Objective To explore the feasibility, safety, and efficacy of transesophageal endoscopic surgery for mediastinal tumors. Methods A retrospective analysis was conducted on the clinical data of 17 patients who underwent transesophageal endoscopic resection for benign mediastinal tumors at the Endoscopy Center of Zhongshan Hospital, Fudan University, between January 1, 2016 and December 31, 2024. Epidemiological characteristics, surgical parameters, adverse events, and follow-up outcomes were analyzed. Results Among the 17 patients, there were 9 males and 8 females, with an average age of (42.4±14.5) years and an average tumor size of (2.6±1.6) cm. Pathological types included esophageal duplication cysts (6 cases, 35.3%), bronchogenic cysts (5 cases, 29.4%), gastroenteric cysts (3 cases, 17.6%), schwannomas (2 cases, 11.8%), and lymphangioma (1 case, 5.9%). Fourteen patients (82.4%) underwent submucosal tunneling endoscopic resection (STER), 3 patients (17.6%) underwent natural orifice transluminal endoscopic mediastinal surgery. All surgeries were successfully completed without conversion to open surgery. En bloc resection was achieved in 11 patients (64.7%), with an average operative time of (60.9±32.6) min. No intraoperative bleeding or mucosal injury occurred, and 4 patients (23.5%) experienced minor complications (pneumothorax, fever, recurrent laryngeal nerve injury), all of which resolved with conservative treatment. The average postoperative hospital stay was (3.2±1.5) days, and no recurrence was observed during the follow-up period. Conclusions Transesophageal endoscopic resection of benign mediastinal tumors is a safe, effective, and minimally invasive treatment method. Further validation of its efficacy and safety through large-scale prospective studies is warranted.

Objective:Endoscopic resection of giant submucosal tumors (SMTs) in the esophagus and gastric cardia is challenging. The aim of this study was to investigate the safety and efficacy of various endoscopic procedures for resection of esophageal or gastric cardia SMTs with longitudinal diameter ≥7 cm and/or transverse diameter ≥3.5 cm.Methods:In this retrospective cohort study, we analyzed data of 109 patients with giant esophageal/cardia SMTs originating in the muscularis propria who had undergone endoscopic resection in Zhongshan Hospital from July 2017 to February 2022. Inclusion criteria were as follows: (1) SMT diameter ≥7 cm longitudinally or ≥3.5 cm transversely; (2) presence of symptoms requiring intervention; and (3) tumor originating in the muscularis propria. Exclusion criteria included severe comorbidities, coagulation disorders, prior surgery, or tumor adjacent to vital organs precluding endoscopic treatment. The primary outcomes were en bloc and piecemeal resection rates, whereas secondary outcomes comprised adverse events and long-term survival.Results:Among the 109 patients who had successfully undergone endoscopic resection, the median tumor diameters were 7.5 (4.0-15.0) cm, and 4.5 (1.5-7.0) cm. Submucosal tunneling endoscopic resection, endoscopic full-thickness resection, and endoscopic submucosal excavation were performed on 77, 22, and 10 patients, respectively. The median duration of the procedures was 90 (30-300) minutes. The overall en bloc resection rate was 78.9% (86/109), and piecemeal resection rate 21.1% (23/109). Major adverse events occurred in 12.8% of patients (14/109), comprising pneumothorax or pleural effusion ( n=12), esophageal-pleural fistula ( n=3), severe delayed bleeding ( n=1), tunnel infection with abdominal abscess ( n=1), pulmonary abscess ( n=1), abdominal abscess ( n=1), and postoperative esophageal stricture ( n=1). During a median follow-up period of 33.6 (15.4-70.4) months, no tumor recurrences or metastases were detected. Multivariate analysis revealed that transverse diameter ≥4.5 cm was an independent risk factor for piecemeal resection (OR=6.016, 95%CI: 2.180-16.597, P<0.001); longitudinal diameter ≥9.0 cm (OR=2.728, 95%CI: 1.005-7.405, P=0.049) and transverse diameter ≥4.5 cm (OR=2.942, 95%CI: 1.099-7.874, P=0.032) were independent risk factors for prolonged operation time; and longitudinal diameter ≥9.0 cm (OR=5.040, 95%CI: 1.425-17.828, P=0.012) and piecemeal resection (OR=6.280, 95%CI: 1.741-22.656, P=0.005) were independent risk factors for major adverse events. Conclusion:Endoscopic resection is a safe and effective treatment modality for giant esophageal or gastric cardia SMTs of longitudinal diameter ≥9.0 cm and transverse diameter ≥4.5 cm.

OBJECTIVES: Cardiovascular disease (CVD) poses a major threat to global health. Evaluating atherosclerosis in asymptomatic individuals can help identify those at high risk of CVD. This study aims to establish an individualized nomogram prediction model to estimate the risk of vascular plaque formation in asymptomatic individuals. METHODS: A total of 5 655 participants who underwent CVD screening at the Health Management Center of The Third Xiangya Hospital, Central South University, between January 2022 and June 2024 we retrospectively enrolled. Using simple random sampling, participants were divided into a training set (n=4 524) and a validation set (n=1 131) in an 8꞉2 ratio. Demographic and clinical data were collected and compared between groups. Multivariate logistic regression analysis was used to identify independent factors associated with vascular plaques and to construct a nomogram prediction model. The predictive performance and clinical utility of the model were evaluated using receiver operating characteristic (ROC) curves, the Hosmer-Lemeshow goodness-of-fit test, calibration plots, and decision curve analysis (DCA). RESULTS: The mean age of participants was 52 years old. There were 3 400 males (60.12%). The overall detection rate of vascular plaque in the screening population was 49.87% (2 820/5 655). No statistically significant differences were observed in clinical indicators between the training and validation sets (all P>0.05). Multivariate Logistic regression analysis identified age, systolic blood pressure, high-density lipoprotein (HDL), low-density lipoprotein (LDL), lipoprotein(a), male sex, smoking history, hypertension history, and diabetes history as independent risk factors for vascular plaque in asymptomatic individuals (all P<0.05). The area under the curve (AUC) of the nomogram model for predicting vascular plaque risk were 0.778 (95% CI 0.765 to 0.791, P<0.001) in the training set and 0.760 (95% CI 0.732 to 0.787, P<0.001) in the validation set. The Hosmer-Lemeshow goodness-of-fit test indicated good model calibration (training set: P=0.628; validation set: P=0.561). The calibration curve plotted using the Bootstrap method demonstrated good agreement between predicted probabilities and actual probabilities. DCA showed that the nomogram provided a clinical net benefit for predicting vascular plaque risk when the threshold probability ranged from 0.02 to 0.99. CONCLUSIONS The nomogram prediction model for vascular plaque risk, constructed using readily available and cost-effective physical examination indicators, exhibited good predictive performance. This model can assist in the early identification and intervention of asymptomatic individuals at high risk for cardiovascular disease.
Humans ; Male ; Middle Aged ; Female ; Nomograms ; Retrospective Studies ; Risk Factors ; Plaque, Atherosclerotic/diagnosis* ; Aged ; Adult ; Physical Examination ; Logistic Models ; Cardiovascular Diseases/epidemiology* ; ROC Curve

Objective:Endoscopic resection of giant submucosal tumors (SMTs) in the esophagus and gastric cardia is challenging. The aim of this study was to investigate the safety and efficacy of various endoscopic procedures for resection of esophageal or gastric cardia SMTs with longitudinal diameter ≥7 cm and/or transverse diameter ≥3.5 cm.Methods:In this retrospective cohort study, we analyzed data of 109 patients with giant esophageal/cardia SMTs originating in the muscularis propria who had undergone endoscopic resection in Zhongshan Hospital from July 2017 to February 2022. Inclusion criteria were as follows: (1) SMT diameter ≥7 cm longitudinally or ≥3.5 cm transversely; (2) presence of symptoms requiring intervention; and (3) tumor originating in the muscularis propria. Exclusion criteria included severe comorbidities, coagulation disorders, prior surgery, or tumor adjacent to vital organs precluding endoscopic treatment. The primary outcomes were en bloc and piecemeal resection rates, whereas secondary outcomes comprised adverse events and long-term survival.Results:Among the 109 patients who had successfully undergone endoscopic resection, the median tumor diameters were 7.5 (4.0-15.0) cm, and 4.5 (1.5-7.0) cm. Submucosal tunneling endoscopic resection, endoscopic full-thickness resection, and endoscopic submucosal excavation were performed on 77, 22, and 10 patients, respectively. The median duration of the procedures was 90 (30-300) minutes. The overall en bloc resection rate was 78.9% (86/109), and piecemeal resection rate 21.1% (23/109). Major adverse events occurred in 12.8% of patients (14/109), comprising pneumothorax or pleural effusion ( n=12), esophageal-pleural fistula ( n=3), severe delayed bleeding ( n=1), tunnel infection with abdominal abscess ( n=1), pulmonary abscess ( n=1), abdominal abscess ( n=1), and postoperative esophageal stricture ( n=1). During a median follow-up period of 33.6 (15.4-70.4) months, no tumor recurrences or metastases were detected. Multivariate analysis revealed that transverse diameter ≥4.5 cm was an independent risk factor for piecemeal resection (OR=6.016, 95%CI: 2.180-16.597, P<0.001); longitudinal diameter ≥9.0 cm (OR=2.728, 95%CI: 1.005-7.405, P=0.049) and transverse diameter ≥4.5 cm (OR=2.942, 95%CI: 1.099-7.874, P=0.032) were independent risk factors for prolonged operation time; and longitudinal diameter ≥9.0 cm (OR=5.040, 95%CI: 1.425-17.828, P=0.012) and piecemeal resection (OR=6.280, 95%CI: 1.741-22.656, P=0.005) were independent risk factors for major adverse events. Conclusion:Endoscopic resection is a safe and effective treatment modality for giant esophageal or gastric cardia SMTs of longitudinal diameter ≥9.0 cm and transverse diameter ≥4.5 cm.

Voice recognition is a key skill for successful human communication,but patients with voice recog-nition defects often suffer from the inability to accurately identify the speaker's identity.Phonagnosia refers to the difficulty in identifying a speaker by voice alone when hearing ability is not impaired.From the perspective of brain injury,the symptoms can be divided into congenital phonagnosia and developmental phonagnosia,and congenital phonagnosia is related to the dysfunction of the functional connection between the temporal lobe and the amygdala.The damaged brain areas in patients with acquired speech recognition defect mainly include the temporal lobe and the frontal lobe.In the future,more attention should be paid to the screening methods,neural mechanisms and differ-ences between patients with speech recognition deficiency and other patients with hearing and cognitive impairment.

To establish a fluorescence-labeled Corynebacterium pseudotuberculosis(Cp),the super-folded green fluorescent protein gene(sfGFP)fused to the red fluorescent protein gene(mCher-ry)was cloned into pXMJ19 and expressed in Cp.The fluorescent signals of recombinant Cp cul-tured under different pH values,and the visualized detection of bacteria in the macrophages J774A.1 or mice infected with recombinant Cp were evaluated.The results showed that a double fluores-cence labeled XH02-pXMJ19-sfGFPmCherry(XH02-sfGFPmCherry)was successfully construc-ted by electrotransformation of Cp with pXMJ19-sfGFPmCherry,which containing sfGFP fused to mCherry.The colony morphology of XH02-sfGFPmCherry on fresh blood agar plates was pink.The XH02-sfGFP mCherry showed green and red fluorescence when observed under the fluo-rescence microscope.Compared with cultivation at pH7.0,XH02-sfGFPmCherry showed a signifi-cant decrease in green fluorescence intensity(fluorescence intensity/D600)at pH5.0,but signifi-cantly increased in red fluorescence intensity at pH5.0.Green and red fluorescences of Cp were ob-served in the XH02-sfGFPmCherry-infected J774A.1 in vitro or in the liver and kidney of XH02-sfGFPmCherry-infected mice in vivo,and with good overlap of two kinds of fluorescences.This study demonstrates that the constructed dual fluorescent labeled Cp can efficiently express both red and green fluorescent proteins,and express the dominant fluorescent signals under different pH value conditions,which can be used for Cp monitoring in vitro infection of macrophages and in vivo infection of mice by this pathogen,and providing potential tool for the localization and tracing research of Cp infection.

To establish a fluorescence-labeled Corynebacterium pseudotuberculosis(Cp),the super-folded green fluorescent protein gene(sfGFP)fused to the red fluorescent protein gene(mCher-ry)was cloned into pXMJ19 and expressed in Cp.The fluorescent signals of recombinant Cp cul-tured under different pH values,and the visualized detection of bacteria in the macrophages J774A.1 or mice infected with recombinant Cp were evaluated.The results showed that a double fluores-cence labeled XH02-pXMJ19-sfGFPmCherry(XH02-sfGFPmCherry)was successfully construc-ted by electrotransformation of Cp with pXMJ19-sfGFPmCherry,which containing sfGFP fused to mCherry.The colony morphology of XH02-sfGFPmCherry on fresh blood agar plates was pink.The XH02-sfGFP mCherry showed green and red fluorescence when observed under the fluo-rescence microscope.Compared with cultivation at pH7.0,XH02-sfGFPmCherry showed a signifi-cant decrease in green fluorescence intensity(fluorescence intensity/D600)at pH5.0,but signifi-cantly increased in red fluorescence intensity at pH5.0.Green and red fluorescences of Cp were ob-served in the XH02-sfGFPmCherry-infected J774A.1 in vitro or in the liver and kidney of XH02-sfGFPmCherry-infected mice in vivo,and with good overlap of two kinds of fluorescences.This study demonstrates that the constructed dual fluorescent labeled Cp can efficiently express both red and green fluorescent proteins,and express the dominant fluorescent signals under different pH value conditions,which can be used for Cp monitoring in vitro infection of macrophages and in vivo infection of mice by this pathogen,and providing potential tool for the localization and tracing research of Cp infection.

Rheumatic fever is an autoimmune disease characterized by recurring acute or chronic systemic connective tissue inflammation caused by group A streptococcal infection in the throat. Although rheumatic fever is common in China, there is a lack of standardized criteria for the diagnosis and treatment of this condition. Based on evidence and guidelines from China and other countries, the Chinese Rheumatology Association developed standardized criteria for the diagnosis and treatment of this disease in China. The aim was to standardize rheumatic fever diagnosis methods, treatment opportunities, and strategies for both short-and long-term treatment, so as to reduce irreversible damage and improve prognosis.

Objective:To examine the association between working hours and urinary sodium and potassium excretion levels in a population undergoing health examinations and the potential mediating effect of timely eating behaviors.Methods:In this cross-sectional study, 64 400 people who received health checkups from August 2017 to August 2022 at the Third Xiangya Hospital of Central South University were recruited as study subjects. General information on socio-demographic characteristics of the enrolled subjects were collected using the health checkup self-assessment questionnaire in the Expert Consensus on Basic Items for Health Checkups. Urinary excretion levels of sodium and potassium were measured with the Kawasaki method. The association between working hours and urinary sodium and potassium excretion levels was checked by using Pearson′s correlation analysis. The relationships between timely eating behaviors, working hours, and urinary sodium and potassium excretion levels and their ratios were analyzed using logistic regression and linear regression models, while the mediating mechanisms involved was also examined.Results:Among the 64 400 subjects, there were 39 274 males (60.98%) and 25 126 females (39.02%), the mean age was (43.80±11.13) years. There were 16 980 individuals (26.37%) with an average working time exceeding 8 hours per day. Additionally, 4 332 subjects (6.73%) were unable to eat three meals on time. The mean urinary sodium and potassium excretion and their ratios were (4.12±1.86) g/d, (2.06±0.80) g/d, 2.05±0.66, respectively. There was a significant positive correlation between working hours and urinary sodium excretion, urinary potassium excretion, and their ratios ( r=0.034, 0.021, 0.032, respectivley); it showed that timely eating behavior had a significant negative correlation with urinary sodium and potassium excretion ( r=-0.022, -0.019, respectivley) (all P<0.001). There was a partial mediating effect of timely eating behavior in the association between working hours and urinary sodium excretion (effect value of -0.006), and after stratifying the labor intensity, this mediating effect was only found among individuals engaged in light physical labor (both P<0.001). Conclusions:Prolonged working hours leads to increased levels of urinary sodium and urinary potassium excretion, and timely eating behavior facilitates salt/sodium reduction in light-duty workers.

Objective:To review publications in the field of digestive endoscopic minimally-invasive resection in the past 10 years in and outside China.Methods:Literature of digestive endoscopic minimally-invasive resection in the Web of Science and CNKI databases from January 1, 2011 to July 17, 2021 was retrieved. VOSviewer 1.6.11 was used for clustering and time series analysis of countries, institutions, authors and keywords, and drawing evidence-based visualization maps, so as to analyze the cooperation among countries, academic institutions and researchers, to compare the differences in research topics between Chinese and English databases, and to predict the future research hot spots and directions.Results:A total of 22 834 English articles and 4 636 Chinese articles were included. Over the past 10 years, the number of Chinese and English publications has been growing steadily, and most of them were published in professional journals. The publications were mainly from China, Japan, South Korea and the United States, where all exceeded 2 000. The National Cancer Center of Japan had 497 publications, ranking the first among all institutions. The cooperation between academic institutions showed obvious regional characteristics, and the inter-institutional and interpersonal cooperation needed improvement. In terms of keyword clustering, there was no significant difference between Chinese and English publications, but there were two additional clusters in Chinese publications, endoscopic nursing and submucosal tumor. Overlays analysis of key words showed that endoscopic surgery, tunneling technique, and submucosal tumor could be hot spots and future directions.Conclusion:Digestive endoscopic minimally-invasive resection has experienced a vigorous development in the past 10 years with a growing number of Chinese and English publications. China is playing an increasingly important role on the international stage. The advanced nature of research focus in Chinese publications is comparable to that in English publications, yet also showing Chinese characteristics. In the future, more efforts should be taken to strengthen regional cooperation and focus on research hot spots.