T-cell acute lymphoblastic leukemia (T-ALL) is a highly aggressive hematologic malignancy with a poor prognosis, despite advancements in treatment. Many patients struggle with relapse or refractory disease. Investigating the role of the super-enhancer (SE) regulated gene ubiquitin-specific protease 20 (USP20) in T-ALL could enhance targeted therapies and improve clinical outcomes. Analysis of histone H3 lysine 27 acetylation (H3K27ac) chromatin immunoprecipitation sequencing (ChIP-seq) data from six T-ALL cell lines and seven pediatric samples identified USP20 as an SE-regulated driver gene. Utilizing the Cancer Cell Line Encyclopedia (CCLE) and BloodSpot databases, it was found that USP20 is specifically highly expressed in T-ALL. Knocking down USP20 with short hairpin RNA (shRNA) increased apoptosis and inhibited proliferation in T-ALL cells. In vivo studies showed that USP20 knockdown reduced tumor growth and improved survival. The USP20 inhibitor GSK2643943A demonstrated similar anti-tumor effects. Mass spectrometry, RNA-Seq, and immunoprecipitation revealed that USP20 interacted with hypoxia-inducible factor 1 subunit alpha (HIF1A) and stabilized it by deubiquitination. Cleavage under targets and tagmentation (CUT&Tag) results indicated that USP20 co-localized with HIF1A, jointly modulating target genes in T-ALL. This study identifies USP20 as a therapeutic target in T-ALL and suggests GSK2643943A as a potential treatment strategy.

Objective:To investigate the related risk factors of surgical appendectomy after endoscopic retrograde appendicitis therapy (ERAT) in children.Methods:From September 2019 to November 2023 at the Children's Hospital Affiliated to Shandong University,the data from all related children with appendectomy after ERAT were analyzed. The general situation and main clinical manifestations of the children were collected. According to the effect of ERAT,the patients were divided into transfer to surgical group and appendicitis recurrence group by the reasons and time of transfer to surgical treatment. The indexes such as ERAT and reoperation process and pathological types of appendix after operation were collected,and the clinical experience was summarized.Results:Among the 242 children who underwent ERAT,32 cases underwent appendectomy again,including 19 males and 13 females,with an average age of（9.16±2.77）years,and the reoperation rate was 13.2%. The clinical manifestation was abdominal pain (32 cases,100.0%),mainly right lower abdominal pain (28 cases,87.5%),and the main duration was less than 3 months (30 cases,93.8%). Abdominal ultrasound or CT before ERAT mainly indicated appendicitis (11 cases,34.4%) and appendicitis complicated with appendiceal calculus (11 cases,34.4%). There were 9 children in transferred to surgical group,of which 5 cases were transferred to surgery because of ERAT intubation failure,and 4 cases were transferred to surgery because of appendix perforation or abscess. Postoperative pathology showed acute suppurative appendicitis in 5 cases and acute gangrenous appendicitis in 4 cases. There were 23 children in appendicitis recurrence group,whose abdominal pain was relieved after ERAT,but their symptoms were repeated after discharge. After clinical evaluation,they were diagnosed as recurrent appendicitis and underwent surgical appendectomy. Most of them were reoperated within 6 months after ERAT (21 cases,91.3%).Postoperative pathology was mainly chronic appendicitis (10 cases,43.5%).Conclusion:Acute suppurative appendicitis and acute gangrenous appendicitis are prone to catheterization or endoscopic failure during ERAT,and there is a high risk of surgical transfer. ERAT may relieve the symptoms of chronic appendicitis in children. If the symptoms are repeated,surgery is still needed to remove the appendix.

Objective To investigate the effectiveness of intravenous thrombolytic therapy mode led by fast-track specialist nurses on patients with acute ischemic stroke(AIS).Methods This study involved 124 AIS patients who underwent intravenous thrombolytic therapy in the Department of Emergency of our hospital from March 2021 to February 2023.Among the patients,61 admitted between March 2021 and February 2022 received conventional AIS thrombolytic therapy were assigned to a control group.While the 63 patients who received AIS thrombolytic therapy under the specialist nurse-led intravenous thrombolytic therapy mode between March 2022 and February 2023 were assigned to an observation group.The two groups were compared in terms of the time from admission to completion of CT examination,time for signing the informed consent for thrombolytic therapy,door to needle time and percentage of DTN<60 minutes,as well as the post-thrombolysis scores according to the National Institute of Health Stroke Scale(NIHSS)and satisfaction to medical consultation.Results The observation group exhibited a significantly shorter time from admission to completion of CT examination,a shorter time for signing an informed consent for thrombolytic therapy,a shorter door to needle time and a higher percentage of DTN<60 minutes,all with significant difference in comparison with those in the control group.After thrombolysis,the NIHSS score of the observation group decreased more than that of the control group(P<0.05).The patients and their families in the observation group reported significantly higher satisfaction compared to those in the control group(both P<0.05).Conclusion The fast-track specialist nurse-led intravenous thrombolytic therapy mode demonstrates the superiority in reduction of the time from admission to completion of CT examination,time for signing an informed consent for thrombolytic therapy,door to needle time and the NIHSS scores,higher percentage of DTN<60 minutes as well as improvement of patient satisfaction.

The rapid development of digital intelligence technologies is providing a powerful boost to the high-quality development of the healthcare system.Considering the current state of our healthcare services and guided by General Secretary Xi Jinping's insights on new quality productive forces and the directives from Third Plenary Session of Communist Party of China's 20th Central Committee,the high-quality development of the healthcare service system should focus on digital intelligence technologies such as cloud computing,big data,privacy computing,blockchain,Internet of Things(IoT),mobile computing,and AI.The key measures should include the optimization of production factors,services,and governance.Emphasis should be placed on enhancing the efficient and intensive development of the development model,ensuring the high-quality and continuous integration of the supply model,and transitioning to scientific and modern management methods.Herein,we analyzed the"factor optimization—service optimization—governance optimization"development mechanism driven by digital intelligence and proposed corresponding implementation pathways,intending to provide references for establishing a high-quality and efficient healthcare service system with Chinese characteristics.

The spectrum of biopsy-confirmed kidney disease varies with regions and periods. We describe the distribution of pathological types and epidemiological characteristics of kidney diseases in Northwest China due to regional differences in geographical environment, social economy, and dietary habits. Methods: Kidney biopsy cases from 2005 to 2020 in Xijing Hospital were retrospectively analyzed. Pathological characteristics of patients in different periods were analyzed using the t test or chi-square test. Joinpoint regression was used to analyze trends in pathological types and disease spectrum. Results: A total of 10,528 eligible patients were included. Primary glomerular disease (PGD) accounted for the majority of the cases and exhibited an obvious downward trend, whereas secondary glomerular disease (SGD) showed an obvious upward trend. Among PGD, immunoglobulin A nephropathy (IgAN) remained the most common pathological type, and the detection rate of membranous nephropathy (MN) was significantly increased. Among SGD, Henoch-Schönlein purpura nephritis (HSPN) was the most common pathological type and may present a significant characteristic of Northwest China. Diabetic nephropathy (DN) exhibited the most obvious upward trend in the whole process, whereas the fastest growth since 2012 was in hypertensive nephropathy. Conclusion: The proportion of SGD increased whereas PGD declined. IgAN remained the most common PGD, and HSPN was the most common SGD. MN and DN showed the most obvious upward trend among PGD and SGD, respectively. Changes in the spectrum of kidney disease, especially the constituent ratio of SGD, pose a great challenge to public health.

Lipid Droplets/metabolism* ; Bacteria ; Lipid Metabolism

ObjectiveTo establish a rat model of diabetic wound by feeding on a high-fat and high-sugar diet combined with intraperitoneal injection of streptozotocin （STZ） and surgical preparation of full-thickness skin defects， observe the effect of cinnamaldehyde on the wound healing of diabetes rats， and explore the therapeutic mechanism of cinnamaldehyde in improving wound healing of diabetes rats based on the PTEN-induced putative kinase （PINK1）/Parkin pathway-mediated mitochondrial autophagy. MethodForty-eight male SD rats were randomly divided into blank group （n=12） and diabetes group （n=36）. The diabetes group was further randomly divided into model group， cinnamaldehyde group， and Beifuxin group， with 12 rats in each group. The blank group and the model group received routine disinfection with physiological saline after creating the wounds， while the cinnamaldehyde group received topical application of polyethylene glycol 400 （PEG 400） gel containing 4 μmol·L^-1 cinnamaldehyde， and the Beifuxin group received topical application of Beifuxin gel. Dressings were changed once daily. The wound healing rate of each group was observed. On the 7th and 14th days after intervention， the wound tissues of the rats were collected. Hematoxylin and eosin （HE） staining was performed to observe the pathological changes in the local tissues. Immunohistochemistry （IHC） was used to detect the expression of interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， vascular endothelial growth factor （VEGF）， and collagen fibers. Immunofluorescence （IF） and Real-time polymerase chain reaction （Real-time PCR） were used to detect the protein， and mRNA expression of PINK1， Parkin， microtubule-associated protein 1 light chain 3 Ⅱ （LC3 Ⅱ）. ResultAfter intraperitoneal injection of STZ， compared with the blank group， the random blood glucose values of rats in the diabetic group increased significantly （P<0.01）， all higher than 16.7 mmol·L^-1， and persistently hyperglycemic for some time after modeling. Compared with the blank group， the model group showed poor growth and healing of granulation tissue in the wounds， and the wound healing rate decreased （P<0.01）. On the 7^th day after intervention， the blank group had squamous epithelial coverage on the wounds. Compared with the blank group， the model group only had a small amount of scab at the wound edges， with a large number of infiltrating inflammatory cells in the wounds. The protein expression levels of IL-6 and TNF-α in the tissues increased （P<0.01）， and the protein and mRNA levels of PINK1， Parkin， and LC3Ⅱ decreased （P<0.01）. On the 14^th day after the intervention， the granulation tissue in the wounds of the blank group was mature and well-healed. Compared with the blank group， the model group still had infiltrating inflammatory cells and red blood cell exudation. The protein expression levels of VEGF and collagen fibers in the tissues decreased （P<0.01）， and the protein and mRNA expression levels of PINK1， Parkin， and LC3Ⅱ increased （P<0.01）. Compared with the model group， the cinnamaldehyde group and the Beifuxin group showed better wound healing， with increased wound healing rates （P<0.01）. On the 7th day after intervention， the protein expression levels of IL-6 and TNF-α in the tissues decreased （P<0.01）， and the protein and mRNA expression levels of PINK1， Parkin， and LC3Ⅱ increased （P<0.01）. On the 14th day after intervention， the protein expression levels of VEGF and collagen fibers in the tissues increased （P<0.01）， and the protein and mRNA expression levels of PINK1， Parkin， and LC3Ⅱ decreased （P<0.01）. ConclusionCinnamaldehyde can promote the wound healing of diabetes rats by increasing the wound healing rate， reducing the levels of inflammatory factors IL-6 and TNF-α， and increasing the levels of VEGF and collagen fibers. Its mechanism may be related to the regulation of the PINK1/Parkin signaling pathway， activation of mitochondrial autophagy， inhibition of inflammatory responses， and promotion of angiogenesis and collagen synthesis， thereby promoting the wound healing of diabetes rats.

Objective:To evaluate artificial intelligence constructed by deep convolutional neural network (DCNN) for the site identification in upper gastrointestinal endoscopy.Methods:A total of 21 310 images of esophagogastroduodenoscopy from the Cancer Hospital of Chinese Academy of Medical Sciences from January 2019 to June 2021 were collected. A total of 19 191 images of them were used to construct site identification model, and the remaining 2 119 images were used for verification. The performance differences of two models constructed by DCCN in the identification of 30 sites of the upper digestive tract were compared. One model was the traditional ResNetV2 model constructed by Inception-ResNetV2 (ResNetV2), the other was a hybrid neural network RESENet model constructed by Inception-ResNetV2 and Squeeze-Excitation Networks (RESENet). The main indices were the accuracy, the sensitivity, the specificity, positive predictive value (PPV) and negative predictive value (NPV).Results:The accuracy, the sensitivity, the specificity, PPV and NPV of ResNetV2 model in the identification of 30 sites of the upper digestive tract were 94.62%-99.10%, 30.61%-100.00%, 96.07%-99.56%, 42.26%-86.44% and 97.13%-99.75%, respectively. The corresponding values of RESENet model were 98.08%-99.95%, 92.86%-100.00%, 98.51%-100.00%, 74.51%-100.00% and 98.85%-100.00%, respectively. The mean accuracy, mean sensitivity, mean specificity, mean PPV and mean NPV of ResNetV2 model were 97.60%, 75.58%, 98.75%, 63.44% and 98.76%, respectively. The corresponding values of RESENet model were 99.34% ( P<0.001), 99.57% ( P<0.001), 99.66% ( P<0.001), 90.20% ( P<0.001) and 99.66% ( P<0.001). Conclusion:Compared with the traditional ResNetV2 model, the artificial intelligence-assisted site identification model constructed by RESENNet, a hybrid neural network, shows significantly improved performance. This model can be used to monitor the integrity of the esophagogastroduodenoscopic procedures and is expected to become an important assistant for standardizing and improving quality of the procedures, as well as an significant tool for quality control of esophagogastroduodenoscopy.

Objective:To explore the effect of three-dimensional(3D) design and printing in the reoperation of asymmetric deformity after orthognathic surgery.Methods:Patients of facial asymmetry after orthognathic surgery were included in the Department of Stomatology, Shenzhen University General Hospital and Department of Oral & Maxillofacial Surgery, Shenzhen Stomatology Hospital Affiliated to Shenzhen University from January 2016 to August 2020. Surgical plans and guide plates (positioning guide plate, bone cutting guide plate, reset guide plate) were made by 3D design and printing. During the operations, guide plates were used to guide osteotomy. The facial shape satisfaction of clinicians/patients/third-party were recorded and analyzed at preoperation and 6-12 months postoperation. These patients’ CT scan data was imported to the digital surgery software. Then the distance of chin-midpoint to mid-sagittal plane and the difference of bilateral protuberant point of mandible body to mid-sagittal plane were measured at preoperation and 6-12 months postoperation to determine whether the asymmetry were corrected and postoperative distance were the same as the preoperative design. Data analysis was conducted using SPSS 17.0 statistical software, and measurement data were expressed as Mean±SD. The preoperative and postoperative satisfaction of patients/clinicians/third-party, digital data of preoperation/postoperation and digital data of design-operations/postoperation were analyzed by paired t-test. Analysis of variance and dunnett- t test were used to compare the satisfaction of the surgeon, the third party and patients before and after operation. Results:There were 16 cases of facial asymmetry after orthognathic surgery, including 3 males and 13 females, aged from 18 to 35 years. In 9 cases, genioplasty were used to correct chin deviation. In the other 4 cases, unilateral buccal cortical bone resection were used to correct mandibular body deviation. In the last 3 cases, genioplasty and unilateral buccal cortical bone resection were both applied. All 16 patients successfully received the operation according to the preoperative digital designed plate. Postoperative follow-up ranged 6 months to 1 year. In the 12 cases of genioplasty, the distance of chin-midpoint to mid-sagittal plane reduced from(4.99±0.83) mm preoperatively to (1.63±0.80) mm postoperatively and the difference significant ( t=9.09, P<0.001). There was no significant difference between the distance of preoperative design [(1.50±0.43) mm] and the postoperative one ( t=-0.83, P=0.423). In the 7 cases of unilateral buccal cortical bone resection, the difference of bilateral protuberant point of mandible body to mid-sagitta plane reduced from (7.26±1.20) mm preoperatively to (2.44±0.56) mm postoperatively and the difference was statistically significant ( t=10.26, P<0.001). There was no significant difference was observed between the distance of preoperative design [(2.39±0.16) mm] and the postoperative one ( t=-0.29, P=0.779). The preoperative satisfaction of patients, clinicians and third-party were 65.94±8.21, 79.69±5.91, 79.38±7.50. The postoperative satisfaction of patients, clinicians and third-party were 90.00±5.48, 90.63±2.50, 90.00±4.08. The postoperative satisfaction of patients, chief surgeon and third party was higher than that preoperative satisfaction and the difference was statistically significant( t=-9.15, P<0.001; t=-7.50, P<0.001; t=-6.04, P<0.001). The difference of preoperation satisfaction was statistically significant( F=18.66, P<0.001). The difference of satisfaction of the clinicians and the patients was statistically significant ( P<0.001). The difference of satisfaction of the third-party and the patients was statistically significant ( P<0.001). The difference of postoperation satisfaction was not statistically significant( F=0.12, P=0.889). Conclusions:3D design and printing can 3D analyze comprehensively, simulate surgery accurately, visualize proposed result and guide 3D printing digital guiding plate to perform surgery accurately. In addition, it can improve postoperative satisfaction. So 3D design and printing had obvious advantages in the secondary surgery of asymmetric deformity correction after orthognathic surgery.

Objective:To explore the effect of three-dimensional(3D) design and printing in the reoperation of asymmetric deformity after orthognathic surgery.Methods:Patients of facial asymmetry after orthognathic surgery were included in the Department of Stomatology, Shenzhen University General Hospital and Department of Oral & Maxillofacial Surgery, Shenzhen Stomatology Hospital Affiliated to Shenzhen University from January 2016 to August 2020. Surgical plans and guide plates (positioning guide plate, bone cutting guide plate, reset guide plate) were made by 3D design and printing. During the operations, guide plates were used to guide osteotomy. The facial shape satisfaction of clinicians/patients/third-party were recorded and analyzed at preoperation and 6-12 months postoperation. These patients’ CT scan data was imported to the digital surgery software. Then the distance of chin-midpoint to mid-sagittal plane and the difference of bilateral protuberant point of mandible body to mid-sagittal plane were measured at preoperation and 6-12 months postoperation to determine whether the asymmetry were corrected and postoperative distance were the same as the preoperative design. Data analysis was conducted using SPSS 17.0 statistical software, and measurement data were expressed as Mean±SD. The preoperative and postoperative satisfaction of patients/clinicians/third-party, digital data of preoperation/postoperation and digital data of design-operations/postoperation were analyzed by paired t-test. Analysis of variance and dunnett- t test were used to compare the satisfaction of the surgeon, the third party and patients before and after operation. Results:There were 16 cases of facial asymmetry after orthognathic surgery, including 3 males and 13 females, aged from 18 to 35 years. In 9 cases, genioplasty were used to correct chin deviation. In the other 4 cases, unilateral buccal cortical bone resection were used to correct mandibular body deviation. In the last 3 cases, genioplasty and unilateral buccal cortical bone resection were both applied. All 16 patients successfully received the operation according to the preoperative digital designed plate. Postoperative follow-up ranged 6 months to 1 year. In the 12 cases of genioplasty, the distance of chin-midpoint to mid-sagittal plane reduced from(4.99±0.83) mm preoperatively to (1.63±0.80) mm postoperatively and the difference significant ( t=9.09, P<0.001). There was no significant difference between the distance of preoperative design [(1.50±0.43) mm] and the postoperative one ( t=-0.83, P=0.423). In the 7 cases of unilateral buccal cortical bone resection, the difference of bilateral protuberant point of mandible body to mid-sagitta plane reduced from (7.26±1.20) mm preoperatively to (2.44±0.56) mm postoperatively and the difference was statistically significant ( t=10.26, P<0.001). There was no significant difference was observed between the distance of preoperative design [(2.39±0.16) mm] and the postoperative one ( t=-0.29, P=0.779). The preoperative satisfaction of patients, clinicians and third-party were 65.94±8.21, 79.69±5.91, 79.38±7.50. The postoperative satisfaction of patients, clinicians and third-party were 90.00±5.48, 90.63±2.50, 90.00±4.08. The postoperative satisfaction of patients, chief surgeon and third party was higher than that preoperative satisfaction and the difference was statistically significant( t=-9.15, P<0.001; t=-7.50, P<0.001; t=-6.04, P<0.001). The difference of preoperation satisfaction was statistically significant( F=18.66, P<0.001). The difference of satisfaction of the clinicians and the patients was statistically significant ( P<0.001). The difference of satisfaction of the third-party and the patients was statistically significant ( P<0.001). The difference of postoperation satisfaction was not statistically significant( F=0.12, P=0.889). Conclusions:3D design and printing can 3D analyze comprehensively, simulate surgery accurately, visualize proposed result and guide 3D printing digital guiding plate to perform surgery accurately. In addition, it can improve postoperative satisfaction. So 3D design and printing had obvious advantages in the secondary surgery of asymmetric deformity correction after orthognathic surgery.