Objective:To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources.Methods:By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0.Results:A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference ( MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased ( MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery ( MD=-33 000.00 yuan) with no significant difference ( P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery ( MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased ( MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery ( P<0.001). Conclusions:In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.

Objective:To investigate the clinical efficacy of liquid nitrogen cryopreservation and reimplantation versus allograft reconstruction in patients underwent resection of primary malignant bone tumors of the long bones of the extremities.Methods:A retrospective analysis was conducted on 144 patients who underwent resection of primary malignant bone tumors of the long bones of the extremities followed by either liquid nitrogen cryopreservation and reimplantation or massive allografts reconstruction at the Beijing Jishuitan Hospital affiliated with Capital Medical University from January 2012 to July 2023. The study included 82 males and 62 females, with an average age of 23.8±12.3 years (range, 6-64 years). Patients were divided into two groups based on the reconstruction method: the cryopreservation and reimplantation group (72 cases) and the allograft group (72 cases). The following outcomes were recorded during follow-up: local tumor recurrence, bone union, union time, graft survival, and reasons for graft removal. Graft-related complications were recorded using the modified Henderson classification system of the International Limb Salvage Association. Limb function was assessed at the last follow-up using the Musculoskeletal Tumor Society score (MSTS-93).Results:All patients completed surgery and were followed up for a mean of 60.2±32.1 months (range, 12-149 months). At the last follow-up, 24 patients were dead from the tumor, 16 patients survived with the tumor (2 cases of local recurrence and 14 cases of distant metastasis), and 104 patients survived without the tumor. The bone union rate and union time in cryopreservation and reimplantation group were 90% (65/72) and 9.6±4.8 months, respectively, which was significantly superior to those in allograft group [68% (49/72) and 15.9±6.7 months, P<0.05]. The 5-year overall graft survival rate was 86.8% [95% CI (80.1%, 95.7%)] in cryopreservation and reimplantation group, higher than 73.2% [95% CI(68.4%, 84.5%)] in allograft group significantly (χ 2=7.122, P=0.017). The rates of graft removal due to non-union and infection in the cryopreservation and reimplantation group were 0% (0/72) and 1.4% (1/72), respectively, which were significantly lower than those in the allograft group [5.6% (4/72) and 9.7% (7/72), P<0.05]. Overall, 48.6% (70/144) of patients experienced at least one graft-related complication, with a complication rate of 33.3% in cryopreservation and reimplantation group, lower than the 61.1% in allograft group significantly (χ 2=11.146, P<0.001). The complications with the highest incidence rate were nonunion (20.8%, 30/144), followed by structural failure (17.4%, 25/144), tumor progression (10.4%, 15/144), infection (10.4%, 15/144), and soft tissue failure (5.6%, 8/144). The incidence rates of the atrophic non-union and the structural failure of grafts were 9.7% (7/72) and 1.4% (1/72) respectively in the cryopreservation and reimplantation group, which were significantly lower compared to the allograft group [29.2% (21/72) and 13.9% (10/72), P<0.05]. At the last follow-up, the MSTS-93 score was 89.7%±8.3% in the cryopreservation and reimplantation group, and 87.6%±7.5% in the allograft group, with no statistically significant difference ( t=0.326, P=0.542). Conclusion:Compared with allograft reconstruction, autologous inactivated bone grafting demonstrated superior bone union efficiency and fewer complications, it may be considered for reconstruction in cases whose tumor bone is not severely osteolytic or pathologically fractured.

Air leak syndrome is a common and critical respiratory issue in neonates. Air leak syndrome not only affects pulmonary gas exchange but also leads to unstable hemodynamics, severe pulmonary hypertension, and other life-threatening conditions. In recent years, despite significant improvements in respiratory support concepts, equipment, and techniques, air leak syndrome remains a prevalent clinical problem, impacting neonatal prognosis and quality of life. This article summarizes the research progress on high-risk factors, early diagnosis, prevention, and treatment of air leak syndrome.

Objective:To investigate the clinical utility of functional near-infrared spectroscopy (fNIRS) in evaluating cerebral function in neonates with hypoxic-ischemic encephalopathy (HIE).Methods:This was a case-control study. Fifteen neonates with moderate to severe HIE who were admitted to the Department of Neonatal Medical Center, Children's Hospital of Fudan University from March 2023 to August 2024 and completed fNIRS testing were selected as the HIE group, and 15 full-term infants without neurological diseases and completed fNIRS testing were selected as the control group during the same period. Resting-state fNIRS data were acquired to construct cerebral functional connectivity networks and topological properties were analyzed. Statistical analyses included independent t-tests, Mann-Whitney U tests, analysis of variance, and Chi-square tests. Results:Compared with controls, the HIE group exhibited significantly reduced global functional connectivity strength [0.15 (0.05-0.26) vs. 0.24 (0.13-0.35), Z=－7.66, P<0.001]. Both groups demonstrated small-world network properties, with no intergroup difference (1.17±0.05 vs. 1.14±0.05, t=2.02, P=0.050). The HIE group showed decreased shortest path length (6.22±0.52 vs. 13.74±0.49, t=48.18, P<0.001), global efficiency (0.26±0.04 vs. 0.30±0.05, t=2.50, P=0.018) and normalized shortest path length (1.50±0.07 vs. 1.62±0.22, t=2.43, P=0.020). No differences were observed in the clustering coefficient or local efficiency between the two groups. Regional analysis revealed reduced nodal efficiency in both left (0.30±0.06 vs. 0.35±0.05, t=2.47, P=0.021) and right hemispheres (0.30±0.06 vs. 0.37±0.06, t=2.68, P=0.013) in HIE neonates compared with that of the corresponding hemispheres in the control group. The intra-group comparison showed no statistical significance in node efficiency between the left and right hemispheres (both P>0.05). Conclusion:fNIRS captures functional network signatures in HIE, demonstrating clinical potential for early detection of cerebral dysfunction in neonates with hypoxic-ischemic injury.

Objective To investigate the expression of EIF5A1 in intrahepatic cholangiocarcinoma cell lines and human hepatobiliary duct epithelia,and its effect on the proliferation,migration and invasion ability and Wnt/β-Catenin signaling pathway in HUCCT1 cells.Methods Western blot was used to detect the basal expression level of EIF5A1 in intrahepatic cholangiocarcinoma cell lines and human intrahepatic cholangiocarcinoma epithelial cells.Transient transfection of siRNA was used to silence the expression of EIF5A1 in intrahepatic cholangiocarcinoma cell HUCCT1.The experimental groups were divided into blank control group(Con),siRNA1 group,and siRNA2 group.The most effective siRNA was screened by Western blot.The effects of EIF5A1 silencing on the proliferation,migration and invasion ability of HUCCT1 cells were detected by CCK-8,EdU cell proliferation assay and Transwell assay.The effect of EIF5A1 silencing on the Wnt/β-Catenin signaling pathway in HUCCT1 cells was detected by Western blot.Results The results of CCK-8 and EdU cell proliferation experiments showed that the proliferation ability of HUCCT1 cells decreased after EIF5A1 silencing(P<0.05),and Transwell migration and invasion experiments showed that the migration and invasion ability of Hucct1 cells decreased after EIF5A1 silencing(P<0.05).Western blot analysis revealed decreased expression of β-Catenin,Cyclin D1,MMP-2 and Survivin in Wnt/β-Catenin signaling pathway after EIF5A1 silencing(P<0.05).Conclusion EIF5A1 may promote the proliferation,migration and invasion of intrahepatic bile duct cancer cells through Wnt/β-Catenin signaling pathway.

Objective:To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources.Methods:By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0.Results:A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference ( MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased ( MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery ( MD=-33 000.00 yuan) with no significant difference ( P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery ( MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased ( MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery ( P<0.001). Conclusions:In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.

Objective:To investigate the clinical efficacy of liquid nitrogen cryopreservation and reimplantation versus allograft reconstruction in patients underwent resection of primary malignant bone tumors of the long bones of the extremities.Methods:A retrospective analysis was conducted on 144 patients who underwent resection of primary malignant bone tumors of the long bones of the extremities followed by either liquid nitrogen cryopreservation and reimplantation or massive allografts reconstruction at the Beijing Jishuitan Hospital affiliated with Capital Medical University from January 2012 to July 2023. The study included 82 males and 62 females, with an average age of 23.8±12.3 years (range, 6-64 years). Patients were divided into two groups based on the reconstruction method: the cryopreservation and reimplantation group (72 cases) and the allograft group (72 cases). The following outcomes were recorded during follow-up: local tumor recurrence, bone union, union time, graft survival, and reasons for graft removal. Graft-related complications were recorded using the modified Henderson classification system of the International Limb Salvage Association. Limb function was assessed at the last follow-up using the Musculoskeletal Tumor Society score (MSTS-93).Results:All patients completed surgery and were followed up for a mean of 60.2±32.1 months (range, 12-149 months). At the last follow-up, 24 patients were dead from the tumor, 16 patients survived with the tumor (2 cases of local recurrence and 14 cases of distant metastasis), and 104 patients survived without the tumor. The bone union rate and union time in cryopreservation and reimplantation group were 90% (65/72) and 9.6±4.8 months, respectively, which was significantly superior to those in allograft group [68% (49/72) and 15.9±6.7 months, P<0.05]. The 5-year overall graft survival rate was 86.8% [95% CI (80.1%, 95.7%)] in cryopreservation and reimplantation group, higher than 73.2% [95% CI(68.4%, 84.5%)] in allograft group significantly (χ 2=7.122, P=0.017). The rates of graft removal due to non-union and infection in the cryopreservation and reimplantation group were 0% (0/72) and 1.4% (1/72), respectively, which were significantly lower than those in the allograft group [5.6% (4/72) and 9.7% (7/72), P<0.05]. Overall, 48.6% (70/144) of patients experienced at least one graft-related complication, with a complication rate of 33.3% in cryopreservation and reimplantation group, lower than the 61.1% in allograft group significantly (χ 2=11.146, P<0.001). The complications with the highest incidence rate were nonunion (20.8%, 30/144), followed by structural failure (17.4%, 25/144), tumor progression (10.4%, 15/144), infection (10.4%, 15/144), and soft tissue failure (5.6%, 8/144). The incidence rates of the atrophic non-union and the structural failure of grafts were 9.7% (7/72) and 1.4% (1/72) respectively in the cryopreservation and reimplantation group, which were significantly lower compared to the allograft group [29.2% (21/72) and 13.9% (10/72), P<0.05]. At the last follow-up, the MSTS-93 score was 89.7%±8.3% in the cryopreservation and reimplantation group, and 87.6%±7.5% in the allograft group, with no statistically significant difference ( t=0.326, P=0.542). Conclusion:Compared with allograft reconstruction, autologous inactivated bone grafting demonstrated superior bone union efficiency and fewer complications, it may be considered for reconstruction in cases whose tumor bone is not severely osteolytic or pathologically fractured.

Air leak syndrome is a common and critical respiratory issue in neonates. Air leak syndrome not only affects pulmonary gas exchange but also leads to unstable hemodynamics, severe pulmonary hypertension, and other life-threatening conditions. In recent years, despite significant improvements in respiratory support concepts, equipment, and techniques, air leak syndrome remains a prevalent clinical problem, impacting neonatal prognosis and quality of life. This article summarizes the research progress on high-risk factors, early diagnosis, prevention, and treatment of air leak syndrome.

Objective:To investigate the clinical utility of functional near-infrared spectroscopy (fNIRS) in evaluating cerebral function in neonates with hypoxic-ischemic encephalopathy (HIE).Methods:This was a case-control study. Fifteen neonates with moderate to severe HIE who were admitted to the Department of Neonatal Medical Center, Children's Hospital of Fudan University from March 2023 to August 2024 and completed fNIRS testing were selected as the HIE group, and 15 full-term infants without neurological diseases and completed fNIRS testing were selected as the control group during the same period. Resting-state fNIRS data were acquired to construct cerebral functional connectivity networks and topological properties were analyzed. Statistical analyses included independent t-tests, Mann-Whitney U tests, analysis of variance, and Chi-square tests. Results:Compared with controls, the HIE group exhibited significantly reduced global functional connectivity strength [0.15 (0.05-0.26) vs. 0.24 (0.13-0.35), Z=－7.66, P<0.001]. Both groups demonstrated small-world network properties, with no intergroup difference (1.17±0.05 vs. 1.14±0.05, t=2.02, P=0.050). The HIE group showed decreased shortest path length (6.22±0.52 vs. 13.74±0.49, t=48.18, P<0.001), global efficiency (0.26±0.04 vs. 0.30±0.05, t=2.50, P=0.018) and normalized shortest path length (1.50±0.07 vs. 1.62±0.22, t=2.43, P=0.020). No differences were observed in the clustering coefficient or local efficiency between the two groups. Regional analysis revealed reduced nodal efficiency in both left (0.30±0.06 vs. 0.35±0.05, t=2.47, P=0.021) and right hemispheres (0.30±0.06 vs. 0.37±0.06, t=2.68, P=0.013) in HIE neonates compared with that of the corresponding hemispheres in the control group. The intra-group comparison showed no statistical significance in node efficiency between the left and right hemispheres (both P>0.05). Conclusion:fNIRS captures functional network signatures in HIE, demonstrating clinical potential for early detection of cerebral dysfunction in neonates with hypoxic-ischemic injury.

In-depth understanding of the clinical diagnosis and treatment practices of various health workers is of great significance for optimizing the allocation of health workforce. In 2023, based on the surveillance platform of National Center for Pediatric Cancer Surveillance(NCPCS), the NCPCS effectively integrated human resources data with clinical diagnosis and treatment data. By clarifying the conceptual and logical structures of the database, a clinical health workforce database was constructed using a distributed relational database. This database adhered to the data quality control principles of uniqueness, integrity, logic, and validity, and implemented scientific and effective data security protection strategies throughout the entire data life cycle. In practical applications, statistical analyses could be conducted on this database from two dimensions: health workforce and diagnosis-treatment processes, assisting relevant departments and hospitals in the refined management of health workforce allocation and promoting discipline construction. As of May 2024, the database had incorporated 931 hospitals, with the number of various health workers exceeding 640 000. The clinical health workforce database provided references for health administrative departments and hospitals at all levels to grasp the clinical practices of various health workers, and to achieve a clinical-demand-oriented allocation of health workforce.