BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in ...BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.展开更多
Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation sys...Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation systems face challenges such as high equipment costs,complex operation,bulky size,and insufficient anti-interference performance.To address these limitations,our study developed and validated a novel portable electromagnetic neuronavigation system designed to improve the precision,accessibility,and clinical applicability of electromagnetic navigation technology in cranial surgery.Methods The software and hardware architecture of a portable neural magnetic navigation system was designed.The key technologies of the system were analysed,including electromagnetic positioning algorithms,miniaturized sensor design,optimization of electromagnetic positioning and navigation algorithms,anti-interference signal processing methods,and fast three-dimensional reconstruction algorithms.A prototype was developed,and its accuracy was tested.Finally,a preliminary clinical application evaluation was conducted.Results This study successfully developed a comprehensive portable electromagnetic neuronavigation system capable of achieving preoperative planning,intraoperative real-time positioning and navigation,and postoperative evaluation of navigation outcomes.Through rigorous collaborative testing of the system’s software and hardware,the accuracy of electromagnetic neuronavigation has been validated to meet clinical requirements.Conclusions This study developed a portable neuroelectromagnetic navigation system and validated its effectiveness and safety through rigorous model testing and preliminary clinical applications.The system is characterized by its compact size,high precision,excellent portability,and user-friendly operation,making it highly valuable for promoting navigation technology and advancing the precision and minimally invasive nature of neurosurgical procedures.展开更多
BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To ...BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.展开更多
BACKGROUND In recent years,the global prevalence of gastric cancer(GC)has witnessed a progressive decrease,accompanied by a step-growth in the incidence of gastric signet ring cell carcinoma(GSRCC).As precision medici...BACKGROUND In recent years,the global prevalence of gastric cancer(GC)has witnessed a progressive decrease,accompanied by a step-growth in the incidence of gastric signet ring cell carcinoma(GSRCC).As precision medicine concepts progress,GSRCC,a distinct sub-type of GC,has drawn considerable attention from researchers.However,there still persist some controversies regarding the associated research findings.AIM To summarize the current obstacles and potential future directions for research on GSRCC.METHODS To begin with,all literature related to GSRCC published from January 1,2004 to December 31,2023 was subjected to bibliometric analysis in this article.Additionally,this paper analyzed the research data using CiteSpace,GraphPad Prism v8.0.2,and VOSviewer,which was obtained from the Web of Science Core Collection database.The analysis results were visually represented.RESULTS This study provided a comprehensive overview of the statistical characteristics of the 995 English articles related to GSRCC,including cited references,authors,journals,countries,institutions,and keywords.The popular keywords and clusters contain"prognosis","survival","expression","histology",and"chemotherapy".CONCLUSION The prognosis,precise definition and classification,as well as chemoresistance of GSRCC,continue to be crucial areas of ongoing research,whose directions are closely tied to advancements in molecular biology research on GSRCC.展开更多
This letter discusses the findings of Pang et al retrospective study on omental patch repair as a balanced treatment for gastric ulcer perforation.We acknowledge its clinical value while highlighting a critical limita...This letter discusses the findings of Pang et al retrospective study on omental patch repair as a balanced treatment for gastric ulcer perforation.We acknowledge its clinical value while highlighting a critical limitation:Conventional mechanical closure often results in fibrotic scarring and functional impairment across the mucosal,muscular,and neurovascular layers.To address this,we propose the innovative concept of“multi-layer repair”and present a proof-ofconcept three-dimensional bioprinted functional biopatch.This patch features a multilayer structure:An inner layer laden with gastric mucosal organoids and an outer layer containing primary gastric muscle cells,both integrated onto a wetadhesive electrospun membrane.Preliminary animal studies have yielded encouraging results,supporting its potential to promote functional restoration beyond mechanical sealing.展开更多
BACKGROUND Immunotherapy has surfaced as a promising therapeutic modality for gastric cancer(GC).A comprehensive review of advancements,current status,and research trends in GC immunotherapy is essential to inform fut...BACKGROUND Immunotherapy has surfaced as a promising therapeutic modality for gastric cancer(GC).A comprehensive review of advancements,current status,and research trends in GC immunotherapy is essential to inform future investigative efforts.AIM To delineate the trends,advancements,and focal points in immunotherapy for GC.METHODS We performed a bibliometric analysis of 2906 articles in English concerning GC immunotherapy published from 2000 to December 20,2023,indexed in the Web of Science Core Collection.Data analysis and visualization were facilitated by CiteSpace(6.1.6R),VOSviewer v.1.6.17,and GraphPad Prism v8.0.2.RESULTS There has been an increase in the annual publication rate of GC immunotherapy research.China leads in publication volume,while the United States demonstrates the highest citation impact.Fudan University is notable for its citation frequency and publication output.Co-citation analysis and keyword frequency revealed and highlighted a focus on GC prognosis,the tumor microenvironment(TME),and integrative immunotherapy with targeted therapy.Emerging research areas include gastroesophageal junction cancer,adoptive immunotherapy,and the role of Treg cell in immunotherapy.CONCLUSION GC immunotherapy research is an expanding field attracting considerable scientific interest.With the clinical adoption of immunotherapy in GC,the primary goals are to enhance treatment efficacy and patient outcomes.Unlike hematological malignancies,GC's solid TME presents distinct immunological challenges that may attenuate the cytotoxic effects of immune cells on cancer cells.For instance,although CAR-T therapy is effective in hematological malignancies,it has underperformed in GC settings.Current research is centered on overcoming immunosuppression within the TME,with a focus on combinations of targeted therapy,adoptive immunotherapy,Treg cell dynamics,and precise prognosis prediction in immunotherapy.Additionally,immunotherapy's role in treating gastroesophageal junction cancer has become a novel research focus.展开更多
The gut microbiome is closely associated with human health and the development of diseases. Isolating, characterizing, and identifying gut microbes are crucial for research on the gut microbiome and essential for adva...The gut microbiome is closely associated with human health and the development of diseases. Isolating, characterizing, and identifying gut microbes are crucial for research on the gut microbiome and essential for advancing our understanding and utilization of it. Although culture-independent approaches have been developed, a pure culture is required for in-depth analysis of disease mechanisms and the development of biotherapy strategies. Currently, microbiome research faces the challenge of expanding the existing database of culturable gut microbiota and rapidly isolating target microorganisms. This review examines the advancements in gut microbe isolation and cultivation techniques, such as culturomics, droplet microfluidics, phenotypic and genomics selection, and membrane diffusion. Furthermore, we evaluate the progress made in technology for identifying gut microbes considering both non-targeted and targeted strategies. The focus of future research in gut microbial culturomics is expected to be on high-throughput, automation, and integration. Advancements in this field may facilitate strain-level investigation into the mechanisms underlying diseases related to gut microbiota.展开更多
This article comprehensively reviews research progress in prostate cancer radiation therapy.It provides an overview of fundamental principles,encompassing the disease’s epidemiology,pathological mechanisms,and radiat...This article comprehensively reviews research progress in prostate cancer radiation therapy.It provides an overview of fundamental principles,encompassing the disease’s epidemiology,pathological mechanisms,and radiation sensitivity,alongside technological advancements.The clinical application,technological progress,and efficacy evaluation of moderate hypofractionated radiation therapy and ultra hypofractionated radiation therapy are discussed.Diagnostic and monitoring techniques specific to radiation therapy are analyzed,alongside prevailing controversies and challenges.Finally,the review outlines future prospects,including novel radiotherapy techniques,multidisciplinary collaboration trends,and the evolving role of radiation within comprehensive treatment.The findings demonstrate continuous technological and clinical evolution in prostate cancer radiotherapy,yet emphasize the need for further exploration to optimize treatments and improve patient survival and quality of life.展开更多
BACKGROUND Lynch syndrome(LS),an autosomal dominant genetic disorder,is distinguished by germline mutations in the DNA mismatch repair genes,including MLH1.These mutations confer an elevated risk for the development o...BACKGROUND Lynch syndrome(LS),an autosomal dominant genetic disorder,is distinguished by germline mutations in the DNA mismatch repair genes,including MLH1.These mutations confer an elevated risk for the development of colorectal cancer(CRC)and an array of other malignancies.Timely detection,facilitated by genetic profiling and stringent molecular surveillance,is crucial.It enables the implementation of customized therapeutic strategies,which have the potential to markedly enhance patient outcomes.Despite its significant public health impact,LS is frequently underdiagnosed,underscoring the necessity for increased vigilance and the adoption of precision medicine tactics.CASE SUMMARY This case presentation focuses on a 54-year-old male patient with a strong familial predisposition to colon cancer,who was identified to have LS-associated multiple colorectal neoplasms.Utilizing a comprehensive,multidisciplinary therapeutic strategy that encompassed precision medicine,immunotherapy with pembrolizumab,and stringent molecular residual disease monitoring,we effectively managed his advanced CRC.This tailored approach led to the achievement of sustained clinical remission exceeding 30 months,illustrating the promise of personalized treatment protocols in optimizing outcomes for individuals with LS and associated colorectal malignancies.CONCLUSION A synergistic,multidisciplinary approach is essential for managing LS-associated CRC,advocating for personalized care pathways in precision medicine.展开更多
Flavonoids,the key active compounds in Epimedii Folium,have both protective and toxic effects on the liver.Their hepatoprotective effects are associated with reducing lipid accumulation and oxidative stress,which cont...Flavonoids,the key active compounds in Epimedii Folium,have both protective and toxic effects on the liver.Their hepatoprotective effects are associated with reducing lipid accumulation and oxidative stress,which contribute to the management of various liver conditions.In contrast,the mechanisms driving Epimedii Folium-induced hepatotoxicity are less understood but likely involve oxidative stress and pyroptosis.Pharmacokinetic studies,especially on icaritin,indicate that it undergoes isopentenyl dehydrogenation,glycosylation,and glucuronidation in vivo,contributing to its pharmacological effects.However,intermediate metabolites of icaritin may interact with biomolecules,potentially leading to liver toxicity.This review offers a detailed examination of the dual effects of Epimedii Folium flavonoids on liver function,emphasizing recent discoveries in their hepatoprotective and hepatotoxic pathways.We also summarize and discuss the pharmacokinetics of these flavonoids,highlighting how their meta-bolism affects therapeutic efficacy and toxicity.Lastly,we propose strategies to mitigate liver injury,providing new perspectives on the safe use of Epimedii Folium.展开更多
Objective:Despite established associations between certain medications and urticaria,the risk profiles of most pharmaceutical agents remain poorly characterized.This investigation aimed to identify risk factors for me...Objective:Despite established associations between certain medications and urticaria,the risk profiles of most pharmaceutical agents remain poorly characterized.This investigation aimed to identify risk factors for medication-induced urticaria through comprehensive analysis of the FDA Adverse Event Reporting System(FAERS)database.Methods:We employed reporting odds ratios(ROR)to evaluate drug-urticaria associations using FAERS data spanning from Q12004 to Q32024.Analytical approaches included univariate screening,LASSO regression,and multivariate logistic regression to identify potential risk factors.Multiple comparison adjustments were implemented using the Bonferroni method.Results:The study identified 1807 pharmaceutical agents potentially associated with urticaria development.Univariate analysis categorized these agents into several therapeutic classes:antimicrobials(19/85),biologics(16/85),analgesics(8/85),dermatologicals(3/85),anti-rheumatic agents(4/85),hormonal preparations(3/85),antihypertensives(2/85),neuropsychiatric medications(2/85),uric acid-lowering drugs(2/85),multiple sclerosis therapies(2/85),and miscellaneous agents(17/85).Multivariate analysis identified three significant risk determinants:middle-aged individuals(36-53 years),female gender,and exposure to any of 82 specific medications.Conclusion:These evidence-based findings provide valuable insights for early clinical recognition of drug-induced urticaria and establish a foundation for subsequent mechanistic investigations into medication-related hypersensitivity reactions.展开更多
The durability of dental implant carrier coatings is of paramount importance for the expeditious and predictable osseointegration process.The present work is based on a bionic micro/nano hierarchy struc-ture,which con...The durability of dental implant carrier coatings is of paramount importance for the expeditious and predictable osseointegration process.The present work is based on a bionic micro/nano hierarchy struc-ture,which consists of titanium surface microstructures and their internal TiO2 nanotubes(TNTs)with drug-carrying capacity.This effectively increases the wear resistance of the drug-carrying coating on the titanium surface.In comparison to untextured samples,the wear volume and wear depth of the optimal texture group are markedly diminished,resulting in a significant enhancement of wear resistance.This improvement was primarily attributed to the smaller contact area of the microstructure.Concurrently,the microstructure serves to safeguard the TNTs from damage during friction.The hydrophilic biomimetic anti-wear micro/nano hierarchies demonstrated the capacity to promote MC3T3-E1 cell adhesion and pro-liferation,while also exhibiting no cytotoxic effects.Moreover,the micro/nano hierarchical structure can be directly applied to the surface of commercialized implants.In simulated clinical conditions,the im-plant was inserted into a fresh Bama porcine mandible,and the structure of the drug-loading coatings remained intact.This structure enhances the abrasion resistance of the drug coating while minimizing alterations to the original treatment process of the implant,which is of great significance in the clinical application of implant-loaded drug delivery.展开更多
Rare earth carbonates are essential precursors for the synthesis of oxide materials.In this study,we utilized in situ monitoring equipment to explore the alterations in the crystallization during the coprecipitation s...Rare earth carbonates are essential precursors for the synthesis of oxide materials.In this study,we utilized in situ monitoring equipment to explore the alterations in the crystallization during the coprecipitation synthesis of cerium carbonate.By controlling the crystallization pathway and in the absence of any te mplating agents,we successfully synthesized a unique sphe rical self-assembled cerium oxide particle(Ceria-S).The Ceria-S exhibits excellent polishing performance.The crystallization process of cerium carbonate at 50℃persists for roughly 50 min.During the initial stages of crystallization from 0 to t_(3),the precipitated particles are amorphous.This is followed by a plateau phase of crystal growth from t_(3)to t_(5).Subsequently,during the burst crystallization phase from t_(5)to t_(6),Ce_(2)(CO_(3))_(3)·6H_(2)O and Ce_(2)O(CO_(3))_(2)·nH2O are formed,exhibiting a rod-like crystal morphology.By rapidly drying the precipitated particles at 60℃for 10 min and calcining,Ceria-S is obtained.The Ceria-S,with an average diameter of 180 nm,is assembled from primary cerium oxide nanoparticles of approximately 15 nm.Owing to the self-assembly structure of cerium oxide spherical nanoparticles,they exhibit a significantly larger specific surface area,resulting in an elevated concentration of Ce^(3+)as high as 35.5%.The Ceria-S exhibits a polishing removal rate of 420 nm/min,effectively decreasing the surface roughness(S_(a))of K9 glass from 1.605 to 0.404 nm.展开更多
Exosomes derived from bone mesenchymal stem cells(BMSCs)show promising potential for treating bone defects.However,their clinical application is hindered by low yield and insufficient repair ability.Three-dimensional(...Exosomes derived from bone mesenchymal stem cells(BMSCs)show promising potential for treating bone defects.However,their clinical application is hindered by low yield and insufficient repair ability.Three-dimensional(3D)mechanical stimulation has been a well-known method for enhancing exosome secretion;however,the traditional stimulation process is always achieved by controlling the displacement of manipulators,which may induce uneven loading distribution and degradation of stimulation strength.Here,we propose a micro-stretching manipulator that automatically controls the stretching force applied to gelatin methacryloyl(GelMA)/hyaluronic acid methacryloyl(HAMA)hybrid hydrogel sheets containing BMSCs within an incubator.To ensure the structural stability of the sheets after long-term stretching,the mixing ratio between GelMA and HAMA was optimized according to the mechanical property response of the sheets to cyclical loading.Subsequently,force-controlled mechanical loading was applied to the BMSC-laden sheets to produce exosomes.Compared with displacement control,force-controlled loading provides a more stable force stimulation,thereby enhancing exosome secretion.Furthermore,continuously stimulated exosomes exhibited a stronger capacity for promoting osteogenic differentiation of BMSCs and facilitating the repair of bone defects in a rat model.These findings suggest that force-controlled loading of cell-laden hydrogels offers a novel approach for the production of BMSC-derived exosomes and their application in bone repair.展开更多
Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of...Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of patients with PDAC after R0 resection.Methods:PDAC patients from six centers in China undergoing R0 resection from 2015 to 2022 were included.Patients were categorized as long-term diabetes(LTD),NOD,or non-diabetes mellitus(non-DM)based on the timing of diagnosis relative to pancreatic resection.We compared the effects of diabetes status on perioperative and oncological outcomes of PDAC.Results:Of 1211 patients,602(49.7%),127(10.5%),and 482(39.8%)were in the non-DM,LTD,and NOD groups,respectively.Patients with NOD suffered from higher rates of fatty pancreas and postoperative pancreatic fistula(POPF)(both P<0.05).When compared with the non-DM group,the NOD group had worse median overall survival(OS)(24.6 vs.29.4 months,P<0.001)and recurrence-free survival(RFS)(13.3 vs.15.8 months,P<0.001);and the LTD group also had worse median OS(25.2 vs.29.4 months,P=0.041)and RFS(13.8 vs.15.8 months,P=0.007)compared with non-DM group.However,there were no significant differences in survival between the NOD and the LTD groups.Multivariate analysis indicated that NOD,LTD,largest tumor size,and poor tumor differentiation were independently associated with worse OS and RFS(all P<0.05).Conclusions:Patients with PDAC undergoing R0 resection experienced a higher probability of POPF in the presence of concurrent NOD.Long-term survival prognosis was worse in NOD or LTD patients than in non-DM patients.展开更多
BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improveme...BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography(ERCP).AIM To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable,balancing ERCP success and the risk of biliary strictures.METHODS We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022.The patients were divided into four groups based on the timing of ERCP:3 days,7 days,14 days,and 21 days.The primary outcome was clinical success,defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage,surgery,or death.The secondary outcome was incidence of biliary strictures.Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.RESULTS In a cohort of 448 consecutive patients diagnosed with BDLs,354 were excluded,leaving 94 patients who underwent ERCP.Clinical success was achieved in 84%of cases(79/94),with a median ERCP timing of 20 days(9.5-35.3 days).Biliary strictures were identified in 29(30.9%)patients.Performing ERCP within 3 weeks,compared to after 3 weeks,was associated with higher success rates[92.0%(46/50)vs 75.0%(33/44),P=0.032]and a lower incidence of biliary stricture incidence[18.0%(9/50)vs 45.5%(20/44),P=0.005].Subsequent multivariate analysis confirmed the association with higher success rates(odds ratio=4.168,P=0.045)and lower biliary stricture rates(odds ratio=0.256,P=0.007).CONCLUSION Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate.If patients with BDLs do not respond to conservative treatment,ERCP is suggested to be performed within 3 weeks.展开更多
Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shor...Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shortand long-term outcomes of RG and laparoscopic gastrectomy(LG)in the treatment of stage cT4a gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of patients with stage cT4a gastric cancer diagnosed and treated at eight high-volume tertiary teaching hospitals in China from 2016 to 2019.Propensity score matching(PSM)analysis and inverse probability of treatment weighting(IPTW)analysis was used to adjust for the imbalance in baseline characteristics.The primary research endpoint was the 3-year overall survival(OS)and disease-free survival(DFS).The secondary research endpoint was intraoperative outcomes and postoperative complications.Results:After IPTW and PSM adjustments,baseline characteristics between the RG and LG groups were comparable[standardized mean difference(SMD)<0.10].Post-PSM analysis revealed that the RG group exhibited longer operative time(P<0.001),lower postoperative complication rates(P<0.001),shorter postoperative hospital stays(P=0.037),and earlier initiation of adjuvant chemotherapy(P=0.041)compared with the LG group.Survival analysis demonstrated comparable 3-year OS(P=0.110)and DFS(P=0.088)in the PSM cohort,whereas the IPTW cohort showed superior OS(P=0.030)and DFS(P=0.046)for RG.No significant differences were observed in overall recurrence rates or recurrence sites between groups.Conclusions:For patients with stage cT4a gastric cancer,compared with the LG group,the RG group had shorter postoperative hospital stay,lower incidence of postoperative complications,earlier postoperative adjuvant chemotherapy,and no worse long-term efficacy.展开更多
Objective:Clinical use of stimulator of interferon genes(STING)agonists has challenges due to poor responsiveness and variable efficacy.Therefore,identifying tumor types that are sensitive to these agents and clarifyi...Objective:Clinical use of stimulator of interferon genes(STING)agonists has challenges due to poor responsiveness and variable efficacy.Therefore,identifying tumor types that are sensitive to these agents and clarifying the underlying mechanisms are essential.Methods:In vitro screening was performed to identify tumor types that are sensitive to STING agonists.The non-nucleotide agonist,SR-717,and the macrocyclic agonist,E7766,were compared for efficacy.Complementary in vivo and in vitro studies,including gene-knockout models,HMGN2-knockout Neuro-2A and CT-2A cells apoptosis assays,and murine tumor models,were then performed.These experiments focused on the mechanism by which SR-717 mediates antitumor effects and emphasized the role of STING signaling-induced high-mobility group nucleosome-binding protein 2(HMGN2).In addition,the potential of HMGN2 as a prognostic biomarker was assessed.Results:Neuroblastomas and glioblastomas,two nervous system tumors,were shown to be sensitive to STING agonists.SR-717 exhibited greater antitumor efficacy compared to E7766.Mechanistic studies indicated that STING agonists promote apoptosis through activation of the intrinsic STING-signal transducer and activator of transcription 1(STAT1)-HMGN2 axis within tumor cells.Ectopic expression of HMGN2 in melanoma cells,which naturally lack HMGN2,led to significant apoptosis.Furthermore,analysis of The Cancer Genome Atlas and Gene Expression Omnibus databases revealed positive correlation between elevated HMGN2 expression and patient survival,supporting the utility of HMGN2 as a prognostic biomarker.Conclusions:This study clarified the mechanism underlying the potent antitumor activity of SR-717 in nervous system tumors through activation of the STING-STAT1-HMGN2 signaling pathway and demonstrated that SR-717 has superior efficacy compared to E7766.In addition,HMGN2 was shown to exhibit translational potential as a prognostic biomarker for patient survival.展开更多
BACKGROUND Mucinous cystic neoplasm(MCN)of the pancreas is characterized by mucinproducing columnar epithelium and dense ovarian-type stroma and at risk for malignant transformation.Early diagnosis and treatment of MC...BACKGROUND Mucinous cystic neoplasm(MCN)of the pancreas is characterized by mucinproducing columnar epithelium and dense ovarian-type stroma and at risk for malignant transformation.Early diagnosis and treatment of MCN are particularly important.AIM To investigate the clinical characteristics of and management strategies for pancreatic mucinous cystadenoma(MCA)and mucinous cystadenocarcinoma(MCC).METHODS The clinical and pathological data of 82 patients with pancreatic MCA and MCC who underwent surgical resection at our department between April 2015 and March 2019 were retrospectively analyzed.RESULTS Of the 82 patients included in this study,70 had MCA and 12 had MCC.Tumor size of MCC was larger than that of MCA(P=0.049).Age and serum levels of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9,and CA12-5 were significantly higher in MCC than in MCA patients(P=0.005,0.026,and 0.037,respectively).MCA tumor size was positively correlated with serum CA19-9 levels(r=0.389,P=0.001).Compared with MCC,MCA had a higher minimally invasive surgery rate(P=0.014).In the MCA group,the rate of major complications was 5.7%and that of clinically relevant pancreatic fistula was 8.6%;the corresponding rates in the MCC group were 16.7%and 16.7%,respectively.CONCLUSION Tumor size,age,and serum CEA,CA19-9,and CA12-5 levels may contribute to management of patients with MCN.Surgical resection is the primary treatment modality for MCC and MCA.展开更多
Objective High glucose(HG)can influence the osteogenic differentiation ability of periodontal ligament stem cells(PDLSCs).Human umbilical cord mesenchymal stem cell-derived exosomes(hUCMSC-exo)have broad application p...Objective High glucose(HG)can influence the osteogenic differentiation ability of periodontal ligament stem cells(PDLSCs).Human umbilical cord mesenchymal stem cell-derived exosomes(hUCMSC-exo)have broad application prospects in tissue healing.The current study aimed to explore whether hUCMSC-exo could promote the osteogenic differentiation of hPDLSCs under HG conditions and the underlying mechanism.Methods We used a 30 mmol/L glucose concentration to simulate HG conditions.CCK-8 assay was performed to evaluate the effect of hUCMSC-exo on the proliferation of hPDLSCs.Alkaline phosphatase(ALP)staining,ALP activity,and qRT-PCR were performed to evaluate the pro-osteogenic effect of hUCMSC-exo on hPDLSCs.Western blot analysis was conducted to evaluate the underlying mechanism.Results The results of the CCK-8 assay,ALP staining,ALP activity,and qRT-PCR assay showed that hUCMSC-exo significantly promoted cell proliferation and osteogenic differentiation in a dosedependent manner.The Western blot results revealed that hUCMSC-exo significantly increased the levels of p-PI3K and p-AKT in cells,and the effect was inhibited by LY294002(PI3K inhibitor)or MK2206(AKT inhibitor),respectively.Moreover,the increases in osteogenic indicators induced by hUCMSC-exo were significantly suppressed by LY294002 and MK2206.Conclusion hUCMSC-exo promote the osteogenic differentiation of hPDLSCs under HG conditions through the PI3K/AKT signaling pathway.展开更多
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.
基金funded by National Natural Science Foundation of China(No.82272134)Innovative Research Group Project of the National Natural Science Foundation of China(No.82272134,Xiao-lei Chen).
文摘Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation systems face challenges such as high equipment costs,complex operation,bulky size,and insufficient anti-interference performance.To address these limitations,our study developed and validated a novel portable electromagnetic neuronavigation system designed to improve the precision,accessibility,and clinical applicability of electromagnetic navigation technology in cranial surgery.Methods The software and hardware architecture of a portable neural magnetic navigation system was designed.The key technologies of the system were analysed,including electromagnetic positioning algorithms,miniaturized sensor design,optimization of electromagnetic positioning and navigation algorithms,anti-interference signal processing methods,and fast three-dimensional reconstruction algorithms.A prototype was developed,and its accuracy was tested.Finally,a preliminary clinical application evaluation was conducted.Results This study successfully developed a comprehensive portable electromagnetic neuronavigation system capable of achieving preoperative planning,intraoperative real-time positioning and navigation,and postoperative evaluation of navigation outcomes.Through rigorous collaborative testing of the system’s software and hardware,the accuracy of electromagnetic neuronavigation has been validated to meet clinical requirements.Conclusions This study developed a portable neuroelectromagnetic navigation system and validated its effectiveness and safety through rigorous model testing and preliminary clinical applications.The system is characterized by its compact size,high precision,excellent portability,and user-friendly operation,making it highly valuable for promoting navigation technology and advancing the precision and minimally invasive nature of neurosurgical procedures.
基金Supported by the National Key Research and Development Program of China,No.2022YFC2503600。
文摘BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.
基金Supported by National Natural Science Foundation of China,No.82073192,and No.82273231Beijing Science and Technology Program,No.Z221100007422125.
文摘BACKGROUND In recent years,the global prevalence of gastric cancer(GC)has witnessed a progressive decrease,accompanied by a step-growth in the incidence of gastric signet ring cell carcinoma(GSRCC).As precision medicine concepts progress,GSRCC,a distinct sub-type of GC,has drawn considerable attention from researchers.However,there still persist some controversies regarding the associated research findings.AIM To summarize the current obstacles and potential future directions for research on GSRCC.METHODS To begin with,all literature related to GSRCC published from January 1,2004 to December 31,2023 was subjected to bibliometric analysis in this article.Additionally,this paper analyzed the research data using CiteSpace,GraphPad Prism v8.0.2,and VOSviewer,which was obtained from the Web of Science Core Collection database.The analysis results were visually represented.RESULTS This study provided a comprehensive overview of the statistical characteristics of the 995 English articles related to GSRCC,including cited references,authors,journals,countries,institutions,and keywords.The popular keywords and clusters contain"prognosis","survival","expression","histology",and"chemotherapy".CONCLUSION The prognosis,precise definition and classification,as well as chemoresistance of GSRCC,continue to be crucial areas of ongoing research,whose directions are closely tied to advancements in molecular biology research on GSRCC.
基金Supported by Beijing Municipal Natural Science Foundation,No.7234387Chinese PLA General Hospital Young Independent Innovation Science Foundation,No.22QNFC004.
文摘This letter discusses the findings of Pang et al retrospective study on omental patch repair as a balanced treatment for gastric ulcer perforation.We acknowledge its clinical value while highlighting a critical limitation:Conventional mechanical closure often results in fibrotic scarring and functional impairment across the mucosal,muscular,and neurovascular layers.To address this,we propose the innovative concept of“multi-layer repair”and present a proof-ofconcept three-dimensional bioprinted functional biopatch.This patch features a multilayer structure:An inner layer laden with gastric mucosal organoids and an outer layer containing primary gastric muscle cells,both integrated onto a wetadhesive electrospun membrane.Preliminary animal studies have yielded encouraging results,supporting its potential to promote functional restoration beyond mechanical sealing.
基金National Natural Science Foundation of China,No.82073192 and No.82273231Beijing Science and Technology Program,No.Z221100007422125The Chinese People's Liberation Army General Hospital Medical Engineering Laboratory Project,No.2022SYSZZKY16.
文摘BACKGROUND Immunotherapy has surfaced as a promising therapeutic modality for gastric cancer(GC).A comprehensive review of advancements,current status,and research trends in GC immunotherapy is essential to inform future investigative efforts.AIM To delineate the trends,advancements,and focal points in immunotherapy for GC.METHODS We performed a bibliometric analysis of 2906 articles in English concerning GC immunotherapy published from 2000 to December 20,2023,indexed in the Web of Science Core Collection.Data analysis and visualization were facilitated by CiteSpace(6.1.6R),VOSviewer v.1.6.17,and GraphPad Prism v8.0.2.RESULTS There has been an increase in the annual publication rate of GC immunotherapy research.China leads in publication volume,while the United States demonstrates the highest citation impact.Fudan University is notable for its citation frequency and publication output.Co-citation analysis and keyword frequency revealed and highlighted a focus on GC prognosis,the tumor microenvironment(TME),and integrative immunotherapy with targeted therapy.Emerging research areas include gastroesophageal junction cancer,adoptive immunotherapy,and the role of Treg cell in immunotherapy.CONCLUSION GC immunotherapy research is an expanding field attracting considerable scientific interest.With the clinical adoption of immunotherapy in GC,the primary goals are to enhance treatment efficacy and patient outcomes.Unlike hematological malignancies,GC's solid TME presents distinct immunological challenges that may attenuate the cytotoxic effects of immune cells on cancer cells.For instance,although CAR-T therapy is effective in hematological malignancies,it has underperformed in GC settings.Current research is centered on overcoming immunosuppression within the TME,with a focus on combinations of targeted therapy,adoptive immunotherapy,Treg cell dynamics,and precise prognosis prediction in immunotherapy.Additionally,immunotherapy's role in treating gastroesophageal junction cancer has become a novel research focus.
文摘The gut microbiome is closely associated with human health and the development of diseases. Isolating, characterizing, and identifying gut microbes are crucial for research on the gut microbiome and essential for advancing our understanding and utilization of it. Although culture-independent approaches have been developed, a pure culture is required for in-depth analysis of disease mechanisms and the development of biotherapy strategies. Currently, microbiome research faces the challenge of expanding the existing database of culturable gut microbiota and rapidly isolating target microorganisms. This review examines the advancements in gut microbe isolation and cultivation techniques, such as culturomics, droplet microfluidics, phenotypic and genomics selection, and membrane diffusion. Furthermore, we evaluate the progress made in technology for identifying gut microbes considering both non-targeted and targeted strategies. The focus of future research in gut microbial culturomics is expected to be on high-throughput, automation, and integration. Advancements in this field may facilitate strain-level investigation into the mechanisms underlying diseases related to gut microbiota.
文摘This article comprehensively reviews research progress in prostate cancer radiation therapy.It provides an overview of fundamental principles,encompassing the disease’s epidemiology,pathological mechanisms,and radiation sensitivity,alongside technological advancements.The clinical application,technological progress,and efficacy evaluation of moderate hypofractionated radiation therapy and ultra hypofractionated radiation therapy are discussed.Diagnostic and monitoring techniques specific to radiation therapy are analyzed,alongside prevailing controversies and challenges.Finally,the review outlines future prospects,including novel radiotherapy techniques,multidisciplinary collaboration trends,and the evolving role of radiation within comprehensive treatment.The findings demonstrate continuous technological and clinical evolution in prostate cancer radiotherapy,yet emphasize the need for further exploration to optimize treatments and improve patient survival and quality of life.
基金Supported by the National Natural Science Foundation of China,No.81972790the Natural Science Foundation of Gansu Province,China,No.22JR5RA004.
文摘BACKGROUND Lynch syndrome(LS),an autosomal dominant genetic disorder,is distinguished by germline mutations in the DNA mismatch repair genes,including MLH1.These mutations confer an elevated risk for the development of colorectal cancer(CRC)and an array of other malignancies.Timely detection,facilitated by genetic profiling and stringent molecular surveillance,is crucial.It enables the implementation of customized therapeutic strategies,which have the potential to markedly enhance patient outcomes.Despite its significant public health impact,LS is frequently underdiagnosed,underscoring the necessity for increased vigilance and the adoption of precision medicine tactics.CASE SUMMARY This case presentation focuses on a 54-year-old male patient with a strong familial predisposition to colon cancer,who was identified to have LS-associated multiple colorectal neoplasms.Utilizing a comprehensive,multidisciplinary therapeutic strategy that encompassed precision medicine,immunotherapy with pembrolizumab,and stringent molecular residual disease monitoring,we effectively managed his advanced CRC.This tailored approach led to the achievement of sustained clinical remission exceeding 30 months,illustrating the promise of personalized treatment protocols in optimizing outcomes for individuals with LS and associated colorectal malignancies.CONCLUSION A synergistic,multidisciplinary approach is essential for managing LS-associated CRC,advocating for personalized care pathways in precision medicine.
基金the National Natural Science Foundation of China(Grant No.:82174071).
文摘Flavonoids,the key active compounds in Epimedii Folium,have both protective and toxic effects on the liver.Their hepatoprotective effects are associated with reducing lipid accumulation and oxidative stress,which contribute to the management of various liver conditions.In contrast,the mechanisms driving Epimedii Folium-induced hepatotoxicity are less understood but likely involve oxidative stress and pyroptosis.Pharmacokinetic studies,especially on icaritin,indicate that it undergoes isopentenyl dehydrogenation,glycosylation,and glucuronidation in vivo,contributing to its pharmacological effects.However,intermediate metabolites of icaritin may interact with biomolecules,potentially leading to liver toxicity.This review offers a detailed examination of the dual effects of Epimedii Folium flavonoids on liver function,emphasizing recent discoveries in their hepatoprotective and hepatotoxic pathways.We also summarize and discuss the pharmacokinetics of these flavonoids,highlighting how their meta-bolism affects therapeutic efficacy and toxicity.Lastly,we propose strategies to mitigate liver injury,providing new perspectives on the safe use of Epimedii Folium.
文摘Objective:Despite established associations between certain medications and urticaria,the risk profiles of most pharmaceutical agents remain poorly characterized.This investigation aimed to identify risk factors for medication-induced urticaria through comprehensive analysis of the FDA Adverse Event Reporting System(FAERS)database.Methods:We employed reporting odds ratios(ROR)to evaluate drug-urticaria associations using FAERS data spanning from Q12004 to Q32024.Analytical approaches included univariate screening,LASSO regression,and multivariate logistic regression to identify potential risk factors.Multiple comparison adjustments were implemented using the Bonferroni method.Results:The study identified 1807 pharmaceutical agents potentially associated with urticaria development.Univariate analysis categorized these agents into several therapeutic classes:antimicrobials(19/85),biologics(16/85),analgesics(8/85),dermatologicals(3/85),anti-rheumatic agents(4/85),hormonal preparations(3/85),antihypertensives(2/85),neuropsychiatric medications(2/85),uric acid-lowering drugs(2/85),multiple sclerosis therapies(2/85),and miscellaneous agents(17/85).Multivariate analysis identified three significant risk determinants:middle-aged individuals(36-53 years),female gender,and exposure to any of 82 specific medications.Conclusion:These evidence-based findings provide valuable insights for early clinical recognition of drug-induced urticaria and establish a foundation for subsequent mechanistic investigations into medication-related hypersensitivity reactions.
基金supported by the Beijing Natural Sci-ence Foundation(No.L242139).
文摘The durability of dental implant carrier coatings is of paramount importance for the expeditious and predictable osseointegration process.The present work is based on a bionic micro/nano hierarchy struc-ture,which consists of titanium surface microstructures and their internal TiO2 nanotubes(TNTs)with drug-carrying capacity.This effectively increases the wear resistance of the drug-carrying coating on the titanium surface.In comparison to untextured samples,the wear volume and wear depth of the optimal texture group are markedly diminished,resulting in a significant enhancement of wear resistance.This improvement was primarily attributed to the smaller contact area of the microstructure.Concurrently,the microstructure serves to safeguard the TNTs from damage during friction.The hydrophilic biomimetic anti-wear micro/nano hierarchies demonstrated the capacity to promote MC3T3-E1 cell adhesion and pro-liferation,while also exhibiting no cytotoxic effects.Moreover,the micro/nano hierarchical structure can be directly applied to the surface of commercialized implants.In simulated clinical conditions,the im-plant was inserted into a fresh Bama porcine mandible,and the structure of the drug-loading coatings remained intact.This structure enhances the abrasion resistance of the drug coating while minimizing alterations to the original treatment process of the implant,which is of great significance in the clinical application of implant-loaded drug delivery.
基金Project supported by the National Key Research and Development Program(2021YFB3501101)Beijing Nova Program(20220484827)+2 种基金National Natural Science Foundation of China(52304370)Central Government Guidance Local Science and Technology Development Fund Project of Hebei Province(236Z4102G)Natural Science Foundation of Hebei Province(E2022103012)。
文摘Rare earth carbonates are essential precursors for the synthesis of oxide materials.In this study,we utilized in situ monitoring equipment to explore the alterations in the crystallization during the coprecipitation synthesis of cerium carbonate.By controlling the crystallization pathway and in the absence of any te mplating agents,we successfully synthesized a unique sphe rical self-assembled cerium oxide particle(Ceria-S).The Ceria-S exhibits excellent polishing performance.The crystallization process of cerium carbonate at 50℃persists for roughly 50 min.During the initial stages of crystallization from 0 to t_(3),the precipitated particles are amorphous.This is followed by a plateau phase of crystal growth from t_(3)to t_(5).Subsequently,during the burst crystallization phase from t_(5)to t_(6),Ce_(2)(CO_(3))_(3)·6H_(2)O and Ce_(2)O(CO_(3))_(2)·nH2O are formed,exhibiting a rod-like crystal morphology.By rapidly drying the precipitated particles at 60℃for 10 min and calcining,Ceria-S is obtained.The Ceria-S,with an average diameter of 180 nm,is assembled from primary cerium oxide nanoparticles of approximately 15 nm.Owing to the self-assembly structure of cerium oxide spherical nanoparticles,they exhibit a significantly larger specific surface area,resulting in an elevated concentration of Ce^(3+)as high as 35.5%.The Ceria-S exhibits a polishing removal rate of 420 nm/min,effectively decreasing the surface roughness(S_(a))of K9 glass from 1.605 to 0.404 nm.
基金support from the National Key Research and Development Program of China(No.2021YFB3802105-3)the National Natural Science Foundation of China(No.62173043).
文摘Exosomes derived from bone mesenchymal stem cells(BMSCs)show promising potential for treating bone defects.However,their clinical application is hindered by low yield and insufficient repair ability.Three-dimensional(3D)mechanical stimulation has been a well-known method for enhancing exosome secretion;however,the traditional stimulation process is always achieved by controlling the displacement of manipulators,which may induce uneven loading distribution and degradation of stimulation strength.Here,we propose a micro-stretching manipulator that automatically controls the stretching force applied to gelatin methacryloyl(GelMA)/hyaluronic acid methacryloyl(HAMA)hybrid hydrogel sheets containing BMSCs within an incubator.To ensure the structural stability of the sheets after long-term stretching,the mixing ratio between GelMA and HAMA was optimized according to the mechanical property response of the sheets to cyclical loading.Subsequently,force-controlled mechanical loading was applied to the BMSC-laden sheets to produce exosomes.Compared with displacement control,force-controlled loading provides a more stable force stimulation,thereby enhancing exosome secretion.Furthermore,continuously stimulated exosomes exhibited a stronger capacity for promoting osteogenic differentiation of BMSCs and facilitating the repair of bone defects in a rat model.These findings suggest that force-controlled loading of cell-laden hydrogels offers a novel approach for the production of BMSC-derived exosomes and their application in bone repair.
基金supported by grants from the Young Elite Sci-entists Sponsorship Program by CAST(2023QNRC001)the Young Elite Scientists Sponsorship Program by BAST(BYESS2024001)the National Key Research and Development Program of China(2022YFC2407402).
文摘Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of patients with PDAC after R0 resection.Methods:PDAC patients from six centers in China undergoing R0 resection from 2015 to 2022 were included.Patients were categorized as long-term diabetes(LTD),NOD,or non-diabetes mellitus(non-DM)based on the timing of diagnosis relative to pancreatic resection.We compared the effects of diabetes status on perioperative and oncological outcomes of PDAC.Results:Of 1211 patients,602(49.7%),127(10.5%),and 482(39.8%)were in the non-DM,LTD,and NOD groups,respectively.Patients with NOD suffered from higher rates of fatty pancreas and postoperative pancreatic fistula(POPF)(both P<0.05).When compared with the non-DM group,the NOD group had worse median overall survival(OS)(24.6 vs.29.4 months,P<0.001)and recurrence-free survival(RFS)(13.3 vs.15.8 months,P<0.001);and the LTD group also had worse median OS(25.2 vs.29.4 months,P=0.041)and RFS(13.8 vs.15.8 months,P=0.007)compared with non-DM group.However,there were no significant differences in survival between the NOD and the LTD groups.Multivariate analysis indicated that NOD,LTD,largest tumor size,and poor tumor differentiation were independently associated with worse OS and RFS(all P<0.05).Conclusions:Patients with PDAC undergoing R0 resection experienced a higher probability of POPF in the presence of concurrent NOD.Long-term survival prognosis was worse in NOD or LTD patients than in non-DM patients.
基金Supported by the National Key Research and Development Program,China,No.2022YFC2503603.
文摘BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography(ERCP).AIM To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable,balancing ERCP success and the risk of biliary strictures.METHODS We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022.The patients were divided into four groups based on the timing of ERCP:3 days,7 days,14 days,and 21 days.The primary outcome was clinical success,defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage,surgery,or death.The secondary outcome was incidence of biliary strictures.Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.RESULTS In a cohort of 448 consecutive patients diagnosed with BDLs,354 were excluded,leaving 94 patients who underwent ERCP.Clinical success was achieved in 84%of cases(79/94),with a median ERCP timing of 20 days(9.5-35.3 days).Biliary strictures were identified in 29(30.9%)patients.Performing ERCP within 3 weeks,compared to after 3 weeks,was associated with higher success rates[92.0%(46/50)vs 75.0%(33/44),P=0.032]and a lower incidence of biliary stricture incidence[18.0%(9/50)vs 45.5%(20/44),P=0.005].Subsequent multivariate analysis confirmed the association with higher success rates(odds ratio=4.168,P=0.045)and lower biliary stricture rates(odds ratio=0.256,P=0.007).CONCLUSION Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate.If patients with BDLs do not respond to conservative treatment,ERCP is suggested to be performed within 3 weeks.
基金supported by Fujian Provincial Medical“Building High-level Hospitals,High-level Clinical Medical Centers and Key Clinical Specialty Projects”([2021]No.76)Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare(No.[2022]954)。
文摘Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shortand long-term outcomes of RG and laparoscopic gastrectomy(LG)in the treatment of stage cT4a gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of patients with stage cT4a gastric cancer diagnosed and treated at eight high-volume tertiary teaching hospitals in China from 2016 to 2019.Propensity score matching(PSM)analysis and inverse probability of treatment weighting(IPTW)analysis was used to adjust for the imbalance in baseline characteristics.The primary research endpoint was the 3-year overall survival(OS)and disease-free survival(DFS).The secondary research endpoint was intraoperative outcomes and postoperative complications.Results:After IPTW and PSM adjustments,baseline characteristics between the RG and LG groups were comparable[standardized mean difference(SMD)<0.10].Post-PSM analysis revealed that the RG group exhibited longer operative time(P<0.001),lower postoperative complication rates(P<0.001),shorter postoperative hospital stays(P=0.037),and earlier initiation of adjuvant chemotherapy(P=0.041)compared with the LG group.Survival analysis demonstrated comparable 3-year OS(P=0.110)and DFS(P=0.088)in the PSM cohort,whereas the IPTW cohort showed superior OS(P=0.030)and DFS(P=0.046)for RG.No significant differences were observed in overall recurrence rates or recurrence sites between groups.Conclusions:For patients with stage cT4a gastric cancer,compared with the LG group,the RG group had shorter postoperative hospital stay,lower incidence of postoperative complications,earlier postoperative adjuvant chemotherapy,and no worse long-term efficacy.
文摘Objective:Clinical use of stimulator of interferon genes(STING)agonists has challenges due to poor responsiveness and variable efficacy.Therefore,identifying tumor types that are sensitive to these agents and clarifying the underlying mechanisms are essential.Methods:In vitro screening was performed to identify tumor types that are sensitive to STING agonists.The non-nucleotide agonist,SR-717,and the macrocyclic agonist,E7766,were compared for efficacy.Complementary in vivo and in vitro studies,including gene-knockout models,HMGN2-knockout Neuro-2A and CT-2A cells apoptosis assays,and murine tumor models,were then performed.These experiments focused on the mechanism by which SR-717 mediates antitumor effects and emphasized the role of STING signaling-induced high-mobility group nucleosome-binding protein 2(HMGN2).In addition,the potential of HMGN2 as a prognostic biomarker was assessed.Results:Neuroblastomas and glioblastomas,two nervous system tumors,were shown to be sensitive to STING agonists.SR-717 exhibited greater antitumor efficacy compared to E7766.Mechanistic studies indicated that STING agonists promote apoptosis through activation of the intrinsic STING-signal transducer and activator of transcription 1(STAT1)-HMGN2 axis within tumor cells.Ectopic expression of HMGN2 in melanoma cells,which naturally lack HMGN2,led to significant apoptosis.Furthermore,analysis of The Cancer Genome Atlas and Gene Expression Omnibus databases revealed positive correlation between elevated HMGN2 expression and patient survival,supporting the utility of HMGN2 as a prognostic biomarker.Conclusions:This study clarified the mechanism underlying the potent antitumor activity of SR-717 in nervous system tumors through activation of the STING-STAT1-HMGN2 signaling pathway and demonstrated that SR-717 has superior efficacy compared to E7766.In addition,HMGN2 was shown to exhibit translational potential as a prognostic biomarker for patient survival.
文摘BACKGROUND Mucinous cystic neoplasm(MCN)of the pancreas is characterized by mucinproducing columnar epithelium and dense ovarian-type stroma and at risk for malignant transformation.Early diagnosis and treatment of MCN are particularly important.AIM To investigate the clinical characteristics of and management strategies for pancreatic mucinous cystadenoma(MCA)and mucinous cystadenocarcinoma(MCC).METHODS The clinical and pathological data of 82 patients with pancreatic MCA and MCC who underwent surgical resection at our department between April 2015 and March 2019 were retrospectively analyzed.RESULTS Of the 82 patients included in this study,70 had MCA and 12 had MCC.Tumor size of MCC was larger than that of MCA(P=0.049).Age and serum levels of tumor markers carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9,and CA12-5 were significantly higher in MCC than in MCA patients(P=0.005,0.026,and 0.037,respectively).MCA tumor size was positively correlated with serum CA19-9 levels(r=0.389,P=0.001).Compared with MCC,MCA had a higher minimally invasive surgery rate(P=0.014).In the MCA group,the rate of major complications was 5.7%and that of clinically relevant pancreatic fistula was 8.6%;the corresponding rates in the MCC group were 16.7%and 16.7%,respectively.CONCLUSION Tumor size,age,and serum CEA,CA19-9,and CA12-5 levels may contribute to management of patients with MCN.Surgical resection is the primary treatment modality for MCC and MCA.
文摘Objective High glucose(HG)can influence the osteogenic differentiation ability of periodontal ligament stem cells(PDLSCs).Human umbilical cord mesenchymal stem cell-derived exosomes(hUCMSC-exo)have broad application prospects in tissue healing.The current study aimed to explore whether hUCMSC-exo could promote the osteogenic differentiation of hPDLSCs under HG conditions and the underlying mechanism.Methods We used a 30 mmol/L glucose concentration to simulate HG conditions.CCK-8 assay was performed to evaluate the effect of hUCMSC-exo on the proliferation of hPDLSCs.Alkaline phosphatase(ALP)staining,ALP activity,and qRT-PCR were performed to evaluate the pro-osteogenic effect of hUCMSC-exo on hPDLSCs.Western blot analysis was conducted to evaluate the underlying mechanism.Results The results of the CCK-8 assay,ALP staining,ALP activity,and qRT-PCR assay showed that hUCMSC-exo significantly promoted cell proliferation and osteogenic differentiation in a dosedependent manner.The Western blot results revealed that hUCMSC-exo significantly increased the levels of p-PI3K and p-AKT in cells,and the effect was inhibited by LY294002(PI3K inhibitor)or MK2206(AKT inhibitor),respectively.Moreover,the increases in osteogenic indicators induced by hUCMSC-exo were significantly suppressed by LY294002 and MK2206.Conclusion hUCMSC-exo promote the osteogenic differentiation of hPDLSCs under HG conditions through the PI3K/AKT signaling pathway.
