BackgroundMedical treatment has been the mainstay of chronic rhinitis management. Meanwhile, innovative minimally invasive nasal surgery has shown promising results. The therapeutic outcomes of these surgical interventions compared with medical treatment in chronic rhinitis have not been discussed previously.ObjectiveThis study aimed to evaluate the efficacy of radiofrequency ablation of the inferior turbinate of the intraturbinate segment of the posterior nasal nerve (RAPN) in comparison with intranasal corticosteroid spray (INCS) plus oral antihistamines for the treatment of chronic rhinitis.MethodsA retrospective cohort study was conducted on patients with chronic rhinitis who had an inadequate response to medication. Inclusion criteria included a 24-h Reflective Total Nasal Symptom Score (rTNSS) ≥4 and a rhinorrhea score ≥1. Patients with prior nasal surgeries, caudal septal deviation, or acute/chronic rhinosinusitis were excluded. The primary endpoint was the change in 24-h rTNSS and Nasal Obstruction Symptom Evaluation (NOSE) scores at the 3-month follow-up.ResultsA total of 64 patients were included: 44 received RAPN, and 20 received INCS. Baseline rTNSS was 7.3 ± 2.1 for RAPN and 6.9 ± 2.3 for INCS (p = .497). Both groups showed significant improvement in rTNSS and NOSE scores at 1 and 3 months (p < .001). However, the RAPN group demonstrated significantly greater improvement than the INCS group at 1 to 3 months of follow-up (p = .001). Subscore analysis revealed that rhinorrhea (at 1 and 3 months) and sneezing (at 1 month) did not differ significantly between groups. One case of postoperative anterior epistaxis was noted in the RAPN group.ConclusionsBoth INCS and RAPN are highly effective in alleviating chronic rhinitis symptoms. Although RAPN does not establish definitive superiority over medical therapy across all neurogenic domains, it provides comparable, sustained symptom control with the distinct advantage of drug-free maintenance, offering a valuable therapeutic alternative.
Cataract surgery in patients with chronic anterior uveitis may be associated with increased risk for complications and poor outcomes. This study analyses visual outcome, uveitis course and complications after cataract surgery with intraocular lens (IOL) implantation in adolescents and adults with juvenile idiopathic arthritis (JIA)-associated or antinuclear antibodies (ANA)-positive uveitis. Data before and at 6 weeks, 1 and 2 years after surgery were retrospectively analysed according to Standardization of Uveitis Nomenclature (SUN) standards. Surgery was performed with small incisions, phacoemulsification and IOL implantation. Surgical technique was adapted to pre-existing uveitis-related morphological abnormalities. Predictors of visual outcome and vision-threatening complications at 2-year follow-up (FU) were analysed. 93 surgeries of 83 patients (84% female; mean age 24.8±16.2 years) with JIA-associated (84%) or ANA-positive (16%) anterior uveitis were analysed. Preoperative treatment included topical steroids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs; 72.0%) or biological (b) DMARDs (65.6%). Besides cataract, uveitis-related complications (eg, fibrotic lens membrane, posterior synechiae and pupil contraction) were present in 95.7% before surgery. Best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) improved from 1.57±1.32 preoperatively to 0.42±0.83 at 2 years (p<0.001). Postoperative complications included posterior synechiae formation (30%), giant-cell deposits (35.7%), posterior capsule opacification (51.9%) and macular oedema (12.7%). Significant preoperative predictors of poor visual outcome included poor BCVA and high laser flare (LF) values, and those of postoperative ocular complications also included poor BCVA and a lack of systemic anti-inflammatory drug use (each, p<0.05). Beneficial outcomes can be achieved following cataract surgery with IOL implantation in adolescents and adults with JIA-associated or ANA-positive anterior uveitis. Important prerequisites include preoperative inactivity, appropriate surgical technique and sustained long-term uveitis inactivity with the use of DMARDs.
Time in the OR is expensive and hands-on training is often scarce for surgical trainees in pediatric urology. Antireflux surgeries are complex procedures consisting of several key steps and training of these is crucial to reduce the learning curve, however, only a few simulation models exist for training surgical procedures in pediatric urology. Our aim was to develop and evaluate a simple, low-budget and easily reproducible training model to simulate common antireflux procedures. A four main component model was developed to simulate the key steps of the procedures for easily accessible at home training. It consists of three commercially available balloons and a piece of synthetic undercast padding. A detailed description of the assembly of the training model as well as the crucial key steps of the procedures were provided. A 5-point Likert scale including 23 items was used to assess the model in regards to anatomical realism, usefulness as a training tool as well as overall reactions to the model. The survey was evaluated within workshops for trainees and final year students. In total, 81 surveys were answered with a 98.5% completion rate of all answered items. The model scored an overall mean value of 4.3 points (median value 4.6) and was reported to be quickly and easily assembled to represent realistic anatomical dimensions. It was evaluated as a useful training tool to improve surgical skills for at home training. Evaluators stated that simulation with the model helped to feel safer in the operating room with a mean of seven simulation procedures with the model. We present a low budget, disposable training model for ureteral reimplantation to train the most important component steps outside the clinical setting. This model demonstrated promising potential for internalizing the different steps of the procedure as well as improving skills in surgical training outside the operating room.
The data of eight patients with end-stage heart failure who experienced in-hospital sudden cardiac arrest and received cardiopulmonary resuscitation (CPR), followed by extracorporeal membrane oxygenation (ECMO) combined with delayed left ventricular assist device (LVAD) implantation in Fujian Medical University Union Hospital from January 2022 to June 2025 were retrospectively reviewed. Among them, there were seven males and one female, with a median age of 56 (50, 63) years. The etiologies included ischemic cardiomyopathy (five cases), dilated cardiomyopathy (two cases) and low cardiac output syndrome after severe valvular heart disease surgery (one case). All patients were stabilized by ECMO rescue before LVAD implantation, with an ECMO support time of 9.5 (6.5, 12.0) days. All surgeries were performed under general anesthesia with cardiopulmonary bypass. Postoperatively, six cases discharged smoothly, two cases died in hospital, and one case developed cerebral infarction which recovered after interventional thrombectomy. For discharged patients, follow-up was conducted at 1, 3, 6 and 12 months, the mechanical pump functioned normally, and cardiac function was significantly improved. The study suggests that ECMO can stabilize the condition of these high-risk patients, and bridging to LVAD can relieve the pressure on the donor heart and improve prognosis. 回顾性纳入2022年1月至2025年6月福建医科大学附属协和医院8例心源性猝死心肺复苏后接受体外膜肺氧合（ECMO）并桥接左心室辅助装置（LVAD）植入治疗的终末期心力衰竭患者。其中男7例，女1例，年龄56（50，63）岁，包括缺血性心肌病5例、扩张型心肌病2例及重症瓣膜病术后低心排血量综合征1例。所有患者经ECMO抢救稳定后行LVAD植入，ECMO支持时间9.5（6.5，12.0）d，手术均在全身麻醉体外循环下进行，术后6例顺利出院，2例院内死亡，1例并发脑梗死经治疗后恢复。患者出院后1、3、6、12个月随访，机械泵运转正常，心功能明显改善。研究结果提示，ECMO可稳定此类高危患者病情，桥接LVAD能缓解供心压力并改善预后。.
Objectives: To investigate the relationship between CD8+ tissue-resident memory T cells (TRM) and CD8+ bystander T cells (Tbys) in the tumor center (TC) and invasive margin (IM) regions of primary non-small cell lung cancer (NSCLC) and recurrence, and to perform stratified analysis based on lymph node status to guide individualized treatment. Methods: A retrospective review was conducted of patients with stage IA-IIIB non-small cell lung cancer (NSCLC) who underwent radical surgery at Shandong Provincial Cancer Hospital between January 1, 2014 and December 31, 2018. Tissue microarrays containing TC and IM regions were prepared, and multicolor immunofluorescence staining was applied to quantify the density of CD8+ T cells (CK- CD8+), tissue-resident memory T cells (CK- CD103+ CD8+), and bystander T cells (CK- CD103- CD8+). Kaplan-Meier and Cox proportional hazards models were used to identify factors associated with recurrence. Results: In the TC region, TRM/CD8+ T cells, Tbys/CD8+ T cells, and TRM/Tbys accounted for 34.3%, 67.9%, and 50.5% of CD8+ T cells, respectively. In the IM region, TRM/CD8+ T cells accounted for 29.6%, Tbys/CD8+ T cells for 70.7%, and TRM/Tbys for 41.9%. At a median follow-up of 37.9 months, recurrence occurred in 87 patients (34.0%). In all 256 patients, TRM/CD8+ T cells, Tbys/CD8+ T cells, and TRM/Tbys in both IM and TC regions were unrelated to RFS (all P＞0.05). Among the 172 N0 patients, the high Tbys/CD8+ T cell group in the IM region showed higher RFS rates than the low group (P=0.050), while the high-level groups for TRM/CD8+ T cells and TRM/Tbys in the TC region showed lower RFS rates than their low-level counterparts (all P＜0.05). Conversely, the high-level group for Tbys/CD8+ T cells in the TC region demonstrated a higher RFS rate than the low-level group (P=0.005). Multivariate Cox analysis revealed that high TC TRM/CD8+ T cells and high TC TRM/Tbys were independent risk factors for postoperative recurrence in N0 NSCLC patients (HR=2.772, 95% CI: 1.260-6.098; HR=2.656, 95% CI: 1.205-5.855), while high TC Tbys/CD8+ T cells was an independent protective factor for postoperative recurrence in N0 NSCLC patients (HR=0.324, 95% CI: 0.147-0.711). Among the 84 N1-2 patients, TRM/CD8+ T cells, Tbys/CD8+ T cells, and TRM/Tbys in the IM and TC regions were not associated with RFS (all P＞0.05). Conclusions: Specific CD8+ T cell subsets in the TC region of the primary tumor in NSCLC patients are associated only with recurrence after curative surgery in N0 patients. Elevated TRM/CD8+ T and TRM/Tbys ratios, coupled with reduced Tbys/CD8+ T ratios, correlate with heightened recurrence risk. This may aid in stratifying the risk of recurrence in N0 patients after surgery and guide treatment strategies. 目的： 探讨非小细胞肺癌（NSCLC）原发灶肿瘤中心（TC）和侵袭边缘（IM）区域CD8+组织驻留记忆T细胞（TRM）和CD8+旁观者T细胞（Tbys）与复发的关系，以指导NSCLC的个体化治疗。 方法： 回顾性收集2014年1月1日至2018年12月31日在山东省肿瘤医院接受根治性手术治疗的ⅠA～ⅢB期NSCLC患者256例。制备包含TC和IM区域的组织芯片，通过多重免疫荧光染色检测CD8+ T细胞（CK- CD8+）、TRM（CK- CD103+ CD8+）和Tbys（CK- CD103- CD8+）的密度。生存分析采用Kaplan-Meier法，采用Cox比例风险模型明确复发影响因素。 结果： 在TC区域，TRM/CD8+ T细胞为34.3%，Tbys/CD8+ T细胞为67.9%，TRM/Tbys为50.5%。在IM区域，TRM/CD8+ T细胞为29.6%，Tbys/CD8+ T细胞为70.7%，TRM/Tbys为41.9%。中位随访37.9个月，复发87例（34.0%）。在全部256例患者中，IM和TC区域的TRM/CD8+ T细胞、Tbys/CD8+ T细胞及TRM/Tbys均与无复发生存时间（RFS）无关（均P＞0.05）。在172例N0期患者中，IM区域的Tbys/CD8+ T细胞高组RFS率高于低组（P=0.050），TC区域的TRM/CD8+ T细胞和TRM/Tbys高组、RFS率低于相应低组（均P＜0.05），TC区域的Tbys/CD8+ T细胞高组的RFS率高于低组（P=0.005）。多因素Cox分析显示，高TC TRM/CD8+ T细胞和高TC TRM/Tbys是N0期NSCLC患者术后复发的独立危险因素（HR=2.772，95% CI：1.260～6.098；HR=2.656，95% CI：1.205～5.855），高TC Tbys/CD8+ T细胞是N0期NSCLC患者术后复发的独立保护因素（HR=0.324，95% CI：0.147～0.711）。在84例N1～2期患者中，IM和TC区域的TRM/CD8+ T细胞、Tbys/CD8+ T细胞及TRM/Tbys均与RFS无关（均P＞0.05）。 结论： NSCLC患者原发灶TC区域中特定CD8+ T细胞亚群仅与N0期患者根治术后复发有关，TC区域TRM/CD8+ T细胞和TRM/Tbys越高、Tbys/CD8+ T细胞越低越易复发。这可能有助于N0期NSCLC患者术后复发风险分层并指导治疗。.
Objective: To investigate the clinical efficacy of Bankart repair combined with Remplissage procedure in the treatment of anterior shoulder instability with glenoid bone defect≤20%. Methods: A retrospective analysis was conducted on patients with recurrent anterior shoulder dislocation combined with Hill-Sachs lesions admitted to Huashan Hospital, Fudan University from January 2020 to June 2024. All patients were confirmed with a glenoid bone defect≤20% by three-dimensional computed tomography (CT) reconstruction of the shoulder joint. The Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California Los Angeles (UCLA) score, and shoulder range of motion were evaluated before surgery and at the last follow-up. The postoperative function and return to sports were observed between patients with 13.5%≤glenoid bone defect≤20% and those with glenoid bone defect<13.5%. Results: A total of 40 patients were included, with an age of (26±6) years, including 35 males and 5 females. The follow-up time was (25.8±12.4) months. The postoperative UCLA score [(33.4±1.1) vs (22.1±3.4)], ASES score [(93.0±4.8) vs (73.3±9.6)], Constant-Murley score [(93.5±4.9) vs (79.3±7.0)], and Rowe score [(96.0±4.1) vs (39.2±9.4)] were all improved compared with those before surgery (all P<0.001). There were no statistically significant differences in postoperative angles of forward flexion, abduction, external rotation at the side, and the spinous process level of internal rotation at the side compared with those before surgery (all P>0.05). No complications such as infection or joint adhesion occurred in any of the patients postoperatively, and there was no recurrence of dislocation. At the last follow-up, all patients returned to sports, of which 31 cases (31/40, 77.5%) returned to the preoperative sports level. There was no statistically significant difference in postoperative function between patients with 13.5%≤glenoid bone defect≤20.0% and those with glenoid bone defect<13.5%, but the proportion of returning to the preoperative sports level (13/21 vs 18/19) showed a statistically significant difference (P<0.05). Conclusion: Arthroscopic Bankart repair combined with Remplissage procedure for patients with recurrent anterior shoulder dislocation combined with Hill-Sachs lesions and a glenoid bone defect≤20% can restore joint stability, improve shoulder function, and does not affect the joint range of motion. 目的： 分析Bankart修补联合Remplissage术治疗肩盂骨缺损≤20%肩关节前向不稳患者的临床疗效。 方法： 回顾性分析复旦大学附属华山医院2020年1月至2024年6月收治的复发性肩关节前脱位合并Hill-Sachs损伤并通过肩关节CT三维重建确诊肩盂骨缺损≤20%的患者。评估患者术前及术后末次随访肩关节Constant-Murley评分、美国肩肘外科医师协会（ASES）评分、Rowe评分、美国加州大学洛杉矶分校（UCLA）评分、肩关节活动度，并观察13.5%≤肩盂骨缺损度≤20.0%与缺损<13.5%患者术后功能和重返运动情况。 结果： 共纳入40例患者，年龄（26±6）岁；其中男35例，女5例；随访时间（25.8±12.4）个月。所有患者术后UCLA评分［（33.4±1.1）比（22.1±3.4）分］、ASES评分［（93.0±4.8）比（73.3±9.6）分］、Constant-Murley评分［（93.5±4.9）比（79.3±7.0）分］、Rowe评分［（96.0±4.1）比（39.2±9.4）分］均较术前改善（均P<0.001），术后肩关节前屈、外展、体侧外旋角度及体侧内旋棘突水平与术前相比差异均无统计学意义（均P>0.05）。所有患者术后均无感染、关节粘连等并发症，亦无脱位复发；末次随访所有患者均重返运动，其中31例（31/40，77.5%）患者重返术前运动水平。13.5%≤肩盂骨缺损度≤20.0%与缺损<13.5%患者术后功能差异均无统计学意义，但重返术前运动水平比例（13/21比18/19）差异有统计学意义（P<0.05）。 结论： 肩盂骨缺损≤20%的复发性肩关节前脱位合并Hill-Sachs损伤患者行关节镜下Bankart修复联合Remplissage术可恢复关节稳定性，改善肩关节功能且不影响关节活动度。.
主动脉扩张性疾病是一类高致死性血管疾病，主要包括主动脉夹层、主动脉瘤与假性动脉瘤，是急性主动脉综合征的重要病因。其发生发展涉及血管平滑肌细胞表型转换与死亡、血管壁炎症反应、细胞外基质降解及遗传易感、高血压、吸烟等危险因素的共同作用。近年来，多组学、单细胞测序和分子影像等技术推动了该领域基础研究进展，并促进了生物标志物筛选、风险分层、靶向干预等转化研究。然而，现有研究仍存在标志物缺乏标准化验证、靶向药物临床证据不足、动物模型与人类疾病差异明显等问题。未来需进一步整合多组学、影像学、生物工程和人工智能等技术，推动主动脉扩张性疾病的早期识别、精准分层和个体化干预。该文系统述评了主动脉扩张性疾病的机制研究、临床转化进展、主要瓶颈及未来发展方向。.
To characterize cortical excitability and synchronization dynamics in patients with idiopathic generalized epilepsy (IGE) and photosensitivity by assessing steady-state visual evoked potentials (SSVEPs) elicited by intermittent photic stimulation. SSVEPs were recorded from the occipital cortex (Oz) in patients with IGE and photoparoxysmal response and in age-matched healthy subjects (HSs) during stimulation at 8 and 16 Hz, with eyes open and closed. We analyzed evoked (phase-locked) and induced (non-phase-locked) responses, inter-trial phase clustering (ITPC), broadband electroencephalographic energy, and resting-state spectral and alpha-peak dynamics. Compared with HSs, patients showed consistently greater electroencephalographic energy at stimulation frequencies and across the broadband spectrum, particularly for induced SSVEP responses. Despite this increased amplitude, patients exhibited reduced phase coherence, reflected by significantly lower ITPC across all conditions. Resting-state analyses revealed heightened broadband power but unstable alpha oscillations, with greater variability in individual alpha-peak frequency. Together these findings indicate enhanced cortical responsiveness accompanied by impaired temporal precision in neural synchronization. Photosensitive IGE is characterized not only by exaggerated visual cortical excitability but also by disrupted synchronization dynamics, suggesting a state of strong but temporally unstable neural activity that may facilitate transitions toward photically induced paroxysms. SSVEP-based measures and alpha-variability metrics may serve as functional biomarkers of network instability in photosensitive epilepsy.
Colorectal cancer rates are rising among adults younger than 50. Visits for benign anorectal conditions may offer an opportunity to identify patients who are not current with screening. This study evaluated screening completion among patients presenting with anorectal complaints and examined colonoscopy uptake after a screening recommendation. We conducted a retrospective study of patients seen for benign anorectal diagnoses at two hospitals within a single tertiary health system between January 1 and October 1, 2023. Data included demographics, examination findings, and screening history. Among 776 patients, only 60.5% of adults aged 45-49 had undergone colonoscopy in the prior 10 years. Of the adults aged 45-49 who were not up to date, when a colonoscopy was recommended, 69.0% completed it, compared with 0% who did not receive a recommendation. Benign anorectal visits provide meaningful opportunities to improve colorectal cancer screening in adults aged 45-49.
Haemorrhagic ascites (HA) is an uncommon clinical entity commonly caused by cirrhosis, malignancy and iatrogenic intervention. In the absence of these causes, it poses a diagnostic challenge. We present a case of a female with recurrent massive HA with a negative extensive work-up of common causes of HA. Laparoscopically obtained tissue eventually confirmed the diagnosis of endometriosis. This case demonstrates important diagnostic pitfalls in HA and highlights consideration of rarer causes.
Despite the high incidence of 5th metacarpal neck (5MCN) fracture, the literature lacks concise information about the ideal treatment option. This review aimed to compare the functional outcome of conservative and operative management of 5MCN fractures. The electronic databases PubMed and Scopus were used for the literature review. This review is intended to include all original studies comparing the outcomes of 5MCN fractures that were managed operatively and conservatively. The final inclusion of 5 eligible studies was based on full-text screening. A total of 311 patients were analyzed from the included five studies, with a majority of males (178/203, 83.7%). Significant reduction in palmar angulation (SMD -1.23, 95% CI -2.21 to -0.25) was noted in surgical group as compared to the conservative group. No significant difference was noted in terms of grip strength (SMD 0.96, 95% CI -2 to 3.98) or shortening (SMD 1.65, 95% CI: -2.39 to 5.69) in both the groups. Although no significant difference was noted in grip strength and shortening, there was statistically significant palmar angulation in patients treated conservatively. The vocation and expectations of each patient should be carefully considered before deciding on the course of treatment. Future studies with uniform functional outcome measurements must establish unambiguous clinical guidelines for treating 5MCN fractures.
Objective: To investigate the expression profile of Centromere Protein N (CENPN) in invasive breast cancer (BRCA), evaluate its prognostic significance, and assess its involvement in immune regulation. Methods: The expression, prognostic value, and correlation with tumor immunogenicity of CENPN in BRCA tissues were analyzed based on The Cancer Genome Atlas (TCGA) database. Verification was conducted using cancerous and adjacent normal tissues from BRCA patients who underwent surgical treatment at Yantai Mountain Hospital between January 2022 and April 2023. CENPN expression in various immune cells in the blood was examined using the Human Protein Atlas (HPA) database. Genetic alterations of CENPN in breast cancer tissues were analyzed via the cBioPortal database. CENPN-related genes were screened using the GEPIA 2.0 database, and the interaction network between CENPN and similar genes was visualized with the STRING database. Gene Ontology (GO) enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, and Gene Set Enrichment Analysis (GSEA) were employed to explore the potential biological functions of CENPN. The correlation between CENPN expression and immune cell infiltration, as well as immune cell markers in BRCA tissues, was assessed using the TIMER 2.0 database. The effect of CENPN on the proliferation ability of breast cancer MCF-7 cells was detected by the CCK-8 assay, and its impact on the migration ability of MCF-7 cells was evaluated by a wound healing assay. Results: Analysis of TCGA database data revealed that CENPN expression was significantly higher in BRCA tissues compared to adjacent normal tissues (P＜0.05). Validation in our institutional cohort demonstrated a significantly higher positivity rate for CENPN in the 17 breast cancer tissues (82.4%) than in the paired paracancerous tissues (5.9%, P＜0.001). According to the HPA database, elevated CENPN expression was observed in T-reg cells, naïve B cells, and myeloid dendritic cells. Kaplan-Meier survival analysis indicated that patients with high CENPN expression had poorer overall survival (HR=1.39, P＜0.001), recurrence-free survival (HR=1.31, P＜0.001), post-progression survival (HR=1.28, P=0.036), and distant metastasis-free survival (HR=1.6, P＜0.001). Correlation analysis revealed a negative association between CENPN expression and tumor mutational burden in BRCA patients (r=-0.196, P＜0.001). Furthermore, CENPN expression was positively correlated with 5 out of 20 common immune checkpoint genes and negatively correlated with the remaining 15, suggesting its potential for predicting immunotherapy response. Analysis via the cBioPortal database showed that invasive lobular breast carcinoma had the highest CENPN alteration frequency, with amplification being the most common alteration in BRCA. Invasive mixed mucinous breast carcinoma exhibited the highest mutation frequency, and a key missense mutation (K329N) was identified as a potential driver in BRCA.GO enrichment analysis demonstrated that CENPN-related genes were primarily involved in cell cycle, DNA metabolic processes, cell division, nuclear lumen, chromosomes, nucleoplasm, and functions related to ATP, nucleotide, and small molecule binding. KEGG pathway analysis indicated significant enrichment in DNA replication, cellular senescence, mismatch repair, homologous recombination, p53 signaling pathway, and FOXO signaling pathway. Correlation analysis using the TIMER 2.0 database established associations between CENPN expression and the infiltration levels of B cells, CD4+ T cells, CD8+ T cells, macrophages, neutrophils, and dendritic cells in BRCA. Positive correlations were also found with markers for CD8+ T cells, B cells, T cells, and T-cell exhaustion.CCK-8 assay and wound healing experiments confirmed that CENPN knockdown significantly suppressed malignant phenotypes, including proliferation and migration, in MCF-7 cells. Additionally, CENPN knockdown was found to enhance the chemosensitivity of MCF-7 cells to the anti-tumor agents 5-fluorouracil and gemcitabine. Conclusion: CENPN serves as a potential prognostic biomarker and a novel target for immunotherapy in BRCA. 目的： 探讨着丝粒蛋白N（CENPN）在浸润性乳腺癌（BRCA）中的表达特征、预后价值及在免疫调控中的作用。 方法： 基于癌症基因组图谱（TCGA）数据库分析BRCA组织中CENPN的表达、预后价值及与BRCA肿瘤免疫原性的相关性，利用2022年1月至2023年4月在烟台市烟台山医院行手术治疗的17例BRCA患者的癌组织及癌旁正常组织进行验证。基于人类蛋白质图谱（HPA）数据库分析CENPN在血液各种免疫细胞中的表达。通过cBioPortal数据库分析乳腺癌组织中的CENPN基因变异情况。通过基因表达谱数据动态分析2.0数据库筛选CENPN相关基因，并通过相互作用基因/蛋白检索工具网站可视化CENPN与相关基因的相互作用网络，采用基因本体论（GO）富集分析、京都基因和基因组百科全书（KEGG）分析以及基因集富集分析探索CENPN可能的生物学功能。利用肿瘤免疫浸润估算资源（TIMER）数据库2.0评估CENPN表达与BRCA组织中免疫细胞浸润及免疫细胞标志物之间的相关性。采用CCK-8法检测CENPN对乳腺癌MCF-7细胞增殖能力的影响，采用划痕实验评估CENPN对MCF-7细胞迁移能力的影响。 结果： TCGA数据库资料显示，BRCA组织中CENPN的表达高于癌旁正常组织（P＜0.05）。自有的17例乳腺癌组织CENPN阳性率为82.4%，显著高于癌旁组织（5.9%，P＜0.001）。HPA数据库资料显示，CENPN在T-reg细胞、初始B细胞以及髓样树突状细胞中表达增强。Kaplan-Meier生存分析显示，CENPN高表达患者的总生存期（HR=1.39，P＜0.001）、无复发生存期（HR=1.31，P＜0.001）、进展后生存期（HR=1.28，P=0.036）和无远处转移生存期（HR=1.6，P＜0.001）较差。相关性分析显示，CENPN表达与BRCA患者的肿瘤突变负荷呈负相关（r=-0.196，P＜0.001），与20个常见的免疫检查点基因中的5个呈正相关，15个呈负相关，具有预测免疫治疗有效性的潜力。cBioPortal数据库分析显示，乳腺浸润性小叶癌中CENPN变异发生率最高，BRCA中CENPN的扩增频率最高，乳腺浸润性混合性黏液癌中突变频率最高，CENPN区错义突变点位位于K329N，其可能是BRCA的推定驱动因素。GO功能富集分析显示，CENPN相关基因主要与细胞周期、DNA代谢过程、细胞分裂、核腔、染色体、核浆、三磷酸腺苷结合、核苷酸结合以及小分子结合等功能有关。KEGG通路富集分析显示，CENPN相关基因主要富集在DNA复制、细胞衰老、错配修复、同源重组、p53及叉头框蛋白O等信号通路中。通过TIMER 2.0数据库的相关分析显示，CENPN表达与BRCA中的B细胞、CD4+ T细胞、CD8+ T细胞、巨噬细胞、中性粒细胞及树突状细胞之间存在相关性，且与CD8+ T细胞标志物、B细胞标志物、T细胞标志物和T细胞衰竭标志物呈正相关。CCK-8法和划痕实验结果显示，敲降CENPN能够显著抑制MCF-7细胞的增殖和迁移等恶性特征，且能够进一步增强MCF-7细胞对抗肿瘤药物5-氟尿嘧啶和吉西他滨的化疗敏感性。 结论： CENPN可作为预测乳BRCA预后的潜在生物标志物，也是BRCA免疫治疗的潜在靶点。.
Conservative management with the placenta left in situ has emerged as an alternative approach for placenta accreta spectrum (PAS). Methotrexate (MTX) is sometimes used to facilitate placental resorption; however, its clinical benefit remains uncertain. We conducted a retrospective cohort study at two tertiary centers including patients with PAS managed conservatively with the placenta left in situ after cesarean delivery between April 2011 and March 2026. Patients were divided into MTX and non-MTX groups. The primary outcome was a composite adverse outcome, defined as cytopenia, bloodstream infection (BSI), late postpartum hypofibrinogenemia (LPH), therapeutic uterine artery embolization (UAE), or delayed hysterectomy. Secondary outcomes included suspected intrauterine infection and time to serum human chorionic gonadotropin (hCG) normalization. Seventeen patients were included (MTX, n = 8; non-MTX, n = 9). The composite adverse outcome occurred in 50.0% of patients in the MTX group and 44.4% in the non-MTX group, with no significant difference (RR 1.13, 95% CI 0.40-3.10; p = 1.00). Cytopenia was observed only in the MTX group (37.5% vs. 0%; p = 0.08). Other outcomes, including BSI, LPH, UAE, hysterectomy, and suspected intrauterine infection, were similar between groups. The median time to hCG normalization did not differ significantly between groups (66.5 vs. 64.0 days; p = 0.76). MTX use in conservatively managed PAS was not associated with improved clinical outcomes and may be associated with increased hematologic toxicity. These findings suggest that routine MTX administration does not appear to provide clinical benefit and may increase toxicity.
心房颤动（房颤）是临床常见的心律失常，其病理机制涉及电重构与代谢调节网络的复杂相互作用。值得注意的是，房颤可引发显著的心肌代谢重编程，这种代谢稳态失衡不仅加速心房结构重构，更是维持颤动波持续传导的关键病理基础。该文系统阐述了房颤中心肌能量代谢障碍、脂质代谢失调、氨基酸代谢紊乱等核心代谢表型特征，以及线粒体功能障碍与氧化应激级联反应在其中的调控作用，并分别介绍不同类型的心脏细胞在房颤中的代谢重编程，从代谢维度揭示房颤的重要分子机制，以期为其精准防治提供新的视角和干预靶点。.
Distal radius fractures (DRFs) are prevalent injuries, particularly among the elderly and young active individuals. Recent studies have emphasized the timing of surgical intervention, which may influence complication rates and functional outcomes. While some reviews have found no significant differences in outcomes between early and late surgery, others have suggested benefits from early intervention. Current guidelines from the British Orthopaedic Association Audit Standards for Trauma (BOAST) recommend surgical fixation within specific timeframes, yet optimal timing remains a topic of ongoing debate. This systematic review and meta-analysis aimed to assess the impact of surgical timing on complication rates and functional outcomes in closed DRFs. A comprehensive search was conducted across multiple electronic databases, including PubMed, EMBASE, and the Cochrane Library, to identify relevant studies. Eligible studies included randomized control trials and observational studies which compared early versus late surgical treatment. Meta-analyses were conducted on pooled data from compatible studies. Fourteen studies involving 2104 patients were included in this analysis. Meta-analysis revealed late surgical intervention was associated with an 8% increase in complication rates (95% CI 4% to 13%). Functional outcomes demonstrated that early surgery led to improved range of motion in flexion, pronation, and supination; however, no statistically significant differences were observed in extension. Further, Patient-Reported Outcome Measures did not exhibit significant differences between early and late surgical interventions. Early surgical intervention for DRFs is associated with lower complication rates and improved range of motion, however it does not improve patient reported outcomes.
Objective: To evaluate the predictive value of the admission creatinine-to-albumin ratio (CAR) for 30-day all-cause mortality and in-hospital adverse events in patients with type B aortic dissection (TBAD) undergoing thoracic endovascular aortic repair (TEVAR). Methods: This retrospective cohort study analyzed clinical data from 968 consecutive TBAD patients undergoing TEVAR at Guangdong Provincial People's Hospital from January 2010 to January 2024. Admission serum creatinine and albumin levels within 24 hours were used to calculate CAR. The optimal cut-off value of CAR was identified via maximally selected rank statistics for predicting 30-day all-cause mortality. Patients were stratified into high-CAR (≥the cut-off value of CAR) and low-CAR (<the cut-off value of CAR) groups. The primary endpoint was 30-day all-cause mortality. The secondary endpoints were in-hospital adverse events with particular focus on new-onset dialysis. Analyses included Kaplan-Meier survival, multivariable Cox and logistic regression, restricted cubic spline (RCS) analysis. Subgroup analyses were performed by age (<65 vs.≥65 years), sex, clinical phase of TBAD (acute, subacute, chronic), TBAD type (complicated vs. uncomplicated), DeBakey classification, and maximum aortic diameter. Sensitivity analyses were conducted by excluding patients with stage Ⅳ to V chronic kidney disease or cirrhosis. Results: A total of 968 patients were included, with an age of (55.2±11.4) years, and 835 (86.3%) were male. CAR predicted 30-day mortality with an area under the curve of 0.714. The optimal cut-off value was 3.00, yielding a low-CAR group (n=621) and a high-CAR group (n=347). The 30-day mortality was 4.6% (16/347) in the high-CAR group versus 1.1% (7/621) in the low-CAR group (P<0.01). Kaplan-Meier survival analysis yielded consistent results (Plog-rank<0.01). RCS analysis indicated a non-linear association between CAR and 30-day mortality risk (non-linearity P=0.03). The multivariable Cox regression analysis showed that CAR was an independent risk factor for 30 d all-cause mortality (HR=1.10, 95%CI 1.03-1.17). In-hospital adverse events were more frequent in the high-CAR group than in the low-CAR group (15.9% (55/347) vs. 5.6% (35/621), P<0.01), and logistic regression confirmed CAR as an independent predictor (OR=1.10, 95%CI 1.05-1.17). Notably, new-onset dialysis showed the most pronounced intergroup difference among all individual adverse events (5.8% (20/347) vs. 0.6% (4/621), P<0.01) and multivariable logistic regression further confirmed CAR as an independent predictor of new-onset dialysis (OR=1.09, 95%CI 1.02-1.16). Subgroup analyses demonstrated consistent predictive performance for 30-day mortality and in-hospital adverse events across major clinical subgroups (all interaction P>0.05). For new-onset dialysis, the effect of CAR was significantly stronger in complicated TBAD than in uncomplicated TBAD (interaction P=0.02). Results held after excluding patients with Ⅳ-Ⅴ time renal disease or cirrhosis. Conclusions: Admission CAR≥3.00 independently predicts 30-day mortality and in-hospital adverse events in TBAD patients following TEVAR, with a non-linear dose-response relationship. Among all endpoints, CAR demonstrates the strongest predictive value for postoperative severe renal deterioration (new-onset dialysis), an effect that appears amplified in complicated TBAD. 目的： 评估入院24 h内肌酐与白蛋白比值（CAR）对接受胸主动脉腔内修复术（TEVAR）的B型主动脉夹层患者术后30 d全因死亡及院内不良事件的预测价值。 方法： 本研究为回顾性队列研究。纳入2010年1月至2024年1月于广东省人民医院接受TEVAR治疗的B型主动脉夹层患者。采集入院24 h内血清肌酐与白蛋白并计算CAR。以最大选择秩统计量确定CAR预测30 d全因死亡的截断值，据此将患者分为高CAR组（≥截断值）与低CAR组。主要终点为术后30 d全因死亡，次要终点为术后院内不良事件（重点关注新发透析）。采用受试者工作特征曲线、Kaplan-Meier生存曲线、限制性立方样条分析CAR对术后30 d全因死亡的评估效能及二者的剂量-反应关系，使用多因素Cox比例风险回归模型分析CAR对患者术后30 d死亡的影响，logistic回归分析探讨CAR对院内不良事件和新发透析事件的影响。并按年龄（<65岁与≥65岁）、性别、临床分期（急性期、亚急性期、慢性期）、B型主动脉夹层类型（复杂型与非复杂型）、DeBakey分型及主动脉最大直径进行亚组分析，通过剔除慢性肾脏病Ⅳ~Ⅴ期及肝硬化患者进行敏感性分析。 结果： 共纳入968例患者，年龄（55.2±11.4）岁，男性835例（86.3%）。CAR预测术后30 d死亡的曲线下面积为0.714。CAR的截断值为3.00。低CAR组621例，高CAR组347例。高CAR组术后30 d全因死亡率高于低CAR组［4.6%（16/347）比1.1%（7/621），P<0.01］，Kaplan-Meier生存分析结果与之一致（Plog-rank<0.01）。限制性立方样条分析提示CAR与术后30 d全因死亡风险呈非线性关联（非线性P=0.03）。高CAR组院内不良事件发生率高于低CAR组［15.9%（55/347）比5.6%（35/621），P<0.01］，各单项事件中两组在新发透析发生率方面差异明显［5.8%（20/347）比0.6%（4/621），P<0.01］。多因素Cox比例风险回归分析结果显示，CAR是术后30 d全因死亡的独立危险因素（HR=1.10，95%CI 1.03~1.17）；多因素logistic回归分析结果显示，CAR是院内不良事件（OR=1.10，95%CI 1.05~1.17）及新发透析（OR=1.09，95%CI 1.02~1.16）的独立危险因素。亚组分析显示CAR对术后30 d全因死亡及院内不良事件的预测效能在各亚组中保持一致（P交互均>0.05）；对于新发透析，CAR在复杂型亚组中的预测效应值高于非复杂型亚组（P交互=0.02）。排除Ⅳ~Ⅴ期肾病及肝硬化患者后结果稳健。 结论： 入院CAR≥3.00可独立预测B型主动脉夹层患者TEVAR术后30 d死亡及院内不良事件风险增加，且该关联呈非线性剂量-反应关系。CAR对术后严重肾功能恶化（新发透析）的预判价值在所有终点中最为突出，且该效应在复杂型B型主动脉夹层患者中可能进一步增强。.
Functional recovery after radical prostatectomy happens continually but is only measured at set times when questionnaires are given. This leads to what is known as interval censoring. In the urologic literature, patients are typically considered to have recovered function at the moment they complete a follow-up survey, although recovery may have occurred earlier, leading to systematic overestimation of recovery time. At our institution, patients completing function assessments are additionally asked to estimate when recovery occurred, and this estimate is incorporated into the analysis. We aimed to compare our approach with the standard method, which assigns recovery to the survey completion date. We retrospectively identified 11 161 men who underwent radical prostatectomy between 2009 and 2025. Patients completed urinary and erectile function questionnaires at regular intervals after surgery; at the first response meeting recovery criteria (eg, pads no longer used), patients estimated the timing of recovery using predefined intervals. We used Kaplan-Meier analyses to estimate cumulative recovery over time, using both the survey completion date and the patient-reported estimate. We identified 7896 patients who recovered continence and 6521 who recovered erectile function. Patient-estimated recovery time was considerably earlier than recovery time based on the survey completion date. Median time to continence recovery was 5 mo using our approach versus 8 mo using the survey completion date approach, whereas median time to erectile function recovery was 18 mo versus 23 mo. At 6 mo, recovery rates were higher when based on patient-estimated dates compared with survey completion dates for both continence (57% vs 40%) and erectile function (35% vs 28%). Functional questionnaires should include an additional item asking patients to report when recovery occurred. The reported time of recovery should be used in the analysis rather than the survey completion date.
The prevalence of pediatric chronic conditions and demand for lower urinary tract symptom management have risen in recent decades, contributing to growing clinical demand for pediatric urology services. Meeting this demand requires a sufficient and well-supported workforce, and Advanced Practice Providers (APPs) have become an increasingly recognized component of urological care delivery. The Pediatric Urology Nurses and Specialists (PUNS) organization represents APPs in pediatric urology in the United States and Canada. This study aimed to conduct a census survey of PUNS members to better understand APP education and roles in pediatric urology. This descriptive survey, developed by the PUNS research special interest group, was administered to PUNS fall meeting attendees in 2023. The electronic survey collected information on demographics, professional settings, the degree of independence in practice versus physician-supervised roles, procedures, and diagnoses managed, and engagement in research. There were 112 of 300 respondents (37%), predominantly female (97.9%). 46.3% were between 31 and 40 years, followed by the 41-50 years group (27.4%), those aged 51 years and older (15.8%), and the 20-30 years (10.5%). 90% of the respondents work in urban centers, with 98.7% based in university settings or academic institutions. Respondents held advanced degrees, including a Master of Science in Nursing (MSN) (71.4%), a Doctor of Nursing Practice (DNP) (9.8%), and a Doctor of Philosophy (PhD) (1.8%). Most respondents evaluate patients independently of physicians (94.7%). 58% were involved in research through their roles, 24.1% assisted with patient recruitment and consent, another 24.1% were co-investigators, 8.9% were primary investigators, and 8.9% of respondents had published in peer-reviewed journals over the past two years. APPs reported independently managing most pediatric urology conditions, with many also performing procedures independently. APPs are also involved with research activities to various degrees. This information can be used to improve APP utilization internationally, fully optimizing their practice scope and improving surgeon time utilization. This survey revealed a well-educated, predominantly female membership primarily working in urban academic environments and exhibiting high clinical independence. Less than half of the membership participates in research; those who do are significantly involved across various capacities.
This retrospective cohort study was performed to compare the long-term survival rates of implants placed following onlay versus interpositional bone grafting in the atrophic mandible. Forty-eight patients with an adequate bone width who required ridge heightening were included. Twenty-six patients received an interpositional bone graft by sandwich technique (sandwich group) and 22 received an onlay graft (onlay group). The results showed a significant difference in implant failure: 17 of 52 implants (32.7%) placed in the onlay group failed, compared with 1 of 63 implants (1.6%) placed in the sandwich group (P < 0.001). Cox regression demonstrated a significantly lower hazard of implant failure in the sandwich group when compared to the onlay group (hazard ratio = 0.022, P = 0.002). Mean marginal bone loss (MBL) from implant placement to final follow-up was significantly lower in the interpositional sandwich group (2.98 ± 1.34 mm; mean follow-up 92.50 ± 20.45 months) than in the onlay group (4.50 ± 0.58 mm; mean follow-up 81.81 ± 18.54 months) (P = 0.004). In the multivariate analysis (general linear model), augmentation type (P < 0.001), follow-up duration (P < 0.001), initial bone gain (P = 0.030), and gingival biotype (P = 0.010) were significantly associated with MBL, while keratinized tissue width was not (P = 0.080). Within the limitations of this study, dental implants placed after interpositional sandwich grafting showed higher long-term survival and less MBL than implants placed after onlay grafting in the atrophic mandible.
Computer-aided detection (CADe) improves adenoma detection rate (ADR) in randomised trials; however, translation into routine practice remains uncertain, with real-world studies showing inconsistent results. To evaluate CADe in a pragmatic multicentre setting using a within-endoscopist design, with endoscopists serving as their own comparators under routine clinical conditions. Pragmatic multicentre observational study analysing prospectively recorded data from 13 units. Six endoscopists performed procedures in a unit with routine CADe use and in units without CADe, enabling within-operator comparisons under naturalistic conditions. The primary outcome was ADR. Secondary outcomes included combined adenoma plus clinically significant serrated polyp detection rate (A+CSSPDR) and additional polyp-related metrics. Of 3161 colonoscopies, 2973 were analysed (947 CADe; 2026 non-CADe). ADR was higher with CADe (34.4%vs 30.7%; p = 0.042). A+CSSPDR was also higher (40.3%vs 35.8%; p = 0.018), with consistent improvements across other metrics. In multivariable analysis, CADe remained independently associated with higher ADR (aOR 1.31, 95%CI 1.11-1.55; p = 0.002) and A+CSSPDR (aOR 1.33, 95%CI 1.13-1.56; p = 0.001), with attenuation after adjustment for endoscopist. In a pragmatic real-world setting, CADe improved detection of colorectal neoplasia. This within-endoscopist design provides a balanced estimate of effectiveness by minimising behavioural bias affecting both trial and real-world studies.