Objective To evaluate the clinical application of vaginal hysterectomy. Methods Clinical data of 118 patients with benign uterine diseases treated by vaginal hysterectomy (Vaginal Group) were retrospectively reviewed and were compared with those of 124 patients who underwent open hysterectomy (Open Group). Results The operative time (50 1 min?15 3 min), the intraoperative blood loss (150 4 ml?56 ml), the number of patients with a need for postoperative analgesics (26 cases), the postoperative pyrexia (42 cases), the time to first getting out of bed (26 4 h?6 3 h) and the length of hospitalization (5 2 d?1 2 d) in the Vaginal Group were significantly less than those in the Open Group (70 3 min?12 4 min, 212 2 ml?70 3 ml, 124 cases, 94 cases, 48 5 h?12 1 h, 8 2 d?2 2 d, respectively; P =0 000). There were no statistical significances between the two groups in occurrence of intra- or post- operative complications (Vaginal Group: 0 8%, 1/118, Open Group: 5 6%, 7/124; ? 2=2 982, P =0 084). Conclusions Vaginal hysterectomy has the advantages over open hysterectomy in minimal invasion and rapid recovery.

This study was aimed to provide a reference for the development, registration, and clinical use of hospital traditional Chinese medicine (TCM) preparations, in order to analyze and assess their safety and risk. It also provided a reference for the technical review and supervision of hospital TCM preparations. Through collecting review materials of hospital TCM preparations from 2012 to 2014 in the Sichuan Food and Drug Administration, 21 preparations developed by clinical experiences were screened out. Analysis was made on their ingredients, preparation process and acute toxicity data. The results showed that 98 kinds of Chinese herbal medicines were contained in 21 preparations. The dosages of herbs were in compliance with theChina Pharmacopoeia2010 Edition. Preparation processes of 16 preparations were made by water extraction, grinding and other traditional techniques. The preparation processes of the remaining 5 preparations were involved with alcohol extraction or alcohol precipitation. Acute toxicity test data were obtained with experimental data in mice. Clinical usages of preparation were much lower than MTD or LD50. It was concluded that these hospital TCM preparations developed by clinical experiences were with high safety.

Objective:To investigate the clinical significance of gene mutations in epidermal growth factor receptor (EGFR), tumor suppressor gene P53 (TP53), phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), or SMAD family member 4 (SMAD4) in patients with advanced non-small cell lung cancer (NSCLC) based on circulating tumor DNA (ctDNA) analysis.Methods:A single-center, retrospective study was conducted among patients with NSCLC who visited Shanghai Chest Hospital from June 2022 to January 2024. Peripheral blood was collected from patients prior to targeted therapy, and cell-free DNA (cfDNA) and leukocyte DNA were isolated for next-generation sequencing. ctDNA data was obtained through comparative analysis. Patient gene mutations were analyzed according to the guidelines for the interpretation of somatic variants jointly established by the Association for Molecular Pathology/College of American Pathologists/American Society of Clinical Oncology. Analysis of variance and Kaplan-Meier survival curves were applied to assess the partial response (PR) rate among patients with EGFR gene mutations and those with concurrent mutations in other genes.Results:Among 126 patients, the rate of carrying only EGFR mutations was 46.0% (58/126), with a PR rate of 74.1% (43/58). The rate of double mutations in EGFR and TP53 was 37.3% (47/126), with a PR rate of 53.2% (25/47). The rate of triple mutations in EGFR, TP53, and concurrent mutations in PIK3CA or SMAD4 was 16.7% (21/126), with a PR rate of 28.6% (6/21). The comparison of progression-free survival curves among the three groups showed a statistically significant difference (χ 2=23.81, P<0.01). Conclusions:next-generation sequencing detection technology based on ctDNA can detect concurrent mutations in TP53, PIK3CA, or SMAD4 along with EGFR mutations. Multiple gene mutations are significant factors for poor PR rates and progression-free survival curves in patients.

Background As one of the key populations in the prevention and treatment of iodine deficiency disorders, it is important to continuously monitor the iodine nutritional level of school-age children. The current reference interval for thyroid volume in China is based on age only, without taking into account differences in individual developmental levels, and the distribution of thyroid volume may vary regionally due to economic, demographic, and environmental factors. The current reference cut-off points for thyroid volume proposed by the World Health Organization are not based on the Chinese population. Objective To understand the iodine nutritional status and distribution of thyroid volume (Tvol) among children aged 8-10 years in Huangpu District, Shanghai, China, to identify impact factors of Tvol, and to propose a reference range upper limit for local thyroid health surveillance, so as to provide a basis for goiter control and prevention. Methods Six hundred children aged 8-10 years in Huangpu District were recruited in 2017, 2020, and 2023, and body height, weight, thyroid volume, urinary iodine, and iodine content of household edible salt were determined. A multilevel model was constructed using population density and area as regional variables, and age, body surface area (BSA), and body mass index (BMI) as potential impact factors for at the individual level, to assess their effects on thyroid volume. Quantile regression of thyroid volume was performed, and the 98th percentile (P₉₈) of thyroid volume was predicted based on age and BSA. Results The iodized salt coverage in the households of surveyed children in 2017, 2020, and 2023 was 72.0%, 57.0%, and 48.0%, respectively, and the iodized salt coverage decreased by year (χ²=24.31, P<0.001). The urinary iodine level of children in 2017 was higher than that in 2020 and 2023 (χ²=18.77, P<0.001). The Tvol medians of children in 2017, 2020, and 2023 were 2.29, 2.49, and 2.97 mL, respectively, and the Tvol increased by year (χ²=60.04, P<0.001). The proportion of goiter was higher in children in 2023 than in 2017 and 2020 (χ²=6.57, P<0.05). Sex differences were not statistically significant for urinary iodine levels, thyroid volume, and goiter. The median Tvol was 2.26, 2.58, and 2.76 mL in children of 8, 9, and 10 years old respectively, and the Tvol increased with age (χ²=49.02, P <0.001). Tvol was positively correlated with age, BSA, and BMI with correlation coefficients of 0.2846, 0.3723, and 0.2950, respectively. The final quantile regression model showed that the strongest effect of BSA was associated with the 98th percentile of Tvol. Multilevel models considering population density or area as regional variables failed to achieve convergence. Conclusion To establish the upper limit of the reference interval for thyroid volume of healthy children in Huangpu District, the effects of age and BSA should be considered at the individual level, and the upper limit of the normal interval for goiter screening is suggested to be the 98th percentile value of BSA at the same age. In addition, the adaptability of population density and regional area as indicators of regional aggregation of thyroid volume distribution still needs to be further explored.

The bile acid-responsive G-protein-coupled receptor TGR5 is expressed in monocytes and macrophages, and plays a critical role in regulating inflammatory response. Our previous work has shown its role in promoting the progression of non-small cell lung cancer (NSCLC), yet the mechanism remains unclear. Here, using Tgr5-knockout mice, we show that TGR5 is required for M2 polarization of tumor-associated macrophages (TAMs) and suppresses antitumor immunity in NSCLC via involving TAMs-mediated CD8⁺ T cell suppression. Mechanistically, we demonstrate that TGR5 promotes TAMs into protumorigenic M2-like phenotypes via activating cAMP-STAT3/STAT6 signaling. Induction of cAMP production restores M2-like phenotypes in TGR5-deficient macrophages. In NSCLC tissues from human patients, the expression of TGR5 is associated with the infiltration of TAMs. The co-expression of TGR5 and high TAMs infiltration are associated with the prognosis and overall survival of NSCLC patients. Together, this study provides molecular mechanisms for the protumor function of TGR5 in NSCLC, highlighting its potential as a target for TAMs-centric immunotherapy in NSCLC.