Objective:To compare the short-term clinical outcomes of thoracoscopy-assisted minimally invasive mitral valve surgery(minimally invasive cardiac surgery MICS group)versus conven-tional median sternotomy mitral valve surgery(conventional surgery group),including surgical metrics,postoperative complications,transfusion volume,and in-hospital mortality rate.Methods:A ret-rospective analysis was performed for 141 patients who underwent mitral valve surgery in Chongqing General Hospital from January 2021 to June 2022,and these patients were divided into MICS group with 42 patients and conventional surgery group with 99 patients.Propensity score matching at a ratio of 1∶1 was performed to ob-tain 82 patients,with 41 patients in each group,and related data were collected and compared,including surgical procedure,cardiopul-monary bypass time,postoperative ventilation time,transfusion volume,and in-hospital mortality.Results:There were no significant differences between the MICS group and the conventional surgery group in sex,age,cardiac functional grading,and comorbidity with diabetes or hypertension,and as for the surgical procedure,there was no significant difference between the two groups in the number of patients undergoing atrial fibrillation radiofrequency ablation(11/42 vs.26/99,P=0.583)or tricuspid valvuloplasty(14/42 vs.39/99,P=0.310).Compared with the conventional surgery group,the MICS group had significantly longer aortic cross-clamp time[(122±48)min vs.(91±50)min,P=0.031]and cardiopulmonary bypass time[(180±73)min vs.(136±72)min,P=0.033],while there was no significant difference in postoperative ventilation time between the two groups after surgery[18.6(12.0,36.2)h vs.24.0(15.5,33.1)h,P=0.265].There was no significant difference in the number of patients with acute renal failure after surgery between the MICS group and the conventional surgery group[grade 1:3(42)vs.7(99);grade 2:0(42)vs.2(99);grade 3:1(42)vs.9(99);P=0.398].There was also no significant difference in the number of patients receiving hemodialysis after surgery between the two groups[1(42)vs.4(99),P=0.531].The MICS group had a significantly lower postoperative transfusion volume than the conventional surgery group[120(80,240)mL vs.400(200,600)mL,P=0.002],and there was no significant difference in in-hospital mortality rate between the two groups[1(42)vs.2(99),P=0.665].After propensity score matching,there were no significant differences between the two groups in general characteristics(sex,age,and comorbidities).Compared with the conventional surgery group,the MICS group had longer cardiopulmonary bypass time[(165±73)min vs.(122±74)min,P=0.053]and aortic cross-clamp time[(119±48)min vs.(98±52)min,P=0.073]and a significantly lower postoperative transfusion volume[120(80,240)mL vs.400(200,600)mL,P<0.001].There were no significant differences between the two groups in 30-day in-hospital mortality rate and postoperative compli-cations(including acute renal failure and requirement for hemodialysis).Conclusion:Thoracoscopy-assisted minimally invasive mitral valve surgery has comparable short-term clinical outcomes and safety to conventional sternotomy.Although MICS requires longer cardiopulmonary bypass time and aortic cross-clamp time,it has relatively low requirements for postoperative transfusion and shows favorable clinical outcomes.

Objective:To evaluate the outcomes of short-segment pedicle screw fixation after vertebroplasty augmentation using polymethylmethacrylate (PMMA) and laminectomy for stage Ⅲ Kümmell's disease with neurological symptoms.Methods:A retrospective study was conducted to analyze the clinical data of the 23 patients who had been treated at Department of Spinal Surgery, Beijing Jishuitan Hospital from January 2016 to August 2022 for single level stage Ⅲ Kümmell's disease with neurological symptoms by short-segment pedicle screw fixation after vertebroplasty augmentation using PMMA and laminectomy. There were 9 males and 14 females, with an age of (69.7±3.8) years. The visual analogue scale (VAS) for low back pain, Oswestry disability index (ODI) for low back pain, kyphotic Cobb angle of the fixed segment, and loss of the anterior vertebral body height were compared between preoperation, 2 weeks after operation, 2 years after operation, and the last follow-up. The improvements in American Spinal Injury Association (ASIA) impairment grading at the last follow-up compared to the preoperative levels, bone graft fusion rates at the last follow-up and complications were recorded.Results:All patients were followed up for (57.4±17.7) months after operation. The VAS pain scores [(2.2±0.3) points, (1.8±0.6) points and (1.6±0.5) points], ODIs (23.9%±4.5%, 21.6%±4.5% and 19.1%±3.8%), kyphotic Cobb angles of the fixed segments (12.2°±2.7°, 12.5°±2.6° and 12.8°±2.8°) and losses of the anterior vertebral body height (20.0%±3.4%, 20.2%±3.5% and 20.3%±3.5%) at 2 weeks after operation, 2 years after operation, and the last follow-up were significantly improved compared to the pre-operative values [(7.8±0.5) points, 79.7%±5.1%, 40.2°±6.2°, and 60.4%±14.2%, respectively] ( P<0.05). However, there were no significantly differences in the above values between 2 weeks after operation, 2 years after operation and the last follow-up ( P>0.05). Of the 2 patients with grade C, the ASIA grading at the last follow-up improved to grade D in one and to grade E in the other; of the 12 patients with grade D, the ASIA grading at the last follow-up improved to grade E in 11. The complications included 2 asymptomatic cases of bone cement leakage from the upper endplate of the affected vertebra, 1 asymptomatic case of bone cement leakage from the lower endplate of the affected vertebra, 1 asymptomatic case of bone cement leakage from the spinal canal, and 1 case of distant vertebral compression fracture. The last follow-up showed good bone graft fusion in all patients. Conclusion:In the treatment of stage Ⅲ Kümmell's disease with neurological symptoms, short-segment pedicle screw fixation after vertebroplasty augmentation using PMMA is a relatively minimally invasive, safe, and effective treatment, because it can alleviate back pain, improve neurological function and daily function, correct thoracolumbar kyphosis, restore vertebral height and reconstruct spinal stability without significant complications.

Background and purpose:With the progressive development of breast cancer surgery toward more individualized and minimally invasive approaches,sentinel lymph node biopsy(SLNB)has replaced axillary lymph node dissection(ALND)as the standard method for axillary management in certain early-stage breast cancer patients.However,there is ongoing debate in clinical practice regarding whether regional lymph node irradiation(RNI)is necessary for patients with sentinel lymph node(SLN)positive status who have not undergone ALND.This study aimed to analyze the clinicopathological features and survival prognosis of patients with SLN-positive status who did not undergo ALND,evaluate the clinical application value of RNI,and provide evidence to support clinical treatment decisions for this group of patients.Methods:This single-center retrospective study screened breast cancer patients who underwent SLNB at Shandong Cancer Hospital from September 1,2014,to August 31,2023.All patients signed informed consent for treatment.Based on whether postoperative radiotherapy included regional lymph node irradiation(internal mammary and/or axillary and/or supra-/infra-clavicular fields),patients were divided into the RNI group and the no-RNI group for follow-up.Additionally,patients were further divided into multiple subgroups based on factors such as the type of breast surgery,tumor molecular subtype,and histological grade,to compare the clinical value of RNI among subgroups.The primary endpoint was locoregional recurrence-free survival(LRRFS),and the secondary endpoints included invasive disease-free survival(iDFS)and overall survival(OS).The Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)checklist was followed for this study.Results:Clinical data of 8 328 breast cancer patients'were screened for this study,and after applying inclusion and exclusion criteria,356 patients were included in the analysis,with 186 in the RNI group and 170 in the no-RNI group.There were no significant differences between the two groups in terms of age,body mass index(BMI),menopausal status,tumor location,pathological type,histological grade,vascular invasion,estrogen receptor(ER)and progesterone receptor(PR)status,and human epidermal growth factor receptor 2(HER-2)expression(P＞0.05).However,the number of positive SLNs,T stage,and the proportion of patients undergoing total mastectomy(TM)were significantly higher in the RNI group than in the no-RNI group(P=0.006,P=0.043,P＜0.001).After a median follow-up of 38 months,no recurrence or metastasis was observed in the RNI group,while the recurrence and metastasis rate in the no-RNI group was 3.5%(6/170).Of these,4 cases had local regional recurrence,and 2 had distant metastasis.The RNI group showed superior iDFS compared to the no-RNI group(P=0.017),however there was no statistically significant difference in LRRFS and OS(P=0.051 and P=0.356).Exploratory subgroup analysis indicated that patients with tumor diameter＞2 cm(P=0.033)and triple-negative molecular(TNBC)(P=0.020)might benefit from RNI treatment in terms of LRRFS.Conclusion:For certain high-risk patients,such as those with larger tumor diameter,TNBC,or high non-SLN metastatic risk,RNI still plays an important role in reducing the risk of recurrence and metastasis in breast cancer.In clinical practice,an individualized RNI strategy should be developed based on the patient's residual lymph node tumor load,biological behavior of the tumor,and surgical method.

Objective To evaluate the effectiveness of standardized video teaching mode in cardiopulmonary resuscitation(CPR)skill training.Methods A total of 357 freshmen from a senior high school in Hexi District,Tianjin,were selected as the research objects.The training mode combining standardized video teaching and on-site demonstration was adopted for CPR skill training.The training content included 4 modules:assessment and call for help,compression,breathing,and external defibrillation.The training process was as follows:standardized video learning(20 minutes),on-site demonstration(20 minutes),group practical training(60 minutes).A self-designed questionnaire assessed pre-and post-training knowledge and attitudes,practical skills,willingness to perform CPR,satisfaction and suggestions.Results Compared with before training,the average knowledge score increased significantly after training(12.22±1.51 vs.7.67±1.84,P<0.05),while there was no statistically significant difference in attitude scores between before and after training(9.18±1.33 vs.9.80±0.62,P>0.05).After training:95.5%(341/357)of students performed compressions satisfactorily,88.5%(316/357)performed breathing,99.7%(356/357)believed the course helpful for understanding CPR knowledge and skills,and all students thought the training was helpful for mastering CPR skills.When investigating students'willingness to perform CPR on different victims,the results showed that 97.2%(347/357)of students would perform CPR on relatives and friends,and 91.9%(328/357)were will to perform CPR on strangers.In the satisfaction survey,students expressed the highest satisfaction with the instructors at 89.6%,followed by satisfaction with the teaching content at 86.8%.Satisfaction with both teaching mode and teaching environment exceeds 80.0%.The survey on suggestions for skill training indicated that 93.3%(333/357)of students preferred to further improve CPR skill training in future sessions,and 85.7%(306/357)hoped to enhance CPR on-site practice and training.Conclusion A standardized video teaching mode can effectively improve the CPR knowledge level and operational skills,with high training satisfaction,which is worthy of popularization and application.

Objective To analyze the current status and development trends of registered clinical trials of TCM for the treatment of cervical spondylosis;To provide references for relevant trials.Methods Clinical trials of TCM for the treatment of cervical spondylosis registered in Chinese Clinical Trial Registry(ChiCTR),International Traditional Medicine Clinical Trial Registry(ITMCTR),and ClinicalTrials.gov from the establishment of the databases to December 31,2024 were retrieved,and the registration characteristic information of the included trials was analyzed.Results A total of 168 registered trials involving 32 665 subjects were included.The number of registered TCM clinical trials for cervical spondylosis showed an overall upward trend;the average implementation cycle of the studies was(20.1±10.7)months;the regions where the research sponsoring institutions were located were mainly in Shanghai,Beijing,and Guangdong;the funding sources were mostly from government finance and institutional funds;a total of 133 studies underwent ethical review;the main study type was interventional research,and the main study design was randomized parallel-controlled trials;the intervention measures were mainly acupuncture,manual therapy,and Chinese materia medica;the main outcome indicators were scale scores;17 studies met the requirements for data sharing and management plans.Conclusion The number of registered TCM clinical trials for cervical spondylosis is generally increasing,involving multiple subtypes of cervical spondylosis and diversified intervention measures.But there are problems such as significant regional differences,uneven methodological quality,and poor data sharing,which should be improved.

Objective:To explore the effects of different combination of Er∶YAG laser irradiation parameters on the dentinal tu-bule sealing.Methods:160 dentin discs with 2 mm thickness were etched with 0.5 mmol/L EDTA to establish the dentine hyper-sensitivity models.The discs were randomly divided into 16 groups(n=10).The R02 and R14 handpieces were used to deliver Er∶YAG laser to the dentin discs according to the different output power(W),irradiation distance(cm)and irradiation time(s/cm2).Then,the samples of each group were divided into immediate irradiation subgroup and acid etching and wear subgroup(n=5).The dentinal tubules were observed with SEM,and the exposed area,the sealed rate and the occlusion depth of dentinal tubules were e-valuated with ImageE-Pro Plus 6.0 software.Results:The dentinal tubules in the control group opened uniformly with clear perime-ter,they were enlarged and opened after acid etching and tooth brushing.The dentinal tubules shrinked or sealed well with the melt layer after treatment by Er∶YAG laser irradiation with either parameter combination.Especially,uniform and seamless melt layer as well as similar dentin surface morphology before and post the acid etching and tooth brushing were obtained when the dentin discs were exposed to the following Er∶YAG laser irradiation parameter combinations,i.e.(R02,0.5 W,3 cm,20 s/cm2),(R14,0.5 W,3 cm,20 s/cm2)and(R14,0.6 W,3 cm,20 s/cm2).Significantly decreased exposed area and increased seal rate in the dentinal tubules treated in the above 3 laser irradiation parameter combina-tion groups were observed than those in the other groups(P＜0.05).Morphological analysis confirmed that whether the acid etching and tooth brushing were exerted.The occlusion depth of dentin tubule was more than 2.0 μm in the dentinal tubules treated in the above 3 groups.Conclusion:Er∶YAG laser irradiation parameter combinations of R02,0.5 W,3 cm,20 s/cm2,R14,0.5 W,3 cm,20 s/cm2 and R14,0.6 W,3 cm,20 s/cm2 are suitable for the best dentin tubule sealing.

The incidence and mortality rates of hepatocellular carcinoma(HCC)remain high in China,and the application of surgical resection is often limited due to the fact that most patients are in the advanced stage at the time of confirmed diagnosis.This article reviews commonly used advanced locoregional therapies for HCC and the advances in mainstream techniques such as local ablation(radiofrequency ablation,microwave ablation,irreversible electroporation,and cryoablation),intravascular intervention(transcatheter arterial chemoembolization,hepatic arterial infusion chemotherapy,and Y90 hepatic arterial infusion chemotherapy),and radiotherapy(CyberKnife,proton therapy,and heavy-ion therapy),and a multidimensional decision-making framework is constructed for HCC locoregional therapy by comparing treatment principles,indications,limitations,and clinical data of these techniques.This article aims to provide evidence-based support for persistent dilemmas in clinical decision-making,promote the role of locoregional therapies in clinical practice,and propose the directions for future research and clinical application.This article also establishes a comprehensive clinical roadmap for HCC locoregional therapy,which helps to address current challenges regarding technique selection and delineate future directions for innovation,in order to reshape the treatment of HCC through technological integration and paradigm innovation.

Objective To explore the expression levels of CD33⁺ myeloid-derived suppressor cell (MDSC)-mediated T lymphocyte function and related inflammatory factors secreted by T lymphocyte subsets in patients with cervical cancer, and to analyze their correlation with the treatment efficacy of ¹²⁵I particle implantation combined with arterial chemoembolization, as well as predictive value for treatment outcomes and interaction effects. Methods From January 1st, 2021 to January 1st, 2024, our hospital admitted 152 patients with advanced cervical cancer, who were confirmed by pathological examination. All patients received uterine artery chemoembolization combined with ¹²⁵I particle implantation. The predictive value of CD33⁺MDSC levels for clinical treatment response in cervical cancer was assessed using receiver operating characteristic (ROC) curve analysis. Multivariate logistic regression analysis was performed to evaluate both multiplicative and additive interactions between CD33⁺MDSC and T lymphocytes in predicting clinical treatment failure of cervical cancer. Kaplan Meier method was used to analyze the survival differences between cervical cancer patients with high and low CD33⁺MDSC expression levels. Results Compared with the effective group, patients in the ineffective group had decreased expression levels of CD3⁺ T lymphocyte, CD4⁺ T lymphocyte, interleukin 2 (IL-2) and interferon γ (IFN-γ), while showing increased expression levels of CD33⁺MDSC, CD8⁺ T lymphocyte, IL-4 and IL-6, along with increased tumor necrosis factor α (TNF-α) levels, larger maximum tumor diameters, and a higher incidence of lymph node metastasis. The expression levels of CD33⁺MDSCs demonstrated good predictive performance for treatment efficacy in cervical cancer patients. The high CD33⁺MDSC expression group had a significantly shorter overall survival (OS) than the low CD33⁺MDSC expression group (6.0±1.0 months vs. 12.0±1.2 months; t=33.280). The interaction analysis revealed that CD33⁺MDSCs and CD8⁺ T lymphocytes were highly expressed, while CD3⁺ and CD4⁺ T lymphocytes were lowly expressed, which was associated with an increased risk of clinical treatment failure in cervical cancer patients. Conclusion CD33⁺MDSCs can inhibit CD3⁺ and CD4⁺ T lymphocytes. It can upregulate the expression of CD8⁺ T lymphocytes, form an immunosuppressive microenvironment, and reduce the treatment response rate of ¹²⁵I particle implantation combined with arterial chemoembolization. CD33⁺MDSCs may serve as an independent biomarker for predicting the therapeutic efficacy and poor prognosis.
Humans ; Female ; Uterine Cervical Neoplasms/immunology* ; Middle Aged ; Chemoembolization, Therapeutic/methods* ; Sialic Acid Binding Ig-like Lectin 3/immunology* ; Adult ; T-Lymphocytes/immunology* ; Aged ; Treatment Outcome

Objective:To investigate the effect of quercetin(QUE)on immune escape of gastric cancer cells by regulating the programmed death protein-1/programmed death ligand-1(PD-1/PD-L1)signaling pathway.Methods:Different concentrations of QUE(0～160 μmol/L)were applied to gastric cancer cell HGC-27,the cell survival rate was measured to screen for the optimal drug con-centration.HGC-27 cells were stochastically grouped into HGC-27 group,QUE low concentration(QUE-L)group,QUE medium con-centration(QUE-M)group,QUE high concentration(QUE-H)group,QUE-H+pcDNA-NC group(negative control for overexpres-sion of PD-1),and QUE-H+pcDNA-PD-1 group(overexpression of PD-1).Cell proliferation activity was analyzed by CCK-8 assay and colony formation assay.Apoptosis rate was detected by flow cytometry.The expression levels of proteins related to the PD-1/PD-L1 signaling pathway were detected by Western blot.Each group was co-cultured with NK cells,and the HGC-27 co-culture group,QUE-L co-culture group,QUE-M co-culture group,QUE-H co-culture group,QUE-H+pcDNA-NC co-culture group,and QUE-H+pcDNA-PD-1 co-culture group were constructed.NK cell killing rate was detected.ELISA was applied to detect the expression levels of IL-2,IFN-γ and TNF-α in various cell culture media.Results:Compared with the HGC-27 group,the cell survival rate,clone formation quantity,and PD-1 and PD-L1 expression levels in the QUE-L group,QUE-M group and QUE-H group were gradually decreased(P<0.05),while the cell apoptosis rate gradually increased(P<0.05).Moreover,the NK cell killing rate and the expression levels of IL-2,IFN-γ and TNF-α in the cell culture medium of the QUE-L co-culture group,QUE-M co-culture group,and QUE-H co-culture group gradually increased compared to the HGC-27 co-culture group(P<0.05).On the basis of high concentration QUE treatment of HGC-27 cells,overexpression of PD-1 reversed the trend of changes in the above indicators(P<0.05).Conclusion:QUE may inhibit immune escape of gastric cancer cells by down-regulating PD-1/PD-L1 signaling pathway.

With the rapid advancements in minimally invasive spine surgery and the increasingly sophisti-cated concept of visualization,transforaminal endoscopic lumbar discectomy(TELD)has become a primary treatment for lumbar disc herniation.Among the critical preoperative steps in TELD,foraminalplasty plays a pivotal role,as its quality directly impacts surgical outcomes and postoperative recurrence rates.This article systemati-cally reviews the evolution of foraminalplasty techniques,evaluates the selection and application of plasty sites,examines factors influencing stability after lumbar foraminalplasty,and highlights recent advancements in computer-assisted navigation.The goal is to serve as a comprehensive reference for clinicians.