This paper systematically elaborates on the key points of diagnosis and differential diagnosis of salivary gland tumors characterized by a substantial amount of extracellular mucus as a main or prominent feature, and clarifies the core differential features. The term "mucus-rich" specifically denotes that mucus is a major component of the tumor, rather than a focal or minor one. This phenomenon is associated with distinct histogenetic mechanisms: it may result from specific genetic mutations (e.g., AKT1 E17K in mucinous adenocarcinoma) that drive ductal epithelial differentiation into mucus-secreting cells, or from myoepithelial cells secreting glycosaminoglycans that form a myxoid stroma. Salivary gland tumors with abundant extracellular mucus include mucinous cystadenoma, sialadenoma papilliferum-like intraductal papillary tumors, mucinous myoepithelioma, pleomorphic adenoma with mucin-rich stroma, mucinous adenocarcinoma, low-grade mucoepidermoid carcinoma, mucin-rich salivary duct carcinoma and intestinal-type adenocarcinoma. The diagnosis of these tumors is complicated by the dual nature of extracellular mucus: while it is a defining feature of some entities, it can also obscure key diagnostic architectural features in others, leading to histological overlap and inconspicuous diagnostic areas. Given the frequent histological morphological overlap among these tumors, immunohistochemical findings and molecular characteristics have emerged as crucial differential diagnostic criteria. Core differential diagnostic points include the following: histologically, there must be meticulous identification of typical structures obscured by mucin (such as squamoid cells in mucoepidermoid carcinoma and apocrine features in salivary duct carcinoma); in immunohistochemical staining, CK20 is useful for distinguishing intestinal-type adenocarcinoma (positive) from mucinous adenocarcinoma (negative), while androgen receptor aids in differentiating salivary duct carcinoma (positive) from mucoepidermoid carcinoma (negative); and molecular testing plays a critical role in definitive diagnosis (e.g., the AKT1 E17K mutation for mucinous adenocarcinoma, MAML2 rearrangement for mucoepidermoid carcinoma, and MEF2C::SS18 fusion for microsecretory adenocarcinoma). This paper systematically summarizes the core pathological features and differential diagnostic points of mucin-rich salivary gland tumors, aiming to provide a practical reference for clinical pathological diagnosis.

Objective:To prepare the bacterial outer membrane vesicles(OMV)that can express programmed death ligand 1(PD-L1)nanobody on surface,and to discuss its structural characteristics,cell compatibility,intracellular distribution,and its blocking effect on the programmed cell death protein-1(PD-1)/PD-L1 signaling axis.Methods:The pET28a-ClyA-PD-L1nb prokaryotic expression vector was constructed and transformed into Escherichia coli BL21(DE3)competent cells;the OMV was isolated from the BL21(DE3)monoclonal colonies transformed with the PD-L1nb expression vector by ultracentrifugation;the protein purification was performed using the histidine(His)tag;transmission electron microscope and nanoparticle size analyzer were used to analyze and identify the OMV;the OMV isolated from the BL21(DE3)monoclonal colonies transformed with the PD-L1nb expression vector was used as experimental group;the OMV isolated from the untransformed BL21(DE3)monoclonal colonies was used as control group;Western blotting method was used to detect the expression levels of ClyA-PD-L1nb fusion protein in the OMV in two groups;cell counting kit-8(CCK-8)assay was used to detect the activities of mouse macrophage RAW 264.7 cells,mouse triple-negative breast cancer 4T1 cells,and human embryonic kidney HEK293T cells after treated with OMV;fluorescence imaging technology was used to observe the tumor cell endocytosis of OMV;flow cytometry was used to detect the binding effect of OMV to the PD-L1 on surface of the tumor cells in PBS group,OMV-PD-L1nb group,and aPD-L1+OMV-PD-L1nb group.Results:The sodium dodecyl sulfate-polyacrylamide gel electrophoresis(SDS-PAGE)results showed that after induction of Escherichia coli,significantly thickened protein bands appeared near the predicted relative molecular mass(about 49 000),and after purification,no obvious impurity proteins existed in the lanes;the OMV-PD-L1nb with a size of about 120 nm was isolated by ultracentrifugation,and it presented a uniform spherical structure under transmission electron microscope;the Western blotting results showed that the specific band of ClyA-PD-L1nb was detected in the OMV in experimental group;the CCK-8 assay results showed that after treated with different concentrations of OMV,the viabilities of the RAW 264.7 cells,4T1 cells,and HEK293T cells were all close to 100％;the fluorescence imaging results showed that OMV-PD-L1nb was endocytosed by 4T1 cells and dispersed in the cytoplasm;compared with OMV-PD-L1nb group,the average fluorescence intensity in the cells in aPD-L1+OMV-PD-L1nb group was significantly decreased(P＜0.001).Conclusion:The OMV surface-displaying PD-L1nb,OMV-PD-L1nb,is successfully prepared and isolated;OMV-PD-L1nb shows good compatibility on mouse macrophage cells,tumor cells,and human embryonic kidney cells,can be endocytosed by tumor cells,and successfully blocks the PD-1/PD-L1 signaling pathway.

Objective To explore the intervention effect of grading activities on postoperative delirium in patients undergoing total hip arthroplasty(THA).Methods A total of 100 patients who underwent THA at the Third Affiliated Hospital of Sun Yat-sen University from January 2024 to January 2025 were selected as subjects.Using a randomized digital table method,patients were divided into intervention group(n=50)and control group(n=50).The control group received standard postoperative care,while intervention group began implementing grading activities program immediately upon returning to the ward.Delirium incidence,Harris hip function scale(HHS)score,Pittsburgh sleep quality index,average length of hospital stay,average hospitalization costs,and patient satisfaction were compared between two groups.Results Postoperative delirium in intervention group was significantly lower than that in control group(P＜0.05).There were statistically significant differences in HHS,pain scores,and joint function scores between two groups.Sleep quality and higher satisfaction rates were better in intervention group than those in control group,while average hospital stays and total hospitalization costs were lower in intervention group than those in control group with statistically significant(P＜0.05).Conclusion Early grading activities can prevent the occurrence of postoperative delirium in patients with THA,reduce postoperative pain,improve joint function and sleep quality,and effectively improve patient satisfaction.

Objective:To explore the application effect of special quality control management for thyroid and breast ultrasound in community hospitals.Methods:This study was a prospective interventional study. From November 2024 to March 2025, the Department of Ultrasound, China-Japan Friendship Hospital conducted special quality control management for thyroid and breast ultrasound in 17 community hospitals in Chaoyang District. Through measures such as standardized training in thyroid and breast ultrasound as well as quality control investigations before and after the training, changes in the qualification rates of ultrasound image storage, report writing, and nodule grading accuracy for thyroid and breast in community hospitals before and after the implementation of this management were compared, A paired t-test was used for statistical analysis. Results:Thyroid ultrasound quality control effects: Image storage qualification rates significantly improved: the qualification rate of image adjustment increased from 62.94%±22.01% to 85.88%±14.17% ( t=6.35, P<0.001), and body markers application rose from 76.47%±4.93% to 95.29%±7.17% ( t=11.14, P<0.001). The qualification rates for nodule sections and blood flow sections both exceeded 95% ( P<0.001). In report writing: the qualification rates for items such as nodule location, measurement, and echo increased by 10%-25%. The description of nodule margins reached 100% ( t=8.79, P<0.001), and the description of echogenic foci features increased from 41.76% to 79.41% ( t=5.46, P<0.001). Nodule classification accuracy significantly improved: The guideline application rate increased from 55.29% to 91.18% ( t=4.84, P<0.001), and the classification correctness rate rose from 54.71% to 69.41% ( t=5.14, P<0.001). Breast ultrasound quality control effects: Overall improvement in image storage qualification rates: body marker application increased from 75.29%±21.54% to 97.00%±65.88% ( t=3.82, P=0.002). The qualification rates for nodule sections and blood flow section imaging both exceeded 94% ( P<0.001). In report writing: the qualification rates for items like nodule location, measurement, and echo increased by 10%-30%. The classification rate of the Breast Imaging Reporting and Data System (BI-RADS) classification rate rose from 68.82% to 98.24% ( t=3.68, P=0.002), and the classification correctness rate increased from 57.65% to 70.00% ( t=2.74, P=0.014). Conclusion:The implementation of special quality control management for thyroid and breast ultrasound is an effective method to improve the quality of ultrasound medical services in community hospitals.

Objective To explore the perioperative therapeutic effects and follow-up manage-ment in 16 patients with left ventricular assist device(LVAD)implantation.Methods A retrospec-tive analysis was conducted in data of 16 patients who underwent LVAD implantation in the depart-ment of cardiovascular surgery.Data of 6-minute walk test(6MWT),European Quality of Life-5 Di-mension-5 Levels(EQ-5D-5L),New York Heart Association(NYHA)classification,echocardio-graphy,chest radiography,cardiothoracic ratio,and occurrence of complications(infection,bleed-ing,thrombosis,right heart failure,neurological issues)were collected via the electronic medical re-cord system before surgery and at 30,60,and 90 days postoperatively.Results All patients sur-vived with the pump at 90 days postoperatively.One patient with preoperative renal insufficiency un-derwent dialysis and received a heart transplant after 8 months.One patient developed a sterile granu-loma at the percutaneous lead site on the abdominal wall,which improved after treatment,no complica-tions occurred in other patients.At 90 days postoperatively,there was no statistically significant differ-ence in the right ventricular area change fraction and tricuspid annular plane systolic excursion com-pared with preoperative values(P＞0.05).The left ventricular ejection fraction,left ventricular end-diastolic diameter,and cardiothoracic ratio showed significant improvement compared with preoperative levels(P＜0.05).At 30 days postoperatively,30％of patients recovered to NYHA class Ⅰ and 70％to class Ⅱ;at 60 days,80％of patients to class Ⅰ and 20％to class Ⅱ;at 90 days,90％to classⅠ and 10％to class Ⅱ.The 6MWT and EQ-5D-5L scores of patients significantly increased within 90 days postoperatively(P＜0.01).Conclusion Through rigorous preoperative assessment by a multidisciplinary LVAD team,refinement of surgical techniques,and comprehensive management during hospitalization,self-management before discharge,daily follow-up after discharge,and fol-low-up management upon returning to the hospital for patients with LVAD implantation,the cardiac function and quality of life of patients are significantly improved at 90 days postoperatively.

Objective:To explore the high-risk factors affecting the severity of neonatal necrotizing enterocolitis (NEC).Methods:This study involved 153 NEC patients admitted to the Neonatology Department of the Children's Hospital of Soochow University from January 1, 2017, to December 30, 2023. Based on the severity of NEC determined by Bell's criteria, these patients were divided into two groups: mild group (Bell stage Ⅱ, n=70) and severe group (Bell stage Ⅲ, n=83). Clinical data including general conditions, clinical treatment and disease status before the onset of NEC, laboratory test results, and perinatal conditions of the mothers were retrospectively collected. Univariate analysis (rank-sum test and Chi-square test) and multivariate analysis (logistic regression analysis) were used to explore the risk factors affecting the severity of NEC. Results:The proportion of infants with gestational age<37 weeks or birth weight<1 500 g, the rate of antibiotic usage, sepsis or shock were higher in the severe group than in the mild group [91.6% (76/83) vs. 75.7% (53/70); 55.4% (46/83) vs. 34.3% (24/70); 85.5% (71/83) vs. 71.4% (50/70); 55.4% (46/83) vs. 17.1% (12/70); 30.1% (25/83) vs. 8.6% (6/70); with χ 2 values of 7.22, 6.84, 4.57, 23.64, and 10.91, respectively, all P<0.05]. Furthermore, the severe group had a late initiation of breastfeeding and longer durations of peripherally inserted central catheter (PICC) placement and parenteral nutrition [2.00 d (1.00-2.00 d) vs. 1.00 d (1.00-2.00 d); 0.00 d (0.00-18.00 d) vs. 0.00 d (0.00-7.50 d); 14.00 d (5.00-21.00 d) vs. 10.50 d (0.00-18.25 d), with Z values of -2.90, -1.98, and -2.09, respectively, all P<0.05]. (2) Within 48 h before the onset, the severe group had higher proportions of infants with decreased white blood cell count, decreased platelet count, electrolyte imbalance, and metabolic acidosis than the mild group [53.0% (44/83) vs. 14.3% (10/70); 49.4% (41/83) vs. 10.0% (7/70); 38.6% (32/83) vs. 14.3% (10/70); 37.3% (31/83) vs. 14.3% (10/70), with χ2 values of 24.94, 27.38, 11.23, and 10.30, respectively, all P<0.05]. Besides, the levels of procalcitonin and C-reactive protein were higher in the severe group than in the mild group [2.31 ng/ml (0.26-11.71 ng/ml) vs. 0.22 ng/ml (0.00-2.19 ng/ml); 58.50 mg/L (14.34-125.25 mg/L) vs. 8.20 mg/L (0.23-34.56 mg/L), with Z values of -3.88 and -5.02, respectively, both P<0.05]. (3) Multivariate logistic regression analysis showed that prolonged duration of PICC placement, decreased platelet count, electrolyte imbalance, metabolic acidosis, and concurrent sepsis were independent risk factors affecting the severity of NEC [ OR (95% CI) values were 1.104 (1.020-1.196), 5.364 (1.667-17.253), 4.047 (1.171-13.986), 4.333 (1.290-14.556), and 3.290 (1.005-10.774), respectively, with all P<0.05]. Conclusions:Prolonged duration of PICC placement, concurrent sepsis, decreased platelet count, electrolyte imbalance, and metabolic acidosis in NEC patients are more likely to lead to severe cases. In clinical practice, attention should be paid to relevant indicators, and abnormal changes should be identified and intervened in a timely manner to reduce the occurrence of severe NEC.

Objective:To explore the high-risk factors affecting the severity of neonatal necrotizing enterocolitis (NEC).Methods:This study involved 153 NEC patients admitted to the Neonatology Department of the Children's Hospital of Soochow University from January 1, 2017, to December 30, 2023. Based on the severity of NEC determined by Bell's criteria, these patients were divided into two groups: mild group (Bell stage Ⅱ, n=70) and severe group (Bell stage Ⅲ, n=83). Clinical data including general conditions, clinical treatment and disease status before the onset of NEC, laboratory test results, and perinatal conditions of the mothers were retrospectively collected. Univariate analysis (rank-sum test and Chi-square test) and multivariate analysis (logistic regression analysis) were used to explore the risk factors affecting the severity of NEC. Results:The proportion of infants with gestational age<37 weeks or birth weight<1 500 g, the rate of antibiotic usage, sepsis or shock were higher in the severe group than in the mild group [91.6% (76/83) vs. 75.7% (53/70); 55.4% (46/83) vs. 34.3% (24/70); 85.5% (71/83) vs. 71.4% (50/70); 55.4% (46/83) vs. 17.1% (12/70); 30.1% (25/83) vs. 8.6% (6/70); with χ 2 values of 7.22, 6.84, 4.57, 23.64, and 10.91, respectively, all P<0.05]. Furthermore, the severe group had a late initiation of breastfeeding and longer durations of peripherally inserted central catheter (PICC) placement and parenteral nutrition [2.00 d (1.00-2.00 d) vs. 1.00 d (1.00-2.00 d); 0.00 d (0.00-18.00 d) vs. 0.00 d (0.00-7.50 d); 14.00 d (5.00-21.00 d) vs. 10.50 d (0.00-18.25 d), with Z values of -2.90, -1.98, and -2.09, respectively, all P<0.05]. (2) Within 48 h before the onset, the severe group had higher proportions of infants with decreased white blood cell count, decreased platelet count, electrolyte imbalance, and metabolic acidosis than the mild group [53.0% (44/83) vs. 14.3% (10/70); 49.4% (41/83) vs. 10.0% (7/70); 38.6% (32/83) vs. 14.3% (10/70); 37.3% (31/83) vs. 14.3% (10/70), with χ2 values of 24.94, 27.38, 11.23, and 10.30, respectively, all P<0.05]. Besides, the levels of procalcitonin and C-reactive protein were higher in the severe group than in the mild group [2.31 ng/ml (0.26-11.71 ng/ml) vs. 0.22 ng/ml (0.00-2.19 ng/ml); 58.50 mg/L (14.34-125.25 mg/L) vs. 8.20 mg/L (0.23-34.56 mg/L), with Z values of -3.88 and -5.02, respectively, both P<0.05]. (3) Multivariate logistic regression analysis showed that prolonged duration of PICC placement, decreased platelet count, electrolyte imbalance, metabolic acidosis, and concurrent sepsis were independent risk factors affecting the severity of NEC [ OR (95% CI) values were 1.104 (1.020-1.196), 5.364 (1.667-17.253), 4.047 (1.171-13.986), 4.333 (1.290-14.556), and 3.290 (1.005-10.774), respectively, with all P<0.05]. Conclusions:Prolonged duration of PICC placement, concurrent sepsis, decreased platelet count, electrolyte imbalance, and metabolic acidosis in NEC patients are more likely to lead to severe cases. In clinical practice, attention should be paid to relevant indicators, and abnormal changes should be identified and intervened in a timely manner to reduce the occurrence of severe NEC.

Objective To explore the intervention effect of grading activities on postoperative delirium in patients undergoing total hip arthroplasty(THA).Methods A total of 100 patients who underwent THA at the Third Affiliated Hospital of Sun Yat-sen University from January 2024 to January 2025 were selected as subjects.Using a randomized digital table method,patients were divided into intervention group(n=50)and control group(n=50).The control group received standard postoperative care,while intervention group began implementing grading activities program immediately upon returning to the ward.Delirium incidence,Harris hip function scale(HHS)score,Pittsburgh sleep quality index,average length of hospital stay,average hospitalization costs,and patient satisfaction were compared between two groups.Results Postoperative delirium in intervention group was significantly lower than that in control group(P＜0.05).There were statistically significant differences in HHS,pain scores,and joint function scores between two groups.Sleep quality and higher satisfaction rates were better in intervention group than those in control group,while average hospital stays and total hospitalization costs were lower in intervention group than those in control group with statistically significant(P＜0.05).Conclusion Early grading activities can prevent the occurrence of postoperative delirium in patients with THA,reduce postoperative pain,improve joint function and sleep quality,and effectively improve patient satisfaction.

Objective:To explore the application effect of special quality control management for thyroid and breast ultrasound in community hospitals.Methods:This study was a prospective interventional study. From November 2024 to March 2025, the Department of Ultrasound, China-Japan Friendship Hospital conducted special quality control management for thyroid and breast ultrasound in 17 community hospitals in Chaoyang District. Through measures such as standardized training in thyroid and breast ultrasound as well as quality control investigations before and after the training, changes in the qualification rates of ultrasound image storage, report writing, and nodule grading accuracy for thyroid and breast in community hospitals before and after the implementation of this management were compared, A paired t-test was used for statistical analysis. Results:Thyroid ultrasound quality control effects: Image storage qualification rates significantly improved: the qualification rate of image adjustment increased from 62.94%±22.01% to 85.88%±14.17% ( t=6.35, P<0.001), and body markers application rose from 76.47%±4.93% to 95.29%±7.17% ( t=11.14, P<0.001). The qualification rates for nodule sections and blood flow sections both exceeded 95% ( P<0.001). In report writing: the qualification rates for items such as nodule location, measurement, and echo increased by 10%-25%. The description of nodule margins reached 100% ( t=8.79, P<0.001), and the description of echogenic foci features increased from 41.76% to 79.41% ( t=5.46, P<0.001). Nodule classification accuracy significantly improved: The guideline application rate increased from 55.29% to 91.18% ( t=4.84, P<0.001), and the classification correctness rate rose from 54.71% to 69.41% ( t=5.14, P<0.001). Breast ultrasound quality control effects: Overall improvement in image storage qualification rates: body marker application increased from 75.29%±21.54% to 97.00%±65.88% ( t=3.82, P=0.002). The qualification rates for nodule sections and blood flow section imaging both exceeded 94% ( P<0.001). In report writing: the qualification rates for items like nodule location, measurement, and echo increased by 10%-30%. The classification rate of the Breast Imaging Reporting and Data System (BI-RADS) classification rate rose from 68.82% to 98.24% ( t=3.68, P=0.002), and the classification correctness rate increased from 57.65% to 70.00% ( t=2.74, P=0.014). Conclusion:The implementation of special quality control management for thyroid and breast ultrasound is an effective method to improve the quality of ultrasound medical services in community hospitals.

Objective:To explore the relationship between school bullying and mental sub-health in middle school students and the potential moderating role of resilience in this relationship.Methods:Totally 792 students aged 10 to 14 years from two middle schools in Wuhan were selected.The Chinese version of Olweus Bully/Victim Questionnaire,Multidimensional Sub-health Questionnaire of Adolescents,and Adolescent Psychological Resilience Scale were used to measure school bullying,mental sub-health,and psychological resilience of students,respectively.Results:Being bullied scores were positively associated with mental sub-health scores(β=1.88).The moderating effect of psychological resilience scores between being the scores of bullied and mental sub-health was statistically significant(β=-0.07).Conclusion:The experience of bullying may be associated with mental sub-health problems of middle school students,and psychological resilience may play a moderating role in the relation-ship between being bullied and mental sub-health.