Objective:To investigate the incidence and risk factors associated with poor healing in closed drainage incisions among elderly lung cancer patients(aged ≥65 years)undergoing thoracoscopic pulmonary resection.Methods:A retrospective cohort study was conducted involving 471 elderly lung cancer patients who underwent single utility port video-assisted thoracic surgery(VATS)pulmonary resection at Beijing Hospital from January 1, 2022, to December 31, 2023.Patients were categorized into'healed’and'poor healing’groups based on the development of grade B/C healing following the removal of the closed drainage tube.A comparative analysis of demographic characteristics, medical history, and perioperative parameters between the groups was performed.Multivariate logistic regression analysis was employed to identify independent risk factors for poor incision healing.Results:A total of 471 elderly lung cancer patients who underwent VATS lobectomy were enrolled, with a mean age of 71.16 ± 3.44 years. Among them, 200(42.46%)were male and 271(57.54%)were female.Among 471 patients, 101(21.44%)developed poor healing, all classified as grade B. Univariate analysis revealed statistically significant differences between the two groups regarding BMI( χ2=1.632, P=0.004), diabetes mellitus( χ2=1.558, P=0.004), prolonged drainage duration ( χ2=1.829, P=0.002), and the extent of pulmonary resection( χ2=2.571, P=0.042).Multivariate logistic regression analysis indicated that a BMI of ≥24 kg/m 2( OR=1.534, 95% CI: 1.191-3.289, P=0.033), drainage tube indwelling time exceeding 4 days postoperatively( OR=1.712, 95% CI: 1.014-3.791, P=0.036), and diabetes mellitus( OR=1.855, 95% CI: 1.418-4.015, P=0.002)were significant factors influencing poor wound healing, with statistically significant differences noted( P<0.05). Conclusions:BMI, prolonged drainage duration, diabetes mellitus, and the extent of pulmonary resection are independent risk factors for poor healing of closed drainage incisions in elderly lung cancer patients following VATS.Clinical strategies should prioritize the control of BMI, perioperative glycemic management, real-time monitoring of drainage, and timely removal of tubes to mitigate complications.

Objective:To investigate the incidence and risk factors associated with poor healing in closed drainage incisions among elderly lung cancer patients(aged ≥65 years)undergoing thoracoscopic pulmonary resection.Methods:A retrospective cohort study was conducted involving 471 elderly lung cancer patients who underwent single utility port video-assisted thoracic surgery(VATS)pulmonary resection at Beijing Hospital from January 1, 2022, to December 31, 2023.Patients were categorized into'healed’and'poor healing’groups based on the development of grade B/C healing following the removal of the closed drainage tube.A comparative analysis of demographic characteristics, medical history, and perioperative parameters between the groups was performed.Multivariate logistic regression analysis was employed to identify independent risk factors for poor incision healing.Results:A total of 471 elderly lung cancer patients who underwent VATS lobectomy were enrolled, with a mean age of 71.16 ± 3.44 years. Among them, 200(42.46%)were male and 271(57.54%)were female.Among 471 patients, 101(21.44%)developed poor healing, all classified as grade B. Univariate analysis revealed statistically significant differences between the two groups regarding BMI( χ2=1.632, P=0.004), diabetes mellitus( χ2=1.558, P=0.004), prolonged drainage duration ( χ2=1.829, P=0.002), and the extent of pulmonary resection( χ2=2.571, P=0.042).Multivariate logistic regression analysis indicated that a BMI of ≥24 kg/m 2( OR=1.534, 95% CI: 1.191-3.289, P=0.033), drainage tube indwelling time exceeding 4 days postoperatively( OR=1.712, 95% CI: 1.014-3.791, P=0.036), and diabetes mellitus( OR=1.855, 95% CI: 1.418-4.015, P=0.002)were significant factors influencing poor wound healing, with statistically significant differences noted( P<0.05). Conclusions:BMI, prolonged drainage duration, diabetes mellitus, and the extent of pulmonary resection are independent risk factors for poor healing of closed drainage incisions in elderly lung cancer patients following VATS.Clinical strategies should prioritize the control of BMI, perioperative glycemic management, real-time monitoring of drainage, and timely removal of tubes to mitigate complications.

Endosomal TLRs (TLR3/7/8/9) are highly analogous innate immunity sensors for various viral or bacterial RNA/DNA molecular patterns. Among them, TLR7, in particular, has been suggested to be a target for various inflammatory disorders and autoimmune diseases including systemic lupus erythematosus (SLE); but few small-molecule inhibitors with elaborated mechanism have been reported in literature. Here, we reported a well-characterized human TLR7-specific small-molecule inhibitor, TH-407b, with promising potency and negligible cytotoxicity through a novel binding mechanism. Notably, TH-407b not only effectively inhibited TLR7-mediated pro-inflammatory signaling in a variety of cultured cell lines but also demonstrated potent inflammation suppressing activities in primary peripheral blood mononuclear cells (PBMCs) derived from SLE patients. Furthermore, TH-407b showed prominent efficacy in vivo, improved survival rate and ameliorated symptoms of SLE model mice. To obtain molecular insights into the TH-407b derivatives' inhibition mechanism, we performed the structural analysis of TLR7/TH-407b complex using cryogenic electron microscopy (cryo-EM) method. As an atomistic resolution cryo-EM structure of the TLR family, it not only of value to facilitate structure-based drug design, but also shed light to methodology development of small proteins using EM. Significantly, TH-407b has unveiled an inhibition strategy for TLR7 via stabilizing its resting/inactivated state. Such a resting state could be generally applicable to all TLRs, rendering a useful method for targeting this group of important immunological receptors.

Objective:To explore the safety and efficiency of a novel bipolar electric knife for endoscopic submucosal dissection.Methods:The thermal damage on tissue caused by the new bipolar knife and traditional monopolar knife were compared by finite element analysis. The vertical thermal damage to the porcine gastric wall caused by the two types of electric knife were analyzed in vitro animal experiments. In vivo animal experiments were used to compare operation related indexes of two types of electric knife, including en bloc resection rate and cutting efficiency in porcine digestive tract submucosal dissection. Results:Through overcoming deviation of experimental individuals and operator experience, the finite element model showed that the length, width and depth of thermal damage on tissue caused by the monopolar knife was 1.08 times, 1.12 times, and 1.23 times of that of the bipolar knife, respectively. Additionally, the bipolar knife caused less vertical thermal damage to the porcine gastric wall than the monopolar knife (433.25±42.58 μm VS 898.03±111.59 μm, t=6.740, P=0.003) in vitro animal experiments when charged for 1 s at the same power. Finally, in vivo animal experiments showed that the en bloc resection rates of the two kinds of electric knife systems were both 100.0%. In addition, the cutting area and cutting time of the bipolar knife was 229.58±185.29 mm 2 and 164.37±96.27 s, respectively. The corresponding indicators of the monopolar knife was 209.70±167.35 mm 2 and 162.65±69.97 s, respectively, and there was no significant difference (all P>0.05). Conclusion:The novel bipolar knife not only ensures the cutting efficiency but also reduces the thermal damage during endoscopic submucosal dissection in simulating experiment and animal experiment, which needs further verification in clinical trial.

Objective: To evaluate the cardiac function of cecal ligation and puncture (CLP) induced sepsis rats with high-resolution ultrasound. Methods: According to the method of random number table, 48 adult male Sprague-Dawley (SD) rats were randomly divided into normal control group and sepsis 6, 12, 24, 30, 48 hours groups, with 8 rats in each group. The sepsis model was produced by CLP, and the rats in the normal control group were only anesthetized and resuscitated. The general situation after modeling in each group was observed, and the left ventricular function was assessed by high-resolution echocardiography at all the time points. The abdominal aorta blood of rats was collected, and the serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and MB isoenzyme of creatine kinase (CK-MB) were determined by enzyme-linked immunosorbent assay (ELISA). The myocardial tissue was harvested, and the pathological changes in myocardial tissue were observed by hematoxylin-eosin (HE) staining. Results: The rats challenged to CLP displayed symptoms of sepsis, such as depression, ruffled fur, decreased diet and activity, and the symptoms became more obvious with the extension of time. High-resolution echocardiography could clearly show the structure of left ventricle in each group and obtain satisfactory M-mode echocardiography of left ventricle. The heart rate (HR) of rats in all sepsis groups was elevated with the increase in model time as measured by high-resolution ultrasound, and it was significantly higher than that in the normal control group at 12, 24, 30 hours (bpm: 359.66±23.33, 361.35±12.85, 392.67±11.33 vs. 306.24±29.79, all P < 0.05). Stroke volume (SV) and cardiac output (CO) in sepsis rats were decreased with the increase in model time, while left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were increased first and then decreased, and SV and LVEF in sepsis 48 hours group were significantly lower than those in the normal control group [SV (μL): 78.43±17.52 vs. 122.61±15.88, LVEF: 0.763±0.018 vs. 0.902±0.011, both P < 0.05]. Left ventricular weight (LVW) in all sepsis groups was increased to different degrees as compared with that in the normal control group, as well as the left ventricular anterior and posterior wall thickness increased in diastole and systole. Compared with the normal control group, the left ventricular posterior wall thickness was increased significantly at the end of diastolic and systolic period in the sepsis 12 hours group, and the left ventricular anterior wall thickness was also increased significantly at the end of diastolic period in the sepsis 48 hours group. The serum levels of TNF-α, IL-1β and CK-MB in sepsis rats were increased first and then decreased with the extension of model making time. The above parameters in the sepsis 48 hours group were still significantly higher than those in the normal control group [TNF-α (ng/L): 61.59±3.99 vs. 16.87±4.89, IL-1β (ng/L): 255.03±13.23 vs. 119.59±10.43, CK-MB (μg/L): 1.27±0.15 vs. 0.52±0.15, all P < 0.05]. HE staining showed that the myocardial striations of the rats in the normal control group were clear and complete, with normal morphology and orderly arrangement of cardiac cells. However in the sepsis groups, myocardial cells were swollen, ruptured and necrotic, and inflammatory cells were infiltrated, with myocardial fibers ruptured and necrosis dissolved, and the above pathological manifestations gradually increased with the extension of the model making time. Conclusion High-resolution ultrasound can evaluate the cardiac function of CLP induced sepsis rat model more comprehensive, and the consequence of evaluation index is consistent with the expression level of myocardial enzyme and histopathologic manifestations.

Objective: To investigate the feasibility and clinic outcome of the turbocharging technique in repairing large defect with free perforator flap. Methods: From January 2017 to December 2018, 6 patients with defect of over length or large size were repaired with free perforator flaps, anterolateral thigh(ALT) flap in 3 cases and deep inferior epigastric artery perforator(DIEP) flap in 3 cases in Department of Hand Surgery, Ningbo No.6 Hospital. There were 4 males and 2 females, aged from 29 to 54 years old, with an average age of 41 years old.It was found that the size of the flap beyond the perforasome, while multiple perforators in the flaps were not from the same pedicle. The turbocharging technique was applied in the operation. The distal perforator of the flap was anastomosed with the proximal pedicle branch. The flap size ranged from 20 cm×8 cm to 25 cm×12 cm. The donor sites were closed directly for 3 cases and skin grafting for 3 cases. Results: All the flaps survived successfully, no distal necrosis occurred. The patients were followed up for 3 to 12 months, with an average of 9 months. All flaps survived well with satisfactory appearance and pliable texture. The healing of skin graft was satisfactory in 3 cases in donor site. No graft skin contracture occurred. The donor sites closed directly in 3 cases had linear scar in donor site, no obvious contracture occurred. The flap sensation returned to S2-S3. Conclusions If the size of the flap is super long or large, beyond the perforasome, while multiple perforators in the flaps were not from the same pedicle, the application of turbocharging technique can avoid partial necrosis of the flap and improve the survival rate of the flap, which is an ideal alternative.

OBJECTIVE: To evaluate the cardiac function of cecal ligation and puncture (CLP) induced sepsis rats with high-resolution ultrasound. METHODS: According to the method of random number table, 48 adult male Sprague-Dawley (SD) rats were randomly divided into normal control group and sepsis 6, 12, 24, 30, 48 hours groups, with 8 rats in each group. The sepsis model was produced by CLP, and the rats in the normal control group were only anesthetized and resuscitated. The general situation after modeling in each group was observed, and the left ventricular function was assessed by high-resolution echocardiography at all the time points. The abdominal aorta blood of rats was collected, and the serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and MB isoenzyme of creatine kinase (CK-MB) were determined by enzyme-linked immunosorbent assay (ELISA). The myocardial tissue was harvested, and the pathological changes in myocardial tissue were observed by hematoxylin-eosin (HE) staining. RESULTS: The rats challenged to CLP displayed symptoms of sepsis, such as depression, ruffled fur, decreased diet and activity, and the symptoms became more obvious with the extension of time. High-resolution echocardiography could clearly show the structure of left ventricle in each group and obtain satisfactory M-mode echocardiography of left ventricle. The heart rate (HR) of rats in all sepsis groups was elevated with the increase in model time as measured by high-resolution ultrasound, and it was significantly higher than that in the normal control group at 12, 24, 30 hours (bpm: 359.66±23.33, 361.35±12.85, 392.67±11.33 vs. 306.24±29.79, all P < 0.05). Stroke volume (SV) and cardiac output (CO) in sepsis rats were decreased with the increase in model time, while left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were increased first and then decreased, and SV and LVEF in sepsis 48 hours group were significantly lower than those in the normal control group [SV (μL): 78.43±17.52 vs. 122.61±15.88, LVEF: 0.763±0.018 vs. 0.902±0.011, both P < 0.05]. Left ventricular weight (LVW) in all sepsis groups was increased to different degrees as compared with that in the normal control group, as well as the left ventricular anterior and posterior wall thickness increased in diastole and systole. Compared with the normal control group, the left ventricular posterior wall thickness was increased significantly at the end of diastolic and systolic period in the sepsis 12 hours group, and the left ventricular anterior wall thickness was also increased significantly at the end of diastolic period in the sepsis 48 hours group. The serum levels of TNF-α, IL-1β and CK-MB in sepsis rats were increased first and then decreased with the extension of model making time. The above parameters in the sepsis 48 hours group were still significantly higher than those in the normal control group [TNF-α (ng/L): 61.59±3.99 vs. 16.87±4.89, IL-1β (ng/L): 255.03±13.23 vs. 119.59±10.43, CK-MB (μg/L): 1.27±0.15 vs. 0.52±0.15, all P < 0.05]. HE staining showed that the myocardial striations of the rats in the normal control group were clear and complete, with normal morphology and orderly arrangement of cardiac cells. However in the sepsis groups, myocardial cells were swollen, ruptured and necrotic, and inflammatory cells were infiltrated, with myocardial fibers ruptured and necrosis dissolved, and the above pathological manifestations gradually increased with the extension of the model making time. CONCLUSIONS High-resolution ultrasound can evaluate the cardiac function of CLP induced sepsis rat model more comprehensive, and the consequence of evaluation index is consistent with the expression level of myocardial enzyme and histopathologic manifestations.
Animals ; Cecum ; Heart/physiopathology* ; Heart Function Tests ; Ligation ; Male ; Punctures ; Rats ; Rats, Sprague-Dawley ; Sepsis ; Tumor Necrosis Factor-alpha ; Ultrasonography

Objective To compare the clinical effects of sodium valproate separately combined with ziprasi -done and olanzapine in the treatment of bipolar disorder type Ⅰ .Methods 100 patients with bipolar disorder type Ⅰ were chosen.According to the digital table ,the patients were randomly divided into two groups ,including A group (50 children) with olanzapine and B group (50 children) with ziprasidone on the basis of sodium valproate .The clinical effects,the BRMS score,digit symbol scores,TMT A/B scores,WCST score and TOH cognitive function scores before and after treatment of the two groups were compared .Results The total effective rates of A group and B group were 88.00％,92.00％,respectively.There was no statistically significant difference in clinical effects between the two groups(χ2 =8.14,P<0.05).The BRMS scores of both two groups after treatment were significantly lower than before treatment(t=3,74,4.06,all P<0.05).There was no statistically significant difference in BRMS score after treatment between the two groups (t =0.89,P >0.05).The digit symbol scores,WCST score and TOH cognitive function scores of B group after treatment were significantly higher than those of A group and before treatment ( t=3.17,4.03,3.96,3.54,2.86,3.81,4.66,4.29,3.81,3.43,all P<0.05).The TMT A/B scores of B group after treatment were significantly lower than those of A group and before treatment ( t=3.82,4.82,4.55,4.09,3.83,all P<0.05).Conclusion Sodium valproate separately combined with ziprasidone and olanzapine in the treatment of bipolar disorder type I possess the same clinical effects in manic symptoms relief ,and sodium valproate combined with ziprasidone can effectively promote the recovery process of cognitive function damage and improve the clinical prognosis for long-term.

OBJECTIVETo discuss the clinical therapeutic effects of electroacupuncture at Neimadian (Extra) and Neiguan (PC 6) on the analgesic effect of thoracic perioperative stage and its effect mechanism.

METHODSSixty cases of esophageal cancer with elective radical resection under general anesthesia were divided into an observation group and a control group according to the operation sequence, 30 cases in each one. In the control group, the general anesthesia was simply applied and sufentanil was administered for patient controlled intravenous analgesia (PCIA) after operation. In the observation group, on the basis of the scheme as the control group, the electroacupuncture was used at Neimadian (Extra) and Neiguan (PC 6) 30 min before anesthesia induction and after operation, with continuous wave, tolerable intensity, lasting for 30 min. Separately, before acupuncture (T1) and 2h (T2), 12h (T3), 24h (T4) and 48h (T5) after operation, the plasma β-endorphin (β-EP), 5-hydroxytryptamine (5-HT) and prostaglandin E(PGE) were determined. During operation, under the same state (from 50 to 60) of bispectrum of EEG (BIS), the intraoperative anesthetic dose was recorded. Using visual analogue scale (VAS), the pain degree was evaluated at T2, T3, T4 and T5 separately and the grade assessment of the therapeutic effects and safety were recorded at each time point.

RESULTS①The total dosage of sufentanil in the observation group was less than that in the control group[(1.83±0.56) mg vs (2.54±0.62) mg,<0.05]. ②VAS scores at T2, T3 and T4 in the patients of the observation group were all lower than those in the control group (all<0.05). ③The levels of plasma β-EP at T3, T4 and T5 in the observation group were increased significantly as compared with those in the control group (all<0.05) and the levels of plasma 5-HT and PGEat T2, T3 and T4 were reduced significantly as compared with those in the control group (all<0.05). ④ The excellent analgesia rates 2h、12h and 24h after operation in the observation group were better than those in the control group (all<0.05). ⑤The rate of the A grade safety in the observation group was higher than that in the control group (<0.05).

CONCLUSIONSElectroacupuncture at Neimadian (Extra) and Neiguan (PC 6) provides the safe and effective postoperative anesthesia of thoracic surgery and reduces the dosage of analgesics during the operation, which is possibly related to the increase of endogenous β-EP and the inhibition on the release of 5-HT and PGE.

Objective To explore the association of ATP-binding cassette (ABC) efflux pump gene Rv1217c-Rv1218c and the drug resistance of Mycobacterium tuberculosis.Methods A total of 34 Mycobacterium tuberculosis clinical isolates including 24 drug-resistance isolates which were resistant to riffampicin,isoniazid,streptomycin or ethambutol and resistant to at least one second-line antituberculosis drug,and 10 drug-sensitive isolates were involved in this study.The RNA of isolated strains was extracted and then reverse transcribed. Gene expression was performed by real-time polymerase chain reaction (PCR) and data was analyzed by t test and Logistic regression analysis.Results The expressions of Rv1217c in rifampicin-resistant group (2.13 ± 1.89,t =3.44,P＜0.01),isoniazid-resistant group ( 1.84 ± 1.86,t =3.16,P＜ 0.05),streptomycin-resistant group ( 1.86 ±1.96,t=2.78,P＜0.05) and ethambutol-resistant groups (3.36±2.35,t=3.04,P＜0.05) were all higher than sensitive isolates (0.42 ± 0.31).The expressions of Rv1218c in rifampicin-resistant group (2.54±1.84,t=3.82,P＜0.01),isoniazid-resistant group (2.34± 1.84,t=3.72,P＜0.01),streptomycin-resistant group (2.15±1.86,t=3.01,P＜0.01) and ethambutol-resistant groups (3.78± 1.78,t=4.22,P＜0.01 ) were all higher than sensitive isolates (0.65 ± 0.42).The expressions of Rv1217c and Rv1218c in multidrug resistant group were 2.74±2.07 and 3.33± 1.77,respectively,which were both higher than polydrug resistant group (0.79 ± 0.47 and 1.03 ± 0.79,respectively; t =2.91,P＜0.05 ; t =3.84,P＜0.01,respectively).Logistic regression analysis found that high Rv1217c expression was positively correlated with rifampicin resistance and negatively correlated with isoniazid resistance (both P＜ 0.01 ),while high Rv1218c expression was negatively correlated with rifampicin resistance and positively correlated with isoniazid resistance (both P＜0.01 ).High expressions of two genes were both positively correlated with ethambutol resistance and multidrug resistance (both P＜0.01 ) and not statistically correlated with streptomycin resistance (P＞0.05).Conclusions The expressions of ABC efflux pump gene,Rv1217c-Rv1218c,are correlated with multiple drug resistance.The overexpression may contribute to the multidrug resistance of Mycobacterium tuberculosis.