Objective To explore the trend of lung cancer prevalence and influencing factors in a Hospital of Zigong from 2019-2023. Methods Select 2 835 lung cancer patients in Zigong region admitted to the Zigong Fourth People's Hospital from January 2019 to December 2023, and analyze the changes in the clinical characteristics and age strata of patients in different time periods in this group. Three thousand non-cancer respiratory patients in the same time period were included to compare the differences in patient data and to analyze the influencing factors affecting the changes in the characteristics of lung cancer in this region. Results There was an upward trend in the number of patients with pneumonia included between 2019 and 2023, with the highest volume of patients included in 2021 (609 cases). Over the 5-year period, the percentage of patients aged 0-39 years did not change significantly and accounted for a relatively low percentage. The proportion of patients aged 40-49 years increased (APC=0.69%, t=2.990, P<0.05), and the proportion of patients over 60 years old decreased, but to a lesser extent (APC=-0.25%, t=2.210, P<0.05). There were no significant differences in male percentage, lesion site, distant metastasis, smoking history and tumor diameter among patients in different years (all P>0.05). There were significant differences in TNM stage and lymphatic metastasis among patients in different years (all P<0.05). Compared with 2019, the proportion of early stage and patients with lymph node metastasis showed an upward trend within five years (χ²_{early stage}=9.153, P_{early stage}=0.002; χ²_{lymph node metastasis}=5.848, P_{lymph node metastasis}=0.016). The factor associated with the change in age of lung cancer patients in different years was family history of lung cancer (P<0.01). Factors associated with histologic changes in lung cancer patients in different years were age, family history of lung cancer and smoking history (all P<0.05). Factors associated with changes in TNM distribution in lung cancer patients in different years were age, tumor diameter, family history of lung cancer and lymph node metastasis (all P<0.05). Factors associated with changes in lymph node metastasis in lung cancer patients in different years were tumor diameter and TNM stage (all P<0.05). Conclusion From 2019 to 2023, the age of patients with lung cancer in a Hospital in Zigong area showed a decreasing trend, which may be influenced by family history of lung cancer.Patients with TNM early stage and lymph node metastasis increased respectively, which influenced each other and were interfered by factors of age, tumor diameter, and family history of lung cancer.

BACKGROUND: Death burden of stroke is severe with over one-third rural residents in China, but there is still a lack of specific national and high-quality reports on the urban-rural differences in stroke burden, especially for subtypes. We aimed to update the understanding of urban-rural differences in stroke deaths. METHODS: This is a descriptive observational study. Data from the national mortality surveillance system, which covers 323.8 million with 605 disease surveillance points (DSPs) across all 31 provinces, municipalities, and autonomous regions in China. All deaths from stroke as the underlying cause from 2015 to 2020 according to DSPs. Crude mortality rate and age-standardized mortality rate (ASMR) were estimated through DSPs. Average annual percentage change was used to explain the change in mortality rate. RESULTS: From 2015 to 2020, the majority of deaths from all stroke subtypes occurred in rural areas. There were significant differences between the changes of urban and rural ASMRs. On the whole, the changes in urban areas were evidently better, and the ASMR differences were basically expanding. Stroke ASMR in urban China decreased by 15.5%. The rural ASMR of ischemic stroke increased by 12.9%. The rural and urban ASMRs of intracerebral hemorrhage decreased by 24.9% and 27.4%, and those of subarachnoid hemorrhage decreased by 29.5% and 40.4%, respectively. The highest ASMRs of all stroke subtypes and the increasing trend of ischemic stroke ASMR make rural males the focus of stroke management. CONCLUSIONS The death burden of stroke varies greatly between urban and rural China. Rural residents face unique challenges.
Humans ; China/epidemiology* ; Stroke/mortality* ; Rural Population/statistics & numerical data* ; Male ; Female ; Urban Population/statistics & numerical data* ; Middle Aged ; Aged ; Aged, 80 and over ; Adult

This paper introduces the concept of the "medical artistic voice", aiming to provide new perspectives for the development of the discipline. This perspective emphasizes the use of medical approaches to promote the growth of artistic voice. Through medical interventions, it assists professional voice users in managing their careers, addressing voice-related diseases, and evaluating clinical demands for voice treatment and the development of new equipment. This approach seeks to expand the research scope and application fields of the medical artistic voice.
Humans ; Voice ; Voice Disorders

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Objective To investigate the genetic causes of auditory neuropathy with optic atrophy in a family.Methods The proband's medical history and family history were inquired in detail,and relevant clinical examina-tions were performed to confirm the diagnosis of auditory neuropathy with optic atrophy,and the genetic pedigree of the family was drawn.Peripheral blood of proband(Ⅲ-7)was collected for whole exome sequencing,and the patho-genicity of the detected mutations were interpreted.Blood samples of proband's wife(Ⅲ-8),eldest daughter(Ⅳ-7),second daughter(Ⅳ-9)and son(Ⅳ-10)were tested for mutation sites by Sanger sequencing.Combined with clinical manifestations and examination results,the family was studied.Results The genetic pattern of this family was autosomal dominant.The proband showed decreased visual acuity at the age of 19,bilateral sensorineural deaf-ness at the age of 30,and decreased speech recognition rate.Among 20 members of the family of 5 generations,10(2 deceased)showed similar symptoms of hearing and visual impairment.Proband(Ⅲ-7),eldest daughter(Ⅳ-7)and son(Ⅳ-10)underwent relevant examination.Pure tone audiometry showed bilateral sensorineural deafness.ABR showed no response bilaterally.The 40 Hz AERP showed no response in both ears.OAE showed responses in some or all of the frequencies.No stapedial reflex was detected.The eye movement of Ⅲ-7 and Ⅳ-10 were reasona-ble in all directions,and color vision was normal.Ocular papilla atrophy was observed in different degrees in fundus examination.OCT showed thinning of optic disc nerve fibers in both eyes,and visual evoked potential showed pro-longed P100 wave peak.They were diagnosed as hereditary auditory neuropathy with optic atrophy.A mutation of the OPA1 gene c.1334G＞A(p.Arg445His,NM_015560.2)at a pathogenic locus on chromosome 3 was detected by whole exon detection in Ⅲ-7.The results of generation sequencing analysis showed that the OPA1 gene c.1334G＞A(p.Arg445His,NM_015560.2)mutation of chromosome 3 was also found in Ⅳ-7 and Ⅳ-10.Meanwhile,the gen-otypes of Ⅲ-8 and Ⅳ-9 were wild homozygous,that is,no mutation occurred.Conclusion The OPA1 c.1334G＞A(p.Arg445His,NM_015560.2)mutation site might be the pathogenic mutation in this family.

Background::Ebstein’s anomaly (EA) is a rare and complex congenital heart anomaly, and the effect of surgical treatment is not ideal. This study aims to introduce our experience in management strategies, surgical techniques, and operative indications for patients with Ebstein’s anomaly.Methods::A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020. 32 patients had previously received cardiac surgery in other hospitals. The clinical data including diagnosis, operative indications, techniques, pathological changes, and survival rates were collected and analyzed.Results::Anatomical correction was performed in 203 (78.7%) operations, 1? ventricle repair in 38 (14.7%) operations, tricuspid valve repair only in four operations (1.6%), tricuspid valve replacement in ten (3.9%), total cavopulmonary connection (TCPC) in two (0.8%), and Glenn operation in one operation (0.4%). Reoperation was performed in five patients (2.0%) during hospitalization. Among them, tricuspid valve replacement was performed in one patient, 1? ventricle repair in two patients, and tricuspid valve annulus reinforcement in two patients. Five patients died with an early mortality rate of 2.0%. Complete atrioventricular conduction block was complicated in one patient (0.4%). A total of 244 patients was followed up (four in the 253 patients lost) with a duration of 3.0-168.0 (87.6 ± 38.4) months. Cardiac function of 244 patients improved significantly with mean New York Heart Association (NYHA) functional class recovery from 3.5 to 1.1. The mean grade of tricuspid valve regurgitation improved from 3.6 to 1.5. Three late deaths (1.2%) occurred. The survival rates at five and ten years after surgery were 98.6% and 98.2%, respectively. Reoperation was performed in five patients (2.0%) during the follow-up period.Conclusion::Based on our management strategies and operative principles and techniques, anatomical correction of EA is capable of achieving excellent long-term results, and low rates of TCPC, 1? ventricle repair and valvular replacement.

Background::Scleroderma is characterized by inflammation and fibrosis, predominantly occurring in the skin and extending to various parts of the body. The pathophysiology of scleroderma is multifaceted, with the current understanding including endothelial damage, inflammatory cell infiltration, and fibroblast activation in its progression. Nonetheless, the mechanism of cellular interactions and the precise spatial distribution of these cellular events within the fibrotic tissues remain elusive, highlighting a critical gap in our comprehensive understanding of scleroderma’s pathogenesis.Methods::In this study, we administered bleomycin intradermally to the dorsal skin of four individual murine models. Subsequently, skin tissues were harvested at predetermined intervals for comprehensive spatial transcriptomic analysis to determine the spatial dynamics influencing scleroderma pathogenesis. To validate the possible results from bioinformatic analysis, further in vitro and in vivo experiments were conducted. Results::Analysis of the spatial transcriptome revealed significant alterations in cell clusters during the progression of scleroderma. Gene Ontology analysis identified disruptions in lipid metabolism as the disease advanced. Pseudotime analysis provided evidence for a phenotypic transition from adipocytes to fibroblasts. In vitro studies demonstrated increased expression of Col1a1 and α-SMA as the disease progressed. These fibroblasts have been identified as key contributors to the increasing inflammation. Co-culturing TGF-β induced adipocytes with RAW264.7 cells resulted in overexpression of pro-inflammatory cytokines in the RAW264.7 cells. Both in vitro and in vivo experiments confirmed adipocyte loss and fibroblast formation, with transformed fibroblasts showing pronounced pro-inflammatory characteristics, highlighting their crucial role in the disease mechanism. Conclusions::Our study showed the spatial distribution and dynamic alterations of various cell types during scleroderma progression. Crucially, we identified the transformation of adipocytes into fibroblasts as a key factor promoting disease advancement. These emergent fibroblasts intensify inflammation, indicating that research on these cell clusters could reveal key scleroderma mechanisms and guide future therapies.

Objective:To investigate the timing and features of fine-needle aspiration biopsy (FNAB) guided by ultrasound for Bethesda Ⅲ thyroid nodules and to further optimize the puncture scheme.Methods:A retrospective analysis was conducted on data from patients who underwent rFNAB for Bethesda Ⅲ thyroid nodules at the China-japan Union Hospital of Jilin University Thyroid Surgery Department from Dec. 2020 to Dec. 2022. The study included 71 cases (73 nodules), consisting of 57 females and 14 males, with an average age of (45.7±10.4) years. Patients were grouped based on rFNAB results: Bethesda Ⅱ as the benign group ( n=21), Bethesda Ⅴ/Ⅵ as the malignant group ( n=39), and the remaining cases categorized as the indeterminate group ( n=13). Data on rFNAB results, puncture interval time, postoperative pathology, ultrasound features, and FNAB characteristics were recorded. Descriptive statistics were used for categorical data, presented as percentages and numbers, while continuous data were presented as mean ± standard deviation ( ± s). The χ2 test or Fisher's exact test was applied for analysis. Results:In this study, rFNAB was performed on 73 Bethesda Ⅲ thyroid nodules. The results showed that 60 nodules (82.2%) received a definite diagnosis, while 13 nodules (17.8%) were indeterminate. There was a statistically significant difference in the calcification classification between the malignant group and the benign group as well as the indeterminate group ( P<0.05). Among the malignant group, 29 patients underwent surgical treatment, with only 2 cases (8.0%) showing intermediate recurrence risk when surgery was performed more than three months after the initial FNAB. Upon reevaluation of the 31 initial FNAB samples from the malignant group, 9 samples (29.0%) exhibited mild cytological atypia, and 22 samples (71.0%) had poor quality specimens, mainly comprising fibrous and calcified components. Conclusions:For nodules initially classified as Bethesda Ⅲ, if suspicious ultrasound features persist or emerge, especially if microcalcifications are present, rFNAB should be performed after a follow-up period exceeding three months. However, during the puncture, multiple points should be targeted at the non-calcified areas of the nodule to enhance the accuracy and reliability of rFNAB.

Objective:To learn about the epidemiological and clinical characteristics of children with brucellosis, in order to provide reference for clinical diagnosis and treatment of brucellosis in children.Methods:Clinical data of children with brucellosis (aged ≤14 years) who visited the Department of Infectious Diseases at Beidahuang Industry Group General Hospital from December 2020 to December 2022 were retrospectively collected, and their epidemiological characteristics, clinical characteristics, laboratory tests, treatment and outcome were summarized and analyzed.Results:A total of 34 children with brucellosis were included, including 25 males (73.53%) and 9 females (26.47%), with a gender ratio of 2.78 ∶ 1.00. The median age was 8 years and 1 month, mainly in the age group of 6 to 14 years (19 cases, 55.88%). Epidemiological investigation showed that most of the affected children were rural residents (25 cases, 73.53%), with more contact with cattle/sheep (26 cases, 76.47%). The onset time was mainly concentrated in summer (15 cases, 44.12%) and spring (13 cases, 38.24%). The clinical symptoms were mainly fever (97.06%, 33/34) and arthralgia (64.71%, 22/34). In the laboratory tests, 25 cases (73.53%) had positive blood cultures, and the white blood cell count (WBC) of 30 cases (88.24%) was (4 - 10) × 10 9/L. Among the abnormalities of liver function, aspartate aminotransferase (AST) increased in 19 cases (55.88%), alanine aminotransferase (ALT) increased in 14 cases (41.18%) and γ-glutamyl transpeptidase (GGT) increased in 6 cases (17.65%). Among the myocardial enzymatic abnormalities, α-hydroxybutyrate dehydrogenase (HBDH) increased in 29 cases (85.29%), lactate dehydrogenase (LDH) increased in 27 cases (79.41%), and creatine kinase isoenzyme (CK-MB) increased in 8 cases (23.53%). After treatment, 25 children with positive blood culture turned negative. Conclusions:Children with brucellosis are mainly male, older and rural residents. The clinical manifestations are mainly fever and arthralgia. Doctors in relevant departments should conduct detailed epidemiological investigations and laboratory tests for such children in clinical work, in order to achieve early detection, diagnosis and treatment of pediatric brucellosis.

Objective:To investigate the status of nursing practice and organizational management for reperfusion therapy in ischemic stroke across medical institutions in Beijing.Methods:In June 2023, a survey was conducted among nursing managers from 62 medical institutions under the jurisdiction of the Beijing Stroke Treatment Quality Control and Improvement Center. The survey aimed to assess the current nursing practices and organizational management for reperfusion therapy in ischemic stroke.Results:Among the 62 medical institutions, 16.13% (10/62) had dedicated reperfusion therapy nurses for stroke, and 87.10% (54/62) had established specific nursing protocols and procedures for stroke reperfusion therapy within their departments. However, 27.42% (17/62) of these institutions based the development and updates of their protocols on experiential summaries rather than standardized guidelines. In terms of nursing practice, there was room for improvement in emergency identification and triage of suspected stroke patients, assistance with intravenous thrombolysis, patient condition monitoring, early rehabilitation, and related health education. Regarding nursing quality control, significant differences were observed between institutions that regularly conducted quality control of stroke reperfusion therapy nursing and those that organized regular training sessions for nurses in this area ( P<0.05) . Conclusions:While nursing practices and quality for stroke reperfusion therapy in Beijing are progressing, there are disparities in regional development. There is a high demand for specialized stroke nursing and targeted technical training.