Lung cancer, a highly prevalent and deadly malignancy globally, poses a significant disease burden in China and is the leading cause of cancer death. Despite rapid advances in medicine, its incidence and mortality rates remain stubbornly high, making it a major challenge in public health. Against the backdrop of rapid progress in precision medicine, the paradigm of lung cancer treatment is shifting from single traditional therapy to multi-dimensional integration. This article comprehensively reviews the innovations and challenges in lung cancer surgery in 2024, aiming to explore the future development of surgical treatment with colleagues and to improve patients' quality of life and achieve the goal of "cure".
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Humans ; Lung Neoplasms/surgery*

Extensive epigenetic reprogramming involves in memory CD8+ T-cell differentiation. The elaborate epigenetic rewiring underlying the heterogeneous functional states of CD8+ T cells remains hidden. Here, we profile single-cell chromatin accessibility and map enhancer-promoter interactomes to characterize the differentiation trajectory of memory CD8+ T cells. We reveal that under distinct epigenetic regulations, the early activated CD8+ T cells divergently originated for short-lived effector and memory precursor effector cells. We also uncover a defined epigenetic rewiring leading to the conversion from effector memory to central memory cells during memory formation. Additionally, we illustrate chromatin regulatory mechanisms underlying long-lasting versus transient transcription regulation during memory differentiation. Finally, we confirm the essential roles of Sox4 and Nrf2 in developing memory precursor effector and effector memory cells, respectively, and validate cell state-specific enhancers in regulating Il7r using CRISPR-Cas9. Our data pave the way for understanding the mechanism underlying epigenetic memory formation in CD8+ T-cell differentiation.
CD8-Positive T-Lymphocytes/metabolism* ; Cell Differentiation ; Chromatin/immunology* ; Animals ; Mice ; Immunologic Memory ; Epigenesis, Genetic ; SOXC Transcription Factors/immunology* ; NF-E2-Related Factor 2/immunology* ; Mice, Inbred C57BL ; Gene Regulatory Networks ; Enhancer Elements, Genetic

China prospective multicenter birth cohort (Prospective Omics Health Atlas birth cohort, POHA birth cohort) study was officially launched in 2022. This study, in collaboration with 12 participating units, aims to establish a high-quality, multidimensional cohort comprising 20 000 naturally conceived families and assisted reproductive families. The study involves long-term follow-up of parents and offspring, with corresponding biological samples collected at key time points. Through multi-omics testing and analysis, the study aims to conduct multi-omics big data research across the entire maternal and infant life cycle. The goal is to identify new biomarkers for maternal and infant diseases and provide scientific evidence for risk prediction related to maternal diseases and neonatal health.

Abstract: Objective　To understand the epidemiological characteristics of the migratory bird population with hypertension in Hainan and to provide a basis for the health management of the migratory bird population. Methods　One hundred and eighty migratory birds with hypertension who had lived in in the Mangrove Bay community of Chengmai, Hainan for 3 months or more were selected as the study population. Demographic data, including gender, age, ethnicity, occupation, medication use, family history of hypertension, hometown living environment, Hainan living environment (presence of water area and greenbelt around the residence, type of water area and greenbelt), smoking and alcohol consumption, and height and weight were collected by questionnaire and physical examination to investigate the epidemiological characteristics of the study subjects, and unconditional dichotomous logistic regression analysis was used to identify factors affecting the reduction of blood pressure among the hypertensive migratory bird population before and after taking medication in Hainan. Results　A total of 180 study subjects were included, including 77 (42.8%) males and 103 (57.2%) females, with 78 (43.3%) subjects aged ≤65. The hypertension levels were: 87 (48.3%) had normal high blood pressure, 56 (31.1%) had grade 1 hypertension and 37 (20.6%) had grade 2 hypertension. The higher the blood pressure classification, the lower the percentage of migratory individuals whose blood pressure dropped during their stay in Hainan. Age, hypertension classification, dietary habits, living environment, body mass index (BMI), and alcohol consumption were associated with a decrease in blood pressure during Hainan among the study participants who took hypertension medication regularly. Salty diet (OR=2.778, 95%CI:1.070-7.213, P=0.036) and alcohol consumption (OR=2.686, 95%CI:1.042-6.925, P=0.041) were unfavorable factors for lower diastolic blood pressure before taking medication; overweight (OR=3.487, 95%CI:1.306-9.310, P=0.013) was an unfavorable factor in the reduction of diastolic blood pressure after taking medication. Conclusion　The blood pressure reduction is more significant in migratory individuals in migratory individuals under 65 years old, with a light diet, no alcohol consumption and normal BMI. Environmental factors, age, dietary habits and lifestyle are the main causes of blood pressure, which can provide a reference basis for the health management of the migratory birds with hypertension in Hainan.

Objective:To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment.Methods:A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University.Results:The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant ( P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥39 °C); other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases ( P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases ( OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions:The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively.

Electroencephalogram (EEG) has been an important tool for scientists to study epilepsy and evaluate the treatment of epilepsy for half a century, since epilepsy seizures are caused by the diffusion of excessive discharge of brain neurons. This paper reviews the clinical application of scalp EEG in the treatment of intractable epilepsy with vagus nerve stimulation (VNS) in the past 30 years. It mainly introduces the prediction of the therapeutic effect of VNS on intractable epilepsy based on EEG characteristics and the effect of VNS on EEG of patients with intractable epilepsy, and expounds some therapeutic mechanisms of VNS. For predicting the efficacy of VNS based on EEG characteristics, EEG characteristics such as epileptiform discharge, polarity of slow cortical potential changes, changes of EEG symmetry level and changes of EEG power spectrum are described. In view of the influence of VNS treatment on patients' EEG characteristics, the change of epileptiform discharge, power spectrum, synchrony, brain network and amplitude of event-related potential P300 are described. Although no representative EEG markers have been identified for clinical promotion, this review paves the way for prospective studies of larger patient populations in the future to better apply EEG to the clinical treatment of VNS, and provides ideas for predicting VNS efficacy, assessing VNS efficacy, and understanding VNS treatment mechanisms, with broad medical and scientific implications.
Drug Resistant Epilepsy ; Electroencephalography ; Humans ; Prospective Studies ; Scalp ; Treatment Outcome ; Vagus Nerve Stimulation

Objective:To investigate the value of first-trimester uterine artery Doppler pulsatility index (PI) in the prediction of preeclampsia (PE) in twin pregnancies.Methods:From April 2014 to October 2016, women with twin pregnancies undergoing Down's screening at 11 +0-13 +6 gestational weeks in Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine were recruited in this prospective cohort study. Bilateral uterine artery PI values were measured by Doppler ultrasound at the first trimester. Pregnancy outcomes and the incidence of PE were followed up. The participants were classified into four groups according to their pregnancy outcomes: early-onset PE (<34 weeks), late-onset PE (≥34 weeks), gestational hypertension and normal groups. Differences in the multiples of median of uterine artery PI (PI MoM) and rates of abnormal PI MoM (≥ P90) were compared among the four groups using the Kruskal-Wallis test, Chi-square test or Fisher exact test. The performance of uterine artery PI in the prediction of PE was evaluated using receiver operating characteristic (ROC) curve. Results:A total of 1 223 twin pregnancies were recruited and 185 of them were excluded for not meeting the eligibility criteria. The 1 038 cases enrolled successfully were 231 monochorionic diamniotic (MCDA) and 807 dichorionic diamniotic (DCDA) twin pregnancies. The incidences of early-onset PE, late-onset PE and gestational hypertension were 3.47% (36/1 038), 7.03% (73/1 038) and 2.79% (29/1 038), respectively. No significant difference was observed in PI MoM [ M( P25~ P75), 1.06 (0.80-1.32), 1.05 (0.75-1.30), 0.99 (0.73-1.23), 1.03 (0.80-1.27); χ2=0.396, P=0.941] or the rates of abnormal PI MoM [8.33% (3/36), 6.85% (5/73), 13.79% (4/29), 10.11% (91/900); Fisher's exact test, P=0.703] among the four groups. Furthermore, there was no significant difference in PI MoM between normal MCDA and DCDA twin pregnancies [1.04 (0.81-1.29) vs 1.03 (0.79-1.27), χ2=0.095, P=0.758]. The area under the ROC curve showed that first-trimester uterine artery PI had limited value in the prediction of early-onset PE (0.514, 95% CI: 0.413-0.615), late-onset PE (0.499, 95% CI: 0.428-0.570) and gestational hypertension (0.530, 95% CI:0.418-0.643) in twin pregnancies. Conclusion:First-trimester uterine artery PI has limited value in predicting early- or late-onset PE in twin pregnancies.

Objective:To assess the safety and efficacy of radiofrequency ablation (RFA) in the treatment of twin reversed arterial perfusion (TRAP) sequence.Methods:This was a retrospective study of all TRAP sequence cases treated by RFA in Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, between January 1, 2012, and December 31, 2018. Perioperative complications, short- and long-term perinatal outcomes, and maternal complications were analyzed by analysis of variance, Kruskal-Wallis test, Chi-square test, or Fisher's exact test. Results:(1) This study recruited 59 pregnant women with an average age of (28.4±4.0) years. The mean gestational age at TRAP sequence diagnosis was (17.0±4.1) weeks, and 23 (39.0%) were diagnosed before 16 weeks. (2) The 59 cases consisted of 45 (76.2%) monochorionic diamniotic (MCDC) twins, five (8.5%) monochorionic monoamniotic (MCMA) twins, four (6.8%) monochorionic triamniotic (MCTA) triplets and five (8.5%) dichorionic triamniotic (DCTA) triplets. Fifty-four cases (91.5%) were acardius acephalus, four (6.8%) were acardius anceps, and one (1.7%) was acardius amorphous. (3) Preterm premature rupture of membranes (PPROM) was a leading complication following RFA with an overall incidence of 25.4% (15/59). PPROM before 28 and at 28-34 gestational weeks occurred in seven (11.9%) and five (8.5%) cases, respectively, leading to fetal loss in six cases. The cumulative incidence of PPROM within one week, two weeks, and one month after RFA was 5.1% (3/59), 6.8% (4/59) and 10.2% (6/59), respectively. No chorioamnionitis, blood transfusion due to hemorrhage, placental abruption, sepsis, bowel perforation, or other maternal complications were reported during or after the procedure. (4) No abnormalities of the nervous system were found in any fetus on postoperative MRI during pregnancy. The mean interval from treatment to delivery was (14.9±7.1) weeks. Twelve pump twins (20.3%) were lost after RFA, while the other 47 (79.7%) were delivered and survived until 28 days after birth, including 18 premature infants and 29 full-term infants. Eight premature infants were admitted to the neonatal intensive care unit (NICU). Intraventricular hemorrhage, neonatal respiratory distress syndrome (NRDS), and NRDS complicated by necrotizing enterocolitis occurred in three different babies who recovered after appropriate treatment. (5) Of the 59 patients, 56 (94.9%) received intrauterine interventions after 16 gestational weeks, and the survival rate of the pump twins was 78.6% (44/56). Three patients (5.1%) received intrauterine interventions before 16 weeks of gestation with all pump twins survived. (6) Of the 45 MCDA twins, 37 (82.2%) survived and were born at a mean gestational age of 38.0 (26.5-41.0) weeks. Three out of the five MCMA twins survived with the median gestational age at birth of 33.5 (32.0-37.0) weeks. Of the nine triplets, seven survived and delivered at the median gestational age of 37.1 (29.2-40.0) weeks. (7) The needle pierced through the placenta during RFA in 23 (39.0%) cases, but not in the rest 36 (61.0%) cases. After excluding four cases opting for pregnancy termination, statistical analysis showed no significant difference in the incidence of PPROM or intrauterine death, or the 28-day survival rate of the pump twins when comparing those cases with the needle going or not going through the placenta. (8) At the final follow-up (December 2019), 47 surviving pump infants were growing normally without any severe neurological sequelae.Conclusions:RFA appears to be a relatively safe and reliable technique in the treatment of TRAP sequence to improve the perinatal outcomes of pump twins.

Emblic medicine is a popular natural source in the world due to its outstanding healthcare and therapeutic functions. Our preliminary results indicated that the quality of emblic medicines might have an apparent regional variation. A rapid and effective geographical traceability system has not been designed yet. To trace the geographical origins so that their quality can be controlled, an integrated spectroscopic strategy including spectral pretreatment, outlier diagnosis, feature selection, data fusion, and machine learning algorithm was proposed. A featured data matrix (245 × 220) was successfully generated, and a carefully adjusted RF machine learning algorithm was utilized to develop the geographical traceability model. The results demonstrate that the proposed strategy is effective and can be generalized. Sensitivity (SEN), specificity (SPE) and accuracy (ACC) of 97.65％, 99.85％ and 97.63％ for the calibrated set, as well as 100.00％ predictive efficiency, were obtained using this spectroscopic analysis strategy. Our study has created an integrated analysis process for multiple spectral data, which can achieve a rapid, nondestructive and green quality detection for emblic medicines originating from seventeen geographical origins.

PURPOSE: Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.METHODS: A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.RESULTS: There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).CONCLUSIONS: Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.
Adrenal Cortex Hormones ; Asthma ; China ; Comorbidity ; Disease Progression ; Education ; Female ; Food Hypersensitivity ; Hospitalization ; Humans ; Hypertension ; Inpatients ; Medication Adherence ; Mortality ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Seasons ; Self Care ; Smoke ; Smoking