BACKGROUND Enhanced recovery after surgery(ERAS)programs provide recommendations for an optimized management of patients undergoing surgery.An ERAS program tailored on surgery for retroperitoneal sarcomas(RPS)may impr...BACKGROUND Enhanced recovery after surgery(ERAS)programs provide recommendations for an optimized management of patients undergoing surgery.An ERAS program tailored on surgery for retroperitoneal sarcomas(RPS)may improve patient outcomes and it has still not been established.AIM To determine how an ERAS program tailored to RPS surgery can be agreed upon,structured,and implemented.METHODS Twenty-five candidate items from existing ERAS programs,potentially relevant for RPS surgery,were identified via literature review and expert input.These were included in a questionnaire refined through cognitive interviews and pilot testing.Expert sarcoma surgeons rated each item’s relevance and feasibility on a 6-point scale.The survey was recirculated after one year.Intra-observer reproducibility,inter-observer concordance,and agreement with the modal value of the most experienced participants were analyzed.RESULTS Thirteen sarcoma surgeons from 6 centers participated in the survey.Although surgeons agreed on several items,their overall concordance was low.After recirculating the survey,the intraobserver reproducibility was low.Interestingly,the median concordance with the reference increased for relevance and decreased for feasibility.CONCLUSION Despite interest in ERAS for RPS,surgeon concordance on item relevance and feasibility remains low,underscoring the need for collaborative efforts toward a standardized,consensus-based protocol.展开更多
Myofibroblastic sarcoma(MS)is a rare malignant soft tissue tumor characterized by myofibroblasts.It most commonly arises in the head and neck region,especially the tongue,with rare occurrences in the limbs.MS exhibits...Myofibroblastic sarcoma(MS)is a rare malignant soft tissue tumor characterized by myofibroblasts.It most commonly arises in the head and neck region,especially the tongue,with rare occurrences in the limbs.MS exhibits varying histopathology,ranging from low-to high-grade,with diverse subtypes showing different clinical behaviors and prognoses.This article reports the first case of high-grade MS in the hand,adding to the limited documentation of this rare condition.Here,we present the case of a 30-year-old healthy female with a year-long history of progressive shortening,mobility loss,and weakness in the first finger of the left hand.Left-hand imaging revealed a lytic,cottony tumor involving the entire first metacarpal.Following surgical resection,which included metatarsal grafting and joint reconstruction,a diagnosis of high-grade MS was confirmed based on histological manifestations and immunohistochemical staining,which was further classified as grade 2 according to the French Federation of Cancer Centers Sarcoma Group system.Postoperative radiotherapy was administered and the patient experienced a successful recovery without graft osteonecrosis.The patient regained 90%mobility and strength,without shortening,after surgical resection and radiotherapy.Six months post-surgery,the patient reported full hand functionality.MS is a rare tumor that infrequently affects bones and is often misdiagnosed owing to its controversial characteristics.The initial treatment should focus on complete resection with negative margins,followed by reconstructive surgery to preserve function.Further case studies are needed to establish standardized surgical treatment protocols.展开更多
The development of pancreatic surgery in China has progressed remarkably over 7 decades.China initiated its pancreatic surgery journey in the 1950s,marked by the first pancreaticoduodenectomy performed by Zeng Xianjiu...The development of pancreatic surgery in China has progressed remarkably over 7 decades.China initiated its pancreatic surgery journey in the 1950s,marked by the first pancreaticoduodenectomy performed by Zeng Xianjiu in 1951.Early progress was hindered by technological limitations and fragmented practices,but the establishment of academic platforms such as the National Pancreatic Disease Symposia in the 1980s catalyzed standardized research and interdisciplinary collaboration.In 2006,Zhang Shengdao spearheaded China’s first Guidelines for the Diagnosis and Treatment of Severe Acute Pancreatitis.The 21st century has seen remarkable progress in pancreatic surgery,marked by the China-specific treatment guidelines,technological breakthroughs in laparoscopic and robotic surgical systems,and the increasing centralization of pancreatic surgery in high-volume medical centers.These synergistic advancements have collectively propelled a paradigm shift in contemporary cancer care.By 2022,China Pancreas Data Center reported a postoperative mortality rate of 0.4% and 3-year survival rates of 43% for resected pancreatic cancer,rivaling global benchmarks.China has also emerged as a leader in minimally invasive pancreatic surgery,with advancements in laparoscopic and robotic pancreatic surgery.Academic growth paralleled clinical progress:the Chinese Pancreatic Association,established in 2022,fosters global collaboration,evidenced by its 2024 annual conference attracting over 10,000 participants.Through technological innovation,centralized care models,and international partnerships,China continues to redefine its role in advancing pancreatic surgery.展开更多
The year 2025 marked a significantmilestone for Laparoscopic,Endoscopic and Robotic Surgery(LERS)—we have awarded our first Impact Factor of 2.0 released by the Journal Citation Reports from Clarivate Analytics,which...The year 2025 marked a significantmilestone for Laparoscopic,Endoscopic and Robotic Surgery(LERS)—we have awarded our first Impact Factor of 2.0 released by the Journal Citation Reports from Clarivate Analytics,which ranks in the second quartile in the surgery category.This remarkable achievement,which reflects LERS’s steadily increasing influencein the area of surgery,would not be possible without the peer reviewer’s invaluable contributions.On behalf of the Editorial Board and Editorial Office,we would express our sincere appreciation to the following reviewers,who reviewed at least one paper with rigorous and insightful comments.We sincerely hope to engage further with them,either as esteemed reviewers or outstanding authors,in 2026 and beyond.展开更多
Objective:To explore the relationship between anesthetic depth and surgical stress response in minimally invasive cardiothoracic surgery.Methods:A total of 89 patients who underwent thoracoscopic minimally invasive ca...Objective:To explore the relationship between anesthetic depth and surgical stress response in minimally invasive cardiothoracic surgery.Methods:A total of 89 patients who underwent thoracoscopic minimally invasive cardiothoracic surgery in our hospital from June 2024 to December 2024 were selected as the research objects.They were divided into the light anesthesia group(n=45)and the deep anesthesia group(n=44).The vital signs at different intraoperative nodes and perioperative stress status of the two groups were compared.Results:Before lesion resection and after surgery,the mean arterial pressure and heart rate of the deep anesthesia group were lower than those of the light anesthesia group,with statistically significant differences.Conclusion:In thoracoscopic minimally invasive cardiothoracic surgery,deep anesthesia can effectively control the patient’s surgical stress response,but the postoperative awakening time is longer;patients under light anesthesia have a shorter awakening time,but the intraoperative stress response is obvious.展开更多
With the advancement of surgical techniques and enhanced management of early gastric cancer(EGC),minimally invasive function-preserving surgical approaches have emerged as a common goal for patients and clinicians.Lap...With the advancement of surgical techniques and enhanced management of early gastric cancer(EGC),minimally invasive function-preserving surgical approaches have emerged as a common goal for patients and clinicians.Laparoscopic-endoscopic cooperative surgery combined with sentinel lymph node navigation surgery(LECSSNNS)has drawn increasing interest because of its dual benefits of minimal invasiveness and organ function preservation.However,robust evidence-based support for guiding clinical implementation remains limited.To address this gap,we systematically evaluated available studies on the clinical application of LECS-SNNS in EGC and integrated expert insights to formulate 20 recommendations.These included preoperative assessment,surgical techniques,intraoperative endoscopic procedures,pathological evaluation,postoperative care,and follow-up.This consensus aimed to provide comprehensive guidance for the standardized application of LECS-SNNS,thereby advancing precise,minimally invasive,and function-preserving treatment for EGC.展开更多
Background:Photodynamic therapy(PDT)may eradicate residual malignant cells following sarcoma resection,through reactive oxygen species(ROS)mediated cytotoxicity,thus improve clinical outcomes.This study aims to assess...Background:Photodynamic therapy(PDT)may eradicate residual malignant cells following sarcoma resection,through reactive oxygen species(ROS)mediated cytotoxicity,thus improve clinical outcomes.This study aims to assess the efficacy of 5-aminolevulinic acid(5-ALA)as a photosensitizer in combination with red light(RL)for PDT of bone sarcoma cells in vitro.Methods:Three bone sarcoma cell lines underwent treatment with 5-ALA and RL or sham-RL(SL).5-ALA uptake was assessed using flow cytometry.Production of ROS was measured using CellROX Green staining and fluorescence microscopy.Cell viability was assessed using Cell Counting Kit-8 assays.Results:All cell lines showed significant 5-ALA uptake in comparison to the 0 mM control(p<0.05).Production of ROS was significantly increased in cells treated with 5-ALA and RL,compared to those treated with RL and no 5-ALA or SL(p<0.05).Viability was significantly reduced in cells treated with 5-ALA and RL,compared to SL(p<0.05).At 72 h post-treatment,cell viability ranged from 6%-12%in 0.5 mM 5-ALA and RL-treated cells vs.90%-137%in 0.5 mM 5-ALA and SL-treated cells.Conclusion:5-ALA-based PDT led to the desired increased production of ROS and reduction in cell viability in all cell lines.These preliminary in vitro results warrant further study with multicellular spheroid or animal models and suggest PDT has potential to be used as an adjuvant therapy to surgical resection in sarcoma management.展开更多
1Introduction A 25-year-old woman presented with a 3-month history of otalgia and aural fullness in the left ear,without associated otological or systemic symptoms.Her medical history was unremarkable,and she denied a...1Introduction A 25-year-old woman presented with a 3-month history of otalgia and aural fullness in the left ear,without associated otological or systemic symptoms.Her medical history was unremarkable,and she denied any history of hepatitis,hypertension,diabetes,cardiovascular disease,or other significant conditions.The patient was diagnosed with external auditory canal cholesteatoma and subsequently underwent canalplasty under general anesthesia.Routine anesthetic drugs,including 2%lidocaine,dexamethasone,propofol,sufentanil,rocuronium bromide,ondansetron,flurbiprofen axetil,neostigmine,and atropine,were used during surgery and anesthesia recovery.No significant events were noted,and the patient experienced only a blood loss of 10 mL.展开更多
Background Computed tomography(CT) and cone-beam computed tomography(CBCT) image registration play pivotal roles in computer-assisted navigation for orthopedic surgery. Traditional methods often apply uniform deformat...Background Computed tomography(CT) and cone-beam computed tomography(CBCT) image registration play pivotal roles in computer-assisted navigation for orthopedic surgery. Traditional methods often apply uniform deformation models, neglecting the biomechanical differences between rigid structures and soft tissues, which compromises registration accuracy, especially during significant bone displacements. Method To address this issue, we introduce RE-Reg, a rigid-elastic CT-CBCT image registration framework that jointly learns rigid bone motion and soft tissue deformation. RE-Reg incorporates a rigid alignment(RA) module to estimate global bone motion and an elastic deformation(ED) module to model soft tissue deformation, preserving bony structures through bone shape preservation(BSP) loss. Result Our comprehensive evaluation on publicly available datasets demonstrates that RE-Reg significantly outperforms existing methods in terms of registration accuracy and rigid bone structure preservation, achieving a 1.3% improvement in Dice similarity coefficient(DSC) and a 23% reduction in rigid bone deformation(%Δvol) compared with the best baseline. Conclusion This framework not only enhances anatomical fidelity but also ensures biomechanical plausibility and provides a valuable tool for image-guided orthopedic surgery. This code is available athttps://github.com/Zq-Huang/RE-Reg.展开更多
AIM:To assess the visual acuity and visual quality of cataract patients who received femtosecond laser-assisted cataract surgery(FLACS)and multifocal intraocular lens(MIOL)implantation with an improved polishing techn...AIM:To assess the visual acuity and visual quality of cataract patients who received femtosecond laser-assisted cataract surgery(FLACS)and multifocal intraocular lens(MIOL)implantation with an improved polishing technique during a 1-year follow-up period.METHODS:This study included 74 eyes from 37 patients,comprising 17 males and 20 females,with a mean age of 51.74±7.80 years.Using a coin toss method,one eye per patient was randomly selected for improved anterior capsular polishing,while the other eye received standard irrigation/aspiration(I/A)polishing.The polishing group consisted of 37 eyes,including 21 right and 16 left eyes,while the control group comprised the contralateral fellow eyes of the same individuals in the polishing group.Visual acuity and quality of the patients were evaluated before surgery and at 1 wk,1,6,and 12 mo after surgery.The OPD-Scan III was utilized to assess high-order aberrations,while the optical quality analysis system(OQAS)was employed to evaluate modulation transfer function(MTF cutoff),Strehl ratio(SR),and objective scatter index(OSI)for the purpose of visual quality assessment.Paired t-tests and repeated measures analysis of variance(ANOVA)were utilized to compare the results,and the SNK-q post hoc test was applied to identify significant differences.RESULTS:The polishing group’s uncorrected distant visual acuity(UDVA)and uncorrected near visual acuity(UNVA)significantly improved 1-week post-surgery(all P<0.05).At 12-months,UDVA,UNVA,and corrected distant visual acuity(CDVA)were better than the control group(P<0.05).The MTF cutoff,SR,OSI,and high-order aberrations in the polishing group also showed significant improvements compared to the control group at 12 mo(P<0.05).CONCLUSION:The improved capsular polishing method has been demonstrated to effectively maintain visual acuity and visual quality in patients with MIOL after FLACS within 1 a.展开更多
The concept of Damage Control Surgery(DCS)emphasizes prioritizing hemorrhage control,preventing hypothermia,correcting coagulopathy,and acidosis in trauma treatment.The application of the DCS concept in trauma treatme...The concept of Damage Control Surgery(DCS)emphasizes prioritizing hemorrhage control,preventing hypothermia,correcting coagulopathy,and acidosis in trauma treatment.The application of the DCS concept in trauma treatment at grassroots hospitals faces numerous challenges such as limited resources,high technical difficulty,and insufficient multidisciplinary collaboration.Therefore,DCS strategies need to be adapted to simplified processes to create conditions for subsequent treatment.This paper retrieves relevant literature to discuss the proposal,promotion,and application of the DCS concept,aiming to provide evidence-based basis for optimizing trauma treatment outcomes at grassroots hospitals.展开更多
Background:Pressure injury(PI)is a prevalent complication in pediatric cardiac surgery,with higher incidence than in general pediatric populations due to children’s thin skin,underdeveloped subcutaneous tissue,and pr...Background:Pressure injury(PI)is a prevalent complication in pediatric cardiac surgery,with higher incidence than in general pediatric populations due to children’s thin skin,underdeveloped subcutaneous tissue,and prolonged intraoperative pressure.Objective:To evaluate the effectiveness of the curvilinear supine position(CSP)in preventing PI among children undergoing congenital heart disease(CHD)surgery.Methods:Between October 2024 and February 2025,a single-center randomized controlled trial was conducted.Of the 80 children initially enrolled for congenital heart disease(CHD)surgery,77(aged 1 month to 14 years)completed the study and were included in the final analysis after 3 were excluded due to protocol violations.Participants were randomly assigned to the CSP group(n=38)or the conventional supine position group(n=39).Results:The incidence of PI was significantly lower in the CSP group(2.6%)compared to the control group(20.5%)(p=0.029).Postoperative LDH levels were also significantly reduced in the CSP group(422.67±86.52 U/L vs.592.92±215.71 U/L;p=0.031),while preoperative LDH and surgical variables(e.g.,cardiopulmonary bypass time)were comparable between groups.Although the CSP group had a shorter hospital stay(17.24 vs.22.51 days),the difference was not statistically significant(p=0.085).Caregiver satisfaction was significantly higher in the CSP group(100.0%vs.84.6%;p=0.025).Conclusion:CSP effectively reduces PI incidence,mitigates tissue injury,and enhances caregiver satisfaction in pediatric cardiac surgery,offering a safe and feasible strategy for perioperative PI prevention.展开更多
Objective:To analyze the impact of nursing interventions based on quantitative assessment using the Kano model on the quality of rehabilitation in patients with early-stage ovarian cancer following laparoscopic radica...Objective:To analyze the impact of nursing interventions based on quantitative assessment using the Kano model on the quality of rehabilitation in patients with early-stage ovarian cancer following laparoscopic radical surgery.Methods:A prospective clinical study was conducted involving 96 patients with newly diagnosed early-stage ovarian cancer who underwent laparoscopic radical surgery from December 2023 to December 2025.Patients were randomly assigned to groups using a random number table method before surgery.After surgery,the control group(n=48)received routine quantitative assessment nursing interventions,while the observation group(n=48)received nursing interventions based on quantitative assessment using the Kano model.Both groups received continuous nursing care until discharge.Differences between the groups were compared in terms of negative emotions,quality of life scores before and after postoperative intervention,postoperative recovery indicators,and nursing satisfaction evaluations on the day of discharge.Results:After intervention,the observation group had lower scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS),as well as shorter recovery times for gastrointestinal function and food intake,and a shorter hospital stay compared to the control group.Additionally,the observation group had higher scores on the Quality-of-Life Instrument for Cancer Patients-Ovarian Cancer(QLICP-OV)than the control group,with statistically significant differences(p<0.05).The overall satisfaction with nursing care in the observation group was also higher than that in the control group,with a statistically significant difference(p<0.05).Conclusion:Implementing quantitative evaluation nursing interventions based on the Kano model for patients with early-stage ovarian cancer after laparoscopic radical surgery can,by addressing their postoperative basic health,disease awareness,and other intervention content needs to a comprehensive degree,actively promote postoperative recovery and improve their mental health and quality of life.展开更多
BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and...BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and high postoperative complication rates,which threaten patient safety and functional outcomes.Enhanced recovery after surgery(ERAS)principles have been shown to improve perioperative outcomes through evidence-based,multidisciplinary care pathways.Despite its widespread adoption,there is a paucity of research focusing specifically on optimizing ERAS-guided nursing processes in the post-anesthesia care unit(PACU)and evaluating its impact on perioperative safety in patients undergoing GI tumor surgery.This study aimed to investigate whether an ERASbased PACU nursing protocol could enhance recovery,reduce complications,and improve patient safety in this surgical population.AIM To explore the impact of optimizing the recovery room nursing process based on ERAS on the perioperative safety of patients with GI tumors.METHODS A total of 260 patients with GI tumors who underwent elective surgeries under general anesthesia in our hospital from August 2023 to August 2025 and were then observed in the recovery unit(PACU)were selected.They were randomly divided into the observation group(the PACU nursing process was optimized based on ERAS)and the control group(the conventional PACU nursing process was adopted)by the random number grouping method,with 130 cases in each group.The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,time of leaving the room after tube removal,retention time in the recovery room,occurrence of complications,satisfaction and readmission rate were compared between the two groups after entering the room.Compare the occurrence of adverse events in the PACU nursing process between the two groups.RESULTS The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,retention time in the recovery room,total incidence of complications and readmission rate in the observation group were significantly lower than those in the control group,and the satisfaction rate was higher than that in the control group(P<0.05).The occurrence of adverse events in the PACU nursing process in the observation group was lower than that in the control group(P<0.05).CONCLUSION Optimizing the PACU nursing process based on ERAS can effectively accelerate the recovery process of patients undergoing GI tumor surgery,reduce adverse events,improve nursing satisfaction,and at the same time,lower the incidence of adverse events in the PACU nursing process,providing a more refined management basis for clinical practice.展开更多
With the intensification of population aging,knee and hip joint replacement surgeries have become core methods for treating end-stage joint diseases,with over a million cases performed globally each year.Postoperative...With the intensification of population aging,knee and hip joint replacement surgeries have become core methods for treating end-stage joint diseases,with over a million cases performed globally each year.Postoperative rehabilitation nursing,as a crucial aspect of enhancing surgical outcomes,reducing complications,and facilitating patients’return to normal life,has its scientific and effective protocols directly influencing patient prognosis.This article systematically reviews the core research findings on rehabilitation nursing after joint replacement surgery based on the concept of evidence-based medicine,aiming to provide references for the formulation of standardized and personalized rehabilitation nursing plans in clinical settings.展开更多
BACKGROUND There has been an increasing focus in recent years on health-care disparities.Studies investigating return to work(RTW)or sports are often performed in large,urban areas.Relatively few studies have investig...BACKGROUND There has been an increasing focus in recent years on health-care disparities.Studies investigating return to work(RTW)or sports are often performed in large,urban areas.Relatively few studies have investigated rates of return to farming or other heavy labor that is of interest to patients in rural areas.AIM To evaluate the literature regarding RTW in farming or heavy labor after orthopedic hip,knee,or shoulder surgery.METHODS A search was performed in the PubMed and EMBASE databases using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Studies were included if they reported patients employed in farming or heavy labor,RTW rates after orthopedic surgery of the hip,knee,or shoulder,and had a minimum 6-month follow-up.A meta-analysis of proportions using a random-effects model was performed on three single-arm observational studies to estimate the pooled RTW rate following arthroscopic shoulder surgery.RESULTS Ten studies were included,and 101 farmers were identified among 440 total patients.One study involved hip surgery,two studies involved knee surgery,and seven studies involved shoulder surgery.RTW rates across studies varied by type of surgery and follow-up interval,ranging from 24%to 100%.The RTW rate was only 53.6%at 1 year following total hip arthroplasty.No studies investigated RTW in farmers following total knee arthroplasty.Among non-comparative studies,meta-analysis revealed a pooled RTW rate of 89%following arthroscopic shoulder surgery,with low heterogeneity(I^(2)=30.1%).Among comparative studies,one study reported significantly higher RTW odds for patients undergoing anatomic total shoulder arthroplasty compared to reverse shoulder arthroplasty(odds ratio=5.45).Overall,surgical intervention for shoulder pathology was associated with a high likelihood of RTW across multiple techniques,with particularly favorable outcomes for anatomic total shoulder arthroplasty.CONCLUSION This systematic review highlights the high rates of RTW in farmers and heavy laborers after shoulder surgery.However,our findings also underscore the need for more rural-specific research to guide patient counseling,rehabilitation expectations,and shared decision-making in this underserved population,particularly for orthopedic surgery of the hip and knee.展开更多
Objective:Sepsis exhibits remarkable heterogeneity in disease progression trajectories,and accurate identificationof distinct trajectory-based phenotypes is critical for implementing personalized therapeutic strategie...Objective:Sepsis exhibits remarkable heterogeneity in disease progression trajectories,and accurate identificationof distinct trajectory-based phenotypes is critical for implementing personalized therapeutic strategies and prognostic assessment.However,trajectory clustering analysis of time-series clinical data poses substantial methodological challenges for researchers.This study provides a comprehensive tutorial framework demonstrating six trajectory modeling approaches integrated with proteomic analysis to guide researchers in identifying sepsis subtypes after laparoscopic surgery.Methods:This study employs simulated longitudinal data from 300 septic patients after laparoscopic surgery to demonstrate six trajectory modeling methods(group-based trajectory modeling,latent growth mixture modeling,latent transition analysis,time-varying effect modeling,K-means for longitudinal data,agglomerative hierarchical clustering)for identifying associations between predefinedsequential organ failure assessment trajectories and 25 proteomic biomarkers.Clustering performance was evaluated via multiple metrics,and a biomarker discovery pipeline integrating principal component analysis,random forests,feature selection,and receiver operating characteristic analysis was developed.Results:The six methods demonstrated varying performance in identifying trajectory structures,with each approach exhibiting distinct analytical characteristics.The performance metrics revealed differences across methods,which may inform context-specificmethod selection and interpretation strategies.Conclusion:This study illustrates practical implementations of trajectory modeling approaches under controlled conditions,facilitating informed method selection for clinical researchers.The inclusion of complete R code and integrated proteomics workflows offers a reproducible analytical framework connecting temporal pattern recognition to biomarker discovery.Beyond sepsis,this pipeline-oriented approach may be adapted to diverse clinical scenarios requiring longitudinal disease characterization and precision medicine applications.The comparative analysis reveals that each method has distinct strengths,providing a practical guide for clinical researchers in selecting appropriate methods based on their specificstudy goals and data characteristics.展开更多
Objective:To investigate the long-term prognosis and postoperative cosmetic outcomes of breast-conserving surgery combined with sentinel lymph node biopsy in patients with early-stage breast cancer,providing a referen...Objective:To investigate the long-term prognosis and postoperative cosmetic outcomes of breast-conserving surgery combined with sentinel lymph node biopsy in patients with early-stage breast cancer,providing a reference for the selection of clinical treatment plans.Methods:A retrospective analysis was conducted on the clinical data of 68 patients with early-stage breast cancer admitted from January 2022 to December 2025.Based on the surgical approach,patients were divided into an observation group(breast-conserving surgery+sentinel lymph node biopsy)and a control group(other surgical methods such as modified radical mastectomy/total mastectomy).Clinical and pathological characteristics,incidence of postoperative complications,follow-up prognosis,and satisfaction with cosmetic outcomes were compared between the two groups.Results:Among the 68 patients,41 were in the observation group and 27 in the control group.The average age of patients in the observation group was(54.32±8.15)years,while that in the control group was(62.45±9.76)years.The average tumor size in the observation group was(1.86±0.72)cm,compared to(3.21±1.45)cm in the control group.The incidence of postoperative complications in the observation group was 9.76%,significantly lower than that in the control group at 33.33%(P<0.05).The 6-month disease-free survival rate was 95.12%in the observation group and 88.89%in the control group,with no statistically significant difference between the two groups(P>0.05).The excellent and good rate of cosmetic outcomes in the observation group was 87.80%,significantly higher than that in the control group at 29.63%(P<0.05).Conclusion:Breast-conserving surgery combined with sentinel lymph node biopsy for early-stage breast cancer can achieve long-term prognostic outcomes comparable to those of traditional radical surgery,with the advantages of fewer postoperative complications and superior cosmetic results.This approach is worthy of clinical promotion and application,particularly for early-stage breast cancer patients who have a demand for preserving breast morphology.展开更多
Background:Clear cell sarcoma of the kidney(CCSK)is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread.Cases of CCSK associated with inferior vena cava(IVC)tumor thr...Background:Clear cell sarcoma of the kidney(CCSK)is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread.Cases of CCSK associated with inferior vena cava(IVC)tumor thrombus(IVCTT)are exceptionally uncommon in the literature.We report a case of CCSK with IVCTT in a 15-month-old male infant.Case Description:We reported a case admitted in May 2020 for a 3-day history of fever and hematuria.Abdominal CT revealed an unevenly enhanced mass and low-density shadows within the IVC.The diagnosis of CCSK was confirmed via needle biopsy.The patient received 4 cycles of adjuvant chemotherapy.The initial surgery lasted 10 h with 600 mL blood loss,and primary closure was achieved.Postoperative management included 6 cycles of radiotherapy and 5 cycles of chemotherapy.In March 2022,CT detected IVCTT recurrence,requiring surgical intervention involving thrombus removal and partial IVC resection.This procedure lasted 8 h with 300 mL blood loss,followed by 5 additional chemotherapy cycles.The patient showed no sign of IVC obstruction,including varicose veins or lower limb edema,and maintained renal function throughout follow-up.However,Intracranial metastases were detected 15 months postoperatively.After the family opted against additional treatment,the patient succumbed to the disease.Conclusions:The management of CCSK associated with IVCTT should include consideration of IVC thrombectomy.In case of recurrent IVCTT with preserved collateral circulation,combined thrombus excision and partial IVC resection may be warranted.展开更多
Background:—Synovial sarcoma is a rare soft tissue sarcoma.Treatment of synovial sarcoma includes surgery,radiation,pazopanib,and chemotherapy.Targeted therapies,such as B-Raf proto-oncogene,serine/threonine kinase(B...Background:—Synovial sarcoma is a rare soft tissue sarcoma.Treatment of synovial sarcoma includes surgery,radiation,pazopanib,and chemotherapy.Targeted therapies,such as B-Raf proto-oncogene,serine/threonine kinase(BRAF)inhibitors,are emerging as a potential treatment option.We describe the sixth case of a BRAF^(V600E)synovial sarcoma,the first extra-thoracic case.This case is the first to show a complete pathological response to BRAF&mitogen-activated protein kinase kinase(MEK)inhibitors.Case description:—We treated a 22-year-old male with a left groin BRAF^(V600E)synovial sarcoma with doxorubicin,Ifosphamide&Sodium 2-Mercaptoethanesulfonate.When we identified BRAF^(V600E)in the tumor,the BRAF^(V600E)and MEK inhibitors(dabrafenib&trametinib)were initiated,followed by surgery,with a complete pathological response.Nine months after the surgery,a local recurrence prompted the resumption of dabrafenib&trametinib followed by radiotherapy,resulting in complete radiological response and the development of hemophagocytic lymphohistiocytosis treated with corticosteroids with resolution of symptoms.Conclusion:—Panel sequencing of synovial sarcoma can identify targetable mutations.Treatment of BRAF^(V600E)synovial sarcoma with dabrafenib&trametinib can lead to complete pathological response and prolonged radiological response,as well as the rare adverse event of hemophagocytic lymphohistiocytosis.Prospective clinical trials are needed to evaluate the efficacy and safety of BRAF^(V600E)&MEK inhibitors as a therapeutic approach in BRAF^(V600E)synovial sarcoma.展开更多
文摘BACKGROUND Enhanced recovery after surgery(ERAS)programs provide recommendations for an optimized management of patients undergoing surgery.An ERAS program tailored on surgery for retroperitoneal sarcomas(RPS)may improve patient outcomes and it has still not been established.AIM To determine how an ERAS program tailored to RPS surgery can be agreed upon,structured,and implemented.METHODS Twenty-five candidate items from existing ERAS programs,potentially relevant for RPS surgery,were identified via literature review and expert input.These were included in a questionnaire refined through cognitive interviews and pilot testing.Expert sarcoma surgeons rated each item’s relevance and feasibility on a 6-point scale.The survey was recirculated after one year.Intra-observer reproducibility,inter-observer concordance,and agreement with the modal value of the most experienced participants were analyzed.RESULTS Thirteen sarcoma surgeons from 6 centers participated in the survey.Although surgeons agreed on several items,their overall concordance was low.After recirculating the survey,the intraobserver reproducibility was low.Interestingly,the median concordance with the reference increased for relevance and decreased for feasibility.CONCLUSION Despite interest in ERAS for RPS,surgeon concordance on item relevance and feasibility remains low,underscoring the need for collaborative efforts toward a standardized,consensus-based protocol.
文摘Myofibroblastic sarcoma(MS)is a rare malignant soft tissue tumor characterized by myofibroblasts.It most commonly arises in the head and neck region,especially the tongue,with rare occurrences in the limbs.MS exhibits varying histopathology,ranging from low-to high-grade,with diverse subtypes showing different clinical behaviors and prognoses.This article reports the first case of high-grade MS in the hand,adding to the limited documentation of this rare condition.Here,we present the case of a 30-year-old healthy female with a year-long history of progressive shortening,mobility loss,and weakness in the first finger of the left hand.Left-hand imaging revealed a lytic,cottony tumor involving the entire first metacarpal.Following surgical resection,which included metatarsal grafting and joint reconstruction,a diagnosis of high-grade MS was confirmed based on histological manifestations and immunohistochemical staining,which was further classified as grade 2 according to the French Federation of Cancer Centers Sarcoma Group system.Postoperative radiotherapy was administered and the patient experienced a successful recovery without graft osteonecrosis.The patient regained 90%mobility and strength,without shortening,after surgical resection and radiotherapy.Six months post-surgery,the patient reported full hand functionality.MS is a rare tumor that infrequently affects bones and is often misdiagnosed owing to its controversial characteristics.The initial treatment should focus on complete resection with negative margins,followed by reconstructive surgery to preserve function.Further case studies are needed to establish standardized surgical treatment protocols.
文摘The development of pancreatic surgery in China has progressed remarkably over 7 decades.China initiated its pancreatic surgery journey in the 1950s,marked by the first pancreaticoduodenectomy performed by Zeng Xianjiu in 1951.Early progress was hindered by technological limitations and fragmented practices,but the establishment of academic platforms such as the National Pancreatic Disease Symposia in the 1980s catalyzed standardized research and interdisciplinary collaboration.In 2006,Zhang Shengdao spearheaded China’s first Guidelines for the Diagnosis and Treatment of Severe Acute Pancreatitis.The 21st century has seen remarkable progress in pancreatic surgery,marked by the China-specific treatment guidelines,technological breakthroughs in laparoscopic and robotic surgical systems,and the increasing centralization of pancreatic surgery in high-volume medical centers.These synergistic advancements have collectively propelled a paradigm shift in contemporary cancer care.By 2022,China Pancreas Data Center reported a postoperative mortality rate of 0.4% and 3-year survival rates of 43% for resected pancreatic cancer,rivaling global benchmarks.China has also emerged as a leader in minimally invasive pancreatic surgery,with advancements in laparoscopic and robotic pancreatic surgery.Academic growth paralleled clinical progress:the Chinese Pancreatic Association,established in 2022,fosters global collaboration,evidenced by its 2024 annual conference attracting over 10,000 participants.Through technological innovation,centralized care models,and international partnerships,China continues to redefine its role in advancing pancreatic surgery.
文摘The year 2025 marked a significantmilestone for Laparoscopic,Endoscopic and Robotic Surgery(LERS)—we have awarded our first Impact Factor of 2.0 released by the Journal Citation Reports from Clarivate Analytics,which ranks in the second quartile in the surgery category.This remarkable achievement,which reflects LERS’s steadily increasing influencein the area of surgery,would not be possible without the peer reviewer’s invaluable contributions.On behalf of the Editorial Board and Editorial Office,we would express our sincere appreciation to the following reviewers,who reviewed at least one paper with rigorous and insightful comments.We sincerely hope to engage further with them,either as esteemed reviewers or outstanding authors,in 2026 and beyond.
文摘Objective:To explore the relationship between anesthetic depth and surgical stress response in minimally invasive cardiothoracic surgery.Methods:A total of 89 patients who underwent thoracoscopic minimally invasive cardiothoracic surgery in our hospital from June 2024 to December 2024 were selected as the research objects.They were divided into the light anesthesia group(n=45)and the deep anesthesia group(n=44).The vital signs at different intraoperative nodes and perioperative stress status of the two groups were compared.Results:Before lesion resection and after surgery,the mean arterial pressure and heart rate of the deep anesthesia group were lower than those of the light anesthesia group,with statistically significant differences.Conclusion:In thoracoscopic minimally invasive cardiothoracic surgery,deep anesthesia can effectively control the patient’s surgical stress response,but the postoperative awakening time is longer;patients under light anesthesia have a shorter awakening time,but the intraoperative stress response is obvious.
基金supported by National Key Research and Development Program of China(No.2023YFC2507406)National Natural Science Foundation of China(No.82300646)+6 种基金Beijing Natural Science Foundation(No.7232334)Beijing Municipal Administration of Hospitals Incubating Program(No.PX2024002,PX2020001)Capital Fund for Health Development Scientific Research(No.2024-2-2028)Beijing Municipal Science&Technology Commission AI+Health Collaborative Innovation Cultivation Project(No.Z241100007724004)Research Ward Excellence Program of Beijing Municipal Health Commission(No.BRWEP2024W162020100,BRWEP2024W162020112,BRWEP2024W162020114)Excellent Plan for Capital Medicine Scientific and Technological Innovation Achievement Transformation Promotion Plan(No.YC202401QX0824)Clinical Scientific Research Fund of Beijing Integrated Medical Association[No.ZHKY-2025-1869(B012)]。
文摘With the advancement of surgical techniques and enhanced management of early gastric cancer(EGC),minimally invasive function-preserving surgical approaches have emerged as a common goal for patients and clinicians.Laparoscopic-endoscopic cooperative surgery combined with sentinel lymph node navigation surgery(LECSSNNS)has drawn increasing interest because of its dual benefits of minimal invasiveness and organ function preservation.However,robust evidence-based support for guiding clinical implementation remains limited.To address this gap,we systematically evaluated available studies on the clinical application of LECS-SNNS in EGC and integrated expert insights to formulate 20 recommendations.These included preoperative assessment,surgical techniques,intraoperative endoscopic procedures,pathological evaluation,postoperative care,and follow-up.This consensus aimed to provide comprehensive guidance for the standardized application of LECS-SNNS,thereby advancing precise,minimally invasive,and function-preserving treatment for EGC.
文摘Background:Photodynamic therapy(PDT)may eradicate residual malignant cells following sarcoma resection,through reactive oxygen species(ROS)mediated cytotoxicity,thus improve clinical outcomes.This study aims to assess the efficacy of 5-aminolevulinic acid(5-ALA)as a photosensitizer in combination with red light(RL)for PDT of bone sarcoma cells in vitro.Methods:Three bone sarcoma cell lines underwent treatment with 5-ALA and RL or sham-RL(SL).5-ALA uptake was assessed using flow cytometry.Production of ROS was measured using CellROX Green staining and fluorescence microscopy.Cell viability was assessed using Cell Counting Kit-8 assays.Results:All cell lines showed significant 5-ALA uptake in comparison to the 0 mM control(p<0.05).Production of ROS was significantly increased in cells treated with 5-ALA and RL,compared to those treated with RL and no 5-ALA or SL(p<0.05).Viability was significantly reduced in cells treated with 5-ALA and RL,compared to SL(p<0.05).At 72 h post-treatment,cell viability ranged from 6%-12%in 0.5 mM 5-ALA and RL-treated cells vs.90%-137%in 0.5 mM 5-ALA and SL-treated cells.Conclusion:5-ALA-based PDT led to the desired increased production of ROS and reduction in cell viability in all cell lines.These preliminary in vitro results warrant further study with multicellular spheroid or animal models and suggest PDT has potential to be used as an adjuvant therapy to surgical resection in sarcoma management.
基金supported by grants from Young Scientists Fund of the National Natural Science Foundation of China(grant number.82301295).
文摘1Introduction A 25-year-old woman presented with a 3-month history of otalgia and aural fullness in the left ear,without associated otological or systemic symptoms.Her medical history was unremarkable,and she denied any history of hepatitis,hypertension,diabetes,cardiovascular disease,or other significant conditions.The patient was diagnosed with external auditory canal cholesteatoma and subsequently underwent canalplasty under general anesthesia.Routine anesthetic drugs,including 2%lidocaine,dexamethasone,propofol,sufentanil,rocuronium bromide,ondansetron,flurbiprofen axetil,neostigmine,and atropine,were used during surgery and anesthesia recovery.No significant events were noted,and the patient experienced only a blood loss of 10 mL.
基金Supported by the National Natural Science Foundation of China(Grant Nos.62025104,62331005,and U22A2052)the Beijing Natural Science Foundation(Grant No.L242100).
文摘Background Computed tomography(CT) and cone-beam computed tomography(CBCT) image registration play pivotal roles in computer-assisted navigation for orthopedic surgery. Traditional methods often apply uniform deformation models, neglecting the biomechanical differences between rigid structures and soft tissues, which compromises registration accuracy, especially during significant bone displacements. Method To address this issue, we introduce RE-Reg, a rigid-elastic CT-CBCT image registration framework that jointly learns rigid bone motion and soft tissue deformation. RE-Reg incorporates a rigid alignment(RA) module to estimate global bone motion and an elastic deformation(ED) module to model soft tissue deformation, preserving bony structures through bone shape preservation(BSP) loss. Result Our comprehensive evaluation on publicly available datasets demonstrates that RE-Reg significantly outperforms existing methods in terms of registration accuracy and rigid bone structure preservation, achieving a 1.3% improvement in Dice similarity coefficient(DSC) and a 23% reduction in rigid bone deformation(%Δvol) compared with the best baseline. Conclusion This framework not only enhances anatomical fidelity but also ensures biomechanical plausibility and provides a valuable tool for image-guided orthopedic surgery. This code is available athttps://github.com/Zq-Huang/RE-Reg.
文摘AIM:To assess the visual acuity and visual quality of cataract patients who received femtosecond laser-assisted cataract surgery(FLACS)and multifocal intraocular lens(MIOL)implantation with an improved polishing technique during a 1-year follow-up period.METHODS:This study included 74 eyes from 37 patients,comprising 17 males and 20 females,with a mean age of 51.74±7.80 years.Using a coin toss method,one eye per patient was randomly selected for improved anterior capsular polishing,while the other eye received standard irrigation/aspiration(I/A)polishing.The polishing group consisted of 37 eyes,including 21 right and 16 left eyes,while the control group comprised the contralateral fellow eyes of the same individuals in the polishing group.Visual acuity and quality of the patients were evaluated before surgery and at 1 wk,1,6,and 12 mo after surgery.The OPD-Scan III was utilized to assess high-order aberrations,while the optical quality analysis system(OQAS)was employed to evaluate modulation transfer function(MTF cutoff),Strehl ratio(SR),and objective scatter index(OSI)for the purpose of visual quality assessment.Paired t-tests and repeated measures analysis of variance(ANOVA)were utilized to compare the results,and the SNK-q post hoc test was applied to identify significant differences.RESULTS:The polishing group’s uncorrected distant visual acuity(UDVA)and uncorrected near visual acuity(UNVA)significantly improved 1-week post-surgery(all P<0.05).At 12-months,UDVA,UNVA,and corrected distant visual acuity(CDVA)were better than the control group(P<0.05).The MTF cutoff,SR,OSI,and high-order aberrations in the polishing group also showed significant improvements compared to the control group at 12 mo(P<0.05).CONCLUSION:The improved capsular polishing method has been demonstrated to effectively maintain visual acuity and visual quality in patients with MIOL after FLACS within 1 a.
文摘The concept of Damage Control Surgery(DCS)emphasizes prioritizing hemorrhage control,preventing hypothermia,correcting coagulopathy,and acidosis in trauma treatment.The application of the DCS concept in trauma treatment at grassroots hospitals faces numerous challenges such as limited resources,high technical difficulty,and insufficient multidisciplinary collaboration.Therefore,DCS strategies need to be adapted to simplified processes to create conditions for subsequent treatment.This paper retrieves relevant literature to discuss the proposal,promotion,and application of the DCS concept,aiming to provide evidence-based basis for optimizing trauma treatment outcomes at grassroots hospitals.
文摘Background:Pressure injury(PI)is a prevalent complication in pediatric cardiac surgery,with higher incidence than in general pediatric populations due to children’s thin skin,underdeveloped subcutaneous tissue,and prolonged intraoperative pressure.Objective:To evaluate the effectiveness of the curvilinear supine position(CSP)in preventing PI among children undergoing congenital heart disease(CHD)surgery.Methods:Between October 2024 and February 2025,a single-center randomized controlled trial was conducted.Of the 80 children initially enrolled for congenital heart disease(CHD)surgery,77(aged 1 month to 14 years)completed the study and were included in the final analysis after 3 were excluded due to protocol violations.Participants were randomly assigned to the CSP group(n=38)or the conventional supine position group(n=39).Results:The incidence of PI was significantly lower in the CSP group(2.6%)compared to the control group(20.5%)(p=0.029).Postoperative LDH levels were also significantly reduced in the CSP group(422.67±86.52 U/L vs.592.92±215.71 U/L;p=0.031),while preoperative LDH and surgical variables(e.g.,cardiopulmonary bypass time)were comparable between groups.Although the CSP group had a shorter hospital stay(17.24 vs.22.51 days),the difference was not statistically significant(p=0.085).Caregiver satisfaction was significantly higher in the CSP group(100.0%vs.84.6%;p=0.025).Conclusion:CSP effectively reduces PI incidence,mitigates tissue injury,and enhances caregiver satisfaction in pediatric cardiac surgery,offering a safe and feasible strategy for perioperative PI prevention.
文摘Objective:To analyze the impact of nursing interventions based on quantitative assessment using the Kano model on the quality of rehabilitation in patients with early-stage ovarian cancer following laparoscopic radical surgery.Methods:A prospective clinical study was conducted involving 96 patients with newly diagnosed early-stage ovarian cancer who underwent laparoscopic radical surgery from December 2023 to December 2025.Patients were randomly assigned to groups using a random number table method before surgery.After surgery,the control group(n=48)received routine quantitative assessment nursing interventions,while the observation group(n=48)received nursing interventions based on quantitative assessment using the Kano model.Both groups received continuous nursing care until discharge.Differences between the groups were compared in terms of negative emotions,quality of life scores before and after postoperative intervention,postoperative recovery indicators,and nursing satisfaction evaluations on the day of discharge.Results:After intervention,the observation group had lower scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS),as well as shorter recovery times for gastrointestinal function and food intake,and a shorter hospital stay compared to the control group.Additionally,the observation group had higher scores on the Quality-of-Life Instrument for Cancer Patients-Ovarian Cancer(QLICP-OV)than the control group,with statistically significant differences(p<0.05).The overall satisfaction with nursing care in the observation group was also higher than that in the control group,with a statistically significant difference(p<0.05).Conclusion:Implementing quantitative evaluation nursing interventions based on the Kano model for patients with early-stage ovarian cancer after laparoscopic radical surgery can,by addressing their postoperative basic health,disease awareness,and other intervention content needs to a comprehensive degree,actively promote postoperative recovery and improve their mental health and quality of life.
基金Supported by 2025 Henan Medical Education Research Project,No.WJLX2025038.
文摘BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and high postoperative complication rates,which threaten patient safety and functional outcomes.Enhanced recovery after surgery(ERAS)principles have been shown to improve perioperative outcomes through evidence-based,multidisciplinary care pathways.Despite its widespread adoption,there is a paucity of research focusing specifically on optimizing ERAS-guided nursing processes in the post-anesthesia care unit(PACU)and evaluating its impact on perioperative safety in patients undergoing GI tumor surgery.This study aimed to investigate whether an ERASbased PACU nursing protocol could enhance recovery,reduce complications,and improve patient safety in this surgical population.AIM To explore the impact of optimizing the recovery room nursing process based on ERAS on the perioperative safety of patients with GI tumors.METHODS A total of 260 patients with GI tumors who underwent elective surgeries under general anesthesia in our hospital from August 2023 to August 2025 and were then observed in the recovery unit(PACU)were selected.They were randomly divided into the observation group(the PACU nursing process was optimized based on ERAS)and the control group(the conventional PACU nursing process was adopted)by the random number grouping method,with 130 cases in each group.The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,time of leaving the room after tube removal,retention time in the recovery room,occurrence of complications,satisfaction and readmission rate were compared between the two groups after entering the room.Compare the occurrence of adverse events in the PACU nursing process between the two groups.RESULTS The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,retention time in the recovery room,total incidence of complications and readmission rate in the observation group were significantly lower than those in the control group,and the satisfaction rate was higher than that in the control group(P<0.05).The occurrence of adverse events in the PACU nursing process in the observation group was lower than that in the control group(P<0.05).CONCLUSION Optimizing the PACU nursing process based on ERAS can effectively accelerate the recovery process of patients undergoing GI tumor surgery,reduce adverse events,improve nursing satisfaction,and at the same time,lower the incidence of adverse events in the PACU nursing process,providing a more refined management basis for clinical practice.
文摘With the intensification of population aging,knee and hip joint replacement surgeries have become core methods for treating end-stage joint diseases,with over a million cases performed globally each year.Postoperative rehabilitation nursing,as a crucial aspect of enhancing surgical outcomes,reducing complications,and facilitating patients’return to normal life,has its scientific and effective protocols directly influencing patient prognosis.This article systematically reviews the core research findings on rehabilitation nursing after joint replacement surgery based on the concept of evidence-based medicine,aiming to provide references for the formulation of standardized and personalized rehabilitation nursing plans in clinical settings.
文摘BACKGROUND There has been an increasing focus in recent years on health-care disparities.Studies investigating return to work(RTW)or sports are often performed in large,urban areas.Relatively few studies have investigated rates of return to farming or other heavy labor that is of interest to patients in rural areas.AIM To evaluate the literature regarding RTW in farming or heavy labor after orthopedic hip,knee,or shoulder surgery.METHODS A search was performed in the PubMed and EMBASE databases using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Studies were included if they reported patients employed in farming or heavy labor,RTW rates after orthopedic surgery of the hip,knee,or shoulder,and had a minimum 6-month follow-up.A meta-analysis of proportions using a random-effects model was performed on three single-arm observational studies to estimate the pooled RTW rate following arthroscopic shoulder surgery.RESULTS Ten studies were included,and 101 farmers were identified among 440 total patients.One study involved hip surgery,two studies involved knee surgery,and seven studies involved shoulder surgery.RTW rates across studies varied by type of surgery and follow-up interval,ranging from 24%to 100%.The RTW rate was only 53.6%at 1 year following total hip arthroplasty.No studies investigated RTW in farmers following total knee arthroplasty.Among non-comparative studies,meta-analysis revealed a pooled RTW rate of 89%following arthroscopic shoulder surgery,with low heterogeneity(I^(2)=30.1%).Among comparative studies,one study reported significantly higher RTW odds for patients undergoing anatomic total shoulder arthroplasty compared to reverse shoulder arthroplasty(odds ratio=5.45).Overall,surgical intervention for shoulder pathology was associated with a high likelihood of RTW across multiple techniques,with particularly favorable outcomes for anatomic total shoulder arthroplasty.CONCLUSION This systematic review highlights the high rates of RTW in farmers and heavy laborers after shoulder surgery.However,our findings also underscore the need for more rural-specific research to guide patient counseling,rehabilitation expectations,and shared decision-making in this underserved population,particularly for orthopedic surgery of the hip and knee.
基金funding from the China National Key Research and Development Program(No.2023YFC3603104)the National Natural Science Foundation of China(Nos.82472243 and 82272180)+6 种基金the Fundamental Research Funds for the Central Universities(No.226-2025-00024)the Huadong Medicine Joint Funds of the Zhejiang Provincial Natural Science Foundation of China(No.LHDMD24H150001)the Key Research&Development Project of Zhejiang Province(No.2024C03240)a collaborative scientific project co-established by the Science and Technology Department of the National Administration of Traditional Chinese Medicine and the Zhejiang Provincial Administration of Traditional Chinese Medicine(No.GZY-ZJ-KJ-24082)he General Health Science and Technology Program of Zhejiang Province(No.2024KY1099)the Project of Zhejiang University Longquan Innovation Center(No.ZJDXLQCXZCJBGS2024016)Wu Jieping Medical Foundation Special Research Grant(No.320.6750.2024-23-07).
文摘Objective:Sepsis exhibits remarkable heterogeneity in disease progression trajectories,and accurate identificationof distinct trajectory-based phenotypes is critical for implementing personalized therapeutic strategies and prognostic assessment.However,trajectory clustering analysis of time-series clinical data poses substantial methodological challenges for researchers.This study provides a comprehensive tutorial framework demonstrating six trajectory modeling approaches integrated with proteomic analysis to guide researchers in identifying sepsis subtypes after laparoscopic surgery.Methods:This study employs simulated longitudinal data from 300 septic patients after laparoscopic surgery to demonstrate six trajectory modeling methods(group-based trajectory modeling,latent growth mixture modeling,latent transition analysis,time-varying effect modeling,K-means for longitudinal data,agglomerative hierarchical clustering)for identifying associations between predefinedsequential organ failure assessment trajectories and 25 proteomic biomarkers.Clustering performance was evaluated via multiple metrics,and a biomarker discovery pipeline integrating principal component analysis,random forests,feature selection,and receiver operating characteristic analysis was developed.Results:The six methods demonstrated varying performance in identifying trajectory structures,with each approach exhibiting distinct analytical characteristics.The performance metrics revealed differences across methods,which may inform context-specificmethod selection and interpretation strategies.Conclusion:This study illustrates practical implementations of trajectory modeling approaches under controlled conditions,facilitating informed method selection for clinical researchers.The inclusion of complete R code and integrated proteomics workflows offers a reproducible analytical framework connecting temporal pattern recognition to biomarker discovery.Beyond sepsis,this pipeline-oriented approach may be adapted to diverse clinical scenarios requiring longitudinal disease characterization and precision medicine applications.The comparative analysis reveals that each method has distinct strengths,providing a practical guide for clinical researchers in selecting appropriate methods based on their specificstudy goals and data characteristics.
文摘Objective:To investigate the long-term prognosis and postoperative cosmetic outcomes of breast-conserving surgery combined with sentinel lymph node biopsy in patients with early-stage breast cancer,providing a reference for the selection of clinical treatment plans.Methods:A retrospective analysis was conducted on the clinical data of 68 patients with early-stage breast cancer admitted from January 2022 to December 2025.Based on the surgical approach,patients were divided into an observation group(breast-conserving surgery+sentinel lymph node biopsy)and a control group(other surgical methods such as modified radical mastectomy/total mastectomy).Clinical and pathological characteristics,incidence of postoperative complications,follow-up prognosis,and satisfaction with cosmetic outcomes were compared between the two groups.Results:Among the 68 patients,41 were in the observation group and 27 in the control group.The average age of patients in the observation group was(54.32±8.15)years,while that in the control group was(62.45±9.76)years.The average tumor size in the observation group was(1.86±0.72)cm,compared to(3.21±1.45)cm in the control group.The incidence of postoperative complications in the observation group was 9.76%,significantly lower than that in the control group at 33.33%(P<0.05).The 6-month disease-free survival rate was 95.12%in the observation group and 88.89%in the control group,with no statistically significant difference between the two groups(P>0.05).The excellent and good rate of cosmetic outcomes in the observation group was 87.80%,significantly higher than that in the control group at 29.63%(P<0.05).Conclusion:Breast-conserving surgery combined with sentinel lymph node biopsy for early-stage breast cancer can achieve long-term prognostic outcomes comparable to those of traditional radical surgery,with the advantages of fewer postoperative complications and superior cosmetic results.This approach is worthy of clinical promotion and application,particularly for early-stage breast cancer patients who have a demand for preserving breast morphology.
基金Research Project of Hunan Health Commission in 2023(D202304058618)Innovation Project of Hunan Science and Technology Department(2018SK504)National Nature Science Foundation of China(No.82203414).
文摘Background:Clear cell sarcoma of the kidney(CCSK)is a rare and highly aggressive pediatric renal malignancy with a marked propensity for metastatic spread.Cases of CCSK associated with inferior vena cava(IVC)tumor thrombus(IVCTT)are exceptionally uncommon in the literature.We report a case of CCSK with IVCTT in a 15-month-old male infant.Case Description:We reported a case admitted in May 2020 for a 3-day history of fever and hematuria.Abdominal CT revealed an unevenly enhanced mass and low-density shadows within the IVC.The diagnosis of CCSK was confirmed via needle biopsy.The patient received 4 cycles of adjuvant chemotherapy.The initial surgery lasted 10 h with 600 mL blood loss,and primary closure was achieved.Postoperative management included 6 cycles of radiotherapy and 5 cycles of chemotherapy.In March 2022,CT detected IVCTT recurrence,requiring surgical intervention involving thrombus removal and partial IVC resection.This procedure lasted 8 h with 300 mL blood loss,followed by 5 additional chemotherapy cycles.The patient showed no sign of IVC obstruction,including varicose veins or lower limb edema,and maintained renal function throughout follow-up.However,Intracranial metastases were detected 15 months postoperatively.After the family opted against additional treatment,the patient succumbed to the disease.Conclusions:The management of CCSK associated with IVCTT should include consideration of IVC thrombectomy.In case of recurrent IVCTT with preserved collateral circulation,combined thrombus excision and partial IVC resection may be warranted.
基金Aviad Zick is funded by ISF,grants number 2279/22&3099/22&TRANSCAN3 EpiNanSarc.
文摘Background:—Synovial sarcoma is a rare soft tissue sarcoma.Treatment of synovial sarcoma includes surgery,radiation,pazopanib,and chemotherapy.Targeted therapies,such as B-Raf proto-oncogene,serine/threonine kinase(BRAF)inhibitors,are emerging as a potential treatment option.We describe the sixth case of a BRAF^(V600E)synovial sarcoma,the first extra-thoracic case.This case is the first to show a complete pathological response to BRAF&mitogen-activated protein kinase kinase(MEK)inhibitors.Case description:—We treated a 22-year-old male with a left groin BRAF^(V600E)synovial sarcoma with doxorubicin,Ifosphamide&Sodium 2-Mercaptoethanesulfonate.When we identified BRAF^(V600E)in the tumor,the BRAF^(V600E)and MEK inhibitors(dabrafenib&trametinib)were initiated,followed by surgery,with a complete pathological response.Nine months after the surgery,a local recurrence prompted the resumption of dabrafenib&trametinib followed by radiotherapy,resulting in complete radiological response and the development of hemophagocytic lymphohistiocytosis treated with corticosteroids with resolution of symptoms.Conclusion:—Panel sequencing of synovial sarcoma can identify targetable mutations.Treatment of BRAF^(V600E)synovial sarcoma with dabrafenib&trametinib can lead to complete pathological response and prolonged radiological response,as well as the rare adverse event of hemophagocytic lymphohistiocytosis.Prospective clinical trials are needed to evaluate the efficacy and safety of BRAF^(V600E)&MEK inhibitors as a therapeutic approach in BRAF^(V600E)synovial sarcoma.
