Objective To observe the efficacy and safety of neoadjuvant sintilimab combined with chemotherapy in the treatment of patients with locally advanced resectable esophageal squamous cell carcinoma (ESCC). Methods Clinical data were collected from patients with locally advanced resectable ESCC who received neoadjuvant immunotherapy combined with chemotherapy followed by surgical treatment at the Department of Thoracic Surgery of Jining No.1 People's Hospital from April 2020 to April 2022. The endpoints included major pathological response (MPR), pathological complete response (pCR), R0 resection rate, safety, and postoperative survival. Results A total of 43 patients with ESCC who received at least one cycle of neoadjuvant immunotherapy before surgery were included. Among them, there were 31 males and 12 females with a median age of 65 years (interquartile range: 58-69). All patients successfully completed the surgery without any surgical delays. The pCR rate was 14.0% (6/43), the MPR rate was 58.1% (25/43), and the R0 resection rate was 97.7% (42/43). Patients exhibited reliable safety during neoadjuvant therapy and postoperatively. The 2-year overall survival and disease-free survival rates were 90.7% and 81.4%, respectively. Kaplan-Meier survival analysis and log-rank test revealed lower recurrence rates and better survival in the MPR patients compared to the non-MPR patients. Conclusion The combination of neoadjuvant sintilimab and chemotherapy in the treatment of patients with locally advanced resectable ESCC has demonstrated significant clinical efficacy, while also being safe and reliable.

Objective To investigate clinical therapeutic value of combined posterior nasal nerve and anterior ethmoidal nerve ablation in patients with nasal septal deviation and moderate to severe persistent allergic rhinitis.Methods A total of 47 patients diagnosed with nasal septal deviation and moderate to severe persistent allergic rhinitis from April to December 2024 were divided into two groups.The control group(n=22)underwent septoplasty and bilateral inferior turbinate out-fracture,with postoperative symptom control managed by budesonide nasal spray.The experimental group(n=25)received the same septoplasty and turbinate surgery,supplemented by bilateral posterior nasal nerve and anterior ethmoidal nerve ablation.Symptom improvement was compared between groups by using the Visual Analogue Scale(VAS)and Rhinoconjunctivitis Quality of Life Questionnaire(RQLQ)scores preoperatively and3 months postoperatively.Results The operation time of the control group was(36.3±5.9)min,significantly shorter than that of the experimental group[(59.4±6.6)min,t=12.496,P=0.000].Both groups of patients showed significant improvement in VAS and PQLQ scores for nasal symptoms such as nasal congestion,runny nose,sneezing,and itching at 3 months after surgery compared to preoperative levels(all P=0.000).The mean VAS score of the four symptoms in the control group was(4.6±0.9)points at3 months after surgery,which was significantly lower than that before surgery[(6.3±1.1)points,t=9.796,P=0.000].The mean VAS score of the four symptoms in the experimental group was1.0(0.3-4.3)points at3 months after surgery,which was significantly lower than that before surgery[7.0(4.5-9.0)points,Z=-4.376,P=0.000].The improvement rate of the VAS score in the experimental group was(82.4±14.2)%,significantly higher than that in the control group[(26.9±11.7)%,t=14.510,P=0.000].At3 months after surgery,the RQLQ score of the control group[(2.3±0.8)points]was significantly lower than that before surgery[(3.3±0.8)points,t=10.055,P=0.000].The RQLQ score of the experimental group after surgery was 1.4(0.8-3.5)points,which was significantly lower than the preoperative score[3.6(1.5-6.1)points,Z=-4.373,P=0.000].The improvement rate of RQLQ score in the experimental group was(53.0±14.6)%,significantly higher than that in the control group[(30.2±13.4)%,t=5.555,P=0.000].Conclusion Postnasal nerve and anterior ethmoidal nerve ablation combined with nasal septal deviation correction can significantly improve nasal symptoms and quality of life in patients with nasal septal deviation complicated with moderate to severe allergic rhinitis compared with simple nasal septal deviation correction,but the operation time is prolonged.

Objective To develop a method for rapidly identifying Clostridioides difficile(C.difficile)and de-termining high-producing toxin strains,conduct clinical evaluation.Methods The loop-mediated isothermal amplifi-cation(LAMP)method was used to identify C.difficile based on the tcdC,tcdA,and tcdB genes.The sensitivi-ty,specificity,and overall consistency of the detection method were evaluated.Results Feces specimens from 499 hospitalized patients suspected of C.difficile-associated diarrhea were detected,with C.difficile detection rate of 12.8％(64/499),out of which the detection rate of toxin-producing C.difficile was 10.8％(54/499).The sensi-tivity,specificity,positive predictive value,and negative predictive value of the detection method for tcdA were 87.2％,98.9％,89.1％,and 98.6％,respectively,and 88.2％,99.6％,90.0％,and 98.73％for tcdB,respec-tively.The total toxin levels of different strains were different,but the average toxin production level of A+B+strains(1.79 μg/mL)was higher than those of A-B+strains(0.72 μg/mL)and A-B-strains(＜0.10 μg/mL).Conclusion The portable high-throughput LAMP detection method can rapidly and efficiently identify C.difficile and determine high-producing toxin strains.

The PA-PB1 interface of the influenza polymerase is an attractive site for antiviral drug design. In this study, we designed and synthesized a mini-library of indazole-containing compounds based on rational structure-based design to target the PB1-binding interface on PA. Biological evaluation of these compounds through a viral yield reduction assay revealed that compounds 27 and 31 both had a low micromolar range of the half maximal effective concentration (EC₅₀) values against A/WSN/33 (H1N1) (8.03 μmol/L for 27; 14.6 μmol/L for 31), while the most potent candidate 24 had an EC₅₀ value of 690 nM. Compound 24 was effective against different influenza strains including a pandemic H1N1 strain and an influenza B strain. Mechanistic studies confirmed that compound 24 bound PA with a K _d which equals to 1.88 μmol/L and disrupted the binding of PB1 to PA. The compound also decreased the lung viral titre in mice. In summary, we have identified a potent anti-influenza candidate with potency comparable to existing drugs and is effective against different viral strains. The therapeutic options for influenza infection have been limited by the occurrence of antiviral resistance, owing to the high mutation rate of viral proteins targeted by available drugs. To alleviate the public health burden of this issue, novel anti-influenza drugs are desired. In this study, we present our discovery of a novel class of indazole-containing compounds which exhibited favourable potency against both influenza A and B viruses. The EC₅₀ of the most potent compounds were within low micromolar to nanomolar concentrations. Furthermore, we show that the mouse lung viral titre decreased due to treatment with compound 24. Thus our findings identify promising candidates for further development of anti-influenza drugs suitable for clinical use.

Objective To establish a gas chromatography-mass spectrometry method for simultaneous determination of the contents of volatile components muscone,menthol,borneol,isoborneol,camphor,and carvone in Wuli Huichun pills,and to evaluate the quality of Wuli Huichun pills based on authenticity,effectiveness and safety.Methods The ethyl acetate extract was analyzed by HP-5MS capillary column(30 m×0.25 mm,0.25 μm)with temperature programming.The injection port temperature was set at 230℃,and the split ratio was set at 10∶1.The carrier gas was high-purity helium gas.The injection port was in constant flow mode,with a carrier gas flow rate of 1.0 mL·min-1.The detector was a mass spectrometer with a triple quadrupole in series.The ion source was an electron bombardment source(EI)with a temperature of 250℃.The collision gas was argon.The temperature of the mass spectrometry transmission interface was 250℃.Scanning mode was SIM mode,with a solvent delay of 2 minutes.Results The linear relationships of the six components were good(r>0.999 0),the average recoveries were 93.57%-97.96%,and the RSD was 0.73%-2.5%.Conclusion The method is simple,accurate,and efficient,and can be used for the quality evaluation of Wuli Huichun pills.

This study aims to compare the vaccination rates and incidence of adverse reaction rates following administration of two domestically produced human papillomavirus (HPV) vaccines in individuals aged 9-30 years,investigate the impact of distinct manufacturing processes and vaccination schedules on adverse reaction rates. From November 2023 to June 2024, the Immunization Planning Department of Liuzhou Center for Disease Control and Prevention conducted a single-center, randomized, open-label, parallel-group trial using community-based recruitment of eligible participants aged 9 to 30 years. Participants were randomly assigned to receive either of two domestically produced HPV vaccines (Walrinvax or Cecolin). As specified in the vaccine package inserts, subjects were stratified into a two-dose regimen group (aged 9-14 years) and a three-dose regimen group (aged 15-30 years). Vaccination rates were recorded, and adverse reactions within 0-30 days post-vaccination were monitored. The results showed that a total of 400 participants were enrolled. Both the full vaccination rate and the timely completion rate were significantly higher in the two-dose regimen group compared to the three-dose regimen group (Fisher′s exact test, P<0.01; χ2=7.06, P<0.01). A total of 985 doses were administered. The overall adverse reaction rate was 18.78% (185/985), with local and systemic reactions occurring at 8.02% (79/985) and 10.76% (106/985), respectively. The most frequent adverse reactions were injection site pain (4.97%, 49/985) and fever (4.47%, 44/985). No grade 4 or special-interest adverse events were reported.The incidence of adverse reactions for the two domestic HPV vaccines with different production processes (at 0/6 months) was 13.96% (55/394) and 17.46% (69/395) respectively, with no statistically significant difference (χ2=1.83, P>0.05).The adverse reaction rate was significantly lower in the 9-14 years group (9.77%) compared the 15-30 years group (24.91%)(χ 2=35.67, P<0.01). In conclusion, both domestic HPV vaccines demonstrated a favorable safety profile in the 9-30 years age group, with mostly mild adverse reactions. Compared to the three-dose schedule (15-30 years group), the two-dose HPV vaccination schedule (9-14 years group) significantly reduced the incidence of adverse reactions and improved vaccination compliance.

Objective:To study the feasibility of design and harvest of free medial sural artery perforator flap with the "two-point and two-line method".Methods:From September 2022 to June 2023, Suzhou Ruihua Orthopaedic Hospital implemented the "two-point and two-line method" to guide preoperative perforator positioning and flap design. Thirty medial sural artery perforator flaps were successfully harvested with the method, and 21 wounds of hand and 9 of foot and ankle were reconstructed with the flaps. The size of soft tissue defects were 2.5 cm×2.5 cm-7.0 cm×14.5 cm, and the flaps size were 3.0 cm×3.0 cm-7.5 cm×15.0 cm. All donor sites were directly closed or by skin grafting. All patients were entered in 6-15 months of postoperative outpatient follow-up, and the recovery of donor and recipient sites was assessed by the comprehensive evaluation scales. The sensory function of the flaps was evaluated using the sensory function evaluation standard of British Medical Research Council (BMRC).Results:All perforators were successfully located with 47 perforators in total, and all of them were musculocutaneous perforator. It was found that there was 1 perforator in 14 flaps, 2 perforators in 15 flaps and 3 perforators in 1 flap. All 30 flaps survived after surgery, beside 2 flaps that had arterial insufficiency but survived successfully after surgical exploration. All donor sites healed in one stage. Comprehensive evaluation scale of flap was employed to evaluate the flaps and the scores were 84 points to 96 points with an average score of 92.5 points. The excellent and good grades were achieved in 27 flaps and 3 flaps, respectively, with a combined excellent and good rate at 100%. Sensation of the flaps was evaluated by BMRC with 1 flap of S 1, 17 of S 2 and 12 of S 3. Conclusion:The "two-point and two-line method" has been used in design of the perforator flap of medial sural artery. This method is simple and accurate, and is feasible and ideal in design of flaps before surgery.

Objective To develop a method for rapidly identifying Clostridioides difficile(C.difficile)and de-termining high-producing toxin strains,conduct clinical evaluation.Methods The loop-mediated isothermal amplifi-cation(LAMP)method was used to identify C.difficile based on the tcdC,tcdA,and tcdB genes.The sensitivi-ty,specificity,and overall consistency of the detection method were evaluated.Results Feces specimens from 499 hospitalized patients suspected of C.difficile-associated diarrhea were detected,with C.difficile detection rate of 12.8％(64/499),out of which the detection rate of toxin-producing C.difficile was 10.8％(54/499).The sensi-tivity,specificity,positive predictive value,and negative predictive value of the detection method for tcdA were 87.2％,98.9％,89.1％,and 98.6％,respectively,and 88.2％,99.6％,90.0％,and 98.73％for tcdB,respec-tively.The total toxin levels of different strains were different,but the average toxin production level of A+B+strains(1.79 μg/mL)was higher than those of A-B+strains(0.72 μg/mL)and A-B-strains(＜0.10 μg/mL).Conclusion The portable high-throughput LAMP detection method can rapidly and efficiently identify C.difficile and determine high-producing toxin strains.

Objective:To establish a chain management model for blood glucose in critically ill patients after cardiac surgery and analyze its clinical effectiveness, and to provide a reference for related clinical nursing practices.Methods:A quasi-experimental study design was adopted. Using convenience sampling, 120 critically ill patients after cardiac surgery admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were selected as study subjects. They were divided into groups based on the time of admission to the intensive care unit after surgery. Sixty patients admitted from March to May 2024 were assigned to the control group and received conventional blood glucose management. Another 60 patients admitted from June to August 2024 were assigned to the observation group and received the chain management model for blood glucose control in addition to the conventional approach. Blood glucose levels and quality indicators of blood glucose management (including maximum blood glucose fluctuation, time in target glucose range, duration of insulin use, incidence of hypoglycemia, etc.) were compared between the two groups.Results:The control group included 27 males and 33 females, with an age of 63.00(59.00, 69.25) years; the observation group included 28 males and 32 females, with an age of 66.00(60.00, 70.00) years. The blood glucose levels of the observation group on postoperative days 2, 3, 4 were 9.10(8.68, 9.90), 8.90(8.40, 10.00), 8.75(7.38, 9.03) mmol/L, respectively, which were lower than those of the control group [10.30(9.80, 11.00), 9.95(9.40, 11.05), 9.30(8.10, 10.02) mmol/L], with a statistically significant difference ( Z=-5.85, -4.95, -3.50, all P<0.05). The maximum blood glucose fluctuation in the observation group was (4.09 ± 2.45) mmol/L, lower than that of the control group [(5.19 ± 2.47) mmol/L], with a statistically significant difference ( t=2.46, P<0.05). The time in the target glucose range was 67.00(60.00, 75.00)% in the observation group, higher than that of the control group 52.00(45.00, 60.00)%, with a statistically significant difference ( Z=-6.57, P<0.05). The duration of insulin use was 6.00(5.00, 7.00) h in the observation group, shorter than that of the control group [13.00(9.75, 15.32) h], with a statistically significant difference ( Z=-8.68, P<0.05). The incidence of hypoglycemia was 3.33%(2/60) in the observation group and 15.00%(9/60) in the control group, with a statistically significant difference ( χ2=4.90, P<0.05). The mechanical ventilation time, ICU stay, and total hospital stay in the observation group were 42.00(37.00, 89.25) h, 6.00(5.00, 7.00) d, and 12.00(11.75, 13.00) d, respectively, which were shorter than those of the control group [96.00(86.25, 98.00) h, 7.00(7.00, 10.00) d, and 13.00(11.75, 15.00) d], with a statistically significant difference ( Z=8.67, 17.57, 4.73, all P<0.05). Conclusions:The implemented chain management model for blood glucose control meets the comprehensive requirements of blood glucose management. It not only reduces blood glucose fluctuations and decreases the incidence of hypoglycemia but also effectively improves the quality of blood glucose management in critically ill patients after cardiac surgery, enhances the safety of blood glucose control, and promotes patient recovery.

BACKGROUND: The mechanisms distinguishing metabolically healthy from unhealthy phenotypes within the same BMI categories remain unclear. This study aimed to investigate the associations between regional fat distribution and metabolically unhealthy phenotypes in Chinese adults across different BMI categories. METHODS: This cross-sectional study involving 11833 Chinese adults aged 20 years and older. Covariance analysis, adjusted for age, compared the percentage of regional fat (trunk, leg, or arm fat divided by whole-body fat) between metabolically healthy and unhealthy participants. Trends in regional fat percentage with the number of metabolic abnormalities were assessed by the Jonckheere-Terpstra test. Odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated by logistic regression models. All analyses were performed separately by sex. RESULTS: In non-obese individuals, metabolically unhealthy participants exhibited higher percent trunk fat and lower percent leg fat compared to healthy participants. Additionally, percent trunk fat increased and percent leg fat decreased with the number of metabolic abnormalities. After adjustment for demographic and lifestyle factors, as well as BMI, higher percent trunk fat was associated with increased odds of being metabolically unhealthy [highest vs. lowest quartile: ORs (95%CI) of 1.64 (1.35, 2.00) for men and 2.00 (1.63, 2.46) for women]. Conversely, compared with the lowest quartile, the ORs (95%CI) of metabolically unhealthy phenotype in the highest quartile for percent arm and leg fat were 0.64 (0.53, 0.78) and 0.60 (0.49, 0.74) for men, and 0.72 (0.56, 0.93) and 0.46 (0.36, 0.59) for women, respectively. Significant interactions between BMI and percentage of trunk and leg fat were observed in both sexes, with stronger associations found in individuals with normal weight and overweight. CONCLUSIONS Trunk fat is associated with a higher risk of metabolically unhealthy phenotype, while leg and arm fat are protective factors. Regional fat distribution assessments are crucial for identifying metabolically unhealthy phenotypes, particularly in non-obese individuals.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Adipose Tissue ; Body Fat Distribution ; Body Mass Index ; China/epidemiology* ; Cross-Sectional Studies ; Health Surveys ; Phenotype