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Abstract ECD is considered to have rapid progression and poor prognosis. Studies have shown that vemurafenib is effective for ECD patients with orbital involvement, but not for ECD with multiple organs. The refinement of treatment approaches and the increased awareness of ECD have led to a dramatic improvement in prognosis.

Background: Hepatitis C virus (HCV) genotype 1 is the most prevalent HCV infection in China. Sofosbuvir-based direct antiviral agent (DAA) regimens are the current mainstays of treatment. Sofosbuvir/velpatasvir (SOF/VEL) and sofosbuvir/ledipasvir (SOF/LDV) regimens became reimbursable in China in 2020. Thus, this study aimed to identify the optimal SOF-based regimen and to inform efficient use of healthcare resources by optimizing DAA use in treating HCV genotype 1.Methods and Models: A modeling-based cost-utility analysis was conducted from the payer's perspective targeting adult Chinese patients with chronic HCV genotype 1 infection. Direct medical costs and health utilities were inputted into a Markov model to simulate lifetime experiences of chronically infected HCV patients after receiving SOF/LDV, SOF/VEL or the traditional strategy of pegylated interferon (pegIFN) + ribavirin (RBV). Discounted lifetime cost and quality adjusted life years (QALYs) were computed and compared to generate the incremental cost utility ratio (ICUR). An ICUR below the threshold of 31,500 $/QALY suggests cost-effectiveness. Deterministic and probabilistic sensitivity analyses were performed to examine the robustness of model findings.Results: Both SOF/LDV and SOF/VEL regimens were dominant to the pegIFN + RBV regimen by creating more QALYs and incurring less cost. SOF/LDV produced 0.542 more QALYs but cost $10,390 less than pegIFN + RBV. Relative to SOF/LDV, SOF/VEL had an ICUR of 168,239 $/QALY which did not meet the cost-effectiveness standard. Therefore SOF/LDV was the optimal strategy. These findings were robust to linear and random variations of model parameters. However, reducing the SOF/VEL price by 40% would make this regimen the most cost-effective option.Conclusions: SOF/LDV was found to be the most cost-effective treatment, and SOF/VEL was also economically dominant to pegIFN + RBV. These findings indicated that replacing pegIFN + RBV with DAA regimens could be a promising strategy.

Abstract Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non‐small cell lung cancer (NSCLC) with an extremely poor prognosis making it a therapeutic challenge. However, the development of genetic variation molecular diagnosis and targeted agents has brought the treatment of such malignancies to the precision era. Co‐existing mutations of EGFR and MET have been reported in NSCLC, but rarely found in PSC. We herein present a rare case of a 74‐year‐old female patient diagnosed with PSC, carrying an activating mutation in exon 21 L858R of EGFR and a concurrent MET amplification prior to treatment. Combined application of gefitinib and crizotinib, inhibitors targeting EGFR and MET, respectively, was prescribed. The patient experienced a partial response and was stable for 9.7 months off therapy. The observation stresses the importance of genetic testing and paves the way for combined targeted strategies in PSC.

Different from conventional reservoirs, unconventional tight sand oil reservoirs are characterized by low or ultra-low porosity and permeability, small pore-throat size, complex pore structure and strong heterogeneity. For the continuous exploration and enhancement of oil recovery from tight oil, further analysis of the origins of the different reservoir qualities is required. The Upper Triassic Chang 8 sandstone of the Yanchang Formation from the Maling Oilfield is one of the major tight oil bearing reservoirs in the Ordos Basin. Practical exploration demonstrates that this formation is a typical tight sandstone reservoir. Samples taken from the oil layer were divided into 6 diagenetic facies based on porosity, permeability and the diagenesis characteristics identified through thin section and scanning electron microscopy. To compare pore structure and their seepage property, a high pressure mercury intrusion experiments (HPMI), nuclear magnetic resonance (NMR), andwater-oil relative permeability test were performed on the three main facies developed in reservoir. The reservoir quality and seepage property are largely controlled by diagenesis. Intense compaction leads to a dominant loss of porosity in all sandstones, while different degrees of intensity of carbonate cementation and dissolution promote the differentiation of reservoir quality. The complex pore structure formed after diagenesis determines the seepage characteristics, while cementation of chlorite and illite reduce the effective pore radius, limit fluid mobility, and lead to a serious reduction of reservoir permeability.

The feeding trials were carried out with freshwater crayfish ( Procambarus clarkii) to evaluate the three feed stimulants betaine ( Bet), squid extract ( SE) and squid meal ( SM) upon fish meal ( FM) diets or biofeed ( BF) diets in which FM were partially replaced by BF. Results showed the three feed stimulants had no significant effect on growth. By the relative concentration of markers in the faeces and diets, the preference for each diet was estimated, and the best stimulant was the mixture of Bet, SE and SM. As FM replaced by BF increased, added with the mixture, the relative weight gain showed an increasing trend, but decreased significantly by 30% replacement. With the substitution increasing, trypsin activities increased, whereas decreased too upon 30% substitution. Less than 30% replacement, there was no significant effect on muscle proximate composition, intestine amylase activities and serum haemocyanin contents, except the drop of lipid. The results indicated that the mixture of Bet, SE and SM could perform well as a feed stimulant. And with the addition of the mixture, FM in the diet could make about no more than 20% saving without any adverse effects. [ABSTRACT FROM AUTHOR]

Background and objective The efficacy of second or third-line chemotherapy in advanced non-small cell lung cancer (NSCLC) patients is low. The use of targeted drugs brings survival benefit for some patients. Apatinib, as a novel small molecule antiangiogenic drug, has demonstrated satisfactory anticancer activity across a broad range of malignancies. The aim of this study is to evaluate the efficacy and safety of apatinib in patients with advanced NSCLC after first-line treatment failure. Methods A retrospective study of 128 patients was conducted to evaluate the safety, short-term efficacy and survival status with different regimens. Kaplan-Meier method and Cox regression model were used for analysis. Results Compared with chemotherapy alone, the median progression free survival (PFS) in apatinib monotherapy, chemotherapy alone and apatinib combined with chemotherapy were 3.0 (P=0.381), 3.7 and 6.0 months (P

A series of ZSM-5 zeolites with hierarchical porous structure were synthesized using NaOH solutions treatment method. The structural and acidity properties of hierarchical ZSM-5 zeolites as-synthesized were characterized by X-ray diffraction (XRD), N2 adsorption, scanning electron microscope (SEM), NH3-temperature programmed desorption (TPD), and pyridine Fourier transform infrared spectroscopy (Py-FTIR). The adsorption and diffusion performances of benzene in hierarchical ZSM-5 zeolites were studied by an intelligent gravimetric analyzer (IGA). It was found that mass transfer (adsorption and diffusion) performance of benzene was significantly affected by synergetic effect of hierarchical structure, acid amount, acidity, adsorption sites of ZSM-5 zeolites. After suitable alkali treatment, the crystal structure of ZSM-5 was retained and finely tailored. Hierarchical ZSM-5 was obtained with a uniform size of mesoporous and microporous structure. Acidity of hierarchical ZSM-5 zeolites was improved, which produced more adsorption sites and thus increased the adsorption performance of benzene in hierarchical ZSM-5. As a result, connectivity in hierarchical ZSM-5 was improved with increasing of mesopores in hierarchical ZSM-5. Hierarchical ZSM-5 well-contributed to the adsorption performance of benzene on active sites and improved catalytic performance of hierarchical ZSM-5.

Background—misinformation and mistrust often undermines community vaccine uptake, yet information in rural communities, especially of developing countries, is scarce. This study aimed to identify major challenges associated with coronavirus disease 2019 (COVID-19) vaccine clinical trials among healthcare workers and staff in Uganda. Methods—a rapid exploratory survey was conducted over 5 weeks among 260 respondents (66% male) from healthcare centers across the country using an online questionnaire. Twenty-seven questions assessed knowledge, confidence, and trust scores on COVID-19 vaccine clinical trials from participants in 46 districts in Uganda. Results—we found low levels of knowledge (i.e., confusing COVID-19 with Ebola) with males being more informed than females (OR = 1.5, 95% CI: 0.7–3.0), and mistrust associated with policy decisions to promote herbal treatments in Uganda and the rushed international clinical trials, highlighting challenges for the upcoming Oxford–AstraZeneca vaccinations. Knowledge, confidence and trust scores were higher among the least educated (certificate vs. bachelor degree holders). We also found a high level of skepticism and possible community resistance to DNA recombinant vaccines, such as the Oxford–AstraZeneca vaccine. Preference for herbal treatments (38/260; 14.6%, 95% CI: 10.7–19.3) currently being promoted by the Ugandan government raises major policy concerns. High fear and mistrust for COVID-19 vaccine clinical trials was more common among wealthier participants and more affluent regions of the country. Conclusion—our study found that knowledge, confidence, and trust in COVID-19 vaccines was low among healthcare workers in Uganda, especially those with higher wealth and educational status. There is a need to increase transparency and inclusive participation to address these issues before new trials of COVID-19 vaccines are initiated.

Objective:A meta-analysis was performed to augment the insufficient data on the impact of mutative EGFR downstream phosphatidylinositol-3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) pathways on the clinical efficiency of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment of non-small cell lung cancer (NSCLC) patients.Methods:Network databases were explored in April, 2015. Papers that investigated the clinical outcomes of NSCLC patients treated with EGFR-TKIs according to the status of K-ras and/or PIK3CA gene mutation were included. A quantitative meta-analysis was conducted using standard statistical methods. Odds ratios (ORs) for objective response rate (ORR) and hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS) were calculated.Results:Mutation in K-ras significantly predicted poor ORR[OR=0.22; 95% confidence interval (CI), 0.13-0.35], shorter PFS (HR=1.56; 95% CI, 1.27-1.92), and shorter OS (HR=1.59; 95% CI, 1.33-1.91) in NSCLC patients treated with EGFR-TKIs. Mutant PIK3CA significantly predicted shorter OS (HR=1.83; 95% CI, 1.05-3.20), showed poor ORR (OR=0.70; 95% CI, 0.22-2.18), and shorter PFS (HR=1.79; 95% CI, 0.91-3.53) in NSCLC patients treated with EGFR-TKIs.Conclusion:K-ras mutation adversely affected the clinical response and survival of NSCLC patients treated with EGFRTKIs. PIK3CA mutation showed similar trends. In addition to EGFR, adding K-ras and PIK3CA as routine gene biomarkers in clinical genetic analysis is valuable to optimize the effectiveness of EGFR-TKI regimens and identify optimal patients who will benefit from EGFR-TKI treatment.

Setting up a bikeway network has been recognized as one of the most effective measures to motivate cycling. In fact, a highly connected, exclusive bikeway network that covers all demand sources can be an attractive and time-saving measure, but it requires very high setup costs. The planner often needs to have a trade-off between demand coverage and travel time under a given construction cost. This paper introduces a novel bikeway design problem which determines an optimal bikeway network that covers all potential cycling demand sources with minimal total travel time and under budget constraints. In the context of designing a bike sharing system, the resultant node set of the bikeway network can be interpreted as the locations of the shared bike stations which can cover all cycling demands. A two-stage solution method, by combining the genetic algorithm and a novel elimination heuristic, is proposed to solve the problem by firstly determining the subset of nodes (selected nodes) that can cover all the demand sources and then designing the bikeway network that connects all selected nodes within a given budget. Numerical studies illustrate the advantages of elimination heuristics in solving the proposed problem and the effect of the budget towards the solution fitness with or without a solution. Case studies of two proposed new towns in Hong Kong are provided to illustrate the applicability and effectiveness of the method in bikeway design. This optimization model can be applied to bike-sharing system design problems which aims to cover all demand sources by providing bike stations that are also well connected with exclusive bikeways subject to budget constraints. [ABSTRACT FROM AUTHOR]

IDO has been reported to induce immunotolerance and promote metastasis in solid malignancy, but the mechanisms involved were not fully understood. In this study, the expression of IDO in primary breast cancer was examined and the correlation between the expression levels of IDO and the densities of Foxp3+ Tregs in situ was studied. The IDO stably-expressing CHO cells(IDO/CHO) were generated to evaluate the induction of Foxp3+ Tregs after coculturing with CD3+ T cells in vitro. The IDO expression in cancer was higher than that in benign diseases both at RNA and protein levels. The IDO expression was significantly upregulated in tumors of more advanced stages and with more extensive lymph node metastasis, and displayed positive linear correlation with the density of Foxp3+ Tregs. We further demonstrated that CD4+CD25+CD127− Tregs could be amplified by coculturing CD3+ T cells with IDO/CHO cells in vitro which displayed increasing Foxp3 expression both at mRNA and protein levels. Our results implied that up-regulation of IDO in primary breast cancer may inhibit local immune surveillance and promote metastasis by favoring development and infiltration of Foxp3+ Tregs in the tumor microenvironment.

Hong Kong has numerous outlying islands that are relatively underdeveloped due to isolation from the urban core and are dependent on ferries. Concurrently, the Hong Kong Government has expressed a desire for outlying islands to be places for urban expansion and has proposed building more bridges, tunnels, and reclaimed land. Development of these fixed links may transform the outlying island communities' current ways of life. Ferry operators struggle to maintain efficient operation, fleet investments, improved services, and attract passengers while competing with fixed link transport modes. Urban ferry transport has been resurgent in parts of Europe, North America, and Australia, but not Hong Kong. This paper identifies a new typology of island communities according to connectivity based on available transport links. Using census and ferry statistics, the socioeconomic development of island communities is analysed. The transport problems faced by outlying islands are further conceptualised, and possible scenarios for socially sustainable island futures are proposed. [ABSTRACT FROM AUTHOR]

Purpose: To assess health-related quality of life (HRQoL) and its influencing factors in these pediatric patients undergoing parotidectomy., Methods: This was a cross-sectional study that included 37 children and adolescents (≤ 19 years) with parotid gland tumors who were treated in Sichuan Cancer Hospital between January 2006 and November 2021. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The Wilcoxon rank sum test was used to analyze the factors influencing patients' HRQoL., Results: 37 children and adolescents were included in the study, including 22 cases of benign tumors and 15 cases of malignant tumors. All patients underwent surgery, and some patients with malignant tumors received radiotherapy or chemotherapy. Malignancy, permanent facial palsy, and Frey syndrome were associated with worse HRQoL in children and adolescents with parotid gland tumors. Radiotherapy and no cervical lymph node dissection were associated with worse HRQoL in pediatric patients with malignancy. The surgical approach of parotid is not a factor influencing HRQoL., Conclusion: Factors associated with HRQoL in children and adolescents with parotid gland tumors include pathological types, permanent facial palsy, and Frey syndrome. In addition, factors affecting patients with malignancy include lateral lymph node dissection and radiotherapy., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: To evaluate the preoperative health-related quality of life (HRQoL) and influencing factors of HRQoL in patients undergoing thyroidectomy based on patient-reported outcomes., Materials and Methods: Patients who were diagnosed and treated in Sichuan Cancer Hospital from February 2022 to December 2022 and were scheduled to undergo thyroidectomy were included. Each participant completed the basic information questionnaire and patient-reported outcome assessment scales before surgery. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30), the Thyroid Cancer-Specific Quality of Life (THYCA-QoL), and the Hamilton Anxiety Scale (HAMA). The Wilcoxon rank sum test or the Kruskal-Wallis test was used to analyze the association between patient characteristics and HRQoL, and the variables with statistical significance were included in multiple linear regression analysis., Results: 450 patients were included in the study. According to the analysis of the THYCA-QoL scores, the psychological subscale was the most complained about. Anxiety was the most common symptom of the HAMA. Factors associated with worse general QoL on the EORTC QLQ-C30 included nondiagnostic/unsatisfactory fine-needle aspiration (FNA) result. Planned lateral neck dissection and nondiagnostic/unsatisfactory FNA result were influential factors for preoperative anxiety. Males and longer sleep duration were associated with better thyroid cancer-specific QoL, better general QoL, and less anxiety., Conclusion: The preoperative HRQoL of patients undergoing thyroidectomy was generally good. Females, insufficient sleep duration, planned lateral neck dissection, and nondiagnostic/unsatisfactory FNA result were associated with worse preoperative HRQoL., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Liu, Xiang, Xiong, Li, Dai, Hu, Shui, Zhou, Wang, Ma, Xu, Hu and Cai.)

Background: Patient-reported outcome measures (PROMs) have become important tools for evaluating health-related quality of life (HRQOL) in patients with differentiated thyroid cancer (DTC). While there are many PROMs available to measure HRQOL, there is a lack of a comprehensive overview of these PROMs. Therefore, we aimed to systematically review and categorize all PROMs that have been used to measure HRQOL in patients with DTC., Materials and Methods: After determining the search strategy and identifying inclusion and exclusion criteria, articles were searched in PubMed and EMBASE from January 1900 to September 2023. Information on PROMs from the included studies, such as development language, target population, (sub)scales name, number of items per (sub)scale, completion time, and validation, was extracted and synthesized. The frequency with which PROMs were utilized in the included studies was also graphed. After innovatively classifying PROMs as five categories, all of the included PROMs were allocated to their respective categories., Results: A total of 330 articles fulfilled all of the criteria, and they utilized 96 different PROMs to measure HRQOL in DTC patients. The 96 PROMs were classified into five categories, namely universal PROMs (16/96), DTC-related PROMs (11/96), radioiodine-related PROMs (4/96), operation-related PROMs (37/96), and psychology-related PROMs (28/96). Among them, some PROMs were the frequently employed PROMs to assess diverse aspects of HRQOL in patients with DTC., Conclusion: A large number of PROMs are available for patients with DTC, which evaluate all aspects of HRQOL. Combining the relevant information and frequency of PROMs utilization, it can provide convenience and reference for researchers to select PROMs across different categories. However, a more detailed critical appraisal of the PROMs used in various clinical scenarios is required. Additionally, PROMs usage frequency in previous studies can indirectly indicate the comprehensiveness or gaps in HRQOL aspects studied, guiding further review or research., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: The objective of this study is to summarize the clinical characteristics, treatment, and prognosis of parotid tumors in children and adolescents., Methods: Fifty-three children and adolescents diagnosed with parotid gland tumors were included. Survival was evaluated using the Kaplan-Meier method. Log-rank test and multivariate analysis were used to analyze the association between clinical factors and recurrence., Results: Of the 53 patients, 30 cases were benign and 23 cases were malignant. All patients underwent surgery. Patients with malignant tumors with high-risk factors received radiotherapy or chemotherapy. The median follow-up time was 61 months. Of these, 1 patient with benign tumor and 5 patients with malignant tumors recurred. Of the patients with malignant tumors, 2 developed distant metastases and 2 died. The 5-year overall survival (OS) and 5-year locoregional recurrence-free survival (LRFS) rates for benign tumors were 100.0% and 92.9%, respectively, whereas the 5-year OS and 5-year LRFS rates for malignant tumors were 94.4% and 72.5%, respectively. The log-rank univariate test showed that tumor size >3.5 cm ( p  = .056), distant metastasis ( p  = .056), and stage III and IV ( p  = .032) were associated with recurrence. However, multivariate analysis did not show the above factors to be independent prognostic factors for LRFS., Conclusion: Surgery for benign tumors depends on the location and size. Surgery for malignant parotid tumors depends mainly on the stage, grade, pathological type, and recurrence. Prophylactic lymph node dissection is required for high-grade tumors. Radiotherapy or chemotherapy for children needs more research. Both benign and malignant tumors have high survival rates after active treatment., Level of Evidence: Level 2., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Background: Although there are many reasons for extubation failure, maintaining negative or lower positive fluid balances 24 hours before extubation may be a key measure for successful extubation., Aim: To assess the predictive value of fluid balance before extubation and its outcome in mechanically ventilated cases in the intensive care unit (ICU)., Study Design: This retrospective cohort study involved collecting clinical data from patients undergoing mechanical ventilation in Lanzhou general adult ICU from January 2022 to December 2022. Based on extubation outcomes, the patients were divided into a successful extubation group and a failed extubation group. Their fluid balance levels 24 h before extubation were compared with analyse the predictive value of fluid balance on extubation outcomes in patients undergoing mechanical ventilation., Results: In this study, clinical data from 545 patients admitted to a general adult ICU were collected. According to the inclusion and exclusion criteria, 265 (48.6%) patients were included, of which 197 (74.3%) were successfully extubated; extubation was unsuccessful in 68 (25.7%) patients. The total intake and fluid balance levels in patients in the failed extubation group 24 h before extubation were significantly higher than those in the successful extubation group, with a median of 2679.00 (2410.44-3193.50) mL versus 2435.40 (1805.04-2957.00) mL, 831.50 (26.25-1407.94) mL versus 346.00 (-163.00-941.50) mL. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for predicting extubation outcomes was 497.5 mL (sensitivity 64.7%, specificity 59.4%) for fluid balance 24 h before extubation. The area under the ROC curve was 0.627 (95% confidence interval [CI] 0.547-0.707). Based on the logistic regression model, cumulative fluid balance >497.5 mL 24 h before extubation could predict its outcomes in mechanically ventilated patients in the ICU (OR = 5.591, 95% CI [2.402-13.015], p < .05)., Conclusions: The fluid balance level 24 h before extubation was correlated with the outcome of extubation in mechanically ventilated patients in the ICU. The risk of extubation failure was higher when the fluid balance level was >497.5 mL., Relevance to Clinical Practice: Tracheal intubation is a crucial life support technique for many critically ill patients, and determining the appropriate time for extubation remains a challenge for clinicians. Although there are many reasons for extubation failure, acute pulmonary oedema caused by continuous positive fluid balance and volume overload is one of the main reasons for extubation failure. Therefore, it is very important to study the relationship between fluid balance and extubation outcome to improve the prognosis of patients with invasive mechanical ventilation in ICU., (© 2024 British Association of Critical Care Nurses.)

Introduction: We previously made a detailed expansion to the gasless transaxillary endoscopic thyroidectomy(GTET) procedure described in the previous literatures. In this study, we optimized the procedure focused on the limitation of the approach in terms of trauma and lymph node dissection and made a comparison with the early procedure., Materials and Methods: This paper gave a detailed description of the updated procedure and prospectively collected data about patients with papillary thyroid carcinoma(PTC) performed by the two procedures from December 2020 to April 2023. The differences in surgical outcome, surgical trauma and parathyroid gland(PG) function protection were analyzed., Results: Of the 302 patients, 184 underwent with early procedure(EP), and 118 underwent with updated procedure(UP). The surgical outcomes of operative time, time of thyroidectomy and central neck dissection, blood loss, drainage and postoperative hospital stay were shorter in UP than that of the EP. The mean number of lymph nodes retrieved and weight of dissection lymphatic tissue in the UP were significantly more than that in EP without increasing the mean number of metastatic lymph nodes. Postoperative complications did not differ between the two procedures. The UP had more advantages in the identification and preservation of the superior parathyroid gland, however, it did not improve the preservation in situ of the inferior parathyroid gland. The visual analog scale score for pain and the changes among inflammation factors was lower in the UP., Conclusion: The UP of GTET could perform safely and efficiently while reducing surgical trauma in selected patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhou, Shui, Ma, Cai, Sun, Jiang, Zeng, Wang, Xu, Huang and Li.)

Far lateral disc herniations account for between 7% and 12% of all disk herniations and occur predominantly at L3/4 and L4/5.1,2 They can cause severe radicular pain due to dorsal root ganglion involvement and are exacerbated by lateral bending to the side of the lesion. Back pain is less of a feature with this pathology.3 The Wiltse approach was first described in the 1960s as an approach to L5/S1 noninstrumented fusion for isthmic spondylolisthesis4; its use in pedicle screws and far lateral discs was described in 1988.5 It has been shown to reduce muscle atrophy, wound infection, and blood loss.6,7 The Wiltse approach for a far lateral disc herniation provides a direct route to the disc pathology and as such is useful in cases with this isolated pathology. It confers less extensive muscle dissection and therefore less postoperative pain, minimal bone resection with preservation of the integrity of the facet joint, and it does not rely on endoscopy (rather the traditional operating microscope). It can also be used where endoscopy is contraindicated such as in revision cases. Here we present the case of a 53-year-old woman who presented with several weeks of back pain and right L3 radiculopathy, as well as right hip flexion and knee extension weakness. A Wiltse approach microdiscectomy was proposed for her far lateral disk herniation, and the patient consented to the procedure. At 6 weeks of follow-up, her radicular pain had resolved and there was improvement in hip flexion and knee extension. Image at 5:50 of Surgical Video is used with permissions from the Wiltse, L, Bateman, JD, Hutchinson, RH, and Nelson, WE. The Paraspinal Sacrospinalis-Splitting Approach to the Lumbar Spine. J Bone Joint Surg Am. 1968;50(5):919-926. Copyright © 1968 by The Journal of Bone and Joint Surgery, Inc., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Surgical Site Infection (SSI) is one of the common postoperative complications after hysterectomy for endometrial cancer (EC). Previous studies have investigated the risk factors for SSI in patients with EC. However, big differences in research results exist, and the correlation coefficients of different research results are quite different. A meta-analysis was conducted to examine the risk factors related to SSI in patients with EC. We searched English databases to collect case-control studies or cohort studies published before July 20, 2023, including PubMed, Web of Science, Embase and ScienceDirect. The risk of bias in the included studies was assessed via Newcastle-Ottawa Scale. The analysis was performed using RevMan 5.4.1 tool. A total of 6 articles (n = 3647) were selected in this meta-analysis. The following risk factors were presented to be significantly correlated with SSI in EC: laparotomy (OR = 2.66, 95% CI [1.57, 4.54]), postoperative blood sugar ≥10 mmol/L (OR = 4.38, 95% CI [2.83, 6.78]), Federation International of Gynaecology and Obstetrics (FIGO) stage-III or IV (OR = 2.27, 95% CI [1.49, 3.46]). The occurrence of SSI is influenced by a variety of factors. Thus, we should pay close attention to high-risk subjects and take crucial targeted interventions to lower the SSI risk after hysterectomy. Owing to the limited quality and quantity of the included studies, more rigorous studies with adequate sample sizes are needed to verify the conclusion., (© 2023 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Radical cure and functional preservation of tumors are the fundamental goals of surgical treatment of head and neck tumors, and the preservation of good aesthetics is a higher pursuit on this basis. Fully hiding the surgical incision and reducing the visibility of scars are important goals of cosmetic surgery. Using complete endoscopy for the head and neck is an effective method. CO 2 -free transaxillary total endoscopic surgery is a method with many advantages, which has been widely used in the resection of thyroid tumors, but for other parts and types of tumors in the head and neck, this surgical method is rarely used. The research team expanded its application scope and applied it to submandibular gland tumor resection and other head and neck surgeries for the first time. Through this exploration, it improved traction devices such as retractors, strictly limited the surgical indications, analyzed and summarized the key points, steps and methods of surgery, and built a treatment system for head and neck tumor surgery under complete endoscopy using the non-inflatable transaxillary approach. In this article, we introduce the system and select typical cases to share., (© 2023. The Author(s).)

Learning knowledge from different tasks to improve the general learning performance is crucial for designing an efficient algorithm. In this work, we tackle the Multi-task Learning (MTL) problem, where the learner extracts the knowledge from different tasks simultaneously with limited data. Previous works have been designing the MTL models by taking advantage of the transfer learning techniques, requiring the knowledge of the task index, which is not realistic in many practical scenarios. In contrast, we consider the scenario that the task index is not explicitly known, under which the features extracted by the neural networks are task agnostic. To learn the task agnostic invariant features, we implement model agnostic meta-learning by leveraging the episodic training scheme to capture the common features across tasks. Apart from the episodic training scheme, we further implemented a contrastive learning objective to improve the feature compactness for a better prediction boundary in the embedding space. We conduct extensive experiments on several benchmarks compared with several recent strong baselines to demonstrate the effectiveness of the proposed method. The results showed that our method provides a practical solution for real-world scenarios, where the task index is agnostic to the learner and can outperform several strong baselines, achieving state-of-the-art performances., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: To compare the efficacies between open surgery and axillary non-inflatable endoscopic surgery in papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was performed on 343 patients with unilateral PTC treated by traditional open surgery (201 cases) and transaxillary non-inflating endoscopic surgery (142 cases) from May 2019 to December 2021 in the Head and Neck Surgery of Sichuan Cancer Hospital. Among them, 97 were males and 246 were females, aged 20-69 years. 1∶1 propensity score matching (PSM) was performed on the enrolled patients, and the basic characteristics, perioperative clinical outcomes, postoperative complications, postoperative quality of life (Thyroid Cancer-Specific Quality of Life), aesthetic satisfaction and other aspects of the two groups were compared after successful matching. SPSS 26.0 software was used for statistical analysis. Results: A total of 190 patients were enrolled after PSM, with 95 cases in open group and 95 cases in endoscopic group. Intraoperative blood losses for endoscopic and open groups were [20 (20) ml vs . 20 (10) ml, M (IQR), Z =-2.22], postoperative drainage volumes [170 (70)ml vs . 101 (55)ml, Z =-7.91], operative time [135 (35)min vs . 95 (35)min, Z =-7.34], hospitalization cost [(28 188.7±2 765.1)yuan vs . (25 643.5±2 610.7)yuan, x¯±s, t =0.73], postoperative hospitalization time [(3.1±0.9)days vs . (2.6±0.9)days, t =-3.24], and drainage tube placement time [(2.5±0.8) days vs . (2.0±1.0)days, t =-4.16], with statistically significant differrences (all P <0.05). There was no significant difference in surgical complications ( P >0.05). There were significant diffferences between two groups in the postoperative quality of life scores in neuromuscular, psychological, scar and cold sensation (all P <0.05), while there were no statistically significant differences in other quality of life scores (all P >0.05). In terms of aesthetic satisfaction 6 months after surgery, the endoscopic group was better than the open group, with statistically significant difference ( χ 2 =41.47, P <0.05). Conclusion: Endoscopic thyroidectomy by a gasless unilateral axillary approach is a safe and reliable surgical method, which has remarkable cosmetic effect and can improve the postoperative quality of life of patients compared with the traditional thyroidectomy.

Objective: To investigate the clinicopathological characteristics and the survival of re-operated patients for persistent/recurrent papillary thyroid carcinoma (PTC) and risk factors for re-recurrence after the second operation. Method: A retrospective analysis of 69 cases underwent re-operation for persistent/recurrent PTC in Sichuan Cancer Hospital from January 2010 to December 2016 was performed. There were 21 males and 48 females, aged 14-85 (44.8) years old. According to the imaging after initial treatment, they were divided into a recurrence group (42 cases) and a persistent disease/residual group (27 cases). The positive rates of ipsilateral paratracheal lymph node metastases at re-operation were calculated and compared by chi-square test. Patients were divided into different subgroups according to potential risk factors for re-recurrence. Kaplan-Meier (K-M) method was used for survival analysis. Results: The positive rate of ipsilateral paratracheal lymph node metastasis in recurrence group (15/42, 35.7%) was significantly lower than that in the persistent disease/residual group (17/27, 63.0%) (χ 2 =4.91, P <0.05). The follow-up period after re-operation was 60-104 months, with a median of 66 months, and 8 patients were lost to follow-up. Permanent hypoparathyroidism occurred in 2 cases (2.9%) and permanent recurrent laryngeal nerve palsy in 1 case (1.4%). Twenty patients had structural recurrences and/or distant metastases. The 5-year disease-specific survival rate was 92.8% and the 5-year recurrence-free survival rate was 68.1%. Survival analysis was performed on risk factors such as age≥55 years old, recurrent tumor diameter ≥4 cm, number of positive lymph nodes ≥ 10, and obvious extracapsular invasion (ENE). Among them, age and diameter of recurrent tumor had significant influences on recurrence-free survival rate (χ 2 was 6.36, 8.17, respectively, both P values<0.05). There was a statistically significant difference in recurrence-free survival rates between ENE(+) group and ENE(-) group (χ 2 =5.52, P <0.05). Conclusion: For the re-operated patients due to persistence/ recurrence PTC, attention should be paid to protecting the parathyroid gland and recurrent laryngeal nerve during re-operation. Timely and effective postoperative follow-up for patients aged ≥ 55 years, with recurrent tumor diameter ≥ 4 cm and ENE(+), can significantly improve their prognoses.

Objective: To compare the long-term survival between laparoscopic surgery and open surgery in patients with apparent early-stage uterine clear cell carcinoma (UCCC)., Patients and Methods: 254 patients with apparent early-stage UCCC were reviewed. Comparisons were made between patients who underwent laparoscopic surgery versus those who underwent open surgery. Baseline data, clinicopathological data, and oncological outcomes were analyzed. 5-year disease-free survival (DFS) rate and 5-year overall survival (OS) rate were estimated and compared using the Kaplan-Meier method and the Log-rank test. The Cox proportional hazard regression model was employed to control the confounding factors., Results: 147 patients underwent laparoscopic surgery, and 107 patients were managed by open surgery. No differences in terms of recurrence rate (laparoscopy versus laparotomy: 10.9% versus 12.9%, P =0.842) and recurrence pattern were observed. For patients who underwent open surgery and patients who underwent laparoscopic surgery, the 5-year DFS rates and 5-year OS rate were 75.8% (95% CI: 65.8%-83.2%) and 69.1% (95% CI: 58.8%-77.4%), 66.0% (95% CI: 57.1%-73.5%) and 60.8% (95% CI: 52.0%-68.5%), respectively. The Cox proportional hazards regression model shown that for apparent early-stage UCCC, the approach of surgical staging was not an independent predictor for survival (laparoscopy versus laparotomy: for DFS, aHR=1.06, 95% CI=0.64-1.75, P =0.826; for OS, aHR=1.10, 95% CI=0.72-1.68, P =0.671)., Conclusion: For apparent early-stage UCCC, in terms of oncological survival, laparoscopic surgery was as safe as open surgery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Shui, Ran, Tian, Qin, Gu, Xu, Hu, Zhang, Xu, Cheng and Huan.)

The rhizosphere context of inulin-accumulating plants, such as Jerusalem artichoke (Helianthus tuberosus), is an ideal starting basis for the discovery of inulolytic enzymes with potential for bio fructose production. We isolated a Glutamicibacter mishrai NJAU-1 strain from this context, showing exo-inulinase activity, releasing fructose from fructans. The growth conditions (pH 9.0; 15 °C) were adjusted, and the production of inulinase by Glutamicibacter mishrai NJAU-1 increased by 90% (0.32 U/mL). Intriguingly, both levan and inulin, but not fructose and sucrose, induced the production of exo-inulinase activity. Two exo-inulinase genes (inu1 and inu2) were cloned and heterologously expressed in Pichia pastoris. While INU2 preferentially hydrolyzed longer inulins, the smallest fructan 1-kestose appeared as the preferred substrate for INU1, also efficiently degrading nystose and sucrose. Active site docking studies with GFn- and Fn-type small inulins (G is glucose, F is fructose, and n is the number of β (2-1) bound fructose moieties) revealed subtle substrate differences between INU1 and INU2. A possible explanation about substrate specificity and INU's protein structure is then suggested. KEY POINTS: • A Glutamicibacter mishrai strain harbored exo-inulinase activity. • Fructans induced the inulolytic activity in G. mishrai while the inulolytic activity was optimized at pH 9.0 and 15 °C. • Two exo-inulinases with differential substrate specificity were characterized., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Head and neck squamous cell carcinoma (HNSCC) is one severe malignancy driven by complex cellular and signaling mechanisms. However, the roles of circular RNAs (circRNAs) in HNSCC's development remains poorly understood. Therefore, this study investigated the functions of differentially expressed circRNAs in regulating HNSCC cell functions., Methods: Differentially expressed circRNAs were characterized through RNA sequencing in HNSCC tissues. CircRNA's identity was then confirmed using RT-PCR and Sanger's sequencing. Next, expression levels of circRNA and mRNA were detected by qRT-PCR, after which protein abundances were measured by Western blotting. Subsequently, the proliferation, migration, and invasion of HNSCC cells was assessed by MTS, wound healing, and Transwell system, respectively, followed by identification of circRNA-binding proteins in HNSCC cells by circRNA pull-down, coupled with mass spectrometry., Results: Great alterations in circRNA profiles were detected in HNSCC tissues, including the elevated expression of circ&#95;0000045. As observed, silencing of circ&#95;0000045 effectively repressed the proliferation, migration, and invasion of HNSCC cell lines (FaDu and SCC-9). Contrarily, circ&#95;0000045's overexpression promoted the proliferation, migration, and invasion in FaDu and SCC-9 cells. Results also showed that circ&#95;0000045 was associated with multiple RNA-binding proteins in HNSCC cells, such as HSP70. Moreover, circ&#95;0000045 knockdown enhanced HSP70 expression and inhibited JNK2 and P38's expression in HNSCC cells, which were oppositely regulated by circ&#95;0000045's overexpression., Conclusion: The high expression of circ&#95;0000045; therefore, promoted cell proliferation, migration, and invasion during HNSCC's development through regulating HSP70 protein and mitogen-activated protein kinase signaling., (© 2022. The Author(s).)