Objective To compare the efficacy and safety of video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of thymoma through subxiphoid uniportal approach using double sternum retractors, and subxiphoid and subcostal arch approach. Methods We retrospectively analyzed the clinical data of the patients diagnosed with thymoma who underwent VATS thymectomy from June 2023 to June 2024 in West China Hospital. Patients were categorized based on the surgical approach into two groups: a subxiphoid uniportal VATS thymectomy (SUVT) group and a subxiphoid and subcostal arch VATS thymectomy (SASAT) group. Comparisons were made between the two groups regarding surgical duration, intraoperative blood loss, postoperative drainage, thymoma size and location, and postoperative pain assessed using the visual analogue scale (VAS). Results The SUVT group consisted of 20 patients, including 11 males and 9 females, with an average age of (51.5±14.3) years. The SASAT group comprised 40 patients, including 26 males and 14 females, with an average age of (50.0±13.0) years. Compared to the SASAT group, the SUVT group had significantly larger thymomas [ (5.9±2.7) cm vs. (4.2±2.1) cm, P=0.010] and a higher proportion of neoplasms located in the superior mediastinum (30.0% vs. 2.5%, P=0.007). Additionally, the VAS pain scores on postoperative days 3, 7, and 30 were significantly lower in the SUVT group compared to the SASAT group (P<0.05). There were no statistical differences between the two groups in demographic characteristics, operative time, intraoperative blood loss, duration and volume of postoperative drainage, length of postoperative hospital stay, or the VAS pain score on the first postoperative day. Conclusion SUVT using double sternum retractors significantly reduces postoperative pain and provides superior efficacy in the resection of larger thymomas or those situated in the superior mediastinum.

Objective To introduce an innovative technique, the "balance-shaped sternal elevation device" and its application in the subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for anterior mediastinal masses resection. Methods Patients who underwent single-port thoracoscopic assisted anterior mediastinal tumor resection through the xiphoid process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from May to June 2024 were included, and their clinical data were analyzed. Results A total of 7 patients were included, with 3 males and 4 females, aged 28-72 years. The diameter of the tumor was 1.9-17.0 cm. The operation time was 62-308 min, intraoperative blood loss was 5-100 mL, postoperative chest drainage tube retention time was 0-9 days, pain score on the 7th day after surgery was 0-2 points, and postoperative hospital stay was 3-12 days. All patients underwent successful and complete resection of the masses and thymus, with favorable postoperative recovery. Conclusion The "balance-shaped sternal elevation device" effectively expands the retrosternal space, providing surgeons with satisfactory surgical views and operating space. This technique significantly enhances the efficacy and safety of minimally invasive surgery for anterior mediastinal masses, reduces trauma and postoperative pain, and accelerates patient recovery, demonstrating important clinical significance and application value.

Objective:To explore the clinical characteristics of adrenal lesions in unilateral primary aldosteronism.Methods:This is a prospective study. Consecutive patients diagnosed with unilateral primary aldosteronism at the First Affiliated Hospital of Chongqing Medical University from December 2023 to November 2024 were included. Inclusion criteria：① Age is 18 to 80 years old；② The laboratory test indicators are in line with the diagnosis of primary aldosteronism；③ The auxiliary examination proved that only one side was involved；④ Patient undergo unilateral total adrenalectomy. The exclusion criteria are as follows：① Complete biochemical remission was not achieved during the 1-6 month follow-up after the surgery；② Postoperative loss to follow-up；③ No surgical specimens were received or the surgical specimens were incomplete，making continuous sectioning impossible. Patients meeting the inclusion criteria were recruited，and their clinical and biochemical data were recorded. The number of adrenal nodules visible on CT scans and the number of macroscopically visible nodules in the postoperative adrenal gross specimens were documented. Hematoxylin-eosin（HE）staining and aldosterone synthase CYP11B2 immunohistochemical staining were performed on the adrenal tissues after the operation. The number of nodules visible under the light microscope and the number of CYP11B2-positive nodules were recorded.Results:A total of 114 cases were included in this study. The age of the patients was（49.86 ± 9.80）years，the body mass index was（25.49 ± 3.40）kg/m2，the preoperative aldosterone level was 352（2012，556）pg/ml，and the direct renin concentration was 1.63（0.50，4.56）μIU/ml. The aldosterone/renin ratio was 224.9（57.1，641.6）（aldosterone concentration unit was pg/ml，renin concentration unit was μIU/ml），the minimum blood potassium concentration was 2.87（2.50，3.40）mmol/L，and the systolic blood pressure was（144.5 ± 19.5）mmHg. Among the 114 patients，105 had adrenal nodules detected by preoperative CT，of whom 2（1.75%）had multiple nodules. Postoperative gross adrenal specimen evaluation and CYP11B2 immunohistochemical staining revealed that 90 out of 114 cases were solitary nodules，2 cases had no nodules，and 22 cases（19.30%）had multiple nodules detected（17 cases had 2 nodules and 5 cases had 3 nodules）. Among them，12 cases（10.53%）presented as grossly visible multinodular lesions，while 10 cases（8.77%）appeared as solitary nodules macroscopically but demonstrated multinodular patterns on immunohistochemical staining. CYP11B2 staining showed that among the 22 patients with multiple nodules，13 had multiple CYP11B2-positive nodules，while the remaining had only one positive nodule. Among the 22 patients with multiple nodules，preoperative CT showed single nodules in 19 cases，hyperplasia in 1 case，and multiple nodules in 2 cases（9.09%）. Among the 12 patients with grossly visible multinodular lesions，preoperative CT showed single nodules in 9 cases，hyperplasia in 1 case，and multiple nodules in 2 cases（16.67%）.Conclusions:Multiple adrenal nodules associated with unilateral primary aldosteronism are relatively common，and are often not detected by preoperative CT examination. Partial adrenalectomy based solely on CT-visible nodules may fail to achieve complete remission of primary aldosteronism. This study provides evidence supporting total adrenalectomy as the preferred surgical approach for unilateral primary aldosteronism.

Objective:To explore the clinical characteristics of adrenal lesions in unilateral primary aldosteronism.Methods:This is a prospective study. Consecutive patients diagnosed with unilateral primary aldosteronism at the First Affiliated Hospital of Chongqing Medical University from December 2023 to November 2024 were included. Inclusion criteria：① Age is 18 to 80 years old；② The laboratory test indicators are in line with the diagnosis of primary aldosteronism；③ The auxiliary examination proved that only one side was involved；④ Patient undergo unilateral total adrenalectomy. The exclusion criteria are as follows：① Complete biochemical remission was not achieved during the 1-6 month follow-up after the surgery；② Postoperative loss to follow-up；③ No surgical specimens were received or the surgical specimens were incomplete，making continuous sectioning impossible. Patients meeting the inclusion criteria were recruited，and their clinical and biochemical data were recorded. The number of adrenal nodules visible on CT scans and the number of macroscopically visible nodules in the postoperative adrenal gross specimens were documented. Hematoxylin-eosin（HE）staining and aldosterone synthase CYP11B2 immunohistochemical staining were performed on the adrenal tissues after the operation. The number of nodules visible under the light microscope and the number of CYP11B2-positive nodules were recorded.Results:A total of 114 cases were included in this study. The age of the patients was（49.86 ± 9.80）years，the body mass index was（25.49 ± 3.40）kg/m2，the preoperative aldosterone level was 352（2012，556）pg/ml，and the direct renin concentration was 1.63（0.50，4.56）μIU/ml. The aldosterone/renin ratio was 224.9（57.1，641.6）（aldosterone concentration unit was pg/ml，renin concentration unit was μIU/ml），the minimum blood potassium concentration was 2.87（2.50，3.40）mmol/L，and the systolic blood pressure was（144.5 ± 19.5）mmHg. Among the 114 patients，105 had adrenal nodules detected by preoperative CT，of whom 2（1.75%）had multiple nodules. Postoperative gross adrenal specimen evaluation and CYP11B2 immunohistochemical staining revealed that 90 out of 114 cases were solitary nodules，2 cases had no nodules，and 22 cases（19.30%）had multiple nodules detected（17 cases had 2 nodules and 5 cases had 3 nodules）. Among them，12 cases（10.53%）presented as grossly visible multinodular lesions，while 10 cases（8.77%）appeared as solitary nodules macroscopically but demonstrated multinodular patterns on immunohistochemical staining. CYP11B2 staining showed that among the 22 patients with multiple nodules，13 had multiple CYP11B2-positive nodules，while the remaining had only one positive nodule. Among the 22 patients with multiple nodules，preoperative CT showed single nodules in 19 cases，hyperplasia in 1 case，and multiple nodules in 2 cases（9.09%）. Among the 12 patients with grossly visible multinodular lesions，preoperative CT showed single nodules in 9 cases，hyperplasia in 1 case，and multiple nodules in 2 cases（16.67%）.Conclusions:Multiple adrenal nodules associated with unilateral primary aldosteronism are relatively common，and are often not detected by preoperative CT examination. Partial adrenalectomy based solely on CT-visible nodules may fail to achieve complete remission of primary aldosteronism. This study provides evidence supporting total adrenalectomy as the preferred surgical approach for unilateral primary aldosteronism.

OBJECTIVE To investigate the effects of total glucosides of paeony （TGP） on enhancing efficacy and reducing toxicity of Tripterygium wilfordii polyglycoside （TWP） in the treatment of eczema. METHODS Totally 50 SD male rats were collected to establish eczema model by sensitizing with 2，4-dinitrofluorobenzene-acetone olive oil solution （volume ratio was 4∶1） on the abdominal area and provoking on the back and ear. Model rats were randomly divided into model group， loratadine group （0.9 mg/kg）， TWP group （9.45 mg/kg）， TGP group （162 mg/kg） and compatibility group （TWP 9.45 mg/kg+TGP 162 mg/kg）， with 10 rats in each group. Other 10 rats were collected to set as normal group. Three days after the first sensitization， administration groups were given relevant medicine intragastrically， and normal group and model group were given constant volume of 0.1% CMC-Na solution intragastrically， once a day， for consecutive 21 d. Twenty-four hours later after the final administration， the general condition of rats in each group was observed， and the eczema area and severity index （EASI） were scored； ear swelling degree of rats was measured， and the skinhistomorphology observation and pathological score were performed； protein expressions of p38 mitogen-activated 13938427612@126.com protein kinase （p38 MAPK）， phosphorylated p38 MAPK （p- MAPK） and phosphorylation level of p38 MAPK in rat skin tissue were detected； the levels of inflammatory indexes （interleukin-4， interferon- γ）， liver and kidney function indexes [glutamic-pyruvic transaminase （GPT）， glutamic-oxaloacetic transaminase （GOT）， serum creatinine （SCr） and blood urea nitrogen （BUN）] and oxidant stress indexes [total superoxide dismutase （T-SOD） and malondialdehyde （MDA）] were measured. RESULTS Compared with normal group， EASI score， ear swelling degree， pathological score， protein expressions of p38 MAPK and p-p38 MAPK， phosphorylation level of p38 MAPK， the levels of inflammatory indexes and BUN were all increased significantly in model group （P＜0.05）. Compared with model group， EASI scores， ear swelling degree， pathological scores， protein expressions of p38 MAPK and p-p38 MAPK， phosphorylation levels of p38 MAPK and levels of inflammatory indexes were all improved significantly in administration groups （P＜0.05）. The levels of GPT， GOT， SCr and BUN were increased significantly in TWP group， while the serum levels of GOT and SCr in TGP group and serum level of SCr in loratadine group were all decreased significantly （P＜0.05）. The levels of T-SOD in liver and kidney tissue were all decreased significantly in TWP group and compatibility group， while the levels of MDA were increased significantly （P＜0.05）. The compatibility group showed more obvious effect in improving the ear swelling degree， pathological score， p38 MAPK expression and its phosphorylation level and levels of inflammatory indexes， and could reverse the abnormality of liver and kidney indexes caused by TWP （P＜0.05）. CONCLUSIONS The combination of TGP and TWP has the effects of anti-inflammatory， synergistic and hepatorenal detoxification in eczema model rats. Its mechanism may be associated with down-regulating the expression of serum proinflammatory indexes and inhibiting the activation of p38 MAPK pathway.

OBJECTIVE To investigate the effect of Compound danshen tablet s o n improving the blood lipid levels and the mechanism of protecting renal functions in hyperlipidemia model rats. METHODS Sixty male SD rats were divided into normal group，model group ，simvastatin combined with （2S）-N-[N-（3，5-difluorophenylacetyl）-L-alanyl]-2-phenylglycine tert butyl （DAPT）group and low-dose ，medium-dose and high-dose groups of Compound danshen tablets ，with 10 rats in each group. Rats in the normal group received routine diet. The other 5 groups were intraperitoneally injected with 75％ yolk emulsion 10 mL/kg， fasting and drinking freely. After 16 h，they were fed high-fat diet for 4 weeks. Simvastatin combined with DAPT group was given simvastatin 0.002 g/kg and DAPT 0.012 g/kg at the same time of modeling. The low-dose ，medium-dose and high-dose groups of Compound danshen tablets were given Compound danshen tablets 0.25，0.5 and 1 g/kg respectively at the same time of modeling ， the normal group and model group were given equal volume of distilled water ，once a day ，for 4 weeks. The serum levels of total cholesterol（TC），triglyceride（TG），creatinine（Cr）and urea nitrogen （BUN）in serum were detected by biochemical method ； kidney coefficient of rats was calculated ；histopathological changes of rat kidney were observed by HE staining ，and the renal injury was scored according to the degree of renal tubular injury and glomerular sclerosis in renal cortex ；expression levels of Notch signal receptor 1（Notch 1），Notch signal ligand 1（Jagged1）and hairy division associated enhancer 1（Hes1）in kidney were detected by immunohistochemistry ；mRNA expressions of Notch 1，Jagged1 and Hes 1 in renal tissue were detected by real-time fluorescence quantitative polymerase chain reaction. RESULTS Compared with normal group ，the serum levels of TG ， TC，Cr and BUN were increased significantly in model group （P＜0.05）；renal coefficient increased significantly （P＜0.05）； pathological changes occurred in renal tissue ，and the scores of renal tubular injury and glomerular sclerosis increased significantly （P＜0.05）；protein and mRNA expressions of Notch1， Jagged1， Hes1 in renal tissue were increased significantly（P＜0.05）. Compared with model group ，serum levels of TG ，TC，Cr and BUN ，renal coefficient ，the scores of renal tubular injury and glomerular sclerosis ，protein and mRNA expression of Notch 1，Jagged1 and Hes 1 in renal tissue were all decreased in low-dose ，medium-dose and high-dose groups of Compound danshen tablets （P＜0.05），and most indexes showed a dose-dependent trend ；the degree of renal lesions was reduced. CONCLUSIONS Compound danshen tablets possess obvious hypolipidemic effect ，and can protect the renal function of hyperlipidemia model rats by down-regulating Notch 1/Jagged1 signal pathway.

OBJECTIVE To study the intervention effect of Bushen qiangshen tablet on polycystic ovary syndrome （PCOS） model rats and its mechanism . METHODS Totally 50 rats were given letrozole suspension （1 mg/kg，once a day ，for consecutive 21 d） instragastrically to induce PCOS model . Model rars were randomly divided into model group ，positive control group （Ethinylestradiol and cyproterone acetate tables 0.2 mg/kg+Metformin hydrochloride tables 230 mg/kg），Bushen qiangshen tablet low-dose，medium-dose and high -dose groups （189，378，756 mg/kg），with 10 rats in each group . Another 10 healthy rats were included in normal group . Each group was given the corresponding drugs ，once a day ，for consecutive 30 d. Twenty-four hours after the last administration ，serum levels of estrogen （E2），testosterone（T），gonadotropin-releasing hormone （GnRH），follicle- stimulating hormone （FSH）and luteinizing hormone （LH）were measured . The ovary index was calculated ，and pathological changes of ovary were observed . The protein expressions of phosphoinositide 3-kinase（PI3K），phosphorylated protein kinase B （p- Akt），phosphorylated mammalian target of rapamycin （p-mTOR）and glucose transporter 4（GLUT4）in ovary were detected ，and mRNA expressions of PI 3K，Akt，mTOR and GLUT 4 in ovary were detected . RESULTS Compared with normal group ，ovarian index and ovarian cystic disease score were significantly increased in model group （P＜0.05），and serum levels of T ，GnRH and LH were significantly increased （P＜0.05）；serum levels of FSH and E 2，protein expressions of PI 3K，p-Akt，p-mTOR and GLUT4，and mRNA expression of PI 3K，AKT，mTOR and GLUT 4 in ovarian tissue were all significantly decreased in the model group （P＜0.05）；in ovarian tissue ，the number of atresia follicles and non -cumulus cystic follicles increased ，and the number of granulosa cell layers decreased . Compared with model group ， above indexes of Bushen qiangshen tablet medium-dose and high -dose g roups were reversed significantly 86550201。E-mail：mary868@163.com （P＜0.05），and most above indexes of low -dose group were reversed significantly （P＜0.05），the pathological changes of ovarian tissue were improved to varying degrees . CONCLUSIONS Bushen qiangshen tablet can regulate the secretion of sex hormones in PCOS model rats and improve ovarian cystic lesions . Its mechanism may be related to the upregulation of PI 3K/Akt/mTOR and PI 3K/Akt/GLUT4 signaling pathways .

Objective:To assess the safety and effectiveness of amphotericin B cholesteryl sulfate complex for injection in the context of empirical and diagnostic antifungal therapy for patients with hematological malignancies in addition to invasive fungal illness.Methods:This single-arm clinical study enrolled 30 patients who received empirical and diagnostic-driven antifungal therapy for hematological malignancies combined with invasive fungal disease. The primary endpoint was safety. Response rate, fever duration, and treatment completion rate were all considered secondary objectives.Results:30 participants were eventually enrolled in the study, and the treatment completion rate was 80.0% . Most adverse events were in grades 1-2. Infusion response was the most frequent adverse event (24/30, 80% ) . The overall response rate was 80.0% (24/30) . In 24 patients (80.0% ) , the fever persisted for 1 day.Conclusions:Treatment of invasive fungal illness in conjunction with hematological malignancies showed good efficacy and safety with amphotericin B cholesteryl sulfate complex for injection.

Objective: To probe the feasibility of decitabine (DAC) combined with micro-transplantation as consolidation treatment for older patients with acute myeloid leukemia (AML). Methods: Between November 2012 and September 2015, 37 consecutive patients with AML ≥60 years of age were analyzed. Of them, 19 patients received consolidation therapy with DAC followed by micro-transplantation (microtransplant group). Another 18 ones (chemo group) were treated with DAC plus priming regimen as consolidation chemotherapy in the same period. Results: There were no significant differences in terms of age, WBC count, and disease status of onset between the microtransplant and chemo groups (P>0.05). The two regimens were well tolerated. There was no difference of CTC grade 3-4 nonhematologic toxicities between the microtransplant and chemo groups (36.8% vs 27.8%, χ²=0.347, P=0.728). The median recovery durations for neutrophil and platelet in the microtransplant group were similar to those in the chemo group (12 vs 13 days, z=1.599, P=0.110; 14 vs 12 days, z=-1.314, P=0.189, respectively). No graft-versus-host disease was observed in the microtransplant group. The 2-year leukemia-free survival and overall survival were better in microtransplant group (50.7% and 54.9%, respectively) than in chemo group (24.3% and 30.0%, respectively) (P=0.047 and P=0.071, respectively). Conclusion DAC combined with micro-transplantation as a consolidation regimen may be a safe and promising option for older patients with AML.

Objective To explore the clinical results of repairing frontal lesions with the combination of the expanded scalp flaps and postoperative laser hair removal.Methods There were 10 patients involved between May 2014 through May 2016 in our department.In the first stage,the expanders were implanted to the pockets under the scalp.In the second stage,the wounds,after lesion removal,were covered by the expanded scalp flaps.In the third stage,laser hair removal was performed 2 weeks postoperatively for 4 to 6 times until complete removing the hair.Results All the lesions were repaired with good results.The incisions healed primarily.The scalp flaps survived without nec rosis.The hair on the flap was removed completely.The color and texture of the flap were similar to these of the adjacent skin.The satisfactory results of the appearance were achieved in all the patients.Conclusions The combination of the expanded scalp flap and laser hair removal is an effective method for the repairing of the frontal lesion.