Chinese Medical Doctor Association

Microvascular decompression (MVD) for hemifacial spasm (HFS) is commonly conducted under a microscope. We report a large series of fully endoscopic MVDs for HFS and describe our initial experience with 3-dimensional (3D) endoscopy. Clinical data of 204 patients with HFS who underwent fully endoscopic MVD using 2-dimensional (2D) and 3D endoscopy (191 and 13 patients, respectively) from July 2017 to October 2024 were retrospectively analyzed. Patients were grouped according to timing of surgery within the study period: early, middle, and late. The mean follow-up was 20.4 months (range, 3-87). At last follow-up, surgery had achieved cessation or significant reduction of spasms in 198 patients (97.1%). Complications immediately after surgery were as follows: facial weakness, 7 patients; hearing loss, 11 patients; tinnitus, 1 patient; infection, 1 patient; dysphagia, 1 patient; and cerebrospinal fluid leakage, 1 patient. The patients who experienced infection, dysphagia, and leakage recovered before discharge. Ten patients had complications that were present at last follow-up (1 tinnitus, 3 facial weakness, 6 hearing loss). The rate of complete or significant remission of spasms in the early, middle, and late groups was 95.6%, 97.1%, and 98.5%, respectively; the corresponding complication rates were 5.9%, 5.9%, and 2.9%, respectively. Compared with the 2D endoscope, the 3D endoscope provided subjectively enhanced stereoscopic vision and depth perception, which facilitated the operation. Fully endoscopic MVD for HFS offers wide visualization of the neurovascular conflict area and minimizes brain injury caused by retraction. Once technical proficiency is achieved, surgical outcomes are favorable and complications are low. Despite the drawbacks such as a slight sense of vertigo during use and high cost, the 3D endoscope provides a stereoscopic view. More research is essential to verify its role in MVD surgery.

<p dir="ltr">Accurate and timely cancer detection remains a persistent challenge. This dissertation, titled "Tumor-Associated Natural Killer Cells and Ultrasensitive Nano Biosensors for Minimally Invasive Cancer Diagnosis," explores Natural Killer (NK) cells in blood as a potential platform for blood-based cancer detection. NK cells are a crucial component of the immune system, serving as the first line of defence against cancer. As NK cells can discriminate between cancerous cells and other healthy cells, their diagnostic value is significant. However, detecting these rare tumor associated NK cells is challenging. An ultrasensitive Nano Biosensor was hence developed utilizing surface-enhanced Raman spectroscopy (SERS) as the detection methodology. The nano sensor achieved single-cell sensitivity and can detect analytes at femtomolar levels. Machine learning algorithms analysed signals from tumor-associated NK cells and detected metabolic changes upon tumor interactions.</p><p dir="ltr">The thesis comprises five research projects focusing on different NK cell components (cells, exosomes, DNA) for detecting various cancers. The first paper differentiates lung, breast, and colon cancer from healthy cells based on spectral changes. Building on this success, the second project detects metastasis by identifying tumor-specific and metastasis-specific signals exhibited by NK cells. The third paper explores the potential of NK exosomes in identifying brain cancer, showing that NK exosomes can serve as non-invasive biomarkers for brain cancer diagnosis. The fourth paper utilizes NK cell DNA as a biomarker for colon cancer by analyzing specific genetic alterations. The fifth paper proposes a combined approach using NK and T cells to identify breast cancer. Although these projects cover diverse topics, they are united by a common idea of detecting informative metabolic features of NK cells and identifying the spectral changes upon tumor interaction.</p><p dir="ltr">The potential applications of this technology are extensive. The proposed method is non invasive and leverages the body's natural intelligence to detect cancer, opening new directions in liquid biopsy-based cancer diagnostics. This technology has the potential to aid in identifying individuals likely to benefit from specific medications, enabling patient stratification for clinical trials and facilitating therapeutic response monitoring through blood tests.</p><p dir="ltr"><br></p>

In recent years, functional dyspepsia (FD) has become increasingly clinically relevant. The effective FD management is an important task for practicing physicians. Phytotherapy represents a promising therapeutic approach. The use of standardized herbal extracts ensures reproducible clinical effects and a predictable safety profile. Gastritol® (oral drops) has proven to be an effective treatment option for FD. This multi-component herbal medicinal product embodies the concept of multitarget therapy, which is especially valuable in complex, polyetiological conditions such as FD. The aim of this review is to summarize current evidence regarding the efficacy and rationale for using the standardized herbal preparation Gastritol® in management of FD symptoms. The material is presented in a structured “question–answer” format, enabling readers to quickly identify clinical guidance and assess the potential integration of Gastritol® into primary healthcare management. The article discusses the definition and subtyping of FD, the criteria for “red flags,” the composition and pharmacological properties of Gastritol®, its mechanisms of therapeutic action, clinical applications, and dosing specifics. Separate sections address data on the clinical efficacy, safety profile, and potential interactions of the preparation in adults and children. FD significantly reduces patients’ quality of life, so an effective outpatient management is a priority. Gastritol® provides a multidirectional therapeutic effect: it reduces spastic pain, reliefs the dyspeptic symptoms, normalizes gastrointestinal motility, and exerts mild sedative and anti-inflammatory actions. Patients often report symptom relief within several days of regular use, with maximal improvement observed within 2–4 weeks. The preparation is well tolerated, and adverse reactions are rare. Gastritol® is an effective and safe option for controlling FD symptoms.

The purpose of this study is to determine perceived challenges faced by MAPEH teachers during the transition from modular to face-to- face modality in terms of workload, students’ behaviour, teaching learning resources, teacher’s competency and training and supports. Also, to determine their perceived coping mechanism using the problem-focused, emotional-focused, and avoidant- focused. Additionally, to know the MAPEH teachers’ level of teaching competency in terms of content knowledge and pedagogy and learning environment. Findings revealed that the MAPEH teachers perceived challenges on limited teaching hours (3.64), students’ disruptive behaviour in sitting still, disturbing, and shouting/screaming toward others (3.78), have personal and family problems such as parent separation, financial support, and school pressure (3.82). As well as the absence of a reliable internet connection to support limited learning materials (4.00), limited textbooks, self-learning modules (3.98), and the lack of available electronic devices such as a computer, television, overhead projector, and audio speaker use for teaching learning (3.91). Moreover, respondents experience limited Trainings, seminars, and webinars for MAPEH teachers (3.71). Meanwhile, research result showed that Problem-focused (4.42) and emotional- focused (4.23) often perceived coping mechanism. Therefore, study shows that there is no significant relationship between challenges variables and Content Knowledge and Pedagogy is partially accepted. However, there is a positive significant relationship between the challenges variables and teacher’s competency is partially sustained. Moreover, there is no significant relationship between coping mechanism variables and content knowledge and pedagogy as well as the teaching environment competency.

With the increasing need for digitalization in mining production, the relevance of applying modern geodesy and surveying technologies, particularly using digital communication systems and satellite navigation, has significantly increased. Scientific and technical progress has enabled the development and implementation of high-precision measurement technologies that significantly surpass traditional methods in performance and accuracy. A differential correction base station utilizing GNSS (Global Navigation Satellite Systems) data for measurements is created as a part of the geodetic work automation at Kacharsk deposit. This article presents the development of a software and a technical facility for a high-precision satellite positioning system, which has successfully passed all testing stages and has been implemented in industrial operation. This integrated system allows measurement tasks to be performed in real-time and post-processing modes, taking into account the complex conditions of signal transmission at the depths of quarries and beyond the dumps. The work was conducted by the D.A. Kunayev Mining Institute in collaboration with the Institute of Space Technique and Technology. The project co-financing by a private partner JSC "SSGPO". The development includes creating a differential correction center, which facilitates the transmission of correction information and differential corrections to mobile devices at the site. This provides the increased measurement accuracy and optimized production management processes in the constantly changing geometry of the quarry. A software-based mathematical algorithm for processing and analyzing satellite data has been developed within the project, significantly enhancing the efficiency of geodetic measurements. The implementation of satellite technologies not only improves the accuracy and efficiency of geodetic works but also promotes the digital transformation of the entire production process at Kacharsk deposit. Such developments are a key element in the strategy of creating an “intelligent mine”, where all processes are maximally automated and optimized to ensure safety, efficiency and sustainability of production. In the context of sustainable development, the adoption of these technologies also contributes to minimizing the environmental impact of mineral extraction through precise positioning and planning of mining, leading to reduced waste and optimized resource usage. Financing and support for such projects highlight the importance of integrating science and technology into the sustainable development of the industry. This research is funded by the Science Committee of the Ministry of Science and Higher Education of the Republic of Kazakhstan (Grant No. BR23991563). The authors also express their profound gratitude for the assistance in implementing the developed high-precision satellite positioning system into industrial operation to the scientific staff of the Institute of Space Technique and Technology, A. S. Raskaliev, A. I. Samsonenko and S. Zh. Zhumagali.

OBESITY AS A MISLEADING FACTOR IN THE DIAGNOSIS OF TYPE 1 DIABETES MELLITUS: A CASE REPORTOlgierd Dróżdż1, Wiktoria Bińczyk1, Bartosz Siudek2, Katarzyna Błaszczyszyn1, Filip Jan Grajnert3, Michalina Zofia Grzelka3, Maciej Rabczyński11Department and Clinic of Diabetology and Internal Medicine, University Teaching Hospital, Wrocław, Poland2T. Marciniak Specialist Hospital, Wrocław, Poland34th Military Clinical Hospital, Wrocław, PolandCorresponding author: Wiktoria Bińczyk, wiktoria.binczyk98@gmail.comAuthors:Olgierd Dróżdż, Medical DoctorOlgierd.drozdz@gmail.comDepartment and Clinic of Diabetology and Internal Medicine, University Teaching Hospital, 50-556 Wrocław, PolandWiktoria Bińczyk, Medical Doctorwiktoria.binczyk98@gmail.comDepartment and Clinic of Diabetology and Internal Medicine, University Teaching Hospital, 50-556 Wrocław, PolandBartosz Siudek, Medical DoctorBartosz.siudek98@gmail.comT. Marciniak Specialist Hospital, 54-049 Wrocław, PolandKatarzyna Błaszczyszyn, Medical Doctork.blaszczyszynn@gmail.comDepartment and Clinic of Diabetology and Internal Medicine, University Teaching Hospital, 50-556 Wrocław, PolandFilip Jan Grajnert, Medical Doctorf.grajnert@icloud.com4th Military Clinical Hospital, 53-114 Wrocław, PolandMichalina Zofia Grzelka, Medical Doctormichalinagrzelka1@gmail.com4th Military Clinical Hospital, 53-114 Wrocław, PolandMaciej Rabczyński, Medical Doctormaciej.rabczynski@umw.edu.plDepartment and Clinic of Diabetology and Internal Medicine, University Teaching Hospital, 50-556 Wrocław, Poland

Hemophagocytic lymphohistiocytosis (HLH) is a rare, lifethreatening hyperinflammatory disorder characterized by dysfunction of NK cells and cytotoxic lymphocytes. We present a rare case of a patient diagnosed with HLH who presented with persistent fever during treatment for refractory T-cell/histiocyte-rich large B-cell lymphoma (TCHRLBCL), highlighting the challenges of managing HLH in the context of refractory lymphoma. According to our review of the literature, this is the first case of HLH that developed several months into treatment for refractory TCHRLBCL and not in close temporal relation to lymphoma diagnosis.

BackgroundRural primary care practices struggle to employ and retain staff, and existing literature regarding recruitment and retention is focused on doctors. Shortages of qualified staff affect practice functioning, quality of care, and patient experience. Dispensing of medications is a rural service valued by patients. However, little is known about how dispensing services are valued by practices or related to the recruitment and retention of staff.AimTo understand barriers to, and facilitators of, joining and remaining in rural dispensing practice employment, and to explore how rural practices value dispensing services.Design & settingQualitative inquiry in rural primary care practices across England.MethodSemi-structured interviews with rural dispensing staff were undertaken, audio-recorded, transcribed verbatim, and analysed using framework analysis.ResultsIn total, 17 staff from 12 practices across England were interviewed between June and November 2021. Reasons for taking up employment in rural dispensing practices included perceived career autonomy, development opportunities, and preference for working and living in a rural setting. Skills required for dispensers’ roles balanced against low wages were a barrier to recruitment. For nurses, barriers included perceived lack of knowledge around their role in rural care. Revenue from dispensing, opportunities for staff development, job satisfaction, and positive work environments drove retention of staff. However, negative perceptions of rural practice, travel difficulties, lack of applicants, and insufficient remuneration for roles were barriers to retention.ConclusionBarriers to, and facilitators of, rural primary care recruitment and retention vary by role, and include factors unique to the rural setting.

Background and Aim:No cohort studies have been performed on Chinese primary retroperitoneal sarcoma (RPS) patients. Data derived from western cohort studies may not be directly superimposable on Asian counterparts. Furthermore, the risk factors for survival of RPS are currently unknown for Chinese patients. The objectives were therefore to (1) gain insight into RPS incidence and patient demographics and clinical details; (2) determine the risk factors for overall survival (OS) and disease-free survival (DFS); and (3) critically appraise the Asian cohort data in relation to information obtained in western cohort studies.Methods:In this retrospective cohort study, the health records of patients that had been diagnosed with primary localized RPS with curative intent between 2009 and 2020 were analyzed. Cox proportional hazards analysis was conducted to evaluate the risk factors for OS and DFS.Results:A total of 261 patients met the inclusion criteria. Ninety-six (36.8%) patients had been diagnosed with well-differentiated liposarcoma, 63 patients (24.1%) with dedifferentiated liposarcoma, 41 patients (15.7%) with leiomyosarcoma (LMS), 22 patients (8.4%) with solitary fibroma, 7 patients (2.7%) with malignant peripheral nerve sheath tumor (MPNST), and 32 patients (12.3%) with another type of RPS. The study further revealed that (1) the 5-y OS and DFS in RPS patients was 67.8% and 51.3%, respectively, with the highest OS and DFS observed in MPNST (100% and 100%, respectively) and the lowest 5-y OS and DFS attributed to LMS (42.6% and 28.9%, respectively); (2) symptoms at presentation, Federal National Cancer Center (FNCLCC) grade, and number of combined resections are independent risk factors in OS; (3) symptoms at presentation, FNCLCC grade, chemotherapy, and hospital length of stay are independent risk factors for DFS; and (4) patients at high risk (symptoms at presentation and high-grade tumors) have less than half the chance of survival at 5 y post-diagnosis than patients with a low-risk profile.Conclusions:Symptoms at presentation constitute a risk factor for OS and DFS. When combined with tumor grade - another risk factor for both OS and DFS - patients can be classified into a high-risk and low-risk category to gauge a patient’s prognosis and, accordingly, frame an optimal clinical trajectory. Moreover, the clinicopathology and overall prognosis of RPS in Asian and Western populations are comparable and hence superimposable.Relevance for Patients:The present study identifies the risk factors of survival in RPS and suggests symptoms at presentation should be considered in the preoperative consultation and added in prognostic grouping.

Background: Inflammation has an important role in the initiation and progression of carcinoma cervix. The measurement of inflammatory biomarkers is a cost-effective method of identifying patients at high risk of recurrence after treatment. This study was done to identify the influence of pre-treatment inflammatory biomarkers on survival in patients treated with radical chemo-radiation or radiation. Methods: Patients with biopsy proven carcinoma cervix treated with Radiotherapy or Chemo-radiation from January 1st, 2016 to September 30th, 2017 were included. Pre-treatment complete blood counts, differential counts, serum albumin and C-reactive protein (CRP) were obtained. Neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and CRP Albumin ratio (CAR) were calculated. The best cut off values for NLR, PLR, serum albumin, CRP and CAR were found out from receiver operating characteristic (ROC) curves. OS (Overall Survival) and DFS (Disease Free Survival) were estimated using Kaplan -Meier method. The prognostic value of inflammatory biomarkers on survival was assessed by cox regression model. Results: Sixty-three patients were included. The median follow up was 42.5 months. The best cut off values for NLR, PLR, albumin, CRP and CAR from the ROC curve were 2.36, 122.725, 3.95, 0.65 and 0.8 respectively. The three-year OS and DFS probability were 68.3% and 63.5% respectively. Patients with CAR >0.8 had 5.7 times more risk of death and 6.01 times risk of relapse or progression compared to patients with CAR ≤0.8. Conclusion: Patients with a CRP-Albumin ratio of more than 0.8 are at significant risk of relapse and death after chemoradiation or radiation.