Taian City Central Hospital

Vascular surgery is an important procedure that is carried out to treat diseases of the entire vascular system. Intraoperative hemostasis, precise vision of intricate vascular anatomy, restenosis, implant-associated infection, and inadequate endothelium regeneration are among the enduring difficulties that continue to limit vascular surgery. Advanced biomaterial techniques are required since conventional materials and imaging technologies often fail to meet these multifactorial limitations. By enabling synthetic nanomaterials with programmable physicochemical qualities that directly interact with biological systems at the molecular and cellular levels, recent developments in nanotechnology have sparked a paradigm shift in vascular surgery. The limitations of conventional contrast media are addressed by nanostructured contrast agents, such as superparamagnetic iron oxide nanoparticles, which significantly improve vascular imaging resolution and diagnostic sensitivity across magnetic resonance modalities. Biodegradable polymers and surface-engineered coatings are examples of controlled-release nanocarriers that enable targeted administration of antiproliferative and antithrombotic drugs, lowering systemic toxicity and minimizing restenosis. In addition to providing long-lasting antibacterial action to avoid surgical site infections, nano-engineered surface topographies and coatings on grafts and stents accelerate endothelialization and reduce thrombogenicity. Additionally, some nanomaterials’ inherent catalytic and redox modulation properties aid in better wound healing and inflammation resolution. With a focus on mechanistic insights into hemostasis, imaging enhancement, drug transport, implant integration, and regenerative processes, this review thoroughly summarizes recent preclinical and translational studies on the use of nanomaterials in vascular surgery. Furthermore, we outline the present obstacles to clinical translation, such as biocompatibility, long-term safety, and manufacturing scalability, and suggest future paths for incorporating nano-enabled techniques into evidence-based surgical practice.

Statins, commonly used lipid-lowering drugs to reduce cardiovascular risk, have also been suggested to have protective effects against epilepsy. However, whether this association is causal remains unclear. We conducted a drug-target Mendelian randomization study to examine the effects of genetically predicted inhibition of 3 established lipid-lowering targets (3-hydroxy-3-methylglutaryl coenzyme A reductase [statins], Niemann-Pick C1-Like 1 [ezetimibe], and proprotein convertase subtilisin/kexin type 9 [PCSK9 inhibitors]) on epilepsy and its subtypes. The inverse-variance weighted approach served as the primary analysis, supplemented with multiple sensitivity tests to ensure robustness. Genetically proxied 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibition was associated with decreased risks of epilepsy (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.82–0.92; P = 1.4 × 10‐6) and focal epilepsy (OR = 0.83; 95% CI: 0.76–0.92; P = 1.5 × 10‐4). Inhibition of Niemann-Pick C1-Like 1 corresponded to a lower risk of generalized epilepsy with tonic−clonic seizures (OR = 0.98; 95% CI: 0.97–0.98; P = 1.2 × 10‐34) but increased risks of focal epilepsy (lesion negative, OR = 1.08; 95% CI: 1.06–1.09; P = 5.9 × 10‐31), childhood absence epilepsy (OR = 1.06; 95% CI: 1.05–1.07; P = 1.8 × 10‐21), and juvenile absence epilepsy (OR = 1.03; 95% CI: 1.01–1.05; P = 9.7 × 10‐3). PCSK9 inhibition was linked to reduced risks of generalized epilepsy with tonic−clonic seizures (OR = 0.99; 95% CI: 0.98–1.00; P = 1.4 × 10‐2), juvenile absence epilepsy (OR = 0.96; 95% CI: 0.93–1.00; P = 2.7 × 10‐2), and juvenile myoclonic epilepsy (OR = 0.96; 95% CI: 0.93–1.00; P = 2.9 × 10‐2). The effects of lipid-lowering drug targets on epilepsy risk vary by target and exhibit pleiotropy. Statins and PCSK9 inhibitors appear protective against epilepsy and several subtypes, whereas ezetimibe may increase susceptibility to certain subtypes. These results underscore the importance of considering target-specific effects when choosing lipid-lowering therapies for patients with or at risk of epilepsy.

Objective Secondary lower limb lymphedema (LLL) is a long-term side effect following surgery or radiotherapy in survivors with gynecological cancer. This systematic review aims to systematically evaluate the effectiveness of physical therapy interventions for LLL patients with gynecological cancer, providing evidence-based support for clinical practice. Methods We searched the Medline, Web of Science, Scopus, and Cochrane Library databases for literature published up to 27 December 2025. We include randomized controlled trials (RCTs) focusing on physical therapy as the main interventions for LLL in gynecological cancer survivors. Literature screening and data extraction were performed using the Rayyan platform, and the methodological quality of included studies was assessed with the Cochrane Risk of Bias 2 (ROB 2) tool. This systematic review has been registered in PROSPERO (Registration number: CRD420251274284). Results Six RCTs involving a total of 289 eligible patients were ultimately included. None of the included RCTs were judged to have a high risk of bias. Results showed that physical therapy interventions resulted in significant reductions in lower limb volume or circumference across studies. Additionally, they alleviated symptoms such as pain and heaviness, and improved physical functions including muscle strength and gait, as well as quality of life. Evidence indicates that the multimodal physical therapy strategy showed a superior trend in improving the most outcomes compared to a single therapy mode. All intervention-related adverse events were mild, with no serious adverse events reported. Conclusion Overall, this systematic review confirms that both multimodal and single physical therapy are safe and effective for secondary lower limb lymphedema in gynecologic cancer survivors. A combination of different physical therapy modalities may be a better option. The results of this study may provide an evidence-based reference for clinical decision-making about LLL intervention strategies in this specific population. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251274284 , identifier CRD420251274284.

ObjectiveTo analyze the clinical phenotype and molecular characteristics of three Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) strains isolated from different sites of the same patient, providing an experimental basis for clinical anti-infection treatment and nosocomial infection prevention and control.MethodsThe collected strains were tested for antimicrobial susceptibility using an automatic drug sensitivity analyzer. Whole-genome sequencing was performed to analyze the presence of resistance and virulence genes and to determine the classification and homology of the three strains.ResultsThe three K. pneumoniae strains were classified as ST11/K47/O13. Whole-genome sequencing revealed that all strains carried the KPC-type carbapenemase gene, and the high-virulence genes, rmpA2, iroB and iutA, along with three plasmids. Antimicrobial susceptibility testing showed that all strains were resistant to carbapenems, including imipenem and meropenem.ConclusionThe three clinically isolated K. pneumoniae strains were highly virulent and carbapenem-resistant, all carrying the KPC resistance gene. They caused multi-site infections through hematogenous dissemination. These findings highlight the need for heightened clinical vigilance and strengthened monitoring, prevention, and control of drug-resistant infections.

Tic disorder (TD) frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and is associated with greater symptom severity and limited treatment options. Qiangzhi Fang is a Traditional Chinese Medicine (TCM) herbal formula that has been clinically used for neurobehavioral disorders, but its experimental evidence and mechanisms remain insufficiently characterized. To evaluate the behavioral effects of Qiangzhi Fang in a drug-induced rat model of TD comorbid with ADHD and to explore potential striatal molecular mechanisms. A drug-induced TD+ADHD rat model was established in male Sprague-Dawley rats. Animals were assigned to control, model, and Qiangzhi Fang treatment groups (low, medium, and high doses). Behavioral assessments included stereotypic behavior scoring (tic-like behaviors), locomotor activity (hyperactivity), anxiety-related behavior, and spatial learning and memory. Striatal expression of tyrosine hydroxylase (TH) and phosphorylated Ca2⁺/calmodulin-dependent protein kinase II (p-CaMKII) was examined using Western blotting and real-time PCR. Qiangzhi Fang treatment ameliorated TD- and ADHD-like behavioral abnormalities, including reduced stereotypic movements, decreased hyperactivity, and improved spatial learning and memory performance, with the most pronounced effects observed at higher doses. At the molecular level, treatment was associated with downregulation of striatal TH and p-CaMKII expression. These markers reflect alterations in dopamine synthesis and synaptic signaling; however, dopamine levels, receptor subtypes, and neural circuitry were not directly assessed. Qiangzhi Fang improved behavioral phenotypes in a preclinical rat model of TD comorbid ADHD and was associated with changes in striatal TH and p-CaMKII expression. These findings suggest a possible neuromodulatory role of Qiangzhi Fang, although the mechanistic evidence remains preliminary. This study may provide an experimental basis for further investigation of herbal formulations in TD and ADHD.

Abstract Objective To compare the patient-reported outcomes (PROs) and quality of life in patients with HR+/HER2- early breast cancer (EBC) treated with ribociclib (RIB) and abemciclib (ABE) as adjuvant therapy. Methods A multicenter, retrospective cohort study was conducted in Chinese patients receiving ribociclib or abemciclib as adjuvant therapy for HR+/HER2- EBC. PRO data were collected via an electronic questionnaire. The questionnaire was based on the PRO scale for breast cancer patients in China (NCC-BC-A scale), EQ-5D-5L and safety information of CDK4/6 inhibitors, including six dimensions of physiological function, psychological status, social support, treatment related symptoms, economic dimension and overall self-evaluation. The higher score of the questionnaire, the better quality of life. Results Between Mar 15, and May 12, 2025, 197 patients completed the survey, including 94 patients who received ribociclib and 103 patients who received abemciclib. Overall, 195 patients (99%) were female and two (1%) were male. No difference was observed in baseline characteristics such as age, employment status, medical insurance, and concomitant treatment. The total score of the PRO in ribociclib group was higher than that in abemciclib group (187.14±17.57 vs 180.66±22.26, p=0.024). In therapeutic domain, the score was significantly higher in ribociclib group (34.81±5.29 vs 32.77±5.51, p=0.009). Patients in ribociclib group were less affected by the treatment-related symptoms of diarrhea (3.88±0.53 vs 2.31±1.33, p<0.001), fatigue (2.29±0.91 vs 2.00±1.02, p=0.038) and hair loss (2.94±1.39 vs 2.49±1.24, p=0.018). The proportion of patients receiving ribociclib who discontinued due to the side effects of long-term treatment (28.6% vs 50%) or reduced the dose due to adverse events (22.2% vs 70%) was lower. The overall health status score of ribociclib group was higher (6.67±1.27 vs 5.83±1.45, p<0.001). Conclusion HR+HER2- EBC patients who received ribociclib had a better PRO score than those who received abemciclib. Patients in ribociclib group experienced less treatment-related adverse reactions, especially diarrhea, fatigue, and hair loss, and had a lower rate of discontinuation/reduction due to adverse events, a better self-evaluation of their overall health status. Citation Format: B. Cong, C. Hou, C. Shan, S. Sun, S. Sun, Y. Wang. Patient-reported outcomes of adjuvant therapy with CDK4/6 inhibitors for HR+/HER2- early breast cancer: a retrospective cohort study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-08-28.

This study aimed to develop and validate an interpretable machine learning (ML) model based on nnU-Net automated segmentation and computed tomography (CT) radiomics for preoperative risk stratification in thymic epithelial tumors (TETs). In this retrospective multicenter study, 764 patients with pathologically confirmed TETs were enrolled and divided into training, internal validation, and two external validation cohorts. An nnU-Net model was trained for automatic tumor segmentation, with performance assessed by the dice similarity coefficient (DSC). Radiomic features were extracted from the automated segmentations of venous-phase CT images, and least absolute shrinkage and selection operator (LASSO) regression was applied for feature selection. Predictive models, including radiomics-only, clinical-only, and a clinical-radiomics (combined) model, were constructed using five ML algorithms (RF, SVM, KNN, DT, and LR). Model performance was evaluated using the receiver operating characteristic (ROC) curve. Delong’s test was employed to compare these ML models and select the best-performing model as the final model. Calibration curve and decision curve analysis (DCA) were performed to assess clinical efficacy of the final model. The interpretability of the optimal model was elucidated using SHapley Additive exPlanations (SHAP). The nnU-Net segmentation model achieved excellent performance, with a DSC of 0.979 on the test cohort. Compared to the other four combined models, the RF-based combined model demonstrated superior predictive efficacy, yielding area under the curve (AUC) values of 0.941 (training), 0.884 (internal validation), 0.867 (external validation 1), and 0.872 (external validation 2). The calibration curves indicated excellent agreement between the RF-based model’s predictions and actual outcomes, and furthermore, DCA confirmed its superior net benefit over baseline strategies across a wide range of thresholds. SHAP tool identified 11 radiomic features and 3 clinical features as the most influential features, providing transparency into the model’s decision-making process. The nnU-Net framework enables accurate and efficient automatic segmentation of TETs. The proposed RF-based combined model, integrating clinical and radiomic features, provides a robust and interpretable tool for identifying the high-risk TETs, holding promise for supporting clinical decision-making towards personalized therapy.

Maintenance hemodialysis (MHD) patients commonly experience stigma during long-term treatment, yet the characteristics of their subgroups and the associated patterns with symptom burden remain unclear. This study aimed to identify latent subgroups of stigma among MHD patients and depict the symptom network structure of each subgroup. This cross-sectional study enrolled 558 MHD patients from two hospitals between March and December 2024. Stigma was assessed using the Social Impact Scale (SIS), symptom burden was assessed using the Modified Dialysis Symptom Index (DSI), subgroups of stigma were identified using latent profile analysis, and complex relationships between symptoms were explored using network analysis. Network comparison tests were performed to evaluate between-group differences in network connectivity. The study found that there were three subgroups of MHD patients with stigma: low stigma group (38.5%), moderate stigma group (49.6%), and high stigma group (11.8%). The network analysis showed that muscle pain, sadness, and chest pain were the core symptom nodes in the overall sample. Stable symptom networks were observed in the low and moderate stigma groups, with core symptoms differing by subgroup (physical symptoms in the low stigma group vs. emotional symptom in the moderate stigma group), though no significant difference in global network strength was found between these two groups. Stigma among MHD patients presents distinct heterogeneous subgroup characteristics, and there are core symptoms with high connection strength in the symptom network. The difficulty in recruiting patients with high stigma reflects the concealment of this population. Future studies should adopt longitudinal designs and expand the sample size of the high stigma subgroup to verify the value of core symptoms in symptom management. Not applicable.