Background: Malignant pleural effusion (MPE), a common complication of advanced cancers, is associated with poor prognosis and reduced quality of life. Although host–tumor interactions are known to drive MPE development, the associated immune dynamics during disease progression remain unclear. Using a Lewis lung carcinoma-induced MPE model in C57BL/6JNidfc mice, we systematically evaluated general parameters and immune cell changes at two-day intervals throughout disease progression. Results: The day of Lewis lung carcinoma cell injection into the pleural space was designated as day 0. By day 10 post-injection (p.i.), MPE-bearing mice exhibited ~ 10% body weight loss, marking the experimental endpoint. Pleural tumor mass and pleural effusion volume were minimal up to day 4 p.i. but increased sharply from day 6 onward.CD45⁺ immune cell counts rose over time, and days 6, 8, and 10 p.i. marked key stages of MPE progression. On day 6, B cells, T cells, and natural killer cells, but not macrophages and neutrophils, increased significantly compared to earlier timepoints. By day 8, all immune cell subsets except T cells exceeded day 6 levels, and at day 10, natural killer cell numbers declined while others continued to increase. Besides, the numbers of CD8⁺ T cells, Th1 cells, regulatory T cells, and M2 macrophages progressively increased from day 6 to 10. Based on these data, days 6 and 10 were defined as early and advanced MPE stages, respectively, with distinct immune phenotypes. In advanced MPE, CD8⁺ T cells displayed reduced IFN-γ, TNF-α, Granzyme B, Perforin, FasL, and Ki-67, but upregulated PD-1 and CTLA-4 relative to early stage. Similarly, Th1 cells showed decreased IFN-γ, TNF-α, and IL-2 production along with reduced Ki-67 expression. Advanced-stage M2 macrophages exhibited lower MHC-II levels and impaired phagocytosis, but higher PD-L1 and IL-10 production, while neutrophils showed reduced TNF-α release and phagocytic activity. Conclusions Our findings characterize the temporal immune dynamics associated with MPE progression in a mouse model, revealing a transition from an early immunostimulatory state to a late immunosuppressive state. This study enhances our understanding of MPE immunopathogenesis and provides a foundation for developing precise, stagespecific therapeutic strategies.

Congenital long QT syndrome (LQTS) is a life-threatening ion channelopathy caused by mutations in genes encoding specific ion channels, which can result in malignant arrhythmia of the torsades de pointes type. LQTS type 4 represents less than 1% of inherited LQTS cases, in contrast to the 90% attributable to types 1-3, it is specifically caused by loss-of-function mutations in the membrane-binding domain of ANK2. Here, a novel ANK2 variant ( ANK2c 2245 A>C, resulting in p.Lys749Gln) associated with LQTS type 4 and Wolff-Parkinson-White syndrome was identified in a previously healthy 61-year-old male patient who suffered paroxysmal palpitations and pre-syncope due to recurrent torsades de pointes.

Objective:To comparatively observe optical coherence tomography (OCT) image features between traumatic macular hole (TMH) and idiopathic macular hole (IMH).Methods:A retrospective clinical study. A total of 174 patients (174 eyes) with macular hole (MH) diagnosed at Shantou International Eye Center from December 2008 to May 2024 were included in the study. Among them, there were 75 patients (75 eyes) with TMH and 99 patients (99 eyes) with IMH, and they were divided into the TMH group and the IMH group accordingly. All the affected eyes underwent best corrected visual acuity (BCVA) and OCT examinations. The BCVA was examined using a standard logarithmic visual acuity chart, and was converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical analysis. The minimum diameter and basal diameter of the MH, as well as the average, nasal, superior, inferior, and temporal center retinal thickness (CRT) around the MH were measured by OCT. The independent-sample t test was used to compare the logMAR BCVA, hole diameter, and CRT at the hole margin between the groups. Results:There were significant differences in age ( t=-15.857) and gender ratio ( χ2=28.154) between the TMH group and the IMH group ( P<0.05), while there was no significant difference in logMAR BCVA ( t=1.962, P>0.05). The minimum diameter of the hole in the TMH group was smaller than that in the IMH group, but the basal diameter was larger, with significant differences ( t=-3.322, 2.570; P<0.05). The thickness of the neuroepithelial layer at the hole margin in the TMH group was thinner than that in the IMH group, with significant differences in the superior ( t=-2.747), inferior ( t=-2.316), and nasal ( t=-2.851) regions ( P<0.05), and no significant difference in the temporal region ( t=-1.586, P>0.05). In the TMH group, the number of eyes with macular cystoid edema (CME), posterior vitreous detachment (PVD), retinal atrophy, subretinal hemorrhage, choroidal laceration, and focal neuroepithelial detachment was 36 (48.00%, 36/75), 4 (5.33%, 4/75), 4 (5.33%, 4/75), 15 (20.00%, 15/75), 8 (10.67%, 8/75), and 19 (25.33%, 19/75) eyes, respectively. In the IMH group, the number of eyes with CME and PVD was 95 (95.96%, 95/99) and 94 (94.95%, 94/99) eyes, respectively. Conclusion:Compared with IMH, TMH has a larger basal diameter, a thinner CRT at the hole margin, a lower incidence of CME and PVD, and a higher incidence of subretinal hemorrhage, focal neuroepithelial detachment, choroidal laceration, and retinal atrophy.

Objective To investigate the application value of late gadolinium enhancement(LEG)at cardiac MRI in predicting ventricular arrhythmia(VA)events in patients after implantation of ICD.Methods A retrospective analysis was performed on 16 patients at high risk of sudden cardi-ac death after ICD implantation and LEG examination in the First and the Sixth Medical Centers of Chinese PLA General Hospital from June 2020 to March 2024.According the occurrence of VA events receiving appropriate ICD therapy during the follow-up period,they were divided into post-operative VA group(7 cases)and non-VA group(9 cases).The correlation of clinical baseline fea-tures and LEG features with VA events was analyzed.Results The ratios of transmural enhance-ment and myocardial medium enhancement were obviously higher in the VA group than the non-VA group(71.4％vs 11.1％,P=0.035;85.7％vs 22.2％,P=0.041).Multivariate logistic regres-sionanalysis showed that transmural enhancement(OR=5.000,95％CI:0.150-166.589,P=0.368)and myocardial medium enhancement(OR=7.000,95％CI:0.217-226.005,P=0.272)were not independent factors influencing VA occurrence.ROC curve analysis indicated that the combined prediction of transmural enhancement and myocardial media enhancement and the pre-diction of transmural enhancement alone had better diagnostic efficacy(P＜0.05).Conclusion LEG has clinical value in predicting postoperative VA events in patients after ICD implantation.

Congenital long QT syndrome (LQTS) is a life-threatening ion channelopathy caused by mutations in genes encoding specific ion channels, which can result in malignant arrhythmia of the torsades de pointes type. LQTS type 4 represents less than 1% of inherited LQTS cases, in contrast to the 90% attributable to types 1-3, it is specifically caused by loss-of-function mutations in the membrane-binding domain of ANK2. Here, a novel ANK2 variant ( ANK2c 2245 A>C, resulting in p.Lys749Gln) associated with LQTS type 4 and Wolff-Parkinson-White syndrome was identified in a previously healthy 61-year-old male patient who suffered paroxysmal palpitations and pre-syncope due to recurrent torsades de pointes.

Objective To summarize the results of different perioperative anticoagulation protocols for elderly patients with atrial fibrillation(AF)undergoing catheter radiofrequency ablation in our center.Methods A total of 197 elderly AF patients undergoing catheter radiofrequency ablation by a single operator in the First and Sixth Medical Centers of Chinese PLA General Hospital from January 2021 to December 2023 were retrospectively recruited,and the results of relevant exami-nations were collected.Based on the use of different direct oral anticoagulants,they were divided into dabigatran(n=125)and rivaroxaban(n=72)groups.During the procedure,the appropriate dose of unfractionated heparin was administered according to the initial activated clotting time(ACT)with a self-made formula.The time and rate of ACT were recorded,and perioperative ad-verse reactions such as bleeding and thrombosis were observed.Results There were no statistical differences between the two groups in baseline data,including age,gender,BMI,medical history,CHA2DS2-VASc score,HAS-BLED score,and left atrial anteroposterior diameter(P＞0.05).The baseline ACT value was obviously shorter(149.73+23.52 s vs 157.91±24.58 s,P=0.032),the initial heparin dose was significantly higher(0.71±0.12 mg/kg vs 0.65±0.13 mg/kg,P=0.031),and the rate of ACT reaching the target within 15 min was notably lower(60％vs 74％,P＜0.05)in the dabigatran group than the rivaroxaban group.But no significant difference was observed in the rate of ACT reaching the target in 45 min after additional heparin administration according to the formula(86％vs 88％,P＞0.05).The dabigatran group used higher dose of heparin during the procedure than the rivaroxaban group(0.99±0.30 mg/kg vs 0.85±0.31 mg/kg,P=0.009).Peri-cardial effusion was observed in one patient of the rivaroxaban group,and hematoma at the site of femoral vein puncture was seen in one patients of the dabigatran group in 1 d after procedure,which was treated surgically.No other severe complications occurred.Conclusion For elderly pa-tients with AF undergoing catheter ablation therapy,continuous perioperative anticoagulation and individualized application of unfractionated heparin based on initial ACT value can rapidly achieve ACT targets and improve anticoagulation efficacy.

Objective To summarize the results of different perioperative anticoagulation protocols for elderly patients with atrial fibrillation(AF)undergoing catheter radiofrequency ablation in our center.Methods A total of 197 elderly AF patients undergoing catheter radiofrequency ablation by a single operator in the First and Sixth Medical Centers of Chinese PLA General Hospital from January 2021 to December 2023 were retrospectively recruited,and the results of relevant exami-nations were collected.Based on the use of different direct oral anticoagulants,they were divided into dabigatran(n=125)and rivaroxaban(n=72)groups.During the procedure,the appropriate dose of unfractionated heparin was administered according to the initial activated clotting time(ACT)with a self-made formula.The time and rate of ACT were recorded,and perioperative ad-verse reactions such as bleeding and thrombosis were observed.Results There were no statistical differences between the two groups in baseline data,including age,gender,BMI,medical history,CHA2DS2-VASc score,HAS-BLED score,and left atrial anteroposterior diameter(P＞0.05).The baseline ACT value was obviously shorter(149.73+23.52 s vs 157.91±24.58 s,P=0.032),the initial heparin dose was significantly higher(0.71±0.12 mg/kg vs 0.65±0.13 mg/kg,P=0.031),and the rate of ACT reaching the target within 15 min was notably lower(60％vs 74％,P＜0.05)in the dabigatran group than the rivaroxaban group.But no significant difference was observed in the rate of ACT reaching the target in 45 min after additional heparin administration according to the formula(86％vs 88％,P＞0.05).The dabigatran group used higher dose of heparin during the procedure than the rivaroxaban group(0.99±0.30 mg/kg vs 0.85±0.31 mg/kg,P=0.009).Peri-cardial effusion was observed in one patient of the rivaroxaban group,and hematoma at the site of femoral vein puncture was seen in one patients of the dabigatran group in 1 d after procedure,which was treated surgically.No other severe complications occurred.Conclusion For elderly pa-tients with AF undergoing catheter ablation therapy,continuous perioperative anticoagulation and individualized application of unfractionated heparin based on initial ACT value can rapidly achieve ACT targets and improve anticoagulation efficacy.

Objective To investigate the application value of late gadolinium enhancement(LEG)at cardiac MRI in predicting ventricular arrhythmia(VA)events in patients after implantation of ICD.Methods A retrospective analysis was performed on 16 patients at high risk of sudden cardi-ac death after ICD implantation and LEG examination in the First and the Sixth Medical Centers of Chinese PLA General Hospital from June 2020 to March 2024.According the occurrence of VA events receiving appropriate ICD therapy during the follow-up period,they were divided into post-operative VA group(7 cases)and non-VA group(9 cases).The correlation of clinical baseline fea-tures and LEG features with VA events was analyzed.Results The ratios of transmural enhance-ment and myocardial medium enhancement were obviously higher in the VA group than the non-VA group(71.4％vs 11.1％,P=0.035;85.7％vs 22.2％,P=0.041).Multivariate logistic regres-sionanalysis showed that transmural enhancement(OR=5.000,95％CI:0.150-166.589,P=0.368)and myocardial medium enhancement(OR=7.000,95％CI:0.217-226.005,P=0.272)were not independent factors influencing VA occurrence.ROC curve analysis indicated that the combined prediction of transmural enhancement and myocardial media enhancement and the pre-diction of transmural enhancement alone had better diagnostic efficacy(P＜0.05).Conclusion LEG has clinical value in predicting postoperative VA events in patients after ICD implantation.

Objective:To comparatively observe optical coherence tomography (OCT) image features between traumatic macular hole (TMH) and idiopathic macular hole (IMH).Methods:A retrospective clinical study. A total of 174 patients (174 eyes) with macular hole (MH) diagnosed at Shantou International Eye Center from December 2008 to May 2024 were included in the study. Among them, there were 75 patients (75 eyes) with TMH and 99 patients (99 eyes) with IMH, and they were divided into the TMH group and the IMH group accordingly. All the affected eyes underwent best corrected visual acuity (BCVA) and OCT examinations. The BCVA was examined using a standard logarithmic visual acuity chart, and was converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity for statistical analysis. The minimum diameter and basal diameter of the MH, as well as the average, nasal, superior, inferior, and temporal center retinal thickness (CRT) around the MH were measured by OCT. The independent-sample t test was used to compare the logMAR BCVA, hole diameter, and CRT at the hole margin between the groups. Results:There were significant differences in age ( t=-15.857) and gender ratio ( χ2=28.154) between the TMH group and the IMH group ( P<0.05), while there was no significant difference in logMAR BCVA ( t=1.962, P>0.05). The minimum diameter of the hole in the TMH group was smaller than that in the IMH group, but the basal diameter was larger, with significant differences ( t=-3.322, 2.570; P<0.05). The thickness of the neuroepithelial layer at the hole margin in the TMH group was thinner than that in the IMH group, with significant differences in the superior ( t=-2.747), inferior ( t=-2.316), and nasal ( t=-2.851) regions ( P<0.05), and no significant difference in the temporal region ( t=-1.586, P>0.05). In the TMH group, the number of eyes with macular cystoid edema (CME), posterior vitreous detachment (PVD), retinal atrophy, subretinal hemorrhage, choroidal laceration, and focal neuroepithelial detachment was 36 (48.00%, 36/75), 4 (5.33%, 4/75), 4 (5.33%, 4/75), 15 (20.00%, 15/75), 8 (10.67%, 8/75), and 19 (25.33%, 19/75) eyes, respectively. In the IMH group, the number of eyes with CME and PVD was 95 (95.96%, 95/99) and 94 (94.95%, 94/99) eyes, respectively. Conclusion:Compared with IMH, TMH has a larger basal diameter, a thinner CRT at the hole margin, a lower incidence of CME and PVD, and a higher incidence of subretinal hemorrhage, focal neuroepithelial detachment, choroidal laceration, and retinal atrophy.

BACKGROUND:High tibial osteotomy results in massive blood loss during the perioperative period.Tranexamic acid can effectively reduce perioperative blood loss.However,the method of tranexamic acid application has not been unified. OBJECTIVE:To investigate the effect and safety of different methods of tranexamic acid on perioperative blood loss in the high tibial osteotomy. METHODS:A total of 160 patients who underwent primary unilateral high tibial osteotomy in the Binzhou Medical University Hospital from January 2019 to December 2021,including 69 males and 91 females,were randomly divided into four groups(n=40 per group).Among them,40 patients were given an intravenous infusion of saline containing 2 g tranexamic acid 10 minutes before tourniquet release(venous group);40 patients were given an intravenous infusion of 1 g tranexamic acid and 1 g tranexamic acid was injected through a drainage tube after the closure of the incision(combined group);40 patients were given 2 g tranexamic acid infusion into drainage tube after the closure of the incision(perfusion group);an additional 40 patients were given an intravenous infusion of the same amount of normal saline(blank group).The general information was compared among the four groups of patients.The hemoglobin,hematocrit,intraoperative blood loss,drainage volume,blood transfusion rate,incision complication,and the incidence of deep vein thrombosis were recorded on days 1,3 and 5 after operation in the four groups.The total blood loss and hidden blood loss were calculated. RESULTS AND CONCLUSION:(1)There was no statistically significant difference in general information among the four groups.(2)No significant difference was found in intraoperative blood loss among the four groups.(3)The maximum decreased values of hemoglobin and hematocrit on days 1,3 and 5 after operation,drainage volume,total blood loss and hidden blood loss were all ranked as the combined group