Objective:To investigate the clinical, pathological and CT characteristics of lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) 19 and 21 exon mutations.Methods:Clinical, pathological and imaging data of 683 patients with lung adenocarcinoma in the First Affiliated Hospital of Chongqing Medical University from December 2012 to December 2020 were retrospectively analyzed. According to the gene mutation status, patients were divided into EGFR common loci mutation group (exons 19 or 21) with 382 cases (mutation group), including 19 exon mutation in 165 cases (exon 19 mutation subgroup) and 21 exon mutation in 217 cases (exon 21 mutation subgroup), and EGFR negative mutation group with 301 cases (negative mutation group). Independent sample t-test and χ 2 test were used to compare those features between mutation group and negative mutation group, exon 19 mutation subgroup and exon 21 mutation subgroup. The indicators with statistically significant differences in univariate analysis were included in binary logistic regression analysis to screen out independent predictors and establish the model. Receiver operating characteristic curve and area under curve (AUC) were used to evaluate the predictive performance of the model or index. Results:There were significant differences between mutation group and negative mutation group in gender distribution, smoking history, the proportion of solid-dominated growth pattern, peripheral distribution, tumor maximum diameter (3 cm as the cut-off point) distribution, spiculation, ground-glass opacity (GGO), air bronchogram, vascular convergence sign, pleural retraction, the number of lung metastases (10 as the cut-off point), pleural effusion, necrosis, and lymph node metastasis in lung adenocarcinoma patients ( P<0.05). The logistic regression showed that female (OR=5.230,95%CI 3.534-7.740, P<0.001), non-smoking history (OR=2.970, 95%CI 1.986-4.443, P<0.001), GGO (OR=3.092, 95%CI 1.746-5.477, P<0.001), absence of necrosis (OR=1.754, 95%CI 1.047-2.939, P=0.033), vascular convergence sign (OR=3.129, 95%CI 1.971-4.969, P<0.001), pleural retraction (OR=2.434, 95%CI 1.680-3.526, P<0.001), and the number of lung metastases≥10 (OR=2.242, 95%CI 1.284-3.915, P=0.005) were independent predictors of EGFR exon 19 and 21 mutations, and the AUC of the logistic model based on these predictors in predicting EGFR exon 21 and 19 mutations in lung adenocarcinoma was 0.804. There were significant differences between EGFR exon 19 mutation subgroup and EGFR 21 mutation subgroup in gender distribution, the proportion of acinar-dominated growth pattern, peripheral distribution, vascular convergence sign, pleural retraction ( P<0.05). The logistic regression showed that vascular convergence sign (OR=1.833, 95%CI 1.187-2.831, P=0.006) was independent predictor of EGFR exon 21, the AUC of vascular convergence sign for distinguishing EGFR exon 19 and EGFR 21 mutation was 0.604. Conclusions:There are some differences in the clinical, pathological, and CT features of patients between EGFR common loci mutation and EGFR negative mutations, EGFR exon 19 and exon 21 mutations in lung adenocarcinoma. Familiarity with these differences is helpful for the individualized treatment of patients with unknown gene mutation status of lung adenocarcinoma.

Objective To investigate the effects of banding width on hemodynamic characteristics of pulmonary artery (PA) by constructing pulmonary artery banding (PAB) models with different widths. Methods Based on clinical practice, with the same banding position and degree, computer-aided design (CAD) was utilized to reconstruct three-dimensional PAB models with different banding widths (2, 3, 4, 5 mm). Hemodynamic characteristics of the models with different banding widths, including pressure, streamlines, energy loss, energy efficiency and blood flow distribution ratio, were compared and analyzed through computational fluid dynamics (CFD). Results The pressure of PA decreased significantly, while the change of banding width had no significant effects on the pressure drop level at banding position. With the increase of banding width, the energy loss decreased, and the energy efficiency showed an upward trend. The blood flow of the left PA raised, and the ratio of blood flow distribution between the left PA and right PA increased, with the maximum reaching up to 2.28 : 1. Conclusions The increase of banding width can reduce the energy loss of PA and improve the energy efficiency of blood flow, but it will lead to the imbalance of blood flow distributions between the left and right lungs. Both the balance of blood flow distribution and the energy loss should be considered in choice for banding width of PAB. The virtual design of PAB surgery based on CAD and CFD will assist individualized banding width selection in future.

Pectus excavatum is a common congenital chest wall deformities in children, presented with abnormal collapse of anterior chest wall. Thoracoscopic Nuss procedure is the present widely utilized clinical approach. Due to implanting a steel bar into the substernal area, operative organ injuries, postoperative pain, bar malposition, incomplete correction as well as risks of bar removal may occur. With the advancement of digital precision medicine and the interdisciplinary research of various disciplines and fields, there are more and more clinical applications and translations of these emerging applications represented by computational biomechanical simulations, three-dimensional printing and the latest absorbable biomaterial. They bring new opportunities and prospects for solving problems in the clinical treatment of PE as well as the improvement and development of patient-specific Nuss procedure planning.

The chronic disease management of rheumatoid arthritis has been popularized and applied in China. This article will review the application and research progress of different chronic disease management models, including chronic care mode, chronic disease self-management, transitional care mode, community-based chronic disease management, and "internet + chronic disease management" in rheumatoid arthritis patients in China, and compare the advantages and disadvantages of different intervention models, in order to provide a theoretical basis for exploring the chronic management of rheumatoid arthritis under different regional medical resources.

Medical microbiology is one of the compulsory courses of basic medical sciences, which lays an important theoretical foundation for the follow-up study of infectious diseases, contagions, tumors, and so on. The course of medical microbiology in our college adhered to the concept of student-centered, diversified teaching, scientific evaluation, and continuous improvement. Teaching design was a cross-link of general theories, specific chapters, clinical cases, theory and practice, and the ideological and political education throughout the curriculum. Lectures adopted the mode of offline teaching (such as flipped classroom, case analysis, and comprehensive experimental design), online assistance (such as classroom test, stage test, extracurricular homework, and questionnaire survey), and combined process evaluation. This teaching mode also reflected the deep integration of information technology and classroom teaching. With the development and construction in these years, medical microbiology has completed the renewal of curriculum resources, the construction of online question bank, the construction and design of ideological and political case bank, and process evaluation (10 points of usual score + 10 points of case study + 10 points of experimental performance + 100 points of final examination multiplied by 70%). There was no significant difference in the results of qustionnaire survey in terms of the improvement of independent learning ability, curriculum evaluation system and satisfaction feedback. Students in Batch 2019 were most satisfied with the teaching of keeping pace with the times and the guidance of positive outlook on life and values.

Objective To investigate the effects of non-Newtonian properties on hemodynamic characteristics of Fontan procedure in computational simulation. Methods A Fontan vascular model was reconstructed based on patient-specific medical images. The boundary conditions were set according to velocity profiles measured by real-time echocardiography. The Newtonian model and two non-Newtonian (Casson and Carreau) models were applied to analyze the hemodynamic parameters, including flow ratio (FR), energy loss (EL), wall shear stress (WSS) as well as non-Newtonian importance factor, so as to compare flow differences between the Newtonian model and non-Newtonian models. Results The rheological models had small effects on the FR. The EL of non-Newtonian models was higher than that of the Newtonian model, and the EL of Casson model was the highest. Flow recirculation and flow disturbance accompanied with low WSS were observed in inferior vena cava (IVC). At low inflow velocity, flow disturbance in IVC of Newtonian model was more obvious. The calculations of non-Newtonian importance factor suggested significant non-Newtonian viscosity in IVC. Conclusions Non-Newtonian viscosity is significant in IVC where low velocity and flow recirculation are observed. Non-Newtonian properties of the blood should be considered in patient-specific hemodynamic simulation of Fontan procedure.

Abdominoscrotal hydrocele is rare in clinic. In the past, routine examination and diagnosis were difficult, easy to be misdiagnosed. The daily operations were mostly completed through the groin area or abdominal incision, the wound is large. The application of laparoscopy can clearly diagnose the abdominoscrotal hydrocele through "springing back ball" sign, and can cure the disease by laparoscopic resection of interperitoneal mass and closure of the internal ring. It is worthy of clinical application. In this article, we summarized and analyzed the clinical experience of 15 cases of children with abdominoscrotal hydrocele diagnosed and treated by laparoscopy, to explore the value of the laparoscopic technology in the diagnosis and treatment of the abdominoscrotal hydrocele.

Objective:Explore the efficacy of pulmonary wedge resection in the treatment of non-small cell lung cancer (NSCLC) and risk factors for postoperative recurrence, and construct a risk prediction model.Methods:A retrospective analysis of the clinical data of 126 NSCLC patients were admitted to Mianyang Central Hospital from June 2018 to June 2020. According to different surgical methods, the patients were divided into pulmonary wedge resection group ( n=88) and lobectomy Group ( n=38). Compare the metastasis rate, recurrence rate, and fatality rate at 1 year after the two kinds of operations; according to the recurrence of the lung wedge resection group, the patients are divided into recurrence group ( n=15) and non-recurrence group ( n=73). The general data and preoperative laboratory examination indexes of the two groups of patients were compared; multivariate Logistic analysis of factors affecting postoperative recurrence of patients; a risk scoring model was constructed and its predictive value was evaluated. Enumeration data was expressed by the number of cases and percentage (%), and the comparison between groups was performed by chi-square test. Multivariate Logisitic regression analysis of factors affecting the recurrence of NSCLC patients at 1 year after pulmonary wedge resection; a risk scoring model was constructed according to risk factors, and X-tile software was used to obtain the cutoff value of the score; a calibration curve was used to evaluate the accuracy of the risk prediction model prediction The clinical decision curve evaluates the effectiveness of model predictions. Results:The surgical margin metastasis rate and mortality of patients in the pulmonary wedge resection group were 0 and 6.82%, and the lobectomy group were 13.16% and 21.05%, respectively. The differences between the two groups were statistically significant ( P<0.05); The proportion of patients with smoking history, vascular thrombus cancer, lymph node dissection ≤ 15, carcinoembryonic antigen >5 ng/mL, neutrophil to lymphocyte ratio>2.5, soluble CD105>4 ng/mL, vascular endothelial growth factor >9 ng/mL and matrix metalloproteinase 9 (MMP-9) > 300 μg/L in recurrent group were significantly higher than those in non-recurrent group. All of them were risk factors for recurrence after wedge pneumonectomy ( P<0.05); the above risk factors were incorporated into the risk scoring model, and weights of 22, 38, 25, 33, 20, 27, 36, and 30 were assigned respectively, and patients were classified as medium according to the cut-off value. Risk patients (≤78 points), high-risk patients (>78 points and ≤162 points), and extremely high-risk patients (>162 points). Conclusions:The effect of thoracoscopic wedge resection in the treatment of NSCLC is significantly better than that of thoracoscopic lobectomy. The construction of a risk scoring model for predicting postoperative recurrence of patients is beneficial to early identification of high-risk groups in clinical practice, and to guide medical staff to adopt personalized treatment and nursing care measures.

Objective:To develop a small program for pediatric intravenous maintenance drug calculation and evaluate its usability.Methods:The user-built concept was used to develop a small program for pediatric intravenous maintenance drug calculation from August to December 2019. Using the convenient sampling method, a total of 10 nurses in intensive care unit and ward of Department of Cardiothoracic Surgery of Shanghai Children's Medical Center from January to February 2020 were selected as the research objects. The time required for drug calculation and correctness of results were compared for each of two methods (calculation method based on the developed small program and the traditional method based on the calculator) for 200 times. Usefulness, Satisfaction, and Ease of Use (USE) was used to investigate the acceptability of 10 nurses to the new technology to evaluate usability of the small program.Results:The accuracy rate of medicine calculation using the pediatric intravenous maintenance drug calculation small program was 100% (200/200) , which was higher than 88% (176/200) using traditional calculation methods for medicine calculation, and the difference was statistically significant (χ 2=25.532, P<0.01) . The time required for drug calculation using the small program was (15.15±2.74) s, which was faster than (17.09±5.22) s using the traditional calculation method, and the difference was statistically significant ( t=3.451, P=0.001) . The 10 nurses had a high acceptance of the small program and the average score of USE was (6.22±1.03) . Conclusions:The pediatric intravenous maintenance drug calculation program developed in this research can meet the needs of clinical nurses and has a relatively high acceptance. The program can be calculated by the system, effectively avoid the error of manual calculation and save time of manual calculation and double check by nurses, which has good usability.

Objective    To determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy. Methods    From November 2017 to October 2018, 120 patients who received thoracotomy procedure in our hospital were collected, including 60 males and 60 females aged 40-77 (58.10±7.00) years. The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group (group A, n=40), a single intercostal nerve block group (group B, n=40), and an epidural analgesia group (group C, n=40). All the groups received the same basic analgesia. The pain scores and rescue analgesic doses were compared. Results    On postoperative day (POD) 0, all groups achieved effective pain control, and the visual analogue score was 2.02±0.39 points in the group A, 2.13±0.75 points in the group B and 2.03±0.69 points in the group C (P>0.05). On POD 0-2 and POD 3-4 (without basement analgesia), there was no significant difference between the group A and group C in the pain scores (2.08±0.28 points vs. 1.93±0.53 points, 3.20±0.53 points vs. 3.46±0.47 points, P>0.05), however, the difference between POD 0-2 and POD 3-4 in each group was stastically different (group A, 2.08±0.28 points vs. 3.20±0.53 points; group B, 2.42±0.73 points vs. 5.45±0.99 points; group C 1.93±0.53 points vs. 3.46±0.47 points, P<0.05). In terms of the rescue analgesic doses, there was no significant difference between the group A and group C (220.00±64.08 mg vs. 225.38±78.85 mg, P>0.05); it was larger in the group B than that in the group A and group C (343.33±119.56 mg vs. 220.00±64.08 mg; 343.33±119.56 mg vs. 225.38±78.85 mg, P<0.05). Conclusion    Multimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery. Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.