Objective:To compare the results of plasma samples and histological/cytological samples for detection of lung cancer driver gene by next-generation sequencing (NGS), to provide reference for sampling selection of clinical patients.Methods:A retrospective analysis was performed on 220 patients with lung cancer who were admitted to Quanzhou First Hospital in Fujian Province from May 2017 to May 2024, and NGS detection of lung cancer driver gene was performed on both plasma samples and histological/cytological samples. Histological specimens included biopsy or surgical resection of lung cancer, cervical lymph nodes and pleural metastases; the cytological specimen was pleural fluid cell wax block. Specimens were divided into plasma group (experimental group) and matched histological and cytological group (control group). Eight gene variants recommended by the guidelines were EGFR mutation, ALK rearrangement, ROS1 rearrangement, BRAF V600 mutation, RET rearrangement, MET exon 14 jump mutation, KRAS mutation, and NTRK1/2/3 rearrangement. The detection results of the two groups of specimens were compared and analyzed.Results:Among the 220 cases, 183 were adenocarcinoma, 23 were squamous cell carcinoma and 14 were non-small cell lung cancer. There were 4 cases in stage Ⅰ, 3 cases in stage Ⅱ, 24 cases in stage Ⅲ, and 189 cases in stage Ⅳ. In the plasma group, 120 cases were positive, the detection rate was 54.5%; There were 152 positive cases in the control group, the detection rate was 69.1%; the detection rate in the plasma group was lower than that in the control group ( χ2=6.12, P<0.05). The detection rate of plasma in patients with stage Ⅰ/Ⅱ/Ⅲ was 12.9% (4/31), which was significantly lower than that in stage Ⅳ (61.4%; χ2=22.10, P<0.05). In the early clinical stage (stage Ⅰ/Ⅱ) of 7 cases, 3 cases were positive in the control group, while all were negative in the plasma group. There were 24 stage Ⅲ cases, 8 were positive in the control group and 4 were positive in the plasma group. Among the positive cases in the control group, 34 were negative and 4 were not detected in the matched plasma group. In the plasma positive cases, there were 2 negative cases and 4 partial mutations were not detected in the matched control group. Among these 6 cases, 5 were treated patients, and the mean mutation abundance of corresponding plasma positive genes was 1.5%. There were 110 cases with the same positive result (the same mutation site) and 66 cases with the same negative result, with agreement rate of 80.0% (176/220). The sensitivity and specificity of the plasma group were 75.0% (114/152) and 91.7% (110/120), respectively. Conclusions:When NGS is used for lung cancer driver gene detection, the positive rate of plasma samples is lower than that of tissue/cytology samples, but the consistency rate with the latter can reach 80%, and the sensitivity is higher than 70%, which has a good clinical detection efficiency, especially for patients with non-small cell lung cancer stage Ⅳ.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To compare the results of plasma samples and histological/cytological samples for detection of lung cancer driver gene by next-generation sequencing (NGS), to provide reference for sampling selection of clinical patients.Methods:A retrospective analysis was performed on 220 patients with lung cancer who were admitted to Quanzhou First Hospital in Fujian Province from May 2017 to May 2024, and NGS detection of lung cancer driver gene was performed on both plasma samples and histological/cytological samples. Histological specimens included biopsy or surgical resection of lung cancer, cervical lymph nodes and pleural metastases; the cytological specimen was pleural fluid cell wax block. Specimens were divided into plasma group (experimental group) and matched histological and cytological group (control group). Eight gene variants recommended by the guidelines were EGFR mutation, ALK rearrangement, ROS1 rearrangement, BRAF V600 mutation, RET rearrangement, MET exon 14 jump mutation, KRAS mutation, and NTRK1/2/3 rearrangement. The detection results of the two groups of specimens were compared and analyzed.Results:Among the 220 cases, 183 were adenocarcinoma, 23 were squamous cell carcinoma and 14 were non-small cell lung cancer. There were 4 cases in stage Ⅰ, 3 cases in stage Ⅱ, 24 cases in stage Ⅲ, and 189 cases in stage Ⅳ. In the plasma group, 120 cases were positive, the detection rate was 54.5%; There were 152 positive cases in the control group, the detection rate was 69.1%; the detection rate in the plasma group was lower than that in the control group ( χ2=6.12, P<0.05). The detection rate of plasma in patients with stage Ⅰ/Ⅱ/Ⅲ was 12.9% (4/31), which was significantly lower than that in stage Ⅳ (61.4%; χ2=22.10, P<0.05). In the early clinical stage (stage Ⅰ/Ⅱ) of 7 cases, 3 cases were positive in the control group, while all were negative in the plasma group. There were 24 stage Ⅲ cases, 8 were positive in the control group and 4 were positive in the plasma group. Among the positive cases in the control group, 34 were negative and 4 were not detected in the matched plasma group. In the plasma positive cases, there were 2 negative cases and 4 partial mutations were not detected in the matched control group. Among these 6 cases, 5 were treated patients, and the mean mutation abundance of corresponding plasma positive genes was 1.5%. There were 110 cases with the same positive result (the same mutation site) and 66 cases with the same negative result, with agreement rate of 80.0% (176/220). The sensitivity and specificity of the plasma group were 75.0% (114/152) and 91.7% (110/120), respectively. Conclusions:When NGS is used for lung cancer driver gene detection, the positive rate of plasma samples is lower than that of tissue/cytology samples, but the consistency rate with the latter can reach 80%, and the sensitivity is higher than 70%, which has a good clinical detection efficiency, especially for patients with non-small cell lung cancer stage Ⅳ.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To analyze the prognosis and risk factors for complete common peroneal nerve injury after total hip arthroplasty (THA) and revision via the modified Hardinge approach.Methods:A retrospective study was conducted to analyze the clinical data of 11 patients (nerve injury group) who had developed complete common peroneal nerve injury after THA and revision via the modified Hardinge approach at Department of Joint Surgery, The Affiliated Hospital of Qingdao University from April 2016 to April 2022. There were 7 males and 4 females, with an age at the time of surgery of (59.5±10.1) years and a body mass index of (26.1±3.5) kg/m 2. In a 1∶5 ratio, another 55 patients were included in the nerve injury free group who had not developed common peroneal nerve injury after THA or revision and were matched in surgical year, surgical type, surgical approach, prosthesis fixation mode, and chief surgeon. The clinical data were compared between the 2 groups. Variables with P<0.05 were included in a multifactorial logistic regression model to analyze the risk factors for the complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. The time for recovery of nerve function and functional recovery of the common peroneal nerve at the last follow-up were recorded in the nerve injury group. Results:The differences were statistically significant between the 2 groups in the comparisons of drainage tube placement, body mass index, operative time, and postoperative limb lengthening ( P<0.05). The multifactorial logistic regression analysis showed that absence of drainage tube placement ( OR=0.047, 95% CI: 0.003 to 0.680, P=0.025) and long operative time ( OR=1.063, 95% CI: 1.002 to 1.128, P=0.044) were the risk factors for complete common peroneal nerve injury after THA and revision. The 11 patients were followed up for (48.0±22.0) months after operation. The function of the common peroneal nerve recovered fully at postoperative 3, 21, and 24 months respectively in 3 patients, and began to recover at postoperative 2, 3, 10, and 48 months and recovered to muscle strength levels 3, 2, 2, and 1 at the last follow-up in 4 patients respectively. The neurological function of the common peroneal nerve did not recover in 4 patients whose feet drooped significantly during walking to seriously affect their daily life. Conclusions:Absence of drainage tube placement and long operative time are the risk factors for complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. Once complete common peroneal nerve injury occurs, the prognosis is generally poor for the patients.

Objective:To analyze the prognosis and risk factors for complete common peroneal nerve injury after total hip arthroplasty (THA) and revision via the modified Hardinge approach.Methods:A retrospective study was conducted to analyze the clinical data of 11 patients (nerve injury group) who had developed complete common peroneal nerve injury after THA and revision via the modified Hardinge approach at Department of Joint Surgery, The Affiliated Hospital of Qingdao University from April 2016 to April 2022. There were 7 males and 4 females, with an age at the time of surgery of (59.5±10.1) years and a body mass index of (26.1±3.5) kg/m 2. In a 1∶5 ratio, another 55 patients were included in the nerve injury free group who had not developed common peroneal nerve injury after THA or revision and were matched in surgical year, surgical type, surgical approach, prosthesis fixation mode, and chief surgeon. The clinical data were compared between the 2 groups. Variables with P<0.05 were included in a multifactorial logistic regression model to analyze the risk factors for the complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. The time for recovery of nerve function and functional recovery of the common peroneal nerve at the last follow-up were recorded in the nerve injury group. Results:The differences were statistically significant between the 2 groups in the comparisons of drainage tube placement, body mass index, operative time, and postoperative limb lengthening ( P<0.05). The multifactorial logistic regression analysis showed that absence of drainage tube placement ( OR=0.047, 95% CI: 0.003 to 0.680, P=0.025) and long operative time ( OR=1.063, 95% CI: 1.002 to 1.128, P=0.044) were the risk factors for complete common peroneal nerve injury after THA and revision. The 11 patients were followed up for (48.0±22.0) months after operation. The function of the common peroneal nerve recovered fully at postoperative 3, 21, and 24 months respectively in 3 patients, and began to recover at postoperative 2, 3, 10, and 48 months and recovered to muscle strength levels 3, 2, 2, and 1 at the last follow-up in 4 patients respectively. The neurological function of the common peroneal nerve did not recover in 4 patients whose feet drooped significantly during walking to seriously affect their daily life. Conclusions:Absence of drainage tube placement and long operative time are the risk factors for complete common peroneal nerve injury after THA and revision via the modified Hardinge approach. Once complete common peroneal nerve injury occurs, the prognosis is generally poor for the patients.

Objective:To observe the corneal morphology and visual quality after transepithelial photorefractive keratectomy (Trans-PRK) with smart pulse technique (SPT) and 1 050 Hz cutting frequency in the correction of myopia and astigmatism.Methods:A self-controlled case series study was conducted.Sixty five eyes of 33 patients who underwent Trans-PRK surgery in Ineye Hospital of Chengdu University of TCM from July 2017 to June 2018 were followed up for 6 months.The uncorrected visual acuity (UCVA) converted to logarithm of the minimum angle of resolution (LogMAR) unit, best corrected visual acuity (BCVA) (LogMAR), and spherical equivalent (SE) of the subjects were recorded.The anterior corneal surface symmetry index (SI), the anterior corneal surface Q value in the range of 6, 7, 8, and 9 mm diameter, the spherical aberration, coma, trefoil and total higher-order aberration of the anterior corneal surface, the strehl ratio (SR), and the modulation transfer function (MTF) of 10, 20, 30, and 40 c/d in the horizontal and vertical meridian directions before and after surgery were measured with Sirius corneal topography analyzer.The differences of each index among different time points were compared, and the correlation between indexes was analyzed by Pearson correlation analysis.This study followed the Declaration of Helsinki.The study protocol was approved by the Medical Ethics Committee of Ineye Hospital of Chengdu University of TCM (No.2020yh-004). All patients signed the informed consent form before surgery.Results:The average preoperative BCVA and SE were -0.09±0.06 and (-4.24±1.24)D.The mean UCVA and SE at 7 days, 1, 3 and 6 months postoperatively were -0.10±0.08 and (0.03±0.63)D, -0.12±0.06 and (0.08±0.53)D, 1.16±0.06 and (0.02±0.79)D, -0.18±0.05 and (0.08±0.37)D, respectively.The SI at different time points after the surgery were significantly higher than that before operation (all at P<0.05). At 1, 3 and 6 months after surgery, the Q value of anterior corneal surface in different diameter ranges increased from negative to positive, showing statistically significant differences (all at P<0.05). At each time point after surgery, the trefoil and total higher-order aberrations of the anterior corneal surface increased to varying degrees.Coma at 7 days and 6 months after surgery were significantly higher than that before surgery, and spherical aberration at 3 and 6 months after surgery were significantly higher than that before surgery (all at P<0.05). The SR values at 3 and 6 months after operation were significantly higher than that before operation (all at P<0.05). At 6 months after operation, the MTF values at different spatial frequencies of the horizontal meridian and the MTF values at 30 and 40c/d spatial frequencies of the vertical meridian were lower than those before operation, and the differences were statistically significant (all at P<0.05). The correlation analysis showed that the Q value of different diameter ranges was positively correlated with spherical aberration ( r=0.798-0.925, P<0.05), total higher-order aberration ( r=0.596-0.630, P<0.05), SI ( r=0.235-0.303, P<0.05) and corneal ablation depth ( r=0.583-0.659, P<0.05) at 6 months after surgery.SI was positively correlated with spherical aberration ( r=0.307, P<0.05), coma ( r=0.424, P<0.05), total higher-order aberration ( r=0.300, P<0.05), corneal ablation depth ( r=0.227, P<0.05), and eccentric cutting amount ( r=0.281, P<0.05). There was no correlation between SR and aberration, corneal ablation depth, eccentric cutting amount, etc.(all at P≥0.05). Conclusions:Trans-PRK using SPT to correct myopic astigmatism can improve vision, stabilize diopter, enhance retinal imaging quality, increase the asymmetry of the anterior corneal surface, and introduce different degrees of higher-order aberrations.

Objective To investigate the prevalence rate of occult HBV infection (OBI) in patients with autoimmune hepatitis (AIH) and the influence of OBI in the clinical condition and prognosis of AIH patients. Methods A total of 103 patients with a confirmed diagnosis of AIH who were admitted to Beijing YouAn Hospital from April 2012 to March 2019 were enrolled. Nested PCR and real-time PCR were used to confirm the diagnosis of OBI, and real-time PCR was used to measure HBV pgRNA. Clinical features, laboratory markers, and follow-up analysis of prognosis were compared between the OBI group with 24 patients and the non-OBI group with 79 patients. The independent samples t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the Cox regression model was used to perform univariate and multivariate analyses. Hazard ratio and its 95% confidence interval were calculated. Results The detection rate of OBI was 23.30% (24/103) in AIH patients, with an HBV DNA viral load of < 200 IU/mL, among whom 9 patients with OBI (9/24, 37.50%) were found to have HBV pgRNA in serum. Compared with the non-OBI group, the OBI group had a significantly higher positive rate of the three antibodies anti-HBs, anti-HBc, and anti-HBe ( χ 2 =5.906, P =0.016). The univariate analysis showed that OBI, hypoproteinemia, splenomegaly, and ascites were risk factors for adverse events in AIH (all P < 0.05) and were associated with disease progression, and the multivariate Cox regression analysis showed that hypoproteinemia and ascites were independent risk factors for adverse events (all P < 0.05). Conclusion There is a relatively high detection rate of OBI in AIH patients, and the presence of OBI may accelerate the progression of AIH.

Background Air quality health index (AQHI) has been widely used to quantify the health effects of multiple pollutants observed in population-based epidemiological studies, and can better reflect the widespread linear non-threshold between air pollution and health effects. Objective To explore an AQHI for pediatric respiratory diseases (AQHI_r) in Shanghai and evaluate its feasibility. Methods The daily numbers of hospital outpatient visits for pediatric respiratory diseases from 2015 to 2019 were obtained from five general hospitals in Xuhui, Baoshan, Hongkou, Jinshan, and Chongming Districts of Shanghai. Monitoring data on air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, and O₃), air quality index (AQI), and meteorological variables (temperature, relative humidity, air pressure, and wind speed) were collected from five air quality monitoring sites nearest to selected hospitals. Time-series analysis using generalized additive model (GAM) was conducted to estimate the associations between respiratory-related pediatric outpatient visits and the concentrations of air pollutants. The sum of excess risk (ER) of hospital outpatient visits was used to construct AQHI_r. To assess the predictive power of AQHI_r, the associations of AQHI_r and AQI with the number of pediatric respiratory outpatient visits in three hospitals in Xuhui, Hongkou, and Chongming districts were compared. Results Air pollutants had various effects on respiratory diseases outpatient visits. PM_2.5, NO₂, and O₃ had most significant impacts on lag0 day and the associated ERs of hospital outpatient visits for each 10 μg·m⁻³ increase in pollutant concentration were 1.27% (95%CI: 0.88%-1.66%), 0.75% (95%CI: 0.40%-1.11%), and 0.36% (95%CI: 0.10%-0.62%), respectively. PM₁₀ and SO₂ had most significant impacts on lag3 day and the associated ERs of hospital outpatient visits for each 10 μg·m⁻³ increase in pollutant concentration were 0.81% (95%CI: 0.51%-1.12%) and 5.64% (95%CI: 3.37%-7.96%), respectively. There were significant effects of combinations of two pollutants among PM_2.5, PM₁₀, NO₂, SO₂, and O₃ except for PM₁₀+NO₂, SO₂+PM_2.5, and SO₂+NO₂ (P<0.05). According to the results of single-pollutant and two-pollutant models, PM_2.5, NO₂, SO₂, and O₃ were selected to construct AQHI_r. The comparison showed that for every interquartile range increase in AQHI_r, the ER for pediatric outpatient visits was higher than that for the value corresponding to AQI. Conclusion Air pollutants in Shanghai have an impact on the number of pediatric respiratory outpatient visits. The AQHI_r based on and outpatient visits for pediatric respiratory diseases can be a sensitive index to predict the effects of air pollution on children's respiratory health.

Objective:To research the metabolomic alterations of human lung bronchial epithelial cells infected with human rhinovirus 1B (HRV1B).Methods:Untargeted metabolomics was used to determine the metabolomic alterations in human lung bronchial epithelial cells (BEAS-2B) 6 h, 12 h and during the dynamic process (6 h∶12 h) after HRV1B infection.Results:A total of 93 differentially significant metabolites (DSMs) (47 DSMs were up-regulated and 46 DSMs were down-regulated) and 88 DSMs (37 DSMs were up-regulated and 51 DSMs were down-regulated) at post infection of HRV1B in BEAS-2B at 6 h or 12 h, respectively. A total of 30 DSMs (12 DSMs were up-regulated and 18 DSMs were down-regulated) in a dynamic process (6 h∶12 h) after HRV1B infection. Unknown metabolites took up most proportions. The trends of fatty acid, lipid, amino acid, nucleotide and carbohydrate were increased along with the prolonging of HRV1B infection. DSMs such as Diisononyl phthalate was co-detected DSMs among three groups.Conclusions:Metabolites such as fatty acid, lipid, amino acid, nucleotide and carbohydrate of BEAS-2B cells are changed induced by HRV1B infection.