Objective To study the five-year survival status and influencing factors of elderly patients with lung cancer complicated with chronic obstructive pulmonary disease (COPD). Methods A cohort study was conducted to follow up 450 patients with lung cancer and chronic obstructive pulmonary disease who were hospitalized in our hospital from January 2018 to December 2023. The endpoint of the follow-up was the end of a five-year period or death. The Life Tables method was used to calculate survival rates and plot survival curves. The Cox proportional hazards model was used to analyze the influencing factors of five-year survival. Results The results indicated that the overall five-year survival rate of patients was 4.89%, and it decreased year by year. Cox regression analysis showed that age, gender, family functioning, and psychological status significantly influenced patient survival rate (all P<0.05). Stratified analysis found that the smoking status, family functioning, and psychological status of male patients all had an impact on survival rate (all P<0.05), while the psychological status of female patients had a more significant impact on survival (P=0.008). Conclusion This study provides a scientific basis for comprehensive intervention of elderly lung cancer patients with COPD. It is recommended that clinical attention should be paid to psychological and family factors to improve patient prognosis.

Objective To analyze the effect of releasing the lower pulmonary ligament on right residual lung expansion after right upper lobe resection under different body mass index (BMI) levels. Methods The clinical data of patients who underwent thoracoscopic right upper lobe resection in the First Affiliated Hospital with Nanjing Medical University from 2021 to 2022 were retrospectively analyzed. Patients were divided into a group A (17 kg/m2＜BMI≤23 kg/m2), a group B (23 kg/m2＜BMI≤29 kg/m2) and a group C (BMI＞29 kg/m2) according to BMI. The presence of residual cavity was judged by chest X-ray at 7-10 days after operation, the degree of compensation change of the right main bronchus angle was measured, and the changes in lung volume were determined by CT three-dimensional reconstruction. Results A total of 157 patients who underwent thoracoscopic right upper lobe resection were included, including 71 males and 86 females, with an average age of (59.7±11.2) years. There were 50 patients in the group A, 75 patients in the group B, and 32 patients in the group C. In the group A, compared with those without releasing the lower pulmonary ligament, patients with releasing had a lower incidence of postoperative residual cavity (P=0.016), greater changes in bronchus angle (P<0.001), and smaller changes in lung volume (P<0.001). In the group B and C, there was no significant effect of releasing the lower pulmonary ligament on postoperative residual cavity, bronchus angle, and lung volume changes (P>0.05). Conclusion For patients with thin and long body shape and low BMI, releasing the lower pulmonary ligament is helpful to promote the expansion of the residual lung after right upper lobe resection and reduce the occurrence of postoperative residual cavity in patients.

Objective To analyze the efficacy, safety, and learning curve of the three-lobe holmium laser enucleation of the prostate(HoLEP)in the treatment of benign prostatic hyperplasia(BPH)in a county-level hospital.Methods A retrospective analysis was conducted on the clinical data of 65 BPH patients who underwent the three-lobe HoLEP performed by a single surgeon at the Department of Urology, Yining County People's Hospital, during Dec.2023 and Jun.2024.The enucleation efficiency was calculated by dividing the weight of the enucleated prostatic tissue by the enucleation time.A case scatter diagram of enucleation efficiency was plotted according to the chronological order of the operations, and the learning curve was analyzed after fitting.Based on the inflection points of the learning curve, the learning process was divided into the initial learning, mastery, and proficiency phases.The basic clinical data, perioperative indicators, postoperative complications, and follow-up indicators were compared among the different learning phases.Results All 65 procedures were successfully completed.Marked by the enucleation efficiency reaching a plateau, cases 1-20 were defined as the initial learning phase, cases 21-40 as the mastery phase, and cases 41 onwards as the proficiency phase.The prostate volume in the proficiency phase was significantly larger than that in the initial learning and mastery phases(both P＜0.05).There were no statistically significant differences in other baseline characteristics among the three groups(all P＞0.05).The operation time [(105.50±19.12)min vs.(85.25±26.92)min vs.(69.00±23.58)min] and enucleation time [(76.90±14.19)min vs.(63.70±22.24)min vs.(48.80±20.48)min] showed a decreasing trend across the three groups(all P＜0.05).The enucleation efficiency in both the mastery and proficiency phases was significantly higher than that in the initial learning phase [(1.16±0.44)g/min vs.(0.85 ±0.25)g/min, P＜0.05;(1.36±0.49)g/min vs.(0.85±0.25)g/min, P＜0.05].The enucleation efficiency in the proficiency phase was slightly higher than that in the mastery phase, but the difference was not statistically significant(P= 0.389).There was no significant difference in the incidence of perioperative complications among the three groups(all P＞0.05).At the 6-month follow-up, the international prostate symptom score(IPSS), post-void residual(PVR), and maximum urinary flow(Qmax)were significantly improved compared to preoperative values in all three groups(all P＜0.05);however, no significant differences were observed among the three groups(all P＞0.05).Conclusion The three-lobe HoLEP for the treatment of BPH is safe and effective in a county-level hospital setting.Surgeons with some experience in endoscopic surgery can preliminarily master this technique after a learning period of approximately 20 procedures.

Extended reality(XR)technology includes virtual reality(VR),augmented reality(AR)and mixed reality(MR)Combining virtual environments with physical world,the extended reality(XR)technology has great potential in rehabilitation of patients with stroke.This article reviews the intervention effects of XR technology on the functions of limb,swallowing,speech and cognition and psychological outcomes in patients with stroke.Based on this review,issues in application of XR are identified and targeted solutions are proposed,thereby offering a guidance for application of XR technology in stroke rehabilitation in China.

There was a close relationship between microvascular invasion(MVI)and the therapeutic efficacy and prognosis of hepatocellular carcinoma.With the continuous development of imaging examination methods,multimodal magnetic resonance imaging(MRI)was a non-invasive and quantitative examination method that com bines multiple imaging modes,including magnetic resonance T1/T2 weighted imaging(T1/T2WI),functional MRI[diffusion-weighted imaging(DWI),intravoxel incoherent motion(IVIM)and diffusion-kurtosis imaging(DKI)],dynamic contrast-enhanced MRI(DCE-MRI),hepatobiliary phase imaging(HBP),etc,it can obtain various imaging parameters and provide more comprehensive and accurate diagnostic information for clinicians,it has been widely used in the diagnosis and grading,efficacy evaluation,prognosis,and MVI prediction of hepatocellular carcinoma.Based on this,this article reviews the relevant literature on the application of multimodal MRI in MVI of hepatocellular carci noma in recent years,and summarizes the research status and progress of multimodal MRI in predicting hepatocellular carcinoma MVI,the aim was to further analyze the challenges of multimodal MRI in the application of hepatocellular carcinoma MVI,promote the clinical application of predicting hepatocellular carcinoma MVI,and improve the accuracy of predicting of hepatocellular carcinoma MVI.

Objective To explore the correlation between triglyceride-glucose(TyG)index and hyperuricemia in men with normal fasting blood glucose(FPG)levels.Methods A total of 309 men with normal FPG who participated in a health examination at the Ninth Medical Center of the People's Liberation Army General Hospital in April 2024 were enrolled in this study.All the subjects were divided into the normal uric acid(NUA,n=218)group and the hyperuricemia(HUA,n=91)group according to serum uric acid(SUA)levels.Results Scr,TG,weight,SBP,DBP,BMI,ALT,AST,γ-GGT,and TyG index were higher in the HUA group than in the NUA group(P<0.05).Pearson and Spearman correlation analysis showed that SUA were positively correlated with Scr,eGFR,TG,weight,SBP,DBP,BMI,ALT,AST,γ-GGT and TyG(P<0.05),and negatively correlated with HDL-C(P<0.05).Logistic regression analysis showed that after adjusting for confounding factors,TyG index remained an important influencing factor for HUA.ROC curve analysis showed that the area under the ROC curve of TyG index predicting hyperuricemia in men with normal FPG was 0.665,with an cutoff value of 8.45.Conclusions TyG index in men with normal FPG are influencing factors for hyperuricemia,indicating that hyperuricemia has a close association with insulin resistance,and is an important component of metabolic syndrome.

Acute ischemic stroke(AIS)is associated with high mortality and disability rates,presenting a substantial challenge to global public health challenge.Intravenous thrombolysis(IVT)is recognized as a cornerstone of early AIS treatment and is recommended as the standard therapeutic approach by both national and international guidelines.However,the clinical efficacy of IVT remains suboptimal due to several limitations,including a narrow therapeutic time window and the inevitable activation of the coagulation system and platelet aggregagation during thrombolysis.These factors may contribute to adverse outcomes such as early neurological deterioration(END)and vascular re-occlusion.Antiplatelet therapy(APT),which inhibits platelet aggregations,reduces microthrombus formation,and stabilizes the vascular endothelium with multifaceted mechanisms,has emerged as a promising adjunctive strategy to IVT,offering potential synergistic effects.This review summarized the latest evidence from both domestic and international studies,focusing on the mechanisms of APT,recent clinical advancements in IVT combined with APT,and the safety and efficacy of APT administration at different time windows relative to IVT.Emphasis is placed on the influence of various antiplatelet agents,dosing regimens,and initiation timing on therapeutic outcomes,alongside a comprehensive evaluation in the context of current guideline recommendations and clinical practice.Current guidelines recommend initiating APT 24 h after IVT,following imaging confirmation to exclude the risk of intracranial hemorrhage.However,the efficacy and safety of earlier APT initiation remain inconclusive.Individualized treatment strategies,such as early administration of low-dose,short-acting APT or combination therapy in specific patient subgroups,may effectively balance therapeutic benefits and risks.The adjunctive use of APT in IVT holds promise for enhancing efficacy and improving clinical outcomes,but precise stratification of safety and efficacy is essential.Future research should focus on optimizing combination IVT and APT strategies through individualized patient profiling,appropriate drug selection,and dynamic imaging monitoring to achieve precision management in AIS treatment.

The"promising zone"is a method used to analyze interim data from adaptive design clinical trials in an unblinded state.It allows for the adjustment of sample size based on interim results to enhance the trial's probability of success or minimize investment in unnecessary sample size.Mehta and Pocock proposed rules for increasing sample size based on interim analysis results using the concept of the"promising zone"(MP design).Furthermore,combination of the MP design with group sequential design can set up early stopping boundaries in trials,allowing for a reduction in sample size under favorable or unfavorable zone.The combination test(CT)design further optimizes the framework of the"promising zone",by considering sample size and conditional power in combination to achieve the highest conditional power with the smallest sample size.This review summarizes the principles of the"promising zone",introduces the method of determining the"promising zone"and re-estimating sample size,and further illustrates the feasibility of this method in clinical trials with a practical case.

Objective To determine the effect of limb dominance on landing biomechanics and lower limb functional outcomes in patients with anterior cruciate ligament reconstruction(ACLR).Methods Forty-nine participants were recruited and divided into the ACLR on dominant limb(ACLR-D)group,ACLR on nondominant limb(ACLR-ND)group and healthy control group.Single-leg jump landing,knee isokinetic muscle strength,Y balance,and single-leg hop distance were tested on both limbs of all participants.Kinematics and kinetics data during the single-leg jump landing were collected by an infrared motion capture system and a force platform,and knee joint muscle strength was collected using the isokinetic muscle strength testing system.Two-way mixed-design ANOVAs were used to observe the effects of limb and group on the outcomes of each test.Results The non-surgical limbs had greater knee valgus,knee external rotation angles and knee valgus moments during single-leg jump landing in the ACLR-D group compared with those in the ACLR-ND group,and the ACLR-D group had significantly smaller bilateral knee flexion angles than the control group.There were no differences in knee muscle strength,Y-balance composite scores and single-leg hop distance between ACLR-D and ACLR-ND groups,but the Y balance scores in the ACLR-ND group were smaller than those in the control group.Conclusions Limb dominance has no effects on knee muscle strength,dynamic postural control,and single-leg hop function in ACLR patients.The non-surgical limbs of ACLR-D patients are at a higher risk of ACL injury due to the presence of greater knee valgus and external rotation angles and knee valgus moments.

Objective To determine the effect of limb dominance on landing biomechanics and lower limb functional outcomes in patients with anterior cruciate ligament reconstruction(ACLR).Methods Forty-nine participants were recruited and divided into the ACLR on dominant limb(ACLR-D)group,ACLR on nondominant limb(ACLR-ND)group and healthy control group.Single-leg jump landing,knee isokinetic muscle strength,Y balance,and single-leg hop distance were tested on both limbs of all participants.Kinematics and kinetics data during the single-leg jump landing were collected by an infrared motion capture system and a force platform,and knee joint muscle strength was collected using the isokinetic muscle strength testing system.Two-way mixed-design ANOVAs were used to observe the effects of limb and group on the outcomes of each test.Results The non-surgical limbs had greater knee valgus,knee external rotation angles and knee valgus moments during single-leg jump landing in the ACLR-D group compared with those in the ACLR-ND group,and the ACLR-D group had significantly smaller bilateral knee flexion angles than the control group.There were no differences in knee muscle strength,Y-balance composite scores and single-leg hop distance between ACLR-D and ACLR-ND groups,but the Y balance scores in the ACLR-ND group were smaller than those in the control group.Conclusions Limb dominance has no effects on knee muscle strength,dynamic postural control,and single-leg hop function in ACLR patients.The non-surgical limbs of ACLR-D patients are at a higher risk of ACL injury due to the presence of greater knee valgus and external rotation angles and knee valgus moments.