Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.

Radical gastrectomy is the core of comprehensive treatment for patients with locally advanced gastric cancer,while reasonable and standardized lymphadenectomy is the key to radical gastrectomy.With the continuous development of treatment methods and therapeutic drugs for advanced gastric cancer, it is worth exploring whether the scope of lymphadenectomy needs to be changed. Neoadjuvant immunotherapy has brought a new breakthrough for locally advanced gastric cancer, increased pathological complete response rate, reduced clinical stage of tumors, and increased radical surgical resection rate, but it has not brought long-term benefits to patients. Lymph nodes play an important role in human anti-tumor immune response, and some basic studies suggest that preserving some normal lymph nodes may be more helpful to enhance the efficacy of immunotherapy. Thus, in the era of immunotherapy, the extent of lymph node dissection for locally advanced gastric cancer needs to balance continuous drug benefits, patient quality of life, and survival benefits, awaiting further high-quality clinical research for determination. Questions such as how to differentiate between normal and metastatic lymph nodes, how to rationally preserve normal lymph nodes, and whether preserving partial lymph node function can lead to greater benefits for patients from immunotherapy warrant further exploration.

Objective To explore application value of transaxillary single-port gasless endoscopic-assisted fibroadenomas excision in adolescents.Methods A retrospective analysis was conducted on clinical data of 60 cases of fibroadenoma from June 2019 to June 2023.The patients were 17.3(range,13-19)years old.There were 54 cases of unilateral tumors and 6 cases of bilateral tumors.The average number of tumors was 2.5(range,1-13),and the mean tumor diameter was 4.0(range,3-10)cm.The fibroadenoma excision was performed by using transaxillary single-port gasless endoscopy.Results Of the 60 patients,the average operation time was 64.9(range,35-130)min and the intraoperative blood loss was less than 20 ml.Postoperative complications occurred in 5 cases(8.3％).At 3 months after surgery,the psychosocial well-being scores of BREAST-Q Scale were increased from(79.2±8.9)to(83.4±9.9)(P＜0.001).Conclusion Transaxillary single-port gasless endoscopic-assisted fibroadenomas excision is safe and effective for multiple or large fibroadenomas in adolescents,offering minimal invasion and concealed incision.

Radical gastrectomy is the core of comprehensive treatment for patients with locally advanced gastric cancer,while reasonable and standardized lymphadenectomy is the key to radical gastrectomy.With the continuous development of treatment methods and therapeutic drugs for advanced gastric cancer, it is worth exploring whether the scope of lymphadenectomy needs to be changed. Neoadjuvant immunotherapy has brought a new breakthrough for locally advanced gastric cancer, increased pathological complete response rate, reduced clinical stage of tumors, and increased radical surgical resection rate, but it has not brought long-term benefits to patients. Lymph nodes play an important role in human anti-tumor immune response, and some basic studies suggest that preserving some normal lymph nodes may be more helpful to enhance the efficacy of immunotherapy. Thus, in the era of immunotherapy, the extent of lymph node dissection for locally advanced gastric cancer needs to balance continuous drug benefits, patient quality of life, and survival benefits, awaiting further high-quality clinical research for determination. Questions such as how to differentiate between normal and metastatic lymph nodes, how to rationally preserve normal lymph nodes, and whether preserving partial lymph node function can lead to greater benefits for patients from immunotherapy warrant further exploration.

Objective:To investigate the application value of porcine small intestinal sub-mucosa (SIS) acellular matrix mesh in laparoscopic inguinal hernia repair (LIHR).Methods:The prospective multicenter randomized controlled single-blind non-inferiority-type study was conducted. The clinical data of 216 patients who underwent LIHR in 4 medical centers, including Beijing Chaoyang Hospital of Capital Medical University et al, from April 2021 to August 2022 were selected. Patients were divided into two groups using a central randomization system. Patients in the experimental group were implanted domestic SIS mesh, and patients in the control group were implanted imported mesh of similar material origin. The baseline characteristics of enrolled patients were evaluated using the full analysis set, and the effectiveness indicators were evaluated using the protocol set. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the ttest. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Wilcoxon rank sum test. Count data were expressed as absolute numbers and/or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. If the lower limit of 95% confidence interval( CI) of the difference in effective rates between the experimental group and the control group was greater than the non-inferiority cut-off value of ?10%, the experimental group was considered non-inferior to the control group. Results:(1) Situations of the enrolled patients. A total of 216 patients were selected for eligibility, with 46 patients dropping out due to violation of the trial protocol, and the remaining 170 patients were included in the full analysis set. Nine patients were dislodged due to loss to follow-up, and 161 patients completed follow-up. One case in the experimental group was excluded due to violating the inclusion and exclusion criteria, while the remaining 160 patients were included in the protocol set (80 cases in the experimental group and 80 cases in the control group). There was no significant difference in the gender, age, body mass index (BMI), surgical method, Gilbert type of hernia, volume of intraoperative blood loss, operation time of patients between the experimental group and the control group ( P>0.05), confounding bias ensured comparability. (2) Study endpoints. ① Primary study endpoint. During the postoperative 6 month of follow-up, none of patient in the experimental group or the control group had hernia recurrence, with the recurrence rate as 0. Results of non-inferiority test showed that the difference of hernia recurrence between the two groups was 0 (95% CI as ?4.58% to 4.58%), with the lower limit of ?4.58% greater than the non-inferiority cut-off value of ?10%, which fulfilled the non-inferiority hypothesis. ② Secondary study endpoints. Cases with plasmapheresis during the follow-up were 18 in the experimental group and 29 in the control group, respectively, showing no significant difference between the two groups ( χ2=3.65, P>0.05). There were 4 cases with postoperative pain and 1 case with postoperative malaise in the experimental group, and there were 8 cases with postoperative pain and 0 case with postoperative malaise in the control group, showing no signifi-cant difference in the above indicators between the two groups ( P>0.05). None of patient in the experimental group or the control group had incision infection, enterocutaneous fistula, intestinal obstruction, intestinal canal injury, allergy and rejection, testicular inflammation and/or atrophy, or any other complication. Conclusion:Compared with imported mesh of similar material origin, domestic porcine SIS mesh is safe and effective in LIHR.

Objective:To investigate the clinical efficiency of lumbar hernia repair based on path planning.Methods:The retrospective and descriptive study was conducted. The clinical data of 35 patients with lumbar hernia who were admitted to The First Affiliated Hospital of University of Science and Technology of China from November 2016 to March 2024 were collected. There were 14 males and 21 females, aged (61±8)years. According to preoperative computerized tomography examination of the hernia defect diameter, patients with a defect diameter <4 cm underwent enhan-ced field laparoscopic total extraperitoneal repair (eTEP), patients with a defect diameter of 4-8 cm underwent laparoscopic partial extraperitoneal repair (TAPE), and patients with a defect diameter >8 cm underwent open preperitoneal mesh repair (Sublay). Measurement data with normal distribu-tion were represented as Mean± SD, and comparison of three groups were conducted using the one-way ANOVA or Kruskal Wallis test, and Bonferroni correction was used for pariwise comparison. Measurement data with skewed distribution were represented as M(range). Count data were descri-bed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Operation conditions. Of 35 patients, there were 15 cases undergoing eTEP, of 7 males and 8 females and 12 cases of left hernia and 3 cases of right hernia, with operation time of (92±44)minutes and the duration of postoperative hospital stay of (5.6±2.8)days. There were 17 cases undergoing TAPE, of 5 males and 12 females and 9 cases of left hernia, 7 cases of right hernia and 1 case of bilateral hernia, with operation time of (114±56)minutes and the duration of postoperative hospital stay of (6.4±3.0) days. There were 3 cases undergoing Sublay, of 2 males and 1 female and 1 case of left hernia and 2 cases of right hernia, with operation time of (150±55)minutes and the duration of postoperative hospital stay of (12.3±7.8)days. There were significant differences in the duration of postoperative hospital stay among the three groups ( F=4.83, P<0.05). (2) Follow-up. All 35 patients were followed up for 40.5(range, 3.0-91.0)days. None of patient underwent postoperative complications such as serous swelling, incision infection, intestinal fistula, intestinal obstruction, or puncture hematoma, and no recurrence of lumbar hernia occurred. One patient who underwent TAPE had postoperative abdominal distension, and was cured by symptomatic treatment. Cases with acute pain within postoperative 3 months were 0, 5, 2 in patients undergoing eTEP, TAPE, Sublay, respectively, showing significant differences among them ( χ2=8.69, P<0.05). Results of pariwise comparison showed that there was a significant difference in acute pain within postoperative 3 months between patients undergoing eTEP and Sublay ( P<0.05), and there was a significant difference in acute pain within postoperative 3 months between patients undergoing eTEP and TAPE ( P<0.05); Cases with chronic pain after postoperative 3 months were 0, 1, 1 in patients undergoing eTEP, TAPE, Sublay, respectively, showing no significant difference among them ( χ2=4.00, P>0.05). Conclusion:It is safe and feasible to formulate the surgical method according to the defect diameter of lumbar hernia.

Background and Aims:Parastomal hernia is a common complication after colostomy,with a high incidence rate.Laparoscopic Sugarbaker repair is currently the mainstream surgical approach for treating parastomal hernia.However,compared to other abdominal wall hernia repair techniques,the recurrence rate of parastomal hernia after laparoscopic Sugarbaker repair remains relatively high.Furthermore,the recurrence rate after surgery for recurrent parastomal hernias is significantly higher than that after the initial surgery,with inadequate lateral mesh coverage being one of the major contributing factors.This study was performed to analyze the efficacy of two-point mark-guided laparoscopic Sugarbaker repair in patients with terminal colostomy parastomal hernia,so as to provide evidence-based references for clinical practice. Methods:The clinical data of 120 patients with terminal colostomy parastomal hernia,who underwent laparoscopic Sugarbaker repair guided by the two-point mark of mesh at the Department of Hernia and Obesity Surgery,the First Affiliated Hospital of the University of Science and Technology of China,from January 2015 to December 2023,were retrospectively collected.The parastomal hernias were classified according to the European Hernia Society classification.Postoperative symptomatic and radiological recurrence rates were analyzed,as well as the incidence of complications such as bowel obstruction,stoma infection,and intestinal fistula in recurrent and non-recurrent patients. Results:Of the 120 patients,2(1.7％)were lost to follow-up.The mean follow-up duration was 48(6-96)months.The postoperative symptomatic recurrence rate was 5.1％(6/118),and the radiological recurrence rate was 6.8％(8/118).There were no statistically significant differences between recurrent(n=8)and non-recurrent patients(n=110)in terms of sex,age,body mass index(BMI),or hernia defect size(all P＞0.05),but the operative time in recurrent patients was longer than that in non-recurrent patients(P＜0.05).The overall postoperative complication rate was 8.5％(10/118),including stoma skin-mucosa separation(3 cases),stoma infection(2 cases),delayed bowel obstruction(2 cases),early bowel obstruction(1 case),hernia sac effusion(1 case),and delayed fistula formation in the hernia sac cavity(1 case).According to the Clavien-Dindo classification,there were 6 cases of grade Ⅱ,3 cases of gradeⅢa,and 1 case of grade Ⅳ complications.There were no statistically significant differences between patients with and without complications regarding sex,BMI,hernia defect size,operative time,and comorbidities(all P＞0.05);however,patients with complications were older than those without(P＜0.05). Conclusion:The application of laparoscopic Sugarbaker repair under the guidance of two-point mesh identification can effectively reduce the recurrence rate of parastomal hernia and It has high clinical applicability.

Cardiotoxicity caused by postoperative radiotherapy can increase the risk of cardiovascular adverse events in patients with breast cancer, especially those with left breast cancer, which is proportional to the dose of radiation to the heart. It has been proved that deep inspiration breath-hold (DIBH) technique can significantly reduce the cardiac dose in patients with left breast cancer, but the benefits of this technique vary greatly among different patients, and its implementation requires additional equipment, time, manpower and other resources. Hence, it is necessary to select patients who are suitable for this technique in advance. In addition to comprehensive analysis of general factors before simulation positioning that affect DIBH selection, this review also systematically summarized relevant indicators of CT simulation positioning images. These anatomical indicators included the measurement of the cardiac contact distances in parasagittal (CCD ps) plane, the lateral heart-to-chest distance (HCD), the product of maximum heart width (HW max) and the maximum heart depth (HD max) during CT simulation positioning, and the maximum heart distance, heart volume in the irradiation field (HVIF), the difference of lung volume and heart volume between free breathing (FB) and DIBH measured after CT localization. All of them showed some instructive significance for evaluating whether DIBH should be applied in tangent field based radiotherapy planning. The automatic planning (rapid plan) function in the treatment planning system could quickly predict the benefit of DIBH for breast cancer patients. The purpose of this article is to help clinicians select patients who are suitable for DIBH technique, guaranteeing that DIBH technique resources can be used reasonably.

Objective To observe the effects of tetrandrine on the proliferation,migration,and invasion of melanoma cell B16,and to explore its effects on epithelial mesenchymal transition(EMT)and potential regulatory mechanisms.Methods(1)The proliferation of B16 cells was detected by CCK-8 assay after 0,2,4,6,8 and 10 μmol·L-1 of tetrandrine intervention for 24 and 48 hours.The colony formation ability of B16 cells was detected by plate clone formation assay after 1,2 and 4 μmol·L-1 of tetrandrine intervention;the migration and invasion ability of B16 cells was detected by cell scratch assay and Transwell invasion assay;the expressions of N-cadherin,Vimentin and E-cadherin related to EMT in B16 cells were detected by Western Blot assay.The mouse melanoma lung metastasis model was replicated by tail vein injection of B16 cells to observe the effects of tetrandrine(50 and 100 mg·kg-1)administered by gavage on the number of metastatic tumor nodules in the lungs of mice.(2)The CTD,SwissTargetPrediction and Similarity Ensemble Approach databases were used to predict the targets of tetrandrine;the GeneCards database was used to search for targets related to melanoma disease;the intersection of these two databases was taken as the potential target of tetrandrine for melanoma treatment.The intersected targets were imported into STRING database to construct protein-protein interaction(PPI)network and screen the core targets;the intersected targets were imported into DAVID database for GO function and KEGG pathway enrichment analysis;and molecular docking between tetrandrine and the core targets was verified by Autodock software.(3)In vivo experimental validation:after intervention of 1,2 and 4 μmol·L-1 tetrandrine,Western Blot method was used to detect the expression of the key pathway AKT/NF-κB/CREB pathway-related proteins;and AKT agonist SC79 was used to validate the replication experiments.Results(1)The IC50 of B16 cells intervened by tetrandrine was 4.273 and 4.085 μmol·L-1 at 24 and 48 hours.Compared with the control group,the colony forming ability,scratch healing rate and invasion rate of cells in the 1,2 and 4 μmol·L-1 tetrandrine group were all significantly reduced(P＜0.05,P＜0.01,P＜0.001);the expressions of cellular Vimentin and N-cadherin protein expressions were significantly down-regulated(P＜0.01,P＜0.001),and E-cadherin protein expression was significantly up-regulated(P＜0.01,P＜0.001).Compared with the model control group,the number of melanoma lung metastatic nodules was significantly reduced in the mice in the high-dose group of tetrandrine(P＜0.05).(2)A total of 60 potential targets were obtained for the treatment of melanoma with tetrandrine;core targets such as AKT1,TNF,CCND1,RELA,CASP9,CHUK,and CREBBP were further screened,among which AKT1 was the most strongly interacting target;the signaling pathways such as apoptosis,FoxO,TNF,PI3K-AKT,and NF-κB were mainly involved.The molecular docking showed that tetrandrine had strong binding activity with AKT1,TNF,RELA and other core targets.Compared with the control group,protein expressions of p-AKT/AKT,p-NF-κB p65/NF-κ B p65,and p-CREB/CREB were significantly down-regulated in the cells of the tetrandrine 1,2,and 4 μmol·L-1 groups(P＜0.05,P＜0.01);protein expressions of p-AKT and p-NF-κB p65 were significantly up-regulated in the cells of the SC79 group(P＜0.001).Compared with the SC79 group,protein expressions of p-AKT,p-NF-κB p65,and p-CREB were significantly down-regulated in the cells of the 2 μmol·L-1 tetrandrine+ SC79 group(P＜0.001).Conclusion Tetrandrine may inhibit the proliferation,migration,invasion and EMT of mouse melanoma by regulating the AKT/NF-κB/CREB pathway,and thus inhibit the lung metastasis of mouse melanoma.

Objective:To evaluate the clinical significance of our self-designed three-column scoring system for postoperative X-ray stability of intertrochanteric fracture after intramedullary nailing.Methods:A retrospective study was conducted of the 378 patients with intertrochanteric fracture who had been treated between January 2015 and June 2019 at Department of Orthopaedics, Linyi People's Hospital by internal fixation with proximal femoral nail antirotation (PFNA). They were 161 males and 217 females, aged from 60 to 97 years (average, 72.5 years). By the AO classification, there were 109 cases of type 31-A1, 188 cases of type 31-A2 and 81 cases of type 31-A3. Anteroposterior and lateral X-ray examinations of the hip were performed immediately after internal fixation to evaluate the fracture stability using our self-designed three-column scoring system by which the medial column is given 4 points, middle column 2 points and lateral column 2 points. A single column scoring full points is rated as stable, 3-column stability as excellent, 2-column stability as good, one-column stability as fair, and 3-column unstability as poor. Rehabilitation programs were carried out according to the results of stability evaluation: full weight bearing at an early stage was indicated for excellent patients, partial weight bearing at an early stage for good patients and weight bearing at an early stage contraindicated for fair or poor patients. Fracture union time and failure of internal fixation were recorded. The relationship between internal fixation failure and our three-column scoring system was calculated.Results:The 378 patients were followed up for 6 to 24 months (mean, 10.4 months). Of them, 365 obtained fracture union after an average time of 4.3 months (from 3 to 7 months). Internal fixation failure occurred in 13 patients, giving a failure rate of 3.4%(13/378).Of the 129 excellent patients by our three-column scoring system for post-operative X-ray stability of intertrochanteric fracture, none failed in internal fixation; of the 193 good patients, 4 failed; of the 56 fair patients, 9 failed. Internal fixation failure was closely related to our three-column scoring system for postoperative X-ray stability of intertrochanteric fracture ( r=-0.986, P=0.006), as well as to the column stability ( r=-1.000, P=0.033). Conclusion:Our self-designed three-column scoring system for postoperative X-ray stability of intertrochanteric fracture after intramedullary nailing can accurately reflect the fracture stability so that it can be used to guide rehabilitation programs for the patients and judge their prognosis.