Conventional surgical teaching techniques face several challenges,highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice.The recent rapid adv...Conventional surgical teaching techniques face several challenges,highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice.The recent rapid advancement of computer technology has enabled the integration of virtual reality(VR)into medical training,thereby revolutionizing ophthalmic surgical education through VRbased educational methods.VR technology offers a safe,risk-free environment for trainees to practice repeatedly,enhancing surgical skills and accelerating the learning curve without compromising patient safety.This research outlines the application of VR technology in ophthalmic surgical skills training,particularly in cataract and vitreoretinal surgery.Including assessing the effectiveness of intraocular surgery training systems,evaluating skills transfer to the operating room,comparing it with wet lab cataract surgery training,and enhancing non-dominant hand training for cataract surgery,among other aspects.Additionally,this paper will identify the limitations of VR technology in ocular surgical skills training,offer improvement strategies,and detail the advantages and prospects,with the objective of guiding subsequent researchers.展开更多
BACKGROUND Upper gastrointestinal cancer(UGIC),including esophageal and gastric cancers,poses a major global health challenge due to its high morbidity and mortality.During the preoperative period,patients often face ...BACKGROUND Upper gastrointestinal cancer(UGIC),including esophageal and gastric cancers,poses a major global health challenge due to its high morbidity and mortality.During the preoperative period,patients often face functional decline,malnutrition,and psychological stress,which can impair recovery.Prehabilitation,a multidisciplinary preoperative intervention,shows promise in optimizing patients'physical and mental status.AIM To evaluate the impact of prehabilitation on patients undergoing UGIC surgery and provide a basis for implementation of the prehabilitation compound plan.METHODS A computerized search of databases including Web of Science,PubMed,EMBASE,The Cochrane Library,Cumulative Index to Nursing and Allied Health Literature,China National Knowledge Infrastructure,Wanfang,and Chinese Science and Technology Journal Database was used to collect clinical trials on the impact of prehabilitation on patients undergoing UGIC surgery.After screening,a meta-analysis was conducted using Review Manager 5.0 software,and linear regression analysis was performed on the prehabilitation duration and outcome indicators.RESULTS A total of 13 clinical trials were ultimately included,with 8 literature quality evaluations at A level and 5 literature quality evaluations at B level.The meta-analysis results showed that compared with conventional nursing,the prehabilitation group had higher six-minute walk distance,lower postoperative complications and mortality rates,and shorter hospital stays,with statistically significant differences;there were no statistically significant differences in intensive care unit monitoring time and albumin levels between the two groups;regression analysis between prehabilitation duration and outcome indicators showed no significant relationship.CONCLUSION Prehabilitation can improve the perioperative functional ability of patients with UGIC and promote postoperative recovery,but its impact on nutrition,psychology,and quality of life needs to be further explored through more high-quality trials;in addition,further research is needed on the prehabilitation time,location,and specific plan.展开更多
BACKGROUND Targeted therapy combined with anti-programmed cell death 1 immunotherapy(TP)and trifluridine/tipiracil(TAS-102)combined with bevacizumab(TB)are two common therapies for patients with late-line therapy in m...BACKGROUND Targeted therapy combined with anti-programmed cell death 1 immunotherapy(TP)and trifluridine/tipiracil(TAS-102)combined with bevacizumab(TB)are two common therapies for patients with late-line therapy in microsatellite stable(MSS)metastatic colorectal cancer(mCRC).However,it is still unclear which therapy can bring better prognosis.AIM To evaluate the effectiveness and safety of TP vs TB as the late-line regimen for MSS mCRC in the real world.METHODS This is a dual-center retrospective cohort study conducted in Peking University First Hospital and Jilin Cancer Hospital.Patients with MSS mCRC who had received at least the second line treatment were eligible.Propensity score(PS)would be calculated to balance the baseline characteristics of two cohorts.Progression-free survival(PFS)was set as the primary endpoint.The Kaplan-Meier method and Cox proportional hazard model were used to evaluate PFS and to estimate hazard ratios(HRs)and 95%confidence intervals(CIs).Landmark analysis was performed to create segmented survival curves,studying the impact of treatment regimen on prognosis during different follow-up periods.RESULTS Between July 2019 and March 2025(data cutoff),127 eligible patients were enrolled,with 88 and 39 patients assigned to the TP and TB cohorts,respectively,based on treatment allocation.At a global median follow-up of 9.73 months,the crude median PFS was 3.9 months(95%CI:3.03-5.53)in the TP cohort vs 4.17 months(95%CI:2.87-5.6)in the TB cohort,yielding a nonsignificant HR of 1.43(95%CI:0.94-2.18,P=0.092;TB as reference).Multivariate Cox regression analysis,adjusted for sex,age>60 years,Eastern Cooperative Oncology Group performance status,RAS mutation,primary tumor location(left vs right),number of metastatic organs(liver/lung),and treatment line(≥3rd line),demonstrated an adjusted HR of 1.23(95%CI:0.80-1.88,P=0.348).PS-based analyses using three methodologies:Inverse probability weighting,PS matching(post-matching n=55 vs 30),and PS-adjusted multivariate Cox regression.These analyses revealed consistent nonsignificant trends favoring TB,with HRs for TP of 1.26(95%CI:0.76-2.10,P=0.077),1.42(95%CI:0.87-2.34,P=0.164),and 1.26(95%CI:0.76-2.10,P=0.367),respectively.Notably,landmark PFS analyses at 90,120,and 150 days demonstrated a significantly higher proportion of TP patients maintaining disease control beyond these timepoints(P=0.048,0.031,and 0.035,respectively),suggesting sustained clinical benefits in TP responders.CONCLUSION TP and TB demonstrated similar PFS in both crude and PS-adjusted analyses.However,patients who derived benefits from TP therapy exceeding 90 days showed more sustained clinical advantages compared to TB.Our study suggests that for patients with MSS mCRC who respond to TP therapy in later-line treatments,this regimen could provide additional prolonged clinical benefits,which warrants further validation through large-scale cohort investigations.展开更多
BACKGROUND Motoric cognitive risk(MCR)syndrome represents an“ultra-early”stage of dementia prevention,highlighting the need for effective screening tools.AIM To develop and validate a novel tool for MCR identificati...BACKGROUND Motoric cognitive risk(MCR)syndrome represents an“ultra-early”stage of dementia prevention,highlighting the need for effective screening tools.AIM To develop and validate a novel tool for MCR identification,comparing its effectiveness with existing methods.METHODS As part of a community study on healthy aging,a cross-sectional study recruited 1189 Chinese participants aged 50 years and older between May 1,2022,and March 15,2023.The cohort was randomly split into training(70%)and testing(30%)datasets.Relevant features were selected for logistic regression(LR)and decision tree(DT)models using the training dataset,and their performance was subsequently assessed using the testing dataset to validate reliability and generalizability.RESULTS The prevalence of MCR was 13.12%among 1189 participants.DT models had the area under the curves(AUCs)of 0.834 and 0.821 for training and testing datasets,respectively,while LR models indicated AUCs of 0.840 and 0.859.Non-inferiority tests confirmed the DT model’s comparable effectiveness to the LR models in predicting MCR.Both models demonstrated good calibration and clinical utility.Seven modifiable risk factors were identified:Age,education level,social engagement,physical activity,nutritional status,depressive symptoms,and purpose in life.Notably,social engagement emerged as a novel factor compared to those previously identified.Both models are integrated into an easy-to-use,interpretable web-based user interface.CONCLUSION The interactive,web-based user interface of both models effectively identifies MCR,with the DT model recommended for its simplicity and interpretability,supporting community nurses and clinicians in triaging MCR.展开更多
BACKGROUND Patients with microsatellite stable(MSS)metastatic colorectal cancer(mCRC)typically exhibit an immunosuppressive tumor microenvironment and demonstrate a low response rate to immunotherapy.Reports suggest t...BACKGROUND Patients with microsatellite stable(MSS)metastatic colorectal cancer(mCRC)typically exhibit an immunosuppressive tumor microenvironment and demonstrate a low response rate to immunotherapy.Reports suggest that chemotherapy and anti-angiogenic therapy may have the potential to enhance the response to immunotherapy in these patients.This study aims to evaluate the effectiveness and safety of chemotherapy combined with bevacizumab with or without antiprogrammed death 1(PD-1)immunotherapy as the second-line regimen for MSS mCRC.AIM To evaluate the effectiveness and safety of chemotherapy combined with bevacizumab with or without anti-PD-1 immunotherapy as the second-line regimen for MSS mCRC.METHODS A retrospective analysis was conducted on patients with MSS mCRC diagnosed at Peking University First Hospital and Jilin Cancer Hospital from January 2020 to December 2024.The patients were divided into two groups:The experimental group receiving second-line chemotherapy combined with bevacizumab and anti-PD-1 immunotherapy,and the control group receiving chemotherapy combined with bevacizumab.Propensity score matching was applied to balance potential prognostic factors,including age,gender,Eastern Cooperative Oncology Group score,number of metastases,and primary tumor site.The progression-free survival,overall survival,disease control rate,objective response rate,and treatment-related adverse reactions were compared between the two groups.Kaplan-Meier analysis and log-rank test were used to compare survival outcomes.Inverse probability of treatment weighting was used for sensitivity analysis.RESULTS Propensity score matching resulted in 103 matched eligible patients.The median follow-up period was 13.9 months in the matched cohort.The objective response rate was 11.5%and 9%for the experimental and control groups,respectively(P=0.710),while the disease control rate was 76.9%and 53.2%,respectively(P=0.058).The median progression-free survival in the experimental group was 8.27 months[95%confidence interval(CI):6.7-14.7 months],significantly higher than that in the control group,which was 4.63 months(95%CI:3.9-5.67 months)(hazard ratio=0.4143,95%CI:0.2462-0.6972,P=0.00066).There was a trend towards the higher median overall survival in the experimental group compared to the control group(hazard ratio=0.4504,95%CI:0.1897-1.07,P=0.064).The incidences of adverse events were similar between the two groups.CONCLUSION Compared with the standard second-line chemotherapy combined with bevacizumab regimen,second-line therapy that combines chemotherapy with bevacizumab and anti-PD-1 immunotherapy has demonstrated promising efficacy in the treatment of MSS mCRC,while exhibiting a similar safety profile.展开更多
BACKGROUND Microsatellite stable(MSS)metastatic colorectal cancer(mCRC)is characterized by an immunosuppressive tumor microenvironment,leading to limited efficacy of immunotherapy in these patients.Clinical trial data...BACKGROUND Microsatellite stable(MSS)metastatic colorectal cancer(mCRC)is characterized by an immunosuppressive tumor microenvironment,leading to limited efficacy of immunotherapy in these patients.Clinical trial data suggest that chemotherapy and anti-angiogenic therapy may have the potential to enhance the response to immunotherapy in these patients.However,whether these research findings can be“replicated”in clinical practice still requires further validation through real-world studies.This study aims to evaluate the effectiveness and safety of chemo-therapy combined with bevacizumab with or without anti-programmed death 1(PD-1)immunotherapy as the first-line regimen for MSS mCRC in the real world.AIM To evaluate the effectiveness and safety of chemotherapy combined with beva-cizumab with or without anti-PD-1 immunotherapy as the first-line regimen for MSS mCRC in the real world.METHODS We conducted a retrospective analysis of patients with MSS mCRC diagnosed at Peking University First Hospital and Jilin Cancer Hospital between January 2020 and December 2024.Patients were stratified into two treatment groups:(1)An experimental group receiving first-line chemotherapy combined with bevaci-zumab and anti-PD-1 immunotherapy;and(2)A control group receiving chemo-therapy plus bevacizumab alone.Propensity score matching was employed to balance baseline characteristics,including age,gender,Eastern Cooperative Onco-logy Group performance status,number of metastatic sites,and primary tumor location.The primary endpoints were progression-free survival and overall survival,while secondary endpoints included disease control rate,objective response rate,and treatment-related adverse events.Survival outcomes were assessed using Kaplan-Meier analysis with log-rank testing.Additionally,inverse probability of treatment weighting was applied for sensitivity analysis to validate the robustness of our findings.RESULTS The propensity score matching analysis identified 103 well-balanced patient pairs with a median follow-up of 25.5 months.The experimental group demonstrated numerically higher objective response(36.00%vs 23.08%,P=0.309)and disease control rates(96.00%vs 91.03%,P=0.6759)compared to the control group,though these differences were not statistically significant.Similarly,no significant survival benefit was observed for either progression-free survival[hazard ratio(HR)=0.7076,95%confidence interval(CI):0.4069-1.23,P=0.22]or overall survival(HR=1.154,95%CI:0.4712-2.827,P=0.75).Multivariate analysis identified liver metastases as an independent poor prognostic factor(HR=3.36,95%CI:1.71-6.60,P<0.001),while subgroup analyses revealed potential benefits of the experimental regimen in male patients(HR=0.33,95%CI:0.14-0.81,P=0.025)and those with right-sided primary tumors(HR=0.40,95%CI:0.17-0.95,P=0.022).Safety profiles were comparable between groups,though elevated lactate dehydrogenase emerged as an independent risk factor for poorer outcomes in the experimental group(HR=4.11,95%CI:1.02-16.55,P=0.046).CONCLUSION Chemotherapy combined with bevacizumab and anti-PD-1 immunotherapy could not demonstrate promising efficacy in treating MSS mCRC compared to the standard first-line chemotherapy regimen with bevacizumab.Male patients or those with right-sided mCRC may derive benefits from immune-based combination therapy.Further research is needed to investigate specific clinical characteristics or biomarkers to identify patients who may derive benefit from combined immunotherapy approaches.展开更多
Tuberculous meningitis(TBM),which accounts for 1%-5%of global tuberculosis cases,is a severe neurological infection with a mortality rate of 30%-50%.Its high fatality and disability rates disproportionately affect low...Tuberculous meningitis(TBM),which accounts for 1%-5%of global tuberculosis cases,is a severe neurological infection with a mortality rate of 30%-50%.Its high fatality and disability rates disproportionately affect low-and middle-income regions(e.g.,sub-Saharan Africa and Southeast Asia),threatening the lives of patients and imposing significant psychosocial burdens.Recent studies have highlighted the crucial role of psychosocial factors,including socioeconomic status,disease severity,and social support systems in recovery.However,research gaps persist in developing TBM-specific psychosocial interventions.This narrative review summarizes and organizes the key findings of observational studies,cohort studies,and intervention trials published between 2015 and 2024.Databases including PubMed,Scopus,and Web of Science were searched for terms related to TBM,psychosocial risk factors and mental health interventions.Studies were screened for relevance and quality,focusing on those that examined the psychological and social determinants of mental health outcomes in patients with TBM.展开更多
BACKGROUND Clinical trial evidence points to chemotherapy’s potential in augmenting the effects of immunotherapy.AIM To assess the effectiveness of first-line chemoimmunotherapy(CIT)for microsatellite stable(MSS)meta...BACKGROUND Clinical trial evidence points to chemotherapy’s potential in augmenting the effects of immunotherapy.AIM To assess the effectiveness of first-line chemoimmunotherapy(CIT)for microsatellite stable(MSS)metastatic colorectal cancer(mCRC)verses standard-of-care(SOC;5-fluorouracil/leucovorin/oxaliplatin/bevacizumab).METHODS This was a multicenter retrospective cohort study conducted in Peking University First Hospital and Jilin Cancer Hospital.Patients with MSS mCRC who had received first-line treatment were eligible.The Kaplan-Meier method and Cox proportional hazard model were used to evaluate progression-free survival(PFS)and to estimate hazard ratios(HRs)and 95%confidence intervals(CIs).PFS was set as the primary endpoint.Propensity score(PS)was calculated to balance the baseline characteristics of the two cohorts.With PS,we performed three statistical methods,namely inverse probability weighting,PS matching,and additional adjustment for PS with multivariate cox regression.RESULTS Between July 2019 and November 2024,148 eligible patients were enrolled,with 40 and 108 patients assigned to the CIT and SOC cohorts,respectively.At a global median follow-up of 21.4 months,the crude median PFS was 13.5 months(95%CI:9.77-21.6)in the CIT cohort vs 9.1 months(95%CI:7.8-10.6)in the SOC cohort,yielding a nonsignificant hazard ratio(HR)of 0.5645(95%CI:0.3637-0.8763,P=0.01;SOC as reference).Multivariate Cox regression analysis,adjusted for sex,age>60 years,Eastern Cooperative Oncology Group performance status,rat sarcoma mutation,primary tumor location(left vs right)and number of metastatic organs(liver/lung),demonstrated an adjusted HR of 0.55(95%CI:0.35-0.87,P=0.011).PS-based analyses using PS matching(post-matching n=40 vs 40),PS-adjusted multivariate Cox regression,and inverse probability weighting revealed consistent significant trends favoring CIT,with HRs for CIT of 0.5641(95%CI:0.3303-0.9635,P=0.0361),0.60(95%CI:0.38-0.96,P=0.034),and 0.57(95%CI:0.337-0.973,P=0.039),respectively.CONCLUSION Efficacy of CIT in MSS mCRC could surpass that of standard first-line chemotherapy.Further research is needed to investigate specific clinical characteristics or biomarkers to identify patients who may derive benefit from CIT.展开更多
Ulcerative colitis(UC) is an inflammatory disease that mainly affects the colon and rectum. It is believed that genetic factors, host immune system disorders, intestinal microbiota dysbiosis, and environmental factors...Ulcerative colitis(UC) is an inflammatory disease that mainly affects the colon and rectum. It is believed that genetic factors, host immune system disorders, intestinal microbiota dysbiosis, and environmental factors contribute to the pathogenesis of UC. however, studies on the role of intestinal microbiota in the pathogenesis of UC have been inconclusive. Studies have shown that probiotics improve intestinal mucosa barrier function and immune system function and promote secretion of anti-inflammatory factors, thereby inhibiting the growth of harmful bacteria in the intestine. Fecal microbiota transplantation(FMT) can reduce bowel permeability and thus the severity of disease by increasing the production of short-chain fatty acids, especially butyrate, which help maintain the integrity of the epithelial barrier. FMT can also restore immune dysbiosis by inhibiting Th1 differentiation, activity of T cells, leukocyte adhesion, and production of inflammatory factors. Probiotics and FMT are being increasingly used to treat UC, but their use is controversial because of uncertain efficacy. Here, we briefly review the role of intestinal microbiota in thepathogenesis and treatment of UC.展开更多
BACKGROUND Lymphovascular invasion (LVI) is suggested to be an early and important step in tumor progression toward metastasis, but its prognostic value and genetic mechanisms in colorectal cancer (CRC) have not been ...BACKGROUND Lymphovascular invasion (LVI) is suggested to be an early and important step in tumor progression toward metastasis, but its prognostic value and genetic mechanisms in colorectal cancer (CRC) have not been well investigated. AIM To investigate the prognostic value of LVI in CRC and identify the associated genomic alterations. METHODS We performed a retrospective analysis of 1219 CRC patients and evaluated the prognostic value of LVI for overall survival by the Kaplan-Meier method and multivariate Cox regression analysis. We also performed an array-based comparative genomic hybridization analysis of 47 fresh CRC samples to examine the genomic alterations associated with LVI. A decision tree model was applied to identify special DNA copy number alterations (DCNAs) for differentiating between CRCs with and without LVI. Functional enrichment and protein-protein interaction network analyses were conducted to explore the potential molecular mechanisms of LVI. RESULTS LVI was detected in 150 (12.3%) of 1219 CRCs, and the presence was positively associated with higher histological grade and advanced tumor stage (both P < 0.001). Compared with the non-LVI group, the LVI group showed a 1.77-fold (95% confidence interval: 1.40-2.25, P < 0.001) increased risk of death and a significantly lower 5-year overall survival rate (P < 0.001). Based on the comparative genomic hybridization data, 184 DCNAs (105 gains and 79 losses) were identified to be significantly related to LVI (P < 0.05), and the majority were located at 22q, 17q, 10q, and 6q. We further constructed a decision tree classifier including seven special DCNAs, which could distinguish CRCs with LVI from those without it at an accuracy of 95.7%. Functional enrichment and proteinprotein interaction network analyses revealed that the genomic alterations related to LVI were correlated with inflammation, epithelial-mesenchymal transition, angiogenesis, and matrix remodeling. CONCLUSION LVI is an independent predictor for survival in CRC, and its development may correlate with inflammation, epithelial-mesenchymal transition, angiogenesis, and matrix remodeling.展开更多
The calculation of inelastic creep damage is important for the structural integrity evaluation of the elevated temperature structure in a thorium molten salt reactor(TMSR). However, a creep damage theory model and num...The calculation of inelastic creep damage is important for the structural integrity evaluation of the elevated temperature structure in a thorium molten salt reactor(TMSR). However, a creep damage theory model and numerical simulation method have not been proposed for the key materials(UNS N10003 alloy) in the TMSR. In this study, creep damage characterization of UNS N10003 alloy is investigated using the Norton creep law and Kachanov–Rabotnov(K–R) creep damage model. First, the creep experimental data of the UNS N10003 alloy at 650 °C were adopted to fit the material constants of the two models. Then, the creep damage behavior of the UNS N10003 alloy was analyzed and discussed under uniaxial and multi-axial stress states. The results indicated that the K–R creep damage model is more suitable for the UNS N10003 alloy than the Norton model. Finally, the numerical simulation method was developed by a user-defined UMAT subroutine and subsequently verified through a finite element analysis(FEA). The FEA results were in agreement with the theoretical solutions. This study provides an effective method for the inelastic creep damage analysis of the elevated temperature structure in the TMSR.展开更多
AIM: To investigate the dynamic expression of p-signal transducer and activator of transcription 3 (STAT3) and vascular endothelial growth factor (VEGF) in the formation of gastric tumors induced by drinking water con...AIM: To investigate the dynamic expression of p-signal transducer and activator of transcription 3 (STAT3) and vascular endothelial growth factor (VEGF) in the formation of gastric tumors induced by drinking water containing N-methyl-N’-nitro-N-nitrosoguanidine (MNNG) in Wistar rats. METHODS: One hundred and twenty Wistar rats were randomly divided into two groups (60 in each group): Control group and Model group. The rats in each group were then randomly divided into three groups (20 in each group): C/M15, C/M25 and C/M40 (15, 25 and 40 represent the number of feeding weeks from termination). Rats in the control group received normal drinking water and rats in the model group received drinking water containing 100 μg/mL MNNG. Stomach tissues were collected at the end of the 15<sup>th</sup>, 25<sup>th</sup> and 40<sup>th</sup> week, respectively, for microscopic measurement using hematoxylin and eosin staining. The expression of p-STAT3 and VEGF in different pathological types of gastric tissue, including normal, inflammation, atrophy, hyperplasia and gastric stromal tumor, was observed by immunohistochemistry and Western blot, and the corelation between p-STAT3 and VEGF was analyzed. RESULTS: (1) The expression of p-STAT3 in tissue with gastritis, atrophy, dysplasia and gastric stromal tumor were significantly increased in the model group compared with the control group (2.5 ± 1.0, 2.75 ± 0.36, 6.2 ± 0.45, 5.67 ± 0.55 vs 0.75 ± 0.36, P = 0.026, 0.035, 0.001, 0.002, respectively); the expression of p-STAT3 in tissue with dysplasia was higher than that in samples with gastritis or atrophy (6.2 ± 0.45 vs 2.5 ± 1.0, P = 0.006; 6.2 ± 0.45 vs 2.75 ± 0.36, P = 0.005, respectively); however, the expression of p-STAT3 in gastritis and atrophy was not significantly different (P > 0.05); (2) the expression of VEGF in tissue with gastritis, atrophy, dysplasia and gastric stromal tumor was significantly increased in the model group compared with normal gastric mucosa; and the expression of VEGF in tissue with dysplasia was higher than that in tissue with inflammation and atrophy (10.8 ± 1.96 vs 7.62 ± 0.25, P = 0.029; 10.8 ± 1.96 vs 6.26 ± 0.76, P = 0.033, respectively); similarly, the expression of VEGF in tissue with gastritis and atrophy was not significantly different (P > 0.05); and (3) the expression of VEGF was positively correlated with p-STAT3. CONCLUSION: p-STAT3 plays an important role in gastric cancer formation by regulating the expression of VEGF to promote the progression of gastric tumor from gastritis.展开更多
AIM: To investigate stepwise sedation for elderly patients with mild/moderate chronic obstructive pulmonary disease (COPD) during upper gastrointestinal (GI) endoscopy. METHODS: Eighty-six elderly patients with mild/m...AIM: To investigate stepwise sedation for elderly patients with mild/moderate chronic obstructive pulmonary disease (COPD) during upper gastrointestinal (GI) endoscopy. METHODS: Eighty-six elderly patients with mild/moderate COPD and 82 elderly patients without COPD scheduled for upper GI endoscopy were randomly assigned to receive one of the following two sedation methods: stepwise sedation involving three-stage administration of propofol combined with midazolam [COPD with stepwise sedation (group Cs), and nonCOPD with stepwise sedation (group Ns)] or continuous sedation involving continuous administration of propofol combined with midazolam [COPD with continuous sedation (group Cc), and non-COPD with continuous sedation (group Nc)]. Saturation of peripheral oxygen (SpO 2 ), blood pressure, and pulse rate were monitored, and patient discomfort, adverse events, drugs dosage, and recovery time were recorded. RESULTS: All endoscopies were completed successfully. The occurrences of hypoxemia in groups Cs, Cc, Ns, and Nc were 4 (9.3%), 12 (27.9%), 3 (7.3%), and 5 (12.2%), respectively. The occurrence of hypoxemia in group Cs was significantly lower than that in group Cc (P < 0.05). The average decreases in value of SpO 2 , systolic blood pressure, and diastolic blood pressure in group Cs were significantly lower than those in group Cc. Additionally, propofol dosage and overall rate of adverse events in group Cs were lower than those in group Cc. Finally, the recovery time in group Cs was significantly shorter than that in group Cc, and that in group Ns was significantly shorter than that in group Nc (P < 0.001). CONCLUSION: The stepwise sedation method is effective and safer than the continuous sedation method for elderly patients with mild/moderate COPD during upper GI endoscopy.展开更多
Ti–3Cu alloy has shown low melting point and strong antibacterial properties against S.aureus and E.coli and thus has potential application as dental materials and orthopedic application.In this paper, the corrosion ...Ti–3Cu alloy has shown low melting point and strong antibacterial properties against S.aureus and E.coli and thus has potential application as dental materials and orthopedic application.In this paper, the corrosion properties of Ti–3Cu alloy in five kinds of simulated solutions were investigated in comparison with cp-Ti(commercially pure titanium) by electrochemical technology and immersion experiment.Electrochemical results have demonstrated that Ti–3Cu alloy exhibited much nobler corrosion potential, lower corrosion current density and high corrosion resistance than cp-Ti in all solutions, especially in saliva-pH6.8+0.2 F and saliva-pH3.5, indicating that Ti–3Cu alloy has much better anticorrosion properties than cpTi.Immersion results have shown that Ti ion and Cu ion were released from Ti–3Cu, especially in saliva-pH6.8+0.2 F and saliva-pH3.5 solutions.Both electrochemical data and immersion results have indicated that high corrosion rate and high metal ion release rate were detected in F ion-containing solution and low-pH solution, displaying that F^- and low pH had much strong aggressive attack to cp-Ti and Ti–3Cu alloy.The corroded surface morphology was observed by scanning electron microscopy(SEM), and the roughness was tested in the end.The good corrosion resistance of antibacterial Ti–3Cu alloy suggests its great potential as a long-term biomedical application.展开更多
AIM:To investigate the clinical significance of Bcl-xL gene in the pathogenesis of human colon carcinoma. METHODS:Fifty-six pair tissue samples from patients with colon cancer were collected, and protein level of the ...AIM:To investigate the clinical significance of Bcl-xL gene in the pathogenesis of human colon carcinoma. METHODS:Fifty-six pair tissue samples from patients with colon cancer were collected, and protein level of the Bcl-xL gene was measured by immunohistochemistry method. The correlation of Bcl-xL expression with clinical index was evaluated. After human colon cancer cell line HT29 was transfected with Bcl-xL small interfering RNA (siRNA), the anchorage-independent growth of cancer cells was detected by colony formation in soft agar and invasion ability of cancer cells was determined by a transwell model. RESULTS:The Bcl-xL expression was higher in cancerous tissue samples than in normal tissue samples (38.78 ± 11.36 vs 0.89 ± 0.35, P < 0.001), and was associated with the pathological grade, lymphnode metastasis and Duke’s stage of colorectal carcinoma. Transfection with Bcl-xL siRNA inhibited the colony formation and invasion ability of human colon cancer cell line HT29 in vitro. CONCLUSION:Bcl-xL gene plays an important role in carcinogenesis of human colorectal carcinoma and is associated with malignant biological behaviors of human colorectal carcinoma.展开更多
The microstructure of nickel-based single-crystal(SC) superalloys has a pivotal influence on their creep properties. The addition of the Re element not only enhances the long-term creep properties of nickel-based SC s...The microstructure of nickel-based single-crystal(SC) superalloys has a pivotal influence on their creep properties. The addition of the Re element not only enhances the long-term creep properties of nickel-based SC superalloys, but also results in the formation of a topologically close-packed(TCP) phase which is a harmful and brittle hard phase. Here, high-temperature creep interruption tests of a nickel-based SC superalloy that contains4.8 wt% Re were performed under various temperatures and stress conditions, and the evolution of microstructure during creep was observed by scanning electron microscopy(SEM). The volume fraction of the TCP phase was also extracted to explore the mechanism that controls the impacts of the TCP phase on the creep properties.According to the microstructure evolution mechanism, the influence of the TCP phase was attributed to the initial damage and critical shear stress of the material. A creep performance prediction model for nickel-based SC superalloys considering the precipitation of the TCP phase that is based on the crystal plasticity theory and a modified creep damage model was established. The simulation curves fit well with the experimental results and the errors between prediction creep life with test results are within 5%.展开更多
BACKGROUND Prostate artery embolization(PAE)is a promising minimally invasive therapy that improves lower urinary tract symptoms(LUTS)related to benign prostatic hyperplasia(BPH).Transurethral resection of the prostat...BACKGROUND Prostate artery embolization(PAE)is a promising minimally invasive therapy that improves lower urinary tract symptoms(LUTS)related to benign prostatic hyperplasia(BPH).Transurethral resection of the prostate(TURP)is the gold standard therapy for LUTS/BPH.AIM To evaluate the efficacy and safety of PAE vs TURP on LUTS related to BPH.METHODS A literature review was performed to identify all published articles on PAE vs TURP for LUTS/BPH.Sources included PubMed,Embase,Cochrane library databases,and Chinese databases before June 2022.A systematic review and meta-analysis were conducted.Outcome measurements were combined by calculating the mean difference with a 95%confidence interval.Statistical analysis was carried out using Review Manager 5.3.RESULTS Eleven studies involving 1070 participants were included.Compared with the TURP group,the PAE group had a similar effect on the International Index of Erectile Function(IPSS)score,Peak urinary flow rate(Qmax),postvoid residual volume(PVR),Prostate volume(PV),prostatic specific antigen(PSA),The International Index of Erectile Function short form(IIEF-5)scores,and erectile dysfunction during 24 mo follow-up.Lower quality of life(QoL)score,lower rate of retrograde ejaculation and shorter hospital stay in the PAE group.There was no participant death in either group.A higher proportion of haematuria,urinary incontinence and urinary stricture was identified in the TURP group.CONCLUSION PAE may be an appropriate option for elderly patients,patients who are not candidates for surgery,and patients who do not want to risk the potential adverse effects of TURP.Studies with large cases and long follow-up time are needed to validate results.展开更多
Regulating luminescent dynamics of lanthanide-based luminescent materials via external stimuli is of great significance in the fields of optical thermometry and high-level anti-counterfeiting.However,it is still a hug...Regulating luminescent dynamics of lanthanide-based luminescent materials via external stimuli is of great significance in the fields of optical thermometry and high-level anti-counterfeiting.However,it is still a huge challenge to realize multimodal emissions with tunable color outputs from a single activator in simple structures via smart dynamic control of photon transition processes.Herein,we present a mechanistic strategy to achieve multimodal luminescence of Er^(3+)activators with color-switchable outputs in a non-core-shell host.Under the control of excitation dynamics(λ_(ex)=980,808,1532,377 nm),the population among the intermediate en ergy levels of Er^(3+)and the interaction between Er^(3+)and Yb^(3+)could be precisely modulated through energy transfer and migration processes,leading to the generation of colortunable multimodal luminescence upon diverse excitation modes(non-steady-state,single-/dual-wavelength steady,thermal activation).Inspired by its special luminescent performance,the as-obtained material exhibits great potential in noncontact thermometry,multimodal anticounterfeiting,and high-capacity information encryption by performing a series of proof-of-concept experiments.Our findings might provide a conceptual model to modulate the luminescent dynamics in a simple-structured system for the generation of color-adjustable multimodal emissions,which is convenient for the development of advanced luminescent materials toward versatile cuttingedge applications.展开更多
Ti-Cu alloy has potential to be used in plastic surgery and dental implants due to its strong antibacterialproperties,high strength and good corrosion resistance.In this paper,Ti-5Cu was anodic-oxidized to enhance the...Ti-Cu alloy has potential to be used in plastic surgery and dental implants due to its strong antibacterialproperties,high strength and good corrosion resistance.In this paper,Ti-5Cu was anodic-oxidized to enhance the surface compatibility.The influence of the oxidation on the corrosion resistance,antibacterial properties and biological properties was investigated.X-ray diffraction(XRD)and X-ray photoelectron spectroscopy(XPS)results showed that a double-layer oxide coating with dense inner layer and porous outside layer was formed on Ti-Cu sample.The oxide coating consisted mainly of TiO2,CuzO and small amount of CuO,improved the corrosion resistance of Ti-Cu alloy by one order of magnitude due to the formation of the dense oxide inner layer,but high Cu ion release was detected.The plate count results showed that the antibac-terial activity of Ti-Cu sample was improved to≥99%due to the comprehensive function of CuO and Cu_(2)O in the coating and Cu^(2+)release.Cell test results showed that thecoating exhibited good cell compatibility,the porous sur-face structure improved the adhesion of cells,and Cu ion release promoted the cell proliferation.展开更多
基金Supported by the Key Special Project of“Cutting-Edge Biotechnology”in the National Key Research and Development Program of China(No.2024YFC3406200)Sanming Project of Medicine in Shenzhen(No.SZSM202411007)Shenzhen Science and Technology Program(No.JCYJ20240813152704006).
文摘Conventional surgical teaching techniques face several challenges,highlighting a necessity for ongoing innovation in ophthalmology education to align with the evolving demands of clinical practice.The recent rapid advancement of computer technology has enabled the integration of virtual reality(VR)into medical training,thereby revolutionizing ophthalmic surgical education through VRbased educational methods.VR technology offers a safe,risk-free environment for trainees to practice repeatedly,enhancing surgical skills and accelerating the learning curve without compromising patient safety.This research outlines the application of VR technology in ophthalmic surgical skills training,particularly in cataract and vitreoretinal surgery.Including assessing the effectiveness of intraocular surgery training systems,evaluating skills transfer to the operating room,comparing it with wet lab cataract surgery training,and enhancing non-dominant hand training for cataract surgery,among other aspects.Additionally,this paper will identify the limitations of VR technology in ocular surgical skills training,offer improvement strategies,and detail the advantages and prospects,with the objective of guiding subsequent researchers.
基金Supported by Key Project of Jiangsu Provincial Health(ZD2022052).
文摘BACKGROUND Upper gastrointestinal cancer(UGIC),including esophageal and gastric cancers,poses a major global health challenge due to its high morbidity and mortality.During the preoperative period,patients often face functional decline,malnutrition,and psychological stress,which can impair recovery.Prehabilitation,a multidisciplinary preoperative intervention,shows promise in optimizing patients'physical and mental status.AIM To evaluate the impact of prehabilitation on patients undergoing UGIC surgery and provide a basis for implementation of the prehabilitation compound plan.METHODS A computerized search of databases including Web of Science,PubMed,EMBASE,The Cochrane Library,Cumulative Index to Nursing and Allied Health Literature,China National Knowledge Infrastructure,Wanfang,and Chinese Science and Technology Journal Database was used to collect clinical trials on the impact of prehabilitation on patients undergoing UGIC surgery.After screening,a meta-analysis was conducted using Review Manager 5.0 software,and linear regression analysis was performed on the prehabilitation duration and outcome indicators.RESULTS A total of 13 clinical trials were ultimately included,with 8 literature quality evaluations at A level and 5 literature quality evaluations at B level.The meta-analysis results showed that compared with conventional nursing,the prehabilitation group had higher six-minute walk distance,lower postoperative complications and mortality rates,and shorter hospital stays,with statistically significant differences;there were no statistically significant differences in intensive care unit monitoring time and albumin levels between the two groups;regression analysis between prehabilitation duration and outcome indicators showed no significant relationship.CONCLUSION Prehabilitation can improve the perioperative functional ability of patients with UGIC and promote postoperative recovery,but its impact on nutrition,psychology,and quality of life needs to be further explored through more high-quality trials;in addition,further research is needed on the prehabilitation time,location,and specific plan.
基金Supported by the National High Level Hospital Clinical Research Funding(Multi-Center Clinical Research Project of Peking University First Hospital),No.2022CR65.
文摘BACKGROUND Targeted therapy combined with anti-programmed cell death 1 immunotherapy(TP)and trifluridine/tipiracil(TAS-102)combined with bevacizumab(TB)are two common therapies for patients with late-line therapy in microsatellite stable(MSS)metastatic colorectal cancer(mCRC).However,it is still unclear which therapy can bring better prognosis.AIM To evaluate the effectiveness and safety of TP vs TB as the late-line regimen for MSS mCRC in the real world.METHODS This is a dual-center retrospective cohort study conducted in Peking University First Hospital and Jilin Cancer Hospital.Patients with MSS mCRC who had received at least the second line treatment were eligible.Propensity score(PS)would be calculated to balance the baseline characteristics of two cohorts.Progression-free survival(PFS)was set as the primary endpoint.The Kaplan-Meier method and Cox proportional hazard model were used to evaluate PFS and to estimate hazard ratios(HRs)and 95%confidence intervals(CIs).Landmark analysis was performed to create segmented survival curves,studying the impact of treatment regimen on prognosis during different follow-up periods.RESULTS Between July 2019 and March 2025(data cutoff),127 eligible patients were enrolled,with 88 and 39 patients assigned to the TP and TB cohorts,respectively,based on treatment allocation.At a global median follow-up of 9.73 months,the crude median PFS was 3.9 months(95%CI:3.03-5.53)in the TP cohort vs 4.17 months(95%CI:2.87-5.6)in the TB cohort,yielding a nonsignificant HR of 1.43(95%CI:0.94-2.18,P=0.092;TB as reference).Multivariate Cox regression analysis,adjusted for sex,age>60 years,Eastern Cooperative Oncology Group performance status,RAS mutation,primary tumor location(left vs right),number of metastatic organs(liver/lung),and treatment line(≥3rd line),demonstrated an adjusted HR of 1.23(95%CI:0.80-1.88,P=0.348).PS-based analyses using three methodologies:Inverse probability weighting,PS matching(post-matching n=55 vs 30),and PS-adjusted multivariate Cox regression.These analyses revealed consistent nonsignificant trends favoring TB,with HRs for TP of 1.26(95%CI:0.76-2.10,P=0.077),1.42(95%CI:0.87-2.34,P=0.164),and 1.26(95%CI:0.76-2.10,P=0.367),respectively.Notably,landmark PFS analyses at 90,120,and 150 days demonstrated a significantly higher proportion of TP patients maintaining disease control beyond these timepoints(P=0.048,0.031,and 0.035,respectively),suggesting sustained clinical benefits in TP responders.CONCLUSION TP and TB demonstrated similar PFS in both crude and PS-adjusted analyses.However,patients who derived benefits from TP therapy exceeding 90 days showed more sustained clinical advantages compared to TB.Our study suggests that for patients with MSS mCRC who respond to TP therapy in later-line treatments,this regimen could provide additional prolonged clinical benefits,which warrants further validation through large-scale cohort investigations.
基金Supported by the National Natural Science Foundation of China,No.72174061 and No.71704053China Scholarship Council Foundation,No.202308330251Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2022KY370 and No.2023KY1186.
文摘BACKGROUND Motoric cognitive risk(MCR)syndrome represents an“ultra-early”stage of dementia prevention,highlighting the need for effective screening tools.AIM To develop and validate a novel tool for MCR identification,comparing its effectiveness with existing methods.METHODS As part of a community study on healthy aging,a cross-sectional study recruited 1189 Chinese participants aged 50 years and older between May 1,2022,and March 15,2023.The cohort was randomly split into training(70%)and testing(30%)datasets.Relevant features were selected for logistic regression(LR)and decision tree(DT)models using the training dataset,and their performance was subsequently assessed using the testing dataset to validate reliability and generalizability.RESULTS The prevalence of MCR was 13.12%among 1189 participants.DT models had the area under the curves(AUCs)of 0.834 and 0.821 for training and testing datasets,respectively,while LR models indicated AUCs of 0.840 and 0.859.Non-inferiority tests confirmed the DT model’s comparable effectiveness to the LR models in predicting MCR.Both models demonstrated good calibration and clinical utility.Seven modifiable risk factors were identified:Age,education level,social engagement,physical activity,nutritional status,depressive symptoms,and purpose in life.Notably,social engagement emerged as a novel factor compared to those previously identified.Both models are integrated into an easy-to-use,interpretable web-based user interface.CONCLUSION The interactive,web-based user interface of both models effectively identifies MCR,with the DT model recommended for its simplicity and interpretability,supporting community nurses and clinicians in triaging MCR.
基金Supported by the National High Level Hospital Clinical Research Funding(Multi-center Clinical Research Project of Peking University First Hospital),No.2022CR65.
文摘BACKGROUND Patients with microsatellite stable(MSS)metastatic colorectal cancer(mCRC)typically exhibit an immunosuppressive tumor microenvironment and demonstrate a low response rate to immunotherapy.Reports suggest that chemotherapy and anti-angiogenic therapy may have the potential to enhance the response to immunotherapy in these patients.This study aims to evaluate the effectiveness and safety of chemotherapy combined with bevacizumab with or without antiprogrammed death 1(PD-1)immunotherapy as the second-line regimen for MSS mCRC.AIM To evaluate the effectiveness and safety of chemotherapy combined with bevacizumab with or without anti-PD-1 immunotherapy as the second-line regimen for MSS mCRC.METHODS A retrospective analysis was conducted on patients with MSS mCRC diagnosed at Peking University First Hospital and Jilin Cancer Hospital from January 2020 to December 2024.The patients were divided into two groups:The experimental group receiving second-line chemotherapy combined with bevacizumab and anti-PD-1 immunotherapy,and the control group receiving chemotherapy combined with bevacizumab.Propensity score matching was applied to balance potential prognostic factors,including age,gender,Eastern Cooperative Oncology Group score,number of metastases,and primary tumor site.The progression-free survival,overall survival,disease control rate,objective response rate,and treatment-related adverse reactions were compared between the two groups.Kaplan-Meier analysis and log-rank test were used to compare survival outcomes.Inverse probability of treatment weighting was used for sensitivity analysis.RESULTS Propensity score matching resulted in 103 matched eligible patients.The median follow-up period was 13.9 months in the matched cohort.The objective response rate was 11.5%and 9%for the experimental and control groups,respectively(P=0.710),while the disease control rate was 76.9%and 53.2%,respectively(P=0.058).The median progression-free survival in the experimental group was 8.27 months[95%confidence interval(CI):6.7-14.7 months],significantly higher than that in the control group,which was 4.63 months(95%CI:3.9-5.67 months)(hazard ratio=0.4143,95%CI:0.2462-0.6972,P=0.00066).There was a trend towards the higher median overall survival in the experimental group compared to the control group(hazard ratio=0.4504,95%CI:0.1897-1.07,P=0.064).The incidences of adverse events were similar between the two groups.CONCLUSION Compared with the standard second-line chemotherapy combined with bevacizumab regimen,second-line therapy that combines chemotherapy with bevacizumab and anti-PD-1 immunotherapy has demonstrated promising efficacy in the treatment of MSS mCRC,while exhibiting a similar safety profile.
基金Supported by the National High Level Hospital Clinical Research Funding(Multi-Center Clinical Research Project of Peking University First Hospital),No.2022CR65.
文摘BACKGROUND Microsatellite stable(MSS)metastatic colorectal cancer(mCRC)is characterized by an immunosuppressive tumor microenvironment,leading to limited efficacy of immunotherapy in these patients.Clinical trial data suggest that chemotherapy and anti-angiogenic therapy may have the potential to enhance the response to immunotherapy in these patients.However,whether these research findings can be“replicated”in clinical practice still requires further validation through real-world studies.This study aims to evaluate the effectiveness and safety of chemo-therapy combined with bevacizumab with or without anti-programmed death 1(PD-1)immunotherapy as the first-line regimen for MSS mCRC in the real world.AIM To evaluate the effectiveness and safety of chemotherapy combined with beva-cizumab with or without anti-PD-1 immunotherapy as the first-line regimen for MSS mCRC in the real world.METHODS We conducted a retrospective analysis of patients with MSS mCRC diagnosed at Peking University First Hospital and Jilin Cancer Hospital between January 2020 and December 2024.Patients were stratified into two treatment groups:(1)An experimental group receiving first-line chemotherapy combined with bevaci-zumab and anti-PD-1 immunotherapy;and(2)A control group receiving chemo-therapy plus bevacizumab alone.Propensity score matching was employed to balance baseline characteristics,including age,gender,Eastern Cooperative Onco-logy Group performance status,number of metastatic sites,and primary tumor location.The primary endpoints were progression-free survival and overall survival,while secondary endpoints included disease control rate,objective response rate,and treatment-related adverse events.Survival outcomes were assessed using Kaplan-Meier analysis with log-rank testing.Additionally,inverse probability of treatment weighting was applied for sensitivity analysis to validate the robustness of our findings.RESULTS The propensity score matching analysis identified 103 well-balanced patient pairs with a median follow-up of 25.5 months.The experimental group demonstrated numerically higher objective response(36.00%vs 23.08%,P=0.309)and disease control rates(96.00%vs 91.03%,P=0.6759)compared to the control group,though these differences were not statistically significant.Similarly,no significant survival benefit was observed for either progression-free survival[hazard ratio(HR)=0.7076,95%confidence interval(CI):0.4069-1.23,P=0.22]or overall survival(HR=1.154,95%CI:0.4712-2.827,P=0.75).Multivariate analysis identified liver metastases as an independent poor prognostic factor(HR=3.36,95%CI:1.71-6.60,P<0.001),while subgroup analyses revealed potential benefits of the experimental regimen in male patients(HR=0.33,95%CI:0.14-0.81,P=0.025)and those with right-sided primary tumors(HR=0.40,95%CI:0.17-0.95,P=0.022).Safety profiles were comparable between groups,though elevated lactate dehydrogenase emerged as an independent risk factor for poorer outcomes in the experimental group(HR=4.11,95%CI:1.02-16.55,P=0.046).CONCLUSION Chemotherapy combined with bevacizumab and anti-PD-1 immunotherapy could not demonstrate promising efficacy in treating MSS mCRC compared to the standard first-line chemotherapy regimen with bevacizumab.Male patients or those with right-sided mCRC may derive benefits from immune-based combination therapy.Further research is needed to investigate specific clinical characteristics or biomarkers to identify patients who may derive benefit from combined immunotherapy approaches.
文摘Tuberculous meningitis(TBM),which accounts for 1%-5%of global tuberculosis cases,is a severe neurological infection with a mortality rate of 30%-50%.Its high fatality and disability rates disproportionately affect low-and middle-income regions(e.g.,sub-Saharan Africa and Southeast Asia),threatening the lives of patients and imposing significant psychosocial burdens.Recent studies have highlighted the crucial role of psychosocial factors,including socioeconomic status,disease severity,and social support systems in recovery.However,research gaps persist in developing TBM-specific psychosocial interventions.This narrative review summarizes and organizes the key findings of observational studies,cohort studies,and intervention trials published between 2015 and 2024.Databases including PubMed,Scopus,and Web of Science were searched for terms related to TBM,psychosocial risk factors and mental health interventions.Studies were screened for relevance and quality,focusing on those that examined the psychological and social determinants of mental health outcomes in patients with TBM.
基金Supported by the National High Level Hospital Clinical Research Funding(Multi-center Clinical Research Project of Peking University First Hospital),No.2022CR65。
文摘BACKGROUND Clinical trial evidence points to chemotherapy’s potential in augmenting the effects of immunotherapy.AIM To assess the effectiveness of first-line chemoimmunotherapy(CIT)for microsatellite stable(MSS)metastatic colorectal cancer(mCRC)verses standard-of-care(SOC;5-fluorouracil/leucovorin/oxaliplatin/bevacizumab).METHODS This was a multicenter retrospective cohort study conducted in Peking University First Hospital and Jilin Cancer Hospital.Patients with MSS mCRC who had received first-line treatment were eligible.The Kaplan-Meier method and Cox proportional hazard model were used to evaluate progression-free survival(PFS)and to estimate hazard ratios(HRs)and 95%confidence intervals(CIs).PFS was set as the primary endpoint.Propensity score(PS)was calculated to balance the baseline characteristics of the two cohorts.With PS,we performed three statistical methods,namely inverse probability weighting,PS matching,and additional adjustment for PS with multivariate cox regression.RESULTS Between July 2019 and November 2024,148 eligible patients were enrolled,with 40 and 108 patients assigned to the CIT and SOC cohorts,respectively.At a global median follow-up of 21.4 months,the crude median PFS was 13.5 months(95%CI:9.77-21.6)in the CIT cohort vs 9.1 months(95%CI:7.8-10.6)in the SOC cohort,yielding a nonsignificant hazard ratio(HR)of 0.5645(95%CI:0.3637-0.8763,P=0.01;SOC as reference).Multivariate Cox regression analysis,adjusted for sex,age>60 years,Eastern Cooperative Oncology Group performance status,rat sarcoma mutation,primary tumor location(left vs right)and number of metastatic organs(liver/lung),demonstrated an adjusted HR of 0.55(95%CI:0.35-0.87,P=0.011).PS-based analyses using PS matching(post-matching n=40 vs 40),PS-adjusted multivariate Cox regression,and inverse probability weighting revealed consistent significant trends favoring CIT,with HRs for CIT of 0.5641(95%CI:0.3303-0.9635,P=0.0361),0.60(95%CI:0.38-0.96,P=0.034),and 0.57(95%CI:0.337-0.973,P=0.039),respectively.CONCLUSION Efficacy of CIT in MSS mCRC could surpass that of standard first-line chemotherapy.Further research is needed to investigate specific clinical characteristics or biomarkers to identify patients who may derive benefit from CIT.
基金Supported by the National Natural Science Foundation of China,No.81670504 and No.81472287the New Xiangya Talent Project of the Third Xiangya Hospital of Central South University,No.20150308
文摘Ulcerative colitis(UC) is an inflammatory disease that mainly affects the colon and rectum. It is believed that genetic factors, host immune system disorders, intestinal microbiota dysbiosis, and environmental factors contribute to the pathogenesis of UC. however, studies on the role of intestinal microbiota in the pathogenesis of UC have been inconclusive. Studies have shown that probiotics improve intestinal mucosa barrier function and immune system function and promote secretion of anti-inflammatory factors, thereby inhibiting the growth of harmful bacteria in the intestine. Fecal microbiota transplantation(FMT) can reduce bowel permeability and thus the severity of disease by increasing the production of short-chain fatty acids, especially butyrate, which help maintain the integrity of the epithelial barrier. FMT can also restore immune dysbiosis by inhibiting Th1 differentiation, activity of T cells, leukocyte adhesion, and production of inflammatory factors. Probiotics and FMT are being increasingly used to treat UC, but their use is controversial because of uncertain efficacy. Here, we briefly review the role of intestinal microbiota in thepathogenesis and treatment of UC.
基金the National Natural Science Foundation of China,No.81874201Shanghai Municipal Commission of Health and Family Planning,No.ZK2015A32 and No.201840359
文摘BACKGROUND Lymphovascular invasion (LVI) is suggested to be an early and important step in tumor progression toward metastasis, but its prognostic value and genetic mechanisms in colorectal cancer (CRC) have not been well investigated. AIM To investigate the prognostic value of LVI in CRC and identify the associated genomic alterations. METHODS We performed a retrospective analysis of 1219 CRC patients and evaluated the prognostic value of LVI for overall survival by the Kaplan-Meier method and multivariate Cox regression analysis. We also performed an array-based comparative genomic hybridization analysis of 47 fresh CRC samples to examine the genomic alterations associated with LVI. A decision tree model was applied to identify special DNA copy number alterations (DCNAs) for differentiating between CRCs with and without LVI. Functional enrichment and protein-protein interaction network analyses were conducted to explore the potential molecular mechanisms of LVI. RESULTS LVI was detected in 150 (12.3%) of 1219 CRCs, and the presence was positively associated with higher histological grade and advanced tumor stage (both P < 0.001). Compared with the non-LVI group, the LVI group showed a 1.77-fold (95% confidence interval: 1.40-2.25, P < 0.001) increased risk of death and a significantly lower 5-year overall survival rate (P < 0.001). Based on the comparative genomic hybridization data, 184 DCNAs (105 gains and 79 losses) were identified to be significantly related to LVI (P < 0.05), and the majority were located at 22q, 17q, 10q, and 6q. We further constructed a decision tree classifier including seven special DCNAs, which could distinguish CRCs with LVI from those without it at an accuracy of 95.7%. Functional enrichment and proteinprotein interaction network analyses revealed that the genomic alterations related to LVI were correlated with inflammation, epithelial-mesenchymal transition, angiogenesis, and matrix remodeling. CONCLUSION LVI is an independent predictor for survival in CRC, and its development may correlate with inflammation, epithelial-mesenchymal transition, angiogenesis, and matrix remodeling.
基金supported by the Strategic Priority Research Program of the Chinese Academy of Sciences(No.XDA02010000)
文摘The calculation of inelastic creep damage is important for the structural integrity evaluation of the elevated temperature structure in a thorium molten salt reactor(TMSR). However, a creep damage theory model and numerical simulation method have not been proposed for the key materials(UNS N10003 alloy) in the TMSR. In this study, creep damage characterization of UNS N10003 alloy is investigated using the Norton creep law and Kachanov–Rabotnov(K–R) creep damage model. First, the creep experimental data of the UNS N10003 alloy at 650 °C were adopted to fit the material constants of the two models. Then, the creep damage behavior of the UNS N10003 alloy was analyzed and discussed under uniaxial and multi-axial stress states. The results indicated that the K–R creep damage model is more suitable for the UNS N10003 alloy than the Norton model. Finally, the numerical simulation method was developed by a user-defined UMAT subroutine and subsequently verified through a finite element analysis(FEA). The FEA results were in agreement with the theoretical solutions. This study provides an effective method for the inelastic creep damage analysis of the elevated temperature structure in the TMSR.
文摘AIM: To investigate the dynamic expression of p-signal transducer and activator of transcription 3 (STAT3) and vascular endothelial growth factor (VEGF) in the formation of gastric tumors induced by drinking water containing N-methyl-N’-nitro-N-nitrosoguanidine (MNNG) in Wistar rats. METHODS: One hundred and twenty Wistar rats were randomly divided into two groups (60 in each group): Control group and Model group. The rats in each group were then randomly divided into three groups (20 in each group): C/M15, C/M25 and C/M40 (15, 25 and 40 represent the number of feeding weeks from termination). Rats in the control group received normal drinking water and rats in the model group received drinking water containing 100 μg/mL MNNG. Stomach tissues were collected at the end of the 15<sup>th</sup>, 25<sup>th</sup> and 40<sup>th</sup> week, respectively, for microscopic measurement using hematoxylin and eosin staining. The expression of p-STAT3 and VEGF in different pathological types of gastric tissue, including normal, inflammation, atrophy, hyperplasia and gastric stromal tumor, was observed by immunohistochemistry and Western blot, and the corelation between p-STAT3 and VEGF was analyzed. RESULTS: (1) The expression of p-STAT3 in tissue with gastritis, atrophy, dysplasia and gastric stromal tumor were significantly increased in the model group compared with the control group (2.5 ± 1.0, 2.75 ± 0.36, 6.2 ± 0.45, 5.67 ± 0.55 vs 0.75 ± 0.36, P = 0.026, 0.035, 0.001, 0.002, respectively); the expression of p-STAT3 in tissue with dysplasia was higher than that in samples with gastritis or atrophy (6.2 ± 0.45 vs 2.5 ± 1.0, P = 0.006; 6.2 ± 0.45 vs 2.75 ± 0.36, P = 0.005, respectively); however, the expression of p-STAT3 in gastritis and atrophy was not significantly different (P > 0.05); (2) the expression of VEGF in tissue with gastritis, atrophy, dysplasia and gastric stromal tumor was significantly increased in the model group compared with normal gastric mucosa; and the expression of VEGF in tissue with dysplasia was higher than that in tissue with inflammation and atrophy (10.8 ± 1.96 vs 7.62 ± 0.25, P = 0.029; 10.8 ± 1.96 vs 6.26 ± 0.76, P = 0.033, respectively); similarly, the expression of VEGF in tissue with gastritis and atrophy was not significantly different (P > 0.05); and (3) the expression of VEGF was positively correlated with p-STAT3. CONCLUSION: p-STAT3 plays an important role in gastric cancer formation by regulating the expression of VEGF to promote the progression of gastric tumor from gastritis.
基金Supported by A Grant from the National Natural Science Foundation of China, No. 81172301
文摘AIM: To investigate stepwise sedation for elderly patients with mild/moderate chronic obstructive pulmonary disease (COPD) during upper gastrointestinal (GI) endoscopy. METHODS: Eighty-six elderly patients with mild/moderate COPD and 82 elderly patients without COPD scheduled for upper GI endoscopy were randomly assigned to receive one of the following two sedation methods: stepwise sedation involving three-stage administration of propofol combined with midazolam [COPD with stepwise sedation (group Cs), and nonCOPD with stepwise sedation (group Ns)] or continuous sedation involving continuous administration of propofol combined with midazolam [COPD with continuous sedation (group Cc), and non-COPD with continuous sedation (group Nc)]. Saturation of peripheral oxygen (SpO 2 ), blood pressure, and pulse rate were monitored, and patient discomfort, adverse events, drugs dosage, and recovery time were recorded. RESULTS: All endoscopies were completed successfully. The occurrences of hypoxemia in groups Cs, Cc, Ns, and Nc were 4 (9.3%), 12 (27.9%), 3 (7.3%), and 5 (12.2%), respectively. The occurrence of hypoxemia in group Cs was significantly lower than that in group Cc (P < 0.05). The average decreases in value of SpO 2 , systolic blood pressure, and diastolic blood pressure in group Cs were significantly lower than those in group Cc. Additionally, propofol dosage and overall rate of adverse events in group Cs were lower than those in group Cc. Finally, the recovery time in group Cs was significantly shorter than that in group Cc, and that in group Ns was significantly shorter than that in group Nc (P < 0.001). CONCLUSION: The stepwise sedation method is effective and safer than the continuous sedation method for elderly patients with mild/moderate COPD during upper GI endoscopy.
基金financially supported by the National Natural Science Foundation of China (Nos.81071262 and 31271024)the Funding from Northeastern University, China (Nos.N141008001 and LZ2014018)Beijing Municipal Natural Science Foundation (No.7161001)
文摘Ti–3Cu alloy has shown low melting point and strong antibacterial properties against S.aureus and E.coli and thus has potential application as dental materials and orthopedic application.In this paper, the corrosion properties of Ti–3Cu alloy in five kinds of simulated solutions were investigated in comparison with cp-Ti(commercially pure titanium) by electrochemical technology and immersion experiment.Electrochemical results have demonstrated that Ti–3Cu alloy exhibited much nobler corrosion potential, lower corrosion current density and high corrosion resistance than cp-Ti in all solutions, especially in saliva-pH6.8+0.2 F and saliva-pH3.5, indicating that Ti–3Cu alloy has much better anticorrosion properties than cpTi.Immersion results have shown that Ti ion and Cu ion were released from Ti–3Cu, especially in saliva-pH6.8+0.2 F and saliva-pH3.5 solutions.Both electrochemical data and immersion results have indicated that high corrosion rate and high metal ion release rate were detected in F ion-containing solution and low-pH solution, displaying that F^- and low pH had much strong aggressive attack to cp-Ti and Ti–3Cu alloy.The corroded surface morphology was observed by scanning electron microscopy(SEM), and the roughness was tested in the end.The good corrosion resistance of antibacterial Ti–3Cu alloy suggests its great potential as a long-term biomedical application.
基金The Program of Science and Technology of Zhenjiang City, No. SH2005037, SH2006019
文摘AIM:To investigate the clinical significance of Bcl-xL gene in the pathogenesis of human colon carcinoma. METHODS:Fifty-six pair tissue samples from patients with colon cancer were collected, and protein level of the Bcl-xL gene was measured by immunohistochemistry method. The correlation of Bcl-xL expression with clinical index was evaluated. After human colon cancer cell line HT29 was transfected with Bcl-xL small interfering RNA (siRNA), the anchorage-independent growth of cancer cells was detected by colony formation in soft agar and invasion ability of cancer cells was determined by a transwell model. RESULTS:The Bcl-xL expression was higher in cancerous tissue samples than in normal tissue samples (38.78 ± 11.36 vs 0.89 ± 0.35, P < 0.001), and was associated with the pathological grade, lymphnode metastasis and Duke’s stage of colorectal carcinoma. Transfection with Bcl-xL siRNA inhibited the colony formation and invasion ability of human colon cancer cell line HT29 in vitro. CONCLUSION:Bcl-xL gene plays an important role in carcinogenesis of human colorectal carcinoma and is associated with malignant biological behaviors of human colorectal carcinoma.
基金financially supported by the National Natural Science Foundation of China(No.51875462)the Fundamental Research Funds for the Central Universities(No.3102019PY001)+1 种基金the Seed Foundation of Innovation and Creation for Graduate Students in Northwestern Polytechnical University(Nos.ZZ2019015 and ZZ2019017)the National Science and Technology Major Project(Nos.2017-IV-0003-0040 and 2017-V-00030052)。
文摘The microstructure of nickel-based single-crystal(SC) superalloys has a pivotal influence on their creep properties. The addition of the Re element not only enhances the long-term creep properties of nickel-based SC superalloys, but also results in the formation of a topologically close-packed(TCP) phase which is a harmful and brittle hard phase. Here, high-temperature creep interruption tests of a nickel-based SC superalloy that contains4.8 wt% Re were performed under various temperatures and stress conditions, and the evolution of microstructure during creep was observed by scanning electron microscopy(SEM). The volume fraction of the TCP phase was also extracted to explore the mechanism that controls the impacts of the TCP phase on the creep properties.According to the microstructure evolution mechanism, the influence of the TCP phase was attributed to the initial damage and critical shear stress of the material. A creep performance prediction model for nickel-based SC superalloys considering the precipitation of the TCP phase that is based on the crystal plasticity theory and a modified creep damage model was established. The simulation curves fit well with the experimental results and the errors between prediction creep life with test results are within 5%.
文摘BACKGROUND Prostate artery embolization(PAE)is a promising minimally invasive therapy that improves lower urinary tract symptoms(LUTS)related to benign prostatic hyperplasia(BPH).Transurethral resection of the prostate(TURP)is the gold standard therapy for LUTS/BPH.AIM To evaluate the efficacy and safety of PAE vs TURP on LUTS related to BPH.METHODS A literature review was performed to identify all published articles on PAE vs TURP for LUTS/BPH.Sources included PubMed,Embase,Cochrane library databases,and Chinese databases before June 2022.A systematic review and meta-analysis were conducted.Outcome measurements were combined by calculating the mean difference with a 95%confidence interval.Statistical analysis was carried out using Review Manager 5.3.RESULTS Eleven studies involving 1070 participants were included.Compared with the TURP group,the PAE group had a similar effect on the International Index of Erectile Function(IPSS)score,Peak urinary flow rate(Qmax),postvoid residual volume(PVR),Prostate volume(PV),prostatic specific antigen(PSA),The International Index of Erectile Function short form(IIEF-5)scores,and erectile dysfunction during 24 mo follow-up.Lower quality of life(QoL)score,lower rate of retrograde ejaculation and shorter hospital stay in the PAE group.There was no participant death in either group.A higher proportion of haematuria,urinary incontinence and urinary stricture was identified in the TURP group.CONCLUSION PAE may be an appropriate option for elderly patients,patients who are not candidates for surgery,and patients who do not want to risk the potential adverse effects of TURP.Studies with large cases and long follow-up time are needed to validate results.
基金financially supported by the Natural Science Foundation of Jiangsu Province(No.BK20211280)the National Natural Science Foundation of China(No.51702074)Science Fund for Distinguished Young Scholars,Nanjing Forestry University。
文摘Regulating luminescent dynamics of lanthanide-based luminescent materials via external stimuli is of great significance in the fields of optical thermometry and high-level anti-counterfeiting.However,it is still a huge challenge to realize multimodal emissions with tunable color outputs from a single activator in simple structures via smart dynamic control of photon transition processes.Herein,we present a mechanistic strategy to achieve multimodal luminescence of Er^(3+)activators with color-switchable outputs in a non-core-shell host.Under the control of excitation dynamics(λ_(ex)=980,808,1532,377 nm),the population among the intermediate en ergy levels of Er^(3+)and the interaction between Er^(3+)and Yb^(3+)could be precisely modulated through energy transfer and migration processes,leading to the generation of colortunable multimodal luminescence upon diverse excitation modes(non-steady-state,single-/dual-wavelength steady,thermal activation).Inspired by its special luminescent performance,the as-obtained material exhibits great potential in noncontact thermometry,multimodal anticounterfeiting,and high-capacity information encryption by performing a series of proof-of-concept experiments.Our findings might provide a conceptual model to modulate the luminescent dynamics in a simple-structured system for the generation of color-adjustable multimodal emissions,which is convenient for the development of advanced luminescent materials toward versatile cuttingedge applications.
基金This work was financially supported by the National Natural Science Foundation of China(No.31971253)Beijing Municipal Health Commission(Nos.BMHC-2019-9,BMHC-2018-4 and PXM2020-026275-000002).
文摘Ti-Cu alloy has potential to be used in plastic surgery and dental implants due to its strong antibacterialproperties,high strength and good corrosion resistance.In this paper,Ti-5Cu was anodic-oxidized to enhance the surface compatibility.The influence of the oxidation on the corrosion resistance,antibacterial properties and biological properties was investigated.X-ray diffraction(XRD)and X-ray photoelectron spectroscopy(XPS)results showed that a double-layer oxide coating with dense inner layer and porous outside layer was formed on Ti-Cu sample.The oxide coating consisted mainly of TiO2,CuzO and small amount of CuO,improved the corrosion resistance of Ti-Cu alloy by one order of magnitude due to the formation of the dense oxide inner layer,but high Cu ion release was detected.The plate count results showed that the antibac-terial activity of Ti-Cu sample was improved to≥99%due to the comprehensive function of CuO and Cu_(2)O in the coating and Cu^(2+)release.Cell test results showed that thecoating exhibited good cell compatibility,the porous sur-face structure improved the adhesion of cells,and Cu ion release promoted the cell proliferation.
