Objective To explore the application value of dual-phase dual-energy CT (DECT) perfusion imaging in preoperative lung function assessment of lung cancer patients. Methods Data were collected from patients with stageⅠA non-small cell lung cancer who underwent surgical treatment in the Department of Thoracic Surgery, the First Affiliated Hospital of Nanjing Medical University, from November 2022 to June 2024. All patients underwent DECT perfusion imaging and pulmonary function testing (PFT) before surgery. PFT observation indicators included ventilation function indicators such as forced expiratory volume in one second (FEV1), forced vital capacity (FVC), 1-second rate (FEV1/FVC), maximal voluntary ventilation (MVV), and diffusion function indicators such as diffusing capacity for carbon monoxide (DLCO) and DLCO per liter of alveolar volume (DLCO/VA). The software eXamine was used to obtain quantitative parameters of DECT perfusion imaging, including volume parameters and perfusion parameters of both lungs and each lung lobe. The correlation between the volume parameters and perfusion parameters of both lungs and the ventilation and diffusion function indicators of the patients, as well as the differences in quantitative parameters of each lung lobe, was analyzed. Results The end-inspiration lung volume and biphasic volume difference were strongly positively correlated with FEV1 and FVC (r=0.636, r=0.682, r=0.614, r=0.624, P<0.001) and moderately positively correlated with MVV and DLCO (r=0.499, r=0.514, r=0.549, r=0.447, P<0.001); the end-expiration lung volume was weakly negatively correlated with DLCO/VA (r=−0.295, P=0.026); the volume ratio was positively correlated with FEV1, FVC, MVV, and MVV% (r=0.424, r=0.399, r=0.415, r=0.310, P<0.05); the end-inspiration iodine content was weakly positively correlated with DLCO/VA% (rs=0.292, P=0.030); the end-expiration iodine content was weakly positively correlated with FEV1, FVC, MVV, DLCO%, and DLCO/VA (r=0.307, r=0.299, r=0.295, r=0.366, r=0.320, P<0.05) and moderately positively correlated with DLCO (r=0.439, P<0.001); the end-inspiration iodine concentration was negatively correlated with FEV1, FVC, MVV, and MVV% (rs=−0.407, rs=−0.426, rs=−0.352, rs=−0.277, P＜0.05); the end-expiratory phase iodine concentration was moderately positively correlated with DLCO/VA (r=0.403, P=0.002); both the iodine concentration difference and the iodine concentration ratio were moderately positively correlated with FEV1, FEV1%, FVC, MVV, MVV% (P<0.05). The lung volume and iodine concentration ratio values were both highest in the left upper lung lobe and lowest in the right middle lung lobe; the differences in lung volume, lung volume ratio, intrapulmonary iodine content, and intrapulmonary iodine concentration were all highest in the lower lobes of both lungs and lowest in the middle lobe of the right lung. Conclusion Dual-phase DECT perfusion imaging can accurately assess overall lung function and quantify regional lung function.

Cardiac fibrosis is characterized by an elevated amount of extracellular matrix (ECM) within the heart. However, the persistence of cardiac fibrosis ultimately diminishes contractility and precipitates cardiac dysfunction. Circular RNAs (circRNAs) are emerging as important regulators of cardiac fibrosis. Here, we elucidate the functional role of a specific circular RNA CELF1 in cardiac fibrosis and delineate a novel feedback loop mechanism. Functionally, circ-CELF1 was involved in enhancing fibrosis-related markers' expression and promoting the proliferation of cardiac fibroblasts (CFs), thereby exacerbating cardiac fibrosis. Mechanistically, circ-CELF1 reduced the ubiquitination-degradation rate of BRPF3, leading to an elevation of BRPF3 protein levels. Additionally, BRPF3 acted as a modular scaffold for the recruitment of histone acetyltransferase KAT7 to facilitate the induction of H3K14 acetylation within the promoters of the Celf1 gene. Thus, the transcription of Celf1 was dramatically activated, thereby inhibiting the subsequent response of their downstream target gene Smad7 expression to promote cardiac fibrosis. Moreover, Celf1 further promoted Celf1 pre-mRNA transcription and back-splicing, thereby establishing a feedback loop for circ-CELF1 production. Consequently, a novel feedback loop involving CELF1/circ-CELF1/BRPF3/KAT7 was established, suggesting that circ-CELF1 may serve as a potential novel therapeutic target for cardiac fibrosis.

OBJECTIVE To explore the effects of piperacillin/tazobactam combined with acetylcysteine solution on severe pneumonia after cerebral infarction,and to analyze its impact on cardiopulmonary and neurological function.METHODS A total of 86 patients with severe pneumonia after cerebral infarction admitted to Yulin Xingyuan Hos-pital from Jan.2022 to Jun.2024 were selected and divided into a control group and a study group using the ran-dom number table method(single blind),with 43 cases in each group.The control group was treated with intrave-nous drip of piperacillin/tazobactam,while the study group received additional inhalation of acetylcysteine solution based on the control group's treatment.The levels of inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)],lung function indicators[forced vital capacity(FVC),peak expiratory flow rate(PEF),forced expiratory volume in one second(FEV1)and mean maximal expiratory flow rate(MMEF)],cardiac function indicators[left ventricular ejection fraction(LVEF),cardiac output(CO),cardiac index(CI)and stroke volume(SV)],NIH Stroke Scale(NIHSS)score,clinical efficacy,and the occurrence of adverse reactions were compared before and after treatment.RESULTS Compared with the control group,the study group had low levels of CRP,IL-6,PCT and NIHSS scores after treatment(P<0.05),and high levels of FVC,PEF,FEV1,MMEF,LVEF,CO,CI,and SV after treatment(P<0.05).The overall response rate in the study group was 95.35%,higher than 81.40%in the control group(χ2=4.074,P=0.044).There was no statistically significant difference in the incidence of adverse reactions between the control group and the study group during treatments(χ2=0.179,P=0.672).CONCLUSION Piperacillin/tazobactam combined with inhaled acetylcysteine solution for the treatment of severe pneumonia after cerebral infarction can improve clinical efficacy,reduce levels of inflamma-tory factors,and enhance cardiopulmonary and neurological functions in patients,which has a high safety profile.

OBJECTIVE To explore the effects of piperacillin/tazobactam combined with acetylcysteine solution on severe pneumonia after cerebral infarction,and to analyze its impact on cardiopulmonary and neurological function.METHODS A total of 86 patients with severe pneumonia after cerebral infarction admitted to Yulin Xingyuan Hos-pital from Jan.2022 to Jun.2024 were selected and divided into a control group and a study group using the ran-dom number table method(single blind),with 43 cases in each group.The control group was treated with intrave-nous drip of piperacillin/tazobactam,while the study group received additional inhalation of acetylcysteine solution based on the control group's treatment.The levels of inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6)and procalcitonin(PCT)],lung function indicators[forced vital capacity(FVC),peak expiratory flow rate(PEF),forced expiratory volume in one second(FEV1)and mean maximal expiratory flow rate(MMEF)],cardiac function indicators[left ventricular ejection fraction(LVEF),cardiac output(CO),cardiac index(CI)and stroke volume(SV)],NIH Stroke Scale(NIHSS)score,clinical efficacy,and the occurrence of adverse reactions were compared before and after treatment.RESULTS Compared with the control group,the study group had low levels of CRP,IL-6,PCT and NIHSS scores after treatment(P<0.05),and high levels of FVC,PEF,FEV1,MMEF,LVEF,CO,CI,and SV after treatment(P<0.05).The overall response rate in the study group was 95.35%,higher than 81.40%in the control group(χ2=4.074,P=0.044).There was no statistically significant difference in the incidence of adverse reactions between the control group and the study group during treatments(χ2=0.179,P=0.672).CONCLUSION Piperacillin/tazobactam combined with inhaled acetylcysteine solution for the treatment of severe pneumonia after cerebral infarction can improve clinical efficacy,reduce levels of inflamma-tory factors,and enhance cardiopulmonary and neurological functions in patients,which has a high safety profile.

Objective The purpose of this study is to investigate patients'willingness to pay for pharmacy services and its influencing factors by reviewing and analyzing the literature related to pharmacy services.Methods Relevant studies were identified by searching the CNKI database,Wanfang database,Sinomed,PubMed,and Web of Science from January 2010 to December 2023.Literature in both English and Chinese that elicited patient willingness to pay for pharmacy services was included.An analysis was carried out according to the year of publication,country,methodology,patient willingness to pay,and its influencing factors.Results 24 studies were retrieved,and the average willingness to pay ranged from ＄1 to ＄20.Patient willingness to pay for pharmacy services is influenced by various factors.Higher willingness to pay for pharmacy services is associated with higher income and education levels and lower out-of-pocket spending.Conclusions It is generally found that patients'willingness to pay is generally influenced by their income level,educational background,and medical insurance.We suggest that pharmacy services should be promoted and integrated into medical insurance coverage,and pharmacists'competency should be enhanced to accelerate the high-quality development of pharmacy services.

Objective To investigate whether 3D-guided cone-shaped segmentectomy can achieve comparable long-term outcomes with lobectomy for deep early-stage lung cancer with diameter≤2 cm. Methods We retrospectively screened patients with deep early-stage non-small cell lung cancer (NSCLC) with diameter≤2 cm who underwent lobectomy or segmentectomy in the First Affiliated Hospital of Nanjing Medical University from 2012 to 2018. All pulmonary segmentectomy was performed using 3D-guided cone-shaped segmentectomy with segment or subsegment as the resection unit. Univariate and multivariate regression analyses were performed by Cox proportional hazard regression model. The patients who underwent segmentectomy and lobectomy were matched 1∶1 by propensity-score matching analysis. The oncological outcomes of two groups were compared. Results Our cohort was divided into a segmentectomy group (n=222) and a lobectomy group (n=127). The age, total nodule size, solid component size and proportion of pure solid nodule in the lobectomy group were significantly higher than those in the segmentectomy group. The median follow-up time was 49 months. Surgical margins were negative in all patients. The local recurrence rate of segmentectomy was 0.45%. The disease-free survival (DFS) rate and overall survival (OS) rate of patients in the segmentectomy group were significantly better than those in the lobectomy group (5-year DFS rate: 98.64% vs. 89.77%, P<0.001; 5-year OS rate: 99.55% vs. 92.10%, P<0.001). Multivariate regression analysis showed that the differences between two groups were not significant [DFS rate: HR=0.52. 95%CI (0.11, 2.59), P=0.427; OS rate: HR=0.08. 95%CI (0.00, 3.24), P=0.179] after adjusting for other factors. After propensity score matching, 77 patients were preserved in both segmentectomy group and lobectomy group, with the mean nodule size of 1.44 cm and 1.49 cm and the mean consolidation tumor ratio (CTR) of 0.46 and 0.52, respectively. There was no statistical difference in DFS rate (P=0.640) or OS rate (P=0.310) between the two groups. Conclusion 3D-guided cone-shaped segmentectomy can be an acceptable treatment for low-grade malignant NSCLC deep in lung parenchyma with diameter≤2 cm, and its oncology effect is not inferior to lobectomy.

As a first-line classical drug, glucocorticoids are used in most combination treatment regimens of keloid. However, there are issues such as poor treatment efficacy and recurrence of keloid after keloid was treated with glucocorticoids, which seriously affect the therapeutic effect. In recent years, many studies have explored the factors influencing the efficacy of glucocorticoids in treating keloid and the action mechanism of glucocorticoids from different perspectives. Based on this, this paper reviews the mechanism and the factors influencing the efficacy of glucocorticoids in treating keloid, and explores ways to improve the treatment efficacy of glucocorticoids, aiming to provide thoughts for improving glucocorticoid-related diagnostic and therapeutic strategies.

Objective:To compare the changes of biliary microbiota after enteral extended biliary stents (EEBS) implantation with that of conventional plastic stents in animal experiment, and to preliminarily investigate its possible mechanism in preventing stents occlusion.Methods:A total of 12 healthy Bama minipigs were randomly assigned to the conventional plastic stent group ( n=6) and the EEBS group ( n=6) using simple random method. The bile samples of all pigs were collected before stents implantation and 4 weeks after stents placement. The biliary microbiota composition and diversity before and after different stents implantation were analyzed by 16S rRNA gene sequencing and compared. Results:No complications including acute cholangitis, perforation, bleeding, or death occurred in 12 pigs. Eight days after stents implantation, stents were out of bile duct in all pigs under endoscopy, while the bile samples were collected again for analysis. The main composition of biliary microbiota at the phylum level were Proteobacteria, Firmicutes and Bacteroidota. Alpha-diversities revealed the Shannon ( P=0.004) and Simpson index ( P=0.008) significantly decreased in the conventional stent group after stents placement, and Bata diversity analysis also showed a significant difference in microbial composition (Anosim: R=0.514 8, P=0.011). There was no significant difference in Observed species index ( P=0.095), Chao1 index ( P=0.136), Shannon index ( P=0.353), Simpson index ( P=0.227) or Bata diversity (Anosim: R=0.059 3, P=0.187) in the EEBS group before and after stents placement. LEfSe algorithm indicated Bacteroides_ fragilis and Proteobacteria- Gammaproteobacteria- Enterobacterales- Enterobacteriaceae- scherichia_ Shigella- Escherichia_ coli significantly increased in the conventional stent group, and Desulfobacterota- Desulfovibrionia- Desulfovibrionales- Desulfovibrionaceae- Bilophila significantly increased in the EEBS group after stents placement. Conclusion:The biliary microbiota change slightly after EEBS implantation in the short-term, and EEBS may prevent duodenobiliary reflux by prolonging the reflux path.

Whether anatomical segmentectomy can replace lobectomy in the treatment of early-stage lung cancer remains controversial. A large number of studies have been conducted for decades to explore whether pulmonary segmentectomy can treat early-stage lung cancer, which is actually to explore the indications of intentional segment-ectomy. With the development of scientific researches, it is found that many characteristics affect the malignancy of lung cancer, and the different grades of each characteristic affect the prognosis of patients. It is worth exploring whether different surgical approaches can be used for early-stage lung cancer with different characteristics and different grades. This article reviews the literature and studies to discuss the advances in indications of segmentectomy for early-stage lung in terms of tumor size, consolidation-to-tumor ratio, pathological classification and tumor location, respectively. The objective of this review is to help thoracic surgeons to objectively and scientifically select the surgical method according to the clinical characteristics of early-stage lung cancer.

Objective:To investigate the relationship between the positive surgical margin and clinical factors such as neoadjuvant hormonal therapy after robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk patients with prostate cancer.Methods:The clinical data of 164 patients with high-risk prostate cancer being performed RARP by one surgeon were analyzed retrospectively in our hospital from January 2016 to January 2022. The mean patient’s age was (65.3±6.2) years old, mean body mass index (BMI) was (25.6±3.0) kg/m 2, the median value of total prostate specific antigen (tPSA) before operation was 18.6(11.3, 31.3)ng/ml, the median value of Gleason score before operation was 7 (7, 8), the median value of prostate volume was 29.3 (22.4, 40.2) ml, and the clinical stage was T 2aN 0M 0-T 4N 0M 0. 80 patients with prostate cancer were treated with neoadjuvant endocrine therapy. All of them were treated with complete androgen blockade with a median course of 3 months. Univariate analysis was used to analyze the correlation between age, BMI, prostate volume, neoadjuvant hormonal therapy, preoperative tPSA, clinical stage, Gleason score before operation and positive surgical margin. Then multivariate logistic regression was used to further analyze the independent risk factor of positive surgical margin after RARP. Results:The postoperative pathological diagnosis included pT 2 stage in 111 cases (67.7%), pT 3a stage in 15 cases (9.1%), pT 3b stage in 25 cases (15.2%), pT 4 stage in 13 cases (7.9%). No lymph node metastasis was noticed in all patients. The Gleason scores included 6 in 11 cases (6.7%), 3+ 4 in 26 cases (15.9%), 4+ 3 in 36 cases (22.0%), 8 in 17 cases (10.4%), 9-10 in 24 cases (14.6%), un-evaluation due to endocrine therapy in 50 (30.5%). The positive surgical margin of high-risk patients with prostate cancer was 44.5% (73/164). Univariate analysis showed that the neoadjuvant hormonal therapy, tPSA and clinical stage were correlated with positive surgical margin ( P<0.05). Multivariate logistic regression analysis showed that non-neoadjuvant hormonal therapy, preoperative tPSA>20ng/ml and clinical stage>T 2b were independent risk factors for positive surgical margin of high-risk patients with prostate cancer. Stratified analysis showed that when the preoperative tPSA was 10-20 ng/ml(21.1% vs.55.9%, P=0.014), the clinical stage was T 2c(29.6% vs.49.1%, P=0.040), the Gleason score before operation was 7(19.4% vs.54.1%, P=0.003), the positive surgical margin of high-risk patients in the neoadjuvant hormonal therapy group was significantly lower than that in the non-neoadjuvant hormonal therapy group ( P<0.05). Conclusions:Non-neoadjuvant hormonal therapy, preoperative tPSA>20 ng/ml and clinical stage>T 2b were independent risk factors for positive surgical margin of RARP in the high-risk patients with prostate cancer. For high-risk patients with preoperative tPSA of 10-20 ng/ml, clinical stage of T 2c and Gleason score before operation of 7, neoadjuvant hormonal therapy has important clinical significance in reducing the positive surgical margin of RARP.