The Department of Thoracic Surgery of Shanghai Chest Hospital has performed esophageal function testing for over 30 years, being the only department of its kind in China with this capability. The pressure testing and 24-hour pH/impedance monitoring of the esophagus is of great help to assist in the diagnosis and treatment of benign and malignant esophageal diseases related to it. Thanks to the esophageal function test, in addition to the routine various endoscopic anti-reflux procedures, our hospital has taken the lead in China in recent years to carry out a series of clinical and research work for benign esophageal diseases, such as the development of magnetic ring, double nedoscopic combination and new anti-reflux endoscopic techniques. In recent years, we have carried out high-resolution esophageal manometry and 24-hour pH/impedance monitoring for patients with interstitial pneumonia and pulmonary fibrosis suspected to be caused by gastroesophageal acid reflux. We can better assess the correlation between gastroesophageal reflux and pulmonary fibrosis, and to provide the different clinical treatments and even surgical interventions. The Bravo capsule is used more often in the United States, and it has obvious advantages over traditional approach for acid measurement. We strongly call for the collaboration between industry and academic institutions in this field, and the development of our own related products with independent intellectual property rights.

IL-33 and its receptor ST2 play crucial roles in tissue repair and homeostasis. However, their involvement in optic neuropathy due to trauma and glaucoma remains unclear. Here, we report that IL-33 and ST2 were highly expressed in the mouse optic nerve and retina. Deletion of IL-33 or ST2 exacerbated retinal ganglion cell (RGC) loss, retinal thinning, and nerve fiber degeneration following optic nerve (ON) injury. This heightened retinal neurodegeneration correlated with increased neurotoxic astrocytes in Il33^-/- mice. In vitro, rIL-33 mitigated the neurotoxic astrocyte phenotype and reduced the expression of pro-inflammatory factors, thereby alleviating the RGC death induced by neurotoxic astrocyte-conditioned medium in retinal explants. Exogenous IL-33 treatment improved RGC survival in Il33^-/- and WT mice after ON injury, but not in ST2^-/- mice. Our findings highlight the role of the IL-33/ST2 axis in modulating reactive astrocyte function and providing neuroprotection for RGCs following ON injury.
Animals ; Interleukin-33/genetics* ; Interleukin-1 Receptor-Like 1 Protein/genetics* ; Optic Nerve Injuries/pathology* ; Retinal Ganglion Cells/pathology* ; Astrocytes/pathology* ; Mice ; Mice, Knockout ; Mice, Inbred C57BL ; Neuroprotection/physiology*

OBJECTIVE: To summarize the research progress on the role of macrophage-mediated osteoimmune in osteonecrosis of the femoral head (ONFH) and its mechanisms. METHODS: Recent studies on the role and mechanism of macrophage-mediated osteoimmune in ONFH at home and abroad were extensively reviewed. The classification and function of macrophages were summarized, the osteoimmune regulation of macrophages on chronic inflammation in ONFH was summarized, and the pathophysiological mechanism of osteonecrosis was expounded from the perspective of osteoimmune, which provided new ideas for the treatment of ONFH. RESULTS: Macrophages are important immune cells involved in inflammatory response, which can differentiate into classically activated type (M1) and alternatively activated type (M2), and play specific functions to participate in and regulate the physiological and pathological processes of the body. Studies have shown that bone immune imbalance mediated by macrophages can cause local chronic inflammation and lead to the occurrence and development of ONFH. Therefore, regulating macrophage polarization is a potential ONFH treatment strategy. In chronic inflammatory microenvironment, inhibiting macrophage polarization to M1 can promote local inflammatory dissipation and effectively delay the progression of ONFH; regulating macrophage polarization to M2 can build a local osteoimmune microenvironment conducive to bone repair, which is helpful to necrotic tissue regeneration and repair to a certain extent. CONCLUSION At present, it has been confirmed that macrophage-mediated chronic inflammatory immune microenvironment is an important mechanism for the occurrence and development of ONFH. It is necessary to study the subtypes of immune cells in ONFH, the interaction between immune cells and macrophages, and the interaction between various immune cells and macrophages, which is beneficial to the development of potential therapeutic methods for ONFH.
Humans ; Femur Head/pathology* ; Osteonecrosis/therapy* ; Macrophages/pathology* ; Inflammation ; Femur Head Necrosis/pathology*

Objective:To explore the clinical significance of negative fluid balance and infection management in the treatment of acute respiratory distress syndrome (ARDS) caused by severe novel coronavirus infection.Methods:A retrospective survey was conducted. Patients with ARDS caused by severe novel coronavirus infection who were hospitalized in the department of critical care medicine of the Third Affiliated Hospital of Gansu University of Chinese Medicine and received non-invasive ventilator assisted ventilation were selected as the research objects. The fluid intake and output of all patients were accurately counted every day, and the fluid intake of the next day was adjusted according to the output of the previous day. According to the fluid negative balance, and whether the hospital infection management measures were complied with during the treatment and inspection of the patients, 45 patients with a negative fluid balance of more than 200 mL/d and strict management of nosocomial infection were taken as the observation group, and 48 patients with a negative fluid balance of less than 200 mL/d and no strict management of nosocomial infection were taken as the control group. The general data, weaning success rate, endotracheal intubation rate, mortality, as well as laboratory indicators such as white blood cell count (WBC), procalcitonin (PCT), C-reactive protein (CRP) after treatment were compared between the two groups.Results:There were no significant differences in gender (male: 51.1% vs. 52.1%), age (years old: 66.31±15.92 vs. 67.50±13.59), acute physiology and chronic health evalution Ⅱ (APACHEⅡ: 18.98±4.81 vs. 18.54±4.35) between the observation group and the control group (all P > 0.05), indicating that the baseline data were balanced and comparable. Compared with the control group, the weaning success rate of the observation group significantly increased [53.3% (24/45) vs. 31.2% (15/48), P = 0.031], endotracheal intubation rate significantly decreased [22.2% (10/45) vs. 43.8% (21/48), P = 0.028], mortality significantly reduced [20.0% (9/45) vs. 41.7% (20/48), P = 0.024], laboratory indicators WBC, PCT and CRP levels were significantly reduced [WBC (×10 9/L): 8.085±4.136 vs. 16.898±7.733, CRP (mg/L): 82.827±52.680 vs. 150.679±74.625, PCT (μg/L): 3.142±2.323 vs. 7.539±5.939, all P < 0.01]. Conclusion:Fluid negative balance and infection management have significant clinical significance in the treatment of severe novel coronavirus infection with ARDS.

Background::Breast cancer (BC) risk-stratification tools for Asian women that are highly accurate and can provide improved interpretation ability are lacking. We aimed to develop risk-stratification models to predict long- and short-term BC risk among Chinese women and to simultaneously rank potential non-experimental risk factors.Methods::The Breast Cancer Cohort Study in Chinese Women, a large ongoing prospective dynamic cohort study, includes 122,058 women aged 25-70 years old from the eastern part of China. We developed multiple machine-learning risk prediction models using parametric models (penalized logistic regression, bootstrap, and ensemble learning), which were the short-term ensemble penalized logistic regression (EPLR) risk prediction model and the ensemble penalized long-term (EPLT) risk prediction model to estimate BC risk. The models were assessed based on calibration and discrimination, and following this assessment, they were externally validated in new study participants from 2017 to 2020.Results::The AUC values of the short-term EPLR risk prediction model were 0.800 for the internal validation and 0.751 for the external validation set. For the long-term EPLT risk prediction model, the area under the receiver operating characteristic curve was 0.692 and 0.760 in internal and external validations, respectively. The net reclassification improvement index of the EPLT relative to the Gail and the Han Chinese Breast Cancer Prediction Model (HCBCP) models for external validation was 0.193 and 0.233, respectively, indicating that the EPLT model has higher classification accuracy.Conclusions::We developed the EPLR and EPLT models to screen populations with a high risk of developing BC. These can serve as useful tools to aid in risk-stratified screening and BC prevention.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.

Objective To explore the preference of medical staff in public hospitals for various incentive factors,and to provide theoretical basis for the hospital to formulate a reasonable incentive system and stimulate the enthusiasm of medical staff.Methods Based on the discrete choice experiment,it was conducted from March 2023 to June 2023,through the method of multistage stratified random sampling,the medical staff of a general hospital,a Traditional Chinese Medical Hospital and a maternal and child health hospital in one city in the east,west,south,north and middle of Hainan Province were investigated by questionnaire,and analyzed their incentive preference and willingness to pay by using the mixed logit model.Results All the six attributes have significant influence on medical staff's incentive preference,among which,medical staff prefer to choose the incentive effect brought by the annual salary of 350 000 yuan,good working atmosphere and working intensity of 8 hours,while hospital development has little influence on incentive preference.Among the non-economic factors,when the working atmosphere changes from depression to good,they are willing to get an annual salary of 168 305.4 yuan less,while when the hospital development changes from nothing to good,they are only willing to get an annual salary of 12 433.14 yuan less.Conclusion According to the different incentive needs of medical staff,it is more helpful to formulate accurate incentive schemes and adopt economic and non-economic incentive means to stabilize the hospital talent team and improve work enthusiasm.