Objective:To evaluate the clinical value of surfactant protein-A (SP-A) in exudate pleural effusion (EPE).Methods:This clinical study was prospective,observational and cross-sectional.Two hundred and fifteen patients with pleural effusion were divided into the transudate pleural effusions (TPE) group and the EPE group.TPE patients served as the control group.The concentrations of pleural effusions SP-A (SP-Apl) and serum SP-A (SP-Ase) were measured by ELISA,and receiver operator characteristic (ROC) curve and multivarate Cox analysis of SP-A was analysed for its clinical value.Results:SP-Apl concentrations in the EPE group were significantly higher than that in the TPE group [(189.8±43.4) ng/mLvs (22.3±5.1) ng/mL,P＜0.01];SP-Ase concentrations in the EPE group were higher than that in the TPE group [(78.9±11.3) ng/mL vs (25.8±12.4) ng/mL,P＜0.05];SP-Apl concentrations were significantly higher than the concentrations of SP-Ase in the EPE group (P＜0.01).In EPE group,SP-Apl and SP-Ase concentration in the patients with primary lung adenocarcinomas were the highest.The cut off value of SP-Apl concentrations was more than 484.5 ng/mL,yielding a 85.4％ sensitivity and 95.2％ specificity for diagnosing primary lung adenocarcinomas,with an area under the curve (AUC) of 0.943 (95％ CI 0.852 to 0.934,P＜0.01);when SP-Ase concentration was more than 84.2 ng/mL,it yielded a 76.4％ sensitivity and 94.3％ specificity for diagnosing primary lung adenocarcinomas,with an AUC of 0.910 (95％ CI 0.921 to 0.953,P＜0.01).Conclusion:While SP-Apl concentration is more than 484.5 ng/mL and/or SP-Ase concentration is more than 84.2 ng/mL,it may be helpful for the diagnosis of primary lung adenocarcinomas with the usage ofpleural effusion.

Objective:The purpose of this study was to evaluate the effect of computer-assisted navigation in the removal of foreign bodies in the oral and maxillofacial regions.Methods:A retrospective analysis was performed on the patients who suffered from oral and maxillofacial foreign bodies and were treated with computer-aided navigation technology in the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University from January 2014 to December 2018. All patients received the examination of spiral CT, and the CT data were imported into the computer navigation workstation to complete the presurgical planning. The surgical approach was through the original wound or local small incision, and the computer navigation system was used to accurately locate the foreign body and perform the foreign body removal. All patients underwent postoperative follow-up, and the oral and maxillofacial appearance and functional recovery were evaluated.Results:A total of 35 patients were involved in this study, including 29 males and 6 females, aged 2 to 77 years old(average age: 38.3±20.2 years). Foreign bodies included metals, fish bones, and broken glass. The operation time was 30-90 min [average time: (50.6±16.5) min]. The operation proceeded well in these patients. The foreign bodies were removed successfully. There was no infection in the wound or surgical incision, and the healing was normal. All patients recovered well in the oral and maxillofacial appearance and function during the one-to-twelve-month follow-ups after operation.Conclusions:Computer-assisted navigation is an effective technique that can be applied in the removal of oral and maxillofacial foreign bodies. It can accurately locate the foreign bodies and perform minimally invasive surgery, thereby reducing the impact on facial appearance.

Objective:The purpose of this study was to evaluate the effect of computer-assisted navigation in the removal of foreign bodies in the oral and maxillofacial regions.Methods:A retrospective analysis was performed on the patients who suffered from oral and maxillofacial foreign bodies and were treated with computer-aided navigation technology in the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University from January 2014 to December 2018. All patients received the examination of spiral CT, and the CT data were imported into the computer navigation workstation to complete the presurgical planning. The surgical approach was through the original wound or local small incision, and the computer navigation system was used to accurately locate the foreign body and perform the foreign body removal. All patients underwent postoperative follow-up, and the oral and maxillofacial appearance and functional recovery were evaluated.Results:A total of 35 patients were involved in this study, including 29 males and 6 females, aged 2 to 77 years old(average age: 38.3±20.2 years). Foreign bodies included metals, fish bones, and broken glass. The operation time was 30-90 min [average time: (50.6±16.5) min]. The operation proceeded well in these patients. The foreign bodies were removed successfully. There was no infection in the wound or surgical incision, and the healing was normal. All patients recovered well in the oral and maxillofacial appearance and function during the one-to-twelve-month follow-ups after operation.Conclusions:Computer-assisted navigation is an effective technique that can be applied in the removal of oral and maxillofacial foreign bodies. It can accurately locate the foreign bodies and perform minimally invasive surgery, thereby reducing the impact on facial appearance.

Objective To investigate the diagnostic value Tamm-Horsfall protein(THP)and osteopontin(OPN)in serum and 24-hour urine for urolithiasis.Methods A total of 101 patients with urolithiasis who underwent flexible ureteroscopy lithotripsy at the Urology Department of Civil Aviation General Hospital from April 2020 to March 2023 were included as the stone group,and 50 healthy individuals were enrolled as the control group.The samples of serum and 24-hour urine samples were collected from both the groups,and the levels of THP and OPN were measured using enzyme-linked immunosorbent assay(ELISA).Logistic regression analysis was performed to evaluate the association between each biomarker and urolithiasis,and receiver operating characteristic(ROC)curves were plotted to assess their diagnostic value.Results The stone group showed significantly lower THP levels(20.13[13.12,26.03]mg/d)and OPN levels(51.24[36.72,101.37]μg/d)in 24-hour urine,and THP levels(182.01[160.91,209.20]ng/mL)and OPN lev-els(18.76[15.72,22.48]ng/mL)in serum compared to the control group(all the P＜0.001).Binary Logistic regression analysis re-vealed that THP(OR=0.736,95％CI:0.606-0.895),OPN(OR=0.975,95％CI:0.958-0.993)and citrate(OR=0.067,95％CI:0.012-0.376)in 24-hour urine,and THP(OR=0.946,95％CI:0.908-0.986)and OPN(OR=0.896,95％CI:0.803-0.999)in ser-um were the protective factors for urolithiasis,while calcium level(OR=2.125,95％CI:1.243-3.633)24-hour urine was a risk factor(all the P＜0.05).ROC curve analysis showed that the areas under the curve(AUCROC)for the individual diagnosis of urolithiasis were 0.846,0.809,0.786,0.823,0.748,and 0.755 for the above six biomarkers,respectively.The AUCROC for the combined diagnosis u-sing THP+OPN in serum,THP+OPN in 24-hour urine and all the six biomarkers were 0.882,0.920 and 0.984,respectively,indica-ting better diagnostic performance.Conclusion The combined detection of the THP and OPN levels in serum and 24-hour urine may have good diagnostic value for urolithiasis and serve as potential diagnostic biomarkers.

Chronic hepatitis B (CHB) is an infectious disease characterized by liver damage, which can progress to liver fibrosis, cirrhosis, liver failure or liver cancer, threatening the life of patients. CHB patients are prone to be complicated with hepatitis B virus-associated glomerulonephritis and other kidney diseases, therefore the renal safety should be fully considered in the antiviral treatment of CHB patients. According to current guidelines, telbivudine, entecavir or tenofovir alafenamide are recommended for CHB patients with renal insufficiency or potential renal injury, but each has its advantages and disadvantages. How to carry out antiviral treatment in CHB patients with renal impairment deserves our attention. At the same time, the renal function should be monitored regularly in the course of antiviral treatment to identify the damage of renal function in the early stage. This article reviews the causes of renal dysfunction in CHB patients, the risk of kidney damage during the antiviral treatment, the choices of antiviral therapy and the monitoring of renal function in the patients.

Hepatitis B is a major public health problem in China. Nucleoside/nucleotide analogues and interferon(IFN) can effectively inhibit the replication of hepatitis B virus, but the treatment effect is still not so effective because cccDNA cannot be completely removed. IFNλ is a newly discovered family of cytokines that induces antiviral, antiproliferative and antitumor effects by activating the Jak-STAT pathway. Recent studies have found that IFNλ is also of great significance in hepatitis B as a therapeutic agent and immunological indicator. IFNλ can effectively inhibit the replication of hepatitis B virus, while the gene polymorphisms of IFNλ are closely related to prognosis and susceptibility to hepatitis B; and IFNλ also shows a certain anti-tumor activity in hepatitis B-related hepatocellular carcinoma. IFNλ is expected to be used as a clinical adjuvant treatment for patients with hepatitis B. This article describes the current research progress on IFNλ in hepatitis B.

Objective:To analyze the clinical characteristics and risk factors of systemic lupus erythematosus (SLE) with Libman-Sacks endocarditis (LSE).Methods:Data of SLE patients with LSE ( n=20) who admitted in Peking Union Medical College Hospital from January 2012 to May 2021 were retrospectively collected. SLE patients without LSE ( n=60) were randomly selected as controls according to 1∶3 age and sex matched in the hospitalized patients during the same period. Clinical characteristics, laboratory and imaging examinations were analyzed. Data were expressed as Mean± SD, and t test was used to compare quantitative data in normal distri-bution. Data were expressed as M ( Q1, Q 3), and Wilcoxon signed-rank test or Wilcoxon rank sum test were used to compare quantitative data in non-normal distribution. The count data were compared with Chi-square test or Fisher's exact test. Univariate conditional logistic regression was used for univariable analyses. P values less than 0.05 were considered statistically significant. Results:There were 20 SLE patients with LSE, 18 females with an average age of (32±9) years (13 to 49 years). The disease duration of SLE was 16.04(0, 185.1) months when LSE was discovered, and vegetations were located at the mitral valve in 19 (95.0%) patients. Cerebral infarction (45.0% vs 10.0%, χ2=9.87, P=0.001) and antiphospholipid syndrome (APS) (50.0% vs 5.0%, χ2=22.32, P<0.001) were more common in SLE with LSE. In addition, SLE with LSE had lower platelet counts [(140±67)×10 9/L vs (189±115)×10 9/L, t=-2.29, P=0.026] and higher positive rate of lupus anticoagulant (LA) (80.0% vs 23.6%, χ2=19.65, P<0.001), lower positive rate of anti-SSA antibodies (21.1% vs 60.0%, χ2=6.38, P=0.012). Left atrial enlargement (anteroposterior diameter of left atrium>40 mm) was more common in SLE patients with LSE (35.0% vs 5.4%, χ2=9.37, P=0.002), and anteroposterior diameter of left atrium [(37±7) mm vs (33±4) mm, t=2.15, P=0.043] were larger and left ventricular ejection fraction [(63±10)% vs (68±6)%, t=-2.41, P=0.019] was lower. The risk of SLE with LSE complicated with APS was 19 times compared with SLE without LSE [ OR (95% CI)=19.00 (4.43, 81.38), P<0.001]. Conclusion:SLE patients with LSE have increased risk of APS and cerebrovascular diseases. For patients with positive LA, the possibility of LSE should be alerted.

Objective:To analyze whether there are differences and related influencing factors in liver injury associated with different strains of 2019-nCoV/SARS-CoV-2 infection.Methods:Data of epidemiology, clinical symptoms, laboratory tests, and treatment outcomes of patients with COVID-19 infection confirmed with Alpha and Delta virus strain in Zhejiang Province were retrospectively collected. Statistical analysis was performed using independent samples t-test or Mann-Whitney U test, χ2 test or Fisher's exact test, and logistic regression analysis. Results:A total of 788 and 381 cases with Alpha and Delta virus strain were included. Vaccination ratio was 0% in Alpha and 85.30% in Delta group ( P<0.001), The proportion of patients with fever (80.71% vs. 40.94%, P<0.001) was significantly higher in Alpha than Delta strain group. The proportion of critical ill patients was significantly higher in Delta group (9.90% vs. 1.57%, respectively, P<0.001). The virus negative conversion time was significantly longer in Delta than Alpha group (22 d vs. 11 d, P<0.001), but the incidence of liver injury was significantly higher in Alpha than Delta group (20.05% vs. 13.91%, P=0.011). Univariate analysis showed that Alpha virus strain infection, male sex, body mass index, chronic liver disease, fever, diarrhea, shortness of breath, severe/critical illness, elevated creatine kinase (CK), elevated international normalized ratio (INR) and an elevated neutrophil/lymphocyte ratio was significantly associated with an increased risk of liver injury occurrence, and in patients with pharyngeal pain the risk of liver injury occurrence was significantly reduced. Multivariate analysis showed that shortness of breath [ OR, 2.667 ( CI: 1.389-5.122); P=0.003], increased CK [ OR, 2.544 ( CI: 1.414-4.576); P=0.002] and increased INR [OR, 1.721] ( CI: 1.074-2.758); P=0.024] was significantly associated with an increased risk of liver injury occurrence, and in patients with pharyngeal pain the risk of liver injury occurrence was significantly reduced [ OR, 0.424 ( CI: 0.254-0.709); P=0.001]. Conclusion:Although the virulence of the Delta is stronger than Alpha strain, most patients infected with Delta strain vaccinated against COVID-19 in Zhejiang province had milder clinical symptoms and a lower incidence and degree of liver injury. Notably, the infection risk even remains after vaccination; however, symptoms and the incidence of severe and critical illness can be significantly reduced.

Objective : To explore the spatial and temporal heterogeneity of pathological phenotype of epidermal growth factor receptor (EGFR) -mutant transformed locally advanced or metastatic small-cell lung cancer( SCLC) or neuroendocrine carcinoma (NEC) ． Methods : This study retrospectively analyzed EGFR-mutant LUAD patients who were treated with EGFR-TKIs and underwent a transformation into SCLC / NEC． Baseline clinicopathological characteristics after initial transformation were summarized．According to the different pathological components of initial SCLC / NEC transformation，it was defined as incomplete transformation and complete transformation．Incom- plete transformation was defined as three categories : intratumoral transformation，intertumoral transformation and ef- fusional transformation. Results : This study collected 49 patients who met the criteria．Among forty-nine patients， incomplete transformation was 34. 7% ( 17 /49) and complete transformation was 65. 3% (32 /49) ．In addition， intratumoral transformation ，intertumoral transformation and effusional transformation were respectively 82. 3% ( 14 /17) ，5. 9% ( 1 /17) and 11. 8% (2 /17) . It was mean that the spatial heterogeneity of pathological phenotype of initially transformed SCLC / NEC was 34. 7%．After initial transformation，among the fifteen patients in dynamic histological and / or cytological biopsies，the temporal heterogeneity of pathological phenotype of initially transformed SCLC / NEC was 46. 7% (7 /15) ．In addition，there was no significant difference in first-line treatment post-trans- formation progression-free survival and post-transformation overall survival between incomplete transformation group and complete transformation group． Conclusion EGFR-mutant transformed locally advanced or metaststic SCLC / NEC has spatial and temporal heterogeneity in pathological phenotype.