ObjectiveTo explore the surgical methods and its efficacy on severe chronic obstructive pneumonia disease (COPD) with spontaneous pneumothorax.MethodsClinical features and surgical efficacies of 16 cases of severe COPD were analyzed.Results No death occurred and all patients recovered and discharged.The lung function index including subjective symptoms,motor ability and endurance in 14 cases showed obvious improvement compared with those before combination of pneumothorax.Two patients improved to the level before surgery.ConclusionThe lung function index of patients with severe COPD and pnumothorax can be relatively less restricted and open-chest surgery should be performed as soon as possible.Linear nailing and simple lung volume reduction surgery are recommended to improve lung function,shorten operation time and reduce surgical risks.

Objective To explore the clinical features,laboratory test results,diagnosis,treatment and prognosis of patients with anti-N-methyl-D-aspartic acid receptor (NMDAR) encephalitis.Methods A retrospectives analysis of clinical characteristics,laboratory test,treatment and prognosis of 3 patients with NMDRA encephalitis,admitted to our hospital from February 2012 to November 2014,was performed in our study.Results The most predominant symptoms of 3 patients with anti-NMDAR encephalitis included fever,psychiatric behavioral disturbances,seizures,orofacial dyskinesias and movement disorders and autonomic dysfunction.One patient had immature ovarian teratoma and one had mature mediastinal teratoma.Anti-NMDAR antibody was positive in serum and cerebrospinal fluid of two patients with teratoma,and anti-NMDAR antibody was positive in cerebrospinal fluid and negative in serum of one patient without tumour;all three patients showed abnormal electroencephalography,and 2 had increased signal on MR imaging T2 sequences or fluid-attenuated inversion.Patients were responsive to early immunotherapy and tumour resection.Conclusion The patient with NMDAR encephalitis presented with characteristic clinical manifestations;detection of anti-NMDAR antibody in serum and cerebrospinal fluid may be important for early diagnosis;early immunotherapy and tumour resection are effective for patients with NMDAR encephalitis.

Objective To determine whether the apoptosis of PC12 cells induced by MPP+ can be protected when the activity of cyclin-dependent kinase 5(CDK5)/p25 is inhibited specifically by TFP5.Methods The 100 μg/L of beta nerve growth factor (β-NGF) was used to induce PCI2 cells differentiating into dopaminergic neurons in vitro.Different concentrations of MPP+ (0,100,200,300,400,600,800 and 1000 μmol/L) were added to the cells;CCK8 assay was used to determine the cell activities and adequate concentration of MPP+.After induction,four groups were designed:PBS and PBS group,MPP+ and PBS group,MPP+ and TFP5 group,and MPP+ and Roscovitine group.Pretreatment of TFP5 and Roscovitne for 12 h was given to the MPP+ and TFP5 group and MPP+ and Roscovitine group,respectively.Hochest33258 staining and flow cytometry were used to detect the cell apoptosis.Western blotting was used to detect the protein expressions ofp35/25,caspase3,cleaved caspase3.Results CCK8 assay showed that the survival rate of PC12 cells was (64.84±1.58)％ when the MPP+ concentration was 300 μmol/L.Flow cytometry indicated significant differences in the apoptosis rate between different groups,which was the highest in MPP+ and PBS group ([25.61±2.74]％),following by MPP+ and TFP5 group ([13.33±1.24]％),MPP+ and Roscovitine group ([9.94±1.70]％),and PBS and PBS group ([8.68±0.21]％);significant difference was noted between MPP+ and TFP5 group and MPP+ and Roscovitine group (P＜0.05).Hochest33258 staining indicated the most obvious nucleus condensation and fragmentation and more apoptotic bodies in MPP+ and PBS group,While few apoptotic bodies were found in MPP+ and TFP5 group and MPP+ and Roscovitine group.Western blotting showed that as compared with that in the PBS and PBS group,the p25 protein level in the MPP+ and PBS group,MPP+ and TFP5 group,and MPP+ and Roscovitine group was significantly increased (P＜0.05).The cleaved caspase-3 protein expression in the MPP+ and PBS group was significantly higher than that in the PBS and PBS group (P＜0.05);the cleaved caspase-3 protein expression in the MPP+ and PBS group was significantly higher than that in the MPP+ and TFP5 group (P＜0.05).Conclusion TFP5 has protective effect against the apoptosis of PC12 cells induced by MPP+ through inhibiting the CDK5/p25 expression and reducing the cleaved caspase-3 protein production.

Objective To identify the risk factors of the incidence rate of initial poor graft function (IPGF)in recipients after living donor liver transplantation. Methods Clinical data of 309 patients undergoing living donor liver transplantation were retrospectively analyzed. Candidate risk factors:(1 )donor factors included age,gender and body mass index (BMI);(2)recipient factors included age,gender,BMI and preoperative Child-Pugh classification,model for end-stage liver disease (MELD)grading,preoperative renal insufficiency,serum total bilirubin elevation,hyponatremia and hypopotassaemia;(3)graft factors included graft cold ischemia time,graft recipient weight ratio (GRWR);(4)recipient surgery factors included total operation time,blood loss volume,blood transfusion volume,platelet transfusion and anhepatic phase≥1 00 min. Single factor analysis was performed to identify the potential risk factors of IPGF. Logistic regression analysis was conducted to explore independent risk factors. Results and Conclusions Child-Pugh C of preoperative recipient liver function,MELD score≥20,serum total bilirubin elevation(>68. 4μmol/L),hyponatremia(<1 35 mmol/L), hypopotassaemia (<3. 5 mmol/L)and anhepatic phase≥1 00 min were potential risk factors of IPGF (all P<0. 05 ). Child-Pugh C of preoperative recipient liver function was an independent risk factor of the incidence rate of IPGF following living donor liver transplantation (P=0. 01 9).

BACKGROUND:The imbalance between bone resorption and bone formation in microgravity environments leads to significant bone loss in astronauts.Current research indicates that bone loss under microgravity conditions is the result of the combined effects of various cells,tissues,and systems. OBJECTIVE:To review different biological effects of microgravity on various cells,tissues,or systems,and summarize the mechanisms by which microgravity leads to the development of osteoporosis. METHODS:Databases such as PubMed,Web of Science,and the Cochrane Database were searched for relevant literature from 2000 to 2023.The inclusion criteria were all articles related to tissue engineering studies and basic research on osteoporosis caused by microgravity.Ultimately,85 articles were included for review. RESULTS AND CONCLUSION:(1)In microgravity environment,bone marrow mesenchymal stem cells tend to differentiate more into adipocytes rather than osteoblasts,and hematopoietic stem cells in this environment are more inclined to differentiate into osteoclasts,reducing differentiation into the erythroid lineage.At the same time,microgravity inhibits the proliferation and differentiation of osteoblasts,promotes apoptosis of osteoblasts,alters cell morphology,and reduces the mineralization capacity of osteoblasts.Microgravity significantly increases the number and activity of osteoclasts.Microgravity also hinders the differentiation of osteoblasts into osteocytes and promotes the apoptosis of osteocytes.(2)In a microgravity environment,the body experiences changes such as skeletal muscle atrophy,microvascular remodeling,bone microcirculation disorders,and endocrine disruption.These changes lead to mechanical unloading in the bone microenvironment,insufficient blood perfusion,and calcium cycle disorders,which significantly impact the development of osteoporosis.(3)At present,the mechanism by which microgravity causes osteoporosis is relatively complex.A deeper study of these physiological mechanisms is crucial to ensuring the health of astronauts during long-term space missions,and provides a theoretical basis for the prevention and treatment of osteoporosis.

Objective:To evaluate the effect of flipped classroom combined with problem-based learning (PBL) on the standardized training for perioperative beside echocardiography.Methods:A total of 64 second-year standardized training students from the Department of Anesthesiology at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were selected between January 2021 and June 2022 and assigned to control group ( n=32) and test group ( n=32) using a random number table method. Control group employed the traditional teaching model, and test group utilized the flipped classroom combined with PBL. After a 3-month period of teaching standard views and hemodynamic evaluation of bedside echocardiography, the comprehensive theoretical and clinical practice scores (a score of≥80 was considered excellent or good) were compared between the two groups. Additionally, a questionnaire was distributed to assess students′ self-directed learning ability and initiative, interest in learning, efficiency in mastering professional knowledge, satisfaction with teaching, communication and collaboration skills, and clinical thinking ability. Results:Compared with control group, the students in test group showed significant improvements in both comprehensive theoretical ([87 ± 8] vs [80 ± 8]) and clinical practical ([86 ± 8] vs [78 ± 8]) echocardiography scores( P<0.05 or 0.01).The excellent or good rate for comprehensive theoretical scores (88% vs 47%) and clinical practice scores (84% vs 50%) was significantly higher in test group than in control group( P<0.05 or 0.01).A total of 64 questionnaires were distributed, and all of them were returned, yielding a response rate of 100%. The students in test group demonstrated enhanced self-directed learning ability and initiative (94% vs 69%), increased interest in learning (91% vs 66%), improved efficiency in mastering professional knowledge (97% vs 75%), greater satisfaction with teaching (94% vs 62%), enhanced communication and collaboration skills (84% vs 62%), and improved clinical thinking ability (88% vs 59%) compared to control group ( P<0.05). Conclusions:The combination of a flipped classroom and PBL produces better effect than traditional teaching methods when used for standardized training for perioperative bedside echocardiography.

Urinary tract infection (UTI) is one of the most common infectious diseases. It has the characteristics of high recurrence rate and prolonged course. At present, the problem of antibiotic resistance is becoming more and more serious, the incidence of adverse reactions is high, and the disadvantages of long-term administration appear, which brings severe challenges to the treatment of recurrent urinary tract infection. The prevention and treatment of UTI recurrence has become the focus of research. Recurrent urinary tract infection is related to the immune regulation mechanism of the body. Administration of immune regulation can provide new ideas for prevention and treatment. The vaccine based on immune regulation to prevent rUTI has made some progress. It can not only reduce the frequency of recurrences, but also decrease related symptoms. At the same time, the vaccine has good tolerance, high safety and good application prospect. This paper aims to summarize the progress of immune regulation and immune vaccines in vivo and clinical research.

Objective:To investigate the unqualified hepatitis C virus (HCV) detection result of blood donors from the served area of blood institutions.Methods:The data related to HCV markers detected of the first and repeat blood donors were collected from the system of practice comparison for the Chinese mainland blood institutions from 2017 to 2021. The anti-HCV reactive rate and the rates of anti-HCV negative but HCV-RNA reaction and all the relationship between rates and the annual, regional and different blood donors were statistically analyzed.Results:During 2017-2021, the number of anti-HCV reactive per 100 000 blood donors decreased from 444.3 to 250.44 in the served area of 22 blood institutions ( χ2=49.677, P<0.05). The number of HCV RNA detected positive per 100 000 anti-HCV negative increased from 0.69 to 2.05 year by year, but there was no statistical significance ( χ2=0.643, P>0.05). The anti-HCV unqualified rate was significantly different among regions ( χ2=3 260.283, P<0.05). The anti-HCV unqualified rate of the first blood donors was significantly higher than that of the repeated blood donors ( F=130.993, P < 0.05). The annual number of HCV RNA detected positive per 100 000 anti-HCV negative blood samples from donors ranged from 0 to 17.28. Conclusions:The anti-HCV unqualified rate of blood donors in the served area of 22 blood institutions decreased year by year. Compared with repeated blood donors, HCV infection should be emphasized in first-time blood donors. The implementation of HCV RNA test can detect out much more HCV infections and reduce the risk of transfusion transmitted infectious HCV.

Objective:To investigate the value of intratumoral and peritumoral radiomics models based on 18F-FDG PET-CT in predicting epidermal growth factor receptor (EGFR) mutation status in lung adenocarcinoma and interpret peritumoral radiomics features. Methods:This study was a cross-sectional study. Patients with lung adenocarcinoma who underwent 18F-FDG PET-CT at the Third Affiliated Hospital of Soochow University between January 2018 and April 2022 were retrospectively collected and samplied into a training set (309 cases) and a test set (206 cases) in a 6∶4 ratio randomly. Radiomics features were extracted from the intratumoral and peritumoral regions of interest based on PET and CT images, respectively, and the optimal feature sets were selected. Radiomics models were established using the XGBoost algorithm, and radiomics scores (intratumoral CT label, peritumoral CT label, intratumoral PET label, peritumoral PET label) were calculated. Logistic regression analysis was used to construct a clinical model and a combined model (incorporating PET-CT intratumoral and peritumoral radiomics, clinical features, and CT semantic features). The predictive performance of the models was evaluated using receiver operating characteristic curves and the area under the curve (AUC). Unsupervised clustering, Spearman correlation analysis, and visualization methods were used for the interpretability of peritumoral radiomics features. Results:In both the training and test sets, the AUC value of CT peritumoral labels was greater than that of CT intratumoral labels for predicting EGFR mutation status in lung adenocarcinoma (training set: Z=3.84, P<0.001; test set: Z=1.99, P=0.046). In the test set, the AUC value of PET intratumoral labels (0.684) was slightly higher than that of PET peritumoral labels (0.672) for predicting EGFR mutation status, but the difference was not statistically significant ( P>0.05). The combined model had the highest AUC value for predicting EGFR mutation status of lung adenocarcinoma in both the training and test sets and was significantly better than the clinical model (training set: Z=6.52, P<0.001; test set: Z=2.31, P=0.021). Interpretability analysis revealed that CT peritumoral radiomics features were correlated with CT shape features, and there were significant differences in CT peritumoral features between different EGFR mutation statuses. Conclusions:The value of CT peritumoral labels is superior to that of CT intratumoral labels in predicting EGFR mutation status in lung adenocarcinoma. The predictive performance of the model can be improved by combining PET-CT intratumoral and peritumoral radiomics, clinical features, and CT semantic features.

ObjectiveTo observe the clinical effectiveness and safety of Xiaozhong Zhitong Mixture （消肿止痛合剂） combined with antibiotic bone cement in the treatment of diabetic foot ulcer （DFU） with damp-heat obstructing syndrome. MethodsA total of 72 DFU patients with damp-heat obstructing syndrome were randomly assigned to treatment group （36 cases） and the control group （36 cases）. Both groups received standard treatment and topical antibiotic bone cement for ulcer wounds， while the treatment group received oral Xiaozhong Zhitong Mixture （50 ml per time， three times daily） in additionally. Both groups underwent daily wound dressing changes for 21 consecutive days. Ulcer healing rate， serum levels of tumor necrosis factor-alpha （TNF-α）， interleukin-1 beta （IL-1β）， malondialdehyde （MDA）， superoxide dismutase （SOD）， C-reactive protein （CRP）， and white blood cell （WBC） count were observed before and after treatment， and visual analog scale （VAS） scores for wound pain， traditional Chinese medicine （TCM） syndrome scores， and the DFU Healing Scale （DMIST scale） were also compared. Liver and kidney function were evaluated before and after treatment， and adverse events such as allergic reactions， worsening ulcer pain were recorded. ResultsTotally 35 patients in the treatment group and 33 in the control group were included in the final analysis. The ulcer healing rate in the treatment group was （87.93±9.34）%， significantly higher than （81.82±12.02）% in the control group （P = 0.035）. Compared to pre-treatment levels， both groups showed significant reductions in serum CRP， WBC， MDA， IL-1β， and TNF-α levels， with an increase in SOD level （P＜0.05）. TCM syndrome scores， VAS， and DMIST scores also significantly decreased in both groups （P＜0.05）， with greater improvements in the treatment group （P＜0.05）. No significant adverse reactions were observed in either group during treatment. ConclusionXiaozhong Zhitong Mixture combined with antibiotic bone cement has significant advantages in promoting DFU healing， reducing inflammatory response， and alleviating oxidative stress in DFU patients with damp-heat obstructing syndrome， with good safety for DFU patients with damp-heat obstructing syndrome.