Objective To compare the postoperative enhanced recovery outcomes of lobectomy performed under non-intubated video-assisted thoracic surgery (NIVATS) versus intubated video-assisted thoracic surgery (IVATS). Methods Computerized searches were performed in the following databases: China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Information, China Biomedical Literature Database (CBMdisc), Web of Science, Clinicaltrials.gov, The Cochrane Library, EMbase, and PubMed. We collected randomized controlled trials (RCTs) and observational studies comparing NIVATS and IVATS. The search period extended from the inception of each database to April 1, 2023. Two independent researchers screened the literature and assessed study quality. Results A total of 14 studies were included, comprising 4 RCTs, 7 retrospective cohort studies, and 3 propensity score matching studies, involving 1 840 patients. Meta-analysis results indicated that, compared to IVATS, NIVATS was associated with significantly shorter operative time [MD=–13.39, 95%CI (–20.16, –6.62), P<0.001], shorter length of hospital stay [MD=–0.81, 95%CI (–1.39, –0.22), P=0.005], shorter chest tube duration [MD=–0.73, 95%CI (–1.36, –0.10), P=0.02], shorter postoperative anesthesia recovery time [MD=–20.34, 95%CI (–26.83, –13.84), P<0.001], and shorter time to oral intake after surgery [MD=–5.68, 95%CI (–7.63, –3.73), P<0.001]. Furthermore, NIVATS showed a lower incidence of postoperative airway complications [OR=0.49, 95%CI (0.34, 0.71), P<0.001] and less total chest tube drainage volume [MD=–251.11, 95%CI (–398.25, –103.98), P<0.001], all contributing to significantly accelerated postoperative enhanced recovery for patients. Conclusion NIVATS is a safe and technically feasible anesthesia method in thoracoscopic lobectomy, which can to some extent replace IVATS.

Objective:To investigate the effect of alendronate sodium (ALN) on osteoporosis in postmenopausal mice and the expression of growth differentiation factor-15 (GDF-15).Methods:C57BL/6J female mice (7 - 8 weeks old, weight 18 - 20 g) were selected for ovarian removal surgery (OVX) to establish a postmenopausal osteoporosis animal model. According to the random number table method, they were divided into three groups: control (sham surgery) group, OVX group, and OVX + ALN (0.5 mg·kg -1·d -1, administered orally one week before surgery) group, with 10 mice in each group. After 8 weeks of surgery, femurs and tibias were collected, and bone mineral density (BMD), bone volume fraction (BV/TV), mineral content (BMC), number of trabeculae (Tb.N), thickness of trabeculae (Tb.Th), and degree of trabecular separation (Tb. Sp) were measured in each group of mice using micro computed tomography(Micro-CT) technology. Enzyme linked immunosorbent assay and real-time quantitative PCR (qRT-PCR) were used to detect changes in serum GDF-15 levels and bone tissue GDF-15 mRNA expression levels in mice, respectively. Results:The Micro-CT examination results showed that the OVX group had a decrease of trabeculae, an increase in spacing, and sparse arrangement compared to the control group. The OVX + ALN group had an increase of bone trabeculae and a decrease in spacing compared to the OVX group. Quantitative analysis showed that the levels of BMD, BV/TV, BMC, Tb.N, and Tb.Th of the femur in the OVX group were lower than those in the control group, while the level of Tb.Sp was higher than that in the control group ( P < 0.05). The BMD, BV/TV, BMC, and Tb.N levels of the femur in the OVX + ALN group were higher than those in the OVX group, while the Tb.SP level was lower than that in the OVX group ( P < 0.05). Compared with the control group (1.86 ± 0.08, 1.02 ± 0.21), the serum GDF-15 levels and bone tissue GDF-15 mRNA expression levels in the OVX group (2.80 ± 0.45, 6.04 ± 0.42) were higher ( P < 0.05). Compared with OVX group, the serum GDF-15 levels and bone tissue GDF-15 mRNA expression levels in the OVX + ALN group (1.99 ± 0.15, 0.99 ± 0.13) were lower ( P < 0.05). Conclusion:ALN can prevent osteoporosis in postmenopausal mice, and GDF-15 is involved in its regulatory process.

Objective:To investigate the effect of alendronate sodium (ALN) on osteoporosis in postmenopausal mice and the expression of growth differentiation factor-15 (GDF-15).Methods:C57BL/6J female mice (7 - 8 weeks old, weight 18 - 20 g) were selected for ovarian removal surgery (OVX) to establish a postmenopausal osteoporosis animal model. According to the random number table method, they were divided into three groups: control (sham surgery) group, OVX group, and OVX + ALN (0.5 mg·kg -1·d -1, administered orally one week before surgery) group, with 10 mice in each group. After 8 weeks of surgery, femurs and tibias were collected, and bone mineral density (BMD), bone volume fraction (BV/TV), mineral content (BMC), number of trabeculae (Tb.N), thickness of trabeculae (Tb.Th), and degree of trabecular separation (Tb. Sp) were measured in each group of mice using micro computed tomography(Micro-CT) technology. Enzyme linked immunosorbent assay and real-time quantitative PCR (qRT-PCR) were used to detect changes in serum GDF-15 levels and bone tissue GDF-15 mRNA expression levels in mice, respectively. Results:The Micro-CT examination results showed that the OVX group had a decrease of trabeculae, an increase in spacing, and sparse arrangement compared to the control group. The OVX + ALN group had an increase of bone trabeculae and a decrease in spacing compared to the OVX group. Quantitative analysis showed that the levels of BMD, BV/TV, BMC, Tb.N, and Tb.Th of the femur in the OVX group were lower than those in the control group, while the level of Tb.Sp was higher than that in the control group ( P < 0.05). The BMD, BV/TV, BMC, and Tb.N levels of the femur in the OVX + ALN group were higher than those in the OVX group, while the Tb.SP level was lower than that in the OVX group ( P < 0.05). Compared with the control group (1.86 ± 0.08, 1.02 ± 0.21), the serum GDF-15 levels and bone tissue GDF-15 mRNA expression levels in the OVX group (2.80 ± 0.45, 6.04 ± 0.42) were higher ( P < 0.05). Compared with OVX group, the serum GDF-15 levels and bone tissue GDF-15 mRNA expression levels in the OVX + ALN group (1.99 ± 0.15, 0.99 ± 0.13) were lower ( P < 0.05). Conclusion:ALN can prevent osteoporosis in postmenopausal mice, and GDF-15 is involved in its regulatory process.

Objective To investigate the clinical characteristics,diagnosis,treatment,and prognosis of descending necrotizing mediastinitis(DNM)to provide a reference for the early diagnosis and timely treatment of DNM.Methods Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023.The infection,pathogenic microorganisms,main symptoms,comorbidities and treatment methods of DNM were analyzed.Results The data of a total of 781 DNM patients,with an average age of(52.97±5.64)years,were retrieved,including 554 males and 227 females.Odontogenic source,tonsillitis,pharyngeal abscess,sialoadenitis,upper respiratory tract infection,foreign body injury,or iatrogenic traumatic procedures are common causes.Among these,odontogenic infection is the most common source.Streptococcus sp.(n=217)and Staphylococcus sp.(n=82)were most isolated,followed by Klebsiella pneumoniae and Pseudomonas aeruginosa(equally n=59).A total of 69.4％(542/781)of DNM patients recruited in this study were discovered to have various comorbidities,and more than one-third of these patients(n=185)had diabetes.Of the broad antibiotics,carbapenem was most frequently used as treatment,and vancomycin was the most frequently coadministered.The mediastinal drainage approach varies widely,and the optimal regimen is still unknown.Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage,22 patients were treated with percutaneous catheter drainage,30 underwent the transcervical approach,and 40 underwent thoracotomy.A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus.The overall mortality rate of all 781 DNM pa-tients included was 11.2％.Conclusion The most effective diagnosis and treatment of DNM is a high degree of clini-cal vigilance followed by prompt and adequate drainage with intensive care,including hemodynamic monitoring,nutri-tional support,computer tomographic scanning repeated as necessary,and combined use of systemic antibiotics.

Objective: To explore the relationship of sleep quality and emotional regulation difficulties in middle school students, and to analyze its mediating role of daytime dysfunction, social rejection and selfcontrol ability, so as to provide a scientific reference for improving middle school students mental health. Methods: From October to November, 2023, the Pittsburgh Sleep Quality Index, Adolescent Social Rejection Questionnaire, Brief Selfcontrol Scale and Difficulties in Emotion Regulation Scaleshort Form (DERS-16) were used to assess 806 students recruited from four middle schools in Bengbu City by a convenient cluster random sampling method. And model-6 of PROCESS and 5 000 Bootstraps were used to make a chainmediating model analysis. Results: Daytime dysfunction was positively correlated with sleep quality(r=0.57), social rejection(r=0.19), selfcontrol(r=0.29, P＜0.01). Selfcontrol was positively correlated with emotional regulation difficulties(r=0.54, P<0.01).Poor sleep quality showed a significant positive association with on daytime dysfunction, and daytime dysfunction further affected social rejection, selfcontrol ability and emotional regulation difficulties (β=0.86, 0.60, 1.27, 1.56, P<0.05). Meanwhile, daytime dysfunction, social rejection and selfcontrol played a serial mediating role in the relationship between sleep quality and emotional regulation difficulties (Estimate=0.11,95%CI=0.04-0.20,P<0.05). Conclusion The study reveals the complex relationship between sleep quality and emotional regulation difficulties in middle school students and provides a new theoretical basis for adolescent sleep improvement and mental health interventions.

Objective:To explore the impact of coronary CT angiography (CCTA) image quality and related factors on the diagnostic performance of CT-derived fractional flow reserve (CT-FFR).Methods:Based on the CT-FFR CHINA trial, the prospective multicenter trial enrolled patients with suspected coronary artery disease who underwent CCTA, CT-FFR and FFR measurement. The subjective and objective assessments of CCTA image were performed on a per-vessel level. The objective assessments included the enhancement degree of coronary artery, the signal-to-noise ratio (SNR) of the aortic root. We used χ 2 test and DeLong test to compare the diagnostic performance of CT-FFR with FFR as the reference standard in different subjective groups (non-artifact vs. artifact), enhancement degree of coronary artery groups (≤400 vs. 401-500 vs.>500 HU), SNR of the aortic root groups (≤16.9 vs.>16.9), body mass index (BMI) groups (<25 kg/m 2 vs.≥25 kg/m 2) and heart rate groups (<75 bpm vs.≥75 bpm). FFR and CT-FFR values≤0.80 was identified as myocardial ischemia. Results:The study enrolled 317 patients with 366 vessels. All target vessels in CCTA images were successfully analyzed by CT-FFR. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of the non-artifact group were 90.45%, 86.75%, 93.10%, 90.00%, 90.76% and 0.928, respectively, and those of the artifact group were 83.23%, 87.21%, 79.01%, 81.52%, 85.33% and 0.869, respectively. The differences in accuracy and specificity were statistically significant (χ 2=4.23, P=0.040; χ 2=8.55, P=0.003). The diagnostic efficacy of CT-FFR had no statistically significant differences among different objective groups (all P>0.05). Conclusions:The artifact of CCTA image has an effect on CT-FFR in the diagnosis of myocardial ischemia. The degree of vascular enhancement, SNR, BMI, and heart rate have no significant effect on the diagnostic performance of CT-FFR.

Objective To analyze the risk factors for recurrence of primary spontaneous pneumothorax and to establish a prediction model.Methods The clinical data of 803 patients clearly diagnosed with primary spontaneous pneumothorax in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to January 2021 were retrospectively analyzed,and 70％of the patients were randomly included in the modeling group(562 patients)and 30％in the validation group(241 patients).Risk factors for recurrence were analyzed by univariate and multivariate Cox regression using R 4.2.1 software,and a Nomogram prediction model was developed.Receiver operating characteristic curves were plotted,and the area under the curve(AUC)was calculated to assess model discrimination,and calibration curves were plotted to assess model calibration.Results The overall recurrence rate was 22.67％(182/803).Multivariate Cox regression analysis showed that age,smoking index,dystrophic severity score and treatment regimens were independent risk factors for recurrence of primary spontaneous pneumothorax,and the AUC of the Nomogram prediction model was 71.7％(95％CI 64.1-79.2),with high predictive efficiency.Conclusion This recurrence prediction model of primary spontaneous pneumothorax can assist clinicians to accurately assess the risk of recurrence in individual patients.

Objective     To compare the pain relief and rehabilitation effect of intercostal nerve block and conventional postoperative analgesia in patients undergoing thoracoscopic surgery. Methods     China National Repository, Wanfang Database, VIP, China Biomedical Literature Database, Web of Science, Clinicaltrials.gov, Cochrane Library, EMbase and PubMed were searched from establishment of each database to 10 Febraray, 2022. Relevant randomized controlled trials (RCTs) of intercostal nerve block in thoracoscopic surgery were collected, and meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria. Results     A total of 21 RCTs and one semi-randomized study were identified, including 1 542 patients. Performance bias was the main bias risk. Intercostal nerve block had a significant effect on postoperative analgesia in patients undergoing thoracoscopic surgery. The visual analogue scale (VAS) score at 12 h after surgery (MD=–1.45, 95%CI –1.88 to –1.02, P<0.000 01), VAS score at 24 h after surgery (MD=–1.28, 95%CI –1.67 to –0.89, P<0.000 01), and VAS score at 48 h after surgery  significantly decreased (MD=–0.90, 95%CI –1.22 to –0.58, P<0.000 01). In exercise or cough state, VAS score at 24 h after surgery (MD=–2.40, 95%CI –2.66 to –2.14, P<0.000 01) and at 48 h after surgery decreased significantly (MD=–1.89, 95%CI –2.09 to –1.69, P<0.000 01). In the intercostal nerve block group, the number of compression of the intravenous analgesic automatic pump on the second day after surgery significantly reduced (SMD=–0.78, 95%CI –1.29 to –0.27, P=0.003). In addition to the analgesic pump, the amount of additional opioids significantly reduced (SMD=–2.05, 95%CI –3.65 to –0.45, P=0.01). Postoperative patient-controlled intravenous analgesia was reduced (SMD=–3.23, 95%CI –6.44 to –0.01, P=0.05). Patient satisfaction was significantly improved (RR=1.31, 95%CI 1.17 to 1.46, P<0.01). Chest tube indwelling time was significantly shortened (SMD=–0.64, 95%CI –0.84 to –0.45, P<0.001). The incidence of analgesia-related adverse reactions was significantly reduced (RR=0.43, 95%CI 0.33 to 0.56, P<0.000 01). Postoperative complications were significantly reduced (RR=0.28, 95%CI 0.18 to 0.44, P<0.000 01). Two studies showed that the length of hospital stay was significantly shortened in the intercostal nerve block group, which was statistically different (P≤0.05), and there was no statistical difference in one report. Conclusion     The relief of acute postoperative pain and pain in the movement state is more prominent after intercostal nerve block. Intercostal nerve block is relatively safe and conforms to the concept of enhanced recovery after surgery, which can be extensively utilized in clinical practice.

Kidney mass with calcification is not uncommon clinically. One patient with right kidney mass with multiple calcifications was admitted to our hospital. The postoperative pathological result was calcified fibrous sclerosis nodule which has not been reported worldwide.

Objective:To inspect the relationship between the therapeutic effect of DHA on lupus nephritis and the negative immune regulation of TLR4/NF-κB signal pathway which was induced by SIGIRR;in vitro,to observe the effect of DHA on damaged HK-2 cell.Methods: In vivo,MRL/lpr mice were divided in model group,DHA groups(25,50,100 mg/kg),positive group (prednisone,5 mg/kg),and C57BL/6 mice were taken as control group.Administrate drugs daily for 12 weeks.Examine the changes in renal pathology;the expression of SIGIRR,IRAK1,TRAF6 in kidneys were determined by Western blot.In vitro,treat human renal tubular epithelial cell HK-2 cells with LPS ,and co-culture cells with DHA at the concentration of 0.67 μg/ml to 6.00 μg/ml for 6 h, 12 h and 24 h.Detect SIGIRR expression by Western blot and the level of IL-6 and CCL2 of HK-2 cells by ELISA.Results:In vivo, renal pathology revealed that kidneys of model group were damaged , while treatment with 100 mg/kg DHA alleviated renal injury.Compared to model group ,SIGIRR expression of DHA 100 mg/kg group increased a little ,and the expression of this protein had a tendency to increase with the augment of DHA dose .In vitro,DHA treatment reduced secretion of CCL 2 in HK-2 cells,and treatment of 0.67 μg/ml DHA for 24 h increased SIGIRR expression significantly , which also showed a growing expression with time.Conclusion:DHA could inhibit development of mouse lupus nephritis through increasing SIGIRR expression which inhibited TLR4/NF-κB signal pathway;DHA inhibited CCL2 secretion of HK-2 cells which were irritated by LPS ,and it may be associated with increased expression of SIGIRR .