Objective To introduce an innovative technique, the "balance-shaped sternal elevation device" and its application in the subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for anterior mediastinal masses resection. Methods Patients who underwent single-port thoracoscopic assisted anterior mediastinal tumor resection through the xiphoid process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from May to June 2024 were included, and their clinical data were analyzed. Results A total of 7 patients were included, with 3 males and 4 females, aged 28-72 years. The diameter of the tumor was 1.9-17.0 cm. The operation time was 62-308 min, intraoperative blood loss was 5-100 mL, postoperative chest drainage tube retention time was 0-9 days, pain score on the 7th day after surgery was 0-2 points, and postoperative hospital stay was 3-12 days. All patients underwent successful and complete resection of the masses and thymus, with favorable postoperative recovery. Conclusion The "balance-shaped sternal elevation device" effectively expands the retrosternal space, providing surgeons with satisfactory surgical views and operating space. This technique significantly enhances the efficacy and safety of minimally invasive surgery for anterior mediastinal masses, reduces trauma and postoperative pain, and accelerates patient recovery, demonstrating important clinical significance and application value.

Objective To investigate the clinical value of prophylactic high-flow nasal cannula oxygen therapy (HFNC) in reducing postoperative pulmonary complication (PPC) in elderly patients with non-small cell lung cancer (NSCLC). Methods The clinical data of elderly patients (over 60 years) with NSCLC who underwent video-assisted thoracoscopic lobectomy or segmental resection at the Department of Thoracic Surgery, Fujian Provincial Hospital from January 2021 to March 2022 were retrospectively analyzed. According to whether receiving HFNC after surgery, they were divided into a conventional oxygen therapy (CO) group and a HFNC group. The CO group were matched with the HFNC group by the propensity score matching method at a ratio of 1 : 1. We compared PPC incidence, white blood cell (WBC) count, procalcitonin and C-reactive protein on postoperative day (POD) 1, 3 and 5 and postoperative hospital stay between the two groups. Results A total of 343 patients (165 males, 178 females, average age of 67.25±4.79 years) were enrolled, with 53 (15.45%) receiving HFNC. Before matching, there were statistical differences in gender, rate of combined chronic obstructive pulmonary disease, pathology type and TNM stage between the two groups (all P<0.05). There were 42 patients successfully matched in each of the two groups, with no statistical difference in baseline characteristics (P>0.05). After propensity score matching, the results showed that the PPC incidence in the HFNC group was lower than that in the CO group (23.81% vs. 45.23%, P=0.039). WBC count on POD 3 and 5 and procalcitonin level on POD 3 were less or lower in the HFNC group than those in the CO group [ (8.92±2.91)×109/L vs. (10.62±2.67)×109/L; (7.68±1.58)×109/L vs. (8.86±1.76)×109/L; 0.26 (0.25, 0.44) μg/L vs. 0.31 (0.25, 0.86) μg/L; all P<0.05]. There was no statistical difference in the other inflammatory indexes or the postoperative hospital stay between the two groups (P>0.05). Conclusion Prophylactic HFNC can reduce the PPC incidence and postoperative inflammatory indexes in elderly patients with NSCLC, but does not shorten the postoperative hospital stay.

Objective To investigate the incidence,biochemical manifestations and genetic mutation features of glutaric acidemia type Ⅱ(GA-Ⅱ)in newborns in Quanzhou,Fujian province.Methods From January 2014 to December 2022,a total of 643 606 newborns were screened for inherited metabolic diseases by tandem mass spectrometry in the Quanzhou area.Suspected positive newborns with multiple acylcarnitine elevations were diagnosed by the MassARRAY assay and high-throughput sequencing technology.Results A total of 247 newborns showed multiple acylcarnitine elevations during the study period,and 19 newborns were diagnosed with GA-Ⅱ by genetic diagnosis.In addition,one newborn showed elevated levels of isovalerylcarnitine(C5),and was suspected to be isovaleric acidemia,which was confirmed with GA-Ⅱ by genetic diagnosis.Twenty newborns were eventually diagnosed with GA-Ⅱ,and the incidence of GA-Ⅱ in the study population was 1:32 180.Newborn screening results showed the concentrations of octanoylcarnitine(C8),decanoylcarnitine(C10)and dodecanylcarnitine(C12)were higher than the upper limit of the reference range,which were key indicators for screening GA-Ⅱ.Ten distinct electrontransfer flavoprotein dehydrogenase ETFDH gene mutations were found in patients with GA-Ⅱ,most of which were missense mutations.The most common ETFDH mutation was C.250G>A(p.A84T)with an allele frequency of 47.5％,followed by C.524G>A(R175H),C.998A>G(p.Y333C)and C.1657T>C(p.Y553H).Conclusion Newborn screening is an important approach for early detection of GA-Ⅱ,but patients with GA-Ⅱ may have atypical biochemical changes,and all newborns with abnormal newborn screening results should be subjected to high-throughput sequencing for genetic diagnosis.

Tuberculosis is a worldwide chronic infectious disease that has become a serious threat to human health.Early diagnosis,drug resistance screening and control of disease transmission are key aspects of TB prevention and treatment.However,existing diagnostic techniques and drug sensitivity tests are time-consu-ming and difficult to realize the purpose of early diagnosis and drug resistance screening,which greatly limits the control of disease transmission.Digital polymerase chain reaction(dPCR)is the third generation of poly-merase chain reaction(PCR),which is a quantitative nucleic acid assay with high sensitivity and no calibration curve.This article provides an overview of the principles of dPCR and its application in tuberculosis diagnosis,drug resistance screening and transmission monitoring,compares dPCR with other tuberculosis detection methods,and looks at the challenges and future prospects of dPCR in clinical tuberculosis laboratory applica-tions.

Objective:In order to explore the impact of corona virus disease 2019(COVID-19)on the hospitalization of children with bronchiolitis and to improve clinicians′ understanding of the characteristics of bronchiolitis during the COVID-19 epidemic.Methods:This was a multicenter clinical study, and the data have been collected from 23 children′s medical centers in China.All the clinical data were retrospectively collected from children with bronchiolitis who were hospitalized at each study center from January 1, 2019 to December 31, 2021.The results included gender, age at hospitalization, length of stay, respiratory syncytial virus(RSV) test results, severity rating, ICU treatment, and the total number of children hospitalized with respiratory tract infection during the same period.The clinical data of children with bronchiolitis in 2019 before COVID-19 epidemic and in 2020、2021 during COVID-19 epidemic were statistically analyzed and compared.Results:According to a summary of data provided by 23 children′s medical centers, there were 4 909 cases of bronchiolitis in 2019, 2 654 cases in 2020, and 3 500 cases in 2021.Compared with 2019, the number of bronchiolitis cases decreased by 45.94% in 2020 and 28.70% in 2021.In 2019, 2020 and 2021, there were no significant differences in gender ratio, age, and duration of hospitalization.Compared with 2019, the ratio of bronchiolitis to the total number of hospitalizations for respiratory tract infection decreased significantly in 2020 and 2021( χ2=12.762, P<0.05; χ2=84.845, P<0.05).The proportion of moderate to severe bronchiolitis cases in both 2020 and 2021 was lower than that in 2019, and the difference was statistically significant ( χ2=4.054, P<0.05; χ2=8.109, P<0.05).There was no statistically significant difference in the proportion of bronchiolitis cases requiring ICU treatment between 2019, 2020, and 2021 ( χ2=1.914, P>0.05).In 2019, a total of 52.60%(2 582/4 909) of children with bronchiolitis underwent RSV pathogen testing, and among them, there were 708 cases with RSV positive, accounting for 28.00%.In 2020, 54.14%(1 437/2 654) of children with bronchiolitis underwent RSV pathogen testing, and there were 403 cases with RSV positive, accounting for 28.04%.In 2021, 66.80%(2 238/3 500) of children with bronchiolitis underwent RSV pathogen testing, and there were 935 cases with RSV positive, accounting for 41.78%.Compared with 2019 and 2020, the RSV positive rate in 2021 showed a significant increase( χ2=99.673, P<0.05; χ2=71.292, P<0.05). Conclusion:During the COVID-19 epidemic, the implementation of epidemic prevention and control measures reduced the hospitalization rate and severity of bronchiolitis, but did not reduce the positive rate of RSV detection.

The total number of cancer patients who are eligible for and will benefit from immune checkpoint inhibitors (ICIs) in China has not been quantified. This cross-sectional study was conducted to estimate the number of Chinese cancer patients with eligibility and response to ICIs based on the 2015 Chinese cancer statistics and the immune checkpoint inhibitor clinical practice guideline of the Chinese Society of Clinical Oncology. A total of 11 ICIs were recommended for 17 cancer types. The estimated number of eligible patients annually was 1 290 156 (55.18%), which included 888 738 males (60.05%) and 400 468 females (46.67%). The estimated number of responders annually was 448 972 (19.20%), which included 309 023 males (20.88%) and 139 764 females (16.29%). Gastric cancer (n=291 000, 12.45%), non-small-cell lung cancer (n=289 629, 12.39%), and hepatocellular carcinoma (n=277 100, 11.85%) were the top three cancer types with the highest number of eligible patients. Non-small-cell lung cancer (n=180 022, 7.70%), hepatocellular carcinoma (n=75 648, 3.24%), and small-cell lung cancer (n=64 362, 2.75%) were the top three cancer types with the highest number of responders. In conclusion, ICIs provide considerable benefit in Chinese cancer patients under optimal estimation.
Humans ; Male ; Female ; Carcinoma, Non-Small-Cell Lung/pathology* ; Immune Checkpoint Inhibitors/therapeutic use* ; Lung Neoplasms/drug therapy* ; Antineoplastic Agents, Immunological/therapeutic use* ; Cross-Sectional Studies ; Carcinoma, Hepatocellular ; Liver Neoplasms

To study the molecular mechanism of salt stress response of peanut small GTP binding protein gene AhRabG3f, a 1 914 bp promoter fragment upstream of the start codon of AhRabG3f gene (3f-P) from peanut was cloned. Subsequently, five truncated fragments (3f-P1-3f-P5) with lengths of 1 729, 1 379, 666, 510 and 179 bp were obtained through deletion at the 5' end, respectively. Plant expression vectors where these six promoter fragments were fused with the gus gene were constructed and transformed into tobacco by Agrobacterium-mediated method, respectively. GUS expression in transgenic tobacco and activity analysis were conducted. The gus gene expression can be detected in the transgenic tobacco harboring each promoter segment, among which the driving activity of the full-length promoter 3f-P was the weakest, while the driving activity of the promoter segment 3f-P3 was the strongest. Upon exposure of the transgenic tobacco to salt stress, the GUS activity driven by 3f-P, 3f-P1, 3f-P2 and 3f-P3 was 3.3, 1.2, 1.9 and 1.2 times compared to that of the transgenic plants without salt treatment. This suggests that the AhRabG3f promoter was salt-inducible and there might be positive regulatory elements between 3f-P and 3f-P3 in response to salt stress. The results of GUS activity driven by promoter fragments after salt treatment showed that elements included MYB and GT1 between 1 930 bp and 1 745 bp. Moreover, a TC-rich repeat between 682 bp and 526 bp might be positive cis-elements responsible for salt stress, and an MYC element between 1 395 bp and 682 bp might be a negative cis-element responsible for salt stress. This study may facilitate using the induced promoter to regulate the salt resistance of peanut.
Arachis/genetics* ; Fabaceae/genetics* ; GTP-Binding Proteins/metabolism* ; Gene Expression Regulation, Plant ; Glucuronidase/metabolism* ; Plant Proteins/metabolism* ; Plants, Genetically Modified/genetics* ; Salt Stress ; Stress, Physiological/genetics* ; Tobacco/genetics*

Objective:To study the effect of sacubitril valsartan sodium tablets on serum tenascin-C (TN-C) level and myocardial remodeling in patients of chronic left heart failure (CHF) complicated with renal failure.Methods:A total of 84 patients with chronic left heart failure complicated with renal failure admitted to Qinhuangdao Jungong Hospital from October 2020 to October 2021 were included and divided into the observation group (treated with sacubitril valsartan sodium tablets) and the control group (treated with valsartan), with 42 cases in each group according to the random number table method. The clinical efficacy of the two groups was compared after 3 months of treatment. The TN-C level and cardiac function index left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), troponin T (cTnT) and other index before the treatment and after 3 months of treatment were compared between the two groups.Results:After 3 months of treatment, the total effective rate between the two groups had no significant difference ( P>0.05). After 3 months of treatment, the TN-C level in the observation group was lower than that in the control group: (32.42 ± 4.22) μg/L vs. (37.32 ± 4.86) μg/L; and the LVEF in the observation group was higher than that in the control group: (41.21 ± 5.39)% vs. (37.76 ± 5.45)%, the differences were statistically significant ( P<0.05). The LVEDD and cTnT in the two groups had no significant differences ( P>0.05). After 3 months of treatment, neuroendocrine factors norepinephrine, aldosterone, angiotensin Ⅱlevels in the in the observation group were lower than those in the control group: (1 668.60 ± 251.19) pmol/L vs. (2 005.86 ± 280.91) pmol/L, (246.97 ± 13.99) ng/L vs. (275.41 ± 19.38) ng/L, (99.68 ± 8.57) ng/L vs. (112.20 ± 9.52) ng/L, the differences were statistically significant ( P<0.05). Conclusions:Sacubitril valsartan sodium tablets have a good effect in the treatment of CHF complicated with renal failure, which can improve the cardiac function and inhibit the over-activation of neuroendocrine hormones.

Objective:To evaluate the relationships among contrast-enhanced ultrasound (CEUS) features, molecular type, and biomarker expression of breast cancer.Methods:A retrospectively analysis of breast cancer patients confirmed by pathology were performed using Breast Imaging Report And Data System (BI-RADS) ultrasound category lesions in the Second Affiliated Hospital Zhejiang University School of Medicine from May 2020 to April 2021. All patients underwent conventional ultrasound and CEUS before biopsy and/or surgery. The relationships among BI-RADS category, quantitative and qualitative CEUS features and biomarker expression of breast cancer were evaluated.Results:All 149 patients with 149 breast lesions were included. The numbers of BI-RADS category 4A, 4B, 4C, and 5 were 8, 60, 49, and 32, respectively. Among them, the numbers of Luminal A like, Luminal B like (human epidermal growth factor receptor-2 (HER-2) positive), Luminal B like (HER-2 negative), HER-2 overexpression and triple negative type were 81, 29, 17, 15, and 7. No significant correlations were found among BI-RADS category, molecular types, and biomarker estrogen receptor (ER), progesterone receptor (PR), HER-2, and antigen Ki-67 (Ki-67) expression (all P>0.05). There were no correlations between quantitative or qualitative CEUS features and molecular types of breast cancer (all P>0.05). There were no correlations between qualitative CEUS variables and ER, PR, HER-2, and Ki-67 expression (all P>0.05). Ascending slope (AS) were negatively correlated with ER and PR expression( r=-0.40, P=0.01; r=-0.35, P=0.03). Descending slope (DS) were positively correlated with ER and PR expression( r=0.42, P=0.01; r=0.36, P=0.03). Arrive time (AT) were positively correlated with HER-2 expression( r=0.37, P=0.02). Conclusions:AS and DS are correlated with ER and PR expression.Arrive time (AT) is correlated with HER-2 expression. The quantitative variables of CEUS are helpful for evaluation of biomarker expression in breast cancer.

Objective:To explore whether the regular feedback system in opportunistic screening of colorectal cancer can improve the adenoma detection rate (ADR) of endoscopists.Methods:This study was an observational study, divided into three stages: the baseline stage before intervention (the pre-intervention period), the regular feedback stage (the intervention period) and the post-intervention stage (the post-intervention period). In the pre-intervention period, all patients who underwent opportunistic screening of colorectal cancer in Department of Gastroenterology in Beijing Shijitan Hospital Affiliated to Capital Medical University from June 2017 to May 2018 were reviewed, and the ADR of each endoscopist was calculated. In the intervention period from June 2018 to November 2018, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist during the previous month was calculated at the beginning of each month and feedback was provided in the form of a report. In the post-intervention period from December 2018 to January 2019, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist was calculated after the feedback stopped. ADR and polyp detection rate (PDR) of three stages were compared.Results:A total of 1 768, 1 308 and 344 patients were enrolled for opportunistic screening of colorectal cancer during the pre-intervention, the intervention and the post-intervention period respectively. Eight endoscopists participated in the whole process of this study. The total ADR increased from 23.70% (419/1 768) in the pre-intervention period to 33.72% (441/1 308) in the intervention period ( χ2=37.449, P<0.05). Two months after intervention, ADR decreased slightly to 33.14% (114/344), but was still higher compared with before ( χ2=13.602, P<0.05). The total PDR increased from 47.17% (834/1 768) in the pre-intervention period to 52.68% (689/1 308) in the intervention period ( χ2=9.111, P<0.05). Two months after the intervention, PDR increased slightly to 53.78% (185/344), and still higher compared with before ( χ2=5.035, P<0.05). Conclusion:Regular feedback to endoscopists can improve ADR in opportunistic screening of colorectal cancer.