Objective To analyze the effect of releasing the lower pulmonary ligament on right residual lung expansion after right upper lobe resection under different body mass index (BMI) levels. Methods The clinical data of patients who underwent thoracoscopic right upper lobe resection in the First Affiliated Hospital with Nanjing Medical University from 2021 to 2022 were retrospectively analyzed. Patients were divided into a group A (17 kg/m2＜BMI≤23 kg/m2), a group B (23 kg/m2＜BMI≤29 kg/m2) and a group C (BMI＞29 kg/m2) according to BMI. The presence of residual cavity was judged by chest X-ray at 7-10 days after operation, the degree of compensation change of the right main bronchus angle was measured, and the changes in lung volume were determined by CT three-dimensional reconstruction. Results A total of 157 patients who underwent thoracoscopic right upper lobe resection were included, including 71 males and 86 females, with an average age of (59.7±11.2) years. There were 50 patients in the group A, 75 patients in the group B, and 32 patients in the group C. In the group A, compared with those without releasing the lower pulmonary ligament, patients with releasing had a lower incidence of postoperative residual cavity (P=0.016), greater changes in bronchus angle (P<0.001), and smaller changes in lung volume (P<0.001). In the group B and C, there was no significant effect of releasing the lower pulmonary ligament on postoperative residual cavity, bronchus angle, and lung volume changes (P>0.05). Conclusion For patients with thin and long body shape and low BMI, releasing the lower pulmonary ligament is helpful to promote the expansion of the residual lung after right upper lobe resection and reduce the occurrence of postoperative residual cavity in patients.

Objective:To explore the effectiveness of rapid cycle deliberate practice (RCDP) in training newly hired nurses′comprehensive emergency competence and to provide references for enhancing their capabilities.Methods:A quasi-experimental study was conducted using purposeful sampling. From September to December 2022, newly hired nurses at Liaocheng Second People′s Hospital were selected as research subjects and randomly assigned to a controlor an observation group using random number table. The control group received traditional group drill training, while the observation group underwent RCDP training. The study compared pre- and post-training scores of emergency theory and skill assessments, scores on the Chinese version of the Perceived Cognitive Ability Scale in Emergency Situations (PCAS), and training satisfaction levels between the two groups.Results:Each group comprised 30 nurses. The control group consisted of 3 males and 27 females, with a mean age of (22.70 ± 1.09) years; the observation group included 2 males and 28 females, with a mean age of (22.93 ± 0.87) years. Post-training comprehensive emergency competence assessment scores was (89.19 ± 1.47) in the control group and (93.00 ± 1.41) in the observation group, with a statistically significant difference ( t = - 4.60, P<0.01). The scores and total scores of PCAS in the observation group were (34.23 ± 1.91), (12.70 ± 1.62), (10.03 ± 1.52) and (56.97 ± 3.09), respectively, which were higher than the (31.70 ± 2.42), (11.90 ± 1.16), (9.10 ± 1.42), and (52.47 ± 3.65) in the control group, the difference between the two groups were statistically significant ( t value were - 5.16 - - 2.20, all P<0.05). The total score of training satisfaction of nurses in the observation group was (41.93 ± 2.53) points, and the difference was statistically significant compared with the (33.80 ± 2.58) pointsin the control group ( t = - 12.33, P<0.01). Conclusions:The application of the RCDP method in training newly recruited nurses′comprehensive emergency competence effectively enhances their learning enthusiasm and initiative, thereby improving training outcomes.

Research indicates that microbe activity within the human body significantly influences health by being closely linked to various diseases.Accurately predicting microbe-disease interactions(MDIs)offers critical insights for disease intervention and pharmaceutical research.Current advanced AI-based technologies automatically generate robust representations of microbes and diseases,enabling effec-tive MDI predictions.However,these models continue to face significant challenges.A major issue is their reliance on complex feature extractors and classifiers,which substantially diminishes the models' generalizability.To address this,we introduce a novel graph autoencoder framework that utilizes decoupled representation learning and multi-scale information fusion strategies to efficiently infer po-tential MDIs.Initially,we randomly mask portions of the input microbe-disease graph based on Bernoulli distribution to boost self-supervised training and minimize noise-related performance degradation.Secondly,we employ decoupled representation learning technology,compelling the graph neural network(GNN)to independently learn the weights for each feature subspace,thus enhancing its expressive power.Finally,we implement multi-scale information fusion technology to amalgamate the multi-layer outputs of GNN,reducing information loss due to occlusion.Extensive experiments on public datasets demonstrate that our model significantly surpasses existing top MDI prediction models.This indicates that our model can accurately predict unknown MDIs and is likely to aid in disease discovery and precision pharmaceutical research.Code and data are accessible at:https://github.com/shmildsj/MDI-IFDRL.

To summarize the nursing experience of a patient with anthrax meningoencephalitis caused by cerebrospinal fluid rhinorrhea post-trauma.Nursing points include strict implementation of isolation and hospital infection prevention and control measures;to standardize the use of antibiotics throughout the process to prevent and manage antimicrobial-related diarrhea;to pay attention to the nutritional status of patients and develop individualized nutritional support programs based on evidence;to implement refined airway care to prevent pulmonary complications;to strengthen disease observation,identify intracranial hemorrhage in time;to provide patient and family-centered psychological empowerment in the whole process.After 66 days of careful treatment and nursing care,the patient recovered and was discharged.A follow-up visit after 2 months of discharge showed a good recovery.

Objective:To explore the effectiveness of rapid cycle deliberate practice (RCDP) in training newly hired nurses′comprehensive emergency competence and to provide references for enhancing their capabilities.Methods:A quasi-experimental study was conducted using purposeful sampling. From September to December 2022, newly hired nurses at Liaocheng Second People′s Hospital were selected as research subjects and randomly assigned to a controlor an observation group using random number table. The control group received traditional group drill training, while the observation group underwent RCDP training. The study compared pre- and post-training scores of emergency theory and skill assessments, scores on the Chinese version of the Perceived Cognitive Ability Scale in Emergency Situations (PCAS), and training satisfaction levels between the two groups.Results:Each group comprised 30 nurses. The control group consisted of 3 males and 27 females, with a mean age of (22.70 ± 1.09) years; the observation group included 2 males and 28 females, with a mean age of (22.93 ± 0.87) years. Post-training comprehensive emergency competence assessment scores was (89.19 ± 1.47) in the control group and (93.00 ± 1.41) in the observation group, with a statistically significant difference ( t = - 4.60, P<0.01). The scores and total scores of PCAS in the observation group were (34.23 ± 1.91), (12.70 ± 1.62), (10.03 ± 1.52) and (56.97 ± 3.09), respectively, which were higher than the (31.70 ± 2.42), (11.90 ± 1.16), (9.10 ± 1.42), and (52.47 ± 3.65) in the control group, the difference between the two groups were statistically significant ( t value were - 5.16 - - 2.20, all P<0.05). The total score of training satisfaction of nurses in the observation group was (41.93 ± 2.53) points, and the difference was statistically significant compared with the (33.80 ± 2.58) pointsin the control group ( t = - 12.33, P<0.01). Conclusions:The application of the RCDP method in training newly recruited nurses′comprehensive emergency competence effectively enhances their learning enthusiasm and initiative, thereby improving training outcomes.

Pancreatic cancer is a highly malignant tumor of the digestive system and has an extremely poor prognosis.Due to its insidious onset and rapid progression,major surrounding vessels are frequently invaded at the time of diagnosis.Consequently,resection and reconstruction of the portal vein and/or superior mesenteric vein are often required during pancreatectomy.Various methods of venous resection and reconstruction have been developed,each with its own advantages,limitations,and specific applicability.Compared with open surgery,laparoscopic pancreatectomy requires higher technical proficiency and more precise intraoperative decision-making.To promote the advancement of venous reconstruction techniques in laparoscopic pancreatectomy,in this article,we summarize and evaluate our team's practical experience and relevant literature,focusing on graft selection,technical difficulty,operative risk,and short-and long-term patency.Special emphasis was placed on the applicability of different approaches and materials.In addition,regarding postoperative reconstruction of venous patency,we introduced the"Cross-sectional Area Algorithm",a method simulating the evaluation mode of coronary artery patency,to accurately quantify postoperative venous patency.The evaluation method was first proposed by the team but has not yet been externally validated.By reviewing the current status of venous reconstruction strategies and the prognosis of laparoscopic pancreatic surgery,we aim to inform the development of standardized technical guidelines,enable individualized assessment of venous patency after surgery,and ultimately improve minimally invasive pancreatic surgery and the long-term prognosis of patients.

Objective:To construct a sizeable naive human Fab phage display antibody library to screen high-affinity specific antibodies in vitro. Methods:Total RNA was extracted from peripheral blood mononuclear cells (PBMCs) of 126 healthy individuals, subsequently reverse-transcribed into cDNA, and used as a template. PCR amplification was performed to obtain the V H from IgG, IgM and light chain κ, λ, separately, with the initial PCR products serving as templates for a second round of PCR. Overlap extension PCR was employed to generate fragments of the κ and λ light chains. These fragments were ligated with the phage vector pNC3, which harbors the variable region 1 of the heavy chain, to construct a recombinant phage plasmid. This plasmid was then electroporated into competent Escherichia Coli TG1 cells to establish a naive human Fab phage display antibody library. One hundred clones were randomly selected for identification and sequencing, and antibody gene polymorphisms were analyzed using the IMGT database and MAFFT software. Recombinant α-hemolysin from Staphylococcus aureus was utilized to screen Fab antibody fragments through biopanning of the antibody library, followed by random selection of phage ELISA-identified clones. The positive clones (antigen A450∶blank control A450≥2.1) were sequenced. Results:Two large naive Fab phage display antibody libraries were successfully constructed, in which the capacity of κ and λ chain antibody libraries were 1.25×10 11 and 1.54×10 11, respectively. The titers for two antibody libraries were 6.04×10 13 CFU/ml and 3.50×10 13 CFU/ml. The positive transformation insertion rates for κ and λ chain antibody libraries were 96% (96/100) and 100% (100/100), respectively. Sequence analysis revealed that all antibody sequences were unique. The amino acid sequences in the skeletal region were relatively conserved. In contrast, significant variations in the length of the complementarity determining region (CDR) were found, and the diversity of amino acid sequence of the complementary determining region was high, especially the CDR3. Analysis using the IMGT database indicated that the sequences exhibited a broad distribution across variable-diversity-joining gene families. After six rounds of panning, specific phage antibodies enrichment targeting α-hemolysin were achieved. A total of 142 monoclonal antibodies were sequenced, yielding 8 distinct Fab antibody sequences. Conclusion:This study successfully constructed two naive human Fab phage display antibody libraries with large capacity and good diversity, which can be used for screening human antibodies for serum epidemiology.

Objective To explore the differences between community-based population-wide early screening combined with two-way referral model and the traditional opportunistic screening model for early diagnosis of early-stage prostate cancer.Methods From August 2022 to April 2024,12815high-risk elderly males within the Fifth People's Hospital of Shanghai,Fudan University healthcare al-liance underwent population-wide prostate-specific antigen(PSA)screening across five community health centers.Among them,1005 cases with PSA＞4.0ng/ml were identified and referred via a two-way referral model to the Fifth People's Hospital of Shanghai,Fudan University for further evaluation.Prostate biopsies were performed on 445 eligible patients who consented(mean age was 65.6±6.8 years),and clinical data were collected as the community-based population-wide early screening combined with two-way referral mod-el group(Group A).During the same period,4600high-risk elderly males with lower urinary tract symptoms underwent opportunistic PSA screening at the Fifth People's Hospital of Shanghai,Fudan University identifying 700 cases with abnormal PSA levels.Biopsies were performed on 270 eligible patients who consented(mean age was 64.8±6.4 years),and clinical data were collected as the traditional op-portunistic screening model group(Group B).Baseline characteristics,positive rate of prostate cancer,clinical stages,and pathological grades were compared between the two groups.Results There were no statistically significant differences in age,PSA levels,family his-tory,body mass index(BMI),marital status and education level between the groups.There were 160 positive cases in Group A,the pos-itive rate was 35.9％,while there were 90 positive cases in Group B,the positive rate was 33.3％,with no significant statistical differ-ence(P=0.652).In Group A,100 cases(62.5％of diagnosed cases)were classified as clinical stage ≤T2N0M0,compared to 35 ca-ses(38.9％)in Group B,showing a significant statistical difference(P=0.023).Group A had 105 cases(65.6％of diagnosed cases)with International Society of Urological Pathology(ISUP)grade ≤3,while Group B had 30 cases(33.3％),showing a significant statis-tical difference(P=0.002).Conclusion Community-based population-wide early screening combined with two-way referral model showed no difference in the positive rate of prostate cancer compared to traditional opportunistic screening but exhibited advantages in diag-nosing early-stage prostate cancer.Wider adoption of this model may improve the current status of delayed staging and poor prognosis a-mong prostate cancer patients in China.

Objective To explore the potential pathogenesis of SLE and SS based on GEO database with screening differential expression genes common in systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS),analyzing their functions and identifing their expression levels. Methods The gene expression datasets of SLE and SS whole blood samples were retrieved from GEO database. Differential expression genes in peripheral blood cells of SLE and SS were screened using gene expression datasets GSE50772,GSE81622,GSE84844 and GSE48378,respectively,and the shared differential expression genes of SLE and SS were screened. Functional analysis of differentially expressed genes was performed using Gene Ontology (GO) analysis and the Kyoto Encyclopedia of Genes and Genomes (KEGG). Peripheral blood from SLE and SS patients and healthy controls were collected from March 2024 to April 2024,recruited from the Second Affiliated Hospital of Air Force Medical University. Quantitative fluorescence real-time PCR (qRT-PCR) was used to identify the expression levels of 11 genes with the most significant differences in expression. Results 232 and 110 differentially expressed genes were screened for SLE and SS,respectively,among which 32 genes shared by SLE and SS were up-regulated in expression levels. Functional analysis showed that the 32 differentially expressed genes were mainly enriched in biological processes related to interferon (IFN) signaling pathways,defense response to viruses,response to viruses,negative regulation of viral genome replication,and immune response. KEGG pathway analysis showed that 32 differentialy expressed genes were associated with the process of viral infection. The clinical sample identification results showed that the expression levels of OAS3,IFI44,IFI44L and EPSTI1 were significantly elevated in PBMC of SLE and SS patients. Conclusion This study suggested that changes in biological processes related to IFN signal and viral infection response play important roles in both SLE and SS development,and may be a predisposing factor and potential biomarker for SLE and SS.

Neuronal intranuclear inclusion disease（NIID）is a rare hereditary neurodegenerative disorder that can affect multiple systems. However，it is uncommon for urinary dysfunction to be the initial symptom. This article reports five cases. The five patients began to experience voiding dysfunction such as frequent urination，weak urination，and incomplete urination at the mean ages of 55.4（47 - 65）years old. Four months to twelve years after urinary onset，neurological symptoms such as headache，memory decline，transient loss of consciousness，and unsteady gait began to appear. Four of the five cases had a family history. Brain MRI revealed the “ribbon sign” or “crest sign” in all cases. Skin biopsy revealed eosinophilic inclusions in the cell nuclei，and NOTCH2NLC gene testing identified abnormal GGC mutations. Three of the five patients underwent cystostomy due to secondary hydronephrosis，while the other two received no special treatment. After a follow-up of 18 to 35 months since diagnosis，the patients who underwent cystostomy had normal renal function. Neurological symptoms in all five patients worsened to varying degrees.