Objectives:To construct the “safe core” of the pedicle screw trajectory using CT imaging data of the subaxial cervical spine in adults, and to assess the accuracy and feasibility of the pedicle screw insertion assisted with the “safe core-referred technique” for subaxial cervical spine with a cadaver specimen study.Methods:This is an experimental study. From January 2015 to March 2020,60 adults′ CT images data of the cervical spine were collected from the database of the First Affiliated Hospital of Gannan Medical University,and were imported into Mimics 20.0 software. Virtual cervical pedicle trajectory and safe core were constructed according to the self-designed “virtual construction method of pedicle in the subaxial cervical spine”. The success rate of the construction and the spatial position data of the virtual safe core of was recorded,including the distance between the safe core and the tangent line of the upper and lower outer edge of Luschka′s joint on coronal plane,and the distance between the safe core and the posterior edge of the vertebral body on sagittal plane.The 3.5 mm column was used to simulate the pedicle screw placement,using the safe core as the only hub in pedicle screw trajectory.The length of the anterior pedicle screw trajectory,the interval of the abductive angle of the pedicle screw in axial plane, and the projection area of the entry area on periapical radiograph was calculated.In addition,8 adult cervical cadaver specimens were collected for the pedicle screw insertion experiment.The left side group used the “safe core-referred technique” for pedicle screw insertion,while the right side group used the Abumi method for pedicle screw insertion.The accuracy of pedicle screw placement was verified by CT scan.The difference between the accuracy of subjective judgment based on X-ray monitoring of operator and the actual accuracy of pedicle screw insertion verified by CT scan was compared between the two groups.The chi-square test was used to compare the intergroup data.Results:The total success rate of the virtual construction method for the safe core of the subaxial cervical spine was 97.0% (291/300); The distance between the safe core and the tangent line of the upper and lower outer edge of Luschka′s joint on coronal plane was ( M(IQR)) 0.91 (0.98) mm (range: 0 to 1.85 mm);The distance between the safe core and the posterior wall on the sagittal plane of the vertebral body was (2.01±0.86) mm (range: 0.67 to 3.53 mm). The distance (anterior pedicle screw trajectory) from the posterior cortex to the central point of the safe core was (11.58±1.00)mm (range: 8.27 to 14.93 mm).The projection area of the entry point on the coronal plane was (36.18±11.67) mm 2 (range: 13.38 to 83.11 mm 2). Pedicle screw insertion experiment in cervical cadaver specimen showed the rate of intraoperative correction of the pedicle screw trajectory was 7.5% (3/40) in the experimental group and 12.5% (5/40) in the control group ( χ2=0.139, P=0.709). The operator ′s correct rate of subjective judgment on CT in the stage of pedicle screw trajectory preparation was 100% (40/40) in the experimental group and 82.5% (33/40) in the control group, the difference was statistically significant ( χ2=5.638, P=0.018). The actual correct rate of CT verification in the stage of pedicle screw insertion was 100% (40/40) in the experimental group and 90.0% (36/40) in the control group, the difference was statistically significant ( χ2=2.368, P=0.124); The operator ′s correct rate of subjective judgment in the stage of pedicle screw insertion completion was 100% (83/83) in the experimental group and 92.9% (79/85) in the control group ( χ2=4.199, P=0.040). Conclusions:The virtual safe-core of subaxial cervical spine can be use as a reliable anatomical fluoroscopy landmark for freehand pedicle screw insertion.“Safe core-referred technique” can improve the accuracy rate of the operator′s subjective judgment on the intraoperative fluoroscopy monitoring,and hence improve the accuracy of freehand pedicle screw insertion technology for subaxial cervical spine. And it still needs to be further verified in clinical practice.

Objective To explore the teaching effect of case-integrated scenario simulation instruction model on proba-tionary instruction of acute upper gastrointestinal bleeding.Methods A total of 40 medical students of grade 2021 majoring in clinical medicine,namely,Nanshan Class,from Guangzhou Medical University were selected as participants.The students were randomly divided into two groups,with 22 as an experimental group and 18 as a control group.The former group received the case-integrated based scenario simulation teaching model,while the latter adopted the traditional bedside teaching model.The teaching content was on acute non-variceal upper gastrointestinal bleeding.Results There was no statistically significant differ-ence in the total score of gastroenterology between the experimental group and the control group(P＞0.05).The experimental group scored significantly higher in the gastrointestinal bleeding-related contents compared to the control group(P＜0.05).The post-class survey revealed that the majority of the students in the research group expressed their high-level satisfaction with the new instruction model and demonstrated their greater interests in participation in the new instruction model.Conclusion The case-integrated scenario simulation instruction model demonstrates significant superiority to the traditional bedside teaching model in terms of stimulating learning interests,cultivating medical professionalism,and enlivening classroom atmosphere.It is suitable for practical teaching in gastroenterology and can be widely adopted as routine probationary teaching for undergraduate students.

Objective:To analyze and explore the clinical characteristics and risk factors related to nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia.Methods:252 hospitalized patients with liver cirrhosis combined with atrial arrhythmia from January 2014 to December 2021 were enrolled, and their clinical characteristics were analyzed. The above-mentioned patients were divided into groups according to their nosocomial mortality rate. Among them, 45 nosocomial mortality cases were classified as the mortality group, and 207 survival cases were classified as the survival group. The differences in clinical data and laboratory data between the two groups were compared. The risk factors for nosocomial mortality in patients with liver cirrhosis combined with atrial arrhythmia were analyzed. The t-test, or rank-sum test, was used to compare measurement data. The chi-square test, or Fisher's exact probability method, was used to compare enumeration data. Multivariate analysis was performed by the logistic regression method.Results:Among the 252 cases, the male-to-female ratio was the same (male/female ratio: 126/126). The age range was 26 to 89 (66.77±10.46) years. Han ethnicity accounted for 79.5%. The main type of atrial arrhythmia was atrial fibrillation ( P ?

Objectives:To construct the “safe core” of the pedicle screw trajectory using CT imaging data of the subaxial cervical spine in adults, and to assess the accuracy and feasibility of the pedicle screw insertion assisted with the “safe core-referred technique” for subaxial cervical spine with a cadaver specimen study.Methods:This is an experimental study. From January 2015 to March 2020,60 adults′ CT images data of the cervical spine were collected from the database of the First Affiliated Hospital of Gannan Medical University,and were imported into Mimics 20.0 software. Virtual cervical pedicle trajectory and safe core were constructed according to the self-designed “virtual construction method of pedicle in the subaxial cervical spine”. The success rate of the construction and the spatial position data of the virtual safe core of was recorded,including the distance between the safe core and the tangent line of the upper and lower outer edge of Luschka′s joint on coronal plane,and the distance between the safe core and the posterior edge of the vertebral body on sagittal plane.The 3.5 mm column was used to simulate the pedicle screw placement,using the safe core as the only hub in pedicle screw trajectory.The length of the anterior pedicle screw trajectory,the interval of the abductive angle of the pedicle screw in axial plane, and the projection area of the entry area on periapical radiograph was calculated.In addition,8 adult cervical cadaver specimens were collected for the pedicle screw insertion experiment.The left side group used the “safe core-referred technique” for pedicle screw insertion,while the right side group used the Abumi method for pedicle screw insertion.The accuracy of pedicle screw placement was verified by CT scan.The difference between the accuracy of subjective judgment based on X-ray monitoring of operator and the actual accuracy of pedicle screw insertion verified by CT scan was compared between the two groups.The chi-square test was used to compare the intergroup data.Results:The total success rate of the virtual construction method for the safe core of the subaxial cervical spine was 97.0% (291/300); The distance between the safe core and the tangent line of the upper and lower outer edge of Luschka′s joint on coronal plane was ( M(IQR)) 0.91 (0.98) mm (range: 0 to 1.85 mm);The distance between the safe core and the posterior wall on the sagittal plane of the vertebral body was (2.01±0.86) mm (range: 0.67 to 3.53 mm). The distance (anterior pedicle screw trajectory) from the posterior cortex to the central point of the safe core was (11.58±1.00)mm (range: 8.27 to 14.93 mm).The projection area of the entry point on the coronal plane was (36.18±11.67) mm 2 (range: 13.38 to 83.11 mm 2). Pedicle screw insertion experiment in cervical cadaver specimen showed the rate of intraoperative correction of the pedicle screw trajectory was 7.5% (3/40) in the experimental group and 12.5% (5/40) in the control group ( χ2=0.139, P=0.709). The operator ′s correct rate of subjective judgment on CT in the stage of pedicle screw trajectory preparation was 100% (40/40) in the experimental group and 82.5% (33/40) in the control group, the difference was statistically significant ( χ2=5.638, P=0.018). The actual correct rate of CT verification in the stage of pedicle screw insertion was 100% (40/40) in the experimental group and 90.0% (36/40) in the control group, the difference was statistically significant ( χ2=2.368, P=0.124); The operator ′s correct rate of subjective judgment in the stage of pedicle screw insertion completion was 100% (83/83) in the experimental group and 92.9% (79/85) in the control group ( χ2=4.199, P=0.040). Conclusions:The virtual safe-core of subaxial cervical spine can be use as a reliable anatomical fluoroscopy landmark for freehand pedicle screw insertion.“Safe core-referred technique” can improve the accuracy rate of the operator′s subjective judgment on the intraoperative fluoroscopy monitoring,and hence improve the accuracy of freehand pedicle screw insertion technology for subaxial cervical spine. And it still needs to be further verified in clinical practice.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

Objective:To study effect of STIL gene on proliferation and apoptosis of cervical cancer cells and its mechanism.Methods:Expressions of STIL mRNA and STIL protein in cervical cancer tissues,adjacent tissues,cervical cancer cell lines HeLa,SiHa,caski and human normal cervical epithelial cells HUCEC were calculated by RT-qPCR and Western blot.HeLa cells were divided into control(NC)group,si-NC group,si-STIL group,si-STIL+IL-6 group.CCK-8 and plate cloning assay were utilized to detect cell proliferation and cloning ability,and flow cytometry was used to analyze cell apoptosis rate.Western blot was used to detect IL-6,IL-6R and p-STAT3 proteins levels.sh-STIL stably transfected HeLa cells were subcutaneously inoculated into back of nude mice to investigate effect of inhibiting STIL expression on tumor formation.Results:STIL mRNA and protein expressions in cervical cancer tissues were significantly higher than adjacent tissues(P<0.05).STIL mRNA and protein expressions in HeLa,SiHa,and caski cells were significantly higher than HUCEC cells(P<0.05).Compared with si-NC group,cell absorbance,number of clones,and protein levels of IL-6,IL-6R and p-STAT3 in si-STIL group were significantly reduced(P<0.05),and apoptosis rate was significantly in-creased(P<0.05).Compared with si-STIL group,cell absorbance,number of clones and protein levels of IL-6,IL-6R and p-STAT3 in si-STIL+IL-6 group were significantly increased(P<0.05),and apoptotic rate was significantly reduced(P<0.05).Inhibiting STIL significantly inhibited tumor growth in vivo(P<0.05).Conclusion:STIL gene expression is up-regulated in cervical cancer,and inhi-biting STIL can inhibit proliferation and induce apoptosis of cervical cancer cells by inhibiting IL-6/STAT3 pathway.

Objective:To investigate impacts of paeoniflorin-6′-O-benzene sulfonate(CP-25)on proliferation and apoptosis of ovarian cancer cells through Toll-like receptor 4(TLR-4)/nuclear factor-κB(NF-κB)signaling pathway.Methods:CCK-8 assay was performed to measure the cell activity of human ovarian cancer cells A2780,SK-OV-3,HO8910 and normal ovarian cells HOSEpiC.A2780 cells were separated into control group(0.01%DMSO),CP-25 low(0.5 mg/ml CP-25),medium(1 mg/ml CP-25)and high(2 mg/ml CP-25)concentration groups and CP-25 high concentration+LPS group(2 mg/ml CP-25 and 0.1 μg/ml TLR-4 activator LPS).Cell proliferation was evaluated by CCK-8 and clone formation assays;cell apoptosis was analyzed by flow cytometry and TUNEL staining;proliferating protein Ki67,apoptosis-related proteins(Cleaved caspase-3,Caspase-3,Bax,Bcl-2),TLR-4,p-NF-κB p65,NF-κB p65 protein expression levels were analyzed by Western blot;protein expressions of TLR-4 and NF-κB p65 were observed by immunofluorescence staining.Results:Compared with HOSEpiC cells,viabilities of A2780,SK-OV-3 and HO8910 cells were reduced gradually with the increased of CP-25 concentration(P<0.05),and CP-25 had about 50%inhibitory effect on the growth of A2780 cells at low,medium and high concentrations,so A2780 cells were used for the experiments.Compared with control group,the clone formation rate of A2780 cells in low,medium and high concentration groups of CP-25 reduced obviously,while apoptosis rate and apoptosis index rose obviously,expression levels of Ki67,Bcl-2,TLR-4,p-NF-κB p65 and nuclear NF-κB p65 were reduced obviously,while expression of Cleaved caspase-3/Caspase-3 and Bax were increased obviously in a concentration-dependent manner(P<0.05).Compared with CP-25 high concentration group,cell viability and clone formation rate were significantly increased in CP-25 high concentration+LPS group,while apoptosis rate and apoptosis index were decreased significantly,expression levels of Ki67,Bcl-2,TLR-4,p-NF-κB p65 and nuclear NF-κB p65 were increased significantly,while expressions of Cleaved caspase-3/Cas-pase-3 and Bax were significantly decreased(P<0.05).Conclusion:CP-25 inhibits ovarian cancer cell proliferation and promotes apoptosis by inhibiting TLR-4/NF-κB signaling pathway.

BACKGROUND: Lung cancer is a disease with a high incidence rate in Yunnan province, yet there is a paucity of large-scale studies on its clinical epidemiology. This research aims to investigate the epidemiological characteristics of patients who underwent lung cancer surgery at Yunnan Cancer Hospital over the past decade, thereby providing a theoretical basis for the prevention and treatment of lung cancer. METHODS: Clinical data were collected from 15,967 patients who underwent lung cancer surgery at Yunnan Cancer Hospital between 2013 and 2022. A statistical analysis was conducted on the patients' general data, surgical information, pathological types of lung cancer, and other clinical epidemiological characteristics. RESULTS: Among the 15,967 cases of lung cancer, 46.3% were male and 53.7% were female, with the male-to-female ratio ranging from 0.68 to 1.61:1. The median age was 56 years (interquartile range: 49-63), and 37.0% of the patients were in the age group of 50-59 years. Since 2017, there has been an annual increase in the proportion of patients under the age of 60 years. The smoking status of the patients showed that 28.1% were smokers and 71.9% were non-smokers. Qujing city accounted for 41.4% and Kunming city for 23.2% of the cases in Yunnan province, with 29.6% of patients originating from Xuanwei and Fuyuan areas of Qujing city. The distribution of affected lung lobes was as follows: right upper lobe 28.2%, right middle lobe 6.3%, right lower lobe 20.1%, left upper lobe 22.7%, and left lower lobe 16.4%. The use of thoracoscopic surgery increased from 30.8% to 96.3%, with single-port thoracoscopic surgery comprising 61.3%. Lobectomy was performed in 64.2% of cases, wedge resection in 17.2%, and segmentectomy in 12.2%. The proportion of lobectomy decreased from 83.1% to 46.1%. The proportion of patients in stages 0-I increased from 43.5% to 82.8%, while stages II-IV decreased from 56.5% to 17.2%. Adenocarcinoma increased from 75.6% to 88.3%, and squamous cell carcinoma decreased from 21.5% to 8.6%. Among adenocarcinoma patients, 60.9% were female. Among sguamous cell carcinoma patients, 90.6% were male. The peak age for adenocarcinoma was 50-59 years, and for squamous cell carcinoma, it was 60-69 years. The smoking rate was higher among squamous cell carcinoma patients (65.9%) compared to adenocarcinoma patients (22.3%). Adenocarcinoma patients had a higher proportion in stages 0-I (76.3%), while squamous cell carcinoma patients were more prevalent in stages II-III (64.1%). CONCLUSIONS The findings indicate an increasing proportion of female patients with adenocarcinoma, a younger age of onset, a higher proportion of non-smoking lung cancer patients, and an increased proportion of stages 0-I lung cancer. These trends may reflect the epidemiological characteristics of patients undergoing lung cancer surgery in Yunnan and surrounding areas over the past decade.
Humans ; Female ; Male ; Lung Neoplasms/pathology* ; Middle Aged ; China/epidemiology* ; Aged ; Adult ; Aged, 80 and over

Objective:To investigate the radiosensitizing effect and underlying mechanism of STING agonist (c-di-AMP) on cutaneous melanoma cells.Methods:Human cutaneous melanoma cells (A375) were divided into four groups: the control group, 10 μmol/L c-di-AMP group, X-ray irradiation group and X-ray irradiation combined with c-di-AMP group. The radiosensitizing effect of c-di-AMP on A375 cells was detected by CCK-8-based viability assay, lactate dehydrogenase (LDH) release assay, flow cytometry-based apoptosis assay, and colony formation assay. Western blot analysis was used to determine the expressions of cell death-related proteins.Results:In combination with 10 Gy X-ray irradiation, 10 μmol/L c-di-AMP showed significant radiosensitization effect in A375 cells, which was evidenced by decreased cell activity ( t=5.11, P<0.05), increased cytotoxicity ( t=10.15, P<0.05) and cell apoptosis ( t=4.41, P<0.05) and reduced clone viability( t=6.30, 3.55, 5.45, 3.55, P<0.05). The calculated radiosensitization ratio of c-di-AMP to A375 cells was 1.88. Moreover, 10 μmol/L c-di-AMP further increased the expressions of cell death-related proteins induced by radiation in A375 cells. Conclusions:The STING agonist c-di-AMP can be used as a radiosensitizer for cutaneous melanoma, which may provide a novel strategy for radiotherapy.