Yulin Orthopedics Hospital of Chinese and Western Medicine

IntroductionVanishing lung syndrome (VLS) is a clinical condition that characterized by large bullae that compress the normal lung parenchyma. Longitudinal documentation of VLS disease progression and outcomes following endobronchial valve (EBV) treatment remains scarce, particularly for right middle lobe (RML) involvement.Case PresentationWe report a 7-year longterm follow-up case of a 73-year-old female with chronic obstructive pulmonary disease(COPD) who presented with progressive dyspnea and declining pulmonary function. Serial computed tomography scans over 7 years documented the gradual expansion of emphysematous changes predominantly in the RML, with corresponding deterioration in pulmonary function tests (FEV1 decreased from 0.83L to 0.51L). Bronchoscopic lung volume reduction using a single endobronchial valve (EBV) was performed, leading to a significant improvement in dyspnea. Two months post-intervention, the patient demonstrated remarkable clinical improvement with a six-minute walking distance increase from 310 to 650 meters, FEV1 recovery to 97% of baseline (0.81L), and radiological evidence of complete RML atelectasis with adjacent lobe re-expansion.ConclusionThis case underscores the insidious progression of VLS and highlights the utility of EBV therapy in the management of advanced cases.

Tracheoesophageal fistula (TEF) represents a pathological connection between the trachea and esophagus, classified into congenital and acquired categories. Congenital TEF arises from embryological malformations, often coexisting with esophageal atresia (EA), while acquired TEF primarily stems from malignancies, radiotherapy, or trauma. This condition disrupts normal anatomical functions, leading to significant clinical issues, such as aspiration, respiratory infections, and malnutrition. The current review consolidates findings on the etiology, classification, and pathological mechanisms of TEF, emphasizing how genetic, developmental, and external factors shape its occurrence and progression. Diagnostic advancements, including radiological imaging, endoscopic evaluations, and newer monitoring techniques, have refined clinical assessment. Treatment paradigms for TEF vary from minimally invasive endoscopic interventions, to traditional open and innovative surgical approaches. Conservative management, such as nutritional and anti‐infective therapies, remains vital, especially for milder cases. Emerging therapies in regenerative medicine—such as tissue‐engineered scaffolds and platelet‐rich plasmaoffer transformative potential for refractory cases. Future advancements are oriented toward exploring 3D printing, artificial intelligence, and precision medicine. The necessity of multidisciplinary collaboration is underscored in optimizing holistic patient care. While significant progress has improved cure rates and long‐term outcomes, continued research on innovative technologies and clinical trials addressing knowledge gaps in long‐term efficacy remains crucial.

Background:Cervical cancer remains the fourth most common malignant cancer in females and the fourth most common cause of mortality in women worldwide. Approximately 70% of new cases are diagnosed as locoregionally advanced cervical cancer (LACC), posing a significant threat to women’s health. Concurrent chemoradiotherapy (CCRT) is the established standard treatment for LACC. However, more than 30% of patients still experience local recurrence and distant metastasis. Improving treatment outcomes for LACC is a critical global objective.Objective:To investigate the safety and efficacy of adding Endostar to CCRT in patients with LACC.Design:This is a multicenter, open-label, randomized, controlled, phase II trial.Methods:A total of 120 patients were randomly allocated (1:1) to receive either CCRT alone (definitive radiotherapy plus cisplatin 40 mg/m2 every week for 4–5 cycles) or CCRT plus Endostar, Endostar at a dose of 7.5 mg/m2/day, from 5 days before CCRT for 10 consecutive days every 15 days for four cycles).Results:The CCRT + E arm demonstrated a significantly higher complete response rate (CRR) compared to the CCRT arm (68.3% vs 35.0%, p = 0.001), while the overall response rate (ORR) was similarly in both arms (98.3% vs 100%, p = 1.000). The CCRT + E arm showed significantly improved distant metastasis-free survival (DMFS) (1-year: 91.6% vs 94.8%, 2-year: 82.3% vs 91.6%, 5-year: 67.0% vs 88.0% p = 0.029). No significant differences were found in overall survival (OS), progression-free survival (PFS), or locoregional recurrence-free survival (LRFS) (p > 0.05). Multivariable analysis identified maximum tumor diameter >4 cm and failure to achieve CR as predictive factors of poor PFS, and maximum tumor diameter >4 cm and stage IIIA–IVA disease as poor prognostic factors for OS. According to the subgroup analysis, Endostar significantly improved the DMFS in cohorts of patients with squamous cell carcinoma (p = 0.005), a maximum tumor diameter > 4 cm (p = 0.011), and stage IB2 or IIA2–IIB disease (p = 0.005). The rates of acute and late adverse reactions were similar in both arms (p > 0.05), with no cardiac toxicity, hypertension, or grade 5 toxicity reported.Conclusion:The addition of Endostar to CCRT significantly enhanced tumor response (CRR) and reduced distant metastasis (DMFS) in LACC patients without increasing treatment toxicity, offering a promising therapeutic enhancement. Clinically, patients with squamous cell carcinoma, maximum tumor diameter > 4 cm, and International Federation of Gynecology and Obstetrics stage IB2 or IIA2–IIB disease derived particularly robust DMFS benefits from the combination regimen, suggesting they should be prioritized for this approach. Although the 5-year DMFS results are encouraging, validation in a larger phase III study and longer follow-up are warranted before considering this regimen as a new standard treatment modality for LACC.Trial registration:This trial was registered at ClinicalTrials.gov (NCT 03086681, registered 22 March 2017, https://clinicaltrials.gov/study/NCT03086681.

As the most common primary malignant bone tumor, osteosarcoma (OS) is characterized by drug resistance and poor prognosis, highlighting the urgent need for promising therapeutic agents. Formononetin (FMN), a natural product derived from Spatholobi Caulis, has been reported to possess anti-tumor properties. However, its role in OS has not yet been elucidated. In the present study, we established an OS patient-derived xenograft model to investigate the effects of FMN and the underlying mechanisms of its effects on OS. When FMN treatment was completed, bulk transcriptome sequencing was conducted, and the analyses were combined with OS single-cell RNA sequencing (scRNA-seq) data. Results indicated that GTSF1 was up-regulated in OS but down-regulated after FMN intervention, which may regulate the apoptosis of OS cells. Furthermore, the qRT–PCR and IHC results demonstrated that GTSF1 expression was significantly up-regulated in OS cells, whereas FMN expression was down-regulated both in vitro and in vivo. Moreover, in vitro experiments revealed that FMN effectively promoted apoptosis and suppressed the proliferation, migration, and invasion of OS cells. Therefore, this study demonstrated that FMN exerts anti-OS effects by down-regulating GTSF1 expression, thus effectively promoting the apoptosis and inhibiting the proliferation of OS cells, making FMN a promising anti-OS drug.

BACKGROUNDThe prevalence of colorectal cancer (CRC) in younger people is increasing. Despite advances in precision medicine, the challenges of drug resistance and high costs persist. Nitidine chloride (NC) has pharmacological potential, and kinesin family member 20A (KIF20A) is overexpressed in various tumors; however, their interaction in CRC remains unexplored.AIMTo investigate the KIF20A expression characteristics in CRC cells and determine whether it is a potential target gene for NC in inhibiting CRC treatment.METHODSSingle-cell RNA sequencing (scRNA-seq), spatial transcriptomics, and mRNA expression profiling were used to analyze KIF20A expression in CRC cells. Immunohistochemical staining was used to verify KIF20A expression in 416 clinical samples (208 CRC tissue samples and 208 noncancerous control tissue samples). Clustered regularly interspaced short palindromic repeats (CRISPR) technology was used to evaluate the impact of knocking out KIF20A on CRC cell growth. Molecular docking was applied to analyze NC–KIF20A binding. Finally, RNA sequencing and functional enrichment analysis were performed to explore the mechanism of action of NC in CRC cells.RESULTSTreating HCT116 cells with NC was found to significantly downregulate KIF20A (P < 0.05), and the molecular docking analysis revealed high-affinity binding between NC and KIF20A (binding energy = -9.6 kcal/mol). The scRNA-seq, spatial transcriptomics, and mRNA expression profiling results confirmed the significantly high expression of KIF20A in CRC tissues (standardized mean difference = 1.33, 95% confidence interval: 0.885-1.77, summary receiver operating characteristic curve area = 0.94). The immunohistochemical analysis of the clinical samples showed high KIF20A expression in the CRC tissues (P < 0.05), with significant correlation between the level of expression and gender, tumor size, and tumor grade (P < 0.05). Knocking out KIF20A significantly inhibited the growth of various CRC cell lines (CRISPR score < -0.3). The functional enrichment analysis indicated that NC may inhibit CRC by disrupting several biological processes, such as mitotic nuclear division, chromosome segregation, and microtubule binding.CONCLUSIONOur results indicate that NC binds to KIF20A with high affinity and downregulates its expression in CRC cells, leading to reduced proliferation. Hence, NC has promise as a therapeutic agent in the treatment of CRC, and targeting KIF20A also has potential as a therapeutic strategy. Further KIF20A knockout studies are needed to confirm the binding specificity and mechanistic roles of NC in CRC.

To evaluate the clinical efficacy of acupuncture treatment based on the principles of primary point selection, local point selection, and syndrome differentiation in patients with rheumatoid arthritis (RA). RA patients recruited from the rheumatology department of our hospital between January 2022 and January 2024 were randomly assigned to either the sham acupuncture group or the acupuncture group. The sham group received medication combined with sham acupuncture, while the acupuncture group received medication combined with acupuncture based on the principles above. Comparisons were made on Traditional Chinese Medicine (TCM) syndrome scores, quality of life, clinical symptoms, and inflammatory status after 4 weeks of treatment. A total of 65 patients in the acupuncture group and 66 in the sham group were analyzed. The acupuncture group showed a substantially higher total effective rate than the sham group, underscoring a significant advantage in treatment efficacy (81.56% vs. 60.61%). After treatment, the reduction in TCM syndrome scores in the acupuncture group was greater by 1.16 compared to the sham group (95% CI: 0.21-2.12). Following treatment, both groups showed notable improvements, as shown by notable decreases in their Disease Activity Score for 28 joints and Health Assessment Questionnaire ratings. The acupuncture group reported significantly lower scores than the sham group (all p < 0.05). Additionally, rheumatoid factor, high-sensitivity C-reactive protein, and erythrocyte sedimentation rate levels were decreased in both groups. All of the results were statistically significant (all p < 0.05). However, the acupuncture group had significantly lower levels of these markers than the sham group. This suggests that acupuncture has a stronger therapeutic impact when treating illness. Acupuncture treatment based on primary point selection, local point selection, and syndrome differentiation significantly alleviates clinical symptoms and inflammatory states in patients with RA, thereby improving quality of life.