Objective To investigate the expression levels of serum fibronectin(FN)in patients with non-small cell lung cancer(NSCLC)and evaluate its clinical diagnostic significance.Methods Firstly,the gene and tissue protein expression levels of FN in NSCLC were assessed using the TIMER2.0 database,GTEx database,and Human Protein Atlas(HPA)database.Secondly,from January 2021 to June 2023,a total of 154 patients with lung space-occupying lesions or shadows at the First Affiliated Hospital of Anhui University of Chinese Medicine were enrolled.Based on medical history,clinical manifestations,imaging tests,and pathological histological find-ings,these patients were categorized into two groups:81 patients with NSCLC and 73 patients with benign lung diseases.The serum concentration of FN was measured by immunoturbidimetry,while the serum levels of CEA,SCC,and CYFRA21-1 were determined using chemiluminescence.Results The bioinformatics analysis results demonstrated that the gene expression and tissue protein levels of FN were significantly reduced compared to normal tissues.In serological evaluations,serum FN concentrations in patients with advanced NSCLC(Stage Ⅲ-Ⅳ)and early-stage NSCLC(Stage Ⅰ-Ⅱ)(249.50 ng/mL and 305.00 ng/mL,respectively)were markedly lower than those observed in the benign lung disease group(429.16 ng/mL)(P<0.001).Univariate and multivariate logistic regression analyses indicated that serum FN could serve as a significant predictor for the presence of NSCLC.The area under the receiver operating characteristic curve(ROC)for serum FN in diagnosing early-stage NSCLC was 0.790,which outperformed CEA(0.618),SCC(0.653),and CYFRA21-1(0.601).The optimal critical concen-tration of serum FN for distinguishing early-stage NSCLC from benign diseases was determined to be 347.6 ng/mL,with a sensitivity of 71.93％,surpassing that of CEA(19.30％),SCC(12.28％),and CYFRA21-1(8.77％).Conclusion Serum FN is significantly downregulated in NSCLC and may serve as a potential biomarker for the early diagnosis of NSCLC.

Objective:To investigate the clinical efficacy of laparoscopic iliopubic tract-to-arcuate inferior edge of transversus abdominis suture tightening of the internal ring combined with high ligation of the hernia sac in pediatric giant inguinal hernias.Methods:Randomized controlled study.Clinical data of 62 hernia sides in 61 children with inguinal hernia admitted to the Department of Minimally Invasive Urology, Children′s Hospital Affiliated to Shandong University from March 2021 to June 2024 were retrospectively analyzed.The maximum internal ring diameter, measured intraoperatively using an equal proportional indirect measurement technique, was >1.5 cm, defining a giant hernia.One child had bilateral giant hernias.Patients were divided into 2 groups based on surgical technique: the control group [29 sides (28 patients)] underwent traditional laparoscopic high ligation of the hernia sac; the study group [33 sides (33 patients)] underwent the laparoscopic iliopubic tract-to-arcuate inferior edge of transversus abdominis suture tightening of the internal ring combined with high ligation of the hernia sac.Independent sample t-test, Mann-Whitney U test, and Fisher′s exact test were used to compare preoperative characteristics and postoperative complication rates between the two groups. Results:The study group had a median age of 38.00 (20.00, 107.50) months, 93.9%(31/33) were male, and median maximum internal ring diameter was 1.61(1.53, 1.82) cm.The control group had a median age of 32.50 (22.25, 65.00) months, 78.6%(22/28) were male, and median maximum internal ring diameter was 1.58 (1.54, 1.71) cm.There were no statistically significant differences in baseline characteristics between groups (all P>0.05). The operative time for the suture tightening/high ligation component was longer in the study group [(21.73±9.81) minutes] compared to the simple high ligation time in the control group [(16.69±7.36) minutes], with statistical significance ( t=-2.262, P=0.027). In terms of recurrence rate, there was a statistically significant difference between the study group(0) and the control group (4 cases, 13.80%) ( P=0.043). There was no statistical difference between the two groups in the incidence of other complications including intraoperative bleeding, groin area edema, or pain (all P>0.05). Conclusions:The laparoscopic iliopubic tract-to-arcuate inferior edge of transversus abdominis suture tightening of the internal ring combined with high ligation of the hernia sac can effectively reduces postoperative recurrence when applied to the treatment of large hernias and is safe, making it a technique worthy of promotion.

Objective To investigate the expression levels of serum fibronectin(FN)in patients with non-small cell lung cancer(NSCLC)and evaluate its clinical diagnostic significance.Methods Firstly,the gene and tissue protein expression levels of FN in NSCLC were assessed using the TIMER2.0 database,GTEx database,and Human Protein Atlas(HPA)database.Secondly,from January 2021 to June 2023,a total of 154 patients with lung space-occupying lesions or shadows at the First Affiliated Hospital of Anhui University of Chinese Medicine were enrolled.Based on medical history,clinical manifestations,imaging tests,and pathological histological find-ings,these patients were categorized into two groups:81 patients with NSCLC and 73 patients with benign lung diseases.The serum concentration of FN was measured by immunoturbidimetry,while the serum levels of CEA,SCC,and CYFRA21-1 were determined using chemiluminescence.Results The bioinformatics analysis results demonstrated that the gene expression and tissue protein levels of FN were significantly reduced compared to normal tissues.In serological evaluations,serum FN concentrations in patients with advanced NSCLC(Stage Ⅲ-Ⅳ)and early-stage NSCLC(Stage Ⅰ-Ⅱ)(249.50 ng/mL and 305.00 ng/mL,respectively)were markedly lower than those observed in the benign lung disease group(429.16 ng/mL)(P<0.001).Univariate and multivariate logistic regression analyses indicated that serum FN could serve as a significant predictor for the presence of NSCLC.The area under the receiver operating characteristic curve(ROC)for serum FN in diagnosing early-stage NSCLC was 0.790,which outperformed CEA(0.618),SCC(0.653),and CYFRA21-1(0.601).The optimal critical concen-tration of serum FN for distinguishing early-stage NSCLC from benign diseases was determined to be 347.6 ng/mL,with a sensitivity of 71.93％,surpassing that of CEA(19.30％),SCC(12.28％),and CYFRA21-1(8.77％).Conclusion Serum FN is significantly downregulated in NSCLC and may serve as a potential biomarker for the early diagnosis of NSCLC.

Objective:To investigate the clinical efficacy of laparoscopic iliopubic tract-to-arcuate inferior edge of transversus abdominis suture tightening of the internal ring combined with high ligation of the hernia sac in pediatric giant inguinal hernias.Methods:Randomized controlled study.Clinical data of 62 hernia sides in 61 children with inguinal hernia admitted to the Department of Minimally Invasive Urology, Children′s Hospital Affiliated to Shandong University from March 2021 to June 2024 were retrospectively analyzed.The maximum internal ring diameter, measured intraoperatively using an equal proportional indirect measurement technique, was >1.5 cm, defining a giant hernia.One child had bilateral giant hernias.Patients were divided into 2 groups based on surgical technique: the control group [29 sides (28 patients)] underwent traditional laparoscopic high ligation of the hernia sac; the study group [33 sides (33 patients)] underwent the laparoscopic iliopubic tract-to-arcuate inferior edge of transversus abdominis suture tightening of the internal ring combined with high ligation of the hernia sac.Independent sample t-test, Mann-Whitney U test, and Fisher′s exact test were used to compare preoperative characteristics and postoperative complication rates between the two groups. Results:The study group had a median age of 38.00 (20.00, 107.50) months, 93.9%(31/33) were male, and median maximum internal ring diameter was 1.61(1.53, 1.82) cm.The control group had a median age of 32.50 (22.25, 65.00) months, 78.6%(22/28) were male, and median maximum internal ring diameter was 1.58 (1.54, 1.71) cm.There were no statistically significant differences in baseline characteristics between groups (all P>0.05). The operative time for the suture tightening/high ligation component was longer in the study group [(21.73±9.81) minutes] compared to the simple high ligation time in the control group [(16.69±7.36) minutes], with statistical significance ( t=-2.262, P=0.027). In terms of recurrence rate, there was a statistically significant difference between the study group(0) and the control group (4 cases, 13.80%) ( P=0.043). There was no statistical difference between the two groups in the incidence of other complications including intraoperative bleeding, groin area edema, or pain (all P>0.05). Conclusions:The laparoscopic iliopubic tract-to-arcuate inferior edge of transversus abdominis suture tightening of the internal ring combined with high ligation of the hernia sac can effectively reduces postoperative recurrence when applied to the treatment of large hernias and is safe, making it a technique worthy of promotion.

Objective To evaluate the corneal biomechanical changes after femtosecond laser-assisted in situ kerato-mileusis(FS-LASIK)combined with accelerated corneal cross-linking(FS-LASIK Xtra)for the correction of high myopia u-sing Corvis ST.Methods In this prospective case-control study,185 patients(185 eyes)who underwent surgical correc-tion of high myopia in the Affiliated Eye Hospital of Shandong University of Chinese Medicine from July 2020 to July 2022 were selected,including 93 patients receiving FS-LASIK Xtra in the FS-LASIK Xtra group and 92 patients receiving FS-LASIK in the FS-LASIK group.All patients had their right eyes included in the study.During the 6-month follow-up,the uncorrect-ed visual acuity,spherical equivalent(SE),mean corneal curvature,thinnest corneal thickness,corneal biomechanical pa-rameters[deformation amplitude ratio at 2 mm(DAR 2 mm),integrated radius(IR),stiffness parameter at the first appla-nation(SP-A1),stress-strain index(SSI)],and changes in corneal biomechanical parameters before and after surgery(difference between 6 months after surgery and before surgery,namely ΔDAR 2 mm,ΔIR,ΔSP-A1,and ΔSSI)were recor-ded.Independent sample t test and Mann-Whitney U test were used to compare the data between groups.Results Three months after surgery,the SE in the FS-LASIK group and the FS-LASIK Xtra group was(-0.21±0.31)D and(-0.04±0.36)D,respectively,and the difference was statistically significant(t=3.49,P=0.001).Six months after surgery,the SE in the FS-LASIK group and the FS-LASIK Xtra group was(-0.33±0.31)D and(-0.14±0.37)D,respectively,and the difference was statistically significant(t=4.00,P＜0.001).There was no significant difference in efficacy index and safety index between the FS-LASIK group and the FS-LASIK Xtra group at 6 months after operation(both P＞0.05).There were no significant differences in DAR 2 mm,IR,SP-A1,SSI and other biomechanical parameters between the two groups before surgery(all P＞0.05).At 6 months postoperatively,ΔIR in the FS-LASIK group and the FS-LASIK Xtra group was 3.03±0.78 and 2.67±0.80,respectively;ΔSP-A1 was-35.93±12.04 and-30.43±12.44,respectively;and ΔSSI was-0.09±0.10 and-0.03±0.06,respectively.The differences between the two groups were all statistically significant(all P＜0.05).Conclusion FS-LASIK Xtra for correction of high myopia improves the stability of postoperative visual acuity and SE with good safety and efficacy,but reduces the stability of comeal biomechanical parameters compared with before surgery;still,it is better than conventional FS-LASIK,and the long-term effect needs to be further assessed.

Objective To investigate the effect of compound betamethasone adjuvant on break-through pain after unicompartmental knee arthroplasty under sciatic nerve combined with femoral nerve block.Methods A total of 100 patients underwent unicondylar knee arthroplasty,32 males and 68 females,aged 55-75 years,BMI 18.5-35.0 kg/m2,ASA physical status Ⅰ-Ⅲ,were divided into three groups according to random number table method:no adjuvant group(group C,n=34),dexamethasone adjuvant group(group D,n=33)and compound betamethasone adjuvant group(group B,n=33).The patients in the three groups received sciatic nerve block and 0.4％ropivacaine 15 ml before anesthesia in-duction,then femoral nerve block,0.4％ropivacaine 15 ml in group C,0.4％ropivacaine 15 ml in group D(containing dexamethasone 5 mg),and 0.4％ropivacaine 15 ml in group B(containing compound beca-methasone 4 mg).The occurrence of breakthrough pain,the number of effective analgesic pump compres-sions,opioid dosage,and the number of remedial analgesia cases were recorded.The ground movement dis-tance was recorded 0-24 hours,24-48 hours,and 48-72 hours after operation.The sleep quality scores and adverse events were also recorded.Results Compared with group C,the incidence rate of breakthrough pain was lower(P＜0.05),the number of effective analgesia pump compressions,the dosage of opioid,and the sleep quality score on the first night after operation were significantly decreased in group B(P＜0.05).Compared with group D,the incidence rate of breakthrough pain and breakthrough pain score were lower(P＜0.05),the number of effective analgesia pump compressions,the dosage of opioid,and the sleep quality score on the 1 st night after operation were significantly decreased in group B(P＜0.05).There was no significant difference in the ground movement distance of in different time periods and inci-dence of adverse events among the three groups.Conclusion Compound betamethasone adjuvant can reduce the incidence of breakthrough pain after unicompartmental knee arthroplasty under sciatic nerve com-bined with femoral nerve block,provide perfect analgesic effect,reduce postoperative opioid consumption,and improve the sleep quality of patients on the first night after surgery.

【Objective】 To investigate the factors influencing the length of hospital stays of the acute fatty liver of pregnancy (AFLP) patients, so as to establish the prediction model. 【Methods】 A total of 49 patients diagnosed as AFLP)in ShenZhen People’s Hospital between January 2008 and January 2023 were retrospectively analyzed. According to the median length of hospital stays, the patients were divided into two groups: Group A(n=21)and Group B(n=28). Preoperative general laboratory data, clinical features and postpartum adverse outcomes in both groups were analyzed. Multivariate binary logistic regression was used to analyze the independent factors affecting the length of hospital stays for AFLP, and a prediction model for hospitalization time was established. 【Results】 Comparison between Group B and Group A were as follows: hospital stays(d)(15.5 vs 8), preoperative icterus(%)[16(57.1%)vs 3(14.3%)], thrombin time(TT)(s)(24.2 vs 21.3), prothrombin time(PT)(s)(16.8 vs 15.3), activated partial thromboplastin time(APTT)(s)(52.3 vs 40.7), total bilirubin(TBIL)(μmol/L)(77.2 vs 45.2), indirect bilirubin(IBIL)(μmol/L)(21.2 vs 10), creatinine(Cre)(μmol/L)[(171.97±53.34) vs (131.81±45.06]), TT extension(%)[24(85.7%)vs 11(52.4%)], APTT extension(%)[27(96.4%)vs 7(33.3%)], IBIL elevation(%)[19(67.9%)vs 4(19%)], Cre concentration rise(%)[21(75%)vs 8(38%)], number of postpartum plasma exchange sessions(%)[23(82.1%)vs 5(23.8%)], postpregnancy co-infection phenomenon(%)[21(75%)vs 4(19%)], with Group B significantly higher than Group A. The preoperative platelet count(×10⁹/L)(128 vs 221)and the concentration of fibrinogen(g/L)[0.9 vs 1.6] in Group B were significantly lower than those in Group A. Univariate logistic regression analysis showed that preoperative icterus, postpregnancy co-infection phenomenon, number of postpartum plasma exchange sessions, preoperative TT extension, preoperative APTT extension, Cre concentration rise were influencing factors for the hospital stays of AFLP patients. According to the minimum result of Akaike information criterion, the multivariate binary logistic regression analysis (step-wise selection) showed that the number of postpartum plasma exchange sessions, icterus, preoperative APTT extension were the independent risk factor influencing the hospital stays of AFLP patients, and the logistic regression prediction model was established by incorporating the above three factors. Regularization techniques were further employed in linear regression to address and assess overfitting issues. Additionally, the confidence interval for the estimated effect sizes in each model have been acquired by bootstrapping techniques. 【Conclusion】 Preoperative icterus, preoperative APTT extension(APTT>43s)and the number of postpartum plasma exchange sessions were the independent risk factor influencing the hospital stays of AFLP patients and the logistic regression prediction model with high predictive effectiveness was established successfully.

【Objective】 To strengthen the management of transfusion adverse events, so as to reduce the occurrence of medical damage and accidents, and guarantee the safety of blood transfusion. 【Methods】 The adverse events of blood transfusion reported in our hospital from July 2016 to December 2022 were collected, the reasons were tracked, and continuous improvements were made. 【Results】 From 2016 to 2022, a total of 315 transfusion adverse events were reported, including 233(73.97%, 233/315) cases of transfusion reactions and 82(26.03%, 82/315) transfusion adverse events. There were 271 328 transfusion cases in the same period, and the incidence of transfusion reactions was 0.858 7‰(233/271 328). The number of transfusion application was 129 887, and the incidence of transfusion adverse event is 0.631 3‰(82/129 887). Sixty-eigtht(82.93%, 68/82) cases of transfusion adverse events were caused by human factors, while the other 14(17.07%, 14/82) cases were non-human factors. According to the linear regression analysis, we have concluded that the year is a significant indicator for transfusion reaction rates (P<0.05), but not for transfusion adverse event rates (P>0.05). 【Conclusion】 Strengthening the management of reporting adverse events in clinical blood transfusion, monitoring the incidence, analyzing and improving different types of adverse events by management tools can reduce the medical risks of blood transfusion and help to guarantee the safety of clinical blood transfusion.

Drug-induced immune hemolytic anemia (DIIHA) is a rare cytopenia caused by damage to RBCs by drug-induced antibodies or non-immune protein adsorption (NIPA). The drugs associated with DIIHA and the mechanistic hypotheses that are thought to be involved have been controversial, with complex serological tests often required by specialized Immune Hematology laboratories for diagnosis. It is necessary to know the clinical manifestation and laboratory diagnosis of DIIHA in order to distinguish the immuno-hematological abnormality caused by drugs from other causes. How to improve the diagnostic ability of DIIHA and establish a scientific and reasonable idea of DIIHA serological examination is urgent to help clinical diagnosis and correct treatment.

Objective:To investigate the impact of cleavage factor Im25(CFIm25)on VSMCs-specific knockdown in the context of hyperlipidemia.Methods:Mice models were constructed with specific knockout of CFIm25 in VSMCs(CFIm25f/+ TaglnCre)and control mice(TaglnCre).The mice were fed a normal diet or high-fat diet(HFD)for 18 weeks and their body weight changes were monitored.ELISA was used to measure serum total cholesterol(TC), triacylglycerol(TG), high-density lipoprotein(HDL-C)and low-density lipoprotein(LDL-C)levels.The extent of aortic lipid deposition in mice was assessed by oil red O staining.Results:During the feeding of a high-fat diet, CFIm25f/+ TaglnCre mice showed a significant increase in body weight compared to the control group[Male(1.01±0.06)g and(0.87±0.31)g, t=7.53, P<0.05; Female: (0.64±0.02)g and(0.35±0.04)g, t=9.68, P<0.05].After 18 weeks of high-fat diet feeding, CFIm25f/+ TaglnCre mice had significantly higher levels of TC[(6.80±0.35)mmol/L and(3.76±0.87)mmol/L, t=5.63, P=0.004], TG[(0.97±0.21)mmol/L and(0.42±0.10)mmol/L, t=4.08, P=0.015], and LDL-C[(5.20±0.30)mmol/L and(2.00±0.98)mmol/L, t=5.40, P=0.006]compared to the TaglnCre group.Specifically, TC levels increased by 80.72%, TG increased by 132.79%, and LDL-C increased by 160.32%.There was a significant increase in aorta lipid deposition and atherosclerotic plaque area in CFIm25f/+ TaglnCre mice( P<0.05). Conclusions:The research indicated that VSMCs-specific CFIm25 knockdown in mice further worsened hyperlipidemia and atherosclerotic lesions.