Objective To propose a framework for risk assessment and stepwise management of pulmonary nodules based on existing guidelines and key studies, and to clarify the boundaries for triage, workup escalation, and referral in different detection scenarios. Methods A problem-oriented evidence synthesis approach was used, prioritizing Chinese expert consensus, Fleischner Society Guidelines, British Thoracic Society (BTS) Guidelines, and Lung-RADS. This was supplemented by studies on risk models, imaging measurements, liquid biopsy, tissue sampling, and surgical treatments. This paper is not presented as a formal consensus or a validated clinical pathway. Results A three-tiered framework consisting of basic non-invasive assessment, advanced assessment, and invasive diagnosis was established. It specified the applicable populations, boundaries for the use of risk models, imaging review, management of conflicting results, evaluation of histopathological consistency, and post-intervention follow-up. Liquid biopsy, genetic testing, and artificial intelligence were defined as investigational or adjunctive tools. Conclusion This framework can serve as a preliminary reference for multidisciplinary teams in developing local protocols. It cannot replace applicable guidelines, pathological diagnosis, shared decision-making with patients, or real-world validation.

Objective:To investigate short-term safety, efficacy and the learning curve of this self-developed novel transcatheter valve repair system (Neonova?) in patients with mitral regurgitation, and explore the role of perioperative echocardiography.Methods:Ten patients who visited the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from June 2021 to March 2022 and met the inclusive criteria were prospectively enrolled. All the patients were at high risk of surgery with moderate to severe or severe mitral regurgitation (MR). Clamps of Neonova? were implanted under guidance of transesophageal echocardiography and digital subtraction angiography. Clinical outcomes, echocardiography indexes and learning curves of this technique were evaluated immediately after intervention, 7 d, 1 month and 3 months post-intervention.Results:The technical success rate was 100% with MR relieved in all patients immediately after intervention. The device and procedural success rates were both 90.0% with 1 patient received surgical replacement at 37 days post-intervention while the others′ reduced to mild (8/9) and moderate (1/9) MR. New York Heart Association class and the Kansas City Cardiomyopathy Questionnaire improved significantly (all P<0.001). Mean mitral valve pressure gradient didn′t increase significantly after intervention when compared with that before intervention( P=0.324), and no mitral stenosis was observed. Left ventricular end-diastolic diameter decreased significantly ( P=0.008) during follow up.Procedure duration ranged from 60 to 300 (175.8±75.2)minutes. The simple linear regression model between procedure volume and duration showed that procedure duration decreased significantly with the increase of procedure volume ( F=15.857, P=0.004). Conclusions:Neonova? implantation can improve MR severity and clinical symptoms safely and effectively. Transthoracic echocardiography and transesophageal echocardiography are essential for perioperative management of transcatheter mitral valve repair.

Objective:To investigate the regulatory mechanism of miR-29a-3p/ SGMS2 axis on the inflammatory response of ovarian granulosa cells (KGN). Methods:By constructing and validating overexpression and knockdown of miR-29a-3p and SGMS2 transfected KGN cell models, dual luciferase reporter gene assay was used to detect the binding of miR-29a-3p to SGMS2. MTT assay was used for detecting the cell proliferation. Fluorescence intensity of proliferating cell nuclear antigen (PCNA) and Ki67 protein were detected by immunofluorescence. Apoptosis was detected by flow cytometry. The expression levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-1β and sphingomyelin in cell supernatant were detected by enzyme-linked immunosorbent assay. The protein expression levels of Caspase-3, cleaved-Caspase-3, SGMS2 and p-p65 in KGN were detected by Western blotting. Results:miR-29a-3p had site-specific binding to SGMS2 and can negatively regulated SGMS2 expression level. Overexpression of SGMS2 in KGN cells was able to increase their levels of absorbance ( P=0.007) and enhanced the immunofluorescence intensity of the protein of PCNA and Ki67 (all P<0.001). Overexpression of SGMS2 could reduce the apoptosis rate of KGN cells ( P=0.001). Overexpression of SGMS2 increased the expression levels of TNF-α, IL-6, IL-1β and sphingomyelin (all P<0.001). The expressions of cleaved-Caspase-3, p-p65 and SGMS2 proteins were elevated in KGN cells when SGMS2 was overexpressed ( P=0.001, P<0.001, P<0.001), while knock down SGMS2, the above results had a trend of change opposite to overexpression of SGMS2. Conclusion:There is a targeted negative regulatory relationship between miR-29a-3p and SGMS2, which can promote the inflammatory response of KGN and may provide a target for the treatment of polycystic ovary syndrome.

Objective:To investigate the regulatory mechanism of miR-29a-3p/ SGMS2 axis on the inflammatory response of ovarian granulosa cells (KGN). Methods:By constructing and validating overexpression and knockdown of miR-29a-3p and SGMS2 transfected KGN cell models, dual luciferase reporter gene assay was used to detect the binding of miR-29a-3p to SGMS2. MTT assay was used for detecting the cell proliferation. Fluorescence intensity of proliferating cell nuclear antigen (PCNA) and Ki67 protein were detected by immunofluorescence. Apoptosis was detected by flow cytometry. The expression levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-1β and sphingomyelin in cell supernatant were detected by enzyme-linked immunosorbent assay. The protein expression levels of Caspase-3, cleaved-Caspase-3, SGMS2 and p-p65 in KGN were detected by Western blotting. Results:miR-29a-3p had site-specific binding to SGMS2 and can negatively regulated SGMS2 expression level. Overexpression of SGMS2 in KGN cells was able to increase their levels of absorbance ( P=0.007) and enhanced the immunofluorescence intensity of the protein of PCNA and Ki67 (all P<0.001). Overexpression of SGMS2 could reduce the apoptosis rate of KGN cells ( P=0.001). Overexpression of SGMS2 increased the expression levels of TNF-α, IL-6, IL-1β and sphingomyelin (all P<0.001). The expressions of cleaved-Caspase-3, p-p65 and SGMS2 proteins were elevated in KGN cells when SGMS2 was overexpressed ( P=0.001, P<0.001, P<0.001), while knock down SGMS2, the above results had a trend of change opposite to overexpression of SGMS2. Conclusion:There is a targeted negative regulatory relationship between miR-29a-3p and SGMS2, which can promote the inflammatory response of KGN and may provide a target for the treatment of polycystic ovary syndrome.

Objective:To evaluate the efficacy of the domestic D-Shant device for the treatment of patients with chronic heart failure (CHF) using echocardiography.Methods:Twenty-four CHF patients who were treated with domestic D-Shant device in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2020 to December 2021 were enrolled in the study. Pulmonary capillary wedge pressure (PCWP)/ left atrial pressure (LAP), right atrial pressure (RAP), pulmonary artery pressure, interatrial septal gradient pressure, cardiac index and pulmonary/systemic blood flow ratio (Qp/Qs) were measured before and after implantation using right heart catheterization.Left atrial end-diastolic area index (LAEDAI), left atrial end-diastolic volume index (LAEDVI), left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), left ventricular ejection fraction (LVEF), right atrial end-diastolic diameter, right ventricular end-diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), right ventricular tractional area change (RVFAC), device shunt aperture, velocity and pressure, together with mitral and tricuspid regurgitation severity were measured using echocardiography before, and 1 month as well as 3 months after D-Shant device implantation. Clinical data were collected and analyzed including 6-minute walking test (6MWT), New York Heart Association (NYHA) classification and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Spearman correlation analysis was used to determine the relation between the changes in PCWP/LAP as well as echocardiographic parameters before and 3 months after implantation and NYHA classification. Binary Logistic regression analysis was performed to determine the predictive factors of NYHA classification improvement at 3-month follow-up after D-Shant device implantation.Results:①D-Shant devices were successfully implanted in all patients. ②Compared with preoperative values, invasive PCWP/LAP systolic, diastolic and mean pressures, transatrial septal gradient, and pulmonary systolic, diastolic and mean pressures decreased significantly after implantation(all P<0.001); Qp/Qs increased significantly after implantation( P<0.001). ③Compared with preoperative values, TAPSE, RVFAC and pulmonary artery flow velocity increased at 1 month after implantation(all P<0.05), whereas a significant reduction in mitral regurgitation grade, and an increase in LVEF and pulmonary artery flow velocity at 3 months after implantation(all P<0.05). Right atrial end-diastolic diameter, right ventricular end-diastolic diameter, LAEDAI, LAEDVI, LVEDVI, LVESVI, ratio of early to late diastolic peak velocities of mitral inflow(E/A), systolic peak velocity of mitral annulus at septal site(S′), ratio of early diastolic peak velocity of mitral inflow to diastolic peak velocity of mitral annulus(E/e′), pulmonary artery diameter, inferior vena cava diameter and degree of tricuspid regurgitation did not change among before, and 1 month as well as 3 months after implantation. There were no significant changes in the device shunt aperture, velocity and pressure between 1 month and 3 months after implantation(all P>0.05). ④The significant improvements in NYHA classification, KCCQ scores and 6MWT were observed at 1 and 3 months after implantation compared with preoperative values (all P<0.01). ⑤NYHA classification at 3 months after implantation was correlated with LVEF pre-post, PCWP/LAP pre-post, TAPSE pre-post and RVFAC pre-post ( rs=0.738, -0.730, 0.738, 0.723; all P<0.001). Logistic regression analysis showed that LVEF pre-post was an independent predictor for NYHA classification improvement at 3 months after implantation ( OR=0.687, 95% CI=0.475-0.992, P=0.045) . Conclusions:Domestic D-Shant device can effectively improve the cardiac function and clinical symptoms in patients with CHF. Echocardiography is a feasible and effective method to evaluate the benefits of domestic D-Shant device for the treatment of CHF.

Objective:To investigate the effects of cardiac exercise rehabilitation on heart failure with preserved ejection fraction.Methods:200 patients with clinically diagnosed heart failure with preserved ejection fraction who received treatment from May to December 2019 were included in this study. They were randomly assigned to receive either routine treatment (control group, n = 100) or routine treatment combined with cardiac exercise rehabilitation (observation group, n = 100). Before and after treatment, the distance walked during the 6-minute walk test was compared between the control and observation groups. Before and after treatment, plasma level of brain natriuretic peptide, left ventricular ejection fraction, left ventricular short-axis fractional shortening, left atrial diameter, left ventricular end diastolic diameter were compared between the two groups. Adverse events such as falls during treatment were recorded in each group. Before and after treatment, quality of life was evaluated using The Minnesota Living With Heart Failure Questionnaire in each group. All patients were followed up for 3 months. Three-month rehospitalization rate was calculated in each group. Results:After treatment, the distance walked during the 6-minute walk test in the observation group was significantly longer than that in the control group [(421.63 ± 86.75) m vs. (328.44 ± 74.93) m, t = 8.130, P < 0.001). After treatment, the distance walked during the 6-minute walk test in each group was significantly increased compared with before treatment ( tcontrol group = 6.584, P < 0.001; tobservation group = 15.337, P < 0.001). After treatment, plasma level of brain natriuretic peptide in the observation group was significantly lower than that in the control group [(227.68 ± 31.22) mg/L vs. (269.74 ± 36.81) mg/L, t = 8.714, P < 0.001]. After treatment, plasma level of brain natriuretic peptide in each group was significantly decreased compared with before treatment ( tcontrol group = 24.669, P < 0.001; tobservation group = 38.776, P < 0.001). After treatment, left ventricular end diastolic diameter and left atrial diameter in each group were significantly decreased compared with before treatment ( t = 4.031, 10.166, 3.715 and 12.569, all P < 0.05), while left ventricular ejection fraction and left ventricular short-axis fractional shortening in each group were significantly increased compared with before treatment ( t = 7.610, 11.906, 3.915 and 6.105, all P < 0.05). The amplitude of improvement in abovementioned indices in the observation group was significantly greater than that in the control group ( t = 7.255, 12.739, 4.703 and 2.442, all P < 0.05). During the treatment, no falls, adverse cardiovascular events, or death occurred in each group. After treatment, the Minnesota Living With Heart Failure Questionnaire scores in physical domain, emotional domain and other domains in the observation group were (23.96 ± 4.75) points, (9.47 ± 2.02) points, (26.31 ± 1.84) points, respectively, which were significantly lower than those in the control group [(28.63 ± 5.12) points, (12.35 ± 1.89) points and (32.76 ± 2.49) points, t = 6.867, 10.411 and 20.833, all P < 0.001]. After treatment, the Minnesota Living With Heart Failure Questionnaire scores in various domains in each group were significantly decreased compared with before treatment ( t = 6.648, 14.746, 28.782, 35.262, 9.665 and 27.962, all P < 0.05). Three-month rehospitalization rate in the observation group was significantly lower than that in the control group [10.0% (10/100) vs. 22.0% (22/100), χ2 = 5.357, P = 0.021]. Conclusion:Cardiac exercise rehabilitation for the treatment of heart failure with preserved ejection fraction can help improve the heart function, increase exercise endurance, improve prognosis, reduce rehospitalization rate, and improve quality of life.

Hypoxic microenvironment is a common phenomenon of liver diseases and runs through the whole process of the development and progression of liver diseases. In recent years, the research on liver fibrosis and hypoxic microenvironment of hepatocellular carcinoma has attracted more and more attention. Hypoxia-inducible factor (HIF) is the most important hypoxic stress factor found at present. This article reviews the characteristics of hypoxic microenvironment in the liver and liver diseases and further elaborates on the association of HIF overexpression with hepatocyte damage, formation of fibrosis, and malignant transformation of hepatocytes.

Objective: To investigate the recovery of splenomegaly and hypersplenism after liver transplantation in children and explore the necessity of splenomegaly management before and during liver transplantation. Method: The data of 22 children who were underwent liver transplantation with preoperative splenomegaly and hypersplenism who were not treated with splenomegaly before and during operation and with no recurrence of portal hypertension during postoperative follow-up in Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University from December 2008 to January 2019 were collected. There were 13 male patients and 9 female patients with a median age of 6.5 months. The changes of erythrocyte, platelet, white blood cell and spleen length and thickness were analyzed by paired t-test before and at the 1st, 3rd and 6th months after surgery. Correlation analysis was performed on the change of spleen long diameter and thickness product and blood cell recovery. Results: There were 21 cases of red blood cell decreased before surgery, with a mean value of(3.1±0.5)×10¹²/L, and(3.7±0.7)×10¹²/L, (4.6±0.6)×10¹²/L and (4.3±0.5)×10¹²/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the preoperative and postoperative groups were statistically significant (P<0.05). There were 7 cases of thrombocytopenia before operation, with an average of (70.0±17.0)×10⁹/L, and (191.0±129.0)×10⁹/L, (156.0±79.0)×10⁹/L and (167.0±63.0)×10⁹/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the first, third, and sixth months after surgery were significant compared with that before surgery (P<0.05). Leukocyte count decreased in 5 cases with an average value of (3.30±0.56)×10⁹/L before surgery, (7.5±4.4)×10⁹/L, (7.4±1.4)×10⁹/L, (5.1± 2.5)×10⁹/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the two groups were significant (P<0.05). The average value of preoperative spleen length times thickness was (35.7±12.9) cm² and at the 1st, 3rd, 6th month after surgery it was (26.2±8.1)cm², (25.2±13.4)cm², (27.2±7.4)cm², respectively. The differences between the first, third months after surgery were significant compared with that before surgery (P<0.05). The white blood cell and platelet counts of children before and after surgery were correlated with spleen size negatively (correlation coefficients were -0.902, -0.933, respectively), and the differences were statistically significant (P<0.05). Conclusions In the early stage of liver transplantation, the size of spleen retracts to varying degrees, and hypersplenism can be alleviated continuously. Therefore, it is unnecessary to treat splenomegaly and hypersplenism before and during liver transplantation.

This article was aimed to study the chemical constituents of Dioscorea opposita Thunb.The chemical constituents were isolated and purified by Diaion HP-20,Toyopearl HW-40,Sephadex LH-20,MCI Gel CHP-20,silica gel column chromatography and preparative HPLC,TLC,purification and isolation from Dioscorea opposita Thunb.The structures of isolated compounds were identified by thc physicochemical properties and spectral analysis.The result showed that 14 compounds were isolated from Dioscorea opposita Thunb.The chemical structures were elucidated as L-Tryptophane (1),Seguinosides F (2),1-methoxycarbonyl-β-carboline (3),Helichrysin A (4),Bungein A (5),Hydroquinone (6),Zarzissine (7),Cyclo-(Pro-Thr) (8),4-Hydroxy-3-methoxybenzyl alcohol (9),pyridine-3-carboxamide (10),Arbutin (11),Methyl syringate 4-O-β-D-glucopyranoside (12),L-Phenylalanine (13),1,2-benzenedicarboxylic acid,1,2-bis[2-(2-hydroxyethoxy) ethyl] ester (14).It was concluded that chemical compounds 1-14 were isolated for the first time from Dioscorea opposita Thunb.

Objective To investigate the status of community nurses' turnover intention and job benefits, and analyze the influences of career benefits on turnover intention.Methods A total of 565 community nurses in 28 community health service centers of Shenyang were investigated by the turnover intention scale and the nurses' occupational benefit scale.Results Community nurses occupation benefit sense score was (45.18±5.16) points, and the turnover intention score was (11.73±2.73). The Pearson correlation analysis showed that the community nurses' turnover intention and the gain of occupation sense was negatively correlated (r=-0.524,P<0.01), and hierarchical regression analysis showed that after the control of demographic data, the three dimensions of occupation benefit community nurses senses (occupation protection, affordable occupation, occupation value) could independently explain the turnover intention of 20.8% of the variance (△R2 =0.208).Conclusions The occupation benefit sense is an important factor influencing the turnover intention of community nurses, which can reduce the turnover intention by improving the occupation benefit, so as to ensure the stability and development of community nursing team.