Objective:To explore the effect of home-based online preoperative rehabilitation training on early postoperative recovery in patients with pulmonary nodules.Methods:This study is a randomized controlled study. Fifty patients with pulmonary nodules scheduled for elective surgery in Zhongshan Hospital from January 2023 to September 2023 were randomly divided into the control group and the study group ( n=25 in each group). Patients in the study group carried out home pre-rehabilitation training guided by mobile App before operation, including breathing training, resistance exercise, nutritional intervention and psychological counseling; there was no intervention for patients in the control group while waiting for operation. The lung function, 6-min walking distance, psychological status, nutritional status, postoperative complications, catheterization time, hospitalization time, hospitalization expenses and complications were compared between the two groups before and after operation. Results:There were no significant differences in age, sex, BMI, heart rate, respiratory rate, blood pressure, pulmonary function, nutritional status, location of pulmonary nodules, anesthesia mode, operation modality and surgical pathology results between two groups(all P>0.05). Compared with the control group, the study group had significantly improved forced vital capacity at admission, 1d and 30d after surgery ( Z=-2.338, Z=-2.203, Z=-2.348, all P<0.05), forced expiratory volume in one second (FEV1) ( Z=-3.241, Z=-3.262, Z=-3.564, all P<0.05), and the ratio of forced vital capacity (FVC) to FEV1 ( t=-3.186, t=-2.904, and t=-4.304, all P<0.05), increased 6 min walking distance ( t=-4.466, t=-4.144, t=-4.907, all P<0.05), improved anxiety ( Z=-3.164, Z=-4.425, Z=-3.622, all P<0.05), decreased depression ( Z=-2.598, Z=-3.799, Z=-3.439, all P<0.05); and improved nutritional status at admission and 1d after surgery ( Z=-3.061, Z=-3.648, all P<0.05). The incidence of postoperative complications was decreased ( χ 2=4.878, P<0.05), the time of catheterization was decreased ( Z=-4.056, P<0.001), the length of hospital stay was shortened ( Z=-4.345, P<0.001), and the cost of hospitalization was reduced ( Z=-2.590, P<0.05) in the study group. Conclusion:The home-based online prehabilitation training can effectively improve the cardiopulmonary function and physical fitness of patients, reduce the stress of surgery, and contribute to rapid recovery after surgery; it also can shorten the length of postoperative hospital stay and reduce medical costs.

Objective:To explore the effect of home-based online preoperative rehabilitation training on early postoperative recovery in patients with pulmonary nodules.Methods:This study is a randomized controlled study. Fifty patients with pulmonary nodules scheduled for elective surgery in Zhongshan Hospital from January 2023 to September 2023 were randomly divided into the control group and the study group ( n=25 in each group). Patients in the study group carried out home pre-rehabilitation training guided by mobile App before operation, including breathing training, resistance exercise, nutritional intervention and psychological counseling; there was no intervention for patients in the control group while waiting for operation. The lung function, 6-min walking distance, psychological status, nutritional status, postoperative complications, catheterization time, hospitalization time, hospitalization expenses and complications were compared between the two groups before and after operation. Results:There were no significant differences in age, sex, BMI, heart rate, respiratory rate, blood pressure, pulmonary function, nutritional status, location of pulmonary nodules, anesthesia mode, operation modality and surgical pathology results between two groups(all P>0.05). Compared with the control group, the study group had significantly improved forced vital capacity at admission, 1d and 30d after surgery ( Z=-2.338, Z=-2.203, Z=-2.348, all P<0.05), forced expiratory volume in one second (FEV1) ( Z=-3.241, Z=-3.262, Z=-3.564, all P<0.05), and the ratio of forced vital capacity (FVC) to FEV1 ( t=-3.186, t=-2.904, and t=-4.304, all P<0.05), increased 6 min walking distance ( t=-4.466, t=-4.144, t=-4.907, all P<0.05), improved anxiety ( Z=-3.164, Z=-4.425, Z=-3.622, all P<0.05), decreased depression ( Z=-2.598, Z=-3.799, Z=-3.439, all P<0.05); and improved nutritional status at admission and 1d after surgery ( Z=-3.061, Z=-3.648, all P<0.05). The incidence of postoperative complications was decreased ( χ 2=4.878, P<0.05), the time of catheterization was decreased ( Z=-4.056, P<0.001), the length of hospital stay was shortened ( Z=-4.345, P<0.001), and the cost of hospitalization was reduced ( Z=-2.590, P<0.05) in the study group. Conclusion:The home-based online prehabilitation training can effectively improve the cardiopulmonary function and physical fitness of patients, reduce the stress of surgery, and contribute to rapid recovery after surgery; it also can shorten the length of postoperative hospital stay and reduce medical costs.

The rehabilitation compliance of stroke patients is generally low.Evaluating the rehabilitation motivation of patients is helpful to promote the rehabilitation management of patients,enhance the rehabilitation enthusiasm and compliance of patients,and improve the rehabilitation outcome.This paper reviews the existing stroke patients rehabilitation motivation assessment tools,and expounds the main contents,application status,characteristics and limitations of stroke patients rehabilitation motivation assessment tools,in order to provide references for the appropriate selection of clinical assessment tools,the rehabilitation management of stroke patients and the development of domestic localized stroke rehabilitation motivation assessment tools.

BACKGROUND: It is a great challenge for surgeons to resect pulmonary nodules with small volume, deep position and no solid components under video-assisted thoracoscopic surgery. The purpose of this study is to explore the feasibility and necessity of the localization of pulmonary nodules by injecting indocyanine green (ICG) under the guidance of magnetic navigation bronchoscope and the resection of small pulmonary nodules under the fluoroscope. METHODS: Between December 2018 and August 2019, sixteen consecutive patients with 30 peripheral lung lesions in our hospital received fluorescent thoracoscopic pulmonary nodule resection. Electromagnetic navigation bronchoscope (ENB) was performed before surgery to guide ICG to the target lesion. RESULTS: All patients underwent magnetic navigation-guided pulmonary nodule localization, and surgical resection was performed immediately after localization was completed. The average size of the nodules was (11.12±3.65) mm. The average navigation time was (12.06±2.74) minutes, and the average interval between dye labeling and lung resection was (25.00±5.29) minutes. All lesions were completely resected, the localization success rate was 100.00%, no bleeding and other complications occurred after the localization, the postoperative pathological results confirmed the accuracy of the staining. CONCLUSIONS Indocyanine green injection under the guidance of magnetic navigation bronchoscope is an effective way to locate pulmonary nodules, which can locate small and untouchable lesions in the lung. This method can help surgeons identify lesions more quickly and accurately. It is practical and worthy of promotion.

Objective To explore the accuracy of endoscopic ultrasonography (EUS) for evaluating T3 esophageal squamous cell carcinoma (ESCC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 733 patients diagnosed with T3 ESCC by preoperative EUS who were admitted to the Sun Yat-sen University Cancer Center from January 2003 to December 2015 were collected.All the patients underwent radical resection of ESCC.The postoperative pathological stage as a gold standard,the accuracy,overstaged and understaged rates of clinical staging by preoperative EUS were assessed.Observation indicators:(1) comparison between clinical T staging evaluated by preoperative EUS and postoperative pathological T staging;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect patients' diseases and postoperative survival up to December 30,2016.Overall survival time was from operation time to death or last effective follow-up.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Count data were represented as cases and percentage.The survival curve was drawn by the Kaplan-Meier method,and survival analysis was done using the Log-rank test.Results (1) Comparison between clinical T staging evaluated by preoperative EUS and postoperative pathological T staging:all the 733 patients were confirmed as T3 ESCC by preoperative EUS.Postoperative pathological diagnosis showed that 9 patients were detected in pT1b,87 in pT2,630 in pT3 and 7 in pT4a.The accuracy,overstaged and understaged rates of preoperative EUS in evaluating T3 ESCC were 85.95％(630/733),13.10％(96/733) and 0.95％(7/733),respectively.N0,N1,N2 and N3 of postoperative pathological N stage were respectively detected in 329,247,110 and 47 patients.Twenty-seven,323 and 383 patients were in stage Ⅰ,Ⅱ and Ⅲ of TNM stage,respectively.The high-,moderate-and lowdifferentiated tumors were respectively detected in 125,403 and 205 patients.(2) Follow-up and survival situations:among 733 patients,639 were followed up for 1.0-153.0 months,with a median time of 29.0 months.The median survival time,1-,3-,5-year overall survival rates were 53.0 months (range,37.7-68.3 months),85.3％,58.1％ and 48.2％ in 733 patients,respectively.The 5-year overall survival rate was 75.2％ in 9 patients with pT1b,63.0％ in 87 patients with pT2,46.3％ in 630 patients with pT3 and 0 in 7 patients with pT4a,respectively,with a statistically significant difference (x2=24.089,P＜0.05).Conclusion There is a higher accuracy of EUS for evaluating T3 ESCC,however,the stage migration should be noted.

Objective To investigate the effects of T. gondii soluble tachyzoite antigen (STAgs) on the survival time of mouse heart allograft and the possible mechanism. Methods The STAgs were prepared by pulverizing T. gondii tachyzoite with ultrasound on ice. Cervical heterotopic heart transplantations were done by using Balb/c mice as donors, and C57BL/6 mice as recipients.The recipients were classified randomly into three groups: syngeneic group, acute rejection group and STAgs-treated group. The recipients in acute rejection group and STAgs-treated group were injected subcutaneously with 0. 1 ml PBS and 0. 1 ml (5 μg) STAgs at the 4th day before transplantation respectively, and those in syngeneic group were not subjected to any treatment. The grafts were observed daily by cervical palpation, and the total cessation of cardiac contraction was defined as the endpoint. The heart allografts were harvested at the 7th day after transplantation for pathological examination and immunohistochemical staining for CD4+ T, CD8+ T. Results The recipients in syngeneic group were all alive at the 100th day after transplantation. The average survival time in acute rejection group and STAgs-treated group was (6.7± 0.5) days and (70.8± 3.5) days,respectively (P＜0.05). HE staining showed that the rejection on the 7th day after transplantation in syngeneic group, acute rejection group and STAgs-treated group was fallen into 0 degree, Ⅲ-Ⅳ degree and 0- Ⅰ degree, respectively. Immunohistochemical staining revealed that the CD4+ T and CD8+T were markedly down-regulated in STAgs-treated group as compared with those in acute rejection group. Conclusion T. gondii STAgs can significantly prolong the survival time of mouse heart allograft and inhibit the rejection probably by changing the ratio of TH1/TH2, or inhibiting the effect of dendritic cells by inducing the lipoxin A4.

Objective To explore the expression level of Tim-3,the marker of activated T_H 1 cells.in T lymphocytes in different sites from recipients with acute rejection.Methods The model of cervical heterotopic heart transplantation was established in mice Two groups were get up:the isograft group(C57BL/6→C57BL/6) and the allograft group (Balb/c→C57BL/6).Lymphocytes were isolated from peripheral blood,spleens,draining lymph nodes and grafts 3 or 6 days after transplantation.The expression of TIM-3 in CD4~+ and CD8~+ T subsets was detected by flow cytometry.Results There was no significant difference in Tim-3~+/CD4~+ and Tim-3~+/CD8~+ ratio in peripheral blood or spleens between two groups.As compared with the isograft group,the proportion of Tirn-3~+/CD4~+ cells was slightly elevated in draining lymph node(P<0.05),but the percentage of Tim-3~+/CD4~+ cells had no significant change between 3 days and 6 days in the allograft group(P>0.05).The expression of Tim-3 in CD4~+ and CD8~+ of graft infiltrating T cells was obviously increased in allograft group(P<0.01),and it was significantly (P<0.01) up-regulated on the 6th day as compared with that on the 3rd day.Conclusion The dynamic changes of Tim-3 expression in T lymphocytes in draining lymph node and graft were correlated with the progresston oi acute rejection in mice.

To identify acute renal allograft rejection biomarkers in human serum, two-dimensional differential in-gel electrophoresis (2-D DIGE) and reversed phase high-performance liquid chromatography (RP-HPLC) followed by electrospray ionization mass spectrometry (ESI-MS) were used. Serum samples from renal allograft patients and normal volunteers were divided into three groups: acute rejection (AR), stable renal function (SRF) and normal volunteer (N). Serum samples were firstly processed using Multiple Affinity Removal Column to selectively remove the highest abundance proteins. Differentially expressed proteins were analyzed using 2-D DIGE. These differential protein spots were excised, digested by trypsin, and identified by RP-HPLC-ESI/MS. Twenty-two differentially expressed proteins were identified in serum from AR group. These proteins included complement C9 precursor, apolipoprotein A-IV precursor, vitamin D-binding protein precursor, beta-2-glycoprotein 1 precursor, etc. Vitamin D-binding protein, one of these proteins, was confirmed by ELISA in the independent set of serum samples. In conclusion, the differentially expressed proteins as serum biomarker candidates may provide the basis of acute rejection noninvasive diagnosis. Confirmed vitamin D-binding protein may be one of serum biomarkers of acute rejection. Furthermore, it may provide great insights into understanding the mechanisms and potential treatment strategy of acute rejection.

To identify acute renal allograft rejection biomarkers in human serum, two-dimensional differential in-gel electrophoresis (2-D DIGE) and reversed phase high-performance liquid chromatog-raphy (RP-HPLC) followed by electrospray ionization mass spectrometry (ESI-MS) were used. Serum samples from renal allograft patients and normal volunteers were divided into three groups: acute rejec-tion (AR), stable renal function (SRF) and normal volunteer (N). Serum samples were firstly processed using Multiple Affinity Removal Column to selectively remove the highest abundance proteins. Differ-entially expressed proteins were analyzed using 2-D DIGE. These differential protein spots were ex-cised, digested by trypsin, and identified by RP-HPLC-ESI/MS. Twenty-two differentially expressed proteins were identified in serum from AR group. These proteins included complement C9 precursor,apolipoprotein A-Ⅳ precursor, vitamin D-binding protein precursor, beta-2-glycoprotein 1 precursor,etc. Vitamin D-binding protein, one of these proteins, was confirmed by ELISA in the independent set of serum samples. In conclusion, the differentially expressed proteins as serum biomarker candidates may provide the basis of acute rejection noninvasive diagnosis. Confirmed vitamin D-binding protein may be one of serum biomarkers of acute rejection. Furthermore, it may provide great insights into un-derstanding the mechanisms and potential treatment strategy of acute rejection.