Objective:To explore the related risk factors of diaphragmatic hernia after thoraco-laparoscopic minimally invasive Mckeown esophagectomy (MIME).Methods:This is a retrospective controlled study. A retrospective analysis was conducted on the clinical data of patients who underwent MIME at the Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, from January 2016 to December 2023. A total of 619 patients were included. There were 423 males and 196 females, aged (63.7±7.6) years (range: 37 to 87 years). The diagnosis of diaphragmatic hernia after MIME was made based on clinical symptoms and CT scans. Patients were divided into two groups: the diaphragmatic hernia group ( n=16) and the non-diaphragmatic hernia group ( n=603). Clinical data, including age, gender, body mass index (BMI), smoking history, tumor location (upper, middle, and lower thoracic esophagus), preoperative neoadjuvant therapy history, and tumor staging, were collected and analyzed. A BMI of 25 kg/m2 and age of 65 years were used as cutoff values. The χ2 test and Fisher′s exact test were used to compare the data between the two groups, and Logistic regression was employed for risk factor analysis. The diaphragmatic hernia group and non-diaphragmatic hernia group were matched in a 1∶3 ratio with a caliper value of 0.02 by propensity score matching. Kaplan-Meier method was used for survival analysis and compared using the log-rank test for between-group differences. Results:The proportion of patients with diaphragmatic hernia after MIME who underwent surgical treatment was 6/16. Statistically significant differences were observed between the diaphragmatic hernia group and the non-diaphragmatic hernia group in terms of age ( χ2=16.057, P<0.01), BMI ( χ2=16.057, P<0.01), and tumor location ( χ2=12.048, P=0.002). Multivariate logistic regression analysis revealed that age ≥65 years ( OR=1.236, P=0.023) and BMI<25 kg/m2 ( OR=0.810, P<0.01) were independent risk factors for the development of diaphragmatic hernia after MIME. Survival analysis showed no significant difference in long-term survival between patients with and without diaphragmatic hernia after MIME ( P=0.187), and whether patients with diaphragmatic hernia underwent surgery was not associated with long-term prognosis ( P=0.560). Conclusion:Patients with BMI<25 kg/m 2 and age ≥65 years are independent risk factors for diaphragmatic hernia after MIME. The occurrence of diaphragmatic hernia is not associated with prognosis, and whether patients with diaphragmatic hernia undergo surgery does not affect the prognosis.

Objective:To evaluate the efficacy and safety of immunotherapy combined with chemotherapy as conversion therapy for initially unresectable locally advanced esophageal squamous cell carcinoma.Methods:This retrospective case series study analyzed clinical and pathological data of 32 patients with initially unresectable locally advanced esophageal squamous cell carcinoma who received immunotherapy combined with chemotherapy at the Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University, from June 2020 to December 2024. The cohort included 27 males and 5 females, with an age ( M(IQR)) of 61(9)years (range:46 to 73 years). Five patients were diagnosed with stage Ⅲ, 27 with stage ⅣA. All patients received PD-1 inhibitor sintilimab combined with nedaplatin and albumin-bound paclitaxel. Radiological evaluations were performed every two cycles, the multidisciplinary team evaluation was conducted to determine conversion to resectable status, and patients with successful conversion underwent radical esophagectomy. Follow-up was conducted via telephone or outpatient visits every 3 to 6 months after the last treatment. The primary endpoint was R0 resection rate, secondary endpoints included objective response rate (ORR), pathological complete response (pCR) rate, major pathological response (MPR) rate, event-free survival (EFS), disease-free survival (DFS) in patients with R0 resection, overall survival (OS) and safety. Kaplan-Meier method was used to plot survival curves and estimate median EFS, DFS, OS rates and their 95% CI. The 95% CI for ORR, pCR rate, MPR rate, and downstaging rate were calculated using the Clopper-Pearson method. Results:The median treatment cycle of 2(1) (range:2 to 8). As of June 2025, the median follow-up was 32.5(13.5)months (range:6.4 to 59.1 months). Among the 32 patients, 9 experienced progression or recurrence, including 2 with liver and lymph node metastases, 2 with lung metastases, 2 with thoracic vertebral metastases, and 3 with mediastinal lymph node metastases. After conversion therapy, 29 patients underwent surgery, achieving an R0 resection rate of 84.4% (95% CI:67.2% to 94.7%), a pCR rate of 27.6% (95% CI:12.7% to 47.2%), and an MPR rate of 55.2% (95% CI:35.7% to 73.6%). Grade 3 or higher surgical complications occurred in 6.9%(2/29) of patients, and grade 3 or higher treatment-related adverse events were observed in 15.6%(5/29). Among the 32 patients, the ORR was 56.3% (95% CI:37.7% to 73.6%),the 3-year EFS rate and OS rate was 59.4% (95% CI:40.8% to 86.4%) and 59.7% (95% CI:40.0% to 89.0%) respectively. Conclusion:Immunotherapy combined with chemotherapy demonstrates high conversion rates and favorable safety in the conversion therapy of initially unresectable locally advanced esophageal squamous cell carcinoma, representing a promising treatment strategy.

OBJECTIVE To analyze the ranking of direct economic losses due to postoperative hospital-associated in-fections in patients undergoing surgical excisions for common tumors.METHODS Totally 12,010 tumor patients who were treated in Jiangxi Cancer Hospital from Jan.2019 to Dec.2021 were recruited as the research subjects.The differences in covariates including the population,type of tumor and diagnosis and treatment of tumor without infection between the infection group and the non-infection group were balanced by 1∶1 propensity score matching(PSM).The length of hospital stay and hospitalization costs were observed and compared between the two groups of patients.RESULTS Totally 806 pairs of research subjects were matched,covering 10 sites of tumors(lung,stomach,colon,liver,breast,esophagus,thyroid,cervix,uterine body and brain).In the infec-tion group,the patients with lower respiratory tract infections accounted for 60.52％,the patients with surgical site infections accounted for 27.19％,and the patients with other sites of infections accounted for 12.29％.As compared with the non-infection group,the average length of hospital stay of the infection group was extended by 4 days,and the total hospitalization cost was increased by 9068.99 yuan.Among all the expenses,western medi-cine cost,general treatment operation cost,cost of disposable materials for treatment,cost of laboratory test and nursing cost ranked the top 5 economic losses,and there were significant differences between the two groups(P＜0.05).With the respect to different types of tumors,brain tumors,esophageal tumors,gastric tumors,colorectal tumors and cervical tumors ranked the top 5 economic losses.CONCLUSIONS The tumor patients un-dergoing surgical excisions are at high risk of postoperative hospital-associated infections,which may result in economic losses.It is necessary to focus on the prevention and control of lower respiratory tract infections and SSI.

Objective:To evaluate the efficacy and safety of obinutuzumab combined with glucocorticoid-based therapy in patients with relapsed immune thrombotic thrombocytopenic purpura (iTTP).Methods:This study analyzed the efficacy and adverse reactions of four patients with relapsed iTTP who were treated with a combination of obinutuzumab and glucocorticoids to assess the effectiveness and safety of the treatment.Results:All four patients had a history of multiple relapses and had previously undergone treatment with rituximab and bortezomib. Three patients exhibited additional autoantibodies. Following the combined therapy, all patients achieved clinical remission, with ADAMTS13 activity returning to normal levels and inhibitors testing negative. During a median follow-up period of 11 months (range: 3–17 months), all patients maintained sustained remission. No severe adverse events were reported during treatment or follow-up.Conclusion:The combination of obinutuzumab and glucocorticoid-based therapy is effective and safe for treating relapsed iTTP.

This study aims to establish a method for counting the viral particles in adenovirus vector-based vaccines. Nano-flow cytometry was employed to analyze the viral particles in adenovirus-based vector vaccines at the single-particle level. Monodisperse silica nanoparticles with a refractive index close to that of the virus were selected as the particle size standard to calculate the viral particle size, which was then compared with the results obtained from transmission electron microscopy (TEM) to determine the gating strategy. Subsequently, a particle count standard was employed to calculate the viral particle concentration. The established method demonstrated good linearity, accuracy, precision, and specificity. The results of determined viral particle concentration showed a good correlation with the infectious titer. Compared with the conventional OD₂₆₀ method, nano-flow cytometry can directly measure the viral particle concentration and indicate whether the sample has been disassembled according to changes in viral particle concentration and size, thus more accurately reflecting the actual infectious potency of the sample. The novel quantification method established in this study is capable of indicating the efficacy of adenovirus vector-based vaccines and provides effective technical support for the quality control of such products.
Adenoviridae/genetics* ; Genetic Vectors ; Flow Cytometry/methods* ; Virion/isolation & purification* ; Particle Size ; Nanoparticles ; Viral Vaccines

Iron,a vital trace element and redox-active metal in the human body,is pivotal in cellular processes and en-gages in a multitude of biological reactions.Ferroptosis,an emerging form of regulated cell death,is predominantly instiga-ted by the excessive free iron that catalyzes reactive oxygen species(ROS)production via the Fenton reaction.This process results in the peroxidation of polyunsaturated fatty acids within the cellular lipid membrane,compromising the membrane's integrity and thereby inducing ferroptosis.In the context of diabetic retinopathy(DR),ferroptosis plays a sig-nificant role.The disruption of iron metabolism,the excessive accumulation of ROS,and the imbalance of the antioxidant system are key mechanisms contributing to ferroptosis in retinal tissues and the exacerbation of DR's pathological progres-sion.This review provides a systematic summary and in-depth discussion of the advancements in understanding the role of ferroptosis in DR pathogenesis,intending to offer valuable insights for future research endeavors in this field.

Iron,a vital trace element and redox-active metal in the human body,is pivotal in cellular processes and en-gages in a multitude of biological reactions.Ferroptosis,an emerging form of regulated cell death,is predominantly instiga-ted by the excessive free iron that catalyzes reactive oxygen species(ROS)production via the Fenton reaction.This process results in the peroxidation of polyunsaturated fatty acids within the cellular lipid membrane,compromising the membrane's integrity and thereby inducing ferroptosis.In the context of diabetic retinopathy(DR),ferroptosis plays a sig-nificant role.The disruption of iron metabolism,the excessive accumulation of ROS,and the imbalance of the antioxidant system are key mechanisms contributing to ferroptosis in retinal tissues and the exacerbation of DR's pathological progres-sion.This review provides a systematic summary and in-depth discussion of the advancements in understanding the role of ferroptosis in DR pathogenesis,intending to offer valuable insights for future research endeavors in this field.

OBJECTIVE To analyze the ranking of direct economic losses due to postoperative hospital-associated in-fections in patients undergoing surgical excisions for common tumors.METHODS Totally 12,010 tumor patients who were treated in Jiangxi Cancer Hospital from Jan.2019 to Dec.2021 were recruited as the research subjects.The differences in covariates including the population,type of tumor and diagnosis and treatment of tumor without infection between the infection group and the non-infection group were balanced by 1∶1 propensity score matching(PSM).The length of hospital stay and hospitalization costs were observed and compared between the two groups of patients.RESULTS Totally 806 pairs of research subjects were matched,covering 10 sites of tumors(lung,stomach,colon,liver,breast,esophagus,thyroid,cervix,uterine body and brain).In the infec-tion group,the patients with lower respiratory tract infections accounted for 60.52％,the patients with surgical site infections accounted for 27.19％,and the patients with other sites of infections accounted for 12.29％.As compared with the non-infection group,the average length of hospital stay of the infection group was extended by 4 days,and the total hospitalization cost was increased by 9068.99 yuan.Among all the expenses,western medi-cine cost,general treatment operation cost,cost of disposable materials for treatment,cost of laboratory test and nursing cost ranked the top 5 economic losses,and there were significant differences between the two groups(P＜0.05).With the respect to different types of tumors,brain tumors,esophageal tumors,gastric tumors,colorectal tumors and cervical tumors ranked the top 5 economic losses.CONCLUSIONS The tumor patients un-dergoing surgical excisions are at high risk of postoperative hospital-associated infections,which may result in economic losses.It is necessary to focus on the prevention and control of lower respiratory tract infections and SSI.

Objective:To evaluate the efficacy and safety of obinutuzumab combined with glucocorticoid-based therapy in patients with relapsed immune thrombotic thrombocytopenic purpura (iTTP).Methods:This study analyzed the efficacy and adverse reactions of four patients with relapsed iTTP who were treated with a combination of obinutuzumab and glucocorticoids to assess the effectiveness and safety of the treatment.Results:All four patients had a history of multiple relapses and had previously undergone treatment with rituximab and bortezomib. Three patients exhibited additional autoantibodies. Following the combined therapy, all patients achieved clinical remission, with ADAMTS13 activity returning to normal levels and inhibitors testing negative. During a median follow-up period of 11 months (range: 3–17 months), all patients maintained sustained remission. No severe adverse events were reported during treatment or follow-up.Conclusion:The combination of obinutuzumab and glucocorticoid-based therapy is effective and safe for treating relapsed iTTP.

Objective:To explore the related risk factors of diaphragmatic hernia after thoraco-laparoscopic minimally invasive Mckeown esophagectomy (MIME).Methods:This is a retrospective controlled study. A retrospective analysis was conducted on the clinical data of patients who underwent MIME at the Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, from January 2016 to December 2023. A total of 619 patients were included. There were 423 males and 196 females, aged (63.7±7.6) years (range: 37 to 87 years). The diagnosis of diaphragmatic hernia after MIME was made based on clinical symptoms and CT scans. Patients were divided into two groups: the diaphragmatic hernia group ( n=16) and the non-diaphragmatic hernia group ( n=603). Clinical data, including age, gender, body mass index (BMI), smoking history, tumor location (upper, middle, and lower thoracic esophagus), preoperative neoadjuvant therapy history, and tumor staging, were collected and analyzed. A BMI of 25 kg/m2 and age of 65 years were used as cutoff values. The χ2 test and Fisher′s exact test were used to compare the data between the two groups, and Logistic regression was employed for risk factor analysis. The diaphragmatic hernia group and non-diaphragmatic hernia group were matched in a 1∶3 ratio with a caliper value of 0.02 by propensity score matching. Kaplan-Meier method was used for survival analysis and compared using the log-rank test for between-group differences. Results:The proportion of patients with diaphragmatic hernia after MIME who underwent surgical treatment was 6/16. Statistically significant differences were observed between the diaphragmatic hernia group and the non-diaphragmatic hernia group in terms of age ( χ2=16.057, P<0.01), BMI ( χ2=16.057, P<0.01), and tumor location ( χ2=12.048, P=0.002). Multivariate logistic regression analysis revealed that age ≥65 years ( OR=1.236, P=0.023) and BMI<25 kg/m2 ( OR=0.810, P<0.01) were independent risk factors for the development of diaphragmatic hernia after MIME. Survival analysis showed no significant difference in long-term survival between patients with and without diaphragmatic hernia after MIME ( P=0.187), and whether patients with diaphragmatic hernia underwent surgery was not associated with long-term prognosis ( P=0.560). Conclusion:Patients with BMI<25 kg/m 2 and age ≥65 years are independent risk factors for diaphragmatic hernia after MIME. The occurrence of diaphragmatic hernia is not associated with prognosis, and whether patients with diaphragmatic hernia undergo surgery does not affect the prognosis.