Background and purpose:There is controversial about dissecting the laryngeal nerve in operation of thyroid tumour in clinic. We adopted the methods of exposure of recurrent laryngeal nerve(RLN) to study their deficiencies and benefits. Methods:We reviewed review 456 cases of thyroid tumour who were operated. In 266 cases, RLN was unveiled generally. In 190 cases that RLN was not exposed, had subtotal thyroidectomy with protection of amatomical region.Results:RLN injury did not occur in the exposure group. 4 cases occurred in non-exposure group(3 cases of temporary RLN injury and 1 case of permanent RLN injury). Among the 3 cases of temporary RLN injury, one was caused by the large size of tumour, the other two were caused by the location of thyroid tumor. One case of permanent RLN injury was a case of reoperation for recurrence.Conclusions:The familiarity of the anatomy and variation of RLN, and the exposure of RLN in thyroid operation, can reduce the rate of the RLN injury.

Objective:To investigate the progression pattern of acquired resistance to osimertinib and the treatment method as well as the therapeutic effect of salvage therapy in advanced lung cancer patients with epidermal growth factor receptor (EGFR) sensitive mutation or T790M mutation after the treatment of tyrosine-kinase inhibitor (TKI).Methods:The data of 145 patients with advanced lung cancer treated with osimertinib in Jiangsu Cancer Hospital between April 2017 (the approval time of osimertinib in China) and May 2019 were collected. At the last follow-up (December 2019), a total of 87 (60.0%) patients had acquired resistance to osimertinib, 61 (70.1%) of whom received salvage treatment; for patients with dramatic progression after resistance, chemotherapy was mainly given in the salvage therapy; for patients with gradual or local progression after resistance, the continuing targeted drug therapy and the local therapy were given. Imaging evaluation and Kaplan-Meier method were used to analyze the progression pattern of acquired resistance to osimertinib and the survival status, and to compare the salvage treatment results among subgroups.Results:The median follow-up time of 61 patients receiving salvage therapy was 11 months (4-32 months), among which 58 (95.1%) patients again had resistance to osimertinib, and 24 (39.3%) patients died of lung cancer. The median progression-free survival (PFS) time and overall survival (OS) time for the whole cohort was 2.5 months (95% CI 2.1-3.0 months) and 19.0 months (95% CI 13.7-26.3 months), respectively. The 1-year and 2-year OS rate was 72.1% and 41.7%, respectively. Among 61 patients receiving salvage therapy, 8 (13.1%) , 30 (49.2%) and 23 (37.7%) cases had dramatic progression, gradual progression and local progression, respectively; when given timely and proper salvage treatment, there were no statistically differences in PFS and OS of the patients in the above three subgroups (all P>0.05). There were no statistically differences in PFS and OS between patients receiving local therapy (24 cases) and patients not receiving local therapy (37 cases) after the progression occurred (all P>0.05). Among 58 patients with resistance to osimertinib again after the salvage therapy, 6 patients with gradual or local progression had more than 6-mouth PFS after the salvage therapy. Conclusions:Dramatic, gradual and local progression are the main patterns in patients with acquired resistance to osimertinib. The therapeutic efficacy of salvage therapy still shows some disappointing results.

BACKGROUNDMethylenetetrahydrofolate reductase (MTHFR) plays an important role in metabolism of folate and DNA methylation. In vitro, many studies have demonstrated that abnormal methylation of some genes may affect the sensitivity of tumor cells to cytotoxic drugs and agents interfering with DNA synthesis. The aim of this study is to investigate the relationship between genetic polymorphisms of MTHFR C677T or A1298C and the response to platinum-based chemotherapy in non-small cell lung cancer (NSCLC).

METHODSA total of 97 patients with NSCLC were analyzed. MTHFR genotypes were detected in all the patients by PCR-RFLP method. All the patients were treated with platinum-based chemotherapy.

RESULTS(1) Out of all the cases, the frequencies of MTHFR C677T C/C, C/T and T/T genotypes were 34.0%, 50.5% and 15.5%, respectively, while the frequencies of MTHFR A1298C A/A, A/C and C/C genotypes were 64.6%, 29.2% and 6.3%, respectively. The overall response rate (complete and partial response) to platinum-based chemotherapy was 39.2%. (2) No significant difference in response rate to chemotherapy was observed according to the MTHFR C677T or A1298C genotypes. However, MTHFR C677T and A1298C polymorphisms showed a synergic effect on chemotherapeutic efficacy, the response rate of patients with MTHFR C677T T allele and A1298C A/A genotype (51.1%) was significantly higher than those with MTHFR C677T C/T and A1298C C allele (12.5%)(P=0.007, OR=7.30, 95% CI: 1.34-52.47).

CONCLUSIONSThe results suggest that the synergic effect between MTHFR C677T and A1298C polymorphisms is associated with clinical response to platinum-based chemotherapy. Detection of MTHFR genotypes may indicate the sensitivity of NSCLC patients to platinum-based chemotherapy.

Objective:To screen the optimal process of ambi-extracting of Xinyi Powder and inclusion of volatile oil.Methods:Single factor experiment was used to optimize the extraction process of Xinyi Powder by taking crushing particle size, extraction times, the amount of water added and extraction time as the investigation factors. L 9(3 4) orthogonal test was used to optimize the inclusion process of volatile oil in Xinyi Powder. Results:The optimal extraction process of ambi-extracting of Xinyi Powder was as follows: the slices were not crushed, 10 times the amount of water was added, and extracted for 3 hours; the best inclusion process of volatile oil as follows: β-cyclodextrin:water=1:25, β-cyclodextrin:volatile oil=6:1, inclusion temperature 35 ℃, inclusion time 3 hours.Conclusion:The ambi-extracting process and volatile oil inclusion process are simple, stable and feasible.

Objective To prevent unplanned extubation,reduce complications caused by restraint, improve satisfaction degree of patients′relatives,and to lower nurses′work stress.Methods Transparent restraint protection gloves were developed,within which fingers could move freely and with the help of which unplanned extubation could be prevented.A total of 1 00 ICU patients were selected and divided into intervention group and control group randomly,each with 50 cases.Patients in the intervention group used the new type restraint gloves,while patients in the control group used traditional ones.Restraint effects of the two groups were compared.Results Unplanned extubation happened to non patient in the intervention group,while it happened to 6 cases in the control group,Fisher′s exact test was used in comparison between the two groups (P <0.05). Scores of satisfaction degree in the intervention group were (3.1 4 ±0.639)points,while the scores in the control group were (2.20 ±0.756)points (t =6.71 4,P <0.01 );scores of nurses′work stress on accident extubation of patients in the intervention group were (2.1 2 ±0.761 )points,lower than that in the control group with (t =-8.696,P <0.01 ).Conclusions Transparent restraint protection gloves can effectively prevent unplanned extubation,reduce complications caused by restraint,improve satisfaction degree of patients′relatives,and lower nurses′work stress.

Objective To design the bedside tracheotomy checklist to improve the safety of operation.Methods According to the quality requirements of bedside tracheotomy and perioperative coordination, all the preparatory work and cooperation work in the duration had been summarized and enlist in the ICU bedside tracheotomy checklist. Patients who underwent bedside tracheotomy were enrolled in this study. Sixty-eight patients were evenly and randomly divided into observation group (using ICU bedside tracheotomy checklist) and control group (without the checklist), and each group with 34 cases. Observation and comparison of the two groups were conducted in the passing rate, the operation time and the satisfaction of nursing cooperation. Results The operation time in observation group was (10.94±1.92)min for bedside tracheotomy, while it was (15.00±3.95)min in the control group, and there was statistical significance between two groups (t =-5.383, P<0.01). The qualified rates for operation cooperation were 88.24% in observation group and 35.29% in the control group (χ2=20.176,P<0.01). The doctor's satisfaction was (3.88±0.33) score while nurse's was (3.94±0.24) in observation group, which all were higher than that of control group (t=4.672,5.652;P <0.05). Conclusions The use of ICU bedside tracheotomy checklist after bedside tracheotomy operation tends to make the process standardized, and to ensure the safety of patients, increasing the satisfaction of medical cooperation. It proves its feasibility in clinical practice.

Objective: To analyze the effects of 12week highintensity fitness exercise on body composition,lipid metabolism and gut microbiota in obese adolescents, so as to provide references for improving the health levels of obese adolescents. Methods: From January to June 2023, 20 obese adolescents from Huaifeng Vocational and Technical School in Huaian City were recruited for the study. Participants were assigned to an exercise group (n=10) and a control group (n=10) for a 12week exercise intervention by random number table method, and both groups had the same diet during the intervention period. The exercise group engaged in three exercises every week, mainly consisting of moderate to highintensity aerobic exercise combined with highintensity intervals. In the first week, there was a 30 minutes of aerobic exercise, followed by 10 minutes of highintensity interval training in the total intervention time each week, and the rest of the time was aerobic exercise with a total intervention time of 60 minutes to maintain; the control group did not receive specific interventions. Body composition was measured using bioelectrical impedance analysis, and lipid levels were determined using an automatic biochemical analyzer. The expression levels of serum inflammatory factors were measured at baseline and after 12 weeks of intervention, and gut microbiota was analyzed using 16S rRNA gene sequencing. Statistical analysis was performed using t test and Chisquare test. Results: After 12 weeks of intervention, the levels of triglycerides (TG), and lowdensity lipoprotein cholesterol (LDL-C) in obese adolescents in the exercise group decreased from (1.7±0.6, 3.5±0.8) mmol/L to (0.9±0.3, 2.6±0.4) mmol/L, while highdensity lipoprotein cholesterol (HDL-C) increased from (1.1±0.2) mmol/L to (1.4±0.2) mmol/L; and serum interleukin-1 receptor antagonist(IL-1Rn) decreased from (8.4±1.6) to (4.5±0.4) ng/mL in the exercise group (t=7.34,2.49,-3.05,2.56, P<0.05). The α-diversity results showed that the Chao index (268.00±22.67) and Ace index (243.98±38.64) in the exercise group were higher than those in the control group (184.52±19.28, 171.43±23.33), and the differences were statistically significant (t=2.48, 2.53, P<0.05). The Shannon index (5.36±1.41) in the exercise group was higher than that in the control group (4.73±1.12), and the Simpson index (0.78±0.10) was lower than that in the control group (0.89±0.10), but the differences were not statistically significant (t=1.83, -2.10, P>0.05). The β-diversity results showed that the intergroup differences in gut microbiota structure between the exercise group and the control group were greater than the intragroup differences, and the differences in gut microbiota structure between the exercise group and the control group were statistically significant (R2=0.083，P<0.05). After intervention, there were significant differences in the relative abundances at the levels of phylum, class, genus, and species in gut microbiota among obese adolescents between the exercise group and the control group (P<0.05). Conclusion The 12week highintensity fitness exercise can alleviate obesity symptoms in obese adolescents through the gut microbiota-lipid metabolism pathway and improve mild chronic inflammatory status.

The stimulator of interferon genes(STING),an integral adaptor protein in the DNA-sensing pathway,plays a pivotal role in the innate immune response against infections.Additionally,it presents a valuable therapeutic target for infectious diseases and cancer.We observed that fangchinoline(Fan),a bis-benzylisoquinoline alkaloid(BBA),effectively impedes the replication of vesicular stomatitis virus(VSV),encephalomyocarditis virus(EMCV),influenza A virus(H1 N1),and herpes simplex virus-1(HSV-1)in vitro.Fan treatment significantly reduced the viral load,attenuated tissue inflammation,and improved survival in a viral sepsis mouse model.Mechanistically,Fan activates the antiviral response in a STING-dependent manner,leading to increased expression of interferon(1FN)and interferon-stimulated genes(ISGs)for potent antiviral effects in vivo and in vitro.Notably,Fan interacts with STING,preventing its degradation and thereby extending the activation of IFN-based antiviral responses.Collectively,our findings highlight the potential of Fan,which elicits antiviral immunity by suppressing STING degra-dation,as a promising candidate for antiviral therapy.

Objective? To explore the effects of the problem-oriented intervention model on major nursing issues, self-care behavior and illness perception in elderly patients with type 2 diabetes. Methods? Totally 112 elderly patients with type 2 diabetes admitted in the First Hospital of Jiaxing from September 2016 to September 2017 were selected by convenient sampling and divided into the control group (n=56) and the observation group (n=56) based on the time of admission. Patients in the control group received conventional nursing care, while patients in the observation group received conventional nursing care in addition to problem-oriented nursing interventions. The Omaha Problem Classification Scheme was used to evaluate the nursing issues in the two groups, and the Chinese version of Summary of Diabetes Self-Care Activities (SDSCA) and the Brief Illness Perception Questionnaire (BIPQ) were used to evaluate the intervention effects between the two groups. Results? After 6 months, the resolution rate of major nursing issues in the observation group was 82.93% (68/82), while that in the control group was 63.16% (48/76); (χ2=7.898, P＜ 0.05). The self-care behavior and illness perception in the observation group totaled (27.33±7.36) and (38.49±5.76), respectively, both higher than that in the control group (t=5.180, 7.201; P＜ 0.01). Conclusions? The problem-oriented nursing intervention model can effectively enhance the self-care ability and illness perception in elderly patients with type 2 diabetes.

Objective:To understand the current status of screening, diagnosis, and treatment and analyze the factors influencing micro-elimination strategy, so as to achieve hepatitis C elimination in hospital.Methods:Anti-HCV and HCV RNA test results of patients from October 2017 to September 2020 were retrospectively analyzed. Anti-HCV positive rates and factors influencing different genders, ages, places of residence and departments were analyzed. After comparing anti-HCV-positive patients with HCV RNA-positive patients with duplicate entries in "Name" and "Date of birth", the data were divided into three categories: anti-HCV positive without HCV RNA test, HCV RNA positive in single test, and HCV RNA positive many times in multiple tests. The above three types of patients were followed-up by telephone. According to the hospital follow-up results, current status of diagnosis and treatment and the factors influencing the micro-elimination strategy of hepatitis C were studied and analyzed. The comparison of data between groups were performed using χ2 or χ2 continuity-correction test. Results:Anti-HCV positive detection rate was 1.34% (899/66 866). The positive rate of male patients aged 40 and over residing in cities was significantly higher than female patients under 40 years old residing in rural areas, and the difference was statistically significant ( χ2 = 55.178, 264.11, 36, 351, P < 0.05). There were 90 (10.02%) and 809 cases (89.98%) in outpatient and inpatient departments, respectively, with no statistically significant difference between the two ( χ2 = 0.002, P > 0.05). The total number of anti-HCV positive cases were 196 in Gastroenterology (22.0%), 75 in Respiratory and Critical Care Medicine (8.3%), 74 in Neurology (8.2%), 63 in Orthopedics (7.0%) and 55 in Endocrinology departments (6.1%), and the difference in the positive rate among different departments were also statistically significant ( χ2 = 271.585, P < 0.05). Among the 480 cases who were followed-up, 215 (44.79%) were lost to follow-up, 84 cases (39.07%) were unregistered, 77 cases (16.04%) were untreated, 15 cases (19.48%) were unaware of their state of illness, 46 cases (59.74%) were diagnosed without concern, 16 cases (20.78%) were diagnosed but did not take medicine, 60 cases were under treatment, and 29 cases were mostly on counterfeit drugs (48.33%). Conclusion:Comprehensive diagnosis and treatment education to non-specialist clinicians and timely manner regular follow-up of patients is a key factor and an important link to formulate a simple, easy and sustainable model to improve the efficiency of screening, diagnosis, and treatment of hepatitis C micro-elimination strategy in hospital. In addition, it will also play an important role in achieving the strategic goal of "eliminating hepatitis C as a public health threat by 2030".