Objective To investigate the efficacy and safety of stereotactic body radiotherapy (SBRT) combined with camrelizumab and apatinib in treatment of advanced hepatocellular carcinoma (HCC). Methods The clinical data were retrospectively analyzed of 85 patients with advanced HCC treated in the Fifth Affiliated Hospital of Zhengzhou University and People's Hospital of Zhengzhou from January 2019 to September 2021. They were divided into observation group (n=31, SBRT combined with camrelizumab and apatinib) and control group (n=54, treated with camrelizumab and apatinib) according to whether they received SBRT. The propensity score matching (PSM) was used to balance the influence of confounding factors. The objective remission rate (ORR) and disease control rate (DCR) were compared between the two groups. The 6-month overall survival rate, 1-year overall survival rate and progression-free survival (PFS) were compared between the two groups by Kaplan-Meier method. The safety of the two groups was evaluated by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results Before PSM, there were significant differences in age (P=0.043), number of extrahepatic metastasis (P=0.028), and previous surgical treatment (P=0.038) between the two groups. After PSM, there was no significant difference in baseline characteristics between the two groups (P>0.05). After PSM, 27 cases were included in each groups, and three months after treatment, the ORR in observation group and control group were 66.7% and 29.6%, respectively, showed difference with statistically significant (P=0.006); and the DCR in the both groups were 96.3% and 85.2% respectively, showed no statistically significant difference (P=0.175). There were statistical differences in 6-month overall survival rate (96.3% vs. 80.9%, P=0.001), 1-year overall survival rate (75.0% vs. 61.4%, P=0.034) and median PFS (8 months vs. 5 months, P=0.003) between the observation group and control group. Multi-factor Cox regression analysis showed that baseline alpha-fetoprotein (AFP) ≥400 ng/ml was an independent risk factor for affecting the survival of patients with advanced HCC (HR>1, P<0.05), while the triple therapy and previous targeted drugs therapy were the protective factors for the survival of patients with advanced HCC (HR<1, P<0.05). In the observation group, 4 patients had grade 3 adverse reactions, and the common adverse reactions were dyspepsia (14.8%). One case of grade 3 adverse reactions occurred in control group, and there was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.639). Conclusion SBRT combined with camrelizumab and apatinib is a safe and effective treatment for advanced HCC with significant clinical effect and controllable adverse reactions.

Objective To investigate the effect of dapagliflozin on cardiac function and major adverse cardiac events (MACE) in elderly patients with heart failure after acute myocardial infarction. Methods The clinical data of 59 elderly patients with heart failure after acute myocardial infarction, treated in Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology from May 2021 to February 2022, were collected and retrospectively analyzed. The objects were divided into control group (n=29) and dapagliflozin group (n=30) according to whether they took dapagliflozin during routine treatment. The cardiac function indexes [left vetricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter(LVESD)] and the level of N-terminal pro-brain natriuretic peptide (NT-proBNP); as well as clinical total effective rate, Killip grading and MACE occurrence were detected and compared at discharge and within 6 months after discharge. Results At discharge and within 6 months' treatment, the levels of LVEF increased (P<0.05), and of LVEDD, LVESD and NT-proBNP decreased (P<0.05) in the two groups than those before treatment. The level of LVEF in the dapagliflozin group was higher (P<0.05), and the levels of LVEDD, LVESD and NT-proBNP were lower in dapagliflozin group (P<0.05) than those in control group. There was no statistical difference in the clinical total effective rate between the two groups (86.7% vs. 65.5%, P>0.05) at discharge; The clinical total effective rate of dapagliflozin group was 93.3%, which was higher than control group of 62.1% within 6 months' treatment (P<0.05). Before treatment, at discharge and within 6 months' treatment, there was no statistical difference in the Killip classification between the two groups (P≥0.05). The incidence of MACE in dapagliflozin group was lower than that in control group within 6 months' treatment (P<0.05). Conclusion Compared with conventional anti heart failure therapy, combined with dapagliflozin can improve the cardiac function and prognosis, reduce the incidence of MACE of patients with heart failure after acute myocardial infarction.

Objective To investigate the EMG characteristics and clinical application value of surface EMG in cervical muscle group of children with congenital muscular torticollis (CMT). Methods A retrospective analysis was performed on 478 children diagnosed as CMT from January 2018 to August 2022 in Rehabilitation Center of the Children's Hospital Affiliated to Chongqing Medical University. The torticollis side of the same case was included in observation group and the healthy side was included in control group. Surface EMG was used to record the electromyography root-mean-square values of bilateral sternocleidomastoid muscles, platysma muscles and upper trapezius muscles in the rest and different exercise states. The difference of root-mean-square values between the affected side and the healthy side muscle groups at rest and under different exercise states and the diagnostic value were compared. Spearman correlation analysis was used to evaluate the relationship between the severity of congenital muscular torticollis on the affected side and the root mean square value of each cervical muscle group. Results The root-mean-square value of sternocleidomastoid muscle on the affected side of CMT children was higher than that on the healthy side during relaxation and lower than that on the healthy side during contraction, and the differences were statistically significant (P<0.05), the abnormal root-mean-square value of the affected side in the resting position and in all motion state has higher diagnostic value. The root-mean-square value of platysma muscle on the affected side was higher than that on the healthy side when it was in the resting position and the reverse neck rotation relaxed state (P<0.05), and lower than that on the healthy side when it was in the same neck rotation contraction state (P<0.05), abnormal values detected in resting sitting position and elevation of head have higher value. Root-mean-square value of upper trapezius muscle on the affected side was higher than that on the healthy side in the relaxed state (P<0.05). The abnormal values in sitting position, turning neck and bending head have high diagnostic value. The severity of CMT was positively correlated with the root-mean-square values of sternocleidomastoid muscle, platysma muscle, and upper trapezius muscle (r was 0.721, 0.612, 0.655, P<0.001). Conclusion sEMG could be used as a good method for the clinical diagnosis and evaluation of congenital muscular torticollis in children.

Objective To establish and validate the nomogram prediction model of degenerative lumbar disc disease in young and middle-aged people. Methods From January 2020 to March 2022, 232 young and middle-aged people who were examined with MRI of lumbar intervertebral disc and standard standing position lumbar anteroposterior and lateral X-ray films in Suzhou Ninth Hospital Affiliated to Soochow University were selected as the study subjects. Collecting the factors that may affect the occurrence of degenerative lumbar disc disease in young and middle-aged people, the people were divided into degenerative disease group (n=78) and non-degenerative disease group (n=154) according to the presence or absence of degenerative lumbar disc disease. Influencing factors were compared between the two groups, the independent influencing factors screened out by multifactor logistic regression, the nomograph model was constructed by R software, and the model verified. Results Among 232 young and middle-aged people included in this study, 78 (33.6%) had degenerative lumbar disc diseases. The results of multivariate logistic regression analysis showed that the increase of BMI, sedentariness, the increase of IL-1β level were the risk factors of degenerative lumbar disc disease in young and middle-aged people; the increase of pelvic incidence angle and the increase of miRNA-142-3p level were protective factors for degenerative lumbar disc disease in young and middle-aged people (P<0.05). The nomogram model was constructed according to the results of multifactor analysis. ROC results showed that AUC was 0.889 (95%CI 0.844-0.933, P<0.05), the average absolute error of internal validation was 0.017, the prediction curve was basically fitted with the standard curve, and the H-L goodness of fit test showed that the model was consistent (P>0.05). The decision curve shows that the clinical benefit rate is the highest when the model prediction probability threshold is 0.16-0.80. Conclusions Degenerative lumbar disc disease in young and middle-aged people is affected by such factors as BMI, sedentariness, and incidence angle of pelvis, and the nomogram model established based on this has high differentiation and accuracy of prediction.

Objectives To analyze the risk factors and their predictive value for postoperative hypoxemia in Type-A aortic dissection (TAAD). Methods A single-center retrospective study was conducted among 146 consecutive patients diagnosed as TAAD and undergone aortic arch surgery from January 2018 to June 2021 in Nanfang Hospital of Southern Medical University. According to the lowest postoperative PaO₂/FiO₂ ratio within 24 hours, the patients were classified into two groups: hypoxemia group (PaO₂/FiO₂ ≤200 mmHg) and non-hypoxemia group (PaO₂/FiO₂ >200 mmHg). The difference of preoperative oxygen index, duration of mechanical ventilation and mortality in hospital were analyzed between the two groups. The independent risk factors for postoperative hypoxemia were evaluated by multivariate logistic regression and the predictive value was analyzed by receiver operator character (ROC) curves. Results For TAAD patients, the incidence of postoperative hypoxemia was 45.9%. Compared to non-hypoxemia group, hypoxemia group exhibited longer duration of mechanical ventilation (P<0.001) and longer intensive care unit (ICU) length of stay (P<0.05). Moreover, patients with hypoxemia presented higher mortality during hospital (P=0.011). Multivariate regression analysis identified BMI as independent risk factor (OR=1.701, P<0.001) and preoperation PaO₂/FiO₂ ratio as protective factors for postoperative hypoxemia in patients with TAAD (OR=0.987, P=0.004). Area under the ROC curve of BMI was 0.848, the optimal cut-off point of BMI was 25.8 kg/m². Area under the ROC curve of pre-operation PaO₂/FiO₂ ratio was 0.808, the optimal cut-off point of preoperation PaO₂/FiO₂ ratio was 265 mmHg. Conclusions BMI higher than 25.8 kg/m² is an independent risk factor and preoperation PaO₂/FiO₂ ratio higher than 265 mmHg is a protective factor for postoperative hypoxemia in patients with TAAD. Subjects with hypoxemia had longer duration of mechanical ventilation, ICU stay and higher mortality.

Objective To report 5 cases of amyloid arthropathy with joint flexion contracture as the first manifestation, and perform a literature review to improve the understanding of the disease. Methods Retrospective analysis of the clinical manifestations, laboratory and imaging results clinical data of patients with immunoglobulin light chain (AL) amyloidosis related amyloid arthropathy with joints flexion contracture as the first manifestation at the Department of Rheumatology and Immunology, the First Medical Center of People's Liberation Army General Hospital from January 2012 to February 2022. Meanwhile searching the database (CNKI, Wanfang Data, PubMed), excluding myeloma-associated amyloid arthropathy, and analyzing the literature results comprehensively. Results There were a total of 5 patients with amyloid arthropathy with joint flexion contracture as the initial manifestation in this center, including 4 males and 1 female. By February 2022 (searching CNKI, Wanfang Data and PubMed), two eligible patients were selected, all males. A total of 7 patients were included with male-to-female ratio of 6:1. The median age was 30-year-old (range from 19 to 73). Spine and limb joints were involved, especially finger joints (7 cases, 100%). Soft tissue was involved in 5 patients (71.4%), carpal tunnel syndrome in 4 patients (57.1%), giant tongue in 3 patients (42.9%), shoulder pad sign in 2 patients (28.6%), muscle swelling in 2 patients (28.6%). Five patients were misdiagnosed as rheumatoid arthritis (RA) and 1 patient was misdiagnosed as spondyloarthritis (SpA). The median time of delayed diagnosis was 24 months (2-204 months). The laboratory results showed that 3 patients (42.9%) were positive for immunoelectrophoresis, all of which were λ light chain. Only 1 patient was positive for HLA-B27, while the other patients were negative for autoantibodies and rheumatoid factors. Only 1 patient had elevated C reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Ultrasound examination of the lesion site of 5 patients (71.4%) showed hypoechoic area around the joint, thickening of ligaments or periarticular tenosynovitis. Five patients (71.4%) underwent X-ray examination, of which 4 patients had no bone destruction, 1 patient had soft tissue swelling with bone erosion and subchondral cyst. MRI was performed in 5 patients (71.4%), in which low signal on T₁ weighted image, medium signal on T₂ weighted image and edema signal on peripheral tendon sheath were seen in 1 patient. One patient (14.3%) underwent emission computed tomography (ECT) without abnormal uptake. Conclusion Joint flexion contracture may be the first sign of amyloid arthropathy. Vigilance for amyloid arthropathy is warranted when there is associated soft tissue involvement, negative autoantibodies, and imaging showing no joint destruction but surrounding soft tissue abnormalities.

Metabolism-associated fatty liver disease (MAFLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is one of the most popular chronic liver diseases in the world, and has become one of the main causes of liver cirrhosis, end-stage liver disease, and primary liver cancer. In recent years, the prevalence of MAFLD has gradually increased in China, the Asia Pacific region, and even globally, increasing the medical and socio-economic burden. The exploration of the epidemiology and risk factors of this disease at home and abroad has also gradually increased. Meanwhile, due to the scarcity of MAFLD treatment drugs, their drug treatment has become a hot issue that needs to be urgently addressed in clinical practice. In recent years, there has been an increase in the number of drugs entering the clinical trial stage. Based on this, the current epidemiological status, risk factors, diagnostic criteria, and treatment research progress of MAFLD have been reviewed in order to provide new ideas and directions for the clinical diagnosis, treatment, and scientific research of MAFLD.

Premature ovarian insufficient (POI) is one of the important causes of infertility in woman of reproductive age. At present, the clinical treatment of POI is limited and the therapeutic effect is not ideal. Extracellular vesicles derived from stem cells have attracted the attention of many researchers at home and abroad as a new cell-free therapy. Many animal experiment study shows that a variety of extracellular vesicles from stem cells carry microRNAs, lncRNAs, lipids, proteins, and other bioactive substances, improve ovarian function, affect granulosa cell proliferation and apoptosis, promote ovarian angiogenesis, and reduce oxidative stress response, thus playing a therapeutic role on POI. This article will review the mechanisms of extracellular vesicles in treatment of POI, and provide evidence for the application of extracellular vesicles in clinical treatment of POI.

Tracheoesophageal fistulas (TEF) is a kind of pathological fistula between trachea or bronchus and esophagus, including tracheoesophageal fistula and bronchoesophageal fistula. In clinical practice, tracheoesophageal-fistula is more often seen. There are many pathogenesis of TEF, which could cause serious complications. It is a disease which has serious impact on the quality of life, difficult to treat and high mortality. There are many methods to treat TEF, but the therapeutic effect is poor. There is an urgent need for new treatment methods to TEF. The detection of nasogastric tube retention by chest and abdominal X-ray is the gold standard for diagnosis. The main treatment methods include surgical treatment, stent implantation, local biological glue blocking, stem cell therapy and so on. In order to provide reference for relevant clinical diagnosis and treatment of TEF, this article reviews the main research progress in the diagnosis and treatment of TEF in recent years.

Non-puerperal mastitis (NPM) is a group of chronic inflammatory diseases with breast pain, lumps, abscesses and sinus tracts/fistulas as the main clinical manifestations, which is easily confused with breast cancer or other benign breast diseases. NPM always leads to a long treatment cycle and high recurrence rate, which may cause a large economic and psychological burden to patients. At present, the etiology and pathogenesis of NPM are still unclear, but it has a certain correlation with immune abnormality, bacterial infection, hormone disorder and other factors. Although several diagnostic methods available, the diagnosis of NPM relies on histopathological examination mainly. The treatment methods of the disease include observation and follow-up, pharmacotherapy, surgical treatment, etc., but there is still no unified standard for specific treatment timing and treatment selection. In view of the controversy over etiology and treatment selection of NPM, this paper comprehensively summarizes the latest research progress in disease characteristics, clinical diagnosis and treatment of NPM based on domestic and foreign literature, aiming to provide reference and inspiration for the selection of reasonable clinical diagnosis and treatment.