Objective To investigate the natural progression of pulmonary ground-glass nodule(GGN)to invasive adenocarcinoma(IAC)and the diagnostic value of follow-up CT.Methods A retrospective analysis was performed on 45 GGN in 45 patients who were followed up for more than 2 years,surgically resected and pathologically confirmed.They were divided into IAC group(n=25)and non-IAC group(n=20),and the clinical and imaging characteristics between the two groups were compared.Results Significant differences were observed in initial volume(P=0.025),initial mass(P=0.005),margin(P=0.027),and time to GGN progression(P=0.005)between the IAC group and the non-IAC group.Multivariate logistic regression analysis indicated that initial mass and time to GGN progression were independent predictors for the diagnosis of IAC.The receiver operating characteristic(ROC)curve analysis results revealed that when using a maximum Youden's index of 0.456,the optimal cutoff for time to GGN progression was 30 months,with a sensitivity of 75.0%and a specificity of 70.6%,and an area under the curve(AUC)of 0.761[95%confidence interval(CI)0.606-0.916](P=0.005).When the maximum Youden's index reached 0.615,the sensitivity,specificity and AUC of the logistic regression model in the diagnosis of IAC were 79.2%,82.4%,and 0.860(95%CI 0.743-0.977)(P=0.001),respectively.The calibration curves demonstrated an excellent consistency between predicted and observed probabilities.Conclusion The optimal observation window for GGN is 30 months,during which IAC generally progresses.Close monitoring is recommended after the initiation of lesion growth.

ObjectiveTo analyze the temporal trend of knockdown resistance (kdr) gene mutations highly correlated with pyrethroid resistance in field populations of Aedes aegypti in Jinghong City of Yunnan Province, and to provide a scientific basis for formulating rational insecticide use strategies. MethodsAdult mosquito samples of Aedes aegypti from 2016 to 2023 and larvae mosquito samples from July 2022 to June 2023 were collected in Jinghong City of Yunnan Province. Allele specific PCR (AS-PCR) was used to measure kdr mutations at amino acid positions 989, 1016 and 1534 of the voltage-gated sodium ion channel (VGSC) gene. Data such as mutation rate and mutation allele frequency were calculated, SPSS software was used to perform trend chi square tests on mutation rate and mutation allele frequency with year and month, as well as comparison of mutation allele frequencies and genotype distributions between the dry and rainy seasons, thereby delineating the temporal trend of kdr gene mutations. ResultsAmong the 173 samples collected from 2016 to 2023, the mutation rates of S989P and V1016G were 100.00% for each year, while the mutation rate of F1534C ranged from 62.50% to 100.00%. The mutation rate and mutation allele frequency of F1534C were increased over the years (χ²=22.079, P<0.001; χ²=42.971, P<0.001). Concurrently, the proportion of the PPGGCC genotype was increased annually (χ²=60.790, P<0.001). Among the 288 samples collected from July 2022 to June 2023, the monthly mutation rates for S989P, V1016G, and F1534C were consistently 100.00%. There was only one type of mutation present, namely S989P+V1016G+F1534C. In the combinations of the three genotypes, the SPGGCC genotype accounted for 1.39% (4/288), the PPGGFC accounted for 2.78% (8/288), and the PPGGCC had the highest proportion at 95.83% (276/288). After tesiting the samples collected in August 2023, the mutation rates of 989, 1016 and 1534 sites of VGSC in females, males, and larvae of the same generation were all 100.00%. ConclusionSince 2016, the gene mutations at S989P and V1016G loci in the VGSC gene of wild Aedes aegypti in Jinghong City have remained consistently at 100.00%, while the mutation rate and mutant allele frequency of F1534C have increased year by year during the testing period. By 2023, the mutation rates at three loci in the VGSC gene of Aedes aegypti in Jinghong City had all reached 100.00%, and neither changes in insect developmental stage nor gender differences during transmission exerted a detectable impact on the mutation rates. In the control of Aedes aegypti in Jinghong City, the use of pyrethroid insecticides should be stopped or reduced, and regular monitoring of kdr genes should be carried out to promptly detect new mutations.

Objective To investigate the natural progression of pulmonary ground-glass nodule(GGN)to invasive adenocarcinoma(IAC)and the diagnostic value of follow-up CT.Methods A retrospective analysis was performed on 45 GGN in 45 patients who were followed up for more than 2 years,surgically resected and pathologically confirmed.They were divided into IAC group(n=25)and non-IAC group(n=20),and the clinical and imaging characteristics between the two groups were compared.Results Significant differences were observed in initial volume(P=0.025),initial mass(P=0.005),margin(P=0.027),and time to GGN progression(P=0.005)between the IAC group and the non-IAC group.Multivariate logistic regression analysis indicated that initial mass and time to GGN progression were independent predictors for the diagnosis of IAC.The receiver operating characteristic(ROC)curve analysis results revealed that when using a maximum Youden's index of 0.456,the optimal cutoff for time to GGN progression was 30 months,with a sensitivity of 75.0%and a specificity of 70.6%,and an area under the curve(AUC)of 0.761[95%confidence interval(CI)0.606-0.916](P=0.005).When the maximum Youden's index reached 0.615,the sensitivity,specificity and AUC of the logistic regression model in the diagnosis of IAC were 79.2%,82.4%,and 0.860(95%CI 0.743-0.977)(P=0.001),respectively.The calibration curves demonstrated an excellent consistency between predicted and observed probabilities.Conclusion The optimal observation window for GGN is 30 months,during which IAC generally progresses.Close monitoring is recommended after the initiation of lesion growth.

Many childhood cancer survivors are suffering serious and long-lasting complications or sequelae, taking a significant toll on their health. Adequate physical activity can be effective in mitigating the negative effects of these complications or sequelae. However, low levels of physical activity are prevalent among childhood cancer survivors. Due to the lack of guidelines on physical activity for childhood cancer survivors, there are many difficulties in correctly guiding childhood cancer survivors to participate in physical activity. Therefore, it is necessary to summarize the relevant studies on the physical activity of childhood cancer survivors. This article provides a review of the concept and measurement of physical activity, recommended amount, and the participation of childhood cancer survivors both domestically and internationally, in order to provide a reference for promoting the physical activity level of Chinese childhood cancer survivors.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

Many childhood cancer survivors are suffering serious and long-lasting complications or sequelae, taking a significant toll on their health. Adequate physical activity can be effective in mitigating the negative effects of these complications or sequelae. However, low levels of physical activity are prevalent among childhood cancer survivors. Due to the lack of guidelines on physical activity for childhood cancer survivors, there are many difficulties in correctly guiding childhood cancer survivors to participate in physical activity. Therefore, it is necessary to summarize the relevant studies on the physical activity of childhood cancer survivors. This article provides a review of the concept and measurement of physical activity, recommended amount, and the participation of childhood cancer survivors both domestically and internationally, in order to provide a reference for promoting the physical activity level of Chinese childhood cancer survivors.

Objective:To evaluate the efficacy and safety of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of pseudomyxoma peritonei (PMP).Methods:In this descriptive case series study, we retrospective analyzed the records of PMP patients treated with CRS and HIPEC between January 2013 and June 2023 at Affiliated Cancer Hospital and Institute of Guangzhou Medical University. The inclusion criteria were as follows: (1) Aged 18 to 75 years and nonpregnant women. (2) Histologically confirmed diagnosis of pseudomyxoma peritonei. (3) Karnofsky Performance Scale (KPS)>70. (4) The functions of major organs such as the heart, liver, lungs, and kidneys can tolerate major surgery for long periods of time. (5) No evidence of extra-abdominal metastasis. Patients with extensive intra-abdominal adhesions or severe infectious diseases were excluded. The main outcomes were overall survival (OS) and postoperative major complications. The postoperative major complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0). We used the peritoneal cancer index (PCI) score to quantitatively assess the peritoneal metastases and the completeness of cytoreduction (CCR) score at the end of surgery (CCR-0 and CCR-1 considered to be complete CRS).Results:A total of the 186 PMP patients with a median age of 56 (interquartile range extremes (IQRE), 48-64) years were included, 65 (34.9%) males and 121 (65.1%) females. The median peritoneal cancer index (PCI) score was 28 (20-34). Appendiceal origin accounted for 91.4%. Histological types were low grade in 99 patients (53.2%), high grade in 57 patients (30.6%), and 55 patients (29.6%) received complete cytoreduction (CCR-0/1). The median operative duration was 300 (211-430) minutes for all patients. Treatment-related 30-day mortality was 2.7%; 90-day mortality 4.3%; reoperation 1.6%; and severe morbidity 43.0%. Within the entire series, anemia(27.4%), electrolyte disturbance(11.6%), and hypoalbuminemia(7.5%) were the most frequent major complications (grade 3-4). The incidences of gastrointestinal anastomotic leakage, abdominal bleeding, and abdominal infection were 2.2%, 2.2%, and 4.3%, respectively. After a median follow-up of 38.1 (95%CI:31.2-45.1) months, the 5-year OS was 50.3% (95%CI: 40.7%-59.9%) with a median survival time of 66.1 (95%CI: 43.1-89.1) months. The survival analysis showed that patients with pathological low grade, low PCI, and low CCR score had better survival with statistically significant differences (all P<0.05). Further stratified into complete and incomplete CRS subgroups, the 5-year OS of the CCR-0 and CCR-1 subgroups was 88.9% (95%CI: 68.3%-100.0%) and 77.6% (95%CI: 62.7%-92.5%), respectively; and 42.0% (95%CI: 29.5%-54.5%) in the CCR-2/3 subgroup. Conclusions:CRS and HIPEC may result in a long-term survival benefit for PMP patients with acceptable perioperative morbidity and mortality. This strategy, when complete CRS is possible, could significantly prolong survival for strictly selected patients at experienced centers.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Objective:Intravenous thrombolysis (IVT) in patients with acute ischemic stroke is strongly time-dependent.The purpose of this study was to investigate whether the transfer of ischemic stroke patients to hospital through emergency medical service (EMS) could shorten onset to needle time (ONT),onset to door time (ODT), door to imaging time(DIT), door to needle time(DNT) and improve the clinical outcomes of intravenous thrombolysis patients.Methods:We retrospectively collected the clinical and time data of acute ischemic stroke(AIS) patients who received IVT in the Affiliated Hospital of Qingdao University on Laoshan campus from September 2021 to August 2022 were retrospectively collected. Patients were divided into EMS group and Non-EMS group according to patients whether transferred by ambulance. The baseline characteristics, length of each period and differences in clinical outcome were compared. Good prognosis was defined as modified Rankin Scale score of 0-2 at 3-months.Results:A total of 175 patients aged (66.1 ±12.3) years were selected, including 63 females (36.0%) and 53 patients (30.3%) were transferred by EMS. Compared with the Non-EMS group, the patients in the EMS group were older, the baseline NIHSS score was higher, ODT and ONT were shorter (all P< 0.05), but there were no significant difference in DIT and DNT between the two groups. Binary Logistic regression model showed that after adjusting for age, sex, baseline NIHSS score, bridging therapy, history of atrial fibrillation, history of hypertension, the number of previous diseases and intracranial hemorrhage, EMS was independently associated with good prognosis of patients with acute ischemic stroke [odds ratio ( OR) 0.376, 95% confidence interval ( CI) 0.144~0.890, P=0.027). Conclusion:EMS could improve the clinical outcomes of acute stroke patients by shortening the ODT and ONT in patients with acute ischemic stroke.

Objective:To evaluate the efficacy and safety of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of pseudomyxoma peritonei (PMP).Methods:In this descriptive case series study, we retrospective analyzed the records of PMP patients treated with CRS and HIPEC between January 2013 and June 2023 at Affiliated Cancer Hospital and Institute of Guangzhou Medical University. The inclusion criteria were as follows: (1) Aged 18 to 75 years and nonpregnant women. (2) Histologically confirmed diagnosis of pseudomyxoma peritonei. (3) Karnofsky Performance Scale (KPS)>70. (4) The functions of major organs such as the heart, liver, lungs, and kidneys can tolerate major surgery for long periods of time. (5) No evidence of extra-abdominal metastasis. Patients with extensive intra-abdominal adhesions or severe infectious diseases were excluded. The main outcomes were overall survival (OS) and postoperative major complications. The postoperative major complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0). We used the peritoneal cancer index (PCI) score to quantitatively assess the peritoneal metastases and the completeness of cytoreduction (CCR) score at the end of surgery (CCR-0 and CCR-1 considered to be complete CRS).Results:A total of the 186 PMP patients with a median age of 56 (interquartile range extremes (IQRE), 48-64) years were included, 65 (34.9%) males and 121 (65.1%) females. The median peritoneal cancer index (PCI) score was 28 (20-34). Appendiceal origin accounted for 91.4%. Histological types were low grade in 99 patients (53.2%), high grade in 57 patients (30.6%), and 55 patients (29.6%) received complete cytoreduction (CCR-0/1). The median operative duration was 300 (211-430) minutes for all patients. Treatment-related 30-day mortality was 2.7%; 90-day mortality 4.3%; reoperation 1.6%; and severe morbidity 43.0%. Within the entire series, anemia(27.4%), electrolyte disturbance(11.6%), and hypoalbuminemia(7.5%) were the most frequent major complications (grade 3-4). The incidences of gastrointestinal anastomotic leakage, abdominal bleeding, and abdominal infection were 2.2%, 2.2%, and 4.3%, respectively. After a median follow-up of 38.1 (95%CI:31.2-45.1) months, the 5-year OS was 50.3% (95%CI: 40.7%-59.9%) with a median survival time of 66.1 (95%CI: 43.1-89.1) months. The survival analysis showed that patients with pathological low grade, low PCI, and low CCR score had better survival with statistically significant differences (all P<0.05). Further stratified into complete and incomplete CRS subgroups, the 5-year OS of the CCR-0 and CCR-1 subgroups was 88.9% (95%CI: 68.3%-100.0%) and 77.6% (95%CI: 62.7%-92.5%), respectively; and 42.0% (95%CI: 29.5%-54.5%) in the CCR-2/3 subgroup. Conclusions:CRS and HIPEC may result in a long-term survival benefit for PMP patients with acceptable perioperative morbidity and mortality. This strategy, when complete CRS is possible, could significantly prolong survival for strictly selected patients at experienced centers.