Pneumonia is a common lower respiratory tract infection, which causes a large disease and economic burden worldwide, and is an important public health problem to be solved urgently. Based on review of publications pertaining to the epidemiology of pneumonia from 2013 to 2023, this article summaries the epidemiological characteristics and main influencing factors of pneumonia. It is found that the epidemiological characteristics of pneumonia vary in different areas; men, the elderly and children are the high-risk groups of pneumonia incidence and mortality; and age, smoking, alcohol consumption, air pollution, comorbidity and vaccination are the main factors affecting the incidence and mortality of pneumonia. Strengthening health education, reducing exposure to risk factors and promoting vaccination are recommended to lower the morbidity and mortality of pneumonia in susceptible populations.

OBJECTIVETo observe the therapeutic effect of expanded supraclavicular island flaps for facial and cervical scar.

METHODSFrom Oct. 2010 to Nov. 2013, a series of 16 patients with facial and cervical scars were treated by the expanded supraclavicular island flaps, pedicled by the supraclavicular cutaneous branch of transverse cervical artery. In the first stage, the soft tissue expanders (ranging from 400 ml to 600 ml in volume) were implanted in the anterior thoracic region. In the second stage, the facial and cervical scars were removed and the contructures were released, the expanded flap was transferred to cover the defects. The wounds at the donor sites were closed directly.

RESULTSThe flaps size ranged from 12 cm x 7 cm to 22 cm x 11 cm. All flaps survived with no flap necrosis. Hematoma occurred in one case and healed by debridement. 16 patients were followed up for 3-12 months. The color and texture of all flaps matched well with the surrounding skin tissue, no bulky appearance or hypertrophic scar were noticed.

CONCLUSIONSThe expanded supraclavicular island flap is a good choice for repairing facial and cervical scar. The appearance and function can be improved.

Cicatrix ; surgery ; Face ; surgery ; Humans ; Neck ; surgery ; Reconstructive Surgical Procedures ; Surgical Flaps ; transplantation ; Thoracic Wall ; Tissue Expansion Devices

Objective To design a new cancer vaccine by using alpha-galactosylceramide (α-Galcer,α-GC) loaded tumor cells in combination with TLR 9 ligand and to evaluate its therapeutic effects on colon canc-er in mice.Methods MC38 cells were transfected with lentivirus (GFP-CD1d) to prepare CD1d-MC38 cells. The expression of CD1d molecules in CD1d-MC38 cells was detected by fluorescence microscopy , RT-PCR and flow cytometry.The sorted CD1d-MC38 cells were loaded with α-Galcer to prepare CD1d-MC38/α-GC complex. Flow cytometry was performed to evaluate the efficiency of combination .A mouse model of colon cancer was es-tablished to investigate the therapeutic effects of α-Galcer loaded tumor cells in combination with TLR 9 ligand ( CD1d-MC38/α-GC+CpG1826) on colon cancer in mice by analyzing tumor growth and mice survival time .Im-munohistochemical staining was used to detect CD 4+T and CD8+T infiltrating lymphocytes in tumor tissues .Re-sults The MC38 cancer cells that expressed CD 1d and GFP were successfully constructed , among which 98.10%±2.53%were positive for CD1d.Moreover, the CD1d-MC38 cells could combine with α-Galcer effec-tively in a dose and time dependent manner .Compared with PBS treated group ,α-GC treated group and TLR9 ligand treated group , the experimental vaccine strategy was sufficient to inhibit the growth of established tumors and prolong survival of tumor-bearing mice (P<0.01).Immunohistochemistry analysis revealed that levels of CD4+T cells and CD8+T cells in experiment group were significantly higher than those in groups treated with PBS,α-GC and TLR9 ligand (P<0.01).Conclusion CD1d-MC38/α-GC in combination with CpG1826 could efficiently inhibit the growth of established tumors and prolong survival of tumor-bearing mice .Immunohisto-chemistry analysis revealed that CD 4+T cells and CD8+T cells played important roles in anti-tumor immunity.

OBJECTIVETo investigate the relationship among -75 bp/+83 bp polymorphism in apolipoprotein A1 (apo A1) gene, lipids levels and the occurrence of coronary atherosclerosis disease (CAD).

METHODSWe determined distributions of two MspI polymorphisms of the apo A1 gene at -75 bp and +83 bp, and blood lipids levels among 137 Chinese patients (92 with CAD and 45 in the control group) in relation to circulating lipids and coronary angiography.

RESULTSThe demographic information for 137 subjects showed that subjects with CAD tended to have more unfavorable lipoprotein variables. Genotype distributions at both sites were different between the CAD and control groups. Furthermore, the control group had higher M1-/M2- frequencies than the CAD group (M1: P < 0.005; M2: P < 0.05) and the "M1-" (A) and "M2-" alleles were associated with increased high-density lipoprotein cholesterol (HDL-C) (M1-: P < 0.0001; M2-: P < 0.05) and apo A1 (M1-: P < 0.0001; M2-: P < 0.05) levels. "M1-" and "M2-" were significantly negatively correlated with CAD (P < 0.01 and P < 0.05, respectively).

CONCLUSIONSOur results suggest that changes from G to A at the -75 bp site and from C to T or G to A at the +83 bp site do increase circulating levels of apo A1 and HDL-C. And those individuals with these changes are likely to have a lower risk of developing CAD.

Apolipoprotein A-I ; blood ; genetics ; Case-Control Studies ; Cholesterol, HDL ; blood ; Coronary Artery Disease ; blood ; genetics ; Female ; Humans ; Lipids ; blood ; Male ; Middle Aged ; Polymorphism, Genetic

Objective: To investigate the expression and clinical significance of lysophosphatidic acid receptor 5 (LPA5) protein in breast cancer tissues. Methods: The specimens of breast cancer tissues and adjacent tissues of 80 breast cancer patients from January 2015 to December 2016 in the First People's Hospital of Yongkang were selected in the study.The expression of LPA5 in breast cancer tissues and adjacent tissues was determined by immunohistochemistry.The clinical case characteristics of patients were collected. Results: The positive expression rate of LPA5 in breast cancer tissues(72.5%) was higher than that in adjacent tissues(8.75%)(χ²=67.394, P<0.05). The positive rate of LPA5 in clinical stage Ⅲ-Ⅳ(91.3%) was higher than that in stage Ⅰ-Ⅱ(64.9%)(χ²=5.725, P<0.05). The positive rate of LPA5 in patients with lymph node metastasis(94.7%) was higher than that in patients without lymph node metastasis(52.4%)(χ²=17.951, P<0.05). The positive rate of LPA5 in patients with intravascular tumor thrombus(92.3%) was higher than that in patients without intravascular tumor thrombus (63.3%)(χ²=7.580, P<0.05). The expression of LPA5 in breast cancer tissues was not related to age and tumor diameter (P>0.05). There were no significant differences in the positive expression rates of LPA5 in the breast cancer tissues among luminal type, human epidermal growth factor receptor 2 (Her2) overexpressing type and triple negative type (P>0.05). The disease-free survival rate(86.3%) and overall survival rate(87.5%) of patients with negative expression of LPA5 in breast cancer tissues were higher than those in breast cancer tissues with positive expression (65.0%, 66.3%)(χ²=4.517, 4.328, all P<0.05). Conclusion LPA5 expression is up-regulated in breast cancer tissues, and LPA5 may be involved in the development and progression of breast cancer, which is closely related to the prognosis of breast cancer.

Objective:To construct a surface display system containing various lengths of the Ag43 passenger domain for an optimal bacterial surface display of foreign protein HPV16L1.Methods:(1) Ag43 gene sequences of different lengths were inserted into pET22b vector to construct four Ag43 surface display vectors (Ag43/138, Ag43/551, Ag43/552 and Ag43/700) using PCR and subcloning strategy. (2) The generation of four HPV16L1-Ag43 fusion constructs was completed by PCR and subcloning methods. (3) HPV16L1-Ag43 fusion proteins were expressed and analyzed by SDS-PAGE. (4) The surface exposure of HPV-16L1 was verified using trypsin digestion.Results:PCR analysis and sequencing results showed that Ag43 surface display vectors and HPV16L1-Ag43 fusions were constructed successfully. SDS-PAGE showed that the expression of HPV16L1-Ag43 fusion proteins could be induced with 0.2 mmol/L IPTG and the protein content was reduced after the cells were treated with trypsin, especially the content of Ag43/700-HPV16L1 that showed a drastic reduction.Conclusions:The Ag43 surface display system was successfully constructed and could be used for a successful display of HPV16L1. This study also showed that Ag43/700 comprising only the α-helix and the β-barrel of Ag43 provided an optimal surface display for HPV16L1.

Objective:To summarize and analyze the current application status of oral mucosal graft (OMG) technique in the repair of ureteral strictures in China, and clarify the feasibility, safety and effectiveness of this technique.Methods:The 175 patients who underwent repair of ureteral stricture using oral mucosal patches from June 2015 to February 2022 were etrospectively analyzed in 14 medical centers in China, including 49 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 32 cases in Affiliated Seventh Medical Center of PLA General Hospital, 3 cases in The Second Hospital of Anhui Medical University, 6 cases in The First Affiliated Hospital of Zhengzhou University, 56 cases in Peking University First Hospital, 3 cases in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 cases in Shanghai Sixth People' s Hospital, 4 cases in General Hospital of Estern Theater Command, 4 cases in Lanzhou University Second Hospital, 2 cases in Guizhou Province People 's Hospital, 2 cases in Peking University People' s Hospital, 5 cases in Jinzhou First People's Hospital, 5 cases in The First Affiliated Hospital of Wannan Medical College, 1 case in Shandong Provincial Hospital. In this study, 127 patients (72.6%) used lingual mucosal patches, 32(18.3%) labial mucosa, and 16(9.1%) buccal mucosa. The surgical approach for OMG ureteral reconstruction was mainly minimally invasive, with robot-assisted laparoscopy in 84 patients (48.0%), traditional laparoscopic surgery in 87 patients (49.7%), and open surgery in only 4 patients (2.3%). There were 133 males and 42 females with an average age of (35.0±17.2) years. The mean body mass index (BMI) and stenosis length were (23.1±4.1) kg/m 2 and (4.7±1.8) cm, respectively. The stricture was located in the left ureter in 116 patients, right ureter in 58 case and bilateral ureter in 1 case. The most common causes of ureteral stricture were endoscopic surgery in 88(50.3%)patients, congenital stricture in 55(31.4%)patients, failed ureteroplasty in 29(16.6%)patients, history of extracorporeal shock wave lithotripsy in 13(7.4%)patients, radiotherapy history in 3(1.7%)patients and other causes in 6(3.4%)patients. Strictures were mainly located in the upper ureter, accounting for 61.7% (108/175 cases), followed by 36.0% (63/175) at the ureteropelvic junction and 2.3%(4/175)in the middle ureter. According to the surgical methods, the patients were divided into robot-assisted laparoscopic surgery group ( n=84), traditional laparoscopic surgery group ( n=87)and open surgery group ( n=4). Subgroup analysis of patients in robot-assisted laparoscopic and traditional laparoscopic surgery groups was performed. There were no significant difference in preoperative data between the two groups except for age (32.0±18.3) years vs.(37.0±15.9)years, P=0.040], BMI[(22.5±4.3)kg/m 2 vs. (23.7±3.6)kg/m 2, P=0.028], and etiology of stenosis [endoscopic injury, 34(40.5%) vs. 53(60.9%), P=0.012]. Preoperative hydronephrosis and stricture length were assessed by CTU and ureterography. Ureterography 7-9 weeks after surgery showed patency of the reconstructed segment, or no recurrence of hydronephrosis was judged as success. Evaluate the operation method, operation time, success rate, length of OMG in repairing ureteral stricture between laparoscopic and robot-assisted groups. Results:The overall success rate of oral mucosal graft repair surgery reached 97.7%(171/175). The success rate of ureteral reconstruction in the two groups were 96.4%(81/84)and 98.9%(86/87), respectively ( P=0.351), and the difference was not statistically significant. There was no significant difference for operation time, intraoperative blood loss, and mean oral mucosal length between the robotic and laparoscopic groups[(244.7±85.8) min and (222.7±83.5)min ( P=0.116), (58.9±38.6) ml and (68.4±45.5) ml ( P=0.217), (5.0±2.0) cm and (4.6±1.5) cm ( P=0.350)], respectively.Postoperative complications were reported in 23 (13.1%) patients, such as fever, urinary leakage, lymphatic leakage, infection, but only 2 (1.4%) cases patients had complications of Clavien-Dindo score ≥ Ⅲ. The two patients developed urinary stricture after surgery with failed conservative treatment, and no urinary stricture occurred following endoscopic treatment.The short-term (three months after surgery)incidence of complications in the site where the oral mucosa was taken, such as difficulty in opening mouth, pain, and swelling, was 12.0% (21/175), and there was no significant difference for oral complications between patients harvesting different length of mucosal graft. Conclusions:Ureteroplasty with oral mucosal graft is a safe, feasible and reliable technique for ureteral reconstruction. At present, minimally invasive technology is the main surgical approach for ureteroplasty, and there is no significant difference in operation time and success rate between robotic surgery and laparoscopic surgery.

Increasing evidences suggest the important role of calcium homeostasis in hallmarks of cancer, but its function and regulatory network in metastasis remain unclear. A comprehensive investigation of key regulators in cancer metastasis is urgently needed. Transcriptome sequencing (RNA-seq) of primary esophageal squamous cell carcinoma (ESCC) and matched metastatic tissues and a series of gain/loss-of-function experiments identified potassium channel tetramerization domain containing 4 (KCTD4) as a driver of cancer metastasis. KCTD4 expression was found upregulated in metastatic ESCC. High KCTD4 expression is associated with poor prognosis in patients with ESCC and contributes to cancer metastasis in vitro and in vivo. Mechanistically, KCTD4 binds to CLIC1 and disrupts its dimerization, thus increasing intracellular Ca²⁺ level to enhance NFATc1-dependent fibronectin transcription. KCTD4-induced fibronectin secretion activates fibroblasts in a paracrine manner, which in turn promotes cancer cell invasion via MMP24 signaling as positive feedback. Furthermore, a lead compound K279-0738 significantly suppresses cancer metastasis by targeting the KCTD4‒CLIC1 interaction, providing a potential therapeutic strategy. Taken together, our study not only uncovers KCTD4 as a regulator of calcium homeostasis, but also reveals KCTD4/CLIC1-Ca²⁺-NFATc1-fibronectin signaling as a novel mechanism of cancer metastasis. These findings validate KCTD4 as a potential prognostic biomarker and therapeutic target for ESCC.

Objective: To assess the incidence and characteristics of thyroid dysfunction during anti-Programmed cell death 1 receptor (PD-1) antibody SHR-1210 therapy in patients with advanced solid tumor. Methods: The medical records of 98 patients who initiated SHR-1210 treatment between April 27, 2016 and June 8, 2017 in the phase 1 trial to evaluate the safety, efficacy, and pharmacokinetics of SHR-1210 in patients with advanced solid tumors were retrospectively reviewed. Serological tests of thyroid stimulating hormone (TSH) and free thyroxine (fT4) were measured at baseline and prior to each SHR-1210 administration. Results: A total of 86 patients had normal thyroid function before the first dose of SHR-1210 treatment. Nine out of 86 (10.5%) patients developed new onset hypothyroidism from euthyroid state. 12 patients presented thyroid dysfunction at baseline, 10 of whom were subclinical hypothyroid and 2 were hypothyroidism. Four out of 10 patients developed hypothyroidism from subclinical hypothyroid. Most patients with hypothyroidism were asymptomatic. Thyroid dysfunction occurred early (median, 55days) after the initiation of SHR-1210. The severity of hypothyroidism were all grade 1-2. No grade 3-4 hypothyroidism occurred. No patients discontinue the treatment of SHR-1210 due to clinical impact of the thyroid dysfunctions. Conclusions: Thyroid-related adverse events were common during anti-PD-1 antibody SHR-1210 treatment . The incidence of hypothyroidism is lower in patients with euthyroid state than in patients with thyroid dysfunction at baseline during SHR-1210 treatment . Thyroid function can be improved after thyroid hormone replacement. During SHR-1210 treatment, it is necessary to pay attention to monitor the thyroid function, especially in the patients with thyroid dysfunction at baseline. Trial registration Chinese Clinical Trial Registry, 2016L01455