Volume 106 · Issue 28 · 2026

With an in-depth understanding of the biological behavior of breast cancer, the evolution of surgical treatment concepts and advances in comprehensive therapeutic modalities, the surgical management of early-stage breast cancer is increasingly shifting toward precision and personalization with improved clinical outcomes. Focusing on integration and innovation as the core, this article elaborates on the development path and core advances of precision breast-conserving surgery and axillary surgery for early-stage breast cancer under the concept of precision surgery, focusing on the indication expansion, technical optimization of breast-conserving surgery and the de-escalation strategy and individualized decision-making of axillary management. It analyzes the two-way synergistic integration mechanism between systemic adjuvant therapy and precision surgery, as well as the innovative empowerment of cutting-edge technologies such as artificial intelligence and big data on precision breast-conserving and axillary surgery, and looks forward to the future development direction of this field. Breast precision surgery aims to integrate oncologic radicality, functional preservation and aesthetic. Through multidisciplinary dynamic decision-making, it seeks to balance minimal effective surgical intervention with maximal benefit from systemic therapy, ultimately achieving dual optimization of tumor cure and quality of life for patients.

Perioperative ocular pain, as a significant issue that severely affects patients' rapid postoperative recovery and perioperative experience, has long been neglected in perioperative management. Despite its high incidence and potential to cause serious complications (such as corneal damage and visual impairment), relevant research and clinical practice still lack systematic attention. Addressing this issue not only helps improve patient satisfaction and recovery quality but also reduces medical resource consumption and promotes overall optimization of perioperative management. The author believes that a multi-layered defense system for perioperative ocular pain should be established throughout the entire process, including preoperative assessment, intraoperative protection, and postoperative follow-up. In the future, further exploration should be conducted on the specific mechanisms of perioperative ocular pain to optimize existing prevention and management strategies. At the same time, multidisciplinary collaboration should be strengthened to promote the popularization of standardized procedures for perioperative ocular protection, providing patients with safer and more efficient medical services.

Thyroid eye disease (TED) is the most common orbital disorder in adults and can lead to proptosis, extraocular muscle enlargement, and visual dysfunction. In recent years, imaging biomarkers based on magnetic resonance imaging (MRI) and artificial intelligence approaches have shown considerable potential for the differential diagnosis, disease stratification, and treatment response prediction of TED. However, the lack of standardized protocols for multicenter database construction and quantitative image annotation has limited the reproducibility and clinical translation of related studies. To promote standardized management and multicenter sharing of orbital MRI data, the Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association and the Head and Neck Group of Chinese Society of Radiology Chinese Medical Association jointly developed the "Expert consensus on the construction of an orbital MRI database and imaging annotation for thyroid eye disease (2026 edition)", which focuses on key issues including orbital MRI database construction, image annotation standards, quality control, and multicenter collaboration. Finally, seven recommendations were formulated to provide standardized guidance for clinical research and artificial intelligence model development, ultimately facilitating precision diagnosis and treatment of TED.

To standardize the surgical procedures of oblique lateral interbody fusion (OLIF), optimize perioperative management strategies for elderly patients with comorbidities, mitigate surgical risks, and improve long-term clinical outcomes, the Spinal Surgery Group of the Orthopaedic Branch of the Chinese Medical Association and the Lumbar Research Group of the Spinal Column Professional Committee of the Chinese Association of Rehabilitation Medicine convened a multidisciplinary panel of experts across spinal surgery, cardiology, anesthesiology, endocrinology, and nephrology. Through a modified Delphi method, the panel reached a comprehensive consensus and formulated the Expert Consensus on Surgical Procedures and Perioperative Management of Oblique Lateral Interbody Fusion (2026 Edition). Although OLIF has been widely adopted for degenerative lumbar diseases as a minimally invasive spinal fusion technique utilizing a pre-psoas approach, elderly patients (aged 65 years or older) frequently present with multiple comorbidities—such as hypertension, diabetes, and osteoporosis--rendering perioperative management highly complex and currently lacking standard protocols. This consensus provides a targeted and systematic framework to address these critical clinical challenges. During development, the expert panel performed a systematic literature review and rigorously evaluated the quality of evidence (Levels Ⅰ-Ⅳ) and the strength of recommendations (Grades A-C) using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Based on the best available current evidence and tailored to the specific healthcare context and clinical realities in China, this document integrates the latest evidence-based data regarding standardized OLIF workflows, multidisciplinary perioperative comorbidity management (e.g., cardiopulmonary function, blood pressure, and blood glucose), and complication prevention. Conclusively, 31 recommendations were formulated to provide rational clinical guidance and a robust evidence-based foundation for medical professionals in spinal surgery, anesthesiology, and geriatric medicine at all healthcare levels.

To analyze the association between molecular typing and prognosis with recurrence pattern in triple-negative breast cancer (TNBC) patients based on long-term follow-up of a multi-omics cohort.

A retrospective analysis was performed on the clinical data and transcriptomic data of patients diagnosed with TNBC at Department of Breast Surgery, Fudan University Shanghai Cancer Center from January 1, 2007, to December 31, 2014. The survival status of patients was documented, and the follow-up continued until the patients′ death or August 31, 2025. According to the "Fudan subtype", the patients were categorized into the basal-like immune suppressed (BLIS), immunomodulatory (IM), luminal androgen receptor (LAR), and mesenchymal-like (MES). Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was employed to evaluate the differences in overall survival (OS), disease-free survival (DFS) and recurrence-free interval (RFI) among TNBC patients with different molecular subtypes. Multivariate Cox proportional hazards regression analysis was used to assess the association between "Fudan subtype" and OS, DFS and RFI. Differential expression analysis and subsequent gene set enrichment were conducted. Competing-risk models were used to calculate the cumulative incidence of lung metastasis after accounting for competing events, and the differences were assessed using the Fine-Gray test.

After excluding 9 patients lost to follow-up, a total of 351 patients with TNBC were included in the analysis. The mean age at baseline was (53.46±11.36) years, and the median follow-up duration was 102.09 months. During follow-up, 72 patients died and 84 experienced recurrence or metastasis. Among them, 134 patients were classified as the BLIS subtype, with 27 deaths (20.15%); 86 patients were classified as the IM subtype, with 11 deaths (12.79%); 81 patients were classified as the LAR subtype, with 22 deaths (27.16%); and 50 patients were classified as the MES subtype, with 12 deaths (24.00%). The 10-year RFI rates for the BLIS, IM, LAR, and MES subtypes were 80.12% (95%CI: 73.41%-87.44%), 92.35% (95%CI: 86.64%-98.43%), 81.92% (95%CI: 73.39%-91.44%), and 72.95% (95%CI: 61.37%-86.71%), respectively. Kaplan-Meier survival curves showed that the differences of RFI among the four molecular subtypes of patients were statistically significant (P=0.040). Multivariate analysis showed that LAR subtype (LAR vs IM, HR=2.41, 95%CI: 1.03-5.60, P=0.042) was the independent risk factor for DFS, and BLIS subtype (BLIS vs IM, HR=4.17, 95%CI: 1.38-12.57), LAR subtype (LAR vs IM, HR=3.49, 95%CI: 1.06-11.49) and MES subtype (MES vs IM, HR=3.98, 95%CI: 1.25-12.63) were independent risk factors for RFI(all P<0.05). The BLIS subtype is more likely to develop recurrence or metastasis in the early postoperative period, particularly lung metastasis. Differential gene expression analysis showed that BLIS subtype-specific genes, including those involved in proliferation and cell cycle activity, were predominantly upregulated in tumors with early recurrence or metastasis. Competing-risk analysis demonstrated that BLIS patients had a higher cumulative incidence of lung metastasis both overall and within the first 5 years after surgery compared with non-BLIS patients (both P<0.05).

The "Fudan subtype" was significantly associated with RFI in early-stage TNBC patients. In addition, recurrence and metastasis were more likely to be observed in the early postoperative period in the BLIS subtype, particularly early lung metastasis.

To evaluate the influencing factors of pathological complete response (pCR) rate in patients with estrogen receptor-positive/human epidermal growth factor receptor 2-positive (ER+/HER2+) breast cancer receiving neoadjuvant therapy.

A retrospective analysis was performed on ER+/HER2+breast cancer patients who received neoadjuvant therapy at 8 large medical centers from January 2020 to June 2024. Patients were divided according to different neoadjuvant treatment regimens into: chemotherapy combined with targeted therapy group (Chemo+Tar group); antibody-drug conjugate (ADC) combined with tyrosine kinase inhibitor (TKI) regimen group (ADC+TKI group); endocrine therapy (ET) combined with cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) and TKI group (ET+CDK4/6i+TKI group). The clinical and pathological characteristics and pCR status of different neoadjuvant treatment groups were compared, and univariate and multivariate logistic regression analyses were performed to identify factors influencing postoperative pCR in ER+, HER2+ breast cancer patients.

A total of 305 patients receiving neoadjuvant therapy were included, with a pCR rate of 28.2% (86/305). In the Chemo Tar group, there were 195 patients with a pCR rate of 23.1% (45/195); in the ET CDK4/6i TKI group, there were 79 patients with a pCR rate of 30.4% (24/79); and in the ADC TKI group, there were 31 patients with a pCR rate of 54.8% (17/31). Multivariate logistic regression analysis showed that the neoadjuvant therapy regimen (ADC+AKI: OR=6.22, 95%CI: 2.60-14.89; ET+CDK4/6i+TKI: OR=1.84, 95%CI: 0.97-3.48), ER (OR=0.97, 95%CI: 0.96-0.98), and HER2 (3+) (OR=2.78, 95%CI: 1.38-5.59) were influencing factors for postoperative pCR in patients with ER+, HER2+ breast cancer.

Neoadjuvant treatment regimen, low ER expression, and HER2 (3+) are factors affecting postoperative pCR in ER+, HER2+ breast cancer patients.

To investigate the clinical efficacy of indocyanine green combined with methylene blue (ICG+MB) dual tracer method versus MB tracer method for sentinel lymph node (SLN) biopsy (SLNB) in breast cancer.

A multicenter retrospective study was conducted, enrolling 202 breast cancer patients undergoing SLNB at Yunnan Cancer Hospital and Xiang′an Hospital of Xiamen University between January 2023 and August 2025. Patients were divided into the MB tracer group (117 cases) and ICG+MB dual tracer group (85 cases). The SLN detection rate, number of SLN detected, and positive detection rate of SLN metastasis were compared between the two groups. Clinical characteristics of different tracer groups were compared, and logistic regression analysis was performed. The tracing performance of each tracer was also evaluated.

There were no statistically significant differences in baseline clinicopathological characteristics between the two groups (P>0.05). The ICG+MB group showed significantly higher values than the MB group in the number of SLN stained by the tracer (3.62±1.43 vs 2.58±1.36), total number of SLN detected (4.62±2.08 vs 3.77±2.32), and SLN detection rate [96.4% (82/85) vs 85.5% (100/117)] (P<0.05). No significant differences were observed between the two groups in the number of MB-stained lymph nodes or the rate of axillary lymph node dissection. Multivariate logistic regression analysis revealed that the ICG+MB dual-racer method was an independent influencing factor for the positive detection of SLN metastasis in breast cancer patients undergoing SLNB (OR=0.160, 95%CI: 0.028-0.919, P=0.040). Intra-group comparison within the ICG+MB group showed no significant difference in the SLN detection rate between ICG and MB tracer [95.30%(81/85) vs 91.76%(78/85), P=0.350]. ICG was slightly superior to MB in terms of accuracy (98.80% vs 95.29%), sensitivity (98.80% vs 95.12%), and negative predictive value (75.00% vs 42.86%), and had a slightly lower false-negative rate (1.20% vs 4.88%). Both tracers achieved 100% specificity and positive predictive value.

In SLNB for breast cancer, the dual tracer method combining ICG and MB maintains a high detection rate and identifies more SLNs compared to MB alone. ICG effectively complements missed detections by MB, improving accuracy and reducing the false-negative rate.

To evaluate the efficacy and safety of a novel domestic Class 1 therapeutic biological product, Live Double Combined Lactobacillus Capsule for Vaginal Use (containing Lactobacillus gasseri and Lacticaseibacillus rhamnosus), for the treatment of bacterial vaginosis (BV), and to assess its feasibility for subsequent Phase Ⅲ clinical trial.

A multi-centered, randomized, double-blind, placebo-controlled study was conducted. A total of 66 patients diagnosed with BV were enrolled across 8 hospitals nationwide from January to November 2023, and randomly assigned to the experimental group (Live Double Combined Lactobacillus Capsule for Vaginal Use, 1×10⁸ CFU per capsule) or the placebo group at a 2∶1 ratio. Both groups received intravaginal administration of one capsule twice daily for 14 consecutive days. The primary efficacy endpoint was the clinical cure rate at 7 to 16 days after treatment (D21-30). The secondary efficacy endpoints included the clinical cure rate, bacteriological cure rate, and comprehensive cure rate at 1 to 4 days after treatment (D15-18), as well as the bacteriological cure rate and comprehensive cure rate at D21-30. In addition, the vaginal colonization rate of the administered probiotic strains and changes in the relative abundance of vaginal Lactobacillus at D21-30 were explored. Safety analysis was performed at D21-30.

One patient in each group withdrew from the trial prematurely. Ultimately, 42 patients were included in the experimental group with a median age of 37.0 (30.3, 40.0) years, and 22 patients were included in the placebo group with a median age of 37.0 (32.8, 40.0) years. At D21-30, the clinical cure rate was 52.4% (22/42) in the experimental group versus 31.8% (7/22) in the placebo group, with a between-group rate difference of 20.6% (P=0.117), indicating a trend of superiority for the study drug. At D15-18, the experimental group yielded significantly higher clinical cure rate and bacteriological cure rate than the placebo group [57.1% (24/42) vs 22.7% (5/22), P=0.009; 54.8% (23/42) vs 27.3% (6/22), P=0.036]. The comprehensive cure rate was 45.2% (19/42) in the experimental group and 22.7% (5/22) in the placebo group (P=0.077) at D15-18. At D21-30, the bacteriological and comprehensive cure rates were both 33.3% (14/42) in the experimental group and 18.2% (4/22) in the placebo group (P=0.200). At D21-30, the colonization rate of the administered probiotic strains in the experimental group reached 54.8% (23/42). Notably, the strain colonization rate was significantly higher in clinically cured patients than that in uncured patients [81.8% (18/22) vs 25.0% (5/20), P=0.001]. The change in relative abundance of vaginal Lactobacillus from baseline in the experimental group was 6.64% (0.00, 52.34%) at D21-30, which was higher than -0.04% (-1.97%, 0.13%) in the placebo group (P=0.001). There was no statistically significant difference in the incidence of treatment-related adverse events between the two groups (P=1.000), and no serious adverse events related to the investigational product occurred.

Live Double Combined Lactobacillus Capsule for Vaginal Use can promote vaginal colonization of Lactobacillus and restore vaginal microecological balance, exerting a positive effect on treating BV, with a favorable safety profile. These findings support the conduct of a large-scale Phase Ⅲ clinical trial for further verification.

To observe the anesthetic effect of different doses of ciprofol combined with oxycodone for painless gastroscopy in elderly patients during the peri-endoscopic period.

A total of 150 elderly patients who scheduled for elective painless gastroscopy at the Endoscopy Center of Xuanwu Hospital, Capital Medical University, between October and December of 2025 enrolled. All patients were divided into C_0.20 (0.20 mg/kg), C_0.25 (0.25 mg/kg), and C_0.30 (0.30 mg/kg) groups (n=50 each) according to the induction dose of ciprofol, as determined by a random number table. During the induction of the three groups, patients were intravenously injected with 0.05 mg/kg of oxycodone, followed by intravenous injections of 0.20 mg/kg, 0.25 mg/kg, and 0.30 mg/kg of ciprofol 2 minutes later, respectively. If coughing or body movement reactions occurred during the procedure, an additional intravenous bolus of ciprofol 0.10 mg/kg was given. Adverse events such as respiratory depression during the peri-endoscopic period were recorded. Respiratory rate (RR) and pulse oxygen saturation (SpO₂) with their fluctuationwere measured at different time points: before induction (baseline), loss of eyelash reflex, and 1, 3, and 5 min post-insertion. The total dosage and additional administration of ciprofol were also recorded. The differences among the three groups were compared.

The incidence of respiratory depression was significantly lower in the C_0.25 group than in the C_0.30 group [6/50 (12%) vs 15/50 (30%), P<0.05]. The incidences of coughing and body movement were significantly higher in the C_0.20 group than in both the C_0.25 and C_0.30 groups (all P<0.05). At all time points post-insertion, the RR values in all three groups were lower than those at baseline. In all three groups, RR values at each time point post-insertion were also significantly lower than baseline. Moreover, at 1 min post-insertion, the C_0.25 group exhibited the least RR fluctuation (all P<0.05). In the C_0.20 group, SpO₂ levels at 1, 3, and 5 min post-insertion were significantly lower than baseline. In the C_0.20 group, SpO₂ levels at 1, 3, and 5 min post-insertion were significantly decreased from baseline; in the C_0.25 and C_0.30 groups, this decrease was significant only at 1 min post-insertion. Additionally, at 3 min post-insertion, the C_0.25 group exhibited significantly lower SpO₂ fluctuation than the C_0.20 group. All comparisons were statistically significant (all P<0.05). The total dose of ciprofol was significantly higher in the C_0.30 group than in the C_0.20 and C_0.25 groups. Moreover, the total supplemental dose and the frequency of supplemental doses of ciprofol during the peri-endoscopic period were significantly higher in the C_0.20 group than in the C_0.25 and C_0.30 groups (all P<0.05).

Ciprofol at doses of 0.20, 0.25, and 0.30 mg/kg, combined with oxycodone, can be used for painless gastroscopy in elderly patients, of which the 0.25 mg/kg dose is safer and more effective.

To compare the heterogeneity of ossicular malformations and auditory rehabilitation outcomes in children with congenital middle ear malformations, based on the presence or absence of concurrent outer ear malformations.

A retrospective observational study was conducted on patients diagnosed with congenital ossicular chain malformations (COCM) who underwent treatment at the Department of Otolaryngology-Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, between May 2018 and March 2025. Patients were divided into two groups: the isolated middle ear malformation group (no outer ear involvement) and the combined outer-middle ear malformation group. Demographic data (age, gender), clinical characteristics (medical history, otoscopic findings), audiometric profiles [pre-and postoperative pure-tone audiometry (PTA), air-bone gap (ABG)], high-resolution temporal bone CT findings, surgical approaches, intraoperative anatomical observations, and postoperative follow-up outcomes were systematically compared between the two groups.

A total of 43 patients (45 affected ears) were included in the analysis. The isolated middle ear malformation group comprised 21 patients (22 ears; 11 males, 10 females) with a mean age of (9.1±2.5) years at surgery. The combined outer-middle ear malformation group included 22 patients (23 ears; 14 males, 8 females) with a mean surgical age of (6.5±2.1) years. Patients with isolated middle ear malformations were significantly older at the time of surgery and had a higher prevalence of bilateral involvement compared to those with combined malformations (both P<0.05). No statistically significant differences were observed between groups in terms of gender distribution or preoperative CT diagnostic accuracy (both P>0.05). With respect to ossicular deformity patterns, the isolated middle ear malformation group had higher rates of incus-stapes complex malformation [63.6% (14/22) vs 21.7% (5/23)] and stapes fixation [50.0% (11/22) vs 8.7% (2/23)], while the combined malformation group exhibited a significantly higher incidence of malleus-incus complex malformation [78.3% (18/23) vs 36.4% (8/22)] (all P<0.05). Postoperatively, the combined malformation group showed greater improvements in PTA and ABG than the isolated group, though this difference did not reach statistical significance (both P>0.05). In the subgroup of patients who underwent hearing reconstruction surgery, both groups demonstrated significant reductions in preoperative and postoperative PTA and ABG (both P<0.05). However, there was no statistically significant difference in postoperative PTA and ABG compared with preoperative values in either group of children with stapes malformation (both P>0.05).

Children with isolated congenital middle ear malformations undergo surgical intervention at an older age compared to those with combined outer-middle ear malformations. Isolated cases are characterized by a predominance of incus-stapes complex malformations and stapes fixation, whereas combined malformations more commonly involve the malleus-incus complex. Additionally, patients with combined outer-middle ear malformations show a slight advantage over those with isolated middle ear malformations in terms of hearing improvement, although the difference is not statistically significant.

To compare the analgesic efficacy of intravenous paracetamol and mannitol injection versus flurbiprofen axetil for the treatment of acute postoperative pain in adults undergoing orbital implantation.

This single-center, single-blind, randomized, controlled, non-inferiority trial enrolled adult patients who underwent orbital implantation at Zhongshan Ophthalmic Center, Sun Yat-sen University, between October 2024 and October 2025. Patients were randomly assigned to either the paracetamol and mannitol group (PM group, n=32) or the flurbiprofen axetil group (FA group, n=30). Within 15 min before the end of surgery, patients in the PM group were intravenously administered paracetamol and mannitol injection at a dose of 1 ml/kg, while patients in the FA group received flurbiprofen axetil at a dose of 1 mg/kg. Numeric Rating Scale (NRS) pain scores were recorded at 1, 2, 3, 4, and 24 h after surgery, and the area under the curve of NRS scores over 0-24 h (AUC-NRS_0-24h) was calculated as the primary outcome (margin Δ=8.0). Secondary outcomes included the maximum NRS score within 24 h, the Pain Catastrophizing Scale (PCS) score, rescue analgesia, intraorbital pressure assessed by digital palpation, orbital edema grading at 24 h, and the incidence of adverse events within 24 h postoperatively.

A total of 62 patients were enrolled, including 26 females (41.94%), with a mean age of (41.76±11.61) years. The median difference in AUC-NRS_0-24h between the PM and FA groups was -3.50(95%CI:-11.50-2.00), indicating that analgesic efficacy in the PM group was non-inferior to that in the FA group. No significant differences were observed between the two groups in the NRS scores at 1, 2, 3, 4, and 24 h, NRS_max within 24 h, PCS scores, rescue analgesia rates, or orbital edema grading at 24 h (all P>0.05). The incidence of postoperative orbital pressure elevation was significantly lower in the PM group than in the FA group [6.25% (2/32) vs 26.67% (8/30), P=0.040]. There were no significant differences in the incidence of postoperative nausea and vomiting, and no other adverse events were observed during the study period.

Intravenous paracetamol and mannitol injection provides non-inferior analgesia to flurbiprofen axetil in patients undergoing orbital implantation, and also significantly reducing the incidence of postoperative intraorbital pressure elevation.

To investigate the therapeutic effects of rimegepant on corneal pain induced by different pathogenic factors in mice, and to evaluate its influence on the expression of calcitonin gene-related peptide (CGRP) and the neuronal injury marker activating transcription factor 3 (ATF3) in the trigeminal ganglion (TG).

Male C57BL/6 mice aged 8-12 weeks were randomly divided into 9 groups, with 8 mice in each group. Three corneal pain models were established, including ultraviolet-induced corneal injury, corneal abrasion, and excision of the extraorbital lacrimal gland (EELG), together with their corresponding model control groups and rimegepant treatment groups. The experimental groups were as follows: ultraviolet control group, ultraviolet group, and ultraviolet+rimegepant group; abrasion control group, abrasion group, and abrasion+rimegepant group; EELG control group, EELG group, and EELG+rimegepant group. The control groups were sham operation/injury groups. Mice in the rimegepant treatment groups were administered rimegepant by gavage at a dose of 10 mg/kg once every 2 days. Corneal injury was evaluated using fluorescein sodium staining. Corneal mechanical hyperalgesia was assessed using Von Frey filaments, and corneal chemical hyperalgesia was assessed using capsaicin and menthol. Immunofluorescence staining was performed to detect the expression of CGRP and ATF3 in the TG.

All three corneal pain models were successfully established. Compared with the model groups, rimegepant treatment inhibited the occurrence of hyperalgesia to varying degrees. Compared with the ultraviolet group, the ultraviolet+rimegepant group showed lower mechanical hyperalgesia at 0.008 g on treatment day 3 [(47.50%±10.35%) vs (32.50%±7.07%), P<0.05], and lower capsaicin-induced chemical hyperalgesia [(18.88±4.02) vs (13.88±2.36) times/30 s, P<0.05]. Compared with the abrasion group, the abrasion+rimegepant group showed lower 0.008 g mechanical hyperalgesia on treatment day 3 [(43.75%±9.16%) vs (30.00%±9.26%), P<0.05], and lower capsaicin-induced chemical hyperalgesia [(24.75±6.48) vs (14.50±2.33) times/30 s, P<0.05]. Compared with the EELG group, the EELG+rimegepant group showed lower 0.008 g mechanical hyperalgesia and chemical hyperalgesia on day 21 [(76.25%±9.16%) vs (46.25%±10.61%) and (30.13±3.52) vs (20.63±3.38) times/30 s, respectively; all P<0.05]. Immunofluorescence results showed that, compared with their respective control groups, the numbers of CGRP-and ATF3-positive cells in the TG were increased in all three corneal pain model groups (all P<0.05). After rimegepant treatment, CGRP expression in the TG was lower in the three corneal pain models (ultraviolet and abrasion models, both P<0.05; EELG model, P=0.10), and ATF3 expression was lower in all three models (all P<0.05).

Rimegepant exerts analgesic effects in three different corneal pain models and can slow the progression of chronic corneal pain in the EELG model. Its effects may be related to blockade of the CGRP signaling pathway in the TG and alleviation of neuronal injury; however, the specific molecular mechanisms require further investigation.

To investigate the impact of extrafascial total hysterectomy performed via the transvaginal natural orifice transluminal endoscopic surgery (Vnotes) approach on the treatment of high-grade squamous intraepithelial lesion (HSIL) of cervix in postmenopausal women, a retrospective analysis was conducted on 50 postmenopausal women diagnosed with HSIL of cervix who underwent extrafascial total hysterectomy at Nanjing Drum Tower Hospital Group Suqian Hospital between January 2024 and January 2025. The study population was divided into two groups: 26 cases in the Vnotes group and 24 cases in the transabdominal laparoscopy group. Perioperative and postoperative follow-up indicators were compared between the two groups. The result showed that the ages of the two patient groups were (58.3±4.9) and (58.0±5.4) years, respectively (P>0.05). The Vnotes group exhibited significantly shorter operative time, shorter postoperative hospital stay, earlier time to flatus passage, shorter duration of indwelling urinary catheter use, lower visual analog scale pain score at 12 hours postoperatively, and lower levels of hypersensitive C-reactive protein at 48 hours postoperatively compared to the transabdominal porous laparoscopic group (all P<0.05). There was no statistically significant difference in intraoperative blood loss between the two groups (P>0.05), and both groups achieved negative vaginal margins. The average length of vaginal wall resection in the Vnotes group was shorter than that in the transabdominal porous laparoscopic group (P<0.05). No statistically significant differences were observed in the incidence of complications within 30 days postoperatively or in the HPV-negative rate of vaginal remnants at 6 months postoperatively between the two groups (all P>0.05). The Vnotes approach for extraperitoneal total hysterectomy provides precise control over the length of vaginal wall resection, offers minimal invasiveness, promotes rapid postoperative recovery, and achieves complication rates as well as a 6-month HPV clearance rate comparable to transabdominal porous laparoscopic surgery, making it one of the viable alternative treatment options for postmenopausal cervical HSIL.

Sentinel lymph node biopsy (SLNB) is the standard staging procedure for early breast cancer, yet consensus on tracer selection and surgical protocols remains lacking. In this study, we discovered that methylene blue (MB), a conventional blue dye, and mitoxantrone hydrochloride injection (MHI), a novel domestically developed tracer, both exhibit detectable near-infrared fluorescence with emission spectra non-overlapping with indocyanine green (ICG). Based on this finding, we developed a dual-fluorescence imaging system capable of simultaneously distinguishing MB/MHI and ICG signals. Through precisely mapping the axillary lymphatic drainage pathways, we established an anatomical framework of the regional sentinel lymph node network, comprising the sentinel lymph node (SLN), post-sentinel lymph node (post-SLN), and para-sentinel lymph node (para-SLN). Clinical data revealed that among patients with SLN-positive disease, 75% had negative post-SLN, and the status of post-SLN demonstrated high predictive value for non-sentinel lymph node (non-SLN) metastasis (negative predictive value: 97.0%, P<0.001). Based on these findings, we propose a novel strategy: axillary lymph node dissection (ALND) may be safely omitted in patients with SLN-positive but post-SLN-negative status, potentially sparing a substantial proportion of SLN-positive patients from unnecessary surgical morbidity. Furthermore, by using ICG to label the physiological lymphatic drainage of the upper limb and MHI to trace the tumor-specific lymphatic pathways from the breast, the two drainage routes can be precisely differentiated, thereby enhancing the specificity and safety of SLNB. These technological innovations and clinical insights are driving the management of axillary involvement in breast cancer toward greater individualization and precision.

A case of atypical anti-glomerular basement membrane (GBM) disease with membranoproliferative glomerulonephritis is reported. The patient, a 34-year-old male, was admitted to the Eastern Theatre General Hospital on December 30, 2024 mainly due to "abnormal urine test for half a month". The clinical manifestations were nephrotic syndrome with microscopic hematuria, normal renal function, negative anti-GBM antibody in peripheral blood, renal puncture biopsy showed IgG line-like deposition of capillary haptics and renal tubular basement membrane, IgG subtypes were mainly IgG1 and IgG4, and no electron density was seen under electron microscope. Diagnosis of atypical anti-GBM disease. Treatment with tripterygium wilfordii polyglycoside tablets and sacubitril valsartan. Follow-up until January 2026, the patient's urine protein decreased significantly and renal function improved.