[Objective]To investigate the regulatory effect and potential mechanisms of isocitrate dehydrogenase 3A(IDH3A)on cardiomyocyte hypertrophy.[Methods]The expression of IDH3A in the myocardium of healthy volunteers(n=10)and patients with heart failure(HF)(n=10),and in the myocardium of mice subjected to transverse aortic constriction(TAC)surgery and sham operation,as well as in phenylephrine(PE)-induced neonatal rat ventricular cardiomyocytes(NRVCs),was assessed by real-time quantitative polymerase chain reaction(RT-qPCR)and Western blot assay.The effect of adenovirus-mediated overexpression of IDH3A on the expression of hypertrophy-related genes in PE-induced NRVCs was also evaluated.The effect of IDH3A on NRVCs area was examined by phalloidin staining assay.A mutant of IDH3A with abolished enzymatic activity,IDH3A_D208A,was generated through site-directed mutagenesis.The impact of this IDH3A mutant on the hypertrophic phenotype,ATP and ROS levels in NRVCs was evaluated to investigate whether the regulatory role of IDH3A in cardiomyocyte hypertrophy was dependent on its enzymatic activity.The effect of exogenous α-ketoglutaric acid(AKG)on cardiomyocyte hypertrophy was also detected by Western blot and phalloidin staining assay,respectively.[Results]IDH3A was significantly decreased in the myocardium of HF patients,in the myocardium of TAC-operated mice,and in PE-induced NRVCs(P=0.005 2,P=0.026 6,P=0.041 3 and P=0.006 6,respectively).Overexpression of IDH3A markedly suppressed the expression of hypertrophy-related genes and the increase of cell size of PE-induced NRVCs(P<0.000 1,P=0.000 1 and P=0.000 2,respectively).The ATP and ROS analysis indicated that IDH3A inhibited the increases of ATP and ROS levels in PE-induced NRVCs(P=0.001 2 and P<0.000 1,respectively),whereas the enzymatically inactive IDH3A mutant lacked this effect.Exogenous AKG provision could,but overexpression of IDH3A mutant failed to suppress PE-induced NRVCs hypertrophy.[Conclusion]IDH3A inhibits cardiomyocyte hypertrophy via elevating AKG level,providing scientific evidence for study on IDH3A-based treatment of cardiac hypertrophy.

Objective To investigate the effect of a modified chest drainage management protocol on rapid recovery in patients undergoing thoracoscopic lung resection.Methods A retrospective analysis was conducted on clinical data of 218 patients who underwent segmentectomy,lobectomy,or combined lobectomy surgeries between July 2022 and December 2023 in our department.One medical group utilized the traditional chest drainage management protocol(control group,109 cases),while the other medical group employed the modified chest drainage management protocol(modified group,109 cases).The control group had a large chest tube(20-24F)placed at the mid-axillary line of the 7th intercostal space leading to the apex of the pleural cavity(removed when drainage volume＜300 ml/24 h and air leak＜20 ml/min).In contrast,the modified group had a large tube placed from the anterior axillary line between the 3rd and 4th intercostal spaces leading to the apex of the pleural cavity(removed when air leak＜20 ml/min),and a small tube(7F)placed at the posterior axillary line between the 7th and 8th intercostal spaces near the diaphragm surface(removed when drainage volume＜300 ml/24 h).Comparisons were made between the two groups regarding duration of large tube placement and total duration tube placement,total drainage volume,postoperative hospital stay,and postoperative complications.The pain scores,number of cases with moderate to severe pain(pain score ≥4),analgesic pump drug usage,and functional activity score(FAS)were recorded on the 1st and 2nd day after surgery.Results The duration of large tube placement was shorter in the modified group than in the control group[(2.1±1.6)dvs.(2.7±1.8)d,t=-2.715,P=0.007].and the total duration of tube placement was longer in the modified group than in the control group[(3.3±2.0)dvs.(2.7±1.8)d,t=2.308,P=0.022].without increasing postoperative hospital stay[(4.2±2.2)dvs.(4.1±2.1)d,t=0.247,P=0.805].On the postoperative day 2,the modified group showed lower pain scores during activity than the control group[(2.1±1.1)points vs.(2.6±1.3)points,t=-2.885,P=0.004].fewer cases with moderate to severe pain(5 cases vs.14 cases,x2=4.670,P=0.031),and less analgesic pump drug usage[(17.9±16.2)ml vs.(27.4±29.4)ml,t=-2.951,P=0.004].No significant differences were observed in other indicators between the two groups(P＞0.05).Additionally,the proportion of patients with FAS grade A(no activity limitation due to pain)was higher in the modified group than in the control group on the postoperative day 2[61.5％(67/109)vs.46.8％(51/109),Z=-2.170,P=0.030].There were no significant differences in postoperative complications and incision healing rates between the two groups(P＞0.05).Conclusion The modified chest drainage management protocol not only ensures adequate drainage but also reduces the degree of pain and improves activity status,aligning with the principles of enhanced recovery after surgery(ERAS).

Objective To investigate the effect of a modified chest drainage management protocol on rapid recovery in patients undergoing thoracoscopic lung resection.Methods A retrospective analysis was conducted on clinical data of 218 patients who underwent segmentectomy,lobectomy,or combined lobectomy surgeries between July 2022 and December 2023 in our department.One medical group utilized the traditional chest drainage management protocol(control group,109 cases),while the other medical group employed the modified chest drainage management protocol(modified group,109 cases).The control group had a large chest tube(20-24F)placed at the mid-axillary line of the 7th intercostal space leading to the apex of the pleural cavity(removed when drainage volume＜300 ml/24 h and air leak＜20 ml/min).In contrast,the modified group had a large tube placed from the anterior axillary line between the 3rd and 4th intercostal spaces leading to the apex of the pleural cavity(removed when air leak＜20 ml/min),and a small tube(7F)placed at the posterior axillary line between the 7th and 8th intercostal spaces near the diaphragm surface(removed when drainage volume＜300 ml/24 h).Comparisons were made between the two groups regarding duration of large tube placement and total duration tube placement,total drainage volume,postoperative hospital stay,and postoperative complications.The pain scores,number of cases with moderate to severe pain(pain score ≥4),analgesic pump drug usage,and functional activity score(FAS)were recorded on the 1st and 2nd day after surgery.Results The duration of large tube placement was shorter in the modified group than in the control group[(2.1±1.6)dvs.(2.7±1.8)d,t=-2.715,P=0.007].and the total duration of tube placement was longer in the modified group than in the control group[(3.3±2.0)dvs.(2.7±1.8)d,t=2.308,P=0.022].without increasing postoperative hospital stay[(4.2±2.2)dvs.(4.1±2.1)d,t=0.247,P=0.805].On the postoperative day 2,the modified group showed lower pain scores during activity than the control group[(2.1±1.1)points vs.(2.6±1.3)points,t=-2.885,P=0.004].fewer cases with moderate to severe pain(5 cases vs.14 cases,x2=4.670,P=0.031),and less analgesic pump drug usage[(17.9±16.2)ml vs.(27.4±29.4)ml,t=-2.951,P=0.004].No significant differences were observed in other indicators between the two groups(P＞0.05).Additionally,the proportion of patients with FAS grade A(no activity limitation due to pain)was higher in the modified group than in the control group on the postoperative day 2[61.5％(67/109)vs.46.8％(51/109),Z=-2.170,P=0.030].There were no significant differences in postoperative complications and incision healing rates between the two groups(P＞0.05).Conclusion The modified chest drainage management protocol not only ensures adequate drainage but also reduces the degree of pain and improves activity status,aligning with the principles of enhanced recovery after surgery(ERAS).

The five core indicators(the case mix index, the proportion of level-4 surgery, the proportion of technical service income in medical income, the proportion of personnel expenditure in business expenditure, and the proportion of fixed part in personnel salary) and target values determined by the pilot goal of high-quality development of high-level public hospitals jointly built by National Health Commission and Provincial Government had become the core indicators for evaluating the quality and efficiency of public hospital development. The authors proposed the optimization and improvement measures for the five core indicators one by one from the internal reform and innovation in hospitals, as well as the synergetic development and governance of " insurance-medical-medicine linkage", combined with the current situation of a pilot hospital. The authors also proposed the starting points and driving force for promoting the high-quality development of public hospitals through the synergetic development and governance of " insurance-medical-medicine linkage", including implementing government investment responsibilities, streamlining the price evaluation of medical services, deepening the reform of medical insurance payment, accelerating the expansion of drug and consumable procurement, and promoting the application of advanced technologies and products, in order to provide reference for the in-depth promotion of high-quality development of public hospitals.

Objective To analyze the application value of uterine artery flow and cerebral placental rate(CPR)in diagnosing fetal growth restriction(FGR).Methods A total of 114 pregnant women with clinically diagnosed late-onset FGR who were hospitalized in Jiangxi Maternal and Child Health Hospital from January 2021 to June 2022 were assigned to study group,and 122 pregnant women with normal intrauterine development were assigned to control group.The blood flow parameters of uterine artery(UtA),umbilical artery(UA)and middle cerebral artery(MCA)in two groups were determined by ultrasound,and CPR in two groups was calculated.The blood flow difference and pregnancy outcome of two groups were compared.Receiver operating characteristic(ROC)curve was used to analyze the application value of UtA and CPR alone and combined in the clinical diagnosis of FGR.Results The UtA resistance index(RI)of pregnant women in study group was higher than that of control group,the fetal UA blood flow parameter was higher than that of control group,the MCA blood flow parameter and the CPR value were both lower than those of control group,the differences were statistically significant(P<0.05).The birth weight and 1min Apgar score of study group were lower than those of control group(P<0.001).In addition,the incidence of emergency cesarean section operation,premature delivery and neonates transferred to neonatal intensive care unit(NICU)due to various complications in study group were significantly higher than those in control group(P<0.05).ROC curve showed that in predicting FGR,the area under the curve(AUC)of UtA-RI was 0.82(95%CI:0.77-0.88).The predictive efficiency of CPR was 0.75(95%CI:0.69-0.81).The combination of UtA-RI and CPR parameters had the highest efficiency in predicting FGR,with an AUC of 0.92(95%CI:0.89-0.95).Conclusion CPR combined with UtA-RI monitoring has clinical application value for early detection of FGR,guiding intervention,and improving adverse perinatal outcomes.

Humans ; Muscular Dystrophy, Duchenne/epidemiology* ; Prevalence ; Myocardium

The Chinese Neonatal Network(CHNN) was established in 2018 with the mission of establishing a national collaboration platform, conducting high-quality and collaborative research, and ultimately improving the quality of neonatal-perinatal care and health in China.At present, 112 hospitals across the country have joined CHNN.CHNN has established a national standardized cohort of very premature infants/very low birth weight infants with >10 000 enrollments each year, has been leading data-driven collaborative quality improvement initiatives, conducting multicenter clinical studies, and performing multi-level training programs.Guided by the principles of collaboration and sharing, data-driven, continuous improvement, and international integration, CHNN has become an important platform for clinical and research collaboration in neonatal medicine in China.

Objective:To explore the effect of different HER2 expression levels and gene amplification on the efficacy of immunotherapy in metastatic urothelial carcinoma (UC).Methods:The clinical data of 77 patients with metastatic UC who received immunotherapy from June 2017 to April 2021 after failure to the previous chemotherapy were analyzed retrospectively, including 49 males and 28 females with the median age of 62 years. The primary tumors located in bladder in 28 cases (36.4%), renal pelvis in 25 cases (32.5%) and ureter in 24 cases (31.2%). The common metastatic sites included: lymph nodes (n = 45, 58.4%), lung (n = 40, 51.9%), bone (n = 20, 26.0%) and liver (n = 16, 20.8%). 27 patients with bladder UC received surgery on the primary tumors including radical cystectomy (n = 18), partial cystectomy (n = 4) and transurethral resection (n = 5). 43 patients with renal pelvis or ureteral UC received surgery on the primary tumors including radical nephroureterectomy (n = 38), local resection (n = 3) and palliative resection (n = 2). Postoperative intravesical chemotherapy was performed in 15 cases, adjuvant radiotherapy was performed in 6 cases. 3 patients who emerged postoperative bladder recurrence received local radiotherapy. 7 patients received radiotherapy and 1 case received microwave ablation to their metastatic sites. All patients had received first-line chemotherapy and 30 patients (40.0%) had received at least second-line treatment including 70 cases (90.9%) with platinum containing chemotherapy. All 77 patients received anti-PD-1 treatment. 38 patients received sequential regimen after failed to the anti-PD-1 therapy, including antibody-drug conjugate (n = 17), chemotherapy (n = 18) and chemotherapy combined with anti-angiogenesis drugs (n = 12). Immunohistochemical (IHC) staining was used to detect the expression level of HER2 protein in the tumor tissues (74 cases from primary tumors and 3 cases from metastatic tumors) obtained from the initial diagnosis. For patients with HER2 IHC (+ + ), the copy number (CN) of HER2 gene was detected by next-generation sequencing (NGS). HER2 copy number amplification [CN (+ )] was defined as CN ≥ 4, and HER2 copy number non-amplification [CN(-)] was defined as CN < 4. HER2 IHC (0) was defined as HER2 negative, IHC (+ ) or IHC (+ + ) / CN (-)was defined as HER2 low expression, while IHC (+ + ) / CN(+ ) and IHC (+ + + ) were defined as HER2 high expression. Chi-square test or Fisher exact test were used to evaluate the correlation between HER2 expression and objective response rate (ORR) after anti-PD-1 treatment. Kaplan-Meier method and log-rank test were used to compare the differences of median progression free survival (PFS) and overall survival (OS) under different HER2 expression status.Results:All the 77 patients received a median of 11 (range: 2 - 45) doses of anti-PD-1 treatment with a median duration of treatment of 6.4 (range: 1.5 - 47.8) months and the ORR was 33.8% (26/77). The median follow-up time was 30.9 months. The overall median PFS time was 5.8 (95% CI: 3.0 - 8.6) months and the median OS time was 23.6 (95% CI: 8.5 - 38.7) months. HER2 IHC tests were performed in 77 patients. HER2 IHC levels of (0), (+ ), (+ + ) and (+ + + ) were found in 33 (42.9%), 19 (24.7%), 20 (26.0%) and 5 (6.5%) patients, respectively. HER2 copy number was detected in 20 patients with IHC (+ + ), while 1 CN(+ ) and 19 CN(-) were found. The ORR of HER2 negative, low expression and high expression patients were 42.4% (14/33) vs. 31.6% (12/38) vs. 0 (0/6) ( P = 0.08), respectively. The median PFS of the three groups were 11.0 months, 3.7 months and 1.8 months, respectively, with significant differences in overall and pairwise comparison( P=0.001). The median OS of patients with HER2 negative and low expression after anti-PD-1 treatment were 23.6 months and 22.7 months, respectively, while the median OS of patients with HER2 high expression had not been reached, with no significant difference in the overall comparison ( P=0.623). Conclusions:For patients with metastatic UC received anti-PD-1 treatment, the PFS of patients with high HER2 expression was significantly worse than that of patients with low or negative HER2 expression. HER2 expression may have potential value in predicting the efficacy of immunotherapy for metastatic UC who failed the previous chemotherapy, which needs further research.

Objective:To analyze the internal conditions and external environment of high-quality development of high-level public hospitals and establish a high-quality development strategy model, for reference of public hospitals to formulate and implement high-quality development strategies.Methods:The case hospital was a pilot in high-quality development of high-level public hospitals. SWOT method was used to analyze the influencing factors, AHP analytic hierarchy process was used to compare the importance of each influencing factor, and then the four-quadrant coordinate system method was used to establish a high-quality development strategy model.Results:The total strength(S), the total weaknesses(W), the total opportunity(O), and the total threat(T)were 0.095, 0.063, 0.065 and 0.024 respectively, reflecting that the strength of internal conditions was greater than the weaknesses, and the opportunities of external environment were greater than the threats. In the four-quadrants, the growth strategy model had the largest triangle area(0.003), and the strategic quadrilateral center of gravity was located in the opportunity area of the growth strategy.Conclusions:High-level public hospitals as represented by the case hospital had entered a period of important strategic opportunities, which the external opportunities were greater than its own strength. These hospitals were recommended to fully leverage the external opportunities, adopt a positive growth oriented(SO)strategy, formulate a development strategy with their own characteristics, promote the interaction of internal conditions and external environment to form new momentum, hence achieving high-quality development.

Based on the five core indicators (the case mix index, the proportion of level-4 surgery, the proportion of technical service income in medical income, the proportion of personnel expenditure in business expenditure, and the proportion of fixed part in personnel salary), the authors discussed the guiding significance of " paying attention to the medical level, strengthening the functional orientation, reflecting the technical value, highlighting people-orientation, and ensuring sustainable development" in the high-quality development of public hospitals. In combination with the current situation of a pilot hospital of high-quality development with the corporate supports of National Health Commission and Province Government, the authors explained the common bottlenecks of public hospitals, such as inaccurate functional positioning, weak innovation ability, poor finance structure, poor salary system and insufficient attention to talents. In the last, the authors pointed out that high-quality development was the development of deepening reform, innovation driven, structural optimization, talent oriented, people-oriented and under the leadership of the Communist Party of China, and put forward targeted implementation paths to provide reference for the pilot work.