Objective To investigate the postoperative efficacy of laparoscopic hiatal hernia repair(LHHR)combined with Toupet or Dor fundoplication for the treatment of esophageal hiatal hernia(HH).Methods A retrospective analysis was conducted on the case data of HH patients who underwent LHHR combined with Toupet(Toupet group,n=53)and Dor(Dor group,n=53)fundoplication between December 2018 and December 2022 in Department of General Surgery of Gansu Provincial Hospital.Intraoperative and postoperative recovery outcomes of both groups were observed.We analyzed and compared the incidence of dysphagia and gastroesophageal reflux disease questionnaire(GERD-Q)scores at preoperative and postoperative intervals of 1 month,6 months,and 1 year.The incidence of postoperative complications and the 1-year recurrence rate were compared between the two groups.Additionally,factors influencing postoperative dysphagia within the first month were examined.Results The differences between the two groups in operation time,intraoperative bleeding,postoperative ventilation time,postoperative extubation time and hospitalization time were not statistically significant(P>0.05).There was no significant difference in the incidence of immediate postoperative dysphagia in two groups(P>0.05).Furthermore,the differences between the two groups in the incidence of postoperative complications,such as bloating,abdominal pain and diarrhea,were not statistically significant(P>0.05).The incidence of dysphagia in Toupet group was higher than that in Dor group at 1 month postoperatively,and the difference was statistically significant(P=0.017);but the difference in the incidence of dysphagia between the two groups at 6 months and 1 year postoperatively was not statistically significant(P=0.767,1.000).The results of binary logistic regression analysis showed that both surgical procedure(OR=2.613,95%CI 1.141-5.983,P=0.023)and esophageal contractile reserve function(OR=2.921,95%CI 1.203-7.095,P=0.018)were independent risk factors for the incidence of dysphagia in patients with HH at 1 month after surgery.Compared with the preoperative period,the GERD-Q symptom scores were lower in both groups at 1 month,6 months,and 1 year postoperatively,and the difference was statistically significant(P<0.05);but there was no statistically significant difference between the groups at the same time point(Fintergroup=0.334,P=0.565).The difference between the two groups in 1-year postoperative recurrence rates was not statistically significant(P>0.05).Conclusions LHHR combined with Toupet or Dor fundoplication are both safe and effective surgical procedures for the treatment of HH,with excellent reflux control,fewer complications and lower recurrence rates,but Toupet fundoplication is more likely to have postoperative short-term dysphagia than Dor fundoplication.

Objective To investigate the characteristics of a novel FANCL mutation identified in a patient with premature ovarian insufficiency(POI)and to explore its potential functional impacts in vitro.Methods A novel FANCL heterozygous mutation c.1033G>A(p.Glu345Lys)was screened in a patient with POI using whole exome sequencing(WES),which was found to be inherited from a mother who had undergone early menopause.The authenticity of the mutation was identified by Sanger sequencing and the conserved nature of the mutation site was predicted by software.Overexpressing FANCL mutant and wildtype plasmids were constructed and transiently transfected into HEK293T cell lines,and the effect of the mutation was detected by qPCR,immunofluorescence and Western blot.Results The mutation site of FANCL was located within the Ring domain of FANCL,which was highly conserved across multiple species.The mutant showed no significant change in mRNA expression level,while the protein expression level was significantly down-regulated.In vitro cellular experiments further revealed that the mutation leads to decreased expression levels by reducing protein stability.Conclusion A FANCL c.1033G>A mutation was found and it may cause disease in the POI patient due to decreased protein stability.

Objective:To investigate the clinical efficacy of autologous costal cartilage rhinoplasty combined with costal cartilage block grafting to the alar base in the correction of saddle nose deformity with alar-columellar base depression.Methods:A retrospective analysis was performed on patients who underwent autologous costal cartilage rhinoplasty combined with alar base augmentation at the Department of Plastic Surgery, Zhejiang Provincial People’s Hospital, from January 2022 to December 2023. All patients presented with alar-columellar base depression combined with saddle nose deformity. Through bilateral marginal incisions of the lower lateral cartilage and an inverted V-shaped columellar incision, the 6th costal cartilage near the sternal end was harvested and sculpted into two alar base grafts, one columellar strut graft in an inverted V shape, two septal extension grafts, and one cap graft. On the basis of block costal cartilage grafting to the alar base, a nasal tip support framework and septal extension graft were constructed, combined with implantation of an expanded polytetrafluoroethylene (ePTFE) prosthesis, to correct the aesthetic defects of saddle nose with alar-columellar base depression. Postoperative complications and recovery were recorded. Standardized pre- and 6-month postoperative photographs were analyzed using Adobe Photoshop and Image J to measure nasal base elevation, nasolabial angle, nasofrontal angle, nasal tip angle, nasal tip projection-to-length ratio, and columella-lobule angle. Patient satisfaction was evaluated preoperatively and at 6 months postoperatively using the visual analogue scale (VAS, 0-10 points; higher scores indicate greater satisfaction) and the rhinoplasty outcome evaluation (ROE) questionnaire (total score 0-24; higher scores indicate greater satisfaction). Paired t-tests were used for statistical analysis, with P<0.05 considered statistically significant. Results:A total of 48 patients were enrolled, including 3 males and 45 females, aged from 19 to 37 years (27.3±5.9 years). The postoperative follow-up period ranged from 6 to 12 months. No infections, hemorrhage, or other complications occurred. Swelling subsided substantially within 4-5 weeks postoperatively, and no significant nasal airway obstruction, sensory abnormalities, or olfactory disturbances were observed. Patients were satisfied with their postoperative appearance and outcomes. At 6 months postoperatively, the nasal base elevation was increased compared with preoperative measurements (6.08 ± 0.85) mm. Compared with preoperative values, significant improvements were observed at 6 months postoperatively in nasolabial angle (84.69° ± 4.24° vs. 96.81° ± 5.80°), nasofrontal angle (143.91° ± 3.91° vs. 136.24° ± 2.66°), nasal tip angle (84.13° ± 5.25° vs. 78.20° ± 5.40°), nasal tip projection-to-length ratio (0.45 ± 0.05 vs. 0.53 ± 0.07), columella-lobule angle (49.22° ± 5.29° vs. 44.25° ± 3.52°), VAS score (4.69 ± 0.90 vs. 8.45 ± 0.80), and ROE score (11.99 ± 1.47 vs. 21.50 ± 1.31) (all P<0.05). Conclusion:Autologous costal cartilage rhinoplasty combined with costal cartilage block grafting to the alar base can effectively correct saddle nose deformity with alar-columellar base depression, achieving comprehensive improvement in midfacial aesthetics.

Local anesthetics (LAs), such as articaine (AT), exhibit limited efficacy in inflammatory environments, which constitutes a significant limitation in their clinical application within oral medicine. In our prior research, we developed AT-17, which demonstrated effective properties in chronic inflammatory conditions and appears to function as a novel oral LA that could address this challenge. In the present study, we further elucidated the beneficial effects of AT-17 in acute inflammation, particularly in oral acute inflammation, where mitochondrial-related apoptosis played a crucial role. Our findings indicated that AT-17 effectively inhibited lipopolysaccharide (LPS)-induced nerve cell apoptosis by ameliorating mitochondrial dysfunction in vitro. This process involved the inhibition of mitochondrial reactive oxygen species (mtROS) production and the subsequent activation of the NRF2 pathway. Most notably, improvements in mitochondria-related apoptosis were key contributors to AT-17's inhibition of voltage-gated sodium channels. Additionally, AT-17 was shown to reduce mtROS production in nerve cells through the Na⁺/NCLX/ETC signaling axis. In conclusion, we have developed a novel local anesthetic that exhibits pronounced anesthetic functionality under inflammatory conditions by enhancing mitochondria-related apoptosis. This advancement holds considerable promise for future drug development and deepening our understanding of the underlying mechanisms of action.

OBJECTIVE: To investigate the spatiotemporal patterns and socioeconomic factors influencing the incidence of tuberculosis (TB) in the Guangdong Province between 2010 and 2019. METHOD: Spatial and temporal variations in TB incidence were mapped using heat maps and hierarchical clustering. Socioenvironmental influencing factors were evaluated using a Bayesian spatiotemporal conditional autoregressive (ST-CAR) model. RESULTS: Annual incidence of TB in Guangdong decreased from 91.85/100,000 in 2010 to 53.06/100,000 in 2019. Spatial hotspots were found in northeastern Guangdong, particularly in Heyuan, Shanwei, and Shantou, while Shenzhen, Dongguan, and Foshan had the lowest rates in the Pearl River Delta. The ST-CAR model showed that the TB risk was lower with higher per capita Gross Domestic Product (GDP) [Relative Risk ( RR), 0.91; 95% Confidence Interval ( CI): 0.86-0.98], more the ratio of licensed physicians and physician ( RR, 0.94; 95% CI: 0.90-0.98), and higher per capita public expenditure ( RR, 0.94; 95% CI: 0.90-0.97), with a marginal effect of population density ( RR, 0.86; 95% CI: 0.86-1.00). CONCLUSION The incidence of TB in Guangdong varies spatially and temporally. Areas with poor economic conditions and insufficient healthcare resources are at an increased risk of TB infection. Strategies focusing on equitable health resource distribution and economic development are the key to TB control.
Humans ; China/epidemiology* ; Incidence ; Bayes Theorem ; Spatio-Temporal Analysis ; Tuberculosis/epidemiology* ; Socioeconomic Factors

Sepsis is a life-threatening organ dysfunction disease caused by a dysregulated host response to infection.It has com-plex pathophysiological changes,and in severe cases,it can rap-idly develop into septic shock and multiple organ dysfunction or multiple organ failure.At present,the pathological mechanism of sepsis and its induced organ dysfunction is complex and the in-fluencing factors are numerous.So far,there is still a lack of specific and effective treatment strategies.RNA modify-N6-methyladenosine(m6 A)is one of the most common post-tran-scriptional modifications on eukaryotic RNAs.It is involved in the regulation of the occurrence and development of a variety of inflammatory diseases,including sepsis,and even multiple organ dysfunction induced by sepsis by affecting the metabolism of RNAs.It includes cardiac dysfunction,acute lung injury(ALI)and acute kidney injury(AKI).Therefore,this article will dis-cuss the effect of m6A modification on the function of immune cells,and its important role in sepsis and its induced multiple or-gan dysfunction diseases by regulating inflammatory signals,py-roptosis,mitochondrial damage and ferroptosis.This will provide new therapeutic targets and strategies for the clinical prevention and treatment of sepsis and its induced multiple organ dysfunc-tion diseases.

AIM To evaluate the quality consistency of Tongmai Granules,Tongmai Tablets,Tongmai Capsules and Tongmai Oral Liquid.METHODS The HPLC fingerprints were established,after which the contents of danshensu,protocatechuic aldehyde,3'-hydroxy puerarin,puerarin,puerarin apioside,daidzin,ferulic acid,salvianolic acid B and salvianolic acid A were determined,and cluster analysis and principal component analysis were adopted in the quality analysis from the perspective of daily intake.RESULTS There were 21 common peaks in the fingerprints for 39 batches of samples with the similarities of 0.765-0.997.Various batches of samples were clustered into 5 categories,2 principal components demonstrated the accumulative variance contribution rate of 83.53％ .The daily intakes of various constituents in different dosage forms exhibited obvious differences,especially for that of salvianolic acid B,which were low in tablets and capsules,and their heterogeneities existed among the same dosage forms.CONCLUSION This simple and accurate method can provide a reference for the quality evaluation of Tongmai preparations from different manufacturers.

Sepsis is a life-threatening organ dysfunction disease caused by a dysregulated host response to infection.It has com-plex pathophysiological changes,and in severe cases,it can rap-idly develop into septic shock and multiple organ dysfunction or multiple organ failure.At present,the pathological mechanism of sepsis and its induced organ dysfunction is complex and the in-fluencing factors are numerous.So far,there is still a lack of specific and effective treatment strategies.RNA modify-N6-methyladenosine(m6 A)is one of the most common post-tran-scriptional modifications on eukaryotic RNAs.It is involved in the regulation of the occurrence and development of a variety of inflammatory diseases,including sepsis,and even multiple organ dysfunction induced by sepsis by affecting the metabolism of RNAs.It includes cardiac dysfunction,acute lung injury(ALI)and acute kidney injury(AKI).Therefore,this article will dis-cuss the effect of m6A modification on the function of immune cells,and its important role in sepsis and its induced multiple or-gan dysfunction diseases by regulating inflammatory signals,py-roptosis,mitochondrial damage and ferroptosis.This will provide new therapeutic targets and strategies for the clinical prevention and treatment of sepsis and its induced multiple organ dysfunc-tion diseases.

Objective:To investigate the magnetic resonance imaging (MRI) features of non-midline atypical medulloblastoma (MB) in children and analyze the causes of misdiagnosis, so as to improve the understanding and diagnosis of MB.Methods:The clinical and imaging data of 12 cases with non-midline atypical MB confirmed by pathology in Hunan Children′s Hospital from September 2018 to August 2023 were retrospectively analyzed. 12 cases underwent MRI plain scan, 11 cases underwent enhanced scan, and 10 cases underwent diffusion weighted imaging (DWI) and magnetic sensitivity weighted imaging (SWI). The location, morphology, peritumoral edema, size, signal characteristics (cystic lesion or hemorrhage), diffusion and enhancement of the tumor were observed, and the causes of misdiagnosis were analyzed.Results:Among the 12 cases, 9 cases were single, 4 cases were located in the cerebellar hemisphere, 2 cases were in the cerebellopontine angle (CPA), 2 cases were in the brain stem and CPA, and 1 case was in the left parietal lobe. There were 3 cases of multiple lesions, 1 case was located in the right pontine arm and cerebellar hemisphere (2 masses), 1 case was multiple lesions in bilateral cerebellar hemisphere, and 1 case was multiple nodular lesions in the cerebellar vermis mass and left cerebellar hemisphere. 6 cases were irregular in shape and 6 cases were quasi-circular. There were 3 cases without cystic change and 9 cases with varying degrees of cystic change (5 with large cystic change and 4 with small cystic change). 3 cases of hemorrhage, no calcification, 10 cases of DWI showed varying degrees of limited diffusion; 11 cases of enhanced scanning showed mild to obvious enhancement; There were 2 cases without peritumoral edema and 10 cases with mild to moderate peritumoral edema. There were 11 cases with supratentorial hydrocephalus and interstitial cerebral edema, and 1 case without hydrocephalus. 5 cases complicated with subtonsillar hernia; 9 cases were misdiagnosed before operation. Among them, 3 cases were misdiagnosed as high-grade glioma, 3 as low-grade glioma (1 of which was diagnosed as hair-cell astrocytoma), 2 as ependymoma, and 1 as atypical teratoma/rhabdomyoma.Conclusions:The MRI manifestations of non-midline atypical MB in children are varied. Combined with the location of the disease, age and focal signal characteristics, non-midline atypical MB can be included in the diagnostic range after the exclusion diagnosis, which can improve the preoperative diagnosis accuracy of this disease.

PURPOSE: Lateral patellar compression syndrome (LPCS) is characterized by a persistent abnormally high stress exerted on the lateral articular surface of the patella due to lateral patellar tilt without dislocation and lateral retinaculum contracture, leading to anterior knee pain. The purpose of this study is to evaluate the efficacy and prognosis of lateral retinaculum release (LRR) combined with chondroplasty in the treatment of LPCS. METHODS: This retrospective study evaluated 40 patients who underwent LRR combined with chondroplasty for LPCS between 2020 and 2021. The assessment included improvement in postoperative tenderness and knee joint function. Patients were evaluated using the Lysholm, Tegner, and International Knee Documentation Committee 2000 scoring systems, as well as the visual analog scale, both preoperatively and postoperatively, with the paired comparisons analyzed using a t-test. Additionally, intraoperative observations were made regarding knee joint lesions, including cartilage damage and osteophyte formation, with analysis by the Chi-square test. RESULTS: The visual analog scale score for tenderness showed a significant decrease after surgery (p < 0.001). Evaluation of knee joint function also indicated significant improvements, as demonstrated by increased Lysholm, Tegner, and International Knee Documentation Committee 2000 scores postoperatively (p < 0.001, p = 0.011, p < 0.001, respectively). Furthermore, all LPCS patients included in the study presented with cartilage injuries and osteophyte formation. Significant differences were noted in the incidence of cartilage damage and osteophyte formation at different locations within the knee among patients with LPCS. CONCLUSION LRR combined with chondroplasty is an effective surgical approach for treating patients with LPCS, with satisfactory recovery observed at the 1-year follow-up. Additionally, the incidence of cartilage damage and osteophyte formation in LPCS patients varies significantly depending on the specific location within the knee joint.
Humans ; Male ; Female ; Retrospective Studies ; Adult ; Middle Aged ; Patella/surgery* ; Knee Joint/physiopathology* ; Recovery of Function ; Young Adult ; Treatment Outcome ; Cartilage, Articular/surgery* ; Adolescent