive group experiencing moderate to severe pain at rest (NRS ≥ 4), and 83.5% in the conventional group and 98.0% in the minimally invasive group experiencing moderate to severe pain during activity (NRS ≥ 4). Immediately after drain removal, there was a significant reduction in pain intensity at rest in the minimally invasive group (pre-drain removal NRS 6.0 vs. post-drain removal NRS 2.7), compared to the conventional group (pre-drain removal NRS 4.0 vs. post-drain removal NRS 2.3). However, there was no significant difference in the reduction of pain intensity during activity between the minimally invasive group (pre-drain removal NRS 7.5 vs. post-drain removal NRS 4.2) and the conventional group (pre-drain removal NRS 6.0 vs. post-drain removal NRS 2.7). At 3 months postoperatively, the incidence of CPSP was 35.9% in the conventional group and 35.1% in the minimally invasive group. At 6 months postoperatively, the incidence of CPSP was significantly lower compared to 3 months in both groups (conventional group 8.7% vs. minimally invasive group 6.8%, P<0.001). In the conventional group, higher Europe SCORE Ⅱ was identified as an independent risk factor for CPSP at 3 months postoperatively, while in the minimally invasive group, higher BMI and postoperative use of flurbiprofen for rescue analgesia were identified as independent risk factors. Conclusion:In patients undergoing minimally invasive coronary artery bypass grafting (CABG), the early postoperative acute pain intensity and incidence were higher than those in the conventional CABG group. After drain removal, there were no significant differences in resting pain intensity between the two groups, but pain intensity during movement remained higher in the minimally invasive group compared to the conventional group. The incidence of chronic pain did not differ between the two groups but decreased significantly from 3 months postoperatively. Conventional CABG patients with high preoperative Europe SCORE Ⅱ scores, high preoperative BMI and severe postoperative acute pain tend to have more chronic pain after minimally invasive bypass surgery.

Clamshell incision is widely used in the surgical resection of complex mediastinal tumors, but it is also controversial. Its advantages are the full exposure of the field of vision and the huge operating space, while its disadvantages are the destruction of chest wall muscles and respiratory function impairment. At present, there is a lack of norms for the selection and application of Clamshell incisions, and the definition of complex mediastinal tumors is ambiguous and the dimensions are single. Therefore, this article reviews the literature and combines practical experience to systematically summarize the application progress of Clamshell incisions in the surgical resection of complex mediastinal tumors, with the aim of providing guidance for clinical work.

ObjectiveTo investigate the clinical features and outcomes of recompensation in patients with autoimmune hepatitis （AIH）-related decompensated cirrhosis， to identify independent predictive factors， and to construct a nomogram prediction model for the probability of recompensation. MethodsA retrospective cohort study was conducted among the adult patients with AIH-related decompensated cirrhosis who were admitted to The Fifth Medical Center of PLA General Hospital from January 2015 to August 2023 （n=211）. The primary endpoint was achievement of recompensation， and the secondary endpoint was liver-related death or liver transplantation. According to the outcome of the patients at the end of the follow-up， the patients were divided into the recompensation group （n=16） and the persistent decompensation group（n=150）.The independent-samples t test was used for comparison of normally distributed continuous data with homogeneity of variance， and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data with heterogeneity of variance； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups； the Kaplan-Meier method was used for survival analysis； the Cox proportional-hazards regression model was used to identify independent predictive factors， and a nomogram model was constructed and validated. ResultsA total of 211 patients were enrolled， with a median age of 55.0 years and a median follow-up time of 44.0 months， and female patients accounted for 87.2%. Among the 211 patients， 61 （with a cumulative proportion of 35.5%） achieved recompensation. Compared with the persistent decompensation group， the recompensation group had significantly higher white blood cell count， platelet count （PLT）， total bilirubin （TBil）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bile acid， prothrombin time， international normalized ratio （INR）， SMA positive rate， Model for End-Stage Liver Disease （MELD） score， Child-Pugh score， and rate of use of glucocorticoids （all P0.05）， as well as significantly lower age at baseline， number of complications， and death/liver transplantation rate （all P0.05）. At 3 and 12 months after treatment， the recompensation group had continuous improvements in AST， TBil， INR， IgG， MELD score， and Child-Pugh score， which were significantly lower than the values in the persistent decompensation group （all P0.05）， alongside with continuous increases in PLT and albumin， which were significantly higher than the values in the persistent decompensation group （P0.05）. The multivariate Cox regression analysis showed that baseline ALT （hazard ratio ［HR］=1.067， 95% confidence interval ［CI］： 1.010 — 1.127， P=0.021）， IgG （HR=0.463，95%CI：0.258 — 0.833， P=0.010）， SMA positivity （HR=3.122，95%CI：1.768 — 5.515， P0.001）， and glucocorticoid therapy （HR=20.651，95%CI：8.744 — 48.770， P0.001） were independent predictive factors for recompensation， and the nomogram model based on these predictive factors showed excellent predictive performance （C-index=0.87，95%CI：0.84 — 0.90）. ConclusionAchieving recompensation significantly improves clinical outcomes in patients with AIH-related decompensated cirrhosis. Baseline SMA positivity， a high level of ALT， a low level of IgG， and corticosteroid therapy are independent predictive factors for recompensation. The predictive model constructed based on these factors can provide a basis for decision-making in individualized clinical management.