With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

OBJECTIVE To explore the effects of multi-disciplinary comprehensive management team of tertiary hospital collaborated with the pharmacists from community health service center （hereinafter referred to as “community pharmacists”） on elderly patients with hypertension in the community. METHODS Elderly patients with hypertension from May 2020 to May 2021 in Yuhua Community Health Service Center of Nanjing were divided into control group （76 cases） and observation group （76 cases） according to the management style. The control group was treated with regular community medical services and the observation group received regular community medical services plus pharmaceutical care provided by the comprehensive management team collaborated with community pharmacists. The compliance， blood pressure control status and hypertension-related complications were compared between 2 groups before management and after 24 months of management. RESULTS After 24 months of management， the compliance and blood pressure compliance rates in both groups were higher than before management； meanwhile， the observation group was significantly higher than control group at the corresponding period （P＜0.05 or P＜ 0.01）. The blood pressure levels of both groups were significantly lower than before management， and the systolic blood pressure as well as the incidences of the whole complications and cerebrovascular injury in the observation group were significantly lower than control group at the 583867635@qq.com corresponding period （P＜0.05）. There was statistical significance in the effects of the rate of reaching the standard of blood pressure on the complications （P＜0.01）. CONCLUSIONS The hypertension management mode of comprehensive management team collaborated with community pharmacists can significantly improve the compliance and blood pressure compliance rate of elderly patients with hypertension， and reduce the incidence of hypertension-related complications.

Lipopolysaccharides (LPS) are major outer membrane components of Gram-negative bacteria. Unlike most Gram-negative bacteria, Acinetobacter baumannii can still survive and acquire polymyxin resistance after complete loss of LPS. Previous studies of LPS-deficient Acinetobacter baumannii mostly focused on LPS-deficient strains induced by polymyxin, whose background was complex and unstable. To investigate LPS loss-mediated polymyxin resistant-Acinetobacter baumannii, this study constructed a stable and clear background LPS-deficient strain by knocking out lpxC gene in Acinetobacter baumannii ATCC 19606 with CIRSPR/Cas9, and then studied the phenotypic changes of the lpxC-deficient strain including morphology, growth rate, antibiotic susceptibility, virulence, membrane permeability, and membrane potential. Animal experiments were approved by the Animal Care and Welfare Committee Institute of Medicinal Biotechnology, CAMS and PUMC (approval number: IMB-20240119D₉). The results indicated that the lpxC gene of Acinetobacter baumannii ATCC 19606 was successfully knocked out. After losing the lpxC, the strain underwent the morphological change from rod-shaped to spherical. Furthermore, it leads to reduced growth rate, enhanced membrane permeability, decreased membrane potential, lower virulence, and increased antibiotic susceptibility to β-lactams, quinolones, aminoglycosides, macrolides, glycopeptides. The lpxC deletion results in significant changes in membrane homeostasis and adaptability of Acinetobacter baumannii. Understanding the phenotypic changes of colistin-resistant Acinetobacter baumannii mediated by LPS loss is useful for exploring the resistance mechanism of Acinetobacter baumannii and developing new therapeutic strategies.

Objective To establish a method for the determination of mercury, methylmercury (MeHg) and ethylmercury (EtHg) in the hair of mercury-exposed individuals using high performance liquid chromatography-atomic fluorescence spectrometry. Methods About 0.20 g of hair was mixed with 5.0 mL of hydrochloric acid to a concentration of 5.00 mol/L. After standing for 12 hours, ultrasonic extraction was carried out for 30 minutes at room temperature. Ammonia solution was added dropwise into 2.0 mL supernatant after centrifuge to adjust the pH to 4-5. The solution was diluted to 10.0 mL with pure water after mixed with 0.2 mL of L-cysteine with a mass concentration of 10.0 g/L. The mobile phase consisted of 5.0% methanol + a mass concentration of 0.06 mol/L ammonium acetate + a 0.1% L-cysteine, and was used for separation by a C₁₈ liquid chromatography column, followed by detection using atomic fluorescence spectrometry after UV digestion. Results The linear relationship of mercury, MeHg and EtHg in human hair was good at mass concentrations of 0.0-10.0 μg/L, with all correlation coefficients >0.999 0. The detection limit of mercury, MeHg and EtHg was 0.008, 0.008, and 0.010 μg/g, respectively. The within- and between- run relative standard deviations of the three forms of mercury were 1.6%-4.3% and 2.0%-5.6%, respectively, and the recovery rates were 94.0%-101.2%. Conclusion This method is simple, with low detection limit, high sensitivity, and good accuracy, and is suitable for the simultaneous determination of mercury, MeHg and EtHg in the hair of mercury-exposed individuals.

Objective To evaluate the efficacy and adverse reactions of BRAF inhibitor vermorafenib on the treat-ment of refractory craniopharyngioma carrying BRAF-V600E mutation.Methods Clinical data of two patients with refractory craniopharyngiomas(CP)were recorded and reviewed.The patients were followed up for 3-5 years.Lit-erature on CPs receiving BRAF or BRAF/MEK therapy was reviewed.Results 1)Papillary CP progressed after multiple operations and radiotherapy in two patients.Further treatments were very difficult.2)The presence of BRAF-V600E mutation in the tumor was confirmed,and vermorafenib was administered for 6.5-7.5 months.Tumor volumes remarkably shrank by 95%-99%.No tumor relapse was observed during the follow-up of 3-5 years after discontinuation of vemurafenib.3)The main adverse reaction was rash,which was dose dependent.4)Litera-ture review showed the volume shrank by 50%-100%in 33/34 tumors during BRAF or BRAF/MEK inhibitor therapy.Conclusions BRAF inhibitor vemurafenib is effective in treating refractory craniopharyngioma carrying BRAF-V600E mutation with endurable side effects,which may bring some changes to the management of CP in future.

[Objective] To compare the clinical efficacy of pulsed radiofrequency (PRF) in patients with acute herpes zoster neuralgia (AHN) and postherpetic neuralgia (PHN). [Methods] A retrospective analysis was made on 287 patients with thoracic herpes zoster related pain. The patients were divided into acute herpes zoster neuralgia group (group AHN, within 3 months) and PHN group (group PHN, over 3 months) according to the onset time of herpes zoster. Pain degree (VAS), sleep quality (AIS), anxiety and depression (GAD-7 and PHQ-9) at 1 week, 1 month, 3 months, 6 months and 12 months after the procedure were analyzed and compared between the two groups. [Results] The scores of VAS, AIS, GAD-7 and PHQ-9 significantly decreased in both groups after surgery (P<0.001). The four scores decreased more in AHN group than in PHN group from 1 to 12 months after surgery (P<0.001). After 12 months of follow-up, there were fewer cases of taking oral pregabalin and opioids in the former group than in the latter group (P=0.001). [Conclusion] PRF has a good therapeutic effect on herpes zoster related pain and is better than PHN in relieving pain, improving sleep and anxiety and depression in AHN, or can prevent PHN.

Objective To investigate the degree of fibrosis,the expression of estrogen and progesterone receptors,and the expression of angiogenesis-related molecules in polypoid endometriosis,with the aim of further elucidating its histopathological characteristics.Methods The study retrospectively analyzed the clinicopathological data of 42 patients diagnosed with polypoid endometriosis through surgical treatment at Obstetrics and Gynecology Hospital,Fudan University from Apr 2014 to Aug 2020.Additionally,tissue samples from 19 cases of ovarian endometriotic cysts,20 cases of adenomyosis,20 cases of deep infiltrating endometriosis,and 20 cases of endometrial polyps,all pathologically confirmed,were collected as a control group.The degree of fibrosis,the expression of estrogen and progesterone receptors,and the expression of angiogenesis-related molecules in the lesions of each group were determined using Masson staining and immunohistochemistry.Results The mean age of onset of the 42 patients with polypoid endometriosis was 41.24 years.And the most usual clinical manifestation is pelvic mass(24/42 patients).Immunohistochemical experiments showed that polypoid endometriosis was less fibrotic than ovarian endometriotic cysts,adenomyosis and deep infiltrating endometriosis but more fibrotic than endometrial polyps.Polypoid endometriosis also has a higher vascular density,increased expression of estrogen receptor-β(ER-β),and down-regulated expression of progesterone receptor B(PR-B).Conclusion Polypoid endometriosis is a distinct subtype of endometriosis characterized by a lower degree of fibrosis,higher levels of estrogen receptor expression,and relatively rich vascularization,generally associated with a favorable prognosis.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

OBJECTIVES: To explore the cytotoxicity of four wild mushrooms involved in a case of Yunnan sudden unexplained death (YNSUD), to provide the experimental basis for prevention and treatment of YNSUD. METHODS: Four kinds of wild mushrooms that were eaten by family members in this YNSUD incident were collected and identified by expert identification and gene sequencing. Raw extracts from four wild mushrooms were extracted by ultrasonic extraction to intervene HEK293 cells, and the mushrooms with obvious cytotoxicity were screened by Cell Counting Kit-8 (CCK-8). The selected wild mushrooms were prepared into three kinds of extracts, which were raw, boiled, and boiled followed by enzymolysis. HEK293 cells were intervened with these three extracts at different concentrations. The cytotoxicity was detected by CCK-8 combined with lactate dehydrogenase (LDH) Assay Kit, and the morphological changes of HEK293 cells were observed under an inverted phase contrast microscope. RESULTS: Species identification indicated that the four wild mushrooms were Butyriboletus roseoflavus, Boletus edulis, Russula virescens and Amanita manginiana. Cytotoxicity was found only in Amanita manginiana. The raw extracts showed cytotoxicity at the mass concentration of 0.1 mg/mL, while the boiled extracts and the boiled followed by enzymolysis extracts showed obvious cytotoxicity at the mass concentration of 0.4 mg/mL and 0.7 mg/mL, respectively. In addition to the obvious decrease in the number of HEK293 cells, the number of synapses increased and the refraction of HEK293 cells was poor after the intervention of Amanita manginiana extracts. CONCLUSIONS The extracts of Amanita manginiana involved in this YNSUD case has obvious cytotoxicity, and some of its toxicity can be reduced by boiled and enzymolysis, but cannot be completely detoxicated. Therefore, the consumption of Amanita manginiana is potentially dangerous, and it may be one of the causes of the YNSUD.
Humans ; HEK293 Cells ; Sincalide ; China ; Amanita ; Death, Sudden

Humans ; Mesothelioma/pathology* ; Mesothelioma, Malignant ; Pleural Neoplasms/diagnosis* ; Pleural Effusion, Malignant ; Pleural Effusion/pathology*