Post-esophagectomy anastomotic leak(AL)is a severe complication following esophagectomy,contributing to increased morbidity,prolonged hospitalization,and a significant risk of mortality.Endoscopic vacuum-assisted clos...Post-esophagectomy anastomotic leak(AL)is a severe complication following esophagectomy,contributing to increased morbidity,prolonged hospitalization,and a significant risk of mortality.Endoscopic vacuum-assisted closure(EndoVac)has emerged as a promising first-line treatment,offering a highly effective approach for managing post-esophagectomy AL.EndoVac therapy utilizes continuous negative pressure within the esophageal lumen or mediastinal cavity,promoting granulation tissue formation,accelerating wound healing,and enhancing AL closure rates.Compared to stenting,EndoVac provides distinct advantages,including superior adaptability to varying leak sizes and locations,enhanced secretion drainage,and lower rates of reintervention.Clinical studies have demonstrated higher success rates,decreased post-intervention complications,and shorter hospital stays.Despite its advantages,challenges persist in patient selection,procedural expertise,and accessibility.EndoVac application requires experienced endoscopic teams and multidisciplinary expertise,which is best achieved in high-volume centers with specialized care.Variability in EndoVac protocols necessitate further refinement and standardization to optimize treatment outcomes.The integration of EndoVac into standardized treatment guidelines holds promise for improving patient outcomes and redefining the management approach for this challenging postoperative complication.展开更多
Research into lactylation modifications across various target organs in both health and disease has gained significant attention.Many essential life processes and the onset of diseases are not only related to protein ...Research into lactylation modifications across various target organs in both health and disease has gained significant attention.Many essential life processes and the onset of diseases are not only related to protein abundance but are also primarily regulated by various post-translational protein modifications.Lactate,once considered merely a byproduct of anaerobic metabolism,has emerged as a crucial energy substrate and signaling molecule involved in both physiological and pathological processes within the nervous system.Furthermore,recent studies have emphasized the significant role of lactate in numerous neurological diseases,including Alzheimer's disease,Parkinson's disease,acute cerebral ischemic stroke,multiple sclerosis,Huntington's disease,and myasthenia gravis.The purpose of this review is to synthesize the current research on lactate and lactylation modifications in neurological diseases,aiming to clarify their mechanisms of action and identify potential therapeutic targets.As such,this work provides an overview of the metabolic regulatory roles of lactate in various disorders,emphasizing its involvement in the regulation of brain function.Additionally,the specific mechanisms of brain lactate metabolism are discussed,suggesting the unique roles of lactate in modulating brain function.As a critical aspect of lactate function,lactylation modifications,including both histone and non-histone lactylation,are explored,with an emphasis on recent advancements in identifying the key regulatory enzymes of such modifications,such as lactylation writers and erasers.The effects and specific mechanisms of abnormal lactate metabolism in diverse neurological diseases are summarized,revealing that lactate acts as a signaling molecule in the regulation of brain functions and that abnormal lactate metabolism is implicated in the progression of various neurological disorders.Future research should focus on further elucidating the molecular mechanisms underlying lactate and lactylation modifications and exploring their potential as therapeutic targets for neurological diseases.展开更多
The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by ...The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by trauma,delayed presentation,and corneal perforation—PK restores globe integrity and provides limited visual recovery.However,its application is constrained by graft-related complications and donor shortages,particularly in low-resource settings.These limitations highlight the need for earlier,globe-sparing strategies to prevent progression and reduce surgical demand.Photoactivated chromophore for infectious keratitis-corneal collagen cross-linking(PACK-CXL)has emerged as a promising adjunct or alternative.With both antimicrobial and tissue-stabilizing effects,PACK-CXL may control infection and preserve corneal structure in earlier stages.A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes.Further studies are needed to define their best use in practice.展开更多
Arthrodesis of the first metatarsophalangeal(MTP)joint has been established as the“gold standard”for the treatment of several first ray disorders,due to its perceived efficacy and the consistently reported good resu...Arthrodesis of the first metatarsophalangeal(MTP)joint has been established as the“gold standard”for the treatment of several first ray disorders,due to its perceived efficacy and the consistently reported good results in the literature.Arthrodesis is a commonly performed procedure for the treatment of end stage arthritis,rheumatoid arthritis with severe deformity,selected cases of severe hallux valgus(with or without signs of degenerative joint disease),as well as a salvage procedure after failed previous operation of the first ray.The goals of a successful 1st MTP arthrodesis are pain alleviation and deformity correction in order to restore a comfortable gait pattern and to improve shoe wear.Several techniques have been reported with several proposals regarding the preparation of the articular surfaces and the method of definitive fixation.As with any given surgical procedure,various complications may occur after arthrodesis of the 1st MTP joint,namely delayed union,nonunion,malunion,irritating hardware,etc.展开更多
Pancreatic ductal adenocarcinoma(PDAC)is nowadays the fourth leading cause of cancer-related death worldwide,but according to recent estimations it will become the second leading cause of cancer-related deaths in the ...Pancreatic ductal adenocarcinoma(PDAC)is nowadays the fourth leading cause of cancer-related death worldwide,but according to recent estimations it will become the second leading cause of cancer-related deaths in the USA up to 2030,following lung cancer.The implementation of neoadjuvant chemotherapy during recent years led to an increase of overall survival at 35 months in PDAC after R0 resection[1].However,pancreatic cancer has a particularity that makes it a real challenge for clinicians:only 20%of patients are diagnosed early enough to have a resectable pancreatic cancer,whereas 40%of patients present with locally advanced or non-resectable disease,while the rest present with distant metastases[2].Systemic chemotherapy plays the main role in metastatic PDAC treatment:polychemotherapy regimens such as FOLFIRINOX(folinic acid,5-fluorouracil,irinotecan and oxaliplatin)or combination of gemcitabine/nab-paclitaxel seemed to improve median overall survival from 6.8 to 11.1 months and 6.7 to 8.5 months,respectively[3].展开更多
Dear Editor,Fungal keratitis is a serious and potentially sightthreatening infection that poses a global health concern,with higher incidence rates reported in low-income countries and regions with tropical climates[1...Dear Editor,Fungal keratitis is a serious and potentially sightthreatening infection that poses a global health concern,with higher incidence rates reported in low-income countries and regions with tropical climates[1-3].Risk factors for fungal keratitis include trauma with vegetative matter,contact lens wear,history of ocular surgery,chronic topical steroid use,low socioeconomic status and tropical climate[1-2].Fungi have the propensity to penetrate deep into the corneal stroma,making the infection difficult to treat with topical antifungal agents alone.Complications such as corneal perforation and endophthalmitis can arise in severe cases,making early identification of the causative fungal pathogen of utmost importance[4-5].Moreover,obtaining susceptibilities to the available antifungal agents can be sight and eye saving[5].展开更多
Effective communication and collaboration among healthcare professionals are crucial for delivering high-quality patient care.Interdepartmental miscommunication poses a significant challenge to healthcare systems,pote...Effective communication and collaboration among healthcare professionals are crucial for delivering high-quality patient care.Interdepartmental miscommunication poses a significant challenge to healthcare systems,potentially undermining the quality of healthcare services provided.In the same manner,communication barriers between referring physicians and radiologists can specifically affect radiology services and patient outcomes.This article attempts to put the spotlight on the ever-present chronic challenges of this issue and prompt readers to recognize the relevant potential pitfalls in their daily clinical practice.Practical solutions are explored and proposed,which should be tailored to the specific needs and issues that each individual institution may face.展开更多
Diabetes mellitus and atrial fibrillation(AF)are two global epidemics that frequently coexist,with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis.Pathophysiological mech...Diabetes mellitus and atrial fibrillation(AF)are two global epidemics that frequently coexist,with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis.Pathophysiological mechanisms underlying this relationship include chronic inflammation,oxidative stress,atrial remodeling,autonomic dysfunction,advanced glycation end-products and epicardial adiposity.Management remains challenging;however,recent advances offer promise,including guideline-directed anticoagulation,tailored rate and rhythm control,and particularly,novel antidiabetic therapies,such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists,may improve AF outcomes.A comprehensive,individualized approach is essential to mitigate morbidity and mortality in this high-risk population.展开更多
While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal mana...While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal management remain lacking.Most esophageal GISTs are surgically managed with enucleation,while esophagectomy is reserved for larger tumors.Recent advances in endoscopic techniques,such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection(ER),have allowed for endoscopic removal of submucosal esophageal lesions,including GISTs.Xu et al reported on the clinical and on-cological outcomes of 32 patients with esophageal GISTs treated with ER.The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival.However,it primarily focused on small,inci-dentally detected GISTs,with 75%of cases classified as very low or low risk according to the National Institutes of Health criteria.The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus.In this editorial,we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches.We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.展开更多
Alzheimer’s disease(AD)represents a prototypical neurodegenerative disorder with a multifactorial pathogenesis encompassing amyloid-β(Aβ)deposition,tau protein hyperphosphorylation,and chronic neuroinflammation.Rec...Alzheimer’s disease(AD)represents a prototypical neurodegenerative disorder with a multifactorial pathogenesis encompassing amyloid-β(Aβ)deposition,tau protein hyperphosphorylation,and chronic neuroinflammation.Recent advances in proteomic profiling have identified significant dysregulation in astrocytic and microglial metabolic pathways in AD pathogenesis,establishing mechanistic links between metabolic dyshomeostasis and neuroimmune crosstalk.Accumulating evidence indicates that acupuncture has gained prominence as a non-pharmacological therapeutic modality for AD management,owing to its multimodal regulatory effects on neuroinflammatory cascades,metabolic recalibration,and immune network stabilization.This study aims to elucidate the molecular mechanisms through which acupuncture exerts its neuroprotective effects,focusing on three interconnected axes:immunometabolic reprogramming in glial cells(particularly microglial bioenergetic adaptation),gut microbiota-derived metabolite signaling(including short-chain fatty acid-mediated pathways),and neuro‐immune‐metabolic interplay.We present a novel therapeutic framework highlighting acupuncture-mediated immunometabolic modulation,thereby providing a mechanistic foundation for developing targeted therapeutic strategies in AD management.展开更多
The Ilizarov apparatus was designed by its author 75 years ago and addresses a wide range of orthopedic conditions.Its classical assemblies are still self-sufficient and versatile.However,certain clinical scenarios re...The Ilizarov apparatus was designed by its author 75 years ago and addresses a wide range of orthopedic conditions.Its classical assemblies are still self-sufficient and versatile.However,certain clinical scenarios require a more specialized approach,and some groups of patients may benefit from customized Ilizarov constructs.Engineering science has designed various external fixators for orthopedic purposes,and some of those have become the gold standard for specific clinical tasks.We aimed to determine the current state and novel modifications of specialized external fixators for specific clinical situations which are based on the principles of the Ilizarov method.They are half-pin-based fixators for temporal fracture fixation,ring or hybrid devices for gradual deformity correction,and compression-distraction devices tailored for definite limb segments.Gradual correction of deformities can be achieved with external hexapods incorporating universal reduction units.Alternatively,external fixators with special connection mechanisms are able to provide independent movement of the rings in six degrees of freedom.Deformity correction can be performed with combined or sequential use of external and internal fixators.Special devices were developed for moving the split fragment for revascularization of the tibia.The units of external frames on the foot were modified to consider its complex anatomy and the clinical needs ranging from correction of multi-plane deformities,joint arthrodesis to distraction arthroplasty.Mini-fixators are compact external fixators for small bones of the hand and foot.The varieties of external fixators based on the Ilizarov principles have been designed to fulfill an ultimate goal of improving treatment outcomes.展开更多
Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due...Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.展开更多
Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk fa...Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients≥60 years of age hospitalized due to acute myocardial infarction(AMI).Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61%)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.Results Of 405 patients,57(14%,mean age:80.9±7.3,males:58%)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2%)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9%),infections(78.9 vs.3.7%),pulmonary oedema(73.7 vs.0.6%),hypoxemia(91.1 vs.98.3%),urinary catheter(96.5 vs.17.2%),dehydration(89.5 vs.6.6%),and insomnia(71.9 vs.0.3%)compared to patients without delirium(P<0.001 for all).Valvular heart disease(OR=4.78;95%CI:1.10-2.70;P<0.001,pulmonary oedema(OR=66.79;95%CI:12.04-370.34,P<0.001),and dehydration(OR=37.26;95%CI:10.50-132.27,P<0.001)were risk factors for delirium occurrence.Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14%of patients≥60 years old.Recognizing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.展开更多
BACKGROUND Colorectal cancer(CRC)is a common malignant tumor in the digestive system,whose main treatment comprises surgical resection,radiotherapy and chemotherapy,and targeted drug therapy.At present,the radical res...BACKGROUND Colorectal cancer(CRC)is a common malignant tumor in the digestive system,whose main treatment comprises surgical resection,radiotherapy and chemotherapy,and targeted drug therapy.At present,the radical resection of CRC is the main way of achieving an early cure.AIM To investigate the logistic regression analysis of bone metastasis after CRC surgery and related influencing factors.METHODS We selected 100 patients who underwent surgery for CRC and were admitted from February 2018 to February 2024,collected the general data of bone metastasis,and collected the pathological characteristics of patients with bone metastasis.Next,we divided them into groups with and without bone metastasis(Bone metastases group,n=44;no bone metastases group,n=56),compared the clinical data of the two groups,and analyzed the risk factors of bone metastasis using logistic regression analysis.RESULTS Among the 100 patients,the mean age was 54.33±8.45 years,and most were male(54.55%).The proportion of patients with lytic bone changes was 43.18%.The most common location of combined bone metastasis was the pelvis,whereas only 5 patients had limb transfer.There was a higher incidence of lung than of pancreatic or liver metastases.Regression analysis showed that the primary location of the cancer was rectal cancer.Lymph node involvement,lung metastasis,and no postoperative chemotherapy were the risk factors for postoperative bone metastasis in patients who underwent surgery for CRC(P<0.05).CONCLUSION Rectal cancer,lymph node involvement,complicated pulmonary metastasis,and no postoperative chemotherapy treatment can help predict high risk of bone metastasis in CRC.展开更多
Gastrointestinal stromal tumors(GISTs)feature a unique tumor microenvironment(TME)with abundant immune infiltrates,including CD8+T cells and tertiary lymphoid structures,alongside significant immune escape mechanisms ...Gastrointestinal stromal tumors(GISTs)feature a unique tumor microenvironment(TME)with abundant immune infiltrates,including CD8+T cells and tertiary lymphoid structures,alongside significant immune escape mechanisms such as indoleamine 2,3-dioxygenase(IDO)overexpression,MHC I loss,and regulatory T-cell activity.These factors contribute to an immunosuppressive TME,limiting the effectiveness of immune responses.Recent proteomic and immune profiling has identified distinct immune clusters,ranging from highly infiltrated"hot"tumors to immune-desert"cold"tumors,offering new insights into immune heterogeneity and prognostic stratification.While tyrosine kinase inhibitors(TKIs)like imatinib have shown immunomodulatory effects,clinical trials with immune checkpoint inhibitors(ICIs)alone or in combination have yielded modest outcomes.This editorial examines the immunologic landscape of GIST,explores the interplay between ICIs and TKIs,and highlights emerging therapeutic strategies such as IDO inhibition,bispecific antibodies,and patient selection based on TME characteristics.These insights pave the way for more effective immunotherapy approaches in GIST.展开更多
Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions t...Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow.While intermediate–HR(IHR)individuals remain hemodynamically stable,they face a significant chance of clinical decline and thus need close and continuous observation.Effective risk assessment,mortality prediction,and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies.Catheter-directed therapy(CDT)has emerged as a promising option,offering the ability to alleviate clot burden and reduce strain on the right ventricle,all while posing a lower risk of major bleeding compared to systemic thrombolysis.The growing adoption of CDT reflects its increasing relevance in PE treatment,especially when managed by specialized PE response teams that ensure individualized,multidisciplinary care.As clinical practices evolve,further studies and robust clinical trials are necessary to clearly define CDT’s role in lowering the risks of complications and death among IHR PE patients.This article explores the current understanding and future direction of managing PE,focusing in the role of catheter-based interventions.展开更多
A broad spectrum of liver disorders and their associated complications most notably hepatic encephalopathy impact millions of individuals worldwide,including conditions such as non-alcoholic fatty liver disease,alcoho...A broad spectrum of liver disorders and their associated complications most notably hepatic encephalopathy impact millions of individuals worldwide,including conditions such as non-alcoholic fatty liver disease,alcoholic liver injury,viral hepatitis,hepatic fibrosis,cirrhosis,and hepatocellular carcinoma.The underlying pathogenic mechanisms are multifactorial,encompassing oxidative stress,inflammatory cascades,mitochondrial impairment,and disturbances in immune homeostasis.Hepatic encephalopathy patients experience cognitive impairment,mood disturbances,and psychomotor dysfunction,significantly reducing quality of life through mechanisms including oxidative stress,neuroinflammation,and neurotransmitter imbalances.The nuclear factor erythroid 2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)signaling pathway serves as a critical antioxidative defense mechanism in these conditions.Nrf2 regulates the expression of protective enzymes,while HO-1 exerts anti-inflammatory,anti-apoptotic,and antifibrotic effects through heme degradation products.Natural herbal monomers as Nrf2 activators offer advantages of low toxicity,multi-target actions,and extensive traditional use.Various herbal monomers demonstrate specific effects against different liver diseases:In fatty liver,baicalin alleviates lipid accumulation and inflammation;In alcoholic liver disease,curcumin enhances Nrf2 activity reducing oxidative damage;In drug-induced liver injury,dihydromyricetin mitigates oxidative stress;In viral hepatitis,andrographolide inhibits hepatitis C virus replication;In liver fibrosis,multiple compounds inhibit stellate cell activation.These natural compounds simultaneously alleviate hepatic dysfunction and neuropsychiatric symptoms by modulating the Nrf2/HO-1 pathway,though clinical application still faces challenges such as low bioavailability,requiring further research.展开更多
OBJECTIVE:To evaluate the effects of external application of warm meridian medicated wine and polarized light therapy combined with acupuncture on pain management following vertebroplasty. METHODS:A total of 120 patie...OBJECTIVE:To evaluate the effects of external application of warm meridian medicated wine and polarized light therapy combined with acupuncture on pain management following vertebroplasty. METHODS:A total of 120 patients with osteoporotic vertebral compression fractures treated by vertebroplasty at our hospital were divided into four groups. The control group received non-steroidal anti-inflammatory drugs, the Treatment Group Ⅰ received acupuncture alone, Treatment Group Ⅱ was treated with medicated wine for warming meridians alongside polarized light physiotherapy, and Treatment Group Ⅲ received a combination of medicated wine for warming meridians, polarized light therapy, and acupuncture. The clinical efficacy, pain thresholds at various time points, temperature pain threshold, electric pain threshold, quality of life, sleep quality index, lumbar dysfunction index, visual analog scale(VAS) scores, and incidence of adverse reactions were compared and analyzed across the four groups. RESULTS:The total clinical effective rate in Treatment Group Ⅲ was significantly higher than that in the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ(P < 0.05). At 24 and 72 h post-treatment, the VAS scores, temperature pain thresholds, and electric pain thresholds in Treatment Group Ⅲ were significantly lower than those in the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ(P < 0.05). Additionally, quality-of-life scores in Treatment Group Ⅲ were markedly higher compared to the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ, while the Pittsburgh Sleep Quality Index scores, Oswestry Disability Index scores, and incidence of adverse reactions in Treatment Group Ⅲ were significantly lower than in the other groups(P < 0.05). CONCLUSION:The external application of warm meridian medicated wine and polarized light therapy combined with acupuncture significantly reduces postoperative pain following vertebroplasty, enhances lumbar function, and improves both sleep quality and overall quality of life for patients. This approach is recommended for clinical application.展开更多
BACKGROUND Retroperitoneal liposarcoma(RPLS)is a rare malignant tumor initiated in adipocytes.It is discovered only when the tumor is large because of its deep anatomical location and insidious onset.Giant RPLS with a...BACKGROUND Retroperitoneal liposarcoma(RPLS)is a rare malignant tumor initiated in adipocytes.It is discovered only when the tumor is large because of its deep anatomical location and insidious onset.Giant RPLS with a diameter exceeding 30 cm is extremely rare.Its diagnosis and treatment present extremely great challenges.CASE SUMMARY The patient,a 62-year-old woman,presented to the hospital complaining of abdominal distension for more than six months.Imaging examination revealed a large retroperitoneal mass.Finally,the patient was diagnosed with giant RPLS.The tumor occupied the entire abdominal cavity,severely compressed the abdominal organs,and adhered tightly to the bilateral ureters.After careful preoperative preparation(including three-dimensional visualization and bilateral ureteral stent implantation),we performed resection of the large retroperitoneal mass.The tumor was completely removed and consisted of multiple masses,with a total weight of 17 kg and the largest mass size of 35 cm×28 cm×14 cm.Postoperative pathological results revealed that the mass was a well-differentiated liposarcoma.The patient recovered well after surgery,and there was no sign of recurrence after 2 months of follow-up.CONCLUSION Surgical resection is the only radical treatment for giant RPLS.Preoperative preparation is essential,and three-dimensional visualization reconstruction is helpful for the formulation of surgical plans.Postoperative radiotherapy and neoadjuvant therapy can be reasonably selected,but whether they can reduce the recurrence rate is still controversial.展开更多
BACKGROUND Advanced hepatocellular carcinoma(HCC)with ascites(AS)lacks reliable biomarkers for predicting treatment outcomes.The combined prognostic value of the systemic immune-inflammation index(SII)and prognostic n...BACKGROUND Advanced hepatocellular carcinoma(HCC)with ascites(AS)lacks reliable biomarkers for predicting treatment outcomes.The combined prognostic value of the systemic immune-inflammation index(SII)and prognostic nutritional index(PNI)remains underexplored for novel therapies.AIM To evaluate the clinical efficacy of combining intraperitoneal compound Kushen injection(CKI)with immunotherapy in patients with advanced HCC using a scoring system that combines SII and PNI.METHODS SII and PNI were calculated prior to treatment from peripheral blood samples,and critical values were determined by receiver operating characteristic analysis.SII-PNI scores were categorized as follows:2,high SII(≥558.5)and low PNI(≤33.58);1,high SII or low PNI;and 0,neither high SII nor low PNI.After immunotherapy combined with CKI,patients with advanced HCC were evaluated using the SII-PNI scoring criteria.RESULTS The SII-PNI score was significantly lower in patients without concomitant AS than in those with AS(P=0.017).Progression-free survival was significantly longer in patients with a low SII-PNI score than in those with a high SII-PNI score(P=0.0125).Multivariate analysis identified the SII-PNI score as an independent prognostic factor for 2-year overall survival in patients with advanced HCC and AS(P<0.001).CONCLUSION The pretreatment SII-PNI score is an important indicator of treatment sensitivity for patients with advanced HCC receiving intraperitoneal CKI.It also represents a crucial basis for evaluating treatment efficacy and prognosis,aiding in the identification of high-risk groups and prognosis prediction.展开更多
文摘Post-esophagectomy anastomotic leak(AL)is a severe complication following esophagectomy,contributing to increased morbidity,prolonged hospitalization,and a significant risk of mortality.Endoscopic vacuum-assisted closure(EndoVac)has emerged as a promising first-line treatment,offering a highly effective approach for managing post-esophagectomy AL.EndoVac therapy utilizes continuous negative pressure within the esophageal lumen or mediastinal cavity,promoting granulation tissue formation,accelerating wound healing,and enhancing AL closure rates.Compared to stenting,EndoVac provides distinct advantages,including superior adaptability to varying leak sizes and locations,enhanced secretion drainage,and lower rates of reintervention.Clinical studies have demonstrated higher success rates,decreased post-intervention complications,and shorter hospital stays.Despite its advantages,challenges persist in patient selection,procedural expertise,and accessibility.EndoVac application requires experienced endoscopic teams and multidisciplinary expertise,which is best achieved in high-volume centers with specialized care.Variability in EndoVac protocols necessitate further refinement and standardization to optimize treatment outcomes.The integration of EndoVac into standardized treatment guidelines holds promise for improving patient outcomes and redefining the management approach for this challenging postoperative complication.
基金supported by Applied Basic Research Joint Fund Project of Yunnan Province,No.202301AY070001-200Middle-aged Academic and Technical Training Project for High-Level Talents,No.202105AC160065+1 种基金Yunnan Clinical Medical Center for Neurological and Cardiovascular Diseases,No.YWLCYXZX2023300077Key Clinical Specialty of Neurology in Yunnan Province,No.300064(all to CL)。
文摘Research into lactylation modifications across various target organs in both health and disease has gained significant attention.Many essential life processes and the onset of diseases are not only related to protein abundance but are also primarily regulated by various post-translational protein modifications.Lactate,once considered merely a byproduct of anaerobic metabolism,has emerged as a crucial energy substrate and signaling molecule involved in both physiological and pathological processes within the nervous system.Furthermore,recent studies have emphasized the significant role of lactate in numerous neurological diseases,including Alzheimer's disease,Parkinson's disease,acute cerebral ischemic stroke,multiple sclerosis,Huntington's disease,and myasthenia gravis.The purpose of this review is to synthesize the current research on lactate and lactylation modifications in neurological diseases,aiming to clarify their mechanisms of action and identify potential therapeutic targets.As such,this work provides an overview of the metabolic regulatory roles of lactate in various disorders,emphasizing its involvement in the regulation of brain function.Additionally,the specific mechanisms of brain lactate metabolism are discussed,suggesting the unique roles of lactate in modulating brain function.As a critical aspect of lactate function,lactylation modifications,including both histone and non-histone lactylation,are explored,with an emphasis on recent advancements in identifying the key regulatory enzymes of such modifications,such as lactylation writers and erasers.The effects and specific mechanisms of abnormal lactate metabolism in diverse neurological diseases are summarized,revealing that lactate acts as a signaling molecule in the regulation of brain functions and that abnormal lactate metabolism is implicated in the progression of various neurological disorders.Future research should focus on further elucidating the molecular mechanisms underlying lactate and lactylation modifications and exploring their potential as therapeutic targets for neurological diseases.
文摘The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by trauma,delayed presentation,and corneal perforation—PK restores globe integrity and provides limited visual recovery.However,its application is constrained by graft-related complications and donor shortages,particularly in low-resource settings.These limitations highlight the need for earlier,globe-sparing strategies to prevent progression and reduce surgical demand.Photoactivated chromophore for infectious keratitis-corneal collagen cross-linking(PACK-CXL)has emerged as a promising adjunct or alternative.With both antimicrobial and tissue-stabilizing effects,PACK-CXL may control infection and preserve corneal structure in earlier stages.A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes.Further studies are needed to define their best use in practice.
文摘Arthrodesis of the first metatarsophalangeal(MTP)joint has been established as the“gold standard”for the treatment of several first ray disorders,due to its perceived efficacy and the consistently reported good results in the literature.Arthrodesis is a commonly performed procedure for the treatment of end stage arthritis,rheumatoid arthritis with severe deformity,selected cases of severe hallux valgus(with or without signs of degenerative joint disease),as well as a salvage procedure after failed previous operation of the first ray.The goals of a successful 1st MTP arthrodesis are pain alleviation and deformity correction in order to restore a comfortable gait pattern and to improve shoe wear.Several techniques have been reported with several proposals regarding the preparation of the articular surfaces and the method of definitive fixation.As with any given surgical procedure,various complications may occur after arthrodesis of the 1st MTP joint,namely delayed union,nonunion,malunion,irritating hardware,etc.
文摘Pancreatic ductal adenocarcinoma(PDAC)is nowadays the fourth leading cause of cancer-related death worldwide,but according to recent estimations it will become the second leading cause of cancer-related deaths in the USA up to 2030,following lung cancer.The implementation of neoadjuvant chemotherapy during recent years led to an increase of overall survival at 35 months in PDAC after R0 resection[1].However,pancreatic cancer has a particularity that makes it a real challenge for clinicians:only 20%of patients are diagnosed early enough to have a resectable pancreatic cancer,whereas 40%of patients present with locally advanced or non-resectable disease,while the rest present with distant metastases[2].Systemic chemotherapy plays the main role in metastatic PDAC treatment:polychemotherapy regimens such as FOLFIRINOX(folinic acid,5-fluorouracil,irinotecan and oxaliplatin)or combination of gemcitabine/nab-paclitaxel seemed to improve median overall survival from 6.8 to 11.1 months and 6.7 to 8.5 months,respectively[3].
文摘Dear Editor,Fungal keratitis is a serious and potentially sightthreatening infection that poses a global health concern,with higher incidence rates reported in low-income countries and regions with tropical climates[1-3].Risk factors for fungal keratitis include trauma with vegetative matter,contact lens wear,history of ocular surgery,chronic topical steroid use,low socioeconomic status and tropical climate[1-2].Fungi have the propensity to penetrate deep into the corneal stroma,making the infection difficult to treat with topical antifungal agents alone.Complications such as corneal perforation and endophthalmitis can arise in severe cases,making early identification of the causative fungal pathogen of utmost importance[4-5].Moreover,obtaining susceptibilities to the available antifungal agents can be sight and eye saving[5].
文摘Effective communication and collaboration among healthcare professionals are crucial for delivering high-quality patient care.Interdepartmental miscommunication poses a significant challenge to healthcare systems,potentially undermining the quality of healthcare services provided.In the same manner,communication barriers between referring physicians and radiologists can specifically affect radiology services and patient outcomes.This article attempts to put the spotlight on the ever-present chronic challenges of this issue and prompt readers to recognize the relevant potential pitfalls in their daily clinical practice.Practical solutions are explored and proposed,which should be tailored to the specific needs and issues that each individual institution may face.
文摘Diabetes mellitus and atrial fibrillation(AF)are two global epidemics that frequently coexist,with diabetes mellitus contributing to both an increased risk of new-onset AF and a worse prognosis.Pathophysiological mechanisms underlying this relationship include chronic inflammation,oxidative stress,atrial remodeling,autonomic dysfunction,advanced glycation end-products and epicardial adiposity.Management remains challenging;however,recent advances offer promise,including guideline-directed anticoagulation,tailored rate and rhythm control,and particularly,novel antidiabetic therapies,such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists,may improve AF outcomes.A comprehensive,individualized approach is essential to mitigate morbidity and mortality in this high-risk population.
文摘While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal management remain lacking.Most esophageal GISTs are surgically managed with enucleation,while esophagectomy is reserved for larger tumors.Recent advances in endoscopic techniques,such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection(ER),have allowed for endoscopic removal of submucosal esophageal lesions,including GISTs.Xu et al reported on the clinical and on-cological outcomes of 32 patients with esophageal GISTs treated with ER.The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival.However,it primarily focused on small,inci-dentally detected GISTs,with 75%of cases classified as very low or low risk according to the National Institutes of Health criteria.The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus.In this editorial,we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches.We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.
基金Supported by the National Key Research and Development Program of China(2023YFC3503704)the Harbin Municipal Science and Technology Program(Self-funded Project,022ZCZJNS070).
文摘Alzheimer’s disease(AD)represents a prototypical neurodegenerative disorder with a multifactorial pathogenesis encompassing amyloid-β(Aβ)deposition,tau protein hyperphosphorylation,and chronic neuroinflammation.Recent advances in proteomic profiling have identified significant dysregulation in astrocytic and microglial metabolic pathways in AD pathogenesis,establishing mechanistic links between metabolic dyshomeostasis and neuroimmune crosstalk.Accumulating evidence indicates that acupuncture has gained prominence as a non-pharmacological therapeutic modality for AD management,owing to its multimodal regulatory effects on neuroinflammatory cascades,metabolic recalibration,and immune network stabilization.This study aims to elucidate the molecular mechanisms through which acupuncture exerts its neuroprotective effects,focusing on three interconnected axes:immunometabolic reprogramming in glial cells(particularly microglial bioenergetic adaptation),gut microbiota-derived metabolite signaling(including short-chain fatty acid-mediated pathways),and neuro‐immune‐metabolic interplay.We present a novel therapeutic framework highlighting acupuncture-mediated immunometabolic modulation,thereby providing a mechanistic foundation for developing targeted therapeutic strategies in AD management.
文摘The Ilizarov apparatus was designed by its author 75 years ago and addresses a wide range of orthopedic conditions.Its classical assemblies are still self-sufficient and versatile.However,certain clinical scenarios require a more specialized approach,and some groups of patients may benefit from customized Ilizarov constructs.Engineering science has designed various external fixators for orthopedic purposes,and some of those have become the gold standard for specific clinical tasks.We aimed to determine the current state and novel modifications of specialized external fixators for specific clinical situations which are based on the principles of the Ilizarov method.They are half-pin-based fixators for temporal fracture fixation,ring or hybrid devices for gradual deformity correction,and compression-distraction devices tailored for definite limb segments.Gradual correction of deformities can be achieved with external hexapods incorporating universal reduction units.Alternatively,external fixators with special connection mechanisms are able to provide independent movement of the rings in six degrees of freedom.Deformity correction can be performed with combined or sequential use of external and internal fixators.Special devices were developed for moving the split fragment for revascularization of the tibia.The units of external frames on the foot were modified to consider its complex anatomy and the clinical needs ranging from correction of multi-plane deformities,joint arthrodesis to distraction arthroplasty.Mini-fixators are compact external fixators for small bones of the hand and foot.The varieties of external fixators based on the Ilizarov principles have been designed to fulfill an ultimate goal of improving treatment outcomes.
文摘Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.
基金supported by the First Department of Cardiology,School of Medicine in Katowice,Medical University of Silesia,Katowice,Poland.
文摘Background Delirium is a form of acute brain dysfunction and geriatric patients are particularly vulnerable to this health problem.The aim of the study was to assess the incidence of delirium and determine the risk factors for delirium in patients≥60 years of age hospitalized due to acute myocardial infarction(AMI).Methods The study included 405 consecutive patients(mean age:73.1±8.5,males:61%)hospitalized due to AMI divided and characterized according to the in-hospital delirium presence.Results Of 405 patients,57(14%,mean age:80.9±7.3,males:58%)experienced delirium.Patients with delirium were older(80.9±7.3 vs.71.82±8.1 years),all of them presented multimorbidity,they more frequently used polypharmacy(96.5 vs.30.2%)and their hospitalization was longer(8.0±1.4 vs.4.6±1.0 days)as compared to the patients without delirium.Patients with delirium more frequently experience periprocedural complications as well as the in-hospital reversible problems:fever(40.4 vs.0.9%),infections(78.9 vs.3.7%),pulmonary oedema(73.7 vs.0.6%),hypoxemia(91.1 vs.98.3%),urinary catheter(96.5 vs.17.2%),dehydration(89.5 vs.6.6%),and insomnia(71.9 vs.0.3%)compared to patients without delirium(P<0.001 for all).Valvular heart disease(OR=4.78;95%CI:1.10-2.70;P<0.001,pulmonary oedema(OR=66.79;95%CI:12.04-370.34,P<0.001),and dehydration(OR=37.26;95%CI:10.50-132.27,P<0.001)were risk factors for delirium occurrence.Conclusions The in-hospital course of AMI is complicated by delirium occurrence in 14%of patients≥60 years old.Recognizing and modification of potential,reversible risk factors associated with AMI can reduce the risk of delirium.
文摘BACKGROUND Colorectal cancer(CRC)is a common malignant tumor in the digestive system,whose main treatment comprises surgical resection,radiotherapy and chemotherapy,and targeted drug therapy.At present,the radical resection of CRC is the main way of achieving an early cure.AIM To investigate the logistic regression analysis of bone metastasis after CRC surgery and related influencing factors.METHODS We selected 100 patients who underwent surgery for CRC and were admitted from February 2018 to February 2024,collected the general data of bone metastasis,and collected the pathological characteristics of patients with bone metastasis.Next,we divided them into groups with and without bone metastasis(Bone metastases group,n=44;no bone metastases group,n=56),compared the clinical data of the two groups,and analyzed the risk factors of bone metastasis using logistic regression analysis.RESULTS Among the 100 patients,the mean age was 54.33±8.45 years,and most were male(54.55%).The proportion of patients with lytic bone changes was 43.18%.The most common location of combined bone metastasis was the pelvis,whereas only 5 patients had limb transfer.There was a higher incidence of lung than of pancreatic or liver metastases.Regression analysis showed that the primary location of the cancer was rectal cancer.Lymph node involvement,lung metastasis,and no postoperative chemotherapy were the risk factors for postoperative bone metastasis in patients who underwent surgery for CRC(P<0.05).CONCLUSION Rectal cancer,lymph node involvement,complicated pulmonary metastasis,and no postoperative chemotherapy treatment can help predict high risk of bone metastasis in CRC.
文摘Gastrointestinal stromal tumors(GISTs)feature a unique tumor microenvironment(TME)with abundant immune infiltrates,including CD8+T cells and tertiary lymphoid structures,alongside significant immune escape mechanisms such as indoleamine 2,3-dioxygenase(IDO)overexpression,MHC I loss,and regulatory T-cell activity.These factors contribute to an immunosuppressive TME,limiting the effectiveness of immune responses.Recent proteomic and immune profiling has identified distinct immune clusters,ranging from highly infiltrated"hot"tumors to immune-desert"cold"tumors,offering new insights into immune heterogeneity and prognostic stratification.While tyrosine kinase inhibitors(TKIs)like imatinib have shown immunomodulatory effects,clinical trials with immune checkpoint inhibitors(ICIs)alone or in combination have yielded modest outcomes.This editorial examines the immunologic landscape of GIST,explores the interplay between ICIs and TKIs,and highlights emerging therapeutic strategies such as IDO inhibition,bispecific antibodies,and patient selection based on TME characteristics.These insights pave the way for more effective immunotherapy approaches in GIST.
文摘Pulmonary embolism(PE)ranks as the third leading cause of cardiovascularrelated deaths in Western nations.Patients classified as high-risk(HR)-those exhibiting hemodynamic instability-require immediate interventions to restore blood flow.While intermediate–HR(IHR)individuals remain hemodynamically stable,they face a significant chance of clinical decline and thus need close and continuous observation.Effective risk assessment,mortality prediction,and therapeutic decision-making in these patients rely on a combination of clinical evaluation and imaging studies.Catheter-directed therapy(CDT)has emerged as a promising option,offering the ability to alleviate clot burden and reduce strain on the right ventricle,all while posing a lower risk of major bleeding compared to systemic thrombolysis.The growing adoption of CDT reflects its increasing relevance in PE treatment,especially when managed by specialized PE response teams that ensure individualized,multidisciplinary care.As clinical practices evolve,further studies and robust clinical trials are necessary to clearly define CDT’s role in lowering the risks of complications and death among IHR PE patients.This article explores the current understanding and future direction of managing PE,focusing in the role of catheter-based interventions.
文摘OBJECTIVE:To evaluate the effects of external application of warm meridian medicated wine and polarized light therapy combined with acupuncture on pain management following vertebroplasty. METHODS:A total of 120 patients with osteoporotic vertebral compression fractures treated by vertebroplasty at our hospital were divided into four groups. The control group received non-steroidal anti-inflammatory drugs, the Treatment Group Ⅰ received acupuncture alone, Treatment Group Ⅱ was treated with medicated wine for warming meridians alongside polarized light physiotherapy, and Treatment Group Ⅲ received a combination of medicated wine for warming meridians, polarized light therapy, and acupuncture. The clinical efficacy, pain thresholds at various time points, temperature pain threshold, electric pain threshold, quality of life, sleep quality index, lumbar dysfunction index, visual analog scale(VAS) scores, and incidence of adverse reactions were compared and analyzed across the four groups. RESULTS:The total clinical effective rate in Treatment Group Ⅲ was significantly higher than that in the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ(P < 0.05). At 24 and 72 h post-treatment, the VAS scores, temperature pain thresholds, and electric pain thresholds in Treatment Group Ⅲ were significantly lower than those in the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ(P < 0.05). Additionally, quality-of-life scores in Treatment Group Ⅲ were markedly higher compared to the control group, Treatment Group Ⅰ, and Treatment Group Ⅱ, while the Pittsburgh Sleep Quality Index scores, Oswestry Disability Index scores, and incidence of adverse reactions in Treatment Group Ⅲ were significantly lower than in the other groups(P < 0.05). CONCLUSION:The external application of warm meridian medicated wine and polarized light therapy combined with acupuncture significantly reduces postoperative pain following vertebroplasty, enhances lumbar function, and improves both sleep quality and overall quality of life for patients. This approach is recommended for clinical application.
文摘BACKGROUND Retroperitoneal liposarcoma(RPLS)is a rare malignant tumor initiated in adipocytes.It is discovered only when the tumor is large because of its deep anatomical location and insidious onset.Giant RPLS with a diameter exceeding 30 cm is extremely rare.Its diagnosis and treatment present extremely great challenges.CASE SUMMARY The patient,a 62-year-old woman,presented to the hospital complaining of abdominal distension for more than six months.Imaging examination revealed a large retroperitoneal mass.Finally,the patient was diagnosed with giant RPLS.The tumor occupied the entire abdominal cavity,severely compressed the abdominal organs,and adhered tightly to the bilateral ureters.After careful preoperative preparation(including three-dimensional visualization and bilateral ureteral stent implantation),we performed resection of the large retroperitoneal mass.The tumor was completely removed and consisted of multiple masses,with a total weight of 17 kg and the largest mass size of 35 cm×28 cm×14 cm.Postoperative pathological results revealed that the mass was a well-differentiated liposarcoma.The patient recovered well after surgery,and there was no sign of recurrence after 2 months of follow-up.CONCLUSION Surgical resection is the only radical treatment for giant RPLS.Preoperative preparation is essential,and three-dimensional visualization reconstruction is helpful for the formulation of surgical plans.Postoperative radiotherapy and neoadjuvant therapy can be reasonably selected,but whether they can reduce the recurrence rate is still controversial.
基金Supported by the 2022 Anhui Provincial Health Commission Scientific Research Project,No.AHWJ2022b053the 2022 Scientific Research Project of Anhui University of Chinese Medicine,No.2022AH050415+1 种基金the Horizontal Project,No.2022HZ009the 2024 Open Project of the Key Laboratory of Xin’an Medicine,Ministry of Education,No.2024xayx02.
文摘BACKGROUND Advanced hepatocellular carcinoma(HCC)with ascites(AS)lacks reliable biomarkers for predicting treatment outcomes.The combined prognostic value of the systemic immune-inflammation index(SII)and prognostic nutritional index(PNI)remains underexplored for novel therapies.AIM To evaluate the clinical efficacy of combining intraperitoneal compound Kushen injection(CKI)with immunotherapy in patients with advanced HCC using a scoring system that combines SII and PNI.METHODS SII and PNI were calculated prior to treatment from peripheral blood samples,and critical values were determined by receiver operating characteristic analysis.SII-PNI scores were categorized as follows:2,high SII(≥558.5)and low PNI(≤33.58);1,high SII or low PNI;and 0,neither high SII nor low PNI.After immunotherapy combined with CKI,patients with advanced HCC were evaluated using the SII-PNI scoring criteria.RESULTS The SII-PNI score was significantly lower in patients without concomitant AS than in those with AS(P=0.017).Progression-free survival was significantly longer in patients with a low SII-PNI score than in those with a high SII-PNI score(P=0.0125).Multivariate analysis identified the SII-PNI score as an independent prognostic factor for 2-year overall survival in patients with advanced HCC and AS(P<0.001).CONCLUSION The pretreatment SII-PNI score is an important indicator of treatment sensitivity for patients with advanced HCC receiving intraperitoneal CKI.It also represents a crucial basis for evaluating treatment efficacy and prognosis,aiding in the identification of high-risk groups and prognosis prediction.
