With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

Objective:To explore the effect of goal directed training(GDT)on motor function of children with severe ce-rebral palsy and to provide evidence for clinical application. Method:A prospective case-control study was conducted with 80 children with severe cerebral palsy,random-ly divided into the study group(n=40)and the control group(n=40).The study group received GDT,while the control group received Neurodevelopment therapy(NDT).The children of the two groups were evaluated by supine and prone position(area A)and sitting position(area B)of 88 items of the gross motor function measure(GMFM-88),visual tracking(area A)and upper limb joint activity(area B)of fine motor function measure(FMFM),level of sitting scale(LSS)and activity daily living scale(ADL)before and at 6-month,12-month after the treatment. Result:After 6 months of treatment,there was no significant difference in GMFM-88 area A and B score,LSS score,FMFM area A and B score and ADL score between the study group and the control group(P＞0.05),whereas after 12 months of treatment,the scores of the research group were significantly higher than those of the control group(P＜0.05).As treatment duration increased,the scores of both groups increased.Group classification,time and the interaction between time and group had significant effects on GMFM-A,GMFM-B,LSS and FMFM-B scores.Time and interaction between time and group had significant effects on FMFM-A and ADL scores. Conclusion:GDT can improve gross motor function,sitting ability,fine motor function,and the activities of daily living in children with severe cerebral palsy.

Objective:To examine the social isolation(SI)status among the elderly population in China and its effect on cardiovascular and cerebrovascular diseases(CCVD).Methods:Utilizing data from the Fourth China Urban and Rural Elderly Living Conditions Sample Survey, the social isolation(SI)score was determined based on four components: marital status, living arrangements, frequency of contact with relatives and friends, and social participation.The χ2 test was employed to examine variations among socially isolated individuals, regional disparities within each province, and subgroups within each covariate.Additionally, Logistic regression was conducted to evaluate the impact of SI and its associated factors on CCVD. Results:The final analysis included 218 329 elderly individuals, revealing that the incidence and number of SI in Shandong Province are the highest in China at 18.95%(3 360 out of 17 735).The incidence of SI in the Eastern coastal provinces is notably higher than in the Western region.Factors contributing to a higher prevalence of SI include living in rural areas, being female, older age, belonging to ethnic minorities, having low educational attainment, facing economic disadvantages, smoking, drinking alcohol, lack of exercise, loneliness, poor sleep quality, and dissatisfaction with housing conditions.The study found that SI increased the risk of developing cardiovascular disease even after adjusting for negative emotional experiences or poor lifestyle choices( OR=1.190, 95% CI: 1.016-1.296, P=0.016, OR=1.208, 95% CI: 1.131-1.291, P<0.001), and the risk further increased when both factors were simultaneously adjusted for( OR=1.237, 95% CI: 1.160-1.319, P<0.001). Conclusions:Combining SI with poor lifestyle and negative emotions significantly raises the risk of cardiovascular disease, highlighting the importance of addressing these factors in the elderly population.

Objective:To analyze the correlation of poorly differentiated cluster(PDC)grade with clinicopathological features and prognosis of patients with colon cancer.Methods:Hematoxylin-eosin-stained specimens and data from 102 patients with colon cancer who under-went surgery at the Affiliated Hospital of Anhui West Health Vocational College between December 2016 and July 2021 were analyzed in this study.The PDC grades of tumor tissues were determined in all colon cancer cases.Additionally,associations between the PDC grade and clinicopathological features of patients were analyzed via Chi-square test and Logistic regression analysis,whereas the association between the PDC grade and patient prognosis was evaluated using Cox regression analysis.Results:In total,52 cases were identified as PDC G1,14 as PDC G2,and 36 as PDC G3.Tumor budding(TB)was independently and positively associated with PDC,whereas tumor infiltrating lympho-cytes(TIL)were independently and negatively associated with PDC(all P<0.05).Lymph node metastasis or presence of cancerous nodules(hazard ratio[HR]=2.377;95%confidence interval[CI]=1.237-4.568;P=0.009),distant metastasis(HR=7.455;95%CI=2.597-21.399;P<0.001),and the PDC grade(HR=2.095;95%CI=1.099-3.994;P=0.025)were independent risk factors for colon cancer progression.Conclu-sions:Our findings suggest that both TIL and TB affect the colon cancer PDC grade.Therefore,evaluating the PDC grade in cancer tissues can facilitate the prognostic stratification of patients with colon cancer.

Pseudorabies virus(PRV)is the etiological agent of pseudorabies in pigs,which is char-acterized by dyspnea,reproductive disorders,and neurological diseases,and it spreads widely a-round the world.Since 2011,the newly emerged PRV variants have resulted in poor immunity pro-tection of traditional vaccine strains,and the original method of vaccine strain preparation is time-consuming and labor-intensive.Therefore,it is urgently needed to develop an efficient screening method of the vaccine strain at present.Using CRISPR/Cas9 gene editing technology in this study,two single guide RNAs(sgRNA)were designed targeting the virulence gene TK of PRV variant strain CH/JX/2016,and then the enhanced green fluorescent protein the reporter(EGFP)gene was inserted at the TK locus by a homologous repair plasmid.After multiple rounds of plaque puri-fication,the rPRV-ΔTK/EGFP strain was obtained.The results showed the cleavage efficiency of the two sgRNAs was extremely high.The preparation of rPRV-ΔTK/EGFP strain was succeed af-ter only three rounds of purification,and the EGFP expressed normally.The CRISPR/Cas9 system can edit the PRV gene simply,rapidly,and efficiently,and exhibits great potential in the construction of vaccine candidate strains.Meanwhile,the rescued rPRV-ΔTK/EGFP strain not only could be used as a tracer strain in PRV variant infection progresses,but also for subsequent antivi-ral drug screening.

Objective     To explore the clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach. Methods    The clinical data of patients with robot-assisted thymectomy surgery via subxiphoid approach performed by the same surgical team in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from February 2021 to August 2022 were retrospectively analyzed. The cumulative sum (CUSUM) analysis and best fit curve were used to analyze the learning curve of this surgery. The general information and perioperative indicators of patients at different learning stages were compared to explore the impact of different learning stages on clinical efficacy of patients. Results    A total of 67 patients were enrolled, including 31 males and 36 females, aged 57.10 (54.60, 59.60) years. The operation time was 117.00 (87.00, 150.00) min. The best fitting equation of CUSUM learning curve was y=0.021 2x3–3.192 5x2 +120.17x–84.444 (x was the number of surgical cases), which had a high R2 value of 0.977 8, and the fitting curve reached the top at the 25th case. Based on this, the learning curve was divided into a learning period and a proficiency period. The operation time and intraoperative blood loss in the proficiency stage were significantly shorter or less than those in the learning stage (P<0.001), and there was no statistical difference in thoracic drainage time and volume between the two stages (P>0.05). Conclusion    The learning process of robot-assisted thymectomy via subxiphoid approach is safe, and this technique can be skillfully mastered after 25 cases.

Objective: To analyse monitoring absenteeism due to respiratory symptoms/diseases among preschoolers in Guangzhou, and to provide reference for risk prevention and control of respiratory infectious diseases in kindergartens. Methods: Data of absenteeism due to symptoms and diseases in kindergartens were collected from "Guangzhou Student Health Monitoring System", and was analyzed by using R 4.1.3 software. Results: During 2018-2020 academic year, there were 1 965, 2 019, 2 236 kindergartens being monitored respectively. The absenteeism rate of kindergarten s children due to respiratory symptoms and diseases in Guangzhou were 3.08‰ and 2.02‰. The absenteeism rates due to respiratory symptoms were 3.75‰, 4.17‰, 2.97‰ and 2.09‰ in baby class, junior class, middle class and senior class, respectively. The absenteeism rates due to respiratory diseases were 2.34 ‰, 2.60‰, 1.94‰ and 1.50‰, respectively. The absenteeism rate in higher grade was lower than that in lower grade( χ 2= 65 197.95 ，27 929.44， P <0.01). The absenteeism rates of boys (3.11‰, 2.05‰) due to respiratory symptoms/diseases were significantly higher than those of girls (3.06‰, 1.97‰)( χ 2=57.71，229.45， P <0.01). The absenteeism of preschoolers due to respiratory symptoms/diseases showed two peaks in December of the this year and May of the following year. At the beginning of the second semester of 2019 academic year (after the outbreak of Coronavirus disease 2019), the absenteeism rate due to respiratory symptoms/diseases were lower than those of the same period in previous years. Conclusions The absences due to respiratory symptoms or diseases not only accounted for half of the total absences due to illness, but also had seasonal characteristics. Children in the youngerage group and most boys are treated as a focus group for absence due to respiratory symptoms/illnesses. It s necessary to give full use of timely warning function of health monitoring system.

Objective: To investigate the general situation of scoliosis and influencing factors among middle school students in Guangzhou, so as to provide evidence for behavioral intervention measures. Methods: By stratified cluster random sampling method, 2 121 students from 8 middle schools of Guangzhou were selected to conduct questionnaire survey and physical examination. Results: The detection rate of scoliosis among middle school students in Guangzhou was 8.20%, girls (9.50%)＞boys (7.00%), urban area (10.45%)＞suburb area (4.77%), senior high school (10.08%)＞junior school (6.39%) ( P ＜0.05). Among the most of the 174 positive students were found to have large thoracic curve, right lateral bending, being girls with medium scoliosis. Multivariate Logistic regression analysis showed that students in urban area ( OR=2.56, 95%CI =1.71-3.82), with mobile electronic devices usage time≥3 h/d( OR=1.59, 95%CI =1.12-2.27), prolonged near vision work ≥1 h ( OR=1.40, 95%CI =1.00-1.95), outdoor activity time＜2 h/d( OR=1.82, 95%CI =1.24-2.67) had a higher detection rate of scoliosis ( P <0.05). Conclusion The detection rate of scoliosis among middle school students in Guangzhou is much higher, which might be related to district, mobile electronic devices usage, prolonged near vision work and insufficient outdoor activity. Health education regarding spinal knowledge should be strengthened.

Objective:To evaluate the efficacy and safety of camrelizumab combined with albumin paclitaxel in second-line treatment of advanced esophageal squamous cell carcinoma (ESCC).Methods:Seventy-two patients with advanced or metastatic ESCC who had failed first-line treatment admitted to the Department of Oncology of the Affiliated Hospital of West Anhui Health Vocational College from May 12, 2019 to August 20, 2020 were enrolled. The patients were given camrelizumab combined with albumin paclitaxel (the experimental group, n=45) or second-line chemotherapy (docetaxel or irinotecan, the control group, n=27) according to patients′ preference. Besides, the objective response rate (ORR), disease control rate (DCR), incidence of adverse events, overall survival (OS) and progress free survival (PFS) were assessed. Results:The ORR of the experimental group and the control group were 26.7% (12/45) and 7.4% (2/27) respectively, with a statistically significant difference ( χ2=3.996, P=0.046). The DCR of the two groups were 48.9% (22/45) and 29.6% (8/27) respectively, with no statistically significant difference ( χ2=2.575, P=0.109). In terms of adverse events, the experimental group was better tolerated, and the incidence of grade 3 or above adverse events was lower [28.9% (13/45) vs. 55.6% (15/27)], which was 48% lower than that of the control group, with a statistically significant difference ( χ2=5.049, P=0.025). One patient in the control group had a treatment-related death. The median OS was 8.9 months (95% CI: 7.9-9.8) in the experimental group and 6.5 months (95% CI: 5.6-7.3) in the control group, with a statistically significant difference ( χ2=5.068, P=0.024). The median PFS was 2.2 months (95% CI: 1.6-2.7) in the experimental group and 1.8 months (95% CI: 1.5-2.0) in the control group, with a statistically significant difference ( χ2=4.799, P=0.028). Conclusion:Camrelizumab combined with albumin paclitaxel in second-line treatment of advanced ESCC patients has proven efficacy and tolerable safety, which may be a potential second-line treatment for advanced ESCC.

Objective: To describe the prevalence and relationship between moderate to vigorous physical activity(MVPA), screen time (ST) and depressive symptoms among middle school students in Guangzhou, and to provide a reference for adolescent depression prevention and control. Methods: Using stratified cluster random sampling method, a total of 2 140 students were selected from one urban area and one suburban country for MVPA, ST and depressive symptoms investigation. Logistic regression was used to analyze relations among MVPA, ST and their combined patterns for depressive symptoms. Results: A total of 89.72% students failed to meet the MVPA recommendations, girls (95.52%) were higher than boys(84.38%). Totally 67.38% of the students failed to meet the ST recommendations, boys (69.75%) were higher than girls(64.81%). The prevalence of depressive symptoms was 27.01%, girls (31.58%) higher than boys(22.80%). MVPA, ST failure compliance rate and depression symptoms detection rate of vocational high school and ordinary high school were higher than junior high school ( χ 2=6.40,121.71,27.37, P ＜ 0.05 ). Logistic regression analysis showed that the OR for depressive symptoms was 1.19 ( P =0.35) in students whose MVPA time achieving 1 h<7 d in the last week, and was 1.93 ( P <0.01) in students with the ST>2 h/d independently, no significant interactions were observed. Students with both MVPA time 1 h<7 d in the last week and the ST>2 h/d were more likely to report depressive symptoms( OR=2.03, P <0.05). Conclusion Insufficient MVPA, prolonged ST and high prevalence of depressive symptoms are observed among middle school students in Guangzhou. Students with both insufficient MVPA and prolonged ST are more likely to suffer from depressive symptoms. Specific psychological care and health education regarding physical activity and screen behavior should be implemented to students with different characteristics, as well as their parents for depressive symptom prevention.