Objective: To investigate the role of ferroptosis in transfusion-related acute lung injury (TRALI) and evaluate the efficacy of the specific inhibitor Ferrostatin-1 (Fer-1), thereby to provide a basis for the prevention and treatment of TRALI. Methods: This study utilized a ”2-hit” model to induce TRALI in mice. The mouse model of TRALI was validated through survival curve analysis, lung tissue wet/dry weight ratio (W/D), myeloperoxidase (MPO) activity, and total protein concentration in lung tissue. Samples from the TRALI model group, LPS group, and control group (n=6) were collected. The occurrence of ferroptosis in TRALI was confirmed by measuring key ferroptosis indicators, including iron concentration in lung tissue, malondialdehyde (MDA) level, lipid peroxidation products (LPO) level, and expression levels of related proteins (GPX4, ACSL4). Additionally, a Fer-1 intervention group was added to evaluate its preventive and therapeutic effects. The survival rates and clinical symptoms of the four groups (n=6) were dynamically monitored, and the degrees of lung injury were assessed. Ferroptosis-related indicators were also measured to elucidate the protective mechanism of Fer-1. Results: A mouse model of TRALI was successfully established. Compared to the control and LPS groups, the TRALI group showed significantly higher levels of ferrous iron [(18.32±1.11) nmol/well, MDA [(14.68±0.96) μmol/L], and LPO [(1.60±0.02) μmol/L] in lung tissue (all P<0.01), along with a downregulation of GPX4 and an upregulation of ACSL4. Fer-1 pretreatment significantly reversed these abnormalities: the W/D ratio decreased to 4.01±0.43, and MPO activity significantly decreased [Fer-1 group: (21 606±4 235) pg/mL vs TRALI group: (30 724±2 616) pg/mL], the total protein concentration in lung tissue of the Fer-1 group decreased by approximately 40.8% compared to the TRALI group (all P<0.01). These changes indicate that the lung injury in mice was alleviated after treatment. Following Fer-1 intervention, ferrous iron concentration [(7.46±1.83) nmol/well] was restored to a level close to that of the control group [(5.48±0.70) nmol/well]. Lipid peroxidation tests further revealed that Fer-1 intervention reduced MDA and LPO levels by 35.8% and 29.4%, respectively (P<0.001). Additionally, the expression levels of GPX4 and ACSL4 proteins returned to near-normal levels in the treated mice (both P>0.05). Conclusion: The progression of TRALI is closely related to the activation of ferroptosis, characterized by iron overload, lipid peroxidation accumulation, and the imbalance of GPX4/ACSL4. Ferrostatin-1 significantly alleviates pulmonary edema and inflammatory damage by inhibiting the ferroptosis pathway, suggesting that targeting ferroptosis may provide a new therapeutic strategy for TRALI.

Background::Evaluating the impact of digestive system diseases is vital for devising effective prevention strategies. However, comprehensive reports on the burden of digestive system diseases in China are lacking. Our study aimed to provide an overview of the burden and trends of digestive system diseases from 1990 to 2019 in China and its provinces.Methods::This cross-sectional study utilized the Global Disease Burden Study 2019 to estimate the incidence, mortality rate, disability-adjusted life years (DALYs), years of life disability, years of life lost, and changes in the burden of digestive diseases across Chinese provinces from 1990 to 2019. The analysis of disease burden primarily examines the characteristics of sub-disease distribution, time trends, age distribution, and sex distribution. Additionally, we compared provincial age-standardized DALYs for digestive diseases with the expected rates based on the socio-demographic index (SDI).Results::In 2019, there were 499.2 million cases of digestive system diseases in China, resulting in 1,557,310 deaths. Stomach cancer, colon and rectal cancer, and esophageal cancer are the top three diseases associated with mortality and DALY related to digestive system diseases. Meanwhile, cirrhosis and other chronic liver diseases, gastroesophageal reflux disease, and gallbladder and biliary diseases are the top three kinds of diseases with the highest prevalence among digestive system diseases. The risk of gastric cancer sharply increases among men after the age of 40 years, leading to a significant disparity in burden between men and women. As the SDI increased, the DALYs associated with digestive system diseases in China and its provinces showed a downward trend.Conclusion::Our study highlights the inverse correlation between DALYs associated with digestive system diseases and the SDI.

[摘 要] 目的：基于临床病历信息系统，采用数据挖掘方法从真实世界角度分析中医药非介入治疗肺恶性肿瘤的辨治规律。方法：收集2015年1月1日至2021年12月31日北京中医药大学东直门医院病历系统中诊断为肺恶性肿瘤的患者病史、刻下症和用药信息，在剔除使用介入治疗手段的病例后建立数据库。采用Microsoft Office Excel 2019对高频药物的频数、四气五味、归经及功效进行描述性统计，并对病史和刻下症反映的症状进行数据化统计；对统计得到的高频药物和症状信息借助SPSS Modeler 18.0软件中Apriori算法对核心数据进行关联规则分析，并用Web节点构建关联网状图；借助SPSS Stastistics 23.0进行聚类分析。结果：共纳入119例未进行介入治疗的肺恶性肿瘤患者，中医常见症状为咳嗽、白痰、喘憋、纳差、眠差、痰黏、便秘、乏力、胸闷、气短；药物四气以温药最多；五味以甘味最多；归经以肺经频率最高。关联规则结果显示，二项支持度最高的组合为半夏→柴胡、半夏→瓜蒌、杏仁→麻黄；三项关联支持度最高的组合为半夏→茯苓、柴胡，杏仁→麻黄、半夏，半夏→杏仁、柴胡，半夏→瓜蒌、贝母。聚类结果聚为3类，依次为肺阴虚证、痰热壅肺证和肺气虚证。结论：中医药非介入治疗肺恶性肿瘤的中医药辨治规律为：聚类证型依次为肺阴虚证、痰热壅肺证和肺气虚证。治疗多用和解少阳、行气止咳平喘和清虚热化痰饮为主，药物以半夏、甘草、黄芩、茯苓、柴胡多见。

Objective: To investigate the safety and feasibility of longitudinal transpancreatic U-sutures invaginated pancreatojejunostomy (Chen′s pancreaticojejunostomy technique) in laparoscopic pancreaticoduodenectomy (LPD) . Methods: Clinical data of 116 consecutive patients who underwent LPD using Chen′s pancreaticojejunostomy technique in Hunan Provincial People′s Hospital from May 2017 to December 2018 were retrospectively analyzed. Among these patients, 66 were males and 50 were females. The median age was 58 years old (32-84 yeas old). All 116 patients underwent pure laparoscopic whipple procedure with Child reconstruction method, using Chen′s pancreaticojejunostomy technique. The intraoperative and postoperative data of patients were analyzed. Results: All 116 patients underwent LPD successfully. The mean operative time was (260.3±33.5) minutes (200-620 minutes). The mean time of pancreaticojejunostomy was (18.2±7.6) minutes (14-35 minutes) . The mean time of hepaticojejunostomy was (14.6±6.3) minutes (10-25 minutes). The mean time of gastrojejunostomy was (12.0±5.5) minutes (8-20 minutes). The mean estimated blood loss was (106.0±87.6) ml (20-800 ml). Postoperative complications were: 11.2% (13/116) of cases had postoperative pancreatic fistula (POPF) , including 10.3% (12/116) of biochemical fistula and 0.9% (1/116) of grade B POPF, no grade C POPF occurred; 10.3% (12/116) had gastrojejunal anastomotic bleeding; 3.4% (4/116) had hepaticojejunal anastomotic fistula; 3.4% (4/116) had delayed gastric emptying; 4.3% (5/116) had localized abdominal infection; 12.1% (14/116) had pulmonary infection; postoperative mortality were 0(0/116) and 1.7% (2/116) within 30 days and 90 days, respectively. One patient died of massive abdominal bleeding secondary to Gastroduodenal artery pseudoaneurysm rupture, the other patient died of extensive tumor recurrence and metastasis after surgery. Conclusions Chen′s pancreaticojejunostomy technique is safe and feasible for LPD.It is an option especially for surgeons who have not completed the learning curve of LPD.

Objective:To explore ways and methods for public mental health intervention during the COVID-19 epidemic.Methods:A comprehensive literature review was conducted. Mental healthcare publicity materials posted by over 100 Chinese hospitals in multiple media (till February 24, 2020) were also systematically collected and analyzed.Results:Firstly, anxiety and fear were the most common mental health problems among people during the epidemic. Secondly, to achieve better outcomes, mental health intervention should be provided according to the type of service clients. Thirdly, new media can facilitate the transmission of mental healthcare knowledge, but the limitation is that it can not approach older adults who have limited access to new media. It is therefore essential to strengthen the mental health knowledge transmission to older adults.Conclusions:Mental health intervention is effective when it is provided according to the type of service clients during the COVID-19 epidemic.

Objective To investigate the application value of two-step separation approach in laparoscopic hemihepatectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 81 patients who underwent laparoscopic hemihepatectomy in the People's Hospital of Hunan Provincial between January 2015 and December 2017 were collected.Patients underwent laparoscopic hemihepatectomy using two-step separation approach after preoperative assessment.Hepatic pedicle,hepatic vein and branches were processed in the liver parenchyma,without intrathecal anatomy.Observation indicators:(1) preoperative assessment,intraand post-operative recovery;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed up to February 2018.Patients with hepatolithiasis received abdominal CT reexaminations at 5-7 days postoperatively for observing postoperative residual stones,and patients with malignant tumor were regularly followed up for 1-3 years.Measurement data with normal distribution were represented as (x)±s.Count data were described as frequency and percentage.Results (1) Preoperative assessment,intra-and post-operative recovery:81 patients underwent preoperative blood biochemistry,tumor biomarker and imaging examinations,and remaining functional liver volume and a liver model in 9 patients were respectively calculated and built using the 3D reconstruction software and 3D printing technology.Of 81 patients,68 underwent left hemihepatectomy and 13 underwent fight hemihepatectomy;77 underwent successful laparoscopic hemihepatectomy using two-step separation approach,4 were converted to open operation,with a rate of 4.9％ (4/81).Of 4 patients with conversion to open operation,1 had difficult tumor separation due to tumor invading port vein induced to close adhesion,1 had stone removal difficulties under laparoscopy due to hepatolithiasis,and 2 were converted to open operation due to severe liver cirrhosis induced to massive intraoperative bleeding.Of 81 patients,70 gained dividing line of hemiliver by intraoperatively hemihepatic blood flow occlusion,and then got effectively control of bleeding combined with Pringle blood flow occlusion,and 11 received Pringle blood flow occlusion in whole liver.Laparoscopic fluorescence imaging technology was intraoperatively used for 2 patients.Operation time,volume of intraoperative blood loss,rate of intraoperative blood transfusion and duration of hospital stay in 81 patients were respectively (206±42)minutes,(195±134)mL,11.1％(9/81) and (11.5+2.7)days.Eighty-one patients were complicated with bile leakage and were cured by conservative treatment,with a bile leakage incidence of 2.5％ (2/81),and without severe complications,such as postoperative bleeding,hepatic dysfunction and subphrenic abscess.There was no perioperative death and reoperation within 30 days postoperatively.(2) Follow-up and survival situations:55 patients with hepatolithiasis were followed up and underwent CT examinations of upper abdomen at 5-7 days postoperatively,including 52 with depletion of stones;3 with residual stones received removal of stones by choledochoscope at 3 months postoperatively,without residual stones.Seventeen patients with malignant tumor were followed up for 12-36 months,with a median time of 15 months,16 had tumor-free survival,and 1 was complicated with intrahepatic metastasis at 1 year after resection of hepatocellular carcinoma,and then underwent transcatheter arterial chemoembolization (TACE) and survived with tumor.Nine patients with benign liver diseases had good recovery during follow-up.Conclusion Two-step separation approach that is rationally used in laparoscopic hemihepatectomy is safe,effective and convenient.

The solute carrier protein 25 family (SLC25)is one of superfamily in solute carrier protein family. The members of SLC25 family function by transporting various solutes across the mitochondrial mem-brane. Their substrates vary in property,molecular size and mode of transport,and they closely involve in nu-merous physiological functions. More and more researches indicate that some members of SLC25 family are ab-normally expressed in tumors,and some of them play important roles in the occurrence and development of tumors. For example,some members participate in tumorigenesis by regulating cell metabolism,death and pro-liferation.

Objective To explore the feasibility and clinical application value of total laparoscopic radical resection of Ⅳ-type hilar choangiocarcinoma. Methods Clinical data of 2 patients receiving total laparoscopic radical resection of Ⅳ-type hilar choangiocarcinoma in Hunan Provincial People's Hospital from April 2015 to December 2015 were analyzed retrospectively. The informed consents of both patients were obtained and the local ethical committee approval was received. Case 1, male, 73 years old, hospitalized for icteric skin and sclera for more than 1 month. Case 2, female, 62 years old, hospitalized for icteric skin and sclera for more than 2 months. The admitting diagnosis were both Ⅳ-type hilar choangiocarcinoma. The bilateral hepatic ducts and left portal vein were invaded by tumor in the 2 cases. Before the operation, the patients received symptomatic and supportive treatments for liver protection, jaundice alleviation etc., and then received total laparoscopic radical resection of hilar choangiocarcinoma. The lymph nodes were resected from far to near, the common bile duct was dissected and cut off, the left and caudate lobe was resected, hilar bile duct plasty and Roux-en-Y bilioenterostomy were performed. Results Operations were performed successfully in both patients and the digestive tract was reconstructed. The operative duration were 430, 410 min respectively, the intraoperative blood loss was 800, 600 ml respectively. No perioperative complication was observed.Two patients received abdominal enhanced CT examination 1 year after operation, no tumor recurrence or metastasis was observed. Conclusion Total laparoscopic radical resection of hilar choangiocarcinoma is safe and feasible, in which hemihepatectomy or extended hemihepatectomy including caudate lobe, lymphadenectomy, bile duct plasty and biliary-enteric reconstruction can be performed.

Objective:To express fusion protein of mouse thymic stromal lymphopoietin (TSLP) and HIV-1 gp120BAL V1/V2 subdomain in 293F cell.Methods:Full length of the V1V2 sequence from BAL isolate was fused with the C-terminus of mouse thymic stromal lymphopoietin (TSLP) and sub-cloned into pCEP-Pu vector to construct the eukaryotic expression plasmid-pCTV1V2BAL.The recombinant plasmid was confirmed by enzyme digestion and sequencing , then transfected into 293 F cells using PEI as a transfection reagent .The fusion protein was purified by metal chelate affinity chromatography and characterized by SDS -PAGE and Western blot . The epitopes of V1/V2 in fusion protein were identified by ELISA .Results:The SDS-PAGE and Western blot results showed that there were highly heterogeneous glycoprotein bands at the site between 35 kD and 55 kD, which reacted with anti-mTSLP rabbit polyclonal antibody and anti-His tag mouse monoclonal antibody .The ELISA analysis showed that antibodies to V 1/V2BAL existed in the sera of HIV-1 positive patients.Conclusion:The mTSLP-V1/V2 fusion protein was successfully expressed in 293F cells, which may be useful for HIV-1 vaccine research .

Objective To study the epidemiological status of reproductive health related behaviors of out of school adolescents in Kunming and Shenzhen City,and to explore the social-psychological influencing factors of the behaviors.Methods A cross-sectional study was conducted in 410 out of school adolescents aged 15-24 years who were recruited with accidental sampling.All the subjects were required to complete a self-administrated questionnaire.Single factor Chi-square analysis and multi-factor Logistic method were used for data analysis.Results The correct respondent rate of the questions on reproductive health knowledge among the adolescents was low.The sexual intercourse rate was 42.9％ (176/410).Nearly 44.9％ (79/176) of the adolescents who had sexual experience did not use condom in the latest sexual intercourse,and those who had no less than one sexual partner accounted for 48.9％ (86/176).The prevalence of genital discomfort and sexual transmitted disease was 48.8％ (200/410) and 2.9％ (12/ 410),respectively.Chi-square test showed that marriage,living statue,behaviors of holding hands,kiss,caress the body,sexual intercourse and having no less than one sexual partner influenced the prevalence of genital discomfort(x2 values were 4.667,10.862,10.032,15.619,17.423,28.239,17.817 and 21.369,respectively ; all P ＜ 0.05).In binary Logistic analysis,living in a dormitory or with other people,behaviors of caress the body,sexual intercourse and having no less than one sexual partner influenced the prevalence of genital discomfort (odds ratio (OR) was 0.449 (95％ CI:0.216-0.933),0.377 (95％ CI:0.147-0.967),4.364 (95％ CI:1.594-11.949),0.312 (95％ CI:0.111-0.877) and2.646 (95％ CI:1.417-4.941),respectively ; all P ＜ 0.05).Conclusions The status of reproductive health was poor among out of school girls in kunming and Shenzhen,and living status,behaviors of caress the body,sexual intercourse and having no less than one sexual partner could influence the prevalence of genital discomfort.Comprehensive measures should be taken to strengthen the reproductive health management in this population.