Purpose: Dual anti–human epidermal growth factor receptor 2 (HER2) drugs have become the standard regimen for neoadjuvant systemic treatment (NST) to HER2-positive breast cancer patients. However, the efficacy varies greatly among patients with different HER2 protein expression levels. Materials and Methods: A total of 575 HER2-positive breast cancer patients from multiple centers throughout China from 2013 to 2022 were retrospectively analyzed. We compared clinicopathological features in different HER2 immunohistochemistry classes (HER2 2+/in situ hybridization [ISH] + or HER2 3+), and their difference in response to NST and survival with single or dual anti-HER2 drugs. Drug sensitivity assays were used to evaluate different efficacy of anti-HER2 drugs in vitro. Results: Compared to HER2 3+ subgroup, the HER2 2+/ISH+ group had a higher proportion of hormone receptor–positive status (48.7% vs. 76.1%, p < 0.001), more HER2 protein loss after NST, lower pathological complete response (pCR) rate (46.07% vs. 16.24%, p < 0.001), and tended to have worse disease-free survival (DFS). In HER2 2+/ISH+ patients, treated with pertuzumab and trastuzumab in combination had no significant improvement in pCR (19.12% vs. 12.24%, p=0.287) and DFS (p=0.908) than using alone. Drug sensitivity assay showed poor efficacy with dual anti-HER2 drugs in HER2 2+/ISH+ cell lines; however, fam-trastuzumab deruxtecan drugs had a satisfactory effect. Conclusion Owing to the differences in clinicopathological features and treatment efficacy, we considered the HER2 2+/ISH+ group to be a distinct subtype and defined it as the HER2-moderate–positive subgroup. In this subgroup, dual anti-HER2 drugs did not exert significant improvement in pCR and DFS. Therefore, treatment optimization is warranted, with antibody-drug conjugate drugs as potential options.

AIM:To investigate the visual quality and stereopsis after the implantation of PanOptix trifocal intraocular lens(TFNT00).METHODS: A prospective clinical study was conducted. A total of 36 cataract patients(50 eyes)who underwent phacoemulsification combined with TFNT00 implantation in Jinan Mingshui Eye Hospital from November 2022 to April 2024 were selected. They were followed up until 3 mo after the operation. The uncorrected distance visual acuity(UCDVA), uncorrected intermediate visual acuity(UCIVA), uncorrected near visual acuity(UCNVA), objective scatter index(OSI), modulation transfer function cut off(MTF-cut-off), Strehl ratio(SR)and 100%, 20%, 9% contrast visual acuity(CVA)were observed. The binoptometer was used to collect the patients' far and near stereopsis acuities. The defocus curve was drawn after the operation; the Chinese version of the VF-14 Visual Function Index Scale was used to evaluate the visual quality and satisfaction after the operation.RESULTS: There were statistically significant differences in the UCDVA, UCIVA and UCNVA of the patients at different time after the operation(all P<0.05). The transition of the defocus curve was gentle between +0.5--3.0 D after the operation. The OSI value at 3 mo postoperatively after the operation was significantly lower than that before the operation(P<0.01), and the MTF-cut-off, SR, 100% CVA, 20% CVA and 9% CVA were significantly improved than those before operation(all P<0.01). The far and near stereopsis acuities of 34 patients were abnormal before the operation. The far stereopsis acuities of the patients who underwent bilateral eye surgeries were all normal after the operation, and the near stereopsis acuity of 12 patients was normal. Among the patients who underwent unilateral eye surgeries, the far stereopsis acuities of 13 patients were normal, and the near stereopsis acuities of 11 patients were normal. The far and near stereopsis acuities of the patients who underwent bilateral eye surgeries were significantly better than those patients who underwent unilateral eye surgeries.CONCLUSION: The PanOptix trifocal intraocular lens can provide patients with good full-range visual acuity. The stereopsis of the patients with bilateral implants is better than that of the patients with unilateral implants. The overall visual quality and satisfaction of the patients after the operation are relatively high.

Objective To investigate the clinical value of baseline 18F-fluorodeoxyglucose(18F-FDG)PET/CT metabolic parame-ters and certain clinical indicators in predicting the prognosis of patients with diffuse large B-cell lymphoma(DLBCL).Methods A retrospec-tive analysis was conducted on the baseline 18 F-FDG PET/CT data of 73 DLBCL patients who received R-CHOP treatment.Patients were divided into progression group(24 cases)and non-progression group(49 cases)based on disease progression within 2 years post-treatment.The lesion maximum standardized uptake value(SUVmax),tumour-to-liver blood pool SUVmax ratio(LLR)and tumour-to-mediastinal blood pool SUVmax ratio(L-BPR)were analyzed using receiver operating characteristic(ROC)curves.Kaplan-Meier(K-M)survival curves analysis were performed based on the optimal thresholds of SUVmax,LLR and L-BPR.x2 tests were used to analyze and compare the relationship between each parameter and disease progression.Indicators that were significant in the x2 tests were included in the multivariate Cox regression analysis.Results The area under the curve(AUC)for LLR,L-BPR,and SUVmax were 0.920,0.914,and 0.848,respectively,with optimal thresholds of 7.41,10.67,and 14.70.Based on these thresholds,K-M survival curves analysis showed that the 2-year progression-free survival(PFS)rates for DLBCL patients were 79.2％vs 30.8％(P＜0.001),74.3％vs 22.0％(P=0.009),and 79.5％vs 51.6％(P=0.002),respectively.Significant differences were observed between the progression and non-progression groups in terms of LLR,L-BPR,SUVmax,extranodal involvement,international prognostic index(IPI)score,lactate dehydrogenase(LDH)level,Eastern Cooperative Oncology Group(ECOG)score,and β2-microglobulin(β2-MG)levels(P＜0.05).Multivariate Cox regression analysis revealed that the IPI score and LLR were independent predictors affecting the 2-year PFS of DLBCL patients(P＜0.05).Conclusion Baseline 18F-FDG PET/CT metabolic parameter LLR and IPI score are inde-pendent factors for predicting the prognosis of DLBCL patients.

The European Society of Gastrointestinal and Abdominal Radiology established a multinational expert group and developed a consensus statement and recommendations on the application of magnetic resonance imaging(MRI)in primary sclerosing cholangitis(PSC).The consensus statement clarifies the core imaging features,indications,and operating procedures of MRI examination for PSC patients and constructs a structured report template to provide a standardized reference for radiologists and clinicians.This article provides an excerpt of the consensus statement for reference.

Objective To observe changes in the lactate(Lac)receptor,G protein-coupled receptor 81(GPR81),and apoptosis after hypoxic ischemic brain injury in newborn piglets,and to clarify the mechanism of Lac/GPR81 signal pathway on the cell apoptosis through the intervention of Lac.Methods Thirty newborn piglets were selected.A total of 21 newborn piglets were randomly divided into Sham and hypoxia-ischemia(HI)model groups,and the HI model group was subdivided into 0-2 h,2-6 h,6-12 h,12-24 h,24-48 h,and 48-72 h HI groups,with n=3 each group.Changes in GPR81 expression and apoptosis in the basal ganglia after HI injury were observed using immunohistochemical and TUNEL staining.Nine newborn piglets were randomly divided into Sham+normal saline(NS),HI+NS,and HI+Lac groups,with n=3 each group.The effects of Lac on the expression of GPR81,apoptotic cell percentage,and the expressions of PI3K,AKT,Bcl-2,and Bax in the basal ganglia after HI injury were observed.Results The cell apoptosis rate increased gradually after HI injury and peaked at 24-48 h(P＜0.05).After HI injury,GPR81 expression initially increased and then decreased,peaking at 2-6 h(P＜0.05).The cell apoptosis rate and the expressions of Bax were higher and p-AKT/AKT ratio and the expressions of PI3K and Bcl-2 were lower in the HI+NS group compared with the Sham+NS group(all P＜0.05).The cell apoptosis rate and the expressions of Bax were lower and p-AKT/AKT ratio and the expressions of GPR81,P13K,and Bcl-2 were higher in the HI+Lac group compared with the HI+NS group(all P＜0.05).Conclusion After HI injury,exogenous Lac can inhibit cell apoptosis through activation of the PI3K/AKT signaling pathway mediated by GPR81.

Objective To analyze the 18F-fluorodeoxyglucose(18F-FDG)PET/CT manifestations of autoimmune pancreatitis(AIP)and to explore the diagnostic value of 18F-FDG PET/CT in AIP.Methods Twenty-three patients with suspected AIP who underwent 18F-FDG PET/CT were retrospectively analyzed.Eleven patients were diagnosed with AIP based on the International Consensus Diagnostic Criteria(ICDC)of AIP published by the International Pancreatic Disease Association.The detection rate and diagnostic sensitivity of 18F-FDG PET/CT for pancreatic enlargement,duct stenosis,duct dilation,pseudocapsules,and extrapancreatic involvement were analyzed,along with the 18F-FDG PET/CT manifestations of AIP.Results The 18F-FDG PET/CT manifestations of 11 patients with AIP:9 patients(81.82%)showed diffuse pancreatic enlargement,and 2 patients(18.18%)had local pancreatic head enlargement.And metabolism showed diffuse or localized increase.The maximum standardized uptake value(SUVmax)for the early PET/CT was 1.7-9.1(4.52±1.92),and for the delayed PET/CT,it was 2.6-9.8(5.25±1.98),with a statistically signifi-cant difference between the two phases SUVmax(t=-7.627,P<0.001).Two patients showed duct stenosis,six had distal duct dilation,and three exhibited pseudocapsule formation.Extrapancreatic involvement occurred in ten patients(90.91%),including sclerosing cholangitis,bile duct dilation inside and outside the liver,gallbladder changes,lymph node involvement,salivary gland involvement,prostate involvement,retroperitoneal fibrosis,pulmonary lesions,arteritis,and granulomatous tissue formation,etc.Among them,the same patient may present with multiple manifestations of extrapancreatic involvement.Among the 11 patients,eight were diagnosed as AIP,two as pancreatic cancer,and one as acute pancreatitis by 18F-FDG PET/CT.The diagnostic sensitivity was 72.73%.Conclusion The 18F-FDG PET/CT of AIP demonstrates specificity in anatomical morphology and metabolic changes and can better display extrapancreatic involvement,which has unique clinical value in AIP imaging diagnosis.

Objective To investigate the effects of miR-483-3p on hypoxia/reoxygenation(H/R)-induced apoptosis and pyroptosis of H9c2 cardiomyocytes and its possible mechanism.Methods Rat H9c2 cardiomyocytes were cultured in vitro,adeno-associated virus-infected H9c2 and the H/R model were constructed by triple-air incuba-tor,and the cells were randomly divided into blank control(Sham)group,model(H/R)group,AAV-miR-483-3p mimic+H/R(AAV-miR-483-3p)group,AAV-miR-483-3p negative control+H/R(AAV-NC)group.The growth status of cells in each group was observed using an inverted microscope;cell proliferation activity was detected by cell counting kit-8(CCK-8);LDH release by lactate dehydrogenase(LDH)kit;apoptosis rate by flow cytometry;apoptosis by notched end labeling(TUNEL).Western blot(WB)was used to detect the expression levels of IL-1β and GSDMD proteins in each group.Results Compared with the Sham group,the H/R group showed abnormal cell status and increased cell death,decreased cell activity,increased LDH release,increased apoptosis rate and apopto-sis level,and increased expression levels of IL-1β and GSDMD proteins(P<0.05);compared with the H/R group,the AAV-miR-483-3p group showed improved cell status and less cell death,increased cell proliferation activity,increased LDH release,and increased IL-1β and GSDMD protein expression levels(P<0.05).Compared with the H/R group,the AAV-miR-483-3p group showed improved cell status and less cell death,increased cell proliferation activity,decreased LDH release,decreased apoptosis rate and apoptosis level,and decreased expression of IL-1β and GSDMD proteins(P<0.05).Conclusion Over-expression of miR-483-3p can improve H/R-inducedH9c2 cardiomyocyte injury by enhancing cell activity and cell metabolism,and inhibiting apoptosis and cell charring.

Objective:To analyze application effect of Failure Mode and Effects Analysis(FMEA)in the maintenance and upkeep for equipment in operating room.Methods:The process of FMEA mode was analyzed,and a strategy about maintenance and upkeep for equipment in operating room on the basis of FMEA was formulated from some aspects included preparation stage,analysis for failure mode(FM),construction for the system of prevention,maintenance and upkeep,and improvement and analysis for results.Sixty used equipment in the operating room of Shiyan Taihe Hospital(Affiliated Hospital of Hubei University of Medicine)from January to December 2023 were selected.According to different management methods for equipment,the conventional management mode and the FMEA management mode were respectively selected to conduct maintenance and upkeep for equipment in operating room,with 30 equipment in each management mode.The incidences of adverse events,the satisfaction scores of operators,and the qualities of maintenance and upkeep for equipment of the two kinds of management modes were compared.Results:The number of occurring inadequate preparation of surgical associated facilities,non-standardized operation of surgical equipment,and incidence of faliures in surgical equipment were respectively in 30 equipment in operating room that adopted FMEA management mode,and the total incidence of adverse events was 6.67%(2/30),which was lower than 36.67%(11/30)that adopted conventional management mode,and the difference was statistically significant(x2=7.954,P<0.05).The satisfaction scores of the operators of operating equipment for the operational quality,usage operation,and maintenance and upkeep of the equipment that received the FMEA management mode in operating room were respectively(92.22±3.36),(91.69±2.25)and(93.25±3.69)points,all of which were higher than those that received conventional management mode,and the differences were statistically significant(t=15.418,17.415,16.639,P<0.05).The average increase extents of the response time for fault,repair time for fault,and the cost of operation and maintenance that adopted FMEA management mode were respectively(2.36±0.59)h,(4.25±2.11)h and(1.89±0.14)%for equipment in operating room,all of which were less than those that adopted conventional management mode,and the differences were statistically significant(t=9.943,12.050,11.069,P<0.05).The failure frequency of equipment of adopting FMEA management mode was(1.54±0.21)times per year,which was lower than that of adopting conventional management mode.The average success rate of opening equipment of adopting FMEA management mode was(90.69±3.59)%,which was higher than that of adopting conventional management mode,and the differences of the above two indicators between two modes were statistically significant(t=15.184,18.779,P<0.05).Conclusion:The application of FMEA in the maintenance and upkeep for medical equipment in the operating room can assess the operational quality of the equipment,and carry out preventive operation and maintenance,and reduce the incidence of failures in equipment,and decrease costs for maintenance,and improve the clinical service level for the equipment.

Objective:This article introduces a novel technique for totally laparoscopic, right thoracic approach, esophagojejunostomy for digestive tract reconstruction.Methods:A retrospective analysis was conducted on the clinical data of patients with adenocarcinoma of the esophagogastric junction who successfully underwent totally laparoscopic esophagojejunostomy via the right thoracic approach at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between February 2022 and March 2022.The surgical procedure was performed as follows:(1)Following total laparoscopic resection of the gastric tumor and lymph node dissection, the specimen was transected distal to the tumor margin. The specimen was then placed into a retrieval bag and extracted through the umbilical observation port.(2)Dissection was continued through the esophageal hiatus to mobilize the esophagus. The tumor-bearing tissue, along with the esophagus, was delivered into the thoracic cavity via the esophageal hiatus.(3)The jejunum was transected 20 cm distal to the ligament of Treitz. The distal Jejunum was mobilized for 15-20 cm and subsequently delivered into the thoracic cavity through the esophageal hiatus.(4)A Roux-en-Y jejunojejunostomy was constructed 45-50 cm distal to the cut end of the distal jejunal limb; the mesenteric defect was closed, and the duodenal stump was reinforced.(5)The patient was repositioned into the left lateral decubitus position. Port placement was established as follows: the observation port at the 7th intercostal space (ICS) in the right midaxillary line, the main operating port at the 4th ICS in the anterior axillary line, and the assistant operating port at the 9th ICS in the scapular line.(6)The main operating port incision was enlarged. Using a purse-string instrument, the esophagus was clamped and transected at least 5 cm proximal to the upper tumor margin, and the specimen was removed. (7)The distal jejunum was delivered into the thoracic cavity via the esophageal hiatus. Under total laparoscopic visualization, esophagojejunostomy was completed.Results:Both patients who underwent totally laparoscopic esophagojejunostomy via the right thoracic cavity successfully completed the procedure without conversion to laparotomy, unplanned reoperation, or any intraoperative/postoperative complications. The patients recovered well postoperatively, with no evidence of abdominal or thoracic hemorrhage. Postoperative computed tomography (CT) scans of the chest and abdomen confirmed the absence of anastomotic leakage or other related complications.Conclusions:The esophagojejunostomy was performed totally laparoscopically via the right thoracic cavity. This approach overcomes the drawback of significant trauma associated with open surgery while ensuring safe esophageal resection margins and thorough lymph node dissection. This technique offers advantages including minimal invasiveness, accelerated postoperative recovery, and a reduced incidence of reflux esophagitis. To our knowledge, no similar method of digestive tract reconstruction has been reported in the literature. Its novelty and clinical potential may offer new therapeutic options for patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG).

Objective:To explore the impact of plant and animal dietary behaviors on type 2 diabetes mellitus (T2DM) in older adults aged ≥65 in 18 longevity areas of China.Methods:The subjects were 5 223 older adults over 65 years old from the Healthy Ageing and Biomarkers Cohort Study (HABCS) in 18 longevity areas in China. Through a questionnaire survey and physical examination, information about their demographic characteristics, lifestyles, daily activities, self-health status, current diseases, and fasting venous blood were collected. Food Frequency and Questionnaire (FFQ) was used to collect data on food intake frequency. Based on the prior method, the plant-based diet index (PDI) and animal-based diet index (ADI) of 5 223 older adults were calculated. Subjects were divided into three groups (low-level group: PDI<39 or ADI<31, middle-level group: 39≤PDI≤42 or 31≤ADI≤34, high-level group: PDI>42 or ADI>34) by tertiles of PDI and ADI. Multivariate logistic regression was used to analyze the association between PDI and ADI and the risk of T2DM.Results:The average age of 5 223 subjects was (84.8±11.5) years, with the median ( Q1, Q3) of PDI about 41(38, 43) and the median ( Q1, Q3) of ADI about 33 (30, 35). The prevalence rate of T2DM was 16.41% (857/5 223). After adjusting for covariates, multivariate logistic regression showed that PDI was negatively associated with T2DM. Compared with the low-level group, the OR (95% CI) for T2DM in the high-level group was 0.83 (0.69-0.99). ADI was positively associated with T2DM, and compared with the low-level group, the OR (95% CI) for T2DM in the high-level group was 1.28 (1.06-1.55). For every one-point increase in PDI and ADI, the risk of T2DM decreased by 2% and increased by 3%, respectively, with the OR (95% CI) of 0.98 (0.96-1.00) and 1.03 (1.01-1.06), respectively. Conclusion:In Chinese older adults ≥65 years in 18 longevity areas, higher adherence to the plant-based behavior may be negatively associated with the risk of T2DM, while higher adherence to the animal-based behavior may be positively associated with the risk of T2DM.