Objective:To evaluate the efficacy and safety of sintilimab combined with bevacizumab in the second-line treatment of malignant pleural mesothelioma(MPM).Methods:This was a longitudinal study. Patients with MPM who had progressed after first-line treatment and were admitted to the Day-Care Outpatient Department of Medical Oncology, Ningguo People′s Hospital from February 2019 to February 2022 were included. General clinical data of the patients were collected at baseline. The patients were treated with the second-line treatment regimen of sintilimab (200 mg)+bevacizumab (15 mg/kg) on a 21-day cycle. Enhanced CT scans were performed every 3 cycles to evaluate the efficacy until tumor progression or death. Follow-up period ended in December 2023. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Efficacy was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST), and the best response of each patient was recorded. The objective response rate (ORR) and disease control rate (DCR) were calculated. Adverse reactions were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), ranging from grade Ⅰto Ⅳ. Kaplan-Meier survival curves were used to analyze PFS and OS, and survival times were expressed as median values.Results:A total of 23 MPM patients were included, with the mean age of (55.04±13.27)years, 15 males, 8 females, 19 cases of epithelial type and 4 cases of non-epithelial type. The Eastern Cooperative Oncology Group (ECOG) performance status scores were 0-1 in 12 patients and 2 in 11 patients. There were 17 smokers and 6 non-smokers, 12 cases with PD-L1 positive and 11 cases with PD-L1 negative, and 6 cases with anti-angiogenic drugs and 17 cases without using anti-angiogenic drugs in the first-line treatment. Of the 23 patients, 1 achieved complete response (CR), 9 achieved partial response (PR), 7 had stable disease (SD), and 6 had progressive disease (PD). The ORR and DCR of the enrolled patients were 43.5% (10/23) and 73.9% (17/23), respectively. Kaplan-Meier survival analysis showed that the PFS of the enrolled patients was 7.50 (95% CI: 5.47-9.54) months, and the OS was 12.50 (95% CI: 1.07-23.93) months. The most common adverse reactions related to the treatment of sintilimab combined with bevacizumab were hypertension (14 cases (60.9%)), fatigue (10 cases (43.5%)), decreased appetite (8 cases (34.8%)), proteinuria (6 cases (26.1%)), pruritus (5 cases (21.7%)), constipation (4 cases (17.4%)) and nausea (3 cases (13.0%)), etc. Only 9 patients had grade Ⅲ adverse reactions (8 cases of hypertension and 1 case of nausea), and only 1 patient had grade Ⅳ adverse reaction (hypertension). Conclusion:Sintilimab combined with bevacizumab has some therapeutic effects on progressive MPM, and the adverse reactions are relatively mild.

Objective To explore the effectiveness of the tele-intelligent rehabilitation system based on a wearable device in early rehabilitation of patients after arthroscopic anterior cruciate ligament re-construction(ACLR).Methods A total of 70 patients(48 male,22 female,18～29 years old)undergo-ing arthroscopic ACLR were randomly divided into a tele-rehabilitation group(n=36)and a convention-al rehabilitation group(n=34).The tele-rehabilitation group underwent rehabilitation training using the tele-intelligent rehabilitation system based on a wearable device,while the conventional rehabilitation group conducted a home-based self-rehabilitation exercise according to the conventional education con-tent after surgery.Before surgery and 12 weeks postoperatively,both groups were assessed using the International Knee Documentation Committee(IKDC),lower extremity functional scale(LEFS),knee active range of motion(AROM),numeric pain rating scale(NPRS)and 12-item short-form health survey(SF-12).Results Before surgery,there was no significant difference between the two groups in the IKDC score,LEFS,knee mobility,walking NPRS,as well as physical component summary(PCS)and mental component summary(MCS)scores in the SF-12 scale(P>0.05).However,12 weeks postoperatively,the IKDC score,LEFS score,and knee mobility in the tele-rehabilitation group were 73.4±9.8,70.2±5.1,and 127.9°±5.8°,respectively,significantly better than those of the conventional rehabilitation group(64.3±13.7,63.6±9.6,and 122.7°±10.6°,respectively)(P<0.05 for all).Moreover,the walking NPRS scores in the tele-rehabilitation group were significantly low-er than the conventional rehabilitation group(P=0.01),while the PCS and the MCS scores of the for-mer were significantly superior to the latter(P<0.01).In addition,the minimum clinically important difference compliance rate of IKDC and LEFS score and the patient acceptable symptom state compli-ance rate of NPRS score in tele-rehabilitation group were significantly better than the latter group(P<0.05).Conclusion The remote intelligent rehabilitation system based on a wearable device is superior to the conventional rehabilitation in promoting early knee function recovery,joint mobility,relieving pain,and bettering the life quality of patients after ACLR.

Objective:To compare the application effects of upper arm autogenous arteriovenous fistula (AVF) and forearm arteriovenous graft (AVG) in maintenance hemodialysis (MHD) patients, and to analyze the factors influencing the long-term patency rate of arteriovenous fistulas in MHD patients.Methods:It was a retrospective cohort study. The data of MHD patients treated in the First Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to May 2023 was collected. Participants were stratified into two groups: forearm AVG and upper arm AVF. The parameters including urea clearance index (Kt/V), serum C-reactive protein (CRP), albumin levels, access-related costs, complication rates, and long-term primary patency were compared. The end event was defined as arteriovenous fistula failure, that was, the arteriovenous fistula could not be used for dialysis puncture, or the arteriovenous fistula lost function after adequate blood flow was achieved. Kaplan-Meier survival curves with log-rank tests were employed to compare access survival, while multivariable Cox regression was used to analyze the independent associated factors of patency.Results:A total of 71 MHD patients were enrolled in this study, including 35 males, with age of (64.9±11.7) years and fistula establishment time of 30.0(17.0, 58.0) months. There were 32 cases (45.1%) in the forearm AVG group and 39 cases (54.9%) in the upper arm AVF group. Compared with the forearm AVG group, the upper arm AVF group had higher serum albumin levels [38.9 (37.0, 42.1) g/L vs. 38.0 (34.6, 40.0) g/L, Z=-2.364, P=0.018], higher pain scores [3.0(2.0, 5.0) points vs. 2.0(1.0, 3.0) points, Z=-3.012, P=0.003], and higher long-term patency rates of arteriovenous fistulas (at 3, 6, 12, and 24 months, all P<0.01), while the complication rate[61.5% (24/39) vs. 93.7% (30/32), χ2=10.015, P=0.002], the cost of the access [0 (0, 9,117.0) yuan·year -1·person -1vs. 10 380.5 (7 186.0, 30 228.5) yuan·year -1·person -1, Z=-4.094, P<0.001] were lower, and the length of the available puncture vessel segment was shorter [3.5(3.0, 5.0) cm vs. 6.5(6.0, 8.0) cm, Z=-6.477, P<0.001].The Kaplan-Meier survival analysis results showed that the primary patency rate of the upper arm AVF group was significantly higher than that of the forearm AVG group (Log-rank test, χ2=23.690, P<0.001). The multivariate Cox regression analysis results indicated that the type of fistula being forearm AVG (with upper arm AVF as reference, HR=4.907, 95% CI 1.740-13.840) and increased complications number ( HR=1.234, 95% CI 1.040-1.464) were the independent factors promoting the arteriovenous fistula failure in MHD patients. Conclusions:The type of internal fistula and the complications are the factors affecting the long-term patency rate of internal fistula in MHD patients.Upper arm AVF offers cost-effectiveness and sustained patency advantages over forearm AVG but requires careful consideration of puncture challenges and patient discomfort. Individualized access selection should balance anatomical constraints with clinical priorities.

Objective To explore different construction models and experiences of clinical laboratory centers under exist-ing Integrated county healthservices entity,analyze and discuss the characteristics of various construction models,and provide ref-erences for the development of county-level clinical laboratory centers.Methods Based on the five factors of"man,machine,material,method,and environment"in Total Quality Management theory,an interview outline and questionnaire were designed for county-level clinical laboratory centers.Eleven county-level clinical laboratory centers across the country were investigated to analyze their construction models,investment returns,and other aspects.Literature reviews and case studies were also conducted to summarize the construction models and characteristics of county-level clinical laboratory centers.Results The construction models of county-level clinical laboratory centers are mainly divided into five types,each with distinct features.Through an analy-sis of the investment returns of these models unde rIntegrated county healthservices entity,it was found that a profit distribution ratio of approximately 5∶5 between county-level clinical laboratory centers and township health centers for referred samples is more conducive to maintaining the stability of sample sources.The construction model of county-level clinical laboratory centers is closely related to the medical service capacity of both county and township levels.Conclusion Counties with stronger county hospital capabilities tend to establish relatively independent regional laboratory centers based on the county hospital's laboratory department.Regardless of the model,the primary goal of county-level clinical laboratory centers should be to provide high-quality testing services coverage across the entire county.The key to the success of county-level clinical laboratory centers lies in motiva-ting grassroots personnel.

Objective To explore different construction models and experiences of clinical laboratory centers under exist-ing Integrated county healthservices entity,analyze and discuss the characteristics of various construction models,and provide ref-erences for the development of county-level clinical laboratory centers.Methods Based on the five factors of"man,machine,material,method,and environment"in Total Quality Management theory,an interview outline and questionnaire were designed for county-level clinical laboratory centers.Eleven county-level clinical laboratory centers across the country were investigated to analyze their construction models,investment returns,and other aspects.Literature reviews and case studies were also conducted to summarize the construction models and characteristics of county-level clinical laboratory centers.Results The construction models of county-level clinical laboratory centers are mainly divided into five types,each with distinct features.Through an analy-sis of the investment returns of these models unde rIntegrated county healthservices entity,it was found that a profit distribution ratio of approximately 5∶5 between county-level clinical laboratory centers and township health centers for referred samples is more conducive to maintaining the stability of sample sources.The construction model of county-level clinical laboratory centers is closely related to the medical service capacity of both county and township levels.Conclusion Counties with stronger county hospital capabilities tend to establish relatively independent regional laboratory centers based on the county hospital's laboratory department.Regardless of the model,the primary goal of county-level clinical laboratory centers should be to provide high-quality testing services coverage across the entire county.The key to the success of county-level clinical laboratory centers lies in motiva-ting grassroots personnel.

Objective To explore the effectiveness of the tele-intelligent rehabilitation system based on a wearable device in early rehabilitation of patients after arthroscopic anterior cruciate ligament re-construction(ACLR).Methods A total of 70 patients(48 male,22 female,18～29 years old)undergo-ing arthroscopic ACLR were randomly divided into a tele-rehabilitation group(n=36)and a convention-al rehabilitation group(n=34).The tele-rehabilitation group underwent rehabilitation training using the tele-intelligent rehabilitation system based on a wearable device,while the conventional rehabilitation group conducted a home-based self-rehabilitation exercise according to the conventional education con-tent after surgery.Before surgery and 12 weeks postoperatively,both groups were assessed using the International Knee Documentation Committee(IKDC),lower extremity functional scale(LEFS),knee active range of motion(AROM),numeric pain rating scale(NPRS)and 12-item short-form health survey(SF-12).Results Before surgery,there was no significant difference between the two groups in the IKDC score,LEFS,knee mobility,walking NPRS,as well as physical component summary(PCS)and mental component summary(MCS)scores in the SF-12 scale(P>0.05).However,12 weeks postoperatively,the IKDC score,LEFS score,and knee mobility in the tele-rehabilitation group were 73.4±9.8,70.2±5.1,and 127.9°±5.8°,respectively,significantly better than those of the conventional rehabilitation group(64.3±13.7,63.6±9.6,and 122.7°±10.6°,respectively)(P<0.05 for all).Moreover,the walking NPRS scores in the tele-rehabilitation group were significantly low-er than the conventional rehabilitation group(P=0.01),while the PCS and the MCS scores of the for-mer were significantly superior to the latter(P<0.01).In addition,the minimum clinically important difference compliance rate of IKDC and LEFS score and the patient acceptable symptom state compli-ance rate of NPRS score in tele-rehabilitation group were significantly better than the latter group(P<0.05).Conclusion The remote intelligent rehabilitation system based on a wearable device is superior to the conventional rehabilitation in promoting early knee function recovery,joint mobility,relieving pain,and bettering the life quality of patients after ACLR.

Objective:To evaluate the efficacy and safety of sintilimab combined with bevacizumab in the second-line treatment of malignant pleural mesothelioma(MPM).Methods:This was a longitudinal study. Patients with MPM who had progressed after first-line treatment and were admitted to the Day-Care Outpatient Department of Medical Oncology, Ningguo People′s Hospital from February 2019 to February 2022 were included. General clinical data of the patients were collected at baseline. The patients were treated with the second-line treatment regimen of sintilimab (200 mg)+bevacizumab (15 mg/kg) on a 21-day cycle. Enhanced CT scans were performed every 3 cycles to evaluate the efficacy until tumor progression or death. Follow-up period ended in December 2023. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Efficacy was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST), and the best response of each patient was recorded. The objective response rate (ORR) and disease control rate (DCR) were calculated. Adverse reactions were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), ranging from grade Ⅰto Ⅳ. Kaplan-Meier survival curves were used to analyze PFS and OS, and survival times were expressed as median values.Results:A total of 23 MPM patients were included, with the mean age of (55.04±13.27)years, 15 males, 8 females, 19 cases of epithelial type and 4 cases of non-epithelial type. The Eastern Cooperative Oncology Group (ECOG) performance status scores were 0-1 in 12 patients and 2 in 11 patients. There were 17 smokers and 6 non-smokers, 12 cases with PD-L1 positive and 11 cases with PD-L1 negative, and 6 cases with anti-angiogenic drugs and 17 cases without using anti-angiogenic drugs in the first-line treatment. Of the 23 patients, 1 achieved complete response (CR), 9 achieved partial response (PR), 7 had stable disease (SD), and 6 had progressive disease (PD). The ORR and DCR of the enrolled patients were 43.5% (10/23) and 73.9% (17/23), respectively. Kaplan-Meier survival analysis showed that the PFS of the enrolled patients was 7.50 (95% CI: 5.47-9.54) months, and the OS was 12.50 (95% CI: 1.07-23.93) months. The most common adverse reactions related to the treatment of sintilimab combined with bevacizumab were hypertension (14 cases (60.9%)), fatigue (10 cases (43.5%)), decreased appetite (8 cases (34.8%)), proteinuria (6 cases (26.1%)), pruritus (5 cases (21.7%)), constipation (4 cases (17.4%)) and nausea (3 cases (13.0%)), etc. Only 9 patients had grade Ⅲ adverse reactions (8 cases of hypertension and 1 case of nausea), and only 1 patient had grade Ⅳ adverse reaction (hypertension). Conclusion:Sintilimab combined with bevacizumab has some therapeutic effects on progressive MPM, and the adverse reactions are relatively mild.

Objective:To compare the application effects of upper arm autogenous arteriovenous fistula (AVF) and forearm arteriovenous graft (AVG) in maintenance hemodialysis (MHD) patients, and to analyze the factors influencing the long-term patency rate of arteriovenous fistulas in MHD patients.Methods:It was a retrospective cohort study. The data of MHD patients treated in the First Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to May 2023 was collected. Participants were stratified into two groups: forearm AVG and upper arm AVF. The parameters including urea clearance index (Kt/V), serum C-reactive protein (CRP), albumin levels, access-related costs, complication rates, and long-term primary patency were compared. The end event was defined as arteriovenous fistula failure, that was, the arteriovenous fistula could not be used for dialysis puncture, or the arteriovenous fistula lost function after adequate blood flow was achieved. Kaplan-Meier survival curves with log-rank tests were employed to compare access survival, while multivariable Cox regression was used to analyze the independent associated factors of patency.Results:A total of 71 MHD patients were enrolled in this study, including 35 males, with age of (64.9±11.7) years and fistula establishment time of 30.0(17.0, 58.0) months. There were 32 cases (45.1%) in the forearm AVG group and 39 cases (54.9%) in the upper arm AVF group. Compared with the forearm AVG group, the upper arm AVF group had higher serum albumin levels [38.9 (37.0, 42.1) g/L vs. 38.0 (34.6, 40.0) g/L, Z=-2.364, P=0.018], higher pain scores [3.0(2.0, 5.0) points vs. 2.0(1.0, 3.0) points, Z=-3.012, P=0.003], and higher long-term patency rates of arteriovenous fistulas (at 3, 6, 12, and 24 months, all P<0.01), while the complication rate[61.5% (24/39) vs. 93.7% (30/32), χ2=10.015, P=0.002], the cost of the access [0 (0, 9,117.0) yuan·year -1·person -1vs. 10 380.5 (7 186.0, 30 228.5) yuan·year -1·person -1, Z=-4.094, P<0.001] were lower, and the length of the available puncture vessel segment was shorter [3.5(3.0, 5.0) cm vs. 6.5(6.0, 8.0) cm, Z=-6.477, P<0.001].The Kaplan-Meier survival analysis results showed that the primary patency rate of the upper arm AVF group was significantly higher than that of the forearm AVG group (Log-rank test, χ2=23.690, P<0.001). The multivariate Cox regression analysis results indicated that the type of fistula being forearm AVG (with upper arm AVF as reference, HR=4.907, 95% CI 1.740-13.840) and increased complications number ( HR=1.234, 95% CI 1.040-1.464) were the independent factors promoting the arteriovenous fistula failure in MHD patients. Conclusions:The type of internal fistula and the complications are the factors affecting the long-term patency rate of internal fistula in MHD patients.Upper arm AVF offers cost-effectiveness and sustained patency advantages over forearm AVG but requires careful consideration of puncture challenges and patient discomfort. Individualized access selection should balance anatomical constraints with clinical priorities.

Background and Aims:Recurrent laryngeal nerve (RLN) injury during endoscopic thyroid cancer radical surgery significantly affects postoperative recovery and quality of life. Avoiding RLN injury has always been a key concern during thyroid surgeries. Choosing an appropriate and safe approach to expose the RLN in endoscopic thyroid cancer surgery may reduce the risk of RLN injury. However,the optimal approach for RLN exposure in endoscopic thyroid cancer radical surgery through the anterior chest approach remains inconclusive. This study was performed to compare the surgical outcomes of using the medial and lateral approaches to expose the RLN in endoscopic thyroid cancer surgery through the anterior chest approach,so as to provide reference for clinical practice.Methods:The clinical data of 85 patients who underwent endoscopic thyroid cancer radical surgery (ipsilateral lobectomy and ipsilateral central lymph node dissection) via the anterior chest approach at Zhuzhou Hospital Affiliated to Xiangya Medical College,Central South University,from January 2020 to January 2023 were retrospectively analyzed. Among the patients,medial approach was used in 45 cases (medial approach group) and lateral approach was used for RLN exposure in 40 cases (lateral approach group). The main clinical variables were compared between the two groups. Results:No statistically significant differences were found in baseline data between the two groups (all P>0.05). Both groups successfully completed endoscopic thyroidectomy via the anterior chest approach with complete RLN exposure at the main trunk and its entry into the larynx. The RLN exposure time and endoscopic surgery time in the medial approach group were significantly shorter than those in the lateral approach group (both P<0.05). Intraoperative blood loss was significantly less in the medial approach group compared to the lateral approach group (P<0.05). There were no cases of transient RLN injury in the medial approach group,whereas 5 cases of transient RLN injury occurred in the lateral approach group,with a statistically significant difference (P<0.05). The medial approach group had fewer cases of thyroid tissue residue at the Berry's ligament and transient hypoparathyroidism than the lateral approach group,but the differences were not statistically significant (both P>0.05). There were no statistically significant differences between the two groups in postoperative hospital stay or postoperative drainage volume (both P>0.05). Conclusion:The medial approach for RLN exposure in endoscopic thyroid cancer surgery is safe and feasible. Compared to the lateral approach,it allows faster RLN exposure,effectively reduces the risk of transient RLN injury,decreases intraoperative blood loss and operative time,and may also reduce the incidence of transient hypoparathyroidism and thyroid tissue residue to some extent.

Background and Aims:Recurrent laryngeal nerve (RLN) injury during endoscopic thyroid cancer radical surgery significantly affects postoperative recovery and quality of life. Avoiding RLN injury has always been a key concern during thyroid surgeries. Choosing an appropriate and safe approach to expose the RLN in endoscopic thyroid cancer surgery may reduce the risk of RLN injury. However,the optimal approach for RLN exposure in endoscopic thyroid cancer radical surgery through the anterior chest approach remains inconclusive. This study was performed to compare the surgical outcomes of using the medial and lateral approaches to expose the RLN in endoscopic thyroid cancer surgery through the anterior chest approach,so as to provide reference for clinical practice.Methods:The clinical data of 85 patients who underwent endoscopic thyroid cancer radical surgery (ipsilateral lobectomy and ipsilateral central lymph node dissection) via the anterior chest approach at Zhuzhou Hospital Affiliated to Xiangya Medical College,Central South University,from January 2020 to January 2023 were retrospectively analyzed. Among the patients,medial approach was used in 45 cases (medial approach group) and lateral approach was used for RLN exposure in 40 cases (lateral approach group). The main clinical variables were compared between the two groups. Results:No statistically significant differences were found in baseline data between the two groups (all P>0.05). Both groups successfully completed endoscopic thyroidectomy via the anterior chest approach with complete RLN exposure at the main trunk and its entry into the larynx. The RLN exposure time and endoscopic surgery time in the medial approach group were significantly shorter than those in the lateral approach group (both P<0.05). Intraoperative blood loss was significantly less in the medial approach group compared to the lateral approach group (P<0.05). There were no cases of transient RLN injury in the medial approach group,whereas 5 cases of transient RLN injury occurred in the lateral approach group,with a statistically significant difference (P<0.05). The medial approach group had fewer cases of thyroid tissue residue at the Berry's ligament and transient hypoparathyroidism than the lateral approach group,but the differences were not statistically significant (both P>0.05). There were no statistically significant differences between the two groups in postoperative hospital stay or postoperative drainage volume (both P>0.05). Conclusion:The medial approach for RLN exposure in endoscopic thyroid cancer surgery is safe and feasible. Compared to the lateral approach,it allows faster RLN exposure,effectively reduces the risk of transient RLN injury,decreases intraoperative blood loss and operative time,and may also reduce the incidence of transient hypoparathyroidism and thyroid tissue residue to some extent.