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.

Objective: To investigate factors influencing adolescent idiopathic scoliosis (AIS), and to provide a scientific basis for effective prevention and treatment programs. Methods: A questionnaire survey was conducted among 6 757 students who participated in the scoliosis screening program for primary and middle school students in Zhongshan City, China from April 2019 to March 2020. Visual examination and Adams flexion test were used to measure the rotation angle of trunk. For each student, individual and family demographics, family history of scoliosis, daily postural habits, school bag carrying habits, vision, health, school environment, and physical activity were collected by questionnaire. Factors influencing AIS were analyzed using Chi square test and multivariate Logistic regression. Results: The positive screening rate for AIS was 2.0%(135 cases). Multivariate Logistic regression analysis revealed that female gender, no family history of AIS, standing with lumbar spine tilted forward, habit of leaning to the left when seated, and a monthly family income of >10 000 yuan were related to the occurrence of AIS in adolescents ( OR =3.01, 0.38, 2.29, 1.74, 0.44, P <0.05). Conclusion Female students aged 10-16 years with a family history of scoliosis in Zhongshan are identified as a high risk group for scoliosis screening. Developing proper standing and sitting habits helps to reduce the risk of AIS in adolescents.

ObjectiveTo explore the clinical efficacy of Gouteng prescription in treating the patients with primary hypertension with anxiety disorder due to yang hyperactivity and heat toxin and the impact of the formula on the balance of inflammatory cytokines. MethodA total of 98 patients diagnosed with primary hypertension and anxiety disorder were randomized into control and observation groups. On the basis of conventional western medicine treatment for hypertension， the control group （47 patients） was treated with Shugan Jieyu capsules for 8 weeks， while the treatment group （51 patients） with Gouteng prescription for 8 weeks. The two groups were compared in terms of the blood pressure level， 24-hour blood pressure variability， Hamilton anxiety scale （HAMA） score， Pittsburgh sleep quality index （PSQI） score， quality of life （SF-36 scale） score， traditional Chinese medicine （TCM） syndrome score and efficacy， incidence of adverse reactions， and the levels of interleukin （IL）-1β， IL-6， IL-10， and IL-4 in the serum of peripheral blood. ResultThe final trial was completed with 95 patients， including 46 in the control group and 49 in the observation group. The treatment in both groups lowered the blood pressure and blood pressure variability （P<0.05， P<0.01）. The observation group outperformed the control group in recovering the systolic blood pressure （SBP）， 24-hour mean systolic blood pressure （24 h SBP）， 24-hour systolic blood pressure variability （24 h SBPV）， and 24-hour diastolic blood pressure variability （24 h DBPV） （P<0.05）. After treatment， the HAMA and PSQI scores in both groups decreased （P<0.05， P<0.01）， and the observation group had lower HAMA and PSQI scores than the control group （P<0.05）. Compared with those before treatment， the SF-36 scores in both groups increased （P<0.05， P<0.01）. After treatment， the observation group had higher scores of physiological function （PF）， bodily pain （BP）， social function （SF）， role-emotional （RE）， and mental health （MH） indicators than the control group （P<0.05）. After treatment， the TCM syndrome scores in both groups decreased （P<0.05， P<0.01）， and the observation group had lower score than the control group （P<0.05）. The total response rate regarding TCM syndrome in the observation group was 85.71% （42/49）， which was higher than that （63.04%， 29/46） in the control group （χ²=6.621， P<0.05）. The treatment in both groups lowered the levels of pro-inflammatory cytokines （IL-1β， IL-6） and elevated the levels of anti-inflammatory cytokines （IL-10， IL-4） （P<0.05， P<0.01）， and the changes were more obvious in the observation group than in the control group （P<0.05）. There were no adverse events during the research process. ConclusionGouteng prescription can recover the blood pressure level， reduce blood pressure variability， suppress anxiety state， improve sleep and quality of life， decrease TCM syndrome score， increase total response rate， lower serum IL-1β and IL-6 levels， and elevate serum IL-10 and IL-4 levels in the patients with primary hypertension complicated with anxiety disorder due to yang hyperactivity and heat toxin. It may exert the effects by regulating the balance of pro-inflammatory and anti-inflammatory cytokines.

Objective:To investigate the value of ultrasound findings in the diagnosis of lower extremity arterial disease in patients with type 2 diabetes mellitus and correlate it with clinical factors.Methods:A total of 535 patients with type 2 diabetes mellitus who received treatment in Taiyuan Second People's Hospital from January 2016 to June 2019 underwent color Doppler ultrasound examination (T2DM group). Vascular inner diameter, intima-media thickness, atherosclerotic plaque formation, lumen stenosis or occlusion, and hemodynamic characteristics were determined in patients with type2 diabetes mellitus compared with those in 107 patients with non-type 2 diabetes mellitus (non-T2DM group). These parameters were correlated with the course of the disease, blood glucose level, concomitant hypertension or not, and clinical Wagner grade.Results:The incidences of intima-media thickening, atherosclerotic plaque, stenosis, and occlusion of lower extremity arteries were 69.9%, 89.0%, 77.0% and 11.6% respectively, in the T2DM group, which were significantly higher than 41.1%, 78.5%, 72.0%, and 1.9% respectively in the non-T2DM group ( χ2 = 32.52, P < 0.001; χ2 = 8.76, P = 0.003; χ2 = 27.77, P < 0.001). With the prolongation of the course of T2DM, the incidence of arterial lesions in the lower extremities increased ( P < 0.001). The incidences of intima-media thickening, atherosclerotic plaque, stenosis, and occlusion of lower extremity arteries were significantly greater in the poor blood glucose control group and non-hypertension group compared with the good blood glucose control group and hypertension group (all P < 0.05). The degree of lower extremity arterial stenosis in T2DM patients was related to Wagner's grade. As the degree of stenosis increased, Wagner's grade increased correspondingly and significantly ( P < 0.001). Conclusion:Color Doppler ultrasound examination has an important value in evaluating lower extremity arterial lesions in patients with T2DM. The degree of arterial lesions in the lower extremities of T2DM patients is correlated with the course of the disease, blood glucose levels, concomitant hypertension, and clinical Wagner grade. Color Doppler ultrasound examination has an important clinical significance in evaluating the degree of vascular lesions and guiding early interventions in the clinic.

Objective:To explore the optimal match degree between thoracolumbar kyphosis (TLK) and lower lumbar lordosis (LLL) in adult spinal deformity (ASD) after correction surgery.Methods:Data of 119 ASD patients (male: 28, female: 91), belonging to the Affiliated Hospital of Jining Medical University (19 cases), the Affiliated Hospital of Shandong University of Traditional Chinese Medicine (11 cases), and the First Medical Center of Chinese PLA General Hospital (89 cases) were reviewed and documented from March 2019 to March 2020. All patients (age, 64.48±8.88 years; range, 45-79 years) underwent the surgical procedure of thoracolumbar fusion with instrumentations were followed up over 24 months (51.68±15.60 months; range, 24-87 months) after surgery. Postoperative proximal interface failure, Oswestry disability index (ODI) score and Scoliosis Research Society-22 (SRS-22) score were recorded for all patients. The immediate match of TLK to LLL postoperatively was calculated as follows: TLM=TLK/LLL. The data of those individuals with excellent improvements in the ODI (>50%) at the final follow-up were recorded and analyzed. Then the mean value and the 95% CI of TLM in those individuals were calculated. All participants were subdivided into three groups according to the 95% CI value of TLM. After the receiver operating characteristic curve (ROC) analyzing, the area under the ROC curve (AUC) was the best cutoff value of TLM. The association of proximal junctional failure (PJF) developing with the abnormal TLM postoperatively was analyzed with logistic regression, and the odds ratio (OR) was calculated. Results:62 patients had significant improvements in ODI (>50%) at the final follow-up, and the mean TLM in those individuals was 0.41 [95% CI (0.2, 0.5)]. All patients were divided into three groups: TLM<0.2 (35 cases), 0.2≤TLM≤0.5 (48 cases) and TLM>0.5 (36 cases). The preoperative TLK (13.87°±16.61°) and T 1 pelvic angle (19.69°±10.55°) in the those patients with TLM<0.2 were the smallest, and those were the largest in those with TLM>0.5 (30.59°±16.68°, 28.30°±14.46°). The individuals with TLM<0.2 still had the smallest TLK (2.89°±1.78°), however, those with TLM>0.5 had the largest TLK (17.13°±12.13°) and the smallest LLL (-26.16°±11.02°) accordingly. Additionally, the ODI and SRS-22 for those with 0.2≤TLM≤0.5 at the final follow-up were the best ( P<0.05). ROC curve analysis results showed that the best cutoff value of TLM was 0.4 (sensitivity=78.9%, specificity=76.2%; AUC=0.802, 95% CI (0.708, 0.896) , P<0.001). During the follow-up after orthopedic surgery, there were 19 patients with postoperative proximal junction failure, including 16 patients in the mismatched group (6 patients in the TLM<0.2 group, 10 patients in the TLM>0.5 group) and 3 patients in the matched group (0.2≤TLM≤0.5 group), with the incidence of 23% (16/71) and 6% (3/48), respectively. The difference was statistically significant (χ 2=5.66, P=0.017). Thoracolumbar mismatch was significantly associated with proximal borderline failure after orthosis [ OR=4.35, 95% CI (1.196, 15.924)]. Conclusion:The abnormal correction in thoracolumbar kyphosis and lower lumbar lordosis may result in mismatch between thoracolumbar segments, which would undermine the quality of life, and increase the incidence of proximal junctional failure developing in those ASD patients underwent long-fusion surgeries. The match between TLK and LLL should be 0.2 to 0.5.

Osimertinib, the third generation of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), has demonstrated notable clinical benefit in the targeted therapy for patients with non-small cell lung cancer (NSCLC). However, the development of drug resistance is an inevitable challenge. In order to tackle this issue, ongoing efforts are being made to develop new generations of targeted drugs and treatment strategies, some of which are already undergoing clinical trials. This article aims to review the current research on the mechanisms of osimertinib resistance and outline the advancements made in post-drug resistance treatment strategies.

Cell epidermal growth factor receptor (EGFR) mutation is one of the causes of non-small cell lung cancer (NSCLC). The emergence of targeted drugs for EGFR gene mutation provides a new direction for NSCLC treatment. The common EGFR-targeted drugs like the first-generation gefitinib and erlotinib, the second-generation afatinib and the third-generation osimertinib have shown their good efficacies in a number of large international clinical trials. EGFR gene mutation in Chinese NSCLC patients is different from that in European and American NSCLC patients. This paper briefly reviews the characteristics of EGFR gene mutation and the current status and progress of EGFR-targeted drugs in Chinese NSCLC patients to investigate the mutation characteristics of EGFR in Chinese NSCLC patients and the response as well as prognosis of Chinese patients to EGFR-TKI therapy.

Objective: This study aims to evaluate the efficacy of specific exercise therapy for the treatment of skeletally immature idiopathic scoliosis (IS). Methods: A total of 51 mild IS patients receiving specific exercise therapy in Guangdong Xinmiao Scoliosis Prevention Center from October 2017 to September 2021 were recruited in this study. Treatment outcome were evaluated at 1 year follow up. All the participants were divided into two groups: open ( n =32) and closed triradiate cartilage group ( n =19), and outcome of treatment were compared within the two groups. Results: After (26.5±9.8) months of treatment, the Cobb angle of the major curve was corrected from an average of (15.5±4.2)° to (11.3±6.7)°, with an average correction of (4.5±5.7)°. Among them, 58.9% patients achieved improvement in the major curve Cobb angle, 33.3% achieved stabilization, and 7.8% progressed. There was no significant difference in the major curve Cobb angle between the closed and open triradiate cartilage groups before treatment( t =-0.73, P =0.47), whereas there was a significant difference in the correction of the major curve after treatment( t =-2.73 , P <0.05). Conclusion Specific exercise therapy effectively prevents the progression or corrects the scoliosis in patients with skeletally immature idiopathic scoliosis. It s more effective in patients with open triradiate cartilage than in those with closed triradiate cartilage.

Objective:To compare the one-year postoperative visual quality after trifocal intraocular lens (IOL) implantation and monofocal IOL implantation.Methods:A cohort study was conducted.Forty-one eyes from 41 age-related cataract patients who underwent phacoemulsification extraction combined with IOL implantation in Nanjing Drum Tower Hospital from May 2017 to June 2018 were enrolled.The patients were divided into trifocal IOL group (20 eyes) receiving ZEISS AT LISA tri 839MP trifocal IOL implantation and monofocal IOL group (21 eyes) receiving ZEISS 603P monofocal IOL implantation according to their willingness.One year after surgery, uncorrected distant visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), best corrected distance visual acuity (BCDVA), distance corrected intermediate visual acuity (DCIVA) and distance corrected near visual acuity (DCNVA) were detected in both groups.The patient point spread function (PSF), modulation transfer function (MTF) cutoff frequency, Strehl ratio (SR), OQAS Ⅱ values at 100%, 20%, and 9% contrast (OV 100%, OV 20%, OV 9%) and objective scattering index (OSI) were measured by OQAS Ⅱ.Wavefront aberrations including total aberration (TA), total high order aberrations (tHOAs), spherical aberration, coma, trefoil aberration, total low order aberrations (tLOAs), defocus, and astigmatism were evaluated with the iTrace visual function analyzer.All aberrations were represented by root mean square.The visual acuity of operative eyes was measured with a phoropter, and defocus curves were drawn with visual acuity better than 0.5 LogMAR.The incidence of posterior capsular opacification (PCO) in the IOL region was quantitatively analyzed by Sellman method.Visual function was scored by visual function index (VF-14). This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School (No.2018-219-01). Written informed consent was obtained from each subject prior to any medical examination.Results:One year after the operation, UCIVA, UCNVA, DCIVA, and DCNVA of trifocal IOL group were significantly better than those of monofocal IOL group, and the differences were statistically significant (all at P<0.001). OQAS Ⅱ visual quality indicators showed that the MTF cutoff frequency, SR, OV 100%, and OSI values of trifocal IOL group were significantly higher than those of monofocal IOL group, showing statistically significant differences (all at P<0.001). No significant difference in wavefront aberrations was found between the two groups (all at P>0.05). Defocus curve showed that the LogMAR visual acuity of patients at -1.0 D, -1.5 D, -2.0 D, -2.5 D, -3.0 D, and -3.5 D (namely, 1 m, 66 cm, 50 cm, 40 cm, 33 cm, and 29 cm) in monofocal IOL group were significantly better than those in trifocal IOL group (all at P<0.05). There was a higher incidence of PCO in trifocal IOL group than monofocal IOL group, with a statistically significant difference ( χ 2=41.0, P<0.001). The VF-14 score of trifocal IOL group was 87.99±1.09, which was significantly higher than 81.49±1.67 of monofocal IOL group ( t=10.301, P<0.001). Conclusions:One year after trifocal IOL implantation, the full range of vision, subjective and objective visual quality of eyes are better than eyes implanted with monofocal IOL.

Objective:To evaluate the effect of anti-vascular endothelial growth factor (VEGF) in patients with wet age-related macular degeneration (wAMD) and investigate the recurrence factors.Methods:In this case-control study, 40 eyes of 38 patients with wAMD treated by anti-VEGF therapy in Xijing Hospital from October 2015 to April 2017 were included.Ranibizumab or conbercept was consecutively intravitreally injected monthly under 3+ pro re nata (PRN) regimen.All included patients were followed-up at least 12 months.The best corrected visual acuity (BCVA) was expressed in logarithm of the minimum angle of resolution (LogMAR) units.Optical coherence tomography (OCT) was used to observe the morphologic characteristics of macula and measure the central retina thickness (CRT). Patients were divided into recurrence and recurrence-free group based on whether recurrence occurred during follow-up.Potential associated factors with recurrence after treatment were analyzed by multivariate logistic regression analysis.Meanwhile, the morphological and functional response were identified at 1 month after loading phase as well as at last follow-up visit.This study protocol was approved by the Ethics Committee of Shanghai General Hospital (No.2016KY243) and written informed consent was obtained from each patient prior to receiving injection.Results:All the operative eyes showed retinal effusion absorption at least once, and 21 (52.5%) eyes had relapse during follow-up.The patients with lower BCVA (LogMAR) value at the first absorption time had higher risk of recurrence ( OR=16.7, 95% CI=1.22-100, P<0.05). The eyes in the recurrence group received more times of treatment than eyes in the recurrence-free group (5.8±2.3 vs 3.5±1.4, t=3.64, P<0.05). However, there was no significance between the two groups in BCVA change before and after treatment ( t=-1.52, P>0.05). In the recurrence group, the BCVA (LogMAR) and CRT at last visit were 0.73±0.34 and (187.2±81.7)μm respectively, while were significantly improved in comparison with 0.81±0.37 and (234.2±74.5)μm at the relapse time ( t=2.14, 2.62; both at P<0.05). There were 87.5% (35/40) eyes showed good morphological responses at 1 month after the loading phase while 12.5% (5/40) eyes presented poor morphological responses, the retinal effusion was absorbed after additional (3.2±2.2) times of injections.The BCVA of eyes with a good morphological response at 1 month following loading phase was better than that at the first retinal effusion absorption time ( t=-2.23, P<0.05). Average CRT at last visit was significantly decreased in comparison with the baseline CRT ( Z=-4.62, P<0.01). Conclusions:For wet AMD patients, the anti-VEGF treatment is safe and effective in the short term, while there is still a high rate of recurrence.More attention should be paid to eyes with better vision at the first time of retinal effusion absorption which may have more chance to experience recurrence.Patients need long-term follow-up after treatment to prevent recurrence.In addition, the complete loading treatment is needed for patients who have a good morphological response after the first retinal effusion absorbed.