Objective To develop the Chinese version of the nasal obstruction symptom evaluation (NOSE) questionnaire.Methods After introduction,forward and backward translation,synthesis,expert committee review,pretest,adaptation and validation followed the international guidelines,the Chinese version of NOSE scale was tested among 223 nasal septal deviation patients and 80 health volunteers to further assess its psychometric and clinical properties.SPSS 19.0 software was used to analyze the data.Results The Chinese version demonstrated satisfactory evaluation results.The acceptance rate of the questionnaire was 97.6％ and 94.1％ in the patient group and control group respectively,and the completion time was (1.5 ± 0.5) min and (1.0 ± 0.5) min.Internal consistency reliability (Cronbach' s α) was calculated to be 0.869.Test-retest reliability coefficient was adequate at rs =0.996.Content validity was approved by our expert committee.Criteria validity (Spearman correlation coefficient) between NOSE Chinese version and SF-36,as well as VAS was-0.837 and 0.725 separately.Construct validity of Chinese version was similar to that of the original edition.The standardized response mean and the effect size at three months postoperatively was respectively 1.34 and 1.21,indicating high responsiveness.Calculated by Mann-Whitney U test,the instrument showed excellent sensitivity to discriminate the subjects with or without nasal obstruction (P ＜ O.01).The NOSE scores were also correlated with nasal resistance by rhinomanometry.Conclusions The NOSE Chinese version was successfully cross-cultural adapted and validated.It therefore can be recommended as a robust tool for future measuring subjective severity of nasal obstruction in China.

30%) might be a risk factor in HAPE susceptibility.

Objective:To investigate the therapeutic efficiency of multiple forms of microdissected perforator flaps in the reconstruction of limb defect.Methods:The data of patients treated in the Department of Hand Surgery of Xuzhou Renci Hospital from June 2020 to June 2022 for repairing wound of hands, feet, limbs and popliteal fosses with microdissected perforator flap were retrospectively analyzed. CT angiography and color Doppler ultrasound were performed in all patients before surgery to locate perforator vessels, design the donor flap, and cut the flap retrograde according to the design line. After confirming good blood supple, the flap was harvested under the microscope, and fat particles were cut around the vascular pedicle by "insect eating" technique. After that, the flap was transferred to the recipient area, completed the vascular anastomosis, and placed the drainage tube. The donor site was closed directly. The blood circulation of the flap was observed closely after operation. Regular follow-up visits were conducted in outpatient clinics, door-to-door visits and WeChat to record sensory recovery and complications. Postoperative wound healing, flap shape, flap sensation, flap temperature and scar in donor area were evaluated using the efficacy satisfaction scale, which was divided into four grades: excellent (2 points), good (1 point), fair (0 point) and poor (-1 point). The total score of 5-10 was satisfactory, 0-4 was average, and -1--5 was unsatisfactory.Results:A total of 16 patients were included, including 8 males and 8 females. The age ranged from 26 to 65 years, with an average age of 45.9 years. There were 2 cases of upper limb soft tissue defect, 2 cases of hand degloving injury, 11 cases of hand skin soft tissue defect, and 1 case of popliteal soft tissue defect. The wound size ranged from 3.0 cm×4.5 cm to 13.0 cm×30.0 cm. Free medial sural artery perforator flap was used in 4 cases, interosseous dorsal artery perforator flap in 1 case, anterolateral femoral perforator flap in 6 cases, thoracic umbilical flap in 1 case, anterolateral femoral perforator flap combined with superficial circumflex iliac artery perforator flap in 1 case, and superficial circumflex iliac artery perforator flap in 3 cases. The size of the skin flap was 3.5 cm×5.0 cm - 9.5 cm×30.0 cm. After operation, 15 cases of flaps successfully survived, 1 case of venous crisis occurred 1 day after operation, and successfully survived after exploration and re-anastomosis of blood vessels. The wounds in the donor area healed in one stage without wound infection, delayed healing and other complications. All patients were follow-up for 7 to 18 months (mean 12.1 months), the skin flap survived well, no pigmentation, bloated appearance, and no patients requested secondary thinning treatment. The skin flap sensation recovered light touch in 1 case, protective sense in 9 cases and deep touch only in 6 cases. No significant thickening of skin flap was observed in the later period of follow-up, and skin flap wear was observed in 1 patient. There were only linear scars left in the donor area, and there were no obvious abnormalities in appearance and function. Efficacy satisfaction evaluation showed that all patients were satisfied with the therapeutic effect, scoring 6-9 points, with an average of 7.8 points.Conclusion:Microdissected perforator flap technique provides a one-stage surgical solution for aesthetic and functional areas with high requirements, and satisfactory clinical efficiencies can be obtained.

Objective:To investigate the therapeutic efficiency of multiple forms of microdissected perforator flaps in the reconstruction of limb defect.Methods:The data of patients treated in the Department of Hand Surgery of Xuzhou Renci Hospital from June 2020 to June 2022 for repairing wound of hands, feet, limbs and popliteal fosses with microdissected perforator flap were retrospectively analyzed. CT angiography and color Doppler ultrasound were performed in all patients before surgery to locate perforator vessels, design the donor flap, and cut the flap retrograde according to the design line. After confirming good blood supple, the flap was harvested under the microscope, and fat particles were cut around the vascular pedicle by "insect eating" technique. After that, the flap was transferred to the recipient area, completed the vascular anastomosis, and placed the drainage tube. The donor site was closed directly. The blood circulation of the flap was observed closely after operation. Regular follow-up visits were conducted in outpatient clinics, door-to-door visits and WeChat to record sensory recovery and complications. Postoperative wound healing, flap shape, flap sensation, flap temperature and scar in donor area were evaluated using the efficacy satisfaction scale, which was divided into four grades: excellent (2 points), good (1 point), fair (0 point) and poor (-1 point). The total score of 5-10 was satisfactory, 0-4 was average, and -1--5 was unsatisfactory.Results:A total of 16 patients were included, including 8 males and 8 females. The age ranged from 26 to 65 years, with an average age of 45.9 years. There were 2 cases of upper limb soft tissue defect, 2 cases of hand degloving injury, 11 cases of hand skin soft tissue defect, and 1 case of popliteal soft tissue defect. The wound size ranged from 3.0 cm×4.5 cm to 13.0 cm×30.0 cm. Free medial sural artery perforator flap was used in 4 cases, interosseous dorsal artery perforator flap in 1 case, anterolateral femoral perforator flap in 6 cases, thoracic umbilical flap in 1 case, anterolateral femoral perforator flap combined with superficial circumflex iliac artery perforator flap in 1 case, and superficial circumflex iliac artery perforator flap in 3 cases. The size of the skin flap was 3.5 cm×5.0 cm - 9.5 cm×30.0 cm. After operation, 15 cases of flaps successfully survived, 1 case of venous crisis occurred 1 day after operation, and successfully survived after exploration and re-anastomosis of blood vessels. The wounds in the donor area healed in one stage without wound infection, delayed healing and other complications. All patients were follow-up for 7 to 18 months (mean 12.1 months), the skin flap survived well, no pigmentation, bloated appearance, and no patients requested secondary thinning treatment. The skin flap sensation recovered light touch in 1 case, protective sense in 9 cases and deep touch only in 6 cases. No significant thickening of skin flap was observed in the later period of follow-up, and skin flap wear was observed in 1 patient. There were only linear scars left in the donor area, and there were no obvious abnormalities in appearance and function. Efficacy satisfaction evaluation showed that all patients were satisfied with the therapeutic effect, scoring 6-9 points, with an average of 7.8 points.Conclusion:Microdissected perforator flap technique provides a one-stage surgical solution for aesthetic and functional areas with high requirements, and satisfactory clinical efficiencies can be obtained.

Objective To evaluate the application of Web problem-based learning (WPBL) mode of respiratory system integration curriculum.Methods Experimentclasses 1 and 2 of the 2014 grades of the Qiqihar Medical University were divided into control group(48 students) and experiment group (48 students).Traditional PBL teaching was conducted in control group:the contents of the case were printed and discussed with the material of each class.WPBL teaching was conducted in experiment group:autonomous learning before class,showing cases by Video,asking questions and discussion in group and reporting results in class.The teaching effect was evaluated by PBL evaluation form,questionnaire and final grade.SSPS 19.0 statistical software was used for data analysis and measurement.T test was conducted among groups.Counting data were tested by Chi-square and the results were expressed as percentage.Results The students in the experiment group were better than those of control groupin the aspects of contents understanding,course interest,clinical thinking ability,classroom atmosphere and the course attitude.The scores of PBL (16.65 ±2.82),experiment exam (8.21 ±0.44) and final grade(76.77 ± 12.31) in the experiment group were higher than those in the control group.There are statistical differences in two groups (P＜0.05).Conclusions WPBL teaching can improve students'learning interest,clinical thinking ability and improve the teaching quality of respiratory integration curriculum.

OBJECTIVE: To compare the application among intensity-modulated radiotherapy (IMRT), three-dimensional conformal radiotherapy(3D-CRT) and conventional radiotherapy (CRT) for locally advanced middle-low rectal cancer. METHODS: From January 2015 to December 2016, 93 locally advanced middle-low rectal cancer patients with clinical stage cT3N+M0 or cT4N0/+M0 who underwent preoperative concurrent chemoradiotherapy at Department of Colorectal Surgery, the Third Affiliated Hospital of Kunming Medical University and had complete data were enrolled in this retrospective cohort study. Patients were divided into IMRT group (17 cases), 3D-CRT group (28 cases) and CRT group (48 cases) according to different radiotherapy methods. The frequency and dose of CRT were 1 time/day, 5 times/week, for a total of 5 weeks, with a single dose of 2.0 Gy, the total dose was 50 Gy. Frequency and dose of 3D-CRT and IMRT were 1 time/day, 5 times/week, for a total of 23 to 28 times, with a single dose of 1.8 to 2.0 Gy, and a total dose of 45.0 to 50.4 Gy. The chemotherapy regimen was performed with capecitabine tablets at a dose of 825 mg/m twice a day for 5 days every week, at the same time during radiotherapy. The efficacy, chemotherapy adverse reactions and immune function of the three groups were compared. RESULTS: There was no significant difference in the baseline data among the three groups (all P>0.05). The proportion of patients receiving permanent ostomy in the IMRT group and the 3D-CRT group was 29.4%(5/17) and 32.1%(9/28) respectively, which was lower than 58.3%(28/48) in CRT group, and the difference was statistically significant (χ²=7.982, P=0.030), while this proportion was not significantly different between IMRT and 3D-CRT group(χ²=0.037, P=0.848). The pathologic complete response(pCR) rate was 23.7%(22/93) in the whole study, and the pCR rate was 39.3%(11/28) in the 3D-CRT group, which was higher than that of CRT group and IMRT group [12.5%(6/48) and 29.4%(5/17)], and the difference was statistically significant (χ²=7.407, P=0.025), while there was no significant difference in pCR rate between CRT group and IMRT group (χ²=2.554, P=0.110). There was no adverse reaction of grade 3 or above in all three groups. No significant difference in the incidence of bone marrow suppression, abnormal liver and kidney function markers, digestive tract reaction or radiation dermatitis was found(all P>0.05). After receiving concurrent chemoradiotherapy, the proportion of CD3/CD4 cells in the IMRT group and the CRT group decreased compared with that before treatment(23.1±9.3 vs. 31.1±10.9, 27.4±10.7 vs. 33.6±7.2, respectively); the proportion of CD3/CD8 cells was up-regulated (36.1±15.2 vs. 24.8±10.9, 30.9±14.4 vs. 24.0±8.3,respectively), and the differences were statistically significant (both P<0.05), while the above indexes before and after treatment were not significantly different in the 3D-CRT group(all P>0.05). After treatment, the proportion of CD4/CD8 cells in IMRT group decreased (0.8±0.6 vs. 1.6±1.0, t=3.838, P=0.003), while this proportion was not significantly different in CRT group and 3D-CRT group(all P>0.05). CONCLUSIONS IMRT and 3D-CRT can reduce the rate of permanent stoma. 3D-CRT can increase pCR rate. No obvious advantage is shown in IMRT as compared with 3D-CRT in the short-term efficacy. On the contrary, an immunosuppressive status may occur. Therefore, 3D-CRT is recommended as the best preoperative treatment strategy for patients with locally advanced middle-low rectal cancer, especially for those with immunosuppression status.
Humans ; Radiotherapy ; methods ; standards ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal ; standards ; Radiotherapy, Intensity-Modulated ; standards ; Rectal Neoplasms ; radiotherapy ; Retrospective Studies

Molecular knowledge of human gastric corpus epithelium remains incomplete. Here, by integrated analyses using single-cell RNA sequencing (scRNA-seq), spatial transcriptomics, and single-cell assay for transposase accessible chromatin sequencing (scATAC-seq) techniques, we uncovered the spatially resolved expression landscape and gene-regulatory network of human gastric corpus epithelium. Specifically, we identified a stem/progenitor cell population in the isthmus of human gastric corpus, where EGF and WNT signaling pathways were activated. Meanwhile, LGR4, but not LGR5, was responsible for the activation of WNT signaling pathway. Importantly, FABP5 and NME1 were identified and validated as crucial for both normal gastric stem/progenitor cells and gastric cancer cells. Finally, we explored the epigenetic regulation of critical genes for gastric corpus epithelium at chromatin state level, and identified several important cell-type-specific transcription factors. In summary, our work provides novel insights to systematically understand the cellular diversity and homeostasis of human gastric corpus epithelium in vivo.
Humans ; Epigenesis, Genetic ; Gastric Mucosa/metabolism* ; Chromatin/metabolism* ; Stem Cells ; Epithelium/metabolism* ; Fatty Acid-Binding Proteins/metabolism*

Objective: To understand the consistency of ALK Ventana-D5F3 immunohistochemistry (IHC) interpretation in Chinese lung adenocarcinoma among histopathologists from different hospitals, and to recommend solution for the problems found during the interpretation of ALK IHC in real world, with the aim of the precise selection of patients who can benefit from ALK targeted therapy. Methods: This was a multicenter and retrospective study. A total of 109 lung adenocarcinoma cases with ALK Ventana-D5F3 IHC staining were collected from 31 lung cancer centers in RATICAL research group from January to June in 2018. All cases were scanned into digital imaging with Ventana iSCANcoreo Digital Slide Scanning System and scored by 31 histopathologists from different centers according to ALK binary (positive or negative) interpretation based on its manufacturer′s protocol. The cases with high inconsistency rate were further analyzed using FISH/RT-PCR/NGS. Results: There were 49 ALK positive cases and 60 ALK negative cases, confirmed by re-evaluation by the specialist panel. Two cases (No. 2302 and No.2701) scored as positive by local hospitals were rescored as negative, and were confirmed to be negative by RT-PCR/FISH/NGS. The false interpretation rate of these two cases was 58.1% (18/31) and 48.4% (15/31), respectively. Six out of 31 (19.4%) pathologists got 100% accuracy. The minimum consistency between every two pathologists was 75.8%.At least one pathologist gave negative judgement (false negative) or positive judgement (false positive) in the 49 positive or 60 negative cases, accounted for 26.5% (13/49), 41.7% (25/60), respectively, with at least one uncertainty interpretation accounted for 31.2% (34/109). Conclusion There are certain heterogeneities and misclassifications in the real world interpretation of ALK-D5F3 IHC test, which need to be guided by the oncoming expert consensus based on the real world data.