ObjectiveTo investigate the efficacy of selective internal radiation therapy （SIRT） in patients with unresectable hepatocellular carcinoma， and to provide a reference for the selection of clinical treatment regimens. MethodsA retrospective analysis was performed for the clinical data of 73 patients with unresectable hepatocellular carcinoma who received yttrium-90 microsphere SIRT in Eastern Hepatobiliary Surgery Hospital from May 1， 2023 to September 1， 2024. According to tumor characteristics， physical status， liver reserve function， laboratory tests， and SIRT treatment strategy， the patients were divided into radiation segmentectomy group with 9 patients， conversion therapy group with 47 patients， and palliative treatment group with 17 patients. Based on the results of postoperative follow-up， modified Response Evaluation Criteria in Solid Tumors were used to assess radiographic images. A one-way analysis of variance was used for comparison of normally distributed continuous data between three groups， and the chi-square test was used for comparison of categorical data between three groups； the Logistic regression model was used to perform the multivariate analysis. ResultsThere was a significant difference in postoperative outcome between the radiation segmentectomy group， the conversion therapy group， and the palliative treatment group （χ²=30.060， P<0.001）. The disease control rate was 100.0% （9/9） in the radiation segmentectomy group， 83.0% （39/47） in the conversion therapy group， and 29.4% （5/17） in the palliative treatment group， with a significant difference between the three groups （χ²=19.575， P<0.001）， and there was also a significant difference in objective response rate between the three groups （χ²=17.749， P<0.001）. The multivariate Logistic regression analysis showed that the number of tumors （odds ratio ［OR］=0.085， 95% confidence interval ［CI］： 0.008 — 0.906， P=0.041） and combined targeted immunotherapy （OR=18.808， 95%CI： 1.704 — 207.616， P=0.017） were independent influencing factors for achieving complete response. ConclusionThe number of tumors is an independent influencing factor for the efficacy of SIRT and is an important basis for selecting different treatment goals. SIRT combined with targeted immunotherapy may achieve better efficacy.

Purpose: This study aimed to evaluate the safety and efficacy of gemcitabine and cisplatin (GP) regimen in combination with immune checkpoint inhibitor sintilimab as neoadjuvant therapy for muscle-invasive bladder cancer (MIBC) patients and the feasibility of the following selective bladder sparing surgery. Materials and Methods: Patients with histopathologically confirmed urothelial carcinoma without distant metastases (T2-4a, N ≤ 1, M0, American Joint Committee of Cancer 8th) and with adequate organ function will be enrolled. The therapeutic regimen was sintilimab 200 mg once on day 8, gemcitabine 1,000 mg/m2 and cisplatin 35 mg/m2 once on days 1 and 8, every 21 days for four cycles. The primary endpoint was pathologic complete response (pCR, pT0N0) rate. The secondary end points were ypT < 2 rate, R0 resection rate, event-free survival, and safety. Results: From May 4, 2020, to May 20, 2023, 55 patients were enrolled. Forty-six patients were evaluated for efficacy. Among the 42 patients who underwent surgery, 16 patients (38.0%) achieved pCR. Thirty-three patients (78.6%) achieved pT < 2. With a median follow-up of 15.7 months, the 1-year event-free survival was 91.3%. Notwithstanding the poor pathological baseline characteristic of a high T3-T4a proportion (39.1%), a promising bladder preservation (including 22 patients transurethral resection of bladder tumor, 5 patients partial cystectomy, and 4 surveillances) rate was achieved (67.4%). The most common grade ≥ 3 treatment-related adverse events was neutropenia (n=15, 27.3%), which was related to chemotherapy. There were no grade 3 immune-related adverse events. Conclusion Neoadjuvant GP plus sintilimab is a promising regimen for MIBC patients, with relatively high pT < 2 rate and triggering the emerging roles for the multi-disciplinary team decision-making for bladder sparing surgery.

Spine fracture and dislocation are common traumatic spinal conditions that often require surgical intervention due to compromised spinal stability. Surgical approaches include anterior, posterior, and combined anterior-posterior spinal procedures. According to the specific surgical requirements, patients may be placed in the prone position or repositioned between prone and supine positions during surgery. Intraoperative repositioning has become an essential step in patient positioning. However, during repositioning, patients with spinal fracture and dislocation are at increased risk for complications such as hemodynamic instability, nerve injury, and pressure injuries to the skin and soft tissue. Notably, due to the instability of the spinal cord, even minor manipulations can further exacerbate the damage, potentially leading to severe outcomes like paraplegia. Although the current clinical guidelines provide instructive recommendations for standard position, there remains no specific protocols for intraoperative repositioning in patients with spine fracture and dislocation. With a concern for the lack of clinical studies on positioning techniques, risk prevention, and operational norms for special patients, no applicable guidelines or standards are available. A consensus was required to provide clinical reference, meet the requirements of surgical treatment, and minimize the safety risks of patients caused by improper placement of positions. Professional Committee of Operating Room Nursing of Shaanxi Nursing Association organized experts in nursing management and operating room nursing from major hospitals across China to formulate Expert consensus on intraoperative repositioning for patients with spinal fracture and dislocation ( version 2025). The consensus provides 11 recommendations covering pre-repositioning preparation, intraoperative maneuvers, and post-repositioning observation, aiming to provide references for clinical standardization of the intraoperative repositioning process and protection of patients′ safety.

Objective:To investigate whether continued low-dose aspirin (LDA) intervention affects the incidence of pre-eclampsia (PE) and adverse pregnancy outcomes in pregnant women with high-risk PE screening in the first trimester and reassessed as low risk at 28 weeks of gestation.Methods:This study was a prospective observational cohort study. From April 2022 to April 2024, a total of 106 pregnant women who underwent prenatal examination in the Affiliated Jiangyin Hospital of Nantong University were enrolled. They were assessed as high risk of PE by multiple indicators combined screening at 11-13 +6 weeks of gestation, received LDA intervention, and were reassessed as low risk of PE at 28 weeks of gestation. The patients were divided into withdrawal group (49 cases) and continuation group (57 cases). The incidence of PE and adverse pregnancy outcomes were compared between the two groups. Results:(1) There were no statistically significant differences in general conditions and the incidence of pregnancy complications between the two groups (all P>0.05). During the PE risk screening at 11-13 +6 weeks of gestation, there were no statistically significant differences in mean arterial pressure (MAP) and ultrasound uterine artery pulsation index (UtPI) between the two groups (all P>0.05), but the placental growth factor (PlGF) level in the withdrawal group was significantly lower than that in the continuation group ( P=0.023). There was no significant difference in the proportion of pregnant women with high risk of PE before 32 weeks and 34 weeks of pregnancy between the two groups (all P>0.05). (2) There were 7 cases (14%, 7/49) of PE in the withdrawal group, including 1 case (2%, 1/49) of early-onset PE and 3 cases (6%, 3/49) of PE before 37 weeks of pregnancy. There were 11 cases (19%, 11/57) of PE in the continuation group, including 2 cases (4%, 2/57) of early-onset PE and 4 cases (7%, 4/57) of PE before 37 weeks of pregnancy. There were no significant differences in the incidence of PE (including early-onset PE and PE before 37 weeks of pregnancy), gestational hypertension, severe PE, chronic hypertension complicated with PE and chronic hypertension complicated with pregnancy between the two groups (all P>0.05). (3) There were no significant differences in cesarean section rate, preterm birth rate, placental abruption, postpartum hemorrhage, fetal growth restriction, fetal distress rate, neonatal birth weight, neonatal asphyxia, and 1-minute and 5-minute Apgar scores between the two groups (all P>0.05). No stillbirth occurred in the two groups. Conclusion:For pregnant women with high risk of PE screening in the first trimester and taking LDA intervention, there is no difference in the incidence of PE and adverse pregnancy outcomes whether to continue LDA or not after being reassessed as low risk at 28 weeks of gestation.

Objective To investigate the clinical efficacy of β-blockers in older patients with hypertension combined with vascular dementia.Methods A total of 152 older patients with hypertension combined with vascular dementia who were admitted to Shanxi Provincial Fenyang Hospital between January 2022 and October 2024 were enrolled.The participants were randomly assigned to either the study group or the control group(76 patients each)using the randomized numerical table method.Both groups received conventional treatment,and the study group received metoprolol for 5 weeks in addition to the conventional treatment.Primary outcome indicators,including changes in systolic blood pressure(SBP)and diastolic blood pressure(DBP)before and after treatment,were examined.Additionally,comparison was made to examine the intergroup difference in serological markers,including high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin(IL)-6,IL-8,matrix metalloproteinase 9(MMP-9),homocysteine(Hcy),and superoxide dismutase(SOD)levels,and the scores for intelligence,cognitive,and behavioral assessments.Adverse reactions were recorded.Results After treatment,the study group showed reduced SBP from(146.90±7.35)mmHg(1 mmHg=0.133 kPa)to(120.00±6.03)mmHg and reduced DBP from(90.24±5.97)mmHg to(77.23±6.81)mmHg.The reduction in blood pressure in the study group became more significantly when compared with that of the control group,with intergroup difference in SBP reduction being-8.54 mmHg(P<0.001)and intergroup difference in DBP reduction being-10.80 mmHg(P<0.001).Patients in the 2 groups showed statistically significant differences in the levels of hs-CRP,TNF-α,IL-6,IL-8,MMP-9,and Hcy,and in their cognitive and behavioral scores(P<0.05).No statistically significant differences were found in pulse pressure,von Willebrand factor(vWF)levels,or intelligence scores before and after treatment(P>0.05).The main adverse reactions in the study group were central nervous system reactions(22.37%)and withdrawal syndrome(17.11%).Conclusion The β-blocker metoprolol effectively controlled blood pressure,significantly reduced levels of pro-inflammatory factors and specific vascular injury markers,and improved cognitive function and behavioral symptoms in older patients with hypertension combined with vascular dementia,suggesting its therapeutic efficacy for this condition.However,attention should be paid to its associated adverse reactions.

Objective: To establish a machine learning-based precision blood donor recruitment model at the county level and assess its generalizability and applicability. Methods: A retrospective study was conducted using blood donation and SMS recruitment data from the Taicang Branch of the Suzhou Blood Center between 2019 and 2024. Multiple machine learning algorithms were employed, including extreme gradient boosting, support vector machine, k-nearest neighbor, logistic regression, decision tree, random forest, and multilayer perceptron. These were combined with techniques such as synthetic minority oversampling, undersampling, and cost-sensitive learning (using MFE and MSFE loss functions). Model parameters were optimized through grid search to identify the best-performing model. Results: In a prospective comparative study against conventional methods, the machine learning models increased the recruitment success rate among high-willingness donors by an average of 129.15%, and the recruitment efficiency per SMS improved by 125.02% compared with the traditional method. Under full-scale SMS sending, the recruitment rate per SMS increased by 42.61%, and SMS sending efficiency improved by 31.77%, significantly enhancing recruitment performance. Conclusion: This study represents the first application of a machine learning-based precision donor recruitment model at the county-level in China. The precise recruitment framework not only improves recruitment efficiency and reduces recruitment costs but also demonstrates strong scalability and generalizability. It provides a scientific and feasible intelligent pathway to ensure the safety and sustainability of the blood supply.

Instrument separation is a critical complication during root canal therapy, impacting treatment success and long-term tooth preservation. The etiology of instrument separation is multifactorial, involving the intricate anatomy of the root canal system, instrument-related factors, and instrumentation techniques. Instrument separation can hinder thorough cleaning, shaping, and obturation of the root canal, posing challenges to successful treatment outcomes. Although retrieval of separated instrument is often feasible, it carries risks including perforation, excessive removal of tooth structure and root fractures. Effective management of separated instruments requires a comprehensive understanding of the contributing factors, meticulous preoperative assessment, and precise evaluation of the retrieval difficulty. The application of appropriate retrieval techniques is essential to minimize complications and optimize clinical outcomes. The current manuscript provides a framework for understanding the causes, risk factors, and clinical management principles of instrument separation. By integrating effective strategies, endodontists can enhance decision-making, improve endodontic treatment success and ensure the preservation of natural dentition.
Humans ; Root Canal Therapy/adverse effects* ; Consensus ; Root Canal Preparation/adverse effects*

Immunotherapy has been widely used in cancer treatment in recent years and functions by stimulating the immune system to kill tumor cells. Radiation therapy (RT) uses radiation to induce DNA damage and kill tumor cells. However, this activates the body's immune system, promoting the release of tumor-related antigens from inactive dendritic cells, which stimulates the recurrence and metastasis of tumors in immune system tissues. The combination of RT and immunotherapy has been increasingly evaluated in recent years, with studies confirming the synergistic effect of the two antitumor therapies. Particularly, the combination of RT by dose adjustment with different immunotherapies has positive implications on antitumor immunity as well as disease prognosis compared with respective monotherapies. This review summarizes the current research status, progress, and prospects of RT combined with immunotherapy in cancer treatment. It additionally discusses the prevalent concerns regarding the dose, time window, and toxicity of this combination therapy.
Humans ; Neoplasms/radiotherapy* ; Immunotherapy/methods* ; Combined Modality Therapy ; Radiotherapy/methods*

As a key position in medical insurance reform, public hospitals bear the heavy responsibility of deepening medical reform. In the wave of new quality productive forces, the importance of medical insurance management in public hospitals is becoming increasingly prominent. New quality productive forces provides a theoretical breakthrough and practical path for the transformation of medical insurance management paradigm in public hospitals. The authors analyzed the underlying logic of the coupling of new quality productive forces and the high-quality development of medical insurance management in public hospitals from the academic level. Combined with the current dilemmas of medical insurance management in public hospitals, such as lagging management concept, weak digital governance ability, and management system and mechanism not adapting to the development requirements of new productive forces, the authors proposed a three-dimensional development path of " cognitive revolution, factor reconstruction, governance ecology" and constructed a closed-loop system of high-quality development of " value creation, technology empowerment, collaborative co-governance" , so as to provide theoretical innovation and practical path for the modernization of medical insurance management.

Objective:To explore the effect of the interaction between plasma aluminum concentration and schooling year on cognitive function, it provides the basis for early identification of its damaging effect.Methods:From October to December, 2014, 1114 on-the-job aluminum exposed workers in a large aluminum factory in Shanxi Province were investigated. The plasma aluminum concentrations were measured by inductively coupled plasma-mass spectrometry (ICP-MS) as an internal exposure indicator. The subjects were divided into low, medium, and high aluminum exposure group based on the blood lead concentration levels. The general information was collected with a self-designed questionnaire, and their cognitive function was evaluated with the mini-mental state examination and the clock drawing test. The interaction between plasma aluminum concentration level and education level was analyzed by using unconditional logistic regression fitting multiplication model and cross analysis fitting addition model.Results:The average level of plasma aluminum of the subjects was 21.68 (10.51, 45.78) μg/L. The detection rate of cognitive impairment was 19.9%. The influencing factors of cognitive function were plasma aluminum concentration, age, education level and marital status, among which high schooling year, and being married were the protective factors (all P<0.05), plasma aluminum concentration, and age were the risk factors (all P<0.05) ; After adjusting the confounding factors, such as age, marital status, schooling year, income level, smoking, and drinking, logistic regression model and the multiple linear regression model showed that there was a dose response relationship between plasma aluminum concentration and cognitive impairment. With the increase of plasma aluminum concentration, the score gradually decreased, and the risk of cognitive impairment increased ( Ptrend<0.05) ; There were multiplicative interaction ( AOR=2.15, 95% CI: 1.10-4.19) and additive interaction ( RERI=5.38, 95% CI: 2.60-8.16; AP=0.65, 95% CI: 0.51-0.80; S=3.88, 95% CI: 2.00-7.56) between plasma aluminum concentration and low schooling year on cognitive function. Conclusion:There was a dose-response relationship between aluminum exposure and cognitive impairment. There was an interaction between aluminum exposure and low schooling year. When both of them worked together, the risk of cognitive impairment increases.