Objective:To evaluate the safety and efficacy of accelerator-based boron neutron capture therapy (AB-BNCT) in the treatment of recurrent and refractory malignant tumors.Methods:The data of 14 patients admitted to Xiamen Humanity Hospital from September 2022 to April 2023 were prospectively collected, including 7 patients with primary brain malignancies and 7 patients with locally recurrent inoperable head and neck malignancies. All patients received intravenous infusion of boron drug (NBB-001, p-dihydroxyborylphe nylalanine, a patented freeze-dried formulation) at a total nominal dosage of 500 mg/kg (11 patients) or 750 mg/kg (3 patients), and were irradiated with neutrons (operating with NeuPex system). Adverse events after treatment were recorded and assessed. The primary efficacy endpoint was the 90 d objective response rate (ORR), while the secondary endpoints included progression-free survival (PFS) and complete response rate (CRR). Data were compiled and analyzed by SAS 9.4 software. The rate and 95% CI were calculated using Clopper-Pearson method. Results:The median dose delivered to 80% of the target volume (D 80%) was 16.80 GyE (range: 8.93-23.79 GyE). The most common adverse reactions were hyperamylasemia, alopecia, and hyperprolactinemia. Five patients experienced 8 cases of grade 3 or above adverse events, including 1 case of grade 4 acute kidney injury and 7 cases of grade 3 adverse events. All adverse events were recovered after observation or treatment. At 90 d after treatment, the ORR of all patients was 9/14 (64%, 95% CI: 35%-87%), disease control rate (DCR) was 10/14 (71%, 95% CI: 42%-92%), CRR was 2/14 (14%, 95% CI: 2%-42%); and the best overall response during the entire course included an ORR of 10/14 (71% ,95% CI: 42%-92%), DCR of 13/14 (93%, 95% CI: 66%-100%), and CRR of 3/14 (21% ,95% CI: 5%-51%). The 1-year survival rate for head and neck malignancies was 71.4%, and the 2-year survival rate was 42.8%. The 1-year survival rate for recurrent brain malignancies was 42.8%. Conclusion:AB-BNCT demonstrates favorable safety and promising efficacy in treating primary brain malignancies and recurrent/refractory head and neck malignancies, representing a potential therapeutic option.

Obesity,as a major global public health issue,has seen effective improvements in body weight and metabolic disorders through bariatric-metabolic surgeries such as Roux-en-Y gastric bypass(RYGB)and sleeve gastrectomy(SG).However,the management of postoperative complications remains a significant clinical challenge.Gastrointestinal leakage/fistula is one of the more severe complications,and current endoscopic treatment options include stent placement,double-pigtail stent internal drainage,over-the-scope clips,endoscopic suturing,tissue adhesive sealing,negative pressure drainage systems,and gastric wall incision.The combination with laparoscopic techniques can further enhance treatment efficacy.For SG-related torsion or stenosis,endoscopic balloon dilation is the first-line approach.In refractory cases,additional therapies such as endoscopic radial incision or modified gastric peroral endoscopic myotomy(G-POEM)may be required.G-POEM offers particular advantages in treating non-spiral stenosis but remains limited in practice due to technical complexity.Postoperative gastrointestinal bleeding requires stratified management:thermal coagulation or hemostatic clips can be used in acute bleeding;marginal ulcer bleeding at the gastrojejunostomy site after RYGB responds well to endoscopic treatment,while bleeding at the jejunojejunostomy site often requires enteroscopy or reoperation.Anatomical changes after RYGB increase the complexity of managing common bile duct stones.Among improved endoscopic retrograde cholangiopancreatography(ERCP)techniques,endoscopic ultrasound-guided transgastric ERCP has emerged as a minimally invasive and efficient option,though its long-term safety remains to be fully validated.For patients experiencing weight regain,endoscopic interventions include endoscopic sleeve gastroplasty and transoral outlet reduction(TORe),with TORe offering the dual benefits of narrowing the anastomosis and relieving dumping syndrome.The risk of gastroesophageal reflux disease increases after SG;balloon dilation can relieve reflux caused by anatomical stenosis,while emerging techniques such as anti-reflux mucosal resection and anti-reflux mucosal ablation are still under exploration.In refractory GERD cases,conversion to RYGB remains the mainstream solution.Overall,endoscopic techniques have significantly reduced reoperation rates through diverse strategies,but a balance must be maintained between procedural complexity and long-term efficacy.Future efforts should focus on device innovation,standardization of procedures,and multidisciplinary collaboration to improve the comprehensive management of complications following bariatric-metabolic surgery.

Background and Aims:Approximately 20％-25％of individuals experience insufficient weight loss(IWL)or weight regain(WR)after bariatric surgery.However,there is limited research on using semaglutide in this patient population,and its efficacy and safety remain to be confirmed.Therefore,this study was conducted to evaluate the effectiveness and safety of semaglutide in patients with IWL or WR after bariatric surgery through a systematic review to provide evidence to support clinical decision-making.Methods:A comprehensive search was conducted across multiple domestic and international databases for studies using semaglutide in patients with IWL or WR after bariatric surgery.The search period was from the database's inception to July 1,2024.Relevant studies were screened according to inclusion and exclusion criteria,and data were analyzed using Stata 14.0 software.Results:A total of 5 retrospective studies were included,encompassing 289 patients who received semaglutide treatment after bariatric surgery.The analysis showed that,compared to baseline,semaglutide use resulted in an average total weight reduction of 10.66％(MD=10.66％,95％CI=6.47％-14.89％);body mass index decreased by 3.57 kg/m2(MD=3.57 kg/m2,95％CI=2.46-4.67 kg/m2);the type of surgery did not significantly affect the degree of weight loss(P＞0.05).The proportion of patients who experienced＞5％weight loss was 80％(OR=0.80,95％CI=0.76-0.85);＞10％weight loss was observed in 45％of patients(OR=0.45,95％CI=0.41-0.50);and＞15％weight loss occurred in 18％of patients(OR=0.18,95％CI=0.08-0.27).Most patients had undergone sleeve gastrectomy(69.8％).There was no significant difference in HbA1c levels before and after treatment(P＞0.05).The incidence of adverse events was 14％(OR=0.14,95％CI=0.01-0.28),primarily gastrointestinal side effects.Conclusion:Semaglutide can significantly reduce body weight in patients with IWL or WR after bariatric surgery,with a relatively low incidence of adverse effects.It may be considered for patients who experience suboptimal weight loss following bariatric surgery.However,further prospective and large-scale clinical studies are needed to confirm these findings.

Obesity,as a major global public health issue,has seen effective improvements in body weight and metabolic disorders through bariatric-metabolic surgeries such as Roux-en-Y gastric bypass(RYGB)and sleeve gastrectomy(SG).However,the management of postoperative complications remains a significant clinical challenge.Gastrointestinal leakage/fistula is one of the more severe complications,and current endoscopic treatment options include stent placement,double-pigtail stent internal drainage,over-the-scope clips,endoscopic suturing,tissue adhesive sealing,negative pressure drainage systems,and gastric wall incision.The combination with laparoscopic techniques can further enhance treatment efficacy.For SG-related torsion or stenosis,endoscopic balloon dilation is the first-line approach.In refractory cases,additional therapies such as endoscopic radial incision or modified gastric peroral endoscopic myotomy(G-POEM)may be required.G-POEM offers particular advantages in treating non-spiral stenosis but remains limited in practice due to technical complexity.Postoperative gastrointestinal bleeding requires stratified management:thermal coagulation or hemostatic clips can be used in acute bleeding;marginal ulcer bleeding at the gastrojejunostomy site after RYGB responds well to endoscopic treatment,while bleeding at the jejunojejunostomy site often requires enteroscopy or reoperation.Anatomical changes after RYGB increase the complexity of managing common bile duct stones.Among improved endoscopic retrograde cholangiopancreatography(ERCP)techniques,endoscopic ultrasound-guided transgastric ERCP has emerged as a minimally invasive and efficient option,though its long-term safety remains to be fully validated.For patients experiencing weight regain,endoscopic interventions include endoscopic sleeve gastroplasty and transoral outlet reduction(TORe),with TORe offering the dual benefits of narrowing the anastomosis and relieving dumping syndrome.The risk of gastroesophageal reflux disease increases after SG;balloon dilation can relieve reflux caused by anatomical stenosis,while emerging techniques such as anti-reflux mucosal resection and anti-reflux mucosal ablation are still under exploration.In refractory GERD cases,conversion to RYGB remains the mainstream solution.Overall,endoscopic techniques have significantly reduced reoperation rates through diverse strategies,but a balance must be maintained between procedural complexity and long-term efficacy.Future efforts should focus on device innovation,standardization of procedures,and multidisciplinary collaboration to improve the comprehensive management of complications following bariatric-metabolic surgery.

Background and Aims:Approximately 20％-25％of individuals experience insufficient weight loss(IWL)or weight regain(WR)after bariatric surgery.However,there is limited research on using semaglutide in this patient population,and its efficacy and safety remain to be confirmed.Therefore,this study was conducted to evaluate the effectiveness and safety of semaglutide in patients with IWL or WR after bariatric surgery through a systematic review to provide evidence to support clinical decision-making.Methods:A comprehensive search was conducted across multiple domestic and international databases for studies using semaglutide in patients with IWL or WR after bariatric surgery.The search period was from the database's inception to July 1,2024.Relevant studies were screened according to inclusion and exclusion criteria,and data were analyzed using Stata 14.0 software.Results:A total of 5 retrospective studies were included,encompassing 289 patients who received semaglutide treatment after bariatric surgery.The analysis showed that,compared to baseline,semaglutide use resulted in an average total weight reduction of 10.66％(MD=10.66％,95％CI=6.47％-14.89％);body mass index decreased by 3.57 kg/m2(MD=3.57 kg/m2,95％CI=2.46-4.67 kg/m2);the type of surgery did not significantly affect the degree of weight loss(P＞0.05).The proportion of patients who experienced＞5％weight loss was 80％(OR=0.80,95％CI=0.76-0.85);＞10％weight loss was observed in 45％of patients(OR=0.45,95％CI=0.41-0.50);and＞15％weight loss occurred in 18％of patients(OR=0.18,95％CI=0.08-0.27).Most patients had undergone sleeve gastrectomy(69.8％).There was no significant difference in HbA1c levels before and after treatment(P＞0.05).The incidence of adverse events was 14％(OR=0.14,95％CI=0.01-0.28),primarily gastrointestinal side effects.Conclusion:Semaglutide can significantly reduce body weight in patients with IWL or WR after bariatric surgery,with a relatively low incidence of adverse effects.It may be considered for patients who experience suboptimal weight loss following bariatric surgery.However,further prospective and large-scale clinical studies are needed to confirm these findings.

Objective:To evaluate the safety and efficacy of accelerator-based boron neutron capture therapy (AB-BNCT) in the treatment of recurrent and refractory malignant tumors.Methods:The data of 14 patients admitted to Xiamen Humanity Hospital from September 2022 to April 2023 were prospectively collected, including 7 patients with primary brain malignancies and 7 patients with locally recurrent inoperable head and neck malignancies. All patients received intravenous infusion of boron drug (NBB-001, p-dihydroxyborylphe nylalanine, a patented freeze-dried formulation) at a total nominal dosage of 500 mg/kg (11 patients) or 750 mg/kg (3 patients), and were irradiated with neutrons (operating with NeuPex system). Adverse events after treatment were recorded and assessed. The primary efficacy endpoint was the 90 d objective response rate (ORR), while the secondary endpoints included progression-free survival (PFS) and complete response rate (CRR). Data were compiled and analyzed by SAS 9.4 software. The rate and 95% CI were calculated using Clopper-Pearson method. Results:The median dose delivered to 80% of the target volume (D 80%) was 16.80 GyE (range: 8.93-23.79 GyE). The most common adverse reactions were hyperamylasemia, alopecia, and hyperprolactinemia. Five patients experienced 8 cases of grade 3 or above adverse events, including 1 case of grade 4 acute kidney injury and 7 cases of grade 3 adverse events. All adverse events were recovered after observation or treatment. At 90 d after treatment, the ORR of all patients was 9/14 (64%, 95% CI: 35%-87%), disease control rate (DCR) was 10/14 (71%, 95% CI: 42%-92%), CRR was 2/14 (14%, 95% CI: 2%-42%); and the best overall response during the entire course included an ORR of 10/14 (71% ,95% CI: 42%-92%), DCR of 13/14 (93%, 95% CI: 66%-100%), and CRR of 3/14 (21% ,95% CI: 5%-51%). The 1-year survival rate for head and neck malignancies was 71.4%, and the 2-year survival rate was 42.8%. The 1-year survival rate for recurrent brain malignancies was 42.8%. Conclusion:AB-BNCT demonstrates favorable safety and promising efficacy in treating primary brain malignancies and recurrent/refractory head and neck malignancies, representing a potential therapeutic option.

Objective To explore the regularity and potential mechanisms of medicinal and edible herbs(MEHs)in the treatment of myelosuppression through the retrieval,summary,sorting and visual analysis of relevant literature.Methods Literature about MEHs treatment for myelosuppression was reviewed in document databases,such as Web of Science,CNKI,Wanfang Data Knowledge Service Platform,China Science and Technology Journal Database,and China Biology Medicine Disc.Multivariate statistical analysis was performed using the SPSS and CiteSpace software to explore the frequency,efficacy and correlation of MEHs,as well as the potential mechanisms of MEHs in treating myelosuppression.Results A total of 123 recipes involving 170 traditional Chinese medicines(including 38 MEHs)were screened out.Five pairs of MEHs core combinations in the treatment of myelosuppression were obtained by cluster analysis.Their main functions included benefiting qi and nourishing blood,invigo-rating spleen and dispelling dampness,replenishing qi and solidifying kidney.The potential mechanisms were associated with many related signal pathways,such as Janus kinase 2-signal transducer and activator of transcription 5 andβ-catenini.Conclusion MEHs such as radix astragali combined with angelica sinensis,poria cocos and codonopsis pilosula are mainly used clinically to treat myelosuppression induced by chemotherapy.They play their therapeutic effects by promoting proliferation and delaying senescence of hematopoietic stem cells.

Objective:To investigate the role of subcutaneous negative pressure drainage device in the prevention of surgical site infections (SSI) of superficial incisional in lower digestive tract open surgeries.Methods:Clinical data of 104 patients receiving open surgeries on lower digestive tract at Beijing Friendship Hospital, Capital Medical University from October 2018 to June 2020 was analyzed by a propensity score matching (PSM), and the clinical data of 104 patients receiving open surgeries on lower digestive tract at Beijing Friendship Hospital, Capital Medical University from February to December 2021 was analyzed by a randomized controlled trial (RCT). Chi-square tests were conducted to analyze the association of subcutaneous negative pressure drainage device with SSI of superficial incisional. Univariate and multivariate Logistic regression analysis were used to identify the risk factors for SSI in superficial incisions.Results:Patients with subcutaneous negative pressure drainage device encounter significantly less SSI of superficial incisional in both the PSM study ( P=0.007) and the RCT study ( P=0.049). In the PSM study, the independent risk factors for SSI of superficial incisional via univariate and multivariate Logistic regression analysis were absence of subcutaneous drainage ( Puni=0.012, Pmulti=0.009) and postoperative anastomosis leak ( Puni=0.054, Pmulti=0.034). In the RCT study, the independent risk factors for SSI of superficial incisional via univariate and multivariate Logistic regression analysis were absence of subcutaneous drainage ( Puni=0.061, Pmulti=0.017), eldly ( Puni=0.076, Pmulti=0.032), long incision ( Puni=0.078, Pmulti=0.040). Conclusion:Subcutaneous negative pressure drainage device can significantly reduce SSI of superficial incisional in lower digestive tract open surgeries.

Objective:To assess the efficacy and safety of the combination therapy of camrelizumab, apatinib, nab-paclitaxel, and S-1 for patients with locally unresectable advanced gastric cancer.Methods:From September 1, 2019 to August 1, 2021, in Beijing Friendship Hospital Affiliated to Capital Medical University, 17 patients with advanced gastric cancer were enrolled in this prospective, single-arm study. All the enrolled patients received camrelizumab, nab-paclitaxel, apatinib and S-1 combination therapy (in each 21 days cycle, camrelizumab 200 mg intravenously, D1; nab-paclitaxel 240 mg/m 2 intravenously, D2; apatinib 500 mg orally, once a day, D1-D21; S-1 40-60 mg twice a day, D1-D14). Patients who have been evaluated by multidisciplinary team to be eligible for radical surgery should stop treatment for at least 2 weeks. Patients were discontinued from the study when disease progression or unbearable toxicity, or withdrew consent. We analyzed the conversion rate, objective response rate (ORR), disease control rate (DCR), overall survival (OS) and safety.Statistical data were show by numbers and persentages(%), and comparisons between subgroups were assessed by Fisher′s exact probability method. Patients survival was analyzed using Kaplan-Meier curves and compared between groups using Log-rank. Results:At the data of cutoff (December 15, 2021), the median follow-up duration was 19.6 months. Eight of 17 patients underwent gastrectomy, and all of them were R0 resection (47.1%, 95% CI: 0.262-0.690). ORR was 47.1%, DCR was 82.4%, the median overall survival was 23.63 months. Grade 3 and 4 adverse events occurred in 3 patients (17.6%), including neutropenia, thrombocytopenia, anemia and upper gastrointestinal hemorrhage. There were no serious treatment-related adverse events or treatment-related deaths. Conclusion:In this trial, the combination of camrelizumab, apatinib, nab-paclitaxel and S-1 as the conversion therapy showed significant anti-tumor activity and manageable adverse events, providing a new option for locally unresectable advanced gastric cancer.

Gas chromatography-mass spectrometry (GC-MS) method was established for trace analysis of the potential genotoxic impurity chlorocyclohexane in trihexyphenidyl hydrochloride bulk drug, utilizing an RXI-5SIL MS column at isothermal temperature of 60 °C for the entire 6-minute run time.The inlet temperature was 180 °C and a split ratio of 10∶1 was used with the injection volume of 1.0 μL.The selective ion monitoring mode was set at m/z 82 for chlorocyclohexane with a detector voltage of 0.3 kV and an ion source temperature of 240 °C.The method was verified with respect to specificity, limit of detection (LOD), limit of quantitation (LOQ), accuracy, precision and robustness.Good linear correlation was achieved with coefficient r of 0.999 9 in the concentration range of 59.72-493 ng/mL.The intra- and inter-day precision was satisfactory (RSD ≤ 5.0%) and robust (RSD ≤ 1.65%).The proposed method in this study can be adequately adopted as a tool for quality assurance of trihexyphenidyl hydrochloride in routine test of potential genotoxic impurity.