Guibin Qiao

Background: Postoperative assessment after the Nuss procedure often emphasizes pain intensity, although recovery also includes functional and procedure-specific symptoms. We characterized multidimensional patient-reported recovery during the first 90 postoperative days. Methods: This retrospective single-center cohort included 93 patients with at least three valid assessments on a 10-item Nuss-specific symptom and function scale. Records were summarized in five postoperative windows. Longitudinal domain patterns, pain-function discordance, and exploratory early pain trajectories were described. Internal consistency of the scale and the perioperative anesthesia and analgesia context were additionally evaluated. Results: The cohort contributed 1,729 records. Pain declined from a median of 5.50 [interquartile range (IQR), 4.25–6.50] during days 1–7 to 2.33 (IQR, 1.00–4.00) during days 15–30, whereas functional limitation was 4.82 (IQR, 3.86–5.94) and 3.00 (IQR, 1.71–4.70), respectively. During days 15–30, 11/88 patients (12.5%) had relatively low pain but persistent functional limitation under exploratory, distribution-informed thresholds. An exploratory two-class model yielded an improving class (79/89) and a persistent-high-pain class (10/89). Among 79 patients with trajectory and later outcome data, residual pain during days 31–90 occurred in 6/9 patients in the persistent-high-pain class and 11/70 in the improving class. Internal-consistency coefficients across windows ranged from 0.900 to 0.950 for the symptom domain and from 0.737 to 0.909 for the function domain. Conclusions: Recovery during the first 90 days after the Nuss procedure was multidimensional, with functional limitation and bar awareness improving more slowly than pain. Exploratory trajectory findings also indicated heterogeneity in early recovery. Multidomain follow-up may provide a more complete view of recovery, and prospective studies with standardized analgesia, neuropathic-pain measures, and longer follow-up are warranted.

Lung transplantation (LT) is emerging as a critical final treatment for end-stage lung diseases including pneumoconiosis. Outcomes of single lung transplan

Even ‘low‐risk’ intraductal papillary carcinoma can progress rapidly to invasive disease following unplanned discontinuation of adjuvant endocrine therapy, as illustrated by this case where hepatotoxicity led to treatment cessation and early recurrence. This underscores the critical need for proactive toxicity management, patient education, and consideration of enhanced surveillance for high‐risk patients who interrupt therapy.

The resection of pulmonary segmental tissue involving isolation and transection of only the target segmental artery without individual dissection of the se

Primary giant mediastinal neoplasms are extremely uncommon. Large-sample studies are rare yet urgently needed. We conducted a retrospective analysis of consecutive cases who underwent excision surgery for giant mediastinal neoplasms between January 2019 and December 2023. Demographic, surgical, and prognosis data were retrospective collected and analyzed. Thirty-two cases were analyzed. The most prevalent location was prevascular compartment (21 cases, 65.6%), followed by visceral compartment (9 cases, 28.1%), and paravertebral compartment (2 cases, 6.3%). Eighteen cases underwent preoperative biopsy, of which 15 consistent with postoperative outcomes. Seven cases underwent preoperative embolization. Median thoracotomy was the most common surgical approach (23 cases, 71.9%). The median operation time was 214 min (interquartile range, IQR: 149–252), with a median blood loss of 500 ml (IQR: 200–800). Thymic tumors were the most prevalent (13 cases, 40.6%), followed by mesenchymal (9 cases, 28.1%), germ-cell (5 cases, 15.6%), pulmonary malignant neoplasms (2 cases, 6.2%), and other rare types (3 cases, 9.4%). The pathological classification demonstrated a significant association with prognosis (p = 0.006), with pulmonary malignancies exhibiting the worst outcomes. No significant overall survival difference was observed in malignant tumor patients with versus without local organ invasion (p = 0.896). R2 resection correlated with significantly poorer survival compared to R0 (p = 0.001). With varied pathological types and complex surgical procedures, giant mediastinal tumors demand multidisciplinary treatment in experienced centers. Complete surgical resection is key to a good prognosis.

Background: The detection of pulmonary nodules (PNs) has increased with the use of low-dose computed tomography screening. Effective management requires timely longitudinal surveillance and reliable comparison with prior examinations, yet access to previous imaging across institutions is often fragmented, leading to delays and potentially unnecessary repeat scans and costs. Cloud-based medical imaging (CMI) solutions offer a potential means of improving access and facilitating cross-institutional data exchange. However, the adoption and utility of CMI in PN care, especially in China, remain underexplored. Objective: This study aims to evaluate the possession, use, and impact of CMI on health care utilization, patient knowledge, and financial burden, as well as to identify usability and interoperability barriers through qualitative investigation. Methods: A mixed methods cross-sectional study was conducted from October 2022 to May 2024. The study involved 701 patients with PNs who completed structured surveys, and 20 participants (10 patients and 10 physicians) were interviewed. CMI use was defined as self-reported ability to view radiological images on a mobile device. We compared CMI users and nonusers and estimated adjusted odds ratios using multivariable logistic regression, then applied 1:1 propensity score matching to examine associations between CMI use and health care utilization, costs, and patient perceptions, and qualitative interviews were analyzed for usability themes. Results: The study found that 611 (87.2%) out of 701 patients had obtained CMI, with 404 (57.6%) out of 701 patients actively using it. In multivariable analysis, older age was independently associated with lower CMI use (odds ratios 0.985, 95% CI 0.972‐0.999). After 1:1 propensity score matching, CMI users accessed more internet hospitals, consulted more physicians, and reported lower health care costs compared to nonusers. Users also demonstrated higher disease knowledge. Qualitative data identified key barriers, including poor system usability, limited retention time for images, and weak interoperability. CMI was perceived as beneficial for patient convenience and clinical efficiency, though concerns over image quality and system fragmentation were prevalent. Conclusions: While CMI is widely available, its usage remains suboptimal. Increased use is associated with enhanced health care engagement and reduced costs, suggesting that improving system usability and ensuring consistent access to imaging may help realize potential benefits of CMI. Future improvements should focus on ensuring long-term access, better retention protocols, and overcoming interoperability issues.

Metabolic reprogramming is a hallmark of cancer that promotes tumor progression and immune evasion. Here, we identify a NIPAL1‐driven metabolic‐epigenetic circuit in esophageal squamous cell carcinoma (ESCC) that facilitates tumor growth and suppresses antitumor immunity. Mechanistically, NIPAL1 recruits the tyrosine kinase HCK to phosphorylate LDHA at Y10, enhancing glycolysis and lactate production. Lactate accumulation promotes p300‐mediated histone H3K18 lactylation (H3K18la), which transcriptionally activates NIPAL1 expression, establishing a self‐sustaining NIPAL1‐HCK‐p‐LDHA‐lactate‐p300‐H3K18la loop. This axis functions independently of NIPAL1's canonical magnesium transporter activity and promotes immune escape by impairing CD8 ⁺ T cell function. Pharmacological inhibition of HCK or p300 disrupts this loop and restores antitumor immunity, sensitizing tumors to anti‐PD‐1 therapy. Clinically, expression of NIPAL1, p‐LDHA (Y10), and H3K18la correlates with response to immune checkpoint blockade. Our findings reveal a previously unrecognized NIPAL1‐HCK‐H3K18la signaling loop that integrates tumor metabolism to immune regulation, offering promising targets to improve immunotherapy efficacy in ESCC.