Objective To compare the clinical effects between uniportal video-assisted thoracic surgery (VATS) and 3-portal VATS lobectomy for patients with lung cancer. Methods Patients were divided into uniportal VATS lobectomy group (n=45) and 3-portal VATS lobectomy group (n=53). The clinical data were compared between two groups, including the oper-ation time, intraoperative blood loss, number of lymph node dissection, length of incision, postoperative extubation time, post-operative pain score and postoperative hospitalization. Results There were no significant differences in intraoperative blood lose (128.75±18.32) mL vs (129.15±17.69) mL, lymph node dissection number (13.33±1.05) vs (13.12±1.38), duration of chest drainage (4.90±0.75)d vs (4.75±0.70)d, duration of hospital stay (7.52±1.16)d vs (7.55±1.10)d and incidence of seri-ous postoperative complications between two groups (P>0.05). The incision length (5.36±0.22)cm vs (7.44±0.35)cm, numeric pain intensity scale including first day(6.47±0.54) vs (6.86±0.52),third day(3.59±0.29) vs (4.05±0.25), and patient satisfac-tion scores (91.03 ± 2.62) vs (88.35 ± 2.97) were significantly better in uniportal VATS group than those of 3-portal VATS group (P<0.05). The operation time (143.81±17.97) min vs(130.11±15.03)min was longer in uniportal VATS group than that of 3-portal VATS group (P < 0.05). Conclusion Uniportal VATS lobectomy is safe and reliable for patients with early-stage lung cancer, which has less surgical injury, slighter pain, and higher satisfaction than 3-portal VATS lobectomy.

Objective To evaluate the effect of small interfering RNA targeting caspase-12 (caspase-12-siRNA) pretreatment on lung ischemia/reperfusion (I/R) injury in mice.Methods Forty male C57BL/6J mice,aged 6-8 weeks,weighing 16-24 g,were randomly allocated into 4 groups (n =10 each) using a random number table:sham operation group (group S),group I/R,negative control group (group NC) and caspase-12-siRNA pretreatment group (group siRNA).Lung I/R was induced by clamping the left pulmonary hilum for 30 min followed by 3 h reperfusion in anesthetized mice in IR,NC and siRNA groups.At 48 h before ischemia,negative control siRNA 20 μg and caspase-12-siRNA 20 μg were instilled intranasally in NC and siRNA groups,respectively,and the total volume was 50 μl.At 3 h of reperfusion,the animals were sacrificed and the left lung was removed for determination of wet/dry lung weight (W/D) ratio and lung water content in lung tissues and for microscopic examination.Pulmonary ultrastructure was examined with electron microscope.The quantitative evaluation index (QEI) for alveolar damage and apoptosis rate were calculated.Results Compared with group S,W/D ratio,lung water content,QEI for alveolar damage and apoptosis index were significantly increased in IR and NC groups,QEI for alveolar damage and apoptosis index were increased in group siRNA (P ＜ 0.05).Compared with IR and NC groups,W/D ratio,lung water content,QEI for alveolar damage and apoptosis index were significantly decreased (P ＜ 0.05),and the pathological changes of lungs were alleviated in group siRNA.There was no significant difference in the indices mentioned above between groups IR and NC (P ＞ 0.05).Conclusion Caspase-12-siRNA pretreatment can attenuate lung I/R injury in mice.

Objective To investigate the risk factors of acute kidney injury (AKI) in patients undergoing cardiac valve surgery with cardiopulmonary bypass (CPB).Methods A retrospective cohort database study was conducted, involving 1 349 patients undergoing heart valve surgery with CPB technique.Logistic regression was used to screen out the risk factors of AKI after the surgery.Results Of the 1 349 patients, the incidence of AKI in valve surgery was 28.4%.One year older (OR=1.05, 95%CI 1.03-1.06, P<0.001), diabetes (OR=2.11, 95%CI 1.22-3.68, P=0.008), anemia (OR=1.50, 95%CI 1.05-2.21, P=0.026), each additional basic serum creatinine of 1 mg/dl (OR=1.01, 95%CI 1.01-1.02, P=0.001), each additional operation time of 1 hour (OR=1.28, 95%CI 1.15-1.41, P<0.001), plasma transfusion during surgery (OR=1.50, 95%CI 1.14-1.97, P=0.004) were the independent risk factors for AKI in multivariate logistic regression model.Conclusion AKI is a common and serious complication following cardiac valve surgery.More attention should be paid to the patients with elder age, anemia, prolonged operation time, diabetes, increased basic serum creatinine and requirement of plasma transfusion during surgery.

Immunological checkpoint inhibitors include monoclonal antibodies of cytotoxic T lymphocyte antigen-4 (CTLA-4) and programmed cell death-1 (PD-1).Anti-CTLA-4 drug ezetimab (ipilimumab)and anti-PD-1 drug (pembrolizumab and nivolumab) are approved for the treatment of melanoma and non-small cell lung cancer.The effects of these drugs on renal cell carcinoma,bladder cancer,breast cancer,gastrointestinal cancer and other types of cancers are still in large-scale clinical trials.These drugs have good effects in the clinical application,but they inevitably lead to many adverse reactions.

This article presents a case report of Wernicke's encephalopathy misdiagnosed as schizophrenia. The patient was hospitalized and diagnosed with schizophrenia at a local psychiatric hospital over a month ago. Twelve days ago， the patient gradually developed symptoms such as salivation， difficulty in eating， trembling hands， unsteady walking， glossoptosis and so on. The above symptoms were interpreted as drug-induced adverse reactions and managed accordingly， whereas the patient showed a poor response to treatment， and began to experience intermittent consciousness disorder. After referral to our hospital， findings were diagnostic for Wernicke's encephalopathy and peripheral polyneuropathy. Due to the progression of the disease， the family members abandoned further treatment and requested discharge from the hospital， and the patient died outside the hospital. This case report aims to improve the prognosis of Wernicke's encephalopathy in patients with mental disorder by raising the awareness of the disease and enhancing the early prevention.

In recent years , with the increasing of immunocompromised patients , Trichosporon spp. has become a more and more significant clinical opportunistic pathogen .Medical staff should enhance the clinical awareness to this pathogen . In this paper , the classification , virulence factor and pathogenic mechanism, infections, diagnostic methods of laboratory , antifungal susceptibility and treatment of Trichosporon spp. were reviewed systematically . Trichosporon asahii is the major pathogen of invasive infections.Biofilm formation and enzyme production will promote its ability to escape from antifungal drugs and host immune responses .Matrix assisted laser desorption ionization time of flight mass spectrometry has the advantages of accurate , fast and low cost for identification of Trichosporon spp., and zoles is the first-line treatment for invasive infections .

The sensitivity of cardiac troponin testing for diagnosing acute myocardial infarction(AMI)varies over time from chest pain onset.This study aimed to determine the diagnostic performance of point-of-care testing cardiac troponin T(POCT-cTnT)at different time intervals post-symptom onset to refine rapid rule-out approaches for AMI.Methods This retrospective study included 6,024 patients presenting with chest pain from January 2018 to December 2022.POCT-cTnT and central lab cTnI levels were measured on admission.Receiver operating charac-teristics analysis stratified by time windows assessed the accuracy of POCT-cTnT for diagnosing AMI.Results The overall AUC of POCT-cTnT for diagnosing AMI was 0.826(95%CI:0.816～0.836),with a sensitivity of 72.81%and a specificity of 86.26%.According to the time intervals of chest pain onset(＜3 hours,3～6 hours,6～12 hours,12～24 hours,24～72 hours,and≥72 hours),the AUC values for groups after 6～12 hours were 0.918,0.928,0.920 and 0.908,respectively,with no statistically significant difference(P＞0.05),but all were higher than the groups within 6 hours(P＜0.001).According to the time of chest pain onset,the AUC for the≥8h group was 0.921,with a negative predictive value(NPV)of 98.1%and a negative likelihood ratio(-LR)of 0.11.Its AUC was higher than those of the≥3 h,≥2 h,≥1 h,and overall groups(P＜0.05),but there was no statistically significant differ-ence compared with the groups after≥4 h(P＞0.05).Conclusions Chest pain onset time has a certain impact on the performance of a single POCT-cTnT test for diagnosing AMI.The duration from chest pain onset to hospital admission combined with POCT-cTnT test may improve the reliability in diagnosing AMI.Specifically,a single POCT-cTnT test at four hours after chest pain onset,especially eight hours after chest pain onset,can diagnose or exclude AMI.

Objective To explore the application effect of concept map teaching of group-discussing mode in standardized nursing training. Methods A total of 80 standardized training nurses in Wuxi No.2 People's Hospital from January 2016 to December 2016 were selected by purposive sampling and randomly divided into the intervention group and the control group, with 40 students in each. The control group was taught according to the conventional teaching method, and the intervention group was taught with the concept map teaching of group-discussing mode. The scores of the independent learning ability assessment scale and the scores of theoretical examination were compared before and after the intervention. The scores of the feedback evaluation scale of concept map teaching of group-discussing mode in the intervention group were observed. Results The score of each dimension and the total score of the independent learning ability assessment scale of the intervention group after intervention were higher than those in the control group, and the difference was statistically significant (P<0.05). The score of theoretical examination in the intervention group was higher than that in the control group with statistical difference (P<0.001). The nurses in the intervention group had a better feedback on the concept map teaching of group-discussing mode. Conclusions The concept map teaching of group-discussing mode obtains good application results in clinical nursing teaching and training, and it can improve the nurses' independent learning ability.

Objective To explore the application effect of motivational interview combined with transtheoretical model in self-care of patients with coronary heart disease. Methods From August 2016 to April 2017, a total of 77 patients with coronary heart disease diagnosed in Wuxi Second Hospital Affiliated to Nanjing Medical University were selected by convenience sampling method, and randomly divided into control group (n=38) and observation group (n=39) by random number table. The two groups were given traditional health education and motivational interview combined with transtheoretical model health education. The self-efficacy, self-management ability, ejection fraction and regional wall motion abnormality (RWMA) were compared between the two groups before and after intervention. Results The scores of self-efficacy and self-management ability of patients with coronary heart disease in the observation group were (39.12±5.98) and (88.88±5.01) respectively, which were significantly higher than those in the control group (31.04±6.59) and (81.00±4.25). The differences were statistically significant (P＜0.01). The ejection fraction of the observation group was higher than that of the control group, and the number of RWMA cases in the control group was higher than that in the observation group. The difference was statistically significant (P＜0.05). Conclusions Using motivated interviews combined with cross-theoretical models in self-care of patients with coronary heart disease can effectively improve patients' self-efficacy and self-management ability,it is worthy of clinical promotion.

Objective? To investigate the effect of the cardiac rehabilitation program based Omaha system on patients after percutaneous coronary intervention (PCI). Methods? A convenient sampling method was used to select 127 patients from the Department of Cardiology of Wuxi Second People's Hospital from October 2017 to April 2018. According to the patient's hospitalization number, they were randomly divided into two groups, including 64 in the experimental group and 63 in the control group. During the intervention, 2 patients were lost in the experimental group and 1 patient was lost in the control group. There were 62 patients in each group to complete the study. Patients in the control group received routine care, while patients in the experimental group received cardiac rehabilitation based on the Omaha system. The effect of the intervention was measured by 6 min exercise test, secondary prevention knowledge and behavior questionnaire for post-PCI patients. Results? After the intervention, The 6-minute exercise distance was (439.28±67.94) m in the experimental group, and it was (315.62±45.18) m in the control group. The exercise endurance of the experimental group was higher than that of the control group, and the difference was statistically significant (t=11.934, P＜ 0.01). The secondary prevention knowledge and behavior scores of the experimental group were (87.21±12.46) and (84.27±14.58), which were higher than those of the control group (71.30±8.12) and (65.94±8.97). The differences were statistically significant (t=8.423, 8.431; P ＜0.01). Conclusions? Cardiac rehabilitation programs based Omaha system can improve exercise endurance and secondary prevention behaviors of patients after PCI and its application should be promoted.