Objective To investigate whether 3D-guided cone-shaped segmentectomy can achieve comparable long-term outcomes with lobectomy for deep early-stage lung cancer with diameter≤2 cm. Methods We retrospectively screened patients with deep early-stage non-small cell lung cancer (NSCLC) with diameter≤2 cm who underwent lobectomy or segmentectomy in the First Affiliated Hospital of Nanjing Medical University from 2012 to 2018. All pulmonary segmentectomy was performed using 3D-guided cone-shaped segmentectomy with segment or subsegment as the resection unit. Univariate and multivariate regression analyses were performed by Cox proportional hazard regression model. The patients who underwent segmentectomy and lobectomy were matched 1∶1 by propensity-score matching analysis. The oncological outcomes of two groups were compared. Results Our cohort was divided into a segmentectomy group (n=222) and a lobectomy group (n=127). The age, total nodule size, solid component size and proportion of pure solid nodule in the lobectomy group were significantly higher than those in the segmentectomy group. The median follow-up time was 49 months. Surgical margins were negative in all patients. The local recurrence rate of segmentectomy was 0.45%. The disease-free survival (DFS) rate and overall survival (OS) rate of patients in the segmentectomy group were significantly better than those in the lobectomy group (5-year DFS rate: 98.64% vs. 89.77%, P<0.001; 5-year OS rate: 99.55% vs. 92.10%, P<0.001). Multivariate regression analysis showed that the differences between two groups were not significant [DFS rate: HR=0.52. 95%CI (0.11, 2.59), P=0.427; OS rate: HR=0.08. 95%CI (0.00, 3.24), P=0.179] after adjusting for other factors. After propensity score matching, 77 patients were preserved in both segmentectomy group and lobectomy group, with the mean nodule size of 1.44 cm and 1.49 cm and the mean consolidation tumor ratio (CTR) of 0.46 and 0.52, respectively. There was no statistical difference in DFS rate (P=0.640) or OS rate (P=0.310) between the two groups. Conclusion 3D-guided cone-shaped segmentectomy can be an acceptable treatment for low-grade malignant NSCLC deep in lung parenchyma with diameter≤2 cm, and its oncology effect is not inferior to lobectomy.

Objective:To analyze predictive risk indicators associated with the development of Kümmell's disease (KD) in patients with osteoporotic vertebral compression fractures (OVCFs).Methods:A 1∶1 frequency-matched case-control study design was employed, selecting patients who visited the Department of Spine Surgery at Liuzhou Workers' Hospital from January 2021 to June 2023. Patients were divided into case and control groups based on whether they progressed to Kümmell's disease (KD). Detailed demographic information, comorbidities, and laboratory data were collected, and baseline characteristics of the two groups were compared. Initial predictive variables significantly associated with the target variable were preliminarily screened through univariate analysis. A correlation heatmap was then constructed to assess collinearity among these variables, followed by further selection of potential predictors using the Lasso regression model. Finally, a multivariable logistic regression model was used for the prediction and analysis of KD-related risk indicators.Results:Univariate analysis identified significant predictors of Kümmell's disease, including patient age, bone mineral density, kyphotic Cobb angle, and multiple vertebral fractures. These were included in the subsequent Lasso regression analysis, which identified key predictors with non-zero coefficients: age, bone density, Cobb angle, multiple vertebral fractures, platelet count (PLT), aspartate aminotransferase/alanine aminotransferase (AST/ALT), albumin (Alb), albumin/globulin ratio (Alb/Glb), alkaline phosphatase (ALP), urea (UREA), serum uric acid (SUA), fibrinogen (Fn), blood glucose (BG), and C-reactive protein (CRP). The correlation heatmap revealed the correlation and collinearity risks between these variables, with ALT and AST/ALT showing a high correlation ( r=0.750) and PLT and Alb showing a low correlation ( r=-0.110). Multivariable logistic regression indicated that the presence of multiple vertebral fractures [ OR=2.078, 95% CI (1.072, 4.025), P=0.030], increased Cobb angle [ OR=1.033, 95% CI (1.008, 1.058), P=0.009], elevated levels of ALP [ OR=1.013, 95% CI(1.004, 1.023), P=0.006], and SUA [ OR=1.004, 95% CI (1.000, 1.007), P=0.043] were associated with an increased risk of KD in patients with OVCFs. Conversely, decreased levels of Fn [ OR=0.996, 95% CI (0.992, 0.999), P=0.008] were linked to an increased risk of KD. Conclusion:Multiple vertebral fractures, increased Cobb angle, elevated levels of ALP and SUA, along with decreased levels of Fn, can be used as early-warning indicators to predict whether patients with OVCFs will develop KD. Monitoring these indicators is crucial for the early detection and intervention in these patients.

Background and objective Current studies suggest that for early-stage lung cancers with a component of ground-glass opacity measuring ≤2 cm,sublobar resection is suitable if it ensures adequate margins.However,lobectomy may be necessary for some cases to achieve this.The aim of this study was to explore the impact of size and depth on surgical techniques for wedge resection,segmentectomy,and lobectomy in early-stage lung cancer ≤2 cm,and to determine methods for ensuring a safe resection margin during sublobar resections.Methods Clinical data from 385 patients with early-stage lung can-cer ≤2 cm,who underwent lung resection in 2022,were subject to a retrospective analysis,covering three types of procedures:wedge resection,segmentectomy and lobectomy.The depth indicator as the OA value,which is the shortest distance from the inner edge of a pulmonary nodule to the opening of the corresponding bronchus,and the AB value,which is the distance from the inner edge of the nodule to the pleura,were measured.For cases undergoing lobectomy and segmentectomy,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was performed to statistically determine the number of subsegments required for segmentectomy.The cutting margin width for wedge resection and segmentectomy was recorded,as well as the specific subsegments and their quantities removed during lung segmentectomy were documented.Results In wedge resection,segmentectomy,and lobectomy,the sizes of pulmonary nodules were(1.08±0.29)cm,(1.31±0.34)cm and(1.50±0.35)cm,respectively,while the depth of the nodules(OA values)was 6.05(5.26,6.85)cm,4.43(3.27,5.43)cm and 3.04(1.80,4.18)cm for each procedure,showing a progressive increasing trend(P＜0.001).The median resec-tion margin width obtained from segmentectomy was 2.50(1.50,3.00)cm,significantly greater than the 1.50(1.15,2.00)cm from wedge resection(P＜0.001).In wedge resections,cases where AB value＞2 cm demonstrated a higher proportion of cases with resection margins less than 2 cm compared to those with margins greater than 2 cm(29.03％vs 12.90％,P=0.019).When utilizing the size of the nodule as the criterion for resection margin,the instances with AB value＞2 cm continued to show a higher proportion in the ratio of margin distance to tumor size less than 1(37.50％vs 17.39％,P=0.009).The median number of subsegments for segmentectomy was three,whereas lobectomy cases requiring segmentectomy involved five subsegments(P＜0.001).Conclusion The selection of the surgical approach for lung resection is influenced by both the size and depth of pulmonary nodules.This study first confirms that larger portions of lung tissue must be removed for nodules that are deeper and larger to achieve a safe margin.A distance of ≤2 cm from the inner edge of the pulmonary nodule to the nearest pleura may be the ideal indication for performing wedge resection.

Objective:To analyze the short-term effects of prophylactic intraperitoneal hyperthermic chemotherapy(HIPEC)on elderly patients diagnosed with gastric cancer.Methods:The study enrolled patients with gastric cancer who underwent curative gastrectomy combined with postoperative HIPEC at Beijing Hospital between January 2017 and September 2022.The patients were divided into two groups based on age: young patients(age <65 years, n=45)and elderly patients(age≥65 years, n=32). The study evaluated the safety of HIPEC prophylactic application in elderly patients with gastric cancer by comparing their clinicopathological data, postoperative recovery, complications, and laboratory tests with those of another group of patients.Results:The study found that the elderly patients had a higher rate of comorbidities and higher ASA scores compared to the younger patients.Additionally, the elderly patients received HIPEC treatment less frequently than the younger patients( P=0.030). The proportion of young patients receiving one, two, and three times of HIPEC treatment was 8.9%, 57.8%, and 33.3%, respectively, while the proportion of elderly patients receiving the same was 28.1%, 59.4%, and 12.5%, respectively.The study found no significant differences in pathological characteristics between the two groups, including tumor stage, type, location, and differentiation degree.Additionally, there was no difference in the proportion of laparoscopic gastrectomy, type of resection, combined resection, duration of the operation, and intraoperative blood loss between elderly and young patients.The rate of complications between the two groups was also not significantly different(20.0% vs.21.9%; P=0.100). The mean duration of hospitalization after radical gastrectomy was 14.0 days in the young group and 15.5 days in the elderly group, respectively( P=0.480). Conclusions:Elderly patients with gastric cancer treated with radical gastrectomy combined with HIPEC did not experience increased postoperative complications or hospital stay compared to young patients, suggesting that prophylactic HIPEC was safe and feasible for elderly patients with locally advanced gastric cancer, as evidenced by favorable postoperative recovery and laboratory tests.

【Objective】 To establish a digital model of lumbar 4 and lumbar 5 vertebral bodies through three-dimensional imaging technology so as to explore the precise placement of pedicle screws during the lumbar posterior internal fixation operation. 【Methods】 CT scan image data set of lumbar spine included six specimens. Then lumbar modeling was produced using Mimics software， implanting pedicle screws was simulated with the computer to determine the reliability of pedicle screw for herringbone crest method， Weinstein method， and Magerl method. 【Results】 This study included six specimens （4 males and 2 females）， with an average age of 42.83 years. The distance from the right Magerl entry point to the actual entry point of the lumbar 4 vertebrae was significantly greater than that of the left side. The distance from the left herringbone crest entry point of lumbar 4 vertebrae to the actual entry point was significantly greater than Weinstein method and Magerl method （P<0.001 and P<0.001）， and the distance from the right herringbone crest entry point of lumbar 4 vertebrae to the actual entry point was significantly greater than Weinstein method （P=0.003）. Both left and right abduction angles of lumbar 4 vertebrae were true abduction angle >Magerl abduction angle > Weinstein abduction angle > herringbone abduction angle. The distances of true-Weinstein and true-herringbone ridges on the left side of lumbar 5 vertebrae were significantly greater than those on the right side （P=0.002 and P=0.004）， and the Weinstein abduction angle on the right side of lumbar 5 vertebrae was greater than that on the left side （P=0.003）. For the left and right sides of lumbar 5 vertebrae， the distance from herringbone crest entry point to the actual entry point was significantly greater than that of Weinstein method and Magerl method （P<0.001 and P<0.001）， and the distance from the Magerl entry point to the real entry point was significantly greater than that of the Weinstein method. The abduction angle of left and right sides of lumbar 5 vertebrae was as follows： true abduction angle > Magerl abduction angle > Weinstein abduction angle > herringbone abduction angle. 【Conclusion】 Both Weinstein entry point and Magerl entry point for lumbar 4 and lumbar 5 vertebra are close to the real entry point. The Weinstein abduction angle and Magerl abduction angle of lumbar 4 and lumbar 5 vertebrae have minor differences compared with real abduction angle. Therefore， it is recommended that Weinstein method is the preferred choice for lumbar 4 pedicle screw placement， while Weinstein method or Magerl method is the preferred choice for lumbar 5 pedicle screw placement.

Zwitterionic sulfobetaine-based monolithic stationary phases have attracted increasing attention for their use in hydrophilic interaction chromatography.In this study,a novel hydrophilic polymeric monolith was fabricated through photo-initiated copolymerization of 3-(3-vinyl-1-imidazolio)-l-propanesulfonate(SBVI)with pentaerythritol triacrylate using methanol and tetrahydrofuran as the porogenic system.Notably,the duration for the preparation of this novel monolith was as little as 5 min,which was significantly shorter than that required for previously reported sulfobetaine-based monoliths prepared via conventional thermally initiated copolymerization.Moreover,these monoliths showed good morphology,permeability,porosity(62.4％),mechanical strength(over 15 MPa),column efficiency(51,230 plates/m),and reproducibility(relative standard deviations for all analytes were lower than 4.6％).Mechanistic studies indicated that strong hydrophilic and negative electrostatic interactions might be responsible for the retention of polar analytes on the zwitterionic SBVI-based monolith.In particular,the resulting monolith exhibited good anti-protein adhesion ability and low nonspecific protein adsorption.These excellent features seem to favor its application in bioanalysis.Therefore,the novel zwitterionic sulfobetaine-based monolith was successfully employed for the highly selective separation of small bioactive compounds and the efficient enrichment of N-glycopeptides from complex samples.In this study,we prepared a novel zwitterionic sulfobetaine-based monolith with good performance and developed a simpler and faster method for preparation of zwitterionic monoliths.

Objective:To evaluate the short-term efficacy of left colonic artery preservation in laparoscopic-assisted radical resection in elderly patients with rectal cancer.Methods:168 patients aged 65 and over who had undergonelaparoscopic-assisted radical resection of rectal cancer in the gastrointestinal surgery department of Beijing Hospital from December 2017 to December 2020 were retrospectively analyzed.According to different surgical methods, they were divided into the observation group with 90 subjects(the LCA group)and the control group with 78 subjects(the non-LCA group).Basic data, intraoperative, postoperative and clinicopathological data of the two groups were compared and analyzed.Results:There were no statistically significant differences between the two groups in operative time[(172.3±35.5)min vs.(155.5±28.7)min, t=2.182, P=0.103], intraoperative blood loss[(72.6±22.5)ml vs.(67.3±18.4)ml, t=1.473, P=0.128], number of group 253 lymph nodes dissected[(3.8±1.5) vs.(4.2±1.6), t=0.785, P=0.221], and total number of lymph nodes dissected[(14.1±4.3) vs.(15.8±5.0), t=1.652, P=0.113].There was no significant difference in the incidence of anastomotic hemorrhage[4.4%(4/90) vs.3.8%(3/78), χ2=1.182, P=0.133]and the incidence of urinary retention[4.4%(4/90) vs.6.4%(5/78), χ2=1.785, P=0.148].The time to first postoperative flatus[(52.4±23.2)h vs.(68.3±29.3)h, t=2.652, P=0.023]and length of postoperative hospital stay[(9.07±3.56)d vs.(10.68±4.94)d, t=2.785, P=0.017]in the LCA group were shorter than those in the non-LCA group.The incidences of anastomotic leakage in the LCA group and the non-LAC group were 2.2%(2/90)and 5.1%(4/78), respectively, and the difference was statistically significant( t=3.575, P=0.001). Conclusions:LCA preservation in laparoscopic-assisted radical resection of rectal cancer in elderly patients with rectal cancer is safe and feasible, reduces the incidence of anastomotic leakage, and shorten the time to first postoperative flatus and length of postoperative hospital stay.It has good practical clinical value.

External apical root resorption is among the most common risks of orthodontic treatment, and it cannot be completely avoided and predicted. Risk factors causing orthodontic root resorption can generally be divided into patient- and treatment-related factors. Root resorption that occurs during orthodontic treatment is usually detected by radiographical examination. Mild or moderate root absorption usually does no obvious harm, but close attention is required. When severe root resorption occurs, it is generally recommended to suspend the treatment for 3 months for the cementum to be restored. To unify the risk factors of orthodontic root resorption and its clinical suggestions, we summarized the theoretical knowledge and clinical experience of more than 20 authoritative experts in orthodontics and related fields in China. After discussion and summarization, this consensus was made to provide reference for orthodontic clinical practice.
Humans ; Tooth Movement Techniques/adverse effects* ; Root Resorption/etiology* ; Consensus ; Dental Cementum ; Risk Factors

Objective    To explore the feasibility and clinical value of free-of-puncture positioning in three-dimension-guided anatomical segmentectomy for ground-glass nodule (GGN) compared with percutaneous positioning. Methods    Clinical data of 268 enrolled patients undergoing anatomical pulmonary segmentectomy from October 2018 to June 2019 were retrospectively collected, including 75 males and 193 females with an average age of 56.55±12.10 years. The patients were divided into two groups, including a percutaneous positioning group (n=89) and a free-of-puncture positioning group (n=179). Perioperative data of the two groups were compared. Results    The average CT scan times of the percutaneous positioning group was 3.01±0.98 times, and the numerical rating scale (NRS) score of puncture pain was 3.98±1.61 points. Pulmonary compression pneumothorax (≥30%) occurred in 7 (7.87%) patients and intercostal vascular hemorrhage occurred in 8 (8.99%) patients after puncture. Lung nodules were successfully found and removed in both groups. There was no statistically significant difference between the two groups in the location of nodules (P=0.466), operation time (151.83±39.23 min vs. 154.35±33.19 min, P=0.585), margin width (2.07±0.35 cm vs. 1.98±0.28 cm, P=0.750), or the number of excised subsegments (2.83±1.13 vs. 2.73±1.16, P=0.530). Conclusion    Anatomical segmentectomy with three-dimensional navigation avoids the adverse consequences of puncture, which has the same clinical efficacy and meets the requirements of oncology compared with percutaneous positioning. The free-of-puncture positioning method can be used for GGN located in the central region of pulmonary segment/subsegment or adjacent to   intersegment veins instead of percutaneous positioning.

Objective: To obtain the dietary exposure of lead in primary, middle and high school students, and to provide basic foundation for food safety risk assessment and management for children and adolecsents. Methods: Weighing method, 3-days hour dietary survey, combining with the food frequency questionnaire, was applied to obtain basic dietary data in 616 primary, middle and high school students selected through multi-stage randdom sampling method from Pudong new area of shanghai. Data on lead concentrations were derived from the food safety risk monitoring system, which included 1 145 samples. Results: Lead was detected in 568 of 1 145 samples (49.61%) from 10 categories of foods. The exceeding standard rate was 3.58% (41 samples exceeded). The average content of lead was (0.12±0.25) mg/kg, fungi and algae, beans and the aquatic products were found to be the primary food sources of lead exposure. The average dietary lead exposure in primary, middle and high school students was 9.94 μg/kg per week, accounted for 39.76% of PTWI. The lead exposure level at the 97.5th percentile which accounted for 118.24% of PTWI was 29.56 μg/kg. Vegetables, beans and cereal foods were the mainly source of dietary lead exposure, with average dietary lead exposure 2.57, 2.44 and 1.43 μg/kg peer week, accounted for 10.26%, 9.76% and 5.74% of PTWI, respectively. Conclusion Lead is present in some foods available in local markets in Pudong New Area, Shanghai. Low level of dietary exposure to lead is found in primary, middle and high school students, however, it depends on dietary pattern. Continued efforts are needed to reduce the dietary exposure of lead in school students.