Objective:To investigate the independent and combined effects of maternal smoking during pregnancy and offspring genetic susceptibility on overall cancer mortality.Methods:Based on the United Kingdom Biobank ( n=419 228) data, the Cox proportional hazard regression model was used to estimate the effect of maternal smoking during pregnancy on offspring overall cancer (including 16 cancers in men and 18 in women) mortality and its combined effect and interaction with offspring genetic factors. Results:Maternal smoking during pregnancy was significantly associated with a 13% increased risk of overall cancer mortality in men [hazard ratio( HR)=1.13, 95% CI: 1.06-1.20] and 19% increased risk in women ( HR=1.19, 95% CI: 1.11-1.27). Participants with high genetic risk had the highest overall cancer mortality than those with low genetic risk (men: HR=1.42, 95% CI: 1.30-1.55; women: HR=1.38, 95% CI: 1.25-1.52). Compared with participants without maternal smoking during pregnancy and low genetic risk, those with maternal smoking during pregnancy and high genetic risk were associated with a 56% increased risk of overall cancer mortality in men ( HR=1.56, 95% CI: 1.37-1.77) and 59% in women ( HR=1.59, 95% CI: 1.39-1.83). Conclusion:Maternal smoking during pregnancy may increase offspring overall cancer mortality and more severe harm in individuals with high genetic risk.

Objective:To investigate the impact of air pollution on dynamic changes in lung function and further explore the association between genetic factors and lung function and its changes.Methods:Research data were from 14 506 participants in the United Kingdom Biobank with two complete baseline and follow-up lung function tests. Particulate matter [including particulate matter with aerodynamic diameter ≤2.5 μm and ≤10 μm (PM 2.5 and PM 10)], nitrogen dioxide (NO 2), and nitrogen oxides (NO x) concentrations were estimated using land-use regression models. Annual changes in lung function were calculated based on baseline and follow-up lung function tests. Polygenic risk scores (PRS) of lung function [forced expiratory volume in the first second (FEV 1), forced vital capacity (FVC), and the ratio of FEV 1 to FVC (FEV 1/FVC)] were constructed by genetic variations. The association between air pollution concentrations and lung function changes was analyzed by multiple linear regression models, and the impact of genetic factors on lung function and its changes was also assessed. Results:PM 2.5, PM 10, NO 2, and NO x showed a negative correlation with FVC changes [PM 2.5: -6.66 (95% CI: -9.92- -3.40) ml/year; PM 10: -0.40 (95% CI: -0.77- -0.03) ml/year; NO 2: -1.84 (95% CI: -2.60- -1.07) ml/year; NO x: -1.37 (95% CI: -2.27- -0.46) ml/year]. Additionally, PM 2.5, PM 10and NO 2 were also negatively correlated with changes in FEV 1 [PM 2.5: -3.19 (95% CI: -5.79- -0.59) ml/year; PM 10: -3.00 (95% CI: -5.92- -0.08) ml/year; NO 2: -0.95 (95% CI: -1.56- -0.34) ml/year]. PRS of lung function were positively correlated with baseline lung function (FVC, FEV 1, and FEV 1/FVC) and lung function changes (all β>0, all P<0.001). In different PRS stratification analyses, the effect of air pollution on lung function changes remained significant, and there was no apparent heterogeneity. Conclusions:PRS of lung function are significantly associated with baseline and lung function changes. Long-term exposure to air pollution accelerates the decline of lung function indicators such as FVC and FEV 1. The effects of air pollution are consistent in individuals with different genetic risk scores.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Objective    To analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement. Methods    The clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared. Results    There were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m2. There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m2. Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05). Conclusion    The aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.  

Polymyxin B and polymyxin E (colistin) are presently considered the last line of defense against human infections caused by multidrug-resistant Gram-negative organisms such as carbapenemase-producer Enterobacterales, Acinetobacter baumannii, and Klebsiella pneumoniae. Yet resistance to this last-line drugs is a major public health threat and is rapidly increasing. Polymyxin S₂ (S₂) is a polymyxin B analogue previously synthesized in our institute with obviously high antibacterial activity and lower toxicity than polymyxin B and colistin. To predict the possible resistant mechanism of S₂ for wide clinical application, we experimentally induced bacterial resistant mutants and studied the preliminary resistance mechanisms. Mut-S, a resistant mutant of K. pneumoniae ATCC BAA-2146 (Kpn2146) induced by S₂, was analyzed by whole genome sequencing, transcriptomics, mass spectrometry and complementation experiment. Surprisingly, large-scale genomic inversion (LSGI) of approximately 1.1 Mbp in the chromosome caused by IS26 mediated intramolecular transposition was found in Mut-S, which led to mgrB truncation, lipid A modification and hence S₂ resistance. The resistance can be complemented by plasmid carrying intact mgrB. The same mechanism was also found in polymyxin B and colistin induced drug-resistant mutants of Kpn2146 (Mut-B and Mut-E, respectively). This is the first report of polymyxin resistance caused by IS26 intramolecular transposition mediated mgrB truncation in chromosome in K. pneumoniae. The findings broaden our scope of knowledge for polymyxin resistance and enriched our understanding of how bacteria can manage to survive in the presence of antibiotics.

Objective:To provide references for improving the psychological support to fighter pilots by the investigation on their emotional states and typical negative emotions in different task stages and common causes during major tasks.Methods:The Chinese version of Brunel Mood Scale was used to evaluate the emotional states of 141 high performance fighter pilots in the stages of assignment, pre-task, in-task and post-task. The scores of the scale and the positive rate of the evaluation were analyzed by descriptive statistics. Combined with the on-the-spot interview of pilots′ actual experience, the causes of negative emotions were discussed.Results:The negative emotions with the score greater than 1 were "exhausted" "worried" "uncertain" "extreme fatigue" "anxious" "tired" "nervous". The positive rate of pilots′ self-evaluation of 7 emotions was more than 80%. There were 2-5 typical negative emotions in each stage of the task, which were mainly caused by 3 factors: task adaptation, interpersonal communication and family. The scores of 3 positive emotions were more than 2.8, and the positive rate of pilots′ self-assessment was 100%. Positive emotions were higher in the first 2 stages, decreased significantly in the task stage and increased slightly after the task.Conclusions:The apparent negative emotions exist among the high performance fighter pilots in major tasks. The corresponding regulations and protections should be applied in time in the form of psychological intervention, especially on the maintenance of task adaptation, interpersonal communication and family harmony.

Objective:To provide references for improving the psychological support to fighter pilots by the investigation on their emotional states and typical negative emotions in different task stages and common causes during major tasks.Methods:The Chinese version of Brunel Mood Scale was used to evaluate the emotional states of 141 high performance fighter pilots in the stages of assignment, pre-task, in-task and post-task. The scores of the scale and the positive rate of the evaluation were analyzed by descriptive statistics. Combined with the on-the-spot interview of pilots′ actual experience, the causes of negative emotions were discussed.Results:The negative emotions with the score greater than 1 were "exhausted" "worried" "uncertain" "extreme fatigue" "anxious" "tired" "nervous". The positive rate of pilots′ self-evaluation of 7 emotions was more than 80%. There were 2-5 typical negative emotions in each stage of the task, which were mainly caused by 3 factors: task adaptation, interpersonal communication and family. The scores of 3 positive emotions were more than 2.8, and the positive rate of pilots′ self-assessment was 100%. Positive emotions were higher in the first 2 stages, decreased significantly in the task stage and increased slightly after the task.Conclusions:The apparent negative emotions exist among the high performance fighter pilots in major tasks. The corresponding regulations and protections should be applied in time in the form of psychological intervention, especially on the maintenance of task adaptation, interpersonal communication and family harmony.

Objective    To compare the safety and efficacy of simple mitral valve replacement with the third intercostal incision on the right side and the conventional midsternum incision. Methods    From February 2017 to February 2019, heart surgery in the Affiliated Hospital of Jining Medical College completed the first simple mitral valve replacement (MVR) operation in 103 patients, of whom 39 patients were received minimally invasive right third intercostal small incision (a minimally invasive surgery group). There were 10 males, 29 females at average age of 59.51 years. There were 64 patients with MVR via the middle section of the common sternum (a conventional surgery group), 22 males and 42 females, with an average age of 60.22 years. Types of lesions: 65 patients were with mitral stenosis, 22 patients with incomplete closure, 16 patients with incomplete closure. Results    There was no significant difference in preoperative clinical data between the two groups (P>0.05). The entire group of patients successfully completed the operation. Surgical replacement of mitral valve mechanical valve in 74 patients and biological valve in 29 patients. There was no significant difference between the two groups in the extracardiopulmonary cycle time, aortic blockade time and total hospitalization time. In the early stage of operation, 3 patients were examined for secondary hemostasis, 1 patient was minimally invasive surgery, and the remaining 2 patients were with routine surgery. The infection of incision occurred in 3 patients, all of them were in the routine operation group. All three patients died early after operation in the routine operation group: two were postoperative low cardiac volumetric syndrome leading to multiple organ failure, and the other was sternum infection accompanied by artificial valve endocarditis. Conclusion    There is no significant difference between MVR through the third rib of the right chest and traditional MVR in the safety. However, it has the advantages of small trauma, beauty, low incidence of incision infection and reduced postoperative pain.