ObjectiveTo describe the characteristics of the nasopharyngeal microbiota in children under 5 years of age in Haidong City, Qinghai Province and analyze its associated factors, so as to provide basic data for the evolution and development of nasopharyngeal microbiota in children. MethodsA total of 230 community children from Haidong City, Qinghai Province were included in the study. Participants’ basic information was collected by local volunteers from parents/guardians at enrollment. 16S rDNA sequencing was used to identify the bacterial diversity and abundance of nasopharyngeal microbial community. Bioinformatics methods were used to analyze the characteristics of the nasopharyngeal microbiota, compare the differential species, and investigate the correlation with age. ResultsThere was no statistical difference in either Chao1 index or Shannon index of nasopharyngeal microbial communities among children with different ages (P>0.05). Besides, the structure of nasopharyngeal microbiota in children of different ages was different, either (P=0.020). Age, ethnicity and delivery mode, to some extent, could explain the differences in the structure of nasopharyngeal microbiota in children. There were statistically significant differences in the abundance of Dolosigranulum, Staphylococcus and Corynebacterium in the nasopharyngeal microbiota of children with different ages (P<0.05). Differential analysis revealed that Corynebacterium was found to be over-represented in children under 1 year of age, while Dolosigranulum was found to be over-represented in children between 2 and 3 years old. Furthermore, the results of correlation analysis showed that, Moraxella was positively correlated with Corynebacterium, Dolosigranulum and Streptococcus, but negatively correlated with Pseudomonas. In addition, a strong positive correlation was detected between the Dolosigranulum and Corynebacterium. ConclusionThe diversity of nasopharyngeal microbial community among children under 5 years in Haidong City, Qinghai Province is stable. However, there are differences in the species structure, mainly in the abundance difference of Dolosigranulum, Staphylococcus and Corynebacterium. This study provides basic data on the evolution and maturation of nasopharyngeal microbial communities in early childhood, which can provide a scientific basis for the early prevention and diagnosis of respiratory tract infections in children.

Peptide receptor radionuclide therapy (PRRT) with radiolabeled SSTR2 agonists is a treatment option that is highly effective in controlling metastatic and progressive neuroendocrine tumors (NETs). Previous studies have shown that an SSTR2 agonist combined with albumin binding moiety Evans blue (denoted as ¹⁷⁷Lu-EB-TATE) is characterized by a higher tumor uptake and residence time in preclinical models and in patients with metastatic NETs. This study aimed to enhance the in vivo stability, pharmacokinetics, and pharmacodynamics of ¹⁷⁷Lu-EB-TATE by replacing the maleimide-thiol group with a polyethylene glycol chain, resulting in a novel EB conjugated SSTR2-targeting radiopharmaceutical, ¹⁷⁷Lu-LNC1010, for PRRT. In preclinical studies, ¹⁷⁷Lu-LNC1010 exhibited good stability and SSTR2-binding affinity in AR42J tumor cells and enhanced uptake and prolonged retention in AR42J tumor xenografts. Thereafter, we presented the first-in-human dose escalation study of ¹⁷⁷Lu-LNC1010 in patients with advanced/metastatic NETs. ¹⁷⁷Lu-LNC1010 was well-tolerated by all patients, with minor adverse effects, and exhibited significant uptake and prolonged retention in tumor lesions, with higher tumor radiation doses than those of ¹⁷⁷Lu-EB-TATE. Preliminary PRRT efficacy results showed an 83% disease control rate and a 42% overall response rate after two ¹⁷⁷Lu-LNC1010 treatment cycles. These encouraging findings warrant further investigations through multicenter, prospective, and randomized controlled trials.

ObjectiveTo investigate the etiology and epidemiological characteristics of pneumonia in children of different ages, to better characterize the co-infection patterns of pneumonia and their association with severe diseases. MethodsChildren aged 28 days to 13 years with pneumonia who were hospitalized in the Department of Pediatrics, Dongyang People's Hospital, Zhejiang Province from April 1 to December 28, 2023 were selected as the research subjects. Oropharynx swabs were collected from the patients within 24 hours of hospital admission, and PCR tests were conducted for 18 respiratory pathogens. Binary multivariate logistic regression analysis was used to analyze the status of viral and bacterial infection, patterns of co-infection in patients with different ages, and the risk factors for the outcome of severe pneumonia. ResultsA total of 2 191 hospitalized children with pneumonia were enrolled in the study. Severe cases were more common in children aged 5 years and older (53.3%) and in the second quarter of the year (46.5%). An average of (1.31±0.90) pathogens were detected in severe cases. Mycoplasma pneumoniae (44.4%, 973 cases) had the highest detection rate of pathogens. Streptococcus pneumoniae (21.7%, 476 cases) and rhinovirus (10.1%, 222 cases) were the most common bacteria and viruses, respectively, in hospitalized children with pneumonia in Dongyang City. Multivariate logistic regression analysis indicated positive interactions between different viral and bacterial pathogens. The adjusted OR (aOR) values for different respiratory pathogens in children with severe pneumonia varied significantly (all P<0.04). Among them, Chlamydia pneumoniae (aOR=9.74, 95%CI=2.36‒49.32, P<0.01), Mycoplasma pneumoniae (aOR=2.62, 95%CI=2.04‒3.37, P<0.01), and RSV (aOR=1.69, 95%CI=1.12‒2.54, P<0.01) were the risk factors for severe pneumonia. ConclusionIn the pathogen spectrum of children with pneumonia in Dongyang City, Zhejiang Province from April to December 2023, most viruses and bacteria exhibited positive interactions. Chlamydia pneumoniae, Mycoplasma pneumoniae, and RSV maybe the significant risk factors for severe pneumonia.

Objective To investigate whether 3D-guided cone-shaped segmentectomy can achieve comparable long-term outcomes with lobectomy for deep early-stage lung cancer with diameter≤2 cm. Methods We retrospectively screened patients with deep early-stage non-small cell lung cancer (NSCLC) with diameter≤2 cm who underwent lobectomy or segmentectomy in the First Affiliated Hospital of Nanjing Medical University from 2012 to 2018. All pulmonary segmentectomy was performed using 3D-guided cone-shaped segmentectomy with segment or subsegment as the resection unit. Univariate and multivariate regression analyses were performed by Cox proportional hazard regression model. The patients who underwent segmentectomy and lobectomy were matched 1∶1 by propensity-score matching analysis. The oncological outcomes of two groups were compared. Results Our cohort was divided into a segmentectomy group (n=222) and a lobectomy group (n=127). The age, total nodule size, solid component size and proportion of pure solid nodule in the lobectomy group were significantly higher than those in the segmentectomy group. The median follow-up time was 49 months. Surgical margins were negative in all patients. The local recurrence rate of segmentectomy was 0.45%. The disease-free survival (DFS) rate and overall survival (OS) rate of patients in the segmentectomy group were significantly better than those in the lobectomy group (5-year DFS rate: 98.64% vs. 89.77%, P<0.001; 5-year OS rate: 99.55% vs. 92.10%, P<0.001). Multivariate regression analysis showed that the differences between two groups were not significant [DFS rate: HR=0.52. 95%CI (0.11, 2.59), P=0.427; OS rate: HR=0.08. 95%CI (0.00, 3.24), P=0.179] after adjusting for other factors. After propensity score matching, 77 patients were preserved in both segmentectomy group and lobectomy group, with the mean nodule size of 1.44 cm and 1.49 cm and the mean consolidation tumor ratio (CTR) of 0.46 and 0.52, respectively. There was no statistical difference in DFS rate (P=0.640) or OS rate (P=0.310) between the two groups. Conclusion 3D-guided cone-shaped segmentectomy can be an acceptable treatment for low-grade malignant NSCLC deep in lung parenchyma with diameter≤2 cm, and its oncology effect is not inferior to lobectomy.

Background and objective Current studies suggest that for early-stage lung cancers with a component of ground-glass opacity measuring ≤2 cm,sublobar resection is suitable if it ensures adequate margins.However,lobectomy may be necessary for some cases to achieve this.The aim of this study was to explore the impact of size and depth on surgical techniques for wedge resection,segmentectomy,and lobectomy in early-stage lung cancer ≤2 cm,and to determine methods for ensuring a safe resection margin during sublobar resections.Methods Clinical data from 385 patients with early-stage lung can-cer ≤2 cm,who underwent lung resection in 2022,were subject to a retrospective analysis,covering three types of procedures:wedge resection,segmentectomy and lobectomy.The depth indicator as the OA value,which is the shortest distance from the inner edge of a pulmonary nodule to the opening of the corresponding bronchus,and the AB value,which is the distance from the inner edge of the nodule to the pleura,were measured.For cases undergoing lobectomy and segmentectomy,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was performed to statistically determine the number of subsegments required for segmentectomy.The cutting margin width for wedge resection and segmentectomy was recorded,as well as the specific subsegments and their quantities removed during lung segmentectomy were documented.Results In wedge resection,segmentectomy,and lobectomy,the sizes of pulmonary nodules were(1.08±0.29)cm,(1.31±0.34)cm and(1.50±0.35)cm,respectively,while the depth of the nodules(OA values)was 6.05(5.26,6.85)cm,4.43(3.27,5.43)cm and 3.04(1.80,4.18)cm for each procedure,showing a progressive increasing trend(P＜0.001).The median resec-tion margin width obtained from segmentectomy was 2.50(1.50,3.00)cm,significantly greater than the 1.50(1.15,2.00)cm from wedge resection(P＜0.001).In wedge resections,cases where AB value＞2 cm demonstrated a higher proportion of cases with resection margins less than 2 cm compared to those with margins greater than 2 cm(29.03％vs 12.90％,P=0.019).When utilizing the size of the nodule as the criterion for resection margin,the instances with AB value＞2 cm continued to show a higher proportion in the ratio of margin distance to tumor size less than 1(37.50％vs 17.39％,P=0.009).The median number of subsegments for segmentectomy was three,whereas lobectomy cases requiring segmentectomy involved five subsegments(P＜0.001).Conclusion The selection of the surgical approach for lung resection is influenced by both the size and depth of pulmonary nodules.This study first confirms that larger portions of lung tissue must be removed for nodules that are deeper and larger to achieve a safe margin.A distance of ≤2 cm from the inner edge of the pulmonary nodule to the nearest pleura may be the ideal indication for performing wedge resection.

Whether anatomical segmentectomy can replace lobectomy in the treatment of early-stage lung cancer remains controversial. A large number of studies have been conducted for decades to explore whether pulmonary segmentectomy can treat early-stage lung cancer, which is actually to explore the indications of intentional segment-ectomy. With the development of scientific researches, it is found that many characteristics affect the malignancy of lung cancer, and the different grades of each characteristic affect the prognosis of patients. It is worth exploring whether different surgical approaches can be used for early-stage lung cancer with different characteristics and different grades. This article reviews the literature and studies to discuss the advances in indications of segmentectomy for early-stage lung in terms of tumor size, consolidation-to-tumor ratio, pathological classification and tumor location, respectively. The objective of this review is to help thoracic surgeons to objectively and scientifically select the surgical method according to the clinical characteristics of early-stage lung cancer.

Objective    To analyze the results and rationality of the lesion-focused strategy with subsegment as the pulmonary anatomical unit for pulmonary nodules with a diameter of ≤2 cm which require surgery. Methods    Clinical data of 246 patients with pulmonary nodules who underwent surgery in the Department of Thoracic Surgery of The First Affiliated Hospital of Nanjing Medical University from January 2017 to October 2018 were retrospectively analyzed, including 76 males and 170 females, with an average age of 53.30±11.82 years. The patients were divided into four groups, a single segmentectomy group, a segmentectomy combined with adjacent subsegmentectomy group, a single subsegmentectomy group and a combined subsegmentectomy group, according to the different surgical approaches, to compare preoperative, intraoperative, and postoperative related data. Results    There was no perioperative death. Among the four groups, there was no statistical difference in gender (P=0.163), age (P=0.691), diameter of the nodule (P=0.743), longitudinal position of the nodule (depth ratio, P=0.831), postoperative pulmonary leakage (P=0.752), intraoperative blood loss (P=0.135), pathological type (P=0.951) or TNM stage (P=0.995); there were statistical differences in transverse position of the nodule (P<0.001) and number of subsegments involved (P<0.001). The results of multivariate logistic regression analysis showed that compared with combined subsegmentectomy, the odds ratio (OR) of the lung nodule in segmentectomy combined with adjacent subsegmentectomy as intersegment nodules was 5.759 (95%CI 1.162 to 28.539, P=0.032). Conclusion     The surgical strategy of lesion  focused and subsegment as anatomical unit is safe and feasible for surgical treatment of pulmonary nodules with diameter ≤2 cm. The transverse position of the nodules is an important factor affecting the choice of surgical method for the middle and lateral nodules with a diameter of ≤2 cm, and the longitudinal location of the nodule is not an influencing factor. For nodules in inner zone, the diameter also is one of the factors influencing the choice of surgical method.

Objective    To analyze the incidence and drainage pattern of the specific collateral vein (VL) located between several adjacent segments of the bilateral upper lung, and its clinical significance in the surgical treatment of early lung cancer. Methods    The preoperative three-dimensional computed tomography bronchography and angiography (3D CTBA) data of 1 515 patients in the First Affiliated Hospital of Nanjing Medical University from 2017 to 2020 were analyzed retrospectively, including 524 males and 991 females, with an average age of 54.27±11.43 years. There were 712 patients of right upper lung and 803 patients of left upper lung. The incidence and drainage pattern of VL in bilateral upper lungs were analyzed. Furthermore, the imaging data and medical records of 113 patients in the left upper lung were reviewed to investigate the influence of the relative position relationship between nodules and VL on the selection of operation. Results    The overall incidence of VL was 72.7% (1 102/1 515) in the bilateral upper lungs, including 68.0%(484/712) in the right upper lung, and 77.0% (618/803) in the left upper lung. The incidence of VL in the left side was significantly higher than that in the right side (P<0. 05). VL mainly drained into V2a+b (327/484, 67.6%) in the right upper lung and into V1+2b+c (389/618, 62.9%) in the left upper lung. When the spherical simulative cutting margin of 2 cm of the nodule did not involve VL, it was more feasible to undergo sublobectomy than those whose simulative cutting margin of 2 cm involved VL, and the difference was statistically significant (91.9% vs. 61.5%, P<0.05). When the spherical simulative cutting margin of 2 cm of nodule involved VL, the lesion located in the middle or inner zone was more feasible to undergo lobectomy than that in the outer zone, but the difference was not statistically significant (43.8% vs. 34.8%, P>0.05). Multivariate logistic regression analysis showed that diameter of the lesion, whether the spherical simulative margin of 2 cm involving VL and the depth ratio of the lesion were independent risk factors affecting the surgical options (P<0.05). Conclusion    The incidence of the specific collateral vein in bilateral upper lungs is high, and the drainage pattern is diverse, which has important guiding significance for preoperative planning and intraoperative manipulation. For deep nodules adjacent to VL, lobectomy or resection of left upper division is often performed to ensure a safe margin.

Objective:To investigate the influencing factors for prognoses of patients with high-grade aneurysmal subarachnoid hemorrhage (aSAH).Methods:A retrospective analysis was performed on clinical data of 104 patients with aSAH, admitted to our hospital from January 2012 to March 2010. According to the modified Rankin scale (mRS) scores 3 months after discharge, these patients were divided into good prognosis group (mRS scores≤2) and poor prognosis group (mRS scores >2). Clinical data of patients from the 2 groups were compared. Multivariate Logistic regression analysis was used to analyze the influencing factors for prognoses.Results:Forty patients (38.5%) were with good prognosis and 64 (61.5%) were with poor prognosis. As compared with patients in the poor prognosis group, patients in the good prognosis group had significantly lower proportion of patients>60 years old, and significantly lower Graeb scores, cast fourth ventricle (CFV) incidence, Fisher grading, blood glucose content, diastolic blood pressure, systolic blood pressure and mean arterial pressure, and statistically higher serum potassium content ( P<0.05). There were significant differences in treatment methods and incidence of complications between the two groups ( P<0.05). Multivariate Logistic regression analysis showed that age>60 years ( OR=13.470, 95%CI: 2.177-83.347, P=0.005), Fisher grading ( OR=6.649, 95%CI: 1.141-38.736, P=0.035), conservative treatment ( OR=6.348, 95%CI: 1.048-38.742, P=0.044), mean arterial pressure at admission ( OR=29.721, 95%CI: 3.177-278.012, P=0.003), serum potassium ( OR=5.296, 95%CI: 1.138-24.653, P=0.034), CFV ( OR=9.855, 95%CI: 1.785-51.456, P=0.008), and chronic hydrocephalus ( OR=19.298, 95%CI: 3.294-113.069, P=0.001) were influencing factors for prognoses of high-grade aSAH patients. Conclusion:Severe aSAH patients with advanced age, high Fisher grading, high mean arterial pressure, low serum potassium content, fourth ventricle casting and chronic hydrocephalus under conservative treatment are more likely to have poor prognosis.

Objective    To analyze the difference of location identification of pulmonary nodules in two dimensional (2D) and three dimensional (3D) images, and to discuss the identification methods and clinical significance of pulmonary nodules location in 3D space. Methods    The clinical data of 105 patients undergoing sublobectomy in the Department of Thoracic Surgery, the First Affiliated Hospital with Nanjing Medical University from December 2018 to December 2019 were analyzed retrospectively. There were 28 males and 77 females, with an average age of 57.21±13.19 years. The nodule location was determined by traditional 2D method and 3D depth ratio method respectively, and the differences were compared. Results    A total of 30 nodules had different position identification between the two methods, among which 25 nodules in the inner or middle zone of 2D image were located in the peripheral region of 3D image. The overall differences between the two methods were statistically significant (P<0.05). The diagnostic consistency rates of two methods were 66.67% in the right upper lung, 83.33% in the right middle lung, 73.68% in the right lower lung, 75.76% in the left upper lung, and 64.71% in the left lower lung. In each lung lobe, the difference between the two methods in the right upper lung (P=0.014) and the left upper lung (P=0.019) was statistically significant, while in the right middle lung (P=1.000), right lower lung (P=0.460) and left lower lung (P=0.162) were not statistically significant. Conclusion    The 3D position definition of lung nodules based on depth ratio is more accurate than the traditional 2D definition, which is helpful for preoperative planning of sublobectomy.