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 analyze the spatio-temporal distribution of pulmonary tuberculosis (PTB) among students in Suzhou City, Jiangsu Province from 2015 to 2023, so as to provide the evidence for the prevention and control of PTB in schools. Methods: Data of PTB cases among students in Suzhou City from 2015 to 2023 were collected from Chinese Disease Prevention and Control Information System and Suzhou Report of Investigation and Disposal of Tuberculosis in Schools. The seasonal incidence of PTB among students was analyzed using seasonal index (SI). The spatio-temporal clustering characteristics of PTB among students were analyzed using spatial autocorrelation and retrospective spatio-temporal permutation scanning. Results: Totally 1 374 PTB cases among students were reported in Suzhou City from 2015 to 2023. PTB cases were reported in each month, and the SIs were 100.69%, 124.38%, 108.98%, 135.04%, 106.61% and 106.61% in April, May, July, September, October and November, respectively, indicating the prevalence of PTB among students. Spatial autocorrelation analysis showed there was a positive spatial correlation of PTB among students in 2019 and 2020 (Moran's I=0.053 and 0.089, both P<0.05). From 2015 to 2023, there were high-high clustering sites mainly in Hengtang Street and Shishan Street. Retrospective spatio-temporal permutation scanning showed a primary cluster in Hengtang Street, with aggregation time in 2017, and 6 secondary clusters covering 25 towns (streets). Conclusion From 2015 to 2023, the PTB cases among students in Suzhou City were mainly concentrated in summer and autumn, and were predominantly clustered in Hengtang Street and Shishan Street.

Objective: To understand the association of physical exercise willingness and insomnia with depressive symptoms among college students, so as to provide reference for improving depressive symptoms of college students. Methods: From October 2022 to April 2023, cluster sampling was used to recruit 11 101 college students from four colleges in Anhui Province. The questionnaire survey was conducted to investigate the willingness to engage in physical exercise, insomnia and depressive symptoms of college students. The multivariate Logistic regression model was used to analyze the association of physical exercise willingness and insomnia with depressive symptoms of college students. Results: The prevalence of depressive symptoms among college students was 9.24%. Multivariate Logistic regression analysis showed that college students who were passive participants/non participants in physical activity, or who experienced insomnia, had a higher likelihood of depressive symptoms compared to those who were active participants or did not experience insomnia ( OR =1.84, 2.07, 4.02, all P <0.01). College students who were passive participants or non participants in physical activity and concurrently experienced insomnia had a higher risk of depressive symptoms compared with those who were active participants or did not experience insomnia ( OR =1.87-8.39, all P <0.01). Gender stratified analysis showed that the combined effect of passive physical exercise and insomnia increased the risk of depressive symptoms in both male ( OR = 1.81 -9.87) and female college students ( OR =1.67-7.39) (all P <0.05). Conclusions Both physical exercise willingness and insomnia are associated with depressive symptoms in college students. In order to improve the depressive symptoms of college students, it is necessary to improve the enthusiasm of physical exercise and strengthen the education of sleep health awareness.

Abstract Kidney stones are common and frequently occurring diseases in urology. In recent years, the incidence of urinary stones has increased year by year, affecting people′s quality of life and aggravating the social and economic burden. The occurrence and development of kidney stones are closely related to metabolic factors. This review mainly conducts a systematic overview of the research on the relationship between electrolyte metabolism abnormalities, dyslipidemias and other metabolic disorder diseases and kidney stones in recent years.By exploring the relationship between various metabolic disorder diseases and kidney stones, this review provides reference for exploring the occurrence and development of kidney stones from the perspective of metabolism.

Objective To analyze the effects of different gender,gestational age,birth weight and blood collection date on the value of 17-hydroxyprogesterone(17-OHP)in neonatal screening for congenital adrenal hyperplasia(CAH)and to develop a positive cut-off for CAH screening that is appropriate for the laboratory itself.Methods Time-resolved fluorescence immunoassay was used to detect 17-OHP concentration,and Mann-Whitney U test and Kruskal-Wallis H test were used to compare 17-OHP concentration of newborns with the different gender,birth weight,gestational age and blood collection age.The comparison of rates was conducted using the multi-set rate chi-square test and Fisher's exact probability method.The relationship between the clinical features and 17-OHP concentration was analyzed by multiple linear regression,and the cut-off value of 17-OHP screening was 99.5％percentile.Results The 17-OHP concentration of male neonates was higher than that of female neonates,and the difference was statistically significant(Z=-17.768,P<0.05).The 17-OHP concentration of neonates in groups with different gestational age,different birth weight,and different blood collection days were compared respectively,and the difference was statistically significant(χ2=5 235.187、3 682.665、493.414 respectively,P=0.00).Further pair comparison showed that there were statistically significant differences in 17-OHP concentration of neonates at different gestational weeks,gestational age and blood collection days(P<0.05),except that age of blood collection≥3 and<4 days and≥4 and<7 days(Z=-0.950,P=0.342).Neonatal 17-OHP concentration decreased with the gestational age and birth weight increase.There were statistically significant differences in the initial screening positive rate and screening positive rate of 17-OHP among different gestational ages and different birth weights groups(P<0.05),and they decreased with the increase of gestational age,birth weight and age at the time of blood collection.The results of multiple linear regression showed that 17-OHP concentration was related to the several factors,including the gestational age,birth weight,age of blood collection and gender in descending order.Conclusion The effects of various factors on the concentration of 17-OHP in neonatal peripheral blood should be comprehensively considered.The cut-off value of 17-OHP for CAH screening in the Screening Center for Neonatal Genetic Metabolic Diseases in the First Affiliated Hospital of Kunming Medical University is modified to≥14.00 nmol/L for full-term neonates of normal weight and≥36.00 nmol/L for premature or/and low-weight neonates so as to improve the specificity of neonatal CAH screening and reduce the false positives.

Objective:Patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)combined with severe type Ⅱ respiratory failure have a high probability of ventilation failure using conventional non-invasive positive pressure ventilation(NPPV).This study aims to investigate the clinical efficacy of high intensity NPPV(HI-NPPV)for the treatment of AECOPD combined with severe type Ⅱ respiratory failure. Methods:The data of patients with AECOPD combined with severe type Ⅱ respiratory failure(blood gas analysis pH≤7.25)treated with NPPV in the Second Affiliated Hospital of Chongqing Medical University from July 2013 to July 2023 were collected to conduct a retrospective case-control study.The patients were divided into 2 groups according to the inspired positive airway pressure(IPAP)used during the NPPV treatment:a NPPV group(IPAP<20 cmH2O,1 cmH2O=0.098 kPa)and a HI-NPPV group(20 cmH2O≤IPAP<30 cmH2O).Ninety-nine and 95 patients were included in the NPPV group and the HI-NPPV group,respectively.A total of 86 pairs of data were matched using propensity score matching(PSM)for data matching.The primary outcome indexes(mortality and tracheal intubation rate)and secondary outcome indexes[blood gas analysis pH,arterial partial pressure of oxygen(PaO2)and arterial partial pressure of carbon dioxide(PaCO2),adverse reaction rate,and length of hospitalization]were compared between the 2 groups. Results:The tracheal intubation rates of the NPPV group and the HI-NPPV group were 6.98％and 1.16％,respectively,and the difference between the 2 groups was statistically significant(χ2=4.32,P<0.05);the mortality of the NPPV group and the HI-NPPV group was 23.26％and 9.30％,respectively,and the difference between the 2 groups was statistically significant(χ2=11.64,P<0.01).The PaO2 at 24 h and 48 h after treatment of the HI-NPPV group was higher than that of the NPPV group,and the PaCO2 of the HI-NPPV group was lower than that of the NPPV group,and the differences were statistically significant(all P<0.05).The differences of pH at 24 h and 48 h after treatment between the 2 groups were not statistically significant(both P>0.05).The differences between the 2 groups in adverse reaction rate and hospitalization length were not statistically significant(both P>0.05). Conclusion:HI-NPPV can reduce mortality and tracheal intubation rates by rapidly improving the ventilation of patients with AECOPD combined with severe type Ⅱ respiratory failure.This study provides a new idea for the treatment of patients with AECOPD combined with severe type Ⅱ respiratory failure.

Objectives:To evaluate the efficacy and safety of the self-fixing and self-detachable drainage stent in pancreaticojejunostomy and to provide supportive data for the follow clinical trials.Methods:This is an experimental research in animals which completed from February 2022 to September 2022. A self-fixing and self-detachable pancreaticojejunostomy drainage stent was designed for Hong′s pancreaticojejunostomy technique based on the theory of “fistula healing” in pancreaticojejunostomy. Ten biocompatibility tests were completed invitro before this study. Twenty-five Bama minipigs were selected and double-ligated in the neck of the pancreas to dilate the distal main pancreatic duct. Twenty-three of them were successfully modelled and divided into three groups by a stratified random method: pancreaticojejunostomy drainage stent group (referred to as stent group) with 11 pigs, pancreatic duct to jejunal mucosa anastomosis group (referred to as manual suture group) with 8 pigs, sham operation group with 4 pigs. The anastomic time,amylase content in postoperative abdominal drainage fluid and the tolerable pressure value of pancreaticojejunostomy were compared between the stent group and the manual suture group. An abdominal X-ray fluoroscopy examination was adopted to detect the detach time of the stent. A postoperative pathological examination was performed to verify the healing time,the type of treatment and the stricture rate of pancreaticojejunostomy. Quantitative data was analyzed by independent sample t-test. The classified data were analyzed by Fisher′s exact test. Results:There were no significant differences in the diameter of the pancreatic duct and pancreatic texture,the time of pancreaticojejunostomy,the amylase content in postoperative peritoneal drainage fluid,and the tolerable pressure value of the pancreaticojejunostomy between the stent group and the manual suture group(all P>0.05). Abdominal X-ray fluoroscopy showed that the stents gradually detached and were removed from the body 21 days after operation,and all stents were detached in the follow 3 months after operation. Pancreaticojejunostomy healed 7 days after operation based on fistula formation in the stent group,and 14 days in the manual suture group. The incidence of anastomotic stricture within 35 days after operation was 2/8 in the stent group and 6/8 in the manual suture group (Fisher′s exact test: P=0.132). Conclusion:The stent method is safer and simpler than the manual suture method in pancreaticojejunostomy of Bama minipigs, with shorter anastomotic healing time and lower stricture rate.

Pathology is the gold standard for diagnosis of neoplastic diseases.Whole slide imaging turns traditional slides into digital images,and artificial intelligence has shown great potential in pathological image analysis,especially deep learning models.The application of artificial intelligence in whole slide imaging of lung cancer involves many aspects such as histopathological classification,tumor microenvironment analysis,efficacy and survival prediction,etc.,which is expected to assist clinical decision-making of accurate treatment.Limitations in this field include the lack of precisely annotated data and slide quality varying among institutions.Here we summarized recent research in lung cancer pathology image analysis leveraging artificial intelligence and proposed several future directions.

Objective To construct plasmids and knock out HIF-1α gene expression in an naked mole rat skin fibroblasts(NSF)cell line using CRISPR/Cas9 genomic editing technology,to provide an in vitro cell model for studying the mechanism of hypoxia tolerance and the occurrence and development of hypoxia-related diseases in naked mole rats.Methods We designed four pairs of single guide RNA(sgRNA)sequences targeting exons 1～4 of the NSF HIF-1αgene and successfully constructed an expression plasmid.The plasmid with the optimal sgRNA was identified and transfected into 293T cells,and the supernatant was used for detecting the virus titer.Lentivirus particles carrying sgRNAs of HIF-1α were transfected into NSF cells which express Cas9 protein,based on a previous protocol.After transfection,fluorescence signals were observed under a fluorescence microscope,and HIF-1α expression in NSF cells was detected by Western Blot and T7 endonuclease 1(T7E1)analysis.Results Sanger sequencing showed that the designed sgRNA was successfully inserted into pX459 and pKLV2-U6-sgRNA2 vectors,demonstrating successful construction of a recombinant plasmid for transfection.T7E1 digestion successfully removed three bands and the target efficiency of sgRNA was 54％.Western Blot showed that the HIF-1α gene was successfully knocked out and its protein level was significantly reduced in NSF cells from naked mole rats(P=0.0019).There were no obvious morphological changes in HIF-1α-knockout cells under the microscope,and gene knockout had no obvious effect on cell proliferation.Conclusions We successfully constructed an HIF-1α-knockout cell line using CRISPR/Cas9 technology,to provide an experimental basis for further studies of the biological function of HIF-1α,as well as the mechanism of hypoxia tolerance in naked mole rats.The result also provide a theoretical foundation for the prevention and treatment of hypoxia-related diseases.

Objective: To analyze the relationship between the risk of tuberculosis outbreaks in schools and the visit interval of index cases, so as to provide a scientific reference for predicting the risks of tuberculosis outbreak and making preventive measures. Methods: A total of 630 index cases from school tuberculosis outbreaks were studied during January, 2015 to December, 2022. Data on demographics, consultation history, etiological diagnosis, and methods of detection were collected. Restricted Cubic Splines (RCS), unconditional Logistic regression, and the receiver operating characteristic curve (ROC curve) were used for analysis. Results: The RCS fitted curve showed that the risk of a tuberculosis outbreak linearly increased when the consultation interval for etiologically negative patients exceeded 5.79 days, or for etiologically positive patients exceeded 8.37 days. After multi factor adjustment, for every additional day in the visit interval of the index case, the odds ratio ( OR ) value for a high risk outbreak was 1.10 (95% CI =1.07-1.13)( P <0.05). When analyzed by tertiles of visit intervals, compared to an interval of <14 days, the OR values (95% CI ) for high risk outbreaks in schools with intervals of 14-<28 days and ≥28 days were 10.32(3.04-35.10) and 82.58( 28.42 -239.95), respectively( P <0.01), indicating a trend of increasing outbreak risk with longer visit intervals. Based on the ROC curve analysis, the optimal threshold for predicting a high risk school tuberculosis outbreak was 23.5 days, with an area under the curve ( AUC ) of 0.93 (95% CI =0.89-0.98). Conclusion An extended visit interval of index cases is a good early warning indicator for high risk tuberculosis outbreaks in schools and could be considered a key factor in early intervention and risk control strategies.