To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

To investigate the effect of granulocyte colony-stimulating factor receptor (G-CSFR) on the expression of syndecan-4 (SDC4) in endothelial cells during sepsis-associated acute lung injury (ALI) and its regulatory mechanisms.

A total of 30 C57bl/6 mice were randomly divided into three groups using a random number table: a negative control group (sham group, intraperitoneal injection of an isotonic NaCl solution of equal concentration), a sepsis-associated ALI group [lipopolysaccharide (LPS) group, intraperitoneal injection of 20 mg/kg LPS], and a LPS combined with short hairpin RNA targeting G-CSFR (shG-CSFR) intervention group [LPS + shG-CSFR group, intratracheal injection of shG-CSFR followed by intraperitoneal injection of LPS], with 10 mice in each group. Hematoxylin-eosin staining, immunofluorescence staining and real-time quantitative PCR were used to detect the expression levels of inflammatory factors, the degree of inflammatory damage, and the fluorescence intensities of G-CSFR and SDC4 in lung tissue. For in vitro experiments, pulmonary microvascular endothelial cells were subjected to LPS stimulation, lentivirus overexpression, and PP2 [a non-receptor tyrosine kinase (SRC) inhibitor] treatment. RNA sequencing (RNA-seq), real-time quantitative PCR, and western-blotting were used to identify differentially expressed genes following G-CSFR overexpression in pulmonary microvascular endothelial cells and to investigate the effects of different G-CSFR expression levels on downstream SDC4 expression, as well as the activation status of the phosphorylation SRC (pSRC)/nuclear factor-kappaB (NF-κB) pathway.

Compared with the sham group, the LPS group exhibited significantly higher expression levels of tumor necrosis factor-alpha, interleukin-6 (IL-6), and IL-1β in lung tissue, as well as higher inflammatory damage scores; meanwhile, these changes were significantly attenuated by shG-CSFR-mediated gene interference (all P < 0.05). RNA-seq showed that G-CSFR overexpression further increased SDC4 expression [(66 ± 12) in the LPS group vs. (152 ± 19) in the LPS + shG-CSFR group, t = 43.575, q < 0.001], and the Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway involving SDC4 was enriched in the extracellular matrix receptor interaction. LPS stimulation significantly increased SDC4 expression in pulmonary microvascular endothelial cells, and G-CSFR overexpression further enhanced SDC4 messenger RNA and protein in the LPS + shG-CSFR group as compared with the LPS group, accompanied by increased levels of pSRC and phosphorylation pNF-κB/NF-κB (all P < 0.05). Moreover, treatment with PP2 significantly suppressed the expression of pNF-κB/NF-κB and SDC4.

In the context of sepsis-associated ALI, activation and overexpression of G-CSFR in endothelial cells lead to activation of the intracellular pSRC/NF-κB pathway, resulting in overexpression of the inflammatory coordinating factor SDC4, which aggravates inflammation.

To investigate the relationship between peripheral blood microRNA-125a-5p (miR-125a-5p) and miR-483-3p expression and cardiac function, ischemia-reperfusion injury (IRI), and prognosis in patients with acute myocardial infarction (AMI).

A prospective cohort study was conducted; 136 patients with AMI (AMI group) and 136 healthy volunteers (control group) admitted to Yangling Demonstration Zone Hospital from September 2020 to September 2023 were selected. Patients with AMI were divided into a group Ⅰ-Ⅱ (n = 85) and a group Ⅲ-Ⅳ (n = 51) by Killip class, and also divided into an IRI group (n = 63) and a non-IRI group (n = 73) by IRI occurrence. Patients with AMI were followed up for one year after discharge, with two patients lost. The remaining patients were divided into a good prognosis group (n = 89) and a poor prognosis group (n = 45) according to the prognosis. Peripheral blood miR-125a-5p and miR-483-3p expression levels in all subjects were detected within 24 hours after enrollment, and the differences between groups were compared. Multivariate logistic regression analysis was applied to discover the factors influencing the prognosis of patients with AMI. Based on the analysis results, a combined prediction model was constructed, and a receiver operating characteristic (ROC) curve was used to analyze the predictive value of each indicator individually and jointly in predicting the prognosis of patients with AMI, followed by internal validation.

Peripheral blood miR-125a-5p expression was significantly higher and miR-483-3p expression was significantly lower in the AMI group than in the control group (both P < 0.05), in the group Ⅲ-Ⅳ than in the group Ⅰ-Ⅱ (both P < 0.05), and in the IRI group than in the non-IRI group (both P < 0.05). Killip class Ⅲ-Ⅳ, IRI, and high miR-125a-5p expression were independent risk factors for poor prognosis in patients with AMI, while high miR-483-3p expression was a protective factor (all P < 0.05). The area under the curve (AUC) of peripheral blood miR-125a-5p, miR-483-3p, Killip class Ⅲ-Ⅳ, and IRI for predicting poor prognosis in patients with AMI was 0.785, 0.804, 0.670, and 0.664, and the AUC of the combined prediction model was 0.897. The Delong test demonstrated that the AUC of the combined prediction model was higher than that of peripheral blood miR-125a-5p, miR-483-3p, Killip class Ⅲ-Ⅳ, and IRI alone (Z = 2.637, 2.497, 2.917, 3.017; P = 0.010, 0.014, 0.004, 0.003). The concordance index was 0.684, indicating that the model's predicted results were highly consistent with the actual situation.

High miR-125a-5p and low miR-483-3p expression in peripheral blood are associated with impaired cardiac function, IRI, and poor prognosis in patients with AMI; combining miR-125a-5p, miR-483-3p, Killip class, and IRI can effectively predicting the risk of poor prognosis in these patients.

To investigate the relationship between serum sodium variability within different time windows (0-3 d, 0-7 d, and 0-28 d) after admission to the ICU and the risk of death in patients with cardiac arrest (CA).

Based on the Medical Information Mart for Intensive Care-Ⅳ of the United States, 6 196 CA patients with complete outcome data were included. Serum sodium variability was calculated respectively in the three time windows of 0-3 days, 0-7 days, and 0-28 days, and grouped according to quartiles (Q1-Q4). The highest quartile (Q4) was regarded as the high variability group, and Q1 to Q3 were combined as the low variability group. Demographic characteristics, admission type, laboratory indicators on the first day of ICU admission, and coagulation sub-item scores and total laboratory scores of sequential organ failure assessment (SOFA) were set as covariates, and serum sodium variability was used as the main exposure variable. The propensity score inverse probability of treatment weighting (IPTW) was used to balance the baseline confounding factors among groups, and logistic regression was performed to analyze the influence of serum sodium variability on the mortality of patients with CA.

Among the 6 196 CA patients, the number of effective analysis cases that met the requirement of having at least two daily mean values of serum sodium after washing for calculable variability was 5 564, 5 590, and 5 624 within the time windows of 0-3 days, 0-7 days, and 0-28 days, respectively. After IPTW correction, in the 0-28 days window, the risk of death in the high variability group was significantly higher than that in the low variability group [odds ratio (OR) = 1.950, 95% confidence interval (CI) (1.700, 2.238), P < 0.001]; the results of 0-3 days [OR = 1.411, 95%CI (1.117, 1.782), P = 0.004] and 0-7 days [OR = 1.579, 95%CI (1.335, 1.868), P < 0.001] time windows showed consistent trends.

The high serum sodium variability within different time windows after ICU admission is associated with an increased mortality risk in CA patients, suggesting that the fluctuation range of serum sodium can be used as a reference indicator for prognostic risk stratification in these patients.

To evaluate the non-linear association and threshold effect between serum anion gap (AG) levels on the first day of ICU admission and the risk of delirium during the ICU stay in acute pancreatitis (AP) patients.

This retrospective study utilized the medical information mart for intensive care-Ⅳ (MIMIC-Ⅳ) database, including adult AP patients admitted to the ICU for the first time between 2008 and 2019. The primary exposure variable was the AG value first measured within 24 hours of ICU admission and the primary outcome was the occurrence of delirium during the ICU stay. Multivariate logistic regression models, adjusting for demographic characteristics, disease severity, and other key clinical variables, were used to assess the independent association between AG and delirium. Generalized additive models (GAM) and two-piecewise linear regression models were employed to explore its non-linear relationship and potential threshold.

A total of 890 AP patients were included, of whom 237 (26.6%) experienced delirium during their ICU stay. After multivariate logistic regression models adjustment, the overall AG was not significantly associated with the delirium risk [odds ratio (OR) = 1.028, 95% confidence interval (CI) (0.993, 1.064), P = 0.117]. However, GAM and two-piecewise linear regression analysis revealed a significant non-linear relationship between AG and delirium, with a threshold of 14.0 mmol/L. Specifically, when AG was < 14.0 mmol/L, an increase of 1.0 mmol/L in AG was associated with a 15.5% increased risk of delirium [OR = 1.155, 95%CI (1.018, 1.310), P = 0.025]; when AG was ≥ 14.0 mmol/L, the association was not statistically significant [OR = 1.005, 95%CI (0.963, 1.048), P = 0.827].

Serum AG levels on the first day of ICU admission in AP patients are non-linearly associated with the risk of delirium during ICU stay, with a positive correlation only present when AG is below approximately 14.0 mmol/L. AG, as a routine, convenient, and cost-effective metabolic indicator, has potential value in early delirium risk stratification for AP patients, offering a reference for clinical warning and targeted interventions.

To analyze the perioperative and long-term survival outcomes of robotic-assisted thoracoscopic surgery (RATS) in the treatment of patients with non-small cell lung cancer (NSCLC) based on the 13-year clinical practice at Shanghai Chest Hospital.

Consecutive patients with NSCLC who underwent RATS lung surgery at Shanghai Chest Hospital from May 2009 to May 2022 were retrospectively enrolled. Baseline demographic characteristics, perioperative parameters, and long-term survival outcomes were analyzed.

A total of 1 798 patients were included, consisting of 786 males (43.7%) and 1 012 females (56.3%), with a mean age of (59.4±9.1) years. There were 1 557 cases (86.6%) of lobectomy, 112 cases (6.2%) of segmentectomy, and 129 cases (7.2%) of wedge resection. The mean tumor diameter was (2.4±1.1) cm, and adenocarcinoma accounted for the predominant pathological type (90.3%). The mean operative duration was (101.9±28.5) minutes. 80.9% of patients had intraoperative blood loss ≤100 mL, the conversion rate to thoracotomy was 3.8%, and 99.2% of patients achieved negative surgical margins. The mean number of dissected lymph node stations was 5.5±1.6, with a mean of 11.2±5.2 lymph nodes retrieved. The mean postoperative chest tube drainage volume was (710.5±268.3) mL over a mean drainage duration of (3.2±1.8) days, and the mean postoperative hospital stay was (4.5±2.1) days. Postoperative complications occurred in 332 patients (18.5%), among whom 23 cases (1.3%) had severe complications. Survival analysis revealed that the 5-year recurrence-free survival (RFS) rate and overall survival (OS) rate were 82.5% and 88.8%, respectively. Further multivariable Cox regression analyses showed that age, histological subtype, pathological TNM stage, and neoadjuvant therapy were independent prognostic factors for RFS and OS.

RATS is associated with limited intraoperative blood loss, a low conversion rate to thoracotomy, a low postoperative complication rate, and favorable long-term survival outcomes. In our center’s clinical experience, RATS demonstrates favorable perioperative safety profiles and acceptable long-term oncological outcomes, making it a viable surgical approach for NSCLC.

To retrospectively evaluate the perioperative outcomes and safety of port-only four-arm robotic-assisted precision pulmonary segmentectomy performed under artificial pneumothorax in a single-center cohort, and to explore the technical value of this approach in improving exposure of the deep operative field and facilitating complex segmental resections.

Clinical data were retrospectively collected from patients who underwent totally portal four-arm robotic-assisted pulmonary segmentectomy at our center between May 2022 and December 2025. All procedures were performed using the da Vinci Xi robotic system under a fully closed artificial pneumothorax. Preoperative individualized planning was based on thin-section computed tomography (CT) and three-dimensional CT bronchography and angiography (3D-CTBA). Intraoperatively, coordinated four-arm traction, meticulous dissection using Maryland bipolar forceps, and indocyanine green (ICG) near-infrared fluorescence imaging were applied to assist in identifying the intersegmental plane. Primary outcomes included operative time, estimated blood loss, conversion to thoracotomy, postoperative drainage parameters, chest tube duration, length of postoperative hospital stay, and postoperative complications.

A total of 271 patients were included. The mean age was (58.3±10.3) years; 186 patients (68.6%) were female, and 69 (25.5%) had a history of smoking. Postoperative pathology revealed invasive adenocarcinoma as the predominant histological type (65.3%), followed by minimally invasive adenocarcinoma (21.4%). The mean operative time was (117.8±31.0) min, and the median estimated blood loss was 40 mL (range, 0–200 mL). One patient (0.4%) required conversion to thoracotomy. The mean postoperative drainage volume was (485.2±440.2) mL, the mean chest tube duration was (2.9±1.3) days, and the mean postoperative hospital stay was (4.3±1.5) days. Chest tube drainage lasting >7 days occurred in 4 patients (1.5%). The mean number of dissected lymph node stations was 4.34±2.03, with a mean of 7.07±4.92 lymph nodes retrieved. R0 resection was achieved in all patients (271/271, 100%). 244 (90.0%) experienced no postoperative complications. Clavien-Dindo grade Ⅰ and grade Ⅱ complications occurred in 23 (8.5%) and 3 (1.1%) patients, respectively, while persistent postoperative air leak was observed in 1 patient (0.4%).

Port-only four-arm robotic-assisted precision pulmonary segmentectomy under artificial pneumothorax is feasible and demonstrates favorable perioperative outcomes and safety in a single-center retrospective cohort. Beyond minimizing surgical incisions, this approach enables centralized control of the camera and traction by the primary surgeon, thereby reducing exposure-related variability associated with assistant-dependent maneuvers. Coupled with wristed robotic instruments, it may improve the precision of deep small-vessel dissection and intersegmental plane management, providing a practical technical strategy for complex precision pulmonary segmentectomy.

This paper systematically reviews the evolution and future prospects of thoracoscopic minimally invasive esophagectomy (MIE) in China over the past three decades. The developmental trajectory of MIE in China from the early 1990s to the present was analyzed, focusing on instrument innovation, surgical approach evolution, breakthroughs in key techniques, and the shift in comprehensive treatment paradigms. In the early 1990s, in response to the significant trauma and high morbidity associated with traditional open transthoracic esophagectomy, Chinese thoracic surgeons initiated minimally invasive exploration despite challenges such as reliance on imported instruments, lack of technical precedents, and conservative mindsets. Over the past thirty years, the field has achieved a comprehensive leap: surgical instruments have evolved from "homemade adaptations" to sophisticated domestic manufacturing and intelligent systems; surgical approaches have diversified from video-assisted thoracoscopic surgery to totally thoracoscopic, robot-assisted, uniportal, and mediastinoscopic techniques. Critical breakthroughs have been made in the semi-prone position approach, tubular gastric conduit reconstruction, and the innovative anastomosis techniques. The treatment paradigm has shifted from surgery alone to perioperative multidisciplinary comprehensive therapy. Notably, several high-impact clinical trials led by Chinese researchers have been incorporated into international guidelines, signifying a shift from "following" to "leading" in the global arena. Overall, a standardized and mature technical system for MIE has been established in China. Future developments will focus on greater precision through imaging planning, intelligent robotic platforms, organ preservation strategies, and the standardization of care across regions, aiming to optimize outcomes for esophageal cancer patients with "Chinese solutions" .