BACKGROUND: Lung adenocarcinoma is an important pathohistologic subtype of non-small cell lung cancer (NSCLC). Invasive non-mucinous pulmonary adenocarcinomas (INMA) tend to have a poor prognosis due to their significant heterogeneity and diverse histologic components. Establishing a histologic grading system for INMA is crucial for evaluating its malignancy. In 2021, the International Association for the Study of Lung Cancer (IASLC) proposed that a new histological grading system could better stratify the prognosis of INMA patients. The aim of this study was to establish a visualized nomogram model to predict INMA IASLC grading preoperatively by means of dual-energy computed tomography (DECT), fractal dimension (FD), clinical features and conventional CT parameters. METHODS: A total of 112 patients with INMA who underwent preoperative DECT were retrospectively enrolled from March 2021 to January 2025. Patients were categorized into low-intermediate grade and high grade groups based on IASLC grading. The clinical characteristics and conventional CT parameters, including baseline features, biochemical markers, and serum tumor markers, were collected. DECT-derived parameters, including iodine concentration (IC), effective atomic number (eff-Z), and normalized IC (NIC), were collected and determined as NIC ratio (NICr) and fractal dimension (FD). Univariate analysis was employed to compare differences in conventional characteristics and DECT parameters between the two groups. Variables demonstrating statistical significance were subsequently incorporated into a multivariate Logistic regression analysis. A nomogram model integrating clinical data, conventional CT parameters, and DECT parameters was developed to identify independent predictors for IASLC grading of INMA. The discriminatory performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Multivariate analysis identified smoking history [odds ratio (OR)=2.848, P=0.041], lobulation sign (OR=2.163, P=0.004), air bronchogram (OR=7.833, P=0.005), eff-Z in arterial phase (OR=4.266, P<0.001), and IC in arterial phase (OR=1.290, P=0.012) as independent and significant predictors for IASLC grading of INMA. The nomogram model constructed based on these indicators demonstrated optimal predictive performance, achieving an area under the curve (AUC) of 0.804 (95%CI: 0.725-0.883), with specificity and sensitivity of 85.3% and 65.7%, respectively. CONCLUSIONS The nomogram model based on clinical features, imaging features and spectral CT parameters have a large potential for application in the preoperative noninvasive assessment of INMA IASLC grading.
Humans ; Nomograms ; Female ; Male ; Middle Aged ; Tomography, X-Ray Computed/methods* ; Lung Neoplasms/pathology* ; Aged ; Retrospective Studies ; Adenocarcinoma of Lung/pathology* ; Neoplasm Grading ; Adult

OBJECTIVE To explore the antidepressant effect and potential mechanism of icariside Ⅱ （ICSⅡ） based on the GABAergic nervous system. METHODS The male Kunming mice were randomly divided into a control group （group C， 10 mice） and a modeling group （50 mice）. The depression model was induced by chronic unpredictable mild stress （CUMS） method in the modeling group. After 21 days of stimulation， the rats of modeling group were randomly divided into depression model group （NS group）， positive control group [ECS group， oxalate escitalopram 15 mg/（kg·d）] and ICSⅡ low-dose， medium-dose and high-dose groups [ICSⅡ-L group， ICSⅡ-M group， ICSⅡ-H group； ICSⅡ 10， 20， 30 mg/（kg·d）]， with 10 mice in each group. Administration groups were given relevant medicine intragastrically， once a day， for 14 consecutive days. The sugar water preference rate， total exercise distance， immobility time in tail suspension and forced swimming experiments were detected in each group. The morphology of neurons and Nissl bodies in the hippocampal CA3 region were observed； the contents of γ-aminobutyric acid （GABA） and glutamic acid （Glu）， GABA/Glu ratio， and the expressions of GABAergic nervous system-related proteins （GABA A receptor α1， GABA B receptor 1， vesicular GABA transporter， glutamate decarboxylase 67， GABA membranal transporter 3） were detected in hippocampus. RESULTS Compared with group C， the sugar water preference rate and the total exercise distance significantly reduced in NS group， while the values of immobility time in the tail suspension test and forced swimming test were significantly prolonged （P＜0.05）. The morphology of neurons in the CA3 area of the hippocampus was irregular and the Nissl bodies were reduced， with a significant decrease in the number of structurally intact neurons （P＜0.05）； the content of Glu was significantly increased， while the content of GABA， GABA/Glu ratio， and the expressions of GABAergic nervous system-related proteins were significantly decreased （P＜0.05）. Compared with NS group， depression behavior in each administration group was improved， and the above indexes were mostly reversed （P＜0.05）. CONCLUSIONS ICSⅡ can improve depression behavior of depression model mice. The mechanisms may be associated with regulating the balance of GABA and Glu， increasing the synthesis， transport and release of GABA， and regulating the expressions of GABA-related receptors， so as to improve GABAergic nervous system.

Objective:To investigate the clinical practicability of positive end-expiratory pressure (PEEP) titrated by lung stretch index (SI) in patients with acute respiratory distress syndrome (ARDS).Methods:A parallel randomized controlled trial was conducted. Patients with moderate to severe ARDS who required mechanical ventilation admitted to the department of critical care medicine of General Hospital of the Yangtze River Shipping from August 2022 to February 2023 were enrolled. They were randomly divide into SI guided PEEP titration group (SI group) and pressure-volume curve (P-V curve) inspiratory low inflection point (LIP) guided PEEP titration group (LIP group). All patients were ventilated in a supine position after admission, with the head of the bed raised by 30°. The primary disease was actively treated, prone position ventilation for 12 h/d, and lung protective ventilation strategies such as controlled lung expansion were used for lung recruitment. On this basis, mechanical ventilation parameters were titrated with SI in the SI group; the LIP group titrated mechanical ventilation parameters with P-V curve inspiratory LIP+2 cmH 2O (1 cmH 2O ≈ 0.098 kPa). The oxygenation index (PaO 2/FiO 2), and respiratory mechanics indicators such as lung dynamic compliance (Cdyn), peak airway pressure (Pip) were monitored before recruitment maneuver and after 1, 3, and 5 days of treatment. The therapeutic effect of the two groups was compared. Results:There were 41 patients in the SI group and 40 patients in the LIP group. There was no significant difference in general information such as gender, age, and disease type between the two groups. The mechanical ventilation time and the length of intensive care unit (ICU) stay in the SI group were significantly shorter than those in the LIP group (days: 9.47±3.36 vs. 14.68±5.52, 22.27±4.68 vs. 27.57±9.52, both P < 0.05). Although the 28-day mortality of the SI group was lower than that of the LIP group, the difference was not statistically significant [19.5% (8/41) vs. 35.0% (14/40), P > 0.05]. On the fifth day, the PaO 2/FiO 2 was higher in SI group [mmHg (1 mmHg≈0.133 kPa): 225.57±47.85 vs. 198.32±31.59, P < 0.05], the Cdyn was higher in SI group (mL/cmH 2O: 47.39±6.71 vs. 35.88±5.35, P < 0.01), the Pip was lower in SI group (mmHg: 35.85±5.77 vs. 43.87±6.68, P < 0.05). The Kaplan-Meier survival curve showed no statistically significant difference in the 28 days cumulative survival rate between the two groups (Log-Rank: χ2 = 2.348, P = 0.125). Conclusion:The application of SI titration with PEEP in the treatment of ARDS patients may improve their prognosis.

Objective:To search, evaluate and summarize the best evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy, and to provide reference for clinical practice in order to reduce the complications during labor, such as the proportion of instrument delivery, prolonged labor duration, uterine rupture, postpartum hemorrhage, etc. Standardize the management process of induction of labor with oxytocin, improve the satisfaction of pregnant women to participate in the decision of induction of labor, and improve the outcome of the newborn.Methods:Take the evidence-based nursing method, in view of the full-term pregnancy pregnant women oxytocin drip induced labor evidence-based labor management problems, nearly 10 years related literature retrieval from January 1st 2011 to April 9th, 2021, the Australian JBI evidence-based health care center of literature quality evaluation criteria and evidence classification system, all kinds of research evaluation and classification of retrieval.Results:Early detection to 340 articles, and eventually into 9 articles, including 1 clinical decision, 6 guides, 2 pieces of system evaluation. Totally 45 pieces evidences related to induction of labor by oxytocin infusion in pregnant women with full-term pregnancy were sumarized, including induced labor time, oxytocin side effects, induced labor before evaluation, induced labor of guardianship, infusion solution, such as health education, and other seven aspects.Conclusions:The present study summarized 45 pieces of best evidence on the management of labor induced by oxytocin infusion during term pregnancy, which provided some evidence-based basis for midwives, obstetric nurses and managers. Through the application of the best evidence, it is beneficial to improve the outcome of pregnant women in the neonatal perinatal period, standardize the process of inducing labor with oxytocin, and improve the quality of obstetric care.

Objective To investigate obstetric outcomes of multiparous pregnancies with advanced maternal age in different inter-pregnancy intervals.Methods A retrospective study was performed in 222 multiparous pregnancies with advanced maternal age from January 1 st 2016 to December 31 st 2016.According to the inter-pregnancy intervals,all cases were divided into four groups:Group A (1-3 years),group B (4-6 years) group C (7-9 years) and group D (≥10 years).The clinical characteristics,complications during pregnancy,maternal and fetal outcomes and duration of labor were compared and analyzed in the four groups.Results The average age of groups was significantly different (P ≤ 0.001).But there was no significant difference in the rate of oxytocin (P =0.465),incidence of gestational diabetes mellitus (P =0.698),pregnancy-induced hypertension (P =0.158),premature rupture of membrane (P =0.542)and postpartum hermorrhege (P =0.124) among the four groups.A total of 212 pregnancies underwent vaginal delivery.In group A,the first stage of labor last (239.16 ± 137.63) min,which was significantly shorted than that in group B [(296.36 ± 124.56) min],group C [(332.81 ± 181.01) min] and group D [(337.19 ±224.02)min,P =0.030].However,the interval of delivery did not prolong the second (P =0.137) and third stage of labor (P=0.079).The neonatal birth weight (P =0.276) and the neonatal sex (P =0.918),as well as admission of neonatal intensive care unit (NICU,P =0.103),were similar among three groups.The rate of neonatal asphyxia in group A and group D was higher than that in group B and group C (P =0.021).Conclusions Although the second and third stage were similar among multiparous pregnancies with advanced maternal age,the first stage of labor last longer in the longer inter-pregnancy interval.Furthermore,the risk of neonatal asphyxia was higher in women with inter-pregnancy interval ≤ 3 years or ≥ 10 years.

Objective To investigate the relationship between the polymorphism of cytochrome P450 19 (CYP19) gene rs10046 and the risk of colon and rectal cancer.Methods Using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to analyze gene polymorphism in CYP 19 gene rs10046 in 198 cases of colon and rectal cancer patients (case group) and 309 cases of healthy controls (control group).The genotype frequency and relative risk of CYP19 gene rs10046 between the two groups were compared and the relationship with the clinicopathological features of colorectal cancer was analyzed.Results In case group,the prevalence rates of CYP19 rs10046 genotypes C/C,C/T and T/T were 28.3％,44.4％ and 27.3％,respectively,and 17.2％,51.8％ and 31.1％ in the control group,respectively,with statistical significant difference (P ＜ 0.05).Compared with wild-type C/C,the susceptibility of colorectal cancer with the genotypes of C/T and T/T was decreased by 0.521 (95％ CI:0.330-0.822)and 0.532 (95 ％ CI:0.322-0.880) respectively.Moveover,in the non-smoking group,the risk of colorectal cancer with genotype T/T or C/T was decreased by 0.409 (95％ CI:0.210-0.798) compared with genotype C/C.The interaction was not exist in smoking group.Conclusions The polymorphism of CYP19 gene rs10046 is related to the susceptibility of colon and rectal cancer.The T/T,C/T genotype of CYP19 rs10046 decrease the risk of colon and rectal cancer,and which might be the protective factor of colon and rectal cancer.

Objective To understand the spatial distribution characteristics of wild feces in schistosomiasis endemic areas of Jiangling County,Hubei Province and further explore the source of infection efficiently,so as to provide the evidence for the development of corresponding monitoring and response technology. Methods In 2011,the fresh wild feces were investigated every two months in the selected 15 villages by the severity of historical endemic in Jiangling County. The schistosome miracidi-um hatching method was used to test the schistosome infection of the wild feces. The descriptive analysis and spatial analysis were used for the description of the spatial distribution of the wild feces. Results Totally 701 wild feces samples were collected with the average density of 0.0556/100 m2,and the positive rate of the wild feces was 11.70%(82/701). The results of the re-gression analysis showed a positive spatial correlation between the positive rate of wild feces and the rate of human infection,the area with infected Oncomelania hupensis and the number of fenced cattle,and the corrected R2 of the model was 0.58. Conclu-sion The infection rate of wild feces is positively correlated with the rate of human infection,area with infected O. hupensis and number of fenced cattle in space in Jiangling County,so the prevention and control measures could be conducted according to the spatial distribution of the positive wild feces.

Objective To improve the awareness of fetal cardiac rhabdomyomas (CRs) and investigate a better model for prenatal diagnosis and treatment through analyzing imaging findings and prognosis.Methods A retrospective study was conducted on 23 cases of CRs which were diagnosed by ultrasound in Obstetrics and Gynecology Hospital of Fudan University from January 2008 to November 2015.General conditions,imaging features,prognosis and follow-up data of the 23 cases were described.Results The average gestational age of the 23 fetuses at diagnosis was (29.8±4.1) (22.4-35.7) weeks.Seventeen out of the 23 gravidas received prenatal multidisciplinary consultation.Among all 23 gravidas,three (13％) were lost to follow-up,12 (52％) decided to terminate the pregnancy,and the other eight (35％) continued to term pregnancy and their babies were followed up for three years.Of these eight cases,two cases received prenatal brain MRI and no tuberous sclerosis complex (TSC) was detected,no CRs was identified during the follow-up,and their physical and mental developments were both normal.One case was diagnosed with suspected subependymal nodules by prenatal brain MRI in our hospital,but the MRI images was normal when scanned in the other hospital,and follow-up data revealed neither CRs nor abnormal physical and mental developments.Four cases did not received prenatal brain MRI,but the MRI images of neonatal brains indicated TSC,besides,follow-up data showed that seizures were observed,physical developments were all normal,but three of the four cases had mental retardation;CRs disappeared in only two of the four cases.One case had neither prenatal nor neonatal MRI,but follow-up data showed that CRs had disappeared and physical and mental developments were both normal.Conclusions Prenatal diagnosis of fetal tuberous sclerosis is crucial to the prognosis of CRs.Prenatal ultrasonography in combination with cranial MRI improves the accuracy of prenatal diagnosis of CRs complicated with TSC and assists in clinical decision-making and prognosis analysis.

Objective To investigate the cytopathic effect of amino acid residues 86 to 175 of rotavirus nonstructural protein 4 (NSP486-175) on rat neurons and to analyze the underlying mechanism.MethodsPrimary cultured rat neurons were treated with NSP486-175 and the morphological changes induced in rat neurons were observed.Lactate dehydrogenase (LDH) activity in the culture supernatant of NSP486-175 treated-neurons was measured.Laser scanning confocal microscope was used to detect the concentration of intracellular Ca2+ labeled with Fluo-3 AM.Results Exogenous addition of NSP486-175 induced obvious cytopathic effect on rat neurons.The LDH activity in the culture supernatant of treated-neurons was stronger than that of the control group.The intensity and the distribution of fluorescence in neurons were altered after stimulation with NSP486-175.Conclusion NSP486-175 can induce the damage of rat neurons, which may be related to its role in increasing the concentration of intracellular Ca2+.This study may provide certain theoretical basis for understanding extra-intestinal spread and pathogenesis of rotavirus infection.

Objective To implement a two?level community?based health education pattern of schistosomiasis in residents of endemic areas in marshland and lake regions,so as to explore the suitable pattern of health education under hypo?endemic situa?tion. Methods Two schistosomiasis endemic villages in Jiangling County,Hubei Province were collected as study areas,and among which,one village was treated as an intervention group,where the two?level community?based health education pattern as well as regular control measures was implemented;the other village was a control group,where only regular control measures were implemented. The awareness rates on schistosomiasis control,the rates of correct behavior and the compliance rates of ex?amination,treatment and chemotherapy of the two groups before and after the intervention were compared. Results According to the results of the baseline survey in 2014,the awareness rates of schistosomiasis control of the intervention and control groups were 84.00%and 77.45%,respectively,the correct rates of behavior of the two groups were 72.00%and 63.73%,respectively, and the compliance rates of the treatment were 80.36%and 82.28%,respectively,there were no statistically significant differ? ences between all the above rates of the two groups(all P>0.05). After the intervention of the two?level community?based health education,the correct rates of behavior,and the compliance rates of examination and chemotherapy of the two groups were 92.31%and 80.37%,95.11%and 82.55%,84.13%and 63.64%,respectively,and the differences between all the rates above of the two groups were statistically significant(all P<0.05). When compared to those before intervention,the growing rates of the compliance rates of examination,treatment and chemotherapy of the intervention group were 20.97%,15.33%and 23.29%, respectively,while those of control group were 14.27%,4.17%,-3.77%,respectively,the growing rates of the intervention groups were higher than those of the control groups. Conclusions Through the two?level community?based pattern of health edu?cation,the compliance rates of examination and treatment of the residents have improved,and therefore,the pattern is suitable for popularization and application in marshland and lake regions.