Inducing the degradation of KRAS represents a novel strategy to combat cancers with KRAS mutation. In this study, we identify ubiquitin-specific protease 2 (USP2) as a novel deubiquitinating enzyme of KRAS in multiple myeloma (MM). Specifically, we demonstrate that gambogic acid (GA) forms a covalent bond with the cysteine 284 residue of USP2 through an allosteric pocket, inhibiting its deubiquitinating activity. Inactivation or knockdown of USP2 leads to the degradation of KRAS, resulting in the suppression of MM cell proliferation in vitro and in vivo. Conversely, overexpressing USP2 stabilizes KRAS and partially abrogates GA-induced apoptosis in MM cells. Furthermore, elevated USP2 levels may be associated with poorer prognoses in MM patients. These findings highlight the potential of the USP2/KRAS axis as a therapeutic target in MM, suggesting that strategically inducing KRAS degradation via USP2 inhibition could be a promising approach for treating cancers with KRAS mutations.

Objective     To identify the risk factors for postoperative recurrence of peripheral solid small-nodule lung cancer (PSSNLC) (T≤2 cm), and to explore the effects of surgery types on prognosis. Methods     We extracted data from Western China Lung Cancer Database (WCLCD), a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University, and Surveillance, Epidemiology, and End Results (SEER)  database for peripheral solid small-nodule lung cancer patients (T≤2 cm N0M0, stageⅠ) who underwent surgery between 2005 and 2016. We used univariable and multivariable logistic regression to analyze risk factors for recurrence of PSSNLC. We applied propensity-score matching to compare the long-term results of segmentectomy and lobectomy, as well as the survival of patients from WCLCD and SEER. We finally included 4 800 patients with PSSNLC (T≤2 cm N0M0)(WCLCD: SEER=354∶4 446). We matched 103 segmentectomies and 350 lobectomies in T≤1 cm, and 280 segmentectomies and 1 067 lobectomies in 1 cm

Objective     To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy. Methods     Data were extracted from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University. Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching. Altogether 5 817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy (uniportal: 530 patients; three-port: 5 287 patients). After matching, 529 patients of uniportal and 1 583 patients of three-port were included. There were 529 patients with 320 males and 209 females at median age of 58 (51, 65) years in the uniportal group and 1 583 patients with 915 males and 668 females at median age of 58 (51, 65) years in the three-port group. Results     Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss (20 mL vs. 30 mL, P<0.001), longer operative time (115 min vs. 105 min, P<0.001) than three-port thoracoscopic lobectomy. No significant difference was found between the two groups regarding the number of lymph node dissected, rate of conversion to thoracotomy, incidence of postoperative complication, postoperative pain score within 3 postoperative days, length of hospital stay, or hospitalization expenses. Conclusion     Uniportal video-assisted thoracoscopic lobectomy is safe and effective, and the overall perioperative outcomes are comparable between uniportal and three-port strategies, although the two groups show differences in intraoperative blood loss.

Objective:To investigate the efficacy of Bailing capsule combined with conventional western medicine on diabetic nephropathy patientswith maintenance peritoneal dialysis. Methods:Eighty-six type 2 diabetic nephropathy patients receiving peritoneal dialysis in our hospital from February of 2016 to February of 2019 were selected and were divided into control group and observation group according to the random number table method with 43 cases in each group. All patients received continuous ambulatory peritoneal dialysis. Patients in the control group received routine treatment. In the observation group, patients took Bailing capsules based on the treatment of the control group. The two groups were treated continuously for 3 months. Insulin resistance (IR), fasting blood glucose (FPG), fasting insulin (FINS), renal function, and serum levels of microinflammatory factors high sensitivity c-reactive protein (hs-CRP), interleukin (IL)-6, IL-17, and tumor necrosis factor (TNF)-α were compared in the two groups. Results:After the treatment, FPG, FINS, HOMA-IR, blood creatinine, urea nitrogen, and 24 h urinary protein in the observation group were significantly less than those of the control group ( t value were 5.204, 8.227, 14.070, 5.022, 5.900, 5.246, respectively, all Ps<0.01). After thetreatment, serum levels of hs-CRP, IL-6, IL-17, TNF-α in the observation group were significantly lower than those of the control group ( t value were 12.871, 7.021, 7.733, 8.165, respectively, all Ps<0.01). Conclusions:Bailing capsule can effectively improve the insulin resistance and renal function of diabetic nephropathy patients during maintenance peritoneal dialysis and relieve the state of micro-inflammation.

Objective:To explore the current situation of emotion labor among emergency nurses and to analyze its influence on job engagement.Methods:From May to August 2018, this study selected 448 emergency nurses from 6 ClassⅢ general hospitals in Beijing as subjects by convenience sampling. All nurses were investigated with the General Information Scale, Emotional Labor Scale (ELS) and Utrecht Work Engagement Scale (UWES) . SPSS 22.0 was used to data entry and analysis. T test, variance analysis, Pearson correlation was used to single factor analysis, and multiple hierarchical regression was used to influencing factor analysis. Results:Among 448 emergency nurses, the total average scores of ELS and UWES were (3.94±0.75) and (3.43±0.69) respectively. There were statistical differences in the scores of UWES among emergency nurses with different genders and posts ( t=-2.048, -4.553; P<0.05) . Pearson correlation analysis showed that surface acting and expression of emotions in ELS had negative correlations with dimensions in UWES among nurses with statistical differences ( r=-0.108--0.330, P<0.05) ; deep acting in ELS had positive correlations with dimensions in UWES with statistical differences ( r=0.220-0.256, P<0.01) . Hierarchical regression analysis showed that deep acting positively predicted job engagement, and surface acting negatively predicted job engagement which explained 17.9% of the variance of job engagement. Conclusions:Emergency nurses of Class Ⅲ general hospitals have middle level of emotion labor and upper middle level of job engagement. Nursing managers should pay more attention to emotion labor of nurses and improve the job engagement by emotion labor so as to improve the nursing service quality.

Objective    To explore the safety and effectiveness of video-assisted thoracoscopic surgery (VATS) pneumonectomy for bronchiectasis. Methods    The clinical data of 164 patients undergoing VATS pneumonectomy or open thoracotomy for bronchiectasis in our hospital from March 2002 to July 2012 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods: a thoracotomy group (122 patients, 63 males, 59 females) and a thoracoscopic surgery group (42 patients, 15 males, 27 females). Surgical and follow-up indicators were compared between the two groups. Results    There was no difference between the two groups in the blood loss, operation time, perioperative mortality or complication. However patients undergoing VATS had shorter length of postoperative stay than those undergoing thoracotomy (6.9±2.6 d vs. 8.1±3.1 d, P=0.030). In the thoracoscopic surgery group, 3 patients were lost to follow-up and in the thoracotomy group, 5 patients were lost to follow-up. In a median follow-up of 51 months (ranging from 2 to 116 months), 36 patients (92.3%) fully recovered with no sputum or haemoptysis and 3 (7.7%) partially recovered with a reduced sputum or haemoptysis in the thoracoscopic surgery group; 105 (89.7%) fully recovered with no sputum or haemoptysis, 10 (8.5%) partially recovered with a reduced sputum or haemoptysis while 2 (1.7%) without any improvement in the thoracotomy group with no statistical difference (P=0.700). Conclusion    VATS pneumonectomy for bronchiectasis is equivalent to thoracotomy in terms of safety and effectiveness, and can be used as an alternative surgical procedure for the treatment of bronchiectasis.

OBJECTIVE： To optimize the formulation of Diosmin gel and to investigate its in vitro release property. METHODS： Diosmin gel were prepared by using Carbomer 940 as matrix. Using accumulative release rate as index， with the amount of Carbomer 940， ethanol， acetone and pH as factors， L9（34） orthogonal test was conducted. The formulation of Diosmin gel was optimized and validated. Using Diosmin ointment as reference， dialysis bag diffusion method was used to investigate in vitro release property of Diosmin gel prepared by optimal formulation. RESULTS： The optimal formulation of Diosmin gel included Carbomer 940 1.5 g， ethanol 15 mL， glycerol 8 g， pH 6. The gel prepared with optimal formulation was sticky brown-yellow semi solid， and had good coating and spreading properties. The average accumulative release rate （2 h） was （12.67±0.12）％. Results of drug release test showed that Diosmin gel released rapidly within 12 h， then gradually slowed down. The accumulative release rates were （71.93±0.42）％ （12 h） and （80.47±0.54）％ （24 h）， drug release of which were in line with Higuchi equation. Diosmin ointment was released slowly. The accumulative release rates were （41.74±0.18）％ （12 h） and （62.63±0.59）％ （24 h）. Drug release of it were in line with first-order equation. CONCLUSIONS： The formulation of Diosmin gel is optimized successfully. Prepared Diosmin gel has good drug release property.

Objective? To systematically analyze the incidence and influencing factors of post-extubation dysphagia (PED) among patients with mechanical ventilation. Methods? Observational studies on PED were systematically retrieved in PubMed, CIHNAL, Cochrane Library, WanFang data, China National Knowledge Infrastructure (CNKI) and VIP. We screened literatures, extracted data and evaluated the literature quality. The Stata14.0 was used to meta-analysis. Results? A total of 1 356 literatures were retrieved and 8 of them were included, 5 literatures on cohort study and 3 on cross-sectional study. Totals of 2 384 research objects were included and 553 of them were with PED. Meta-analysis showed that the incidence of PED was 36% (95% CI: 23%-50%), the rates of PED patients with intubation time ≥48 h and ＜48 h were 46% (95%CI: 40%-53%) and 6% (95%CI: 5%-7%) respectively. The independent influencing factors of PED were the intubation time and ages. Subgroup analysis revealed that the ages(OR=2.18,95%CI:1.42～3.34) was the influencing factor among patients with intubation time ＜48 h, but intubation time could not be determined;the ages (OR=1.02, 95%CI: 1.00-1.05) and intubation time (OR=1.28, 95%CI: 1.08-1.52) were the influencing factors among patients with intubation time ≥48 h. Publication bias analysis showed that the included literatures were with no significant bias and with credible results. Conclusions? We should pay attention to problems existing in PED among patients with mechanical ventilation particularly in patients with intubation time ≥48 h and old ages, so as to promote early detection and early intervention of PED.