Objective To explore the feasibility, safety, and efficacy of transesophageal endoscopic surgery for mediastinal tumors. Methods A retrospective analysis was conducted on the clinical data of 17 patients who underwent transesophageal endoscopic resection for benign mediastinal tumors at the Endoscopy Center of Zhongshan Hospital, Fudan University, between January 1, 2016 and December 31, 2024. Epidemiological characteristics, surgical parameters, adverse events, and follow-up outcomes were analyzed. Results Among the 17 patients, there were 9 males and 8 females, with an average age of (42.4±14.5) years and an average tumor size of (2.6±1.6) cm. Pathological types included esophageal duplication cysts (6 cases, 35.3%), bronchogenic cysts (5 cases, 29.4%), gastroenteric cysts (3 cases, 17.6%), schwannomas (2 cases, 11.8%), and lymphangioma (1 case, 5.9%). Fourteen patients (82.4%) underwent submucosal tunneling endoscopic resection (STER), 3 patients (17.6%) underwent natural orifice transluminal endoscopic mediastinal surgery. All surgeries were successfully completed without conversion to open surgery. En bloc resection was achieved in 11 patients (64.7%), with an average operative time of (60.9±32.6) min. No intraoperative bleeding or mucosal injury occurred, and 4 patients (23.5%) experienced minor complications (pneumothorax, fever, recurrent laryngeal nerve injury), all of which resolved with conservative treatment. The average postoperative hospital stay was (3.2±1.5) days, and no recurrence was observed during the follow-up period. Conclusions Transesophageal endoscopic resection of benign mediastinal tumors is a safe, effective, and minimally invasive treatment method. Further validation of its efficacy and safety through large-scale prospective studies is warranted.

Modulating Tankyrases (TNKS), interactions with USP25 to promote TNKS degradation, rather than inhibiting their enzymatic activities, is emerging as an alternative/specific approach to inhibit the Wnt/β-catenin pathway. Here, we identified UAT-B, a novel neoantimycin analog isolated from Streptomyces conglobatus, as a small-molecule inhibitor of TNKS-USP25 protein-protein interaction (PPI) to overcome multi-drug resistance in colorectal cancer (CRC). The disruption of TNKS-USP25 complex formation by UAT-B led to a significant decrease in TNKS levels, triggering cell apoptosis through modulation of the Wnt/β-catenin pathway. Importantly, UAT-B successfully inhibited the CRC cells growth that harbored high TNKS levels, as demonstrated in various in vitro and in vivo studies utilizing cell line-based and patient-derived xenografts, as well as APC^min/+ spontaneous CRC models. Collectively, these findings suggest that targeting the TNKS-USP25 PPI using a small-molecule inhibitor represents a compelling therapeutic strategy for CRC treatment, and UAT-B emerges as a promising candidate for further preclinical and clinical investigations.

Objective To discuss the effect of PI3K-AKT signaling pathway regulated by microRNA-155(miRNA-155)targeted protein tyrosine phosphatase non-receptor type 21(PTPN21)on the proliferation,migration and invasion of hepatocellular carcinoma(HCC)cells.Methods Lentivirus transfection was used to silence the expression of miRNA-155 in human Huh7 HCC cells,and real-time fluorescent quantitative polymerase chain reaction(RT-qPCR)was used to detect the silencing effect of miR-155.After obtaining stable cell lines,the cell lines were randomly divided into Blank group(normal Huh7 cells),shNC group(Huh7 cells+empty miR-155 vector),sh-miR-155(Huh7 cells+miR-155 silencing),sh-miR-155+Recilisib group(Huh7 cells+miR-155 silencing+PI3K-AKT agonist),shNC+Recilisib group(Huh7 cells+empty miR-155 vector+PI3K-AKT agonist).Dual luciferase assay was used to determine whether PTPN21 was the downstream of miR-155.The cell proliferation ability of cells in each group was detected by MTT assay.The apoptosis level of each group was tested by flow cytometry.The invasion and migration ability of cells was assessed by Transwell assay.Western blot analysis was used to observe the differences in protein expression of PTPN21,PI3K,P-PI3K,AKT,P-AKT,and apoptosis-related proteins including BAX,BCL-2 and caspase-3 in all groups.Results The expression level of miR-155 in sh-miR-155 group was lower than that in Blank group and shNC group(P＜0.000 1),and the difference in miR-155 expression level between Blank group and shNC group was not statistically significant(P＞0.05).MTT results showed that A values of Huh7 cells at 2,3,4 and 5 day in sh-miR-155 group were lower than those in Blank group and shNC group(P＜0.000 1),while these differences between Blank group and shNC group were not statistically significant(P＞0.05).In sh-miR-155 group the A values at 2,3,4 and 5 day were lower than those in sh-miR-155+Recilisib group and shNC+Recilisib group(P=0.0052 and P＜0.0001,respectively),while the A values at 2,3,4 and 5 day in sh-miR-155+Recilisib were lower than those in shNC+Recilisib group(P＜0.000 1).There was no significant differences in cell migration and number of invasion cells between the Blank group and shNC group(P＞0.05).After activation of PI3K-AKT signaling pathway,the migration and invasion capacity of HCC cells in the shNC+Recilisib group were significantly enhanced when compared with the Blank group(P＜0.000 1).In contrast,the number of migrated and invaded Huh7 cells after miR-155 silencing was significantly lower than that in the Blank group and shNC group(P＜0.000 1)and this phenomenon became reversed by PI3K agonist.Compared with the sh-miR-155 group,in the sh-miR-155+Recilisib group the migration and invasion ability of HCC cells was enhanced(P=0.000 2).Lentiviral transfection of Huh7 human HCC cells to silence miR-155 and downregulate miR-155 inhibiting PTPN21 regulation of the PI3K-AKT signaling pathway,thus inhibiting the invasion,migration and proliferation ability of HCC cells and promoting the apoptosis of HCC cells.Conclusion miR-155 inhibits the migration,invasion and proliferation of HCC cells through targeting PTPN21 regulation of PI3K-AKT signaling pathway.The miR-155 may be a potential therapeutic target for HCC in the future.(J Intervent Radiol,2024,32:44-51)

Objectives:The purpose of this cross-sectional study was to determine the predictive value of measuring awake blood pressure(BP)at different time points on nocturnal hypertension by ambulatory blood pressure monitoring(ABPM)device in patients with hypertension. Methods:A total of 204 consecutive hypertensive outpatients seeking medical care at the First Affiliated Hospital of Fujian Medical University from April 2023 to July 2023 were enrolled.We measured office BP and out-office BP.Out-office BP include evening BP,bedtime BP,morning BP and mean morning BP which were measured by ABPM device and BP daily record.Nocturnal hypertension was defined by the mean nocturnal systolic blood pressure≥120 mmHg(1 mmHg=0.133 kPa).ROC curve analyses of different awake blood pressure was established to identify significant correlates to nocturnal hypertension.The serial test was also performed.The value of the two indexes in predicting nocturnal hypertension was compared.The predictors of nocturnal hypertension were evaluated by multivariate analysis. Results:Of the 204 subjects,104(51.0%)had nocturnal hypertension.The repeated measures analysis of variance(ANOVA)showed that mean nighttime systolic BP and bedtime systolic BP were similar(P=0.641).Nocturnal hypertension was present in 75.7%(84/111)of patients with bedtime systolic BP≥120 mmHg,in 94.2%(49/52)of patients with bedtime systolic BP≥135 mmHg and in 88.2%(75/85)of patients with mean morning systolic BP≥135 mmHg.ROC curve analyses showed that the diagnostic accuracy of mean morning systolic BP(AUC 0.903,P＜0.05)for subjects with nocturnal hypertension was significantly superior to that of office systolic BP,evening systolic BP,bedtime systolic BP,morning systolic BP.Multivariate logistic regression analysis revealed that mean morning systolic BP and bedtime systolic BP were significantly associated with a higher risk of nocturnal hypertension(P＜0.05).ROC curve analyses of predicted probability of bedtime systolic BP and mean morning systolic BP showed higher diagnostic accuracy(AUC 0.929,P＜0.05).The serial test showed that nocturnal hypertension was present in 98.0%(49/50)of patients with bedtime systolic BP≥130 mmHg and mean morning systolic BP≥135 mmHg. Conclusions:Mean morning BP and bedtime BP are significant correlates of nocturnal hypertension in patients with hypertension,and combined mean morning BP with bedtime BP showed higher diagnostic accuracy,which might used for predicting nocturnal hypertension with high efficiency.

Purpose To explore the clinicopathological features of cholangitis lenta.Methods The clinical data of 12 patients with cholangitis Lenta were collected,HE staining,his-tochemical staining and immunohistochemistry were used to de-tect the clinicopathological changes in 12 cases of cholangitis lenta,and the relevant literature was reviewed.Results All the 12 patients with cholangitis Lenta had acute history and ab-normal liver function,9 cases(75.0％)had abnormal white blood cell count,11 cases(91.7％)had abdominal infection,8 cases(66.7％)had systemic inflammatory response syndrome(SIRS)and 8 cases(66.7％)were diagnosed as sepsis.The common pathological manifestations included spotty necrosis(100％),piecemeal necrosis(100％),confluent necrosis(75.0％),bridging necrosis(66.7％),hepatocyte and capil-lary cholestasis(75.0％),and mild edema in portal area(33.3％).12 cases showed proliferation of bile ductules around the portal area,inspissated bile in dilated bile ductules and no cholestasis in interlobular bile ducts.12 cases had the basis of primary liver disease.2 patients(16.7％)died after being transferred to another hospital for treatment,and 10 patients(83.3％)survived,which lasted for 7 to 55 months.Conclu-sion Cholangitis Lenta shows unique clinical manifestations and morphological features,it is often accompanied by underly-ing diseases.The pathological manifestation of cholangitis Lenta in liver biopsy suggests that patients may have sepsis and/or ab-dominal infection,and therefore its diagnosis should be com-bined with clinical features,laboratory examination and imaging manifestations.

Objective:To explore the effect of comprehensive moxibustion with Huolong cupping in patients with lung-spleen qi deficiency type allergic rhinitis.Methods:This study was a randomized controlled trial. From October 2022 to April 2023, convenience sampling was used to select 66 patients with lung-spleen qi deficiency type allergic rhinitis who visited the Otolaryngology Head and Neck Clinic of Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine as the research subject. The patients were randomly divided into an experimental group ( n=33) and a control group ( n=33). Both groups received routine oral Chinese medicine treatment. On the basis of routine treatment, the experimental group performed comprehensive moxibustion with Huolong cupping on the meridians of the Du meridian and bladder meridian. This study compared the scores of Nasal Airway Resistance (NAR), Total Nasal Symptom Score (TNSS), Visual Analogue Scale (VAS), and Chinese version of Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) between two groups of patients before and after intervention. Results:Eventually 30 patients in each of the experimental group and control group completed the study. After intervention, the NAR score of the experimental group was lower than that of the control group, and the difference was statistically significant ( P<0.05). Repeated measures analysis of variance showed that with the increase of treatment time, the TNSS, VAS, and RQLQ scores of the experimental group were lower than those of the control group with statistical differences ( P<0.05), and the time effect, inter group effect, and interaction effect were statistically significant ( P<0.05) . Conclusions:Huolong cupping comprehensive moxibustion can reduce nasal resistance, meliorate nasal symptoms and accompanying nasal symptoms, and improve the quality of life of patients.

Objective:To investigate the risk factors of postoperative continuous renal replacement therapy application in Stanford type A acute aortic dissection.Methods:This retrospective study included 527 patients with Stanford type A acute aortic dissection from November 2015 to February 2018 in Beijing Anzhen Hospital. They were divided into 2 groups according to whether or not needed postoperative continuous renal replacement therapy, group CRRT(78 cases) and group None CRRT(449 cases). Binary logistic regression analysis was used to analyze the risk factors of continuous renal replacement therapy. Results:Of all the patients, the percentage of using continuous renal replacement therapy was 14.8%(78/527), and the mortality of 30 days after surgery was 8.5%(45/527). The independent risk factors associated with CRRT were preoperative serum creatinine(sCr)( OR=1.012, 95% CI: 1.005-1.019, P<0.001), transfusion of red blood cell in surgery( OR=1.141, 95% CI: 1.071-1.216, P<0.001), transfusion of platelet in surgery( OR=1.307, 95% CI: 1.084-1.576, P=0.005), the total amount of drainage( OR=1.000, 95% CI: 1.000-1.000, P=0.036), and the time of extubation after surgery( OR=1.004, 95% CI: 1.001-1.008, P=0.013). Conclusion:The risk factors of CRRT after emergency surgery of Stanford type A acute aortic dissection are preoperative serum creatinine, transfusion of red blood cell in surgery, transfusion of platelet in surgery, the total amount of drainage and the time of tracheal extubation after surgery. We need to focus on those risk factors in our daily job and manage them timely and properly, in order to improve patients’ prognosis.

Objective:To investigate the correlation between the expressions of miR-524-5p and sex determining region Y box protein 9 (SOX9) in advanced gastric cancer and their influences on the efficacy and prognosis of chemotherapy.Methods:A total of 82 patients diagnosed as advanced gastric cancer who received DCF (docetaxel + cisplatin + fluorouracil) chemotherapy in 910th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army from January 2015 to December 2017 were selected as the research objects. The expression levels of miR-524-5p and SOX9 in gastric cancer tissues were detected by fluorescence quantitative PCR. The correlation between the expressions of miR-524-5p and SOX9 was analyzed, the total effective rates of chemotherapy in patients with different miR-524-5p and SOX9 expression levels were compared, and the predictive value of miR-524-5p combined with SOX9 on the efficacy of chemotherapy was analyzed. Overall survival (OS) and progression-free survival (PFS) were analyzed.Results:The expressions of miR-524-5p and SOX9 were not related to gender or age of patients with advanced gastric cancer (all P>0.05), but were related to the degree of differentiation ( χ2=3.577, P=0.001; χ2=5.654, P<0.001) and distant metastasis ( χ2=2.466, P=0.016; χ2=5.218, P<0.001) of patients with advanced gastric cancer. There was a negative correlation between the expressions of miR-524-5p and SOX9 in advanced gastric cancer ( r=-0.348, P=0.001). According to the median expressions of miR-524-5p and SOX9 in gastric cancer tissues, patients were divided into high expression and low expression groups, miR-524-5p≥0.64 was high expression ( n=41), <0.64 was low expression ( n=41), SOX9≥1.84 was high expression ( n=41), and <1.84 was low expression ( n=41). The total effective rate of advanced gastric cancer patients with high expression of miR-524-5p was 58.54% (24/41), which was higher than that of patients with low expression of miR-524-5p (24.39%, 10/41), and there was a statistically significant difference ( χ2=9.484, P=0.002). The total effective rate of advanced gastric cancer patients with high expression of SOX9 was 21.95% (9/41), which was lower than 60.97% (25/41) of patients with low expression of SOX9, and there was a statistically significant difference ( χ2=12.863, P<0.001). Receiver operating characteristic curve analysis showed that the expressions of miR-524-5p and SOX9 had predictive value for the efficacy of chemotherapy, and the area under the curve was 0.753 (95% CI: 0.644-0.861, P<0.001) and 0.660 (95% CI: 0.540-0.780, P=0.014) respectively. The combination of miR-524-5p and SOX9 had predictive value for the efficacy of chemotherapy, and the area under the curve was 0.768 (95% CI: 0.667-0.868, P<0.001). The median PFS and OS of patients with high expression of miR-524-5p were 8 months and 14 months, which were longer than those of patients with low expression of miR-524-5p (6 months, 9 months), and there were statistically significant differences ( χ2=21.160, P<0.001; χ2=29.730, P<0.001). The median PFS and OS of patients with high expression of SOX9 were 7 months and 10 months, which were shorter than those of patients with low expression of SOX9 (8 months, 12 months), and there were statistically significant differences ( χ2=6.345, P=0.012; χ2=4.107, P=0.043). Conclusion:There is a negative correlation between the expressions of miR-524-5p and SOX9 in advanced gastric cancer tissues. The chemotherapy efficacy and prognosis of patients with high expression of miR-524-5p and low expression of SOX9 are better than those of patients with low expression of miR-524-5p and high expression of SOX9.

Objective:To examine the effects of low-dose Esketamine on circulatory function, respiratory function and pain in elderly patients undergoing peripheral vascular interventions, and to provide evidence for appropriate and safe use of Esketamine in elderly patients under anesthesia.Methods:Forty elderly patients with iliac artery stenosis at Beijing Anzhen Hospital affiliated to the Capital Medical University were enrolled and treated with balloon percutaneous transluminal angioplasty(PTA)and stent implantation on a selective basis.Among them, 33 were male and 7 were female with American Society of Anesthesiologists(ASA)physical classification of Ⅱ-Ⅲ.The patients were randomly divided into two groups(20 in each group)using the randomized number method, with the control group(Group C)given 2 ml normal saline intravenously and the Esketamine group(Group L)given Esketamine 0.25 mg/kg intravenously(slow intravenous administration within 1 min). Values of arterial blood pressure and heart rate in stabilized condition in the operating room were collected as the baseline(T0). Five minutes before the surgeon dilated the stenosed iliac artery, intravenous anesthetics were given in both groups as required for the trial.The first 5 minutes before dilatation of the stenosed iliac artery was used as T1, the first 4 minutes as T2, and the first 3 minutes as T3.The recording continued until the 25th minute after anesthetic administration as T30, with a collection of 25-minute blood pressure and heart rate values for analysis.Blood gas analysis was made for arterial blood samples drawn at the time patients entered the operating room(M1), 5 minutes after drug administration(M2), and 10 minutes after drug administration(M3). For all patients, the pain level was recorded using a self-reported scale while the iliac artery was dilated.The doses of vasoactive drugs were recorded from the beginning of the dilatation of the iliac artery to the end of the procedure in patients.Results:In Group C, PaO 2 at M2 was elevated compared with at M1( P=0.003); In Group L, PaCO 2 at M2 was elevated compared with at M1( P=0.011). At T4, systolic blood pressure and diastolic blood pressure were elevated in Group L compared with Group C, and the differences were statistically significant( t=2.403, 2.119, all P<0.05); At T3, heart rate was elevated in Group L compared with Group C, with a statistically significant difference( t=0.789, P=0.007); Compared with Group C, systolic blood pressure was lower in Group L from T6 to T15, with statistically significant differences( t=3.143, 2.403, 2.272, 3.460, 2.610, 2.568, 2.453, 2.367, 2.282, and 2.187, all P<0.05). Diastolic blood pressure was lower in Group L from T8 to T16, with statistically significant differences( t=3.880, 6.602, 2.967, 3.243, 2.641, 3.253, 3.114, 4.521, and 2.659, all P<0.05), and from T7 to T13, the heart rate was lower in Group L, and the differences were statistically significant( t=2.246, 3.285, 3.207, 2.752, 2.725, 2.713, and 2.473, all P<0.05). Compared with Group C, the incidence of dilatation pain in patients with iliac artery stenosis in Group L was lower, and the difference was statistically significant( χ2=6.140, P=0.030). Doses of vasoactive drugs in both groups, including raceanisodamine hydrochloride, norepinephrine, esmolol, and nicardipine, were lower in Group L, and the differences were statistically significant( t=3.573, 7.883, 3.889, and 6.665, P=0.039, 0.001, 0.046, and 0.006). Conclusions:Low-dose Esketamine causes mild respiratory depression and low circulatory excitation in elderly patients with iliac artery stenosis undergoing PTA, and also reduces painful irritation during blood vessel dilatation in elderly patients.

Psoriatic arthritis is a chronic systemic autoimmune disease, characterized by psoriasis skin lesions and inflammation of the spine and joint. It has complicated clinical manifestations and individual variations. Nearly half of the patients will have joints erosion in two years, which is crippling. The severity of the skin and joint disease frequently do not correlate with each other. Currently, the understanding of the disease is insufficient in China with the lack of standardized diagnosis and treatment. Therefore, researchers from the Chinese Rheumatology Association formulated this specification based on the diagnosis and management experience together with guidelines at home and abroad. The specification summarizes the present situation of domestic diagnosis and treatment, aiming to standardize the diagnosis process and treatment protocols of psoriatic arthritis. Furthermore, it can reduce misdiagnosis and missed diagnosis, as well as improve the prognosis.