With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

ObjectiveTo investigate the effect of Gelian Tiaotang pills on renal fibrosis in db/db mice based on the nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 （NLRP3）/cysteinyl aspartate-specific proteinase （Caspase）-1/gasdermin D （GSDMD） signaling pathway. MethodsForty db/db mice were randomly assigned into model， positive control （0.001 3 g·kg·d^-1 dapagliflozin suspension）， and high-， medium-， and low-dose Gelian Tiaotang pills （3.12， 1.56， and 0.78 g·kg·d^-1 suspension of Gelian Tiaotang pills， respectively） groups， with 8 mice in each group. Eight db/m mice were selected as the normal group. The normal group and model group were given equal volumes of pure water， while the drug interventions groups were administrated with corresponding agents by gavage once a day for 12 consecutive weeks. The general conditions of mice were observed daily. The fasting blood glucose （FBG） and body mass were measured every 4 weeks. Kidneys were weighed after sampling， and the kidney index was calculated. An automatic biochemical analyzer was used to measure the serum levels of triglyceride （TG）， total cholesterol （TC）， serum creatinine （SCr）， and blood urea nitrogen （BUN）. The pathological changes， extracellular matrix deposition， and renal fibrosis degree were examined by hematoxylin-eosin， periodic acid-schiff （PAS）， and Masson staining， respectively. Enzyme-linked immunosorbent assay was employed to measure the levels of interleukin （IL）-1β and IL-18 in the renal tissue. Immunohistochemistry （IHC） was used to detect the localization and expression of fibronectin and collagen Ⅰ in the renal tissue. Western blot was employed to determine the protein levels of NLRP3， Caspase-1， cleaved Caspase-1， GSDMD， and GSDMD-N in the renal tissue. ResultsCompared with the normal group， the model group generally had poor general states and increases in the body mass， kidney weight， kidney index， and levels of FBG， TG， TC， SCr， and BUN （P<0.01）. In addition， glomerular pyknosis， increased matrix， vacuolar degeneration of renal tubular epithelial cells， and interstitial infiltration of inflammatory cells were observed in the model group （P<0.01）， together with rises in the levels of IL-1β and IL-18 in the renal tissue （P<0.01） and up-regulated protein levels of NLRP3， Caspase-1， cleaved Caspase-1， GSDMD， GSDMD-N， fibronectin， and collagen Ⅰ in the renal tissue （P<0.01）. Compared with the model group， 12 weeks of drug interventions reduced the body mass， kidney weight， and kidney index and lowered the levels of FBG， TG， TC， SCr， and BUN in the serum and IL-1β and IL-18 in the renal tissue （P<0.05， P<0.01）. Furthermore， drug interventions ameliorated the renal lesions and down-regulated the protein levels of NLRP3， Caspase-1， cleaved Caspase-1， GSDMD， GSDMD-N， fibronectin， and collagen Ⅰ in the renal tissue （P<0.05， P<0.01）. The high-dose group of Gelian Tiaotang pills had the best effects. ConclusionGelian Tiaotang pills may inhibit pyroptosis and reduce inflammatory responses by regulating the NLRP3/Caspase-1/GSDMD signaling pathway， thus delaying the process of renal fibrosis in diabetes.

Objective: To assess the nutritional supply status of school meals for primary and secondary school students in Henan Province, so as to provide a basis for scientific guidance of school meals. Methods: During 2021-2023, 115 lunch and dinner samples were collected from 25 primary and secondary schools in Zhoukou, Anyang and Luoyang of Henan Province by a direct selection method, and 13 nutrients were determined for each sample. The nutrient supply was evaluated based on Nutrition Guidelines of School Meals and Reference Intake of Dietary Nutrients for Chinese Residents (2023 Edition). Mann-Whitney U test was used to compare the differences of nutritional supply between urban and rural schools. Results: The median values for energy (709.77 kcal,1 kcal=4.18 kJ), fat energy supply ratio (0.27) and carbohydrate energy supply ratio (0.55) in the 66 lunches and dinners from primary school were within the recommended range. The supply of protein (28.39 g) and sodium (1 464.59 mg) was excessive. The median values of zinc (2.62 mg) and dietary fiber (5.19 g) were lower than the reference values. No statistically significant differences were observed in the supply of 13 nutrients between urban and rural primary schools( U = 427.00 -633.00, P > 0.05 ). Among 49 samples from secondary schools, the median value of energy supply (930.02 kcal), carbohydrate energy ratio ( 0.54 ) and fat energy supply ratio(0.25) were within the recommended range; and the median values of protein (38.82 g) and sodium (2 556.80 mg) were higher than the standard; and the median values of calcium (250.32 mg) and vitamin B1 (0.16 mg) were lower than the standard. Additionally, the differences in the level of vitamin B2 ( U =372.00) and zinc ( U =375.00) between the urban and rural secondary schools were statistically significant ( P <0.05). Conclusion Nutrient supply of primary and secondary school meals in three cities of Henan Province is inadequate and imbalanced, and the recipe need to be further optimized and improved.

AIM: To explore the relationship between hyperopia reserve and ocular biometric parameters in 4-14 year-old Uyghur students from Hotan County, Xinjiang, and to provide scientific evidence for myopia prevention.METHODS: From September 1 to October 31, 2023, a stratified random cluster sampling method was used to select 3 264 students(3 264 eyes)from 6 schools in Hotan County. Participants underwent uncorrected distance visual acuity testing, cycloplegic refraction, and ocular biometric measurements. The correlation between spherical equivalent(SE)and ocular biometric parameters was analyzed by multiple linear regression.RESULTS: A total of 1 998 non-myopic students(1 998 eyes)were included in the study, with 1 354 students(67.77%)showing insufficient hyperopia reserve. The detection rate of insufficient hyperopia reserve decreased with age, from 94.12% at age 4 to 18.13% at age 14(P<0.001). Multiple linear regression analysis showed that in the group with sufficient hyperopia reserve, age, gender, uncorrected distance visual acuity, axial length(AL), and keratometry(K)explained 66.5% of the variance in SE; while in the group with insufficient hyperopia reserve, these factors explained only 28.0% of the SE variance.CONCLUSION: In non-myopic Uyghur students aged 4-14 in Hotan County, Xinjiang, the detection rate of insufficient hyperopia reserve was 67.77%. In the group with insufficient hyperopia reserve, age, gender, AL, and K explained only a small portion of the SE variance, suggesting that the refractive status of this population may be influenced by more complex factors.

Objective:To explore the practical effects of achieving transformative learning in students based on the "case-based+problem-oriented" teaching method for the course of "orthopedic rehabilitation".Methods:A "case-based+problem-oriented" method was introduced in clinical courses for students in the rehabilitation therapy program at Tianjin Medical University. The students in the class were randomly divided into the "case-based+problem-oriented" teaching group (56 students) and the traditional teaching group (57 students). This study compared students' exam scores for different types of theoretical questions at the end of the semester. A self-filled anonymous questionnaire survey was conducted to evaluate the effectiveness of transformative learning, including the understanding of rehabilitation theory, learning interest, doctor-patient communication ability, disease analysis and judgment ability, and rehabilitation practice ability. SPSS 20.0 was used for t test and χ2 text. Results:The "case-based+problem-oriented" teaching group achieved significantly higher scores in various types of questions and total scores compared with the traditional teaching group [(85.67±4.78) vs. (72.98±6.49), t=8.78, P=0.004)]. Students in the "case-based+problem-oriented" teaching group showed higher interest in transformative learning and a considerably increased awareness of knowledge acquisition and innovative transformation. Students in the "case-based+problem-oriented" teaching group demonstrated higher abilities in theoretical learning, communication, disease exploration, and analytical judgment in this major and course. Conclusions:The "case-based+problem-oriented" clinical transformative teaching method integrates the theoretical teaching, clinical thinking, and medical training, promotes the students' enthusiasm for learning, and improves their proactive learning of knowledge and ability to transform and innovate.

Objectives:Comparing with traditional open-door laminoplasty,to explore the clinical effects of three modified channal-assisted laminoplasty for the treatment of cervical degenerative diseases.Methods:The data of 122 patients who underwent open-door laminoplasty from October 2020 to October 2022 were retro-spectively analyzed.27 patients who underwent bilateral channel-assisted laminoplasty were defined as BCA group;31 patients who underwent unilateral inter-muscular approach and unilateral channel-assisted lamino-plasty were defined as IM-UCA group;34 patients who underwent unilateral exposure and unilateral channel-assisted laminoplasty were defined as UCA group;30 patients underwent traditional open-door laminoplasty were defined as LP group.There were no significant differences in age,sex,body mass index(BMI)and diag-nosis between the 4 groups(P＞0.05).Surgical parameters such as the operative time,blood loss,postoperative drainage volume,and average length of stay were compared.Clinical parameters such as visual analogue scale(VAS)score of neck pain,neck disability index(NDI),Japanese Orthopaedic Association(JOA)score were all recorded and compared.There was no statistical difference between the 4 groups in preoperative VAS,NDI,and JOA score(P＞0.05).The C2-C7 Cobb angle,T1 slope,C2-C7 sagittal vertical axis(C2-C7 SVA)were measurement on lateral cervical X-rays and bone canal area on CT cross-section before surgery,immediately after surgery,2 months and 12 months after surgery,and at final follow-up.The differences in the above pa-rameters between the three surgical methods were compared.Result:All the patients underwent the operation successfully.The LP group and UCA group weren't statistically different in the operative time(P＞0.05),while the IM-UCA group was longer,and the BCA group was the longest(P＜0.05).The BCA group had the least intraoperative blood loss and postoperative drainage,followed by the IM-UCA group and the UCA group(no difference between the two groups,P＞0.05),and the LP group had the most blood loss and drainage.There was no statistically significant difference in the average length of hospital stay among the 4 groups(P＞0.05).The postoperative scores of NDI and JOA in the 4 groups were significantly improved compared with those before operation(P＜0.05).There was no statistically significant difference in NDI and JOA scores among the 4 groups immediately after surgery,2 months after surgery,12 months after surgery,and at final follow-up(P＞0.05).In the LP group,there were significant differences in the neck pain VAS scores immediately after surgery,12 months after surgery,and at final follow-up compared with before surgery.There was no differ-ence in the neck pain VAS scores 2 months after surgery compared with before surgery(P＞0.05).In the UCA group,BCA group,and IM-UCA group,the neck pain VAS scores of immediate postoperation were similar with the values before surgery(P＞0.05).The neck pain VAS scores in the 3 groups at 2 months after surgery,12 months after surgery and final follow-up were significantly different from those before surgery(P＜0.05).The C2-C7 Cobb angle in the LP group at 12 months after surgery and final follow-up showed significant differ-ences compared with those before surgery(P＜0.05).There was no difference in C2-C7 Cobb angle among the 4 groups before surgery,immediately after surgery,or 2 months after surgery(P＞0.05).There were significant differences in C2-C7 Cobb angle among the 4 groups at 12 months after surgery and final follow-up(P＜0.05).In the 4 groups,compared with before surgery,there was no difference in T1 slope and C2-7 SVA levels immediately after surgery,2 months after surgery,12 months after surgery,and final follow-up(P＞0.05).There was no difference in C2-C7 Cobb angle between the 4 groups immediately after surgery,2 months after surgery,12 months after surgery,and at final follow-up(P＞0.05).In the 4 groups,there was no difference in the increased cross-sectional area of spinal canal immediately after surgery,2 months after surgery,12 months after surgery,and final follow-up(P＞0.05).There was no difference in the increased cross-sectional area of spinal canal among the 4 groups before surgery,immediately after surgery,2 months after surgery,12 months after surgery,and final follow-up(P＞0.05).Conclusions:Compared with the LP group,the UCA group significantly reduced surgical trauma;Compared with the IM-UCA group and BCA group,the UCA group sig-nificantly reduced operative time,and the therapeutic effect of UCA laminoplasty was satisfactory.

Objective:To investigate the safety and efficacy of laparoscopic simultaneous bilateral adrenalectomy in treating ectopic ACTH syndrome (ACTH)caused by medullary thyroid carcinoma(MTC).Methods:A 56-year-old male patient was admitted after MTC surgery and 7 months of general fatigue. The patient had a history of two open thyroid surgeries for medullary thyroid carcinoma, with previous pathological reports indicating lymph node metastasis in the upper mediastinum and mediastinum, accompanied by weak cytoplasmic expression of ACTH and negative CRH staining. After the operation, the patient developed diabetes, hypertension, and hypokalemia. Upon admission, the patient presented with a blood pressure reading of 200/95 mmHg (1 mmHg = 0.133 kPa), a weight of 61.5 kg, a height of 160 cm, a body mass index (BMI)of 24.02 kg/cm 2, and a waist circumference of 83 cm. Laboratory tests revealed the following: blood potassium level of 2.71 mmol/L, blood calcium level of 1.47 mmol/L, parathyroid hormone level of 6.0 pg/ml, fasting blood glucose level of 10.51 mmol/L, glycated hemoglobin level of 8.2%, blood calcitonin level exceeding 2 000 pg/ml, and blood CEA level of 70.8 μg/L. The plasma ACTH levels at 8∶00, 16∶00, and 24∶00 were 189.0, 125.0, and 65.0 pg/ml, respectively. Serum cortisol levels at 08∶00, 16∶00, and 24∶00 were 429.30, 408.14, and 446.61 μg/L, respectively. The 24-hour urine free cortisol measurement was 1 200 μg, and after the midnight 1mg dexamethasone suppression test at 8∶00, the plasma ACTH level was 183.0 pg/ml, and the serum cortisol level was 538.27 μg/L. The aldosterone level in standing position after 2 hours was 8.2 pg/ml. There were no significant abnormality in catecholamine hormone detection or thyroid function in blood and urine samples. An 18F-FDG-PET/CT examination showed multiple lymph node metastases in the neck, while an abdominal CT scan revealed bilateral adrenal hyperplasia. Enhanced MRI revealed pituitary gland thinning, and lung CT and sputum culture examinations showed scattered multiple lung infections. After a multidisciplinary discussion, the patient was diagnosed with EAS, postoperative MTC metastasis, diabetes, hypertension, hypokalemia, pulmonary infection, mild anemia, liver dysfunction, hypoparathyroidism, and hypocalcemia. The patient were accepted laparoscopic bilateral adrenalectomy via an abdominal approach under general anesthesia. The left adrenal gland was removed first, followed by the right adrenal gland after repositioning. Results:The surgery was successful with a surgical duration of approximately 60 minutes and an intraoperative bleeding volume of about 20 ml. No surgical complications occurred during the perioperative period. Pathological examination confirmed nodular hyperplasia of the adrenal cortex and bilateral adrenal medullary hyperplasia with negative ACTH staining. After a 3-month postoperative follow-up, blood calcitonin levels remained above 2000 pg/ml. The blood ACTH levels at 1 week, 1 month, and 3 months after surgery were 183.0, 220.0, and 731.0 pg/ml, respectively. However, hypertension, diabetes, and hypokalemia rapidly improved. One month after surgery, blood pressure was 100/80 mmHg, fasting blood glucose was 4.4 mmol/L, and blood potassium was 3.87 mmol/L. Pulmonary infection showed improvement, and no adrenal crisis occurred. Glucocorticoid replacement therapy consisted of 20 mg of hydrocortisone tablets in the morning and 10 mg in the afternoon, and thyroid hormone replacement therapy involved daily administration of 100 μg of levothyroxine. Genetic testing revealed heterozygous mutations in the Ret gene. The patient is currently undergoing clinical trial treatment with Ret inhibitors.Conclusions:Based on the data from this case and existing literature reports, laparoscopic simultaneous bilateral adrenalectomy might be safe and effective treatment option for EAS caused by unresectable MTC metastasis. It can correct hypertension, diabetes, and hypokalemia and increase the opportunity for MTC treatment.