Lishui Central Hospital

BackgroundElderly and frail patients with gastrointestinal cancer are at significantly increased risk of postoperative complications. The effectiveness of preoperative prehabilitation in this high-risk population requires synthesis of the existing evidence.ObjectiveTo evaluate the impact of preoperative prehabilitation on the incidence of postoperative complications in elderly (≥60 years) and frail patients with gastrointestinal cancer through a systematic review and meta-analysis.MethodsWe systematically searched PubMed, Embase, the Cochrane Library, and Web of Science from January 2020 to November 2025. Randomized controlled trials comparing prehabilitation with usual care were included. The primary outcome was the incidence of overall postoperative complications. Risk ratios were pooled using a random-effects model. Risk of bias was assessed using the ROB 2.0 tool. Subgroup analyses were conducted based on intervention duration (≥4 weeks vs. <4 weeks), surgery type (colorectal vs. other), and frailty status.ResultsNine randomized controlled trials involving 1027 patients were included. The meta-analysis showed that prehabilitation significantly reduced the risk of postoperative complications (risk ratio [RR] = 0.67, 95% confidence interval [CI]: 0.46 to 0.99, p = 0.04), with low heterogeneity among studies (I² = 24%). Subgroup analyses indicated a greater trend towards risk reduction in frail patients (RR = 0.53, 95% CI: 0.24 to 1.16), as well as in interventions lasting <4 weeks (RR = 0.54, 95% CI: 0.30-0.99) and in patients undergoing non-colorectal surgery (RR = 0.54, 95% CI: 0.30-0.99). However, differences between all subgroups were not statistically significant (p for interaction > 0.05).ConclusionCurrent evidence suggests that preoperative prehabilitation reduces postoperative complication risk in elderly patients undergoing gastrointestinal cancer surgery. While the effect is clear in the overall population, the trend suggesting potentially greater benefit in specifically frail patients requires confirmation in future larger, specifically designed trials. Integrating prehabilitation into the clinical pathway for this high-risk population is warranted.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420251275161.

Intramyocardial dissecting hematoma with cardiac rupture poses catastrophic risks following acute myocardial infarction (AMI). While transthoracic echocardiography (TTE) is standard for initial assessment, transesophageal echocardiography (TEE) provides critical anatomical delineation for surgical planning. A 78-year-old male with multiple cardiovascular risk factors presented with a three-day history of chest pain, diagnosed as ST-segment elevation myocardial infarction (STEMI) by electrocardiogram (ECG). TTE revealed segmental left ventricular wall motion abnormalities and cardiac troponin I (cTnI) levels (10.89 ng/ml) were markedly elevated. Despite guideline-directed antithrombotic therapy, he developed acute decompensated heart failure with progressive lower limb edema by day 9, at which point TTE revealed ventricular septal rupture (VSR) with contained perforation. Following 30 days of continuous renal replacement therapy (CRRT) for cardiorenal syndrome, definitive surgical management was undertaken: Intraoperative TEE guidance facilitated VSR repair with concomitant coronary artery bypass grafting (CABG), achieving postoperative hemodynamic stability. Regrettably, the patient suffered sudden respiratory and cardiac arrest in postoperative month 4, and succumbed a few days later. TEE provides indispensable high-resolution characterization of post-infarction intramyocardial dissection and perforation topography, enabling precise surgical navigation for mechanical complications. This case underscores its pivotal role in guiding definitive intervention for high-risk cardiac pathologies.

Titanium carbonate nanoparticles (TiCO3 NPs) were synthesized and extensively characterized using advanced spectroscopic and microscopic techniques to confirm their crystalline structure, morphology, and stability. Biocompatibility assessments revealed minimal cytotoxicity, supporting their potential for biomedical applications. The therapeutic efficacy of TiCO3 NPs was investigated in a diabetic mouse model, where oral administration significantly improved glycemic control, reduced fasting blood glucose levels, and enhanced insulin sensitivity compared to untreated controls. In parallel, the antibacterial potential of TiCO3 NPs was evaluated against clinically relevant pathogens, including Enterobacter sp., and Staphylococcus aureus. These results confirm the broad-spectrum antibacterial potential of TiCO3, highlighting their capacity to disrupt both Gram-positive and Gram-negative bacteria. Collectively, these findings establish TiCO3 NPs as a multifunctional nanomaterial with excellent biocompatibility, effective glycemic regulation in diabetic models, and broad-spectrum antibacterial activity, positioning them as promising candidates for therapeutic and biomedical applications.

To evaluate the efficacy and safety of adding bronchial artery chemoembolization (BACE) to chemotherapy in combination with immune checkpoint inhibitors (ICIs) in patients with lung squamous cell carcinoma (LUSC). This retrospective study included 71 patients with advanced LUSC treated at Lishui Central Hospital between January 2020 and March 2025. Patients received either chemotherapy plus ICIs (Chemo + ICIs group) or chemotherapy plus ICIs combined with BACE (Chemo + ICIs + BACE group). All patients were histologically diagnosed with LUSC. Baseline clinical characteristics, including demographics, comorbidities, tumor burden, and performance status, were recorded. Tumor response was evaluated using the response evaluation criteria in solid Tumors (RECIST) version 1.1. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Prognostic factors were further explored through univariate and multivariate Cox proportional hazards regression analyses. Adverse events (AEs) were recorded throughout the treatment period and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Baseline characteristics were balanced between groups. The objective response rate (ORR) was 59.26% in the Chemo + ICIs + BACE group and 38.64% in the Chemo + ICIs group (p = 0.091). The disease control rate (DCR) was significantly higher in the BACE group (85.19% vs. 61.36%, p = 0.033). Median PFS was significantly longer in the Chemo + ICIs + BACE group (10.8 vs. 5.6months, p = 0.018). Multivariate Cox analysis identified BACE treatment (HR = 0.53, p = 0.037), number of nodules ≤ 3 and tumors size ≤ 5cm as independent predictors of prolonged PFS. Although the difference in OS was not statistically significant (23.3 vs. 18.4months, p = 0.139), a favorable trend was observed in the Chemo + ICIs + BACE group. No grade ≥ 4 adverse events (AEs) were observed, and most AEs were grade 1-2 and manageable with symptomatic treatment. The addition of BACE to chemotherapy and immunotherapy may improve tumor control and prolong progression-free survival in patients with advanced LUSC. These findings support the integration of BACE into combination treatment strategies and warrant further validation in prospective trials.

Antarctic krill oil (KO) is a richsource of omega-3 polyunsaturated fatty acids (PUFAs). Endogenous PUFA-derived specialized pro-resolving mediators (SPMs) have garnered attention due to their beneficial effects on body, especially the cardiovascular system. This study integrated non-targeted and targeted lipidomics to investigate KO's time-dependent effects on the comprehensive lipid profile and SPMs in rats. After 1- and 6-week supplementation, KO significantly altered lipid profiles, reducing arachidonic acid (ARA, 20:4)-containing lipids while elevating eicosapentaenoic acid (EPA, 20:5)/docosahexaenoic acid (DHA, 22:6)-containing lipids. Targeted analysis identified and quantified 33 PUFA-derived oxylipins, including derivatives of ARA, 8 derivatives of EPA, and 13 derivatives of DHA. Notably, KO consumption substantially decreased pro-inflammatory oxylipins like LTB4, PGE2, and TXB2, while increasing anti-inflammatory LXA4 and SPMs such as RvE1, RvE2, RvD1, RvD4, and MaR1. Long-term intake amplified SPM accumulation, suggesting temporal regulation. These findings elucidate KO's potential mechanism in inflammation management through lipidome remodeling, supporting its application in functional foods for metabolic health enhancement.

Early recognition of individuals at elevated risk for new ipsilateral ischemic lesions (NIILs) after carotid artery stenting (CAS) is vital for planning effective preventive interventions. The aim of this study was to develop a deep learning (DL) radiomics model to predict NIILs post-CAS from dual-energy CT (DECT) images. This study retrospectively enrolled patients from three centers. Carotid plaques were delineated on multiparametric DECT images. A combined model integrating clinical-radiological, handcrafted radiomics (HCR), and DL features was constructed using a support vector machine algorithm to predict NIILs. The model's performance was assessed through the area under the receiver operating characteristic curve (AUC). To improve the interpretability of the model, SHapley Additive exPlanations (SHAP) analysis was applied. This study involved 336 patients divided into the training (n = 135), internal validation (n = 58), and external test (n = 143) cohorts. NIILs were present in 38.5%, 37.9%, and 39.9% of the subjects, respectively. Symptomatic events and plaque ulceration were identified as independent risk factors for NIILs. The combined model incorporating 2 clinical-radiological risk factors, 9 HCR features, and 15 DL features demonstrated satisfactory performance in predicting NIILs, with AUCs of 0.908, 0.842, and 0.856 in the three cohorts, respectively. The predictions of the combined model were explained both locally and globally by SHAP analysis. The combined model demonstrated high accuracy in identifying patients at elevated risk for NIILs post-CAS and can serve as an interpretable tool for optimizing treatment strategies. Question Early prediction of new ipsilateral ischemic lesions (NIILs) after carotid artery stenting (CAS) is crucial for timely interventions, but no effective, interpretable predictive method exists. Findings The combined model incorporating deep learning radiomics features extracted from multiparametric dual-energy CT images and clinical-radiological features demonstrated high accuracy in predicting NIILs after CAS. Clinical relevance The combined model offers an interpretable tool for identifying patients at high risk for NIILs post-CAS, potentially improving personalized treatment strategies and patient outcomes by enabling targeted preventive care.