Objective To compare the efficacy and safety of video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of thymoma through subxiphoid uniportal approach using double sternum retractors, and subxiphoid and subcostal arch approach. Methods We retrospectively analyzed the clinical data of the patients diagnosed with thymoma who underwent VATS thymectomy from June 2023 to June 2024 in West China Hospital. Patients were categorized based on the surgical approach into two groups: a subxiphoid uniportal VATS thymectomy (SUVT) group and a subxiphoid and subcostal arch VATS thymectomy (SASAT) group. Comparisons were made between the two groups regarding surgical duration, intraoperative blood loss, postoperative drainage, thymoma size and location, and postoperative pain assessed using the visual analogue scale (VAS). Results The SUVT group consisted of 20 patients, including 11 males and 9 females, with an average age of (51.5±14.3) years. The SASAT group comprised 40 patients, including 26 males and 14 females, with an average age of (50.0±13.0) years. Compared to the SASAT group, the SUVT group had significantly larger thymomas [ (5.9±2.7) cm vs. (4.2±2.1) cm, P=0.010] and a higher proportion of neoplasms located in the superior mediastinum (30.0% vs. 2.5%, P=0.007). Additionally, the VAS pain scores on postoperative days 3, 7, and 30 were significantly lower in the SUVT group compared to the SASAT group (P<0.05). There were no statistical differences between the two groups in demographic characteristics, operative time, intraoperative blood loss, duration and volume of postoperative drainage, length of postoperative hospital stay, or the VAS pain score on the first postoperative day. Conclusion SUVT using double sternum retractors significantly reduces postoperative pain and provides superior efficacy in the resection of larger thymomas or those situated in the superior mediastinum.

OBJECTIVE To investigate the current status and existing issues of hospital-associated infection manage-ment in non-public medical institutions,so as to provide data for the formulation of hospital-associated infec-tion management policies and the construction of a quality evaluation system for hospital-associated infection man-agement in non-public medical institutions.METHODS A qualitative research method was employed.In Dec.2023,semi-structured interviews were conducted with 38 directors of hospital-associated infection management depart-ments in primary,secondary and tertiary non-public medical institutions.The interview data were coded and ana-lyzed by Nvivo 12.0 software to refine themes.RESULTS Three themes were refined:the organizational system for hospital-associated infection management in non-public medical institutions had been basically established,but the division of functions and responsibilities was not yet fully clear,hospital-associated infection management had achieved certain results,including collaborating with other departments to standardize and implement infection control measures,enhancing staff awareness of infection control,and promoting the establishment of organization-al systems.There were issues in infection control works such as insufficient funding,personnel allocation not meeting requirements,and difficulties in implementing infection control measures.The most urgent assis-tance needed was to address the training and professional title promotion for full-time and part-time infection con-trol personnel.CONCLUSION Non-public medical institutions should strengthen staffing and training,enhance the pro-fessional capabilities of infection control personnel,and establish hospital-associated infection management standards that are tailored to the characteristics of non-public medical institutions at all levels.

OBJECTIVE To investigate the current status and existing issues of hospital-associated infection manage-ment in non-public medical institutions,so as to provide data for the formulation of hospital-associated infec-tion management policies and the construction of a quality evaluation system for hospital-associated infection man-agement in non-public medical institutions.METHODS A qualitative research method was employed.In Dec.2023,semi-structured interviews were conducted with 38 directors of hospital-associated infection management depart-ments in primary,secondary and tertiary non-public medical institutions.The interview data were coded and ana-lyzed by Nvivo 12.0 software to refine themes.RESULTS Three themes were refined:the organizational system for hospital-associated infection management in non-public medical institutions had been basically established,but the division of functions and responsibilities was not yet fully clear,hospital-associated infection management had achieved certain results,including collaborating with other departments to standardize and implement infection control measures,enhancing staff awareness of infection control,and promoting the establishment of organization-al systems.There were issues in infection control works such as insufficient funding,personnel allocation not meeting requirements,and difficulties in implementing infection control measures.The most urgent assis-tance needed was to address the training and professional title promotion for full-time and part-time infection con-trol personnel.CONCLUSION Non-public medical institutions should strengthen staffing and training,enhance the pro-fessional capabilities of infection control personnel,and establish hospital-associated infection management standards that are tailored to the characteristics of non-public medical institutions at all levels.

Objective To introduce an innovative technique, the "balance-shaped sternal elevation device" and its application in the subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for anterior mediastinal masses resection. Methods Patients who underwent single-port thoracoscopic assisted anterior mediastinal tumor resection through the xiphoid process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from May to June 2024 were included, and their clinical data were analyzed. Results A total of 7 patients were included, with 3 males and 4 females, aged 28-72 years. The diameter of the tumor was 1.9-17.0 cm. The operation time was 62-308 min, intraoperative blood loss was 5-100 mL, postoperative chest drainage tube retention time was 0-9 days, pain score on the 7th day after surgery was 0-2 points, and postoperative hospital stay was 3-12 days. All patients underwent successful and complete resection of the masses and thymus, with favorable postoperative recovery. Conclusion The "balance-shaped sternal elevation device" effectively expands the retrosternal space, providing surgeons with satisfactory surgical views and operating space. This technique significantly enhances the efficacy and safety of minimally invasive surgery for anterior mediastinal masses, reduces trauma and postoperative pain, and accelerates patient recovery, demonstrating important clinical significance and application value.

Objective:To develop and validate a machine learning (ML) noninvasive model based on routine laboratory parameters to preoperatively predict the microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).Methods:A total of 629 HCC patients who underwent hepatectomy at the First Affiliated Hospital of Fujian Medical University between January 2019 and December 2023 were retrospectively enrolled in this study and were divided chronologically into a training set ( n=464) and internal validation set ( n=165). A cohort with 190 HCC patients from Fujian Provincial Hospital were used as an external validation set. Preoperatively demographic features, tumor size and routine laboratory data were collected. All patients were divided into MVI-positive or MVI-negative group. The Boruta algorithm and LASSO regression algorithm were used to screen out related features in the training set. Eight different ML algorithms including multivariate logistic regression, decision tree (DT), random forest (RF), extreme gradient boosting (XGboost), k-nearest neighbor (KNN), support vector machine (SVM), light gradient boosting machine (LGBM) and Naive Bayes were used to construct the prediction models. The predictive performances of these models on training and internal validation sets were evaluated by the receiver operating characteristic (ROC) curve with the area under the curve (AUC). The ML model with the highest AUC values was defined as the optimal model and its performance was further validated in the external validation set. The calibration curve showed that the probability value curve was close to the actual occurrence probability curve, and the DCA showed that it could be applied within the threshold probability range of 0.3-0.8 to obtain net benefits. Results:After screening, eight parameters including α-fetoprotein (AFP), protein induced by vitamin K absence Ⅱ (PIVKA-Ⅱ), tumor size, eosinophil count, neutrophil count, creatinine, ApoA1 and total bilirubin were finally selected for the construction of the preoperative prediction model for MVI in HCC. Among all the tested eight ML algorithms, XGboost obtained the optimal performance with an AUC of 0.820 in training set, an AUC of 0.803 in internal testing set and an AUC of 0.758 in external testing set. Further stratified analysis showed that the AUC for preoperatively predicting MVI by XGboost was 0.817 for HCC patients with positive hepatitis B surface antigen, 0.779 for male patients and 0.790 for elder patients. The calibration curves showed good agreement between observed and predicted values and the decision curve analysis curve showed relatively higher net benefits.Conclusions:We successfully established and verified a novel XGboost model based on eight routine laboratory parameters with relatively high and reliable predictive accuracy to preoperatively predict MVI in HCC.

Objective To assess the clinical value of a novel surgical technique—Tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device in the resection of anterior mediastinal masses. Methods Patients who underwent tubeless subxiphoid uniportal video-assisted thoracoscopic surgery via balance-shaped sternal elevation device in anterior mediastinal masses process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from March to April 2025 were included, and their clinical data were analyzed. Results A total of 4 patients were included, with 2 males and 2 females, aged 58-75 years. The diameter of the tumor was 2.5-3.0 cm. The operation time was 60.0-150.0 min, intraoperative blood loss was 5-10 mL, pain score on the 3rd day after surgery was 0 points, and postoperative hospital stay was 2-3 days. All patients achieved complete resection of the masses and thymus without perioperative complications. Conclusion The tubeless subxiphoid uniportal video-assisted thoracoscopic surgery with percutaneous suspension technique via balance-shaped sternal elevation device technique optimizes surgical visualization and instrument maneuverability while avoiding complications related to conventional anesthesia and tubing, thereby markedly enhancing the minimally invasive profile of anterior mediastinal masses resections. In addition to maintaining procedural safety, this approach effectively reduces postoperative pain and accelerates patient recovery, highlighting its potential for widespread clinical adoption.

Objective:To develop and validate a machine learning (ML) noninvasive model based on routine laboratory parameters to preoperatively predict the microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC).Methods:A total of 629 HCC patients who underwent hepatectomy at the First Affiliated Hospital of Fujian Medical University between January 2019 and December 2023 were retrospectively enrolled in this study and were divided chronologically into a training set ( n=464) and internal validation set ( n=165). A cohort with 190 HCC patients from Fujian Provincial Hospital were used as an external validation set. Preoperatively demographic features, tumor size and routine laboratory data were collected. All patients were divided into MVI-positive or MVI-negative group. The Boruta algorithm and LASSO regression algorithm were used to screen out related features in the training set. Eight different ML algorithms including multivariate logistic regression, decision tree (DT), random forest (RF), extreme gradient boosting (XGboost), k-nearest neighbor (KNN), support vector machine (SVM), light gradient boosting machine (LGBM) and Naive Bayes were used to construct the prediction models. The predictive performances of these models on training and internal validation sets were evaluated by the receiver operating characteristic (ROC) curve with the area under the curve (AUC). The ML model with the highest AUC values was defined as the optimal model and its performance was further validated in the external validation set. The calibration curve showed that the probability value curve was close to the actual occurrence probability curve, and the DCA showed that it could be applied within the threshold probability range of 0.3-0.8 to obtain net benefits. Results:After screening, eight parameters including α-fetoprotein (AFP), protein induced by vitamin K absence Ⅱ (PIVKA-Ⅱ), tumor size, eosinophil count, neutrophil count, creatinine, ApoA1 and total bilirubin were finally selected for the construction of the preoperative prediction model for MVI in HCC. Among all the tested eight ML algorithms, XGboost obtained the optimal performance with an AUC of 0.820 in training set, an AUC of 0.803 in internal testing set and an AUC of 0.758 in external testing set. Further stratified analysis showed that the AUC for preoperatively predicting MVI by XGboost was 0.817 for HCC patients with positive hepatitis B surface antigen, 0.779 for male patients and 0.790 for elder patients. The calibration curves showed good agreement between observed and predicted values and the decision curve analysis curve showed relatively higher net benefits.Conclusions:We successfully established and verified a novel XGboost model based on eight routine laboratory parameters with relatively high and reliable predictive accuracy to preoperatively predict MVI in HCC.

Objective To investigate the characteristics of infectious occupational exposure among medical staff in newly-built hospitals, find out the high risk points of occupational exposure, and formulate occupational safety protection measures accordingly. Methods A retrospective survey in Beijing Tsinghua Changgung Hospital during January 2015 to October 2017 was carried out on occupation exposure, including gender, age, working years, occupation,exposure time, exposure sites, exposed sites and links, exposure to the source of infection and other aspects of the data, using SPSS 16.0 statistical analysis. Results There were 59 infectious occupational exposures. Among 59 infectious occupational exposures, 52 cases (88.1%) were sharp instrument injuries, 7 cases (11.9%) were blood and body fluid exposure. Occupational exposure occurred mainly in nurses (45 cases, 76.3%), followed by doctors (11 cases, 18.6%). The median age was 26 years, and the median length of work was 2 years. The location of exposure was mainly ward (26 cases, 44.1%), followed by operation room (17 cases, 28.8%). The location of sharp instrument injuries was mainly finger (44 cases, 84.6%). Sharps were mainly needles (38 cases, 73.1%), and the proportion of sharp instruments was 80.4%. The main causes of exposure were themselves (41 cases, 77.5%). Hepatitis B was the main pathogen of exposure (27 cases, 45.8%). No nosocomial infection was not found at follow-up. Conclusions New hospitals should establish a perfect occupational exposure management system, control the high-risk points, strengthen the occupational safety protection training, standardize the operation, and reduce the incidence of infection.

Objective]The aim of this study was to investigate the level of serum C3,C4 and HDL-C in patients with coronary heart disease and the correlation between C3,C4 and HDL-C in patients with coronary heart disease.[Methods]We collected 251 cases of patient diagnosed with coronary artery disease by coronary angiography in Sun Yat-sen Memorial Hospital ,Sun Yat-Sen University from 2015-12 to 2016-07 and collected over our Boji Medical Center healthy people in 214 cases. These patients were divided into acute coronary syndrome group with 180 cases and stable coronary heart disease group with 71 cases. Each test results was adopted from clinical laboratory of Sun Yat-Sen Memorial Hospital ,Sun Yat-Sen University.[Results]Compared with the healthy control ,the difference of serum C3,C4 and HDL-C from acute coronary syndrome group and stable coronary heart disease group,was statistically significant(P<0.05). However,in patients with acute coronary syndrome and stable coronary artery disease groups,there was no significant correlation(P > 0.05)between C3,C4 and HDL-C. In healthy group,complement C3 negatively correlated with HDL-C,the difference was statistically significant(P<0.05).[Conclusions]In patients with coronary heart disease, the level of C3 and C4 increased,while the level of HDL-C decreased ,and inflammation may affect the relevance judgments between complement and HDL-C.

OBJECTIVE To investigate the effect and underlying mechanism of Gypsophila elegans isoorientin on the proliferation and apoptosis of human HepG2 cells. METHODS HepG2 cells were treated with isoorientin 5,10,20,40,80 and 160μmol?L-1 for 24,48 and 72 h,respectively. Cell survival was analyzed by MTT assay. HepG2 cells were treated with isoorientin 5,10 and 20μmol?L-1 for 48 h before the lactate dehydrogenase(LDH)level was detected. After treatment with isoorientin for 24 h, the variation of reactive oxygen species (ROS) was monitored by a fluorescence probe H2DCF-DA. HepG2 apoptosis and mitochondria membrane potential(MMP)were evaluated by flow cytometry. The activi?ties of caspase 3,8 and 9 were determined by colorimetry. The mRNA expression of Bcl-2 and Bax was determined by RT-PCR,and the protein expression of Bcl-2, Bax and cytochrome c was detected by Western blotting. RESULTS Isoorientin(5-160μmol?L-1)inhibited HepG2 cell survial in a concen?tration-dependent manner,the 50%inhibitory concentration(IC50)was 62.7±9.1,47.2±11.4 and(18.2± 7.5)μmol?L-1 after treatment with isoorientin for 24,48 and 72 h,respectively. Compared with the cell control group,treatment with isoorientin 5,10 and 20μmol?L-1 significantly increased the LDH level and cell apoptosis rate(P<0.05). Moreover,isoorientin 10 and 20μmol?L-1 notably increased the production of ROS,decreased the MMP(P<0.05),and increased the activities of caspase 3 and 9. RT-PCR analysis and Western blotting showed that isoorientin significantly decreased the mRNA and protein expressions of Bcl-2,decreased the mRNA and protein expressions of Bax(P<0.05),and inhibited the protein expression of cytochrome c(P<0.05). CONCLUSION Isoorientin inhibits HepG2 cell prolif?eration,but promotes cell apoptosis,which is closely related to the regulation of the mitochondrial apoptosis pathway.