Objective To study the correlation between Periostin, interleukin-33 (IL-33), and chronic cough after thoracoscopic lobectomy in patients with coronary artery bypass grafting (CABG) combined with lung cancer. Methods A total of 102 lung cancer and coronary heart disease patients at Tianjin Chest Hospital from January 2022 to January 2024 were prospectively enrolled, and they were divided into a chronic cough group (n=42) and a non-chronic cough group (n=60) based on whether chronic cough occurred after surgery. Serum levels of Periostin and IL-33 were measured on the 1st, 7th, and 14th days post-lobectomy. The Pearson method was employed to analyze the correlation between Periostin and IL-33 levels and the severity of cough. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the occurrence of chronic cough. Additionally, receiver operating characteristic (ROC) curve analysis was utilized to assess the potential value of serum Periostin and IL-33 levels in predicting postoperative chronic cough. Results In patients with chronic cough, the peripheral blood Periostin and IL-33 levels measured on days 7 and 14 were significantly higher than those in patients with non-chronic cough, and the interactions between the two groups and at different time points were significant (P<0.001). The degree of cough was positively correlated with the levels of Periostin and IL-33 on days 7 and 14 (P<0.05), but had no significant correlation with the levels on day 1 (P>0.05). In patients with lung cancer, after thoracoscopic lobectomy, Periostin [OR=1.619, 95%CI (1.295, 2.025)] and IL-33 [OR=1.831, 95%CI (1.216, 2.758)] on day 7 and Periostin [OR=1.952, 95%CI (1.306, 2.918)] and IL-33 [OR=1.742, 95%CI (1.166, 2.603)] on day 14 were identified as risk factors for chronic cough. ROC curve analysis showed that the sensitivity of Periostin on day 7 was 69.05%, the specificity was 71.67%, and the area under the curve (AUC) was 0.756 [95%CI (0.616, 0.893)]. The sensitivity of Periostin on day 14 increased to 71.43% and the specificity was 76.67%, AUC was 0.762 [95%CI (0.633, 0.898)]. At the same time, the critical value of IL-33 on day 7 was 45.03 pg/mL, the sensitivity and specificity were both 83.33%, the AUC was 0.884 [95%CI (0.789, 0.980)], and the critical value of IL-33 on day 14 was 56.01 pg/mL, the sensitivity was 85.71%, the specificity was 80.00%, and the AUC was 0.899 [95%CI (0.799, 0.999)]. Joint logistic regression analysis of Periostin and IL-33 levels on days 7 and 14 showed showed that the sensitivity was 95.24%, the specificity was 95.00%, and the AUC reached 0.993 [95%CI (0.979, 1.000)]. Conclusion Periostin and IL-33 levels, measured at various time points, are abnormally elevated following thoracoscopic lobectomy in patients with combined CABG and lung cancer. These levels significantly correlate with cough severity. Given their predictive potential for chronic cough, these markers are deemed valuable biomarkers.

Objective To investigate the risk factors for lymph node metastasis in cT1N0M0 stage lung squamous cell carcinoma and develop a logistic regression model to predict lymph node metastasis. Methods A retrospective study was conducted on patients with cT1N0M0 stage lung squamous cell carcinoma treated in the Department of Thoracic Surgery, Tongji Hospital, Huazhong University of Science and Technology from August 2017 to October 2022. The correlation between basic clinical data, imaging data, and pathological data and lymph node metastasis was analyzed. Univariate and multivariate logistic regression analyses were employed for risk factor analysis. Receiver operating characteristic curves and the Hosmer-Lemeshow test were utilized to evaluate the model’s discrimination and calibration. The Bootstrap method with 1 000 resamples was employed for internal validation of the model. Results A total of 192 patients were included, among whom 175 were male and 17 were female. Central tumors, poorly differentiated tumors, cytokeratin 19 fragment (CYFRA21-1) levels, and tumor size were independent risk factors for lymph node metastasis in cT1N0M0 stage lung squamous cell carcinoma. The optimal cutoff values for tumor size and CYFRA21-1 levels were determined to be 2.05 cm and 4.20 ng/mL, respectively. A predictive model incorporating tumor location, CYFRA 21-1 levels, and tumor size demonstrated superior predictive performance compared to models based on any single factor alone. Conclusion Tumor location of central-type, poorly differentiated tumors, CYFRA21-1 levels, and tumor size are risk factors for lymph node metastasis in cT1N0M0 stage lung squamous cell carcinoma. The combined predictive model has certain guiding significance for intraoperative lymph node resection strategies in cT1N0M0 stage lung squamous cell carcinoma.

IgG4-related disease (IgG4-RD) is a chronic, immune-mediated inflammatory and fibrotic condition that can affect virtually any organ system. While some patients experience involvement of only a single organ, isolated IgG4-RD of the mediastinum is even rarer. This article reports a case of a 48-year-old male patient with isolated IgG4-RD of the middle mediastinum. After a biopsy failed to establish a definitive diagnosis, the patient underwent a right thoracotomy-assisted mediastinal tumor resection via video-assisted thoracoscopic surgery. The tumor was completely resected during the procedure, which lasted 130 minutes, with an estimated blood loss of approximately 50 mL. The patient had a favorable postoperative course and satisfactory clinical outcome. No glucocorticoid or other medical treatment was administered postoperatively, and there was no recurrence during a 6-month follow-up period.

Here, we report a previously unrecognized syndromic neurodevelopmental disorder associated with biallelic loss-of-function variants in the RBM42 gene. The patient is a 2-year-old female with severe central nervous system (CNS) abnormalities, hypotonia, hearing loss, congenital heart defects, and dysmorphic facial features. Familial whole-exome sequencing (WES) reveals that the patient has two compound heterozygous variants, c.304C>T (p.R102*) and c.1312G>A (p.A438T), in the RBM42 gene which encodes an integral component of splicing complex in the RNA-binding motif protein family. The p.A438T variant is in the RRM domain which impairs RBM42 protein stability in vivo. Additionally, p.A438T disrupts the interaction of RBM42 with hnRNP K, which is the causative gene for Au-Kline syndrome with overlapping disease characteristics seen in the index patient. The human R102* or A438T mutant protein failed to fully rescue the growth defects of RBM42 ortholog knockout ΔFgRbp1 in Fusarium while it was rescued by the wild-type (WT) human RBM42. A mouse model carrying Rbm42 compound heterozygous variants, c.280C>T (p.Q94*) and c.1306_1308delinsACA (p.A436T), demonstrated gross fetal developmental defects and most of the double mutant animals died by E13.5. RNA-seq data confirmed that Rbm42 was involved in neurological and myocardial functions with an essential role in alternative splicing (AS). Overall, we present clinical, genetic, and functional data to demonstrate that defects in RBM42 constitute the underlying etiology of a new neurodevelopmental disease which links the dysregulation of global AS to abnormal embryonic development.
Female ; Animals ; Mice ; Humans ; Child, Preschool ; Intellectual Disability/genetics* ; Heart Defects, Congenital/genetics* ; Facies ; Cleft Palate ; Muscle Hypotonia

Objective To investigate the correlation between the imaging manifestations and pathological classification of congeni-tal cystic adenomatoid malformation of the lung(CCAM).Methods A retrospective analysis was conducted on the clinical and radiologic data of nine patients with pathologically confirmed CCAM,and all data were compared with Stocker pathological classification,respec-tively.Results The CT images of all nine patients demonstrated cysts filled with either gas or fluid,which corresponded exactly with their gross pathological outcomes.Four cases of large cystic CCAM(cyst diameter exceeding 2 cm)were consistent with Stocker type Ⅰ.CT findings showed single or multiple capsular cavities occupying the thoracic cavity,with gas or fluid mainly in the cyst.Two cases exhibited mass effect and expansion of the involved lung lobes,while two cases showed localized decreased density around the lesion.The pathological features of these large cystic CCAM included single or multiple thick-walled cysts,with pseudostratified ciliated colum-nar epithelium lining the cyst lumen observed under microscopy.The other five cases of small cystic CCAM(cyst diameter less than 2 cm)matched Stocker type Ⅱ.CT findings showed multiple thin-walled cellular cysts confined to a single lung lobe,and none of these patients had significant mass effect or expansion of the involved lung lobes.Pathologically,these cases were characterized by multiple small cysts with septa,and the cysts were primarily lined with ciliated columnar or cuboidal epithelium upon microscopy.Conclusion CT imaging of CCAM has specific manifestations,with accurately displaying the distribution range and morphological characteristics of the lesions and reflecting the internal histological characteristics.There is a significant correlation between the CT manifestations of CCAM and their pathological classification.

Objective:To analyze the application value of multimodal imaging technology in the staging of cervical cancer and evaluation of pathological differentiation.Methods:A cross-sectional study was conducted to retrospectively analyze the clinical data of 83 patients with cervical cancer who received treatment at Xian Yang Central Hospital from February 2022 to September 2023. All patients underwent pelvic magnetic resonance imaging (MRI), including diffusion-weighted imaging (MRI-DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). A double-blind method was used to compare the DWI parameters [apparent diffusion coefficient (ADC), slow diffusion coefficient (D), and fast diffusion coefficient (D*)] and DCE parameters [volume transfer constant (K trans), rate constant (K ep), and extracellular volume fraction (V e)] among patients with different clinical stages and histological grades. The application value of multimodal MRI in the staging of cervical cancer and evaluation of pathological differentiation was analyzed. Results:The ADC values in patients with cervical cancer at stage Ⅰb and below were significantly higher than those in patients with cervical cancer at stages Ⅱa, Ⅱb, and Ⅲ and above ( F = 7.90, P < 0.01). Conversely, the K trans, K ep, and V e values were all lower in patients with cervical cancer at stage Ⅰb and below than those in patients with cervical cancer at stages Ⅱa, Ⅱb, and Ⅲ and above ( F = 8.12, 7.64, 3.13, all P < 0.01). For patients with cervical cancer at stage Ⅱa, the ADC value was (0.84 ± 0.15), which was higher than that of patients with cervical cancer at stage Ⅲ and above (0.76 ± 0.07) ( t = 1.88, P = 0.035). The K trans, K ep, and D* values were (0.29 ± 0.09), (0.53 ± 0.13), and (39.08 ± 7.30), respectively, all of which were lower than those in patients with cervical cancer at stage III and above [(0.39 ± 0.12), (0.69 ± 0.18), (49.04 ± 6.72), t = -2.64, -2.85, -3.94, all P < 0.01]. The ADC values in G1 grade patients were higher than those in G2 and G3 grade patients ( F = 4.26, P < 0.05), while the K trans, K ep, and D* values were all lower than those in G2 and G3 grade patients ( F = 8.14, 6.83, 6.81, all P < 0.05). Pearson correlation analysis showed that the histological grade of patients with cervical cancer was negatively correlated with the ADC value ( r = -0.32, P = 0.003) and positively correlated with the K trans, K ep, and D* values ( r = 0.43, 0.35, 0.28, all P < 0.05). Conclusion:Multimodal imaging technology has good application value in evaluating the clinical staging and pathological differentiation of cervical cancer, making them worthy of clinical reference and application.

Objective:To analyze the application value of multimodal imaging technology in the staging of cervical cancer and evaluation of pathological differentiation.Methods:A cross-sectional study was conducted to retrospectively analyze the clinical data of 83 patients with cervical cancer who received treatment at Xian Yang Central Hospital from February 2022 to September 2023. All patients underwent pelvic magnetic resonance imaging (MRI), including diffusion-weighted imaging (MRI-DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). A double-blind method was used to compare the DWI parameters [apparent diffusion coefficient (ADC), slow diffusion coefficient (D), and fast diffusion coefficient (D*)] and DCE parameters [volume transfer constant (K trans), rate constant (K ep), and extracellular volume fraction (V e)] among patients with different clinical stages and histological grades. The application value of multimodal MRI in the staging of cervical cancer and evaluation of pathological differentiation was analyzed. Results:The ADC values in patients with cervical cancer at stage Ⅰb and below were significantly higher than those in patients with cervical cancer at stages Ⅱa, Ⅱb, and Ⅲ and above ( F = 7.90, P < 0.01). Conversely, the K trans, K ep, and V e values were all lower in patients with cervical cancer at stage Ⅰb and below than those in patients with cervical cancer at stages Ⅱa, Ⅱb, and Ⅲ and above ( F = 8.12, 7.64, 3.13, all P < 0.01). For patients with cervical cancer at stage Ⅱa, the ADC value was (0.84 ± 0.15), which was higher than that of patients with cervical cancer at stage Ⅲ and above (0.76 ± 0.07) ( t = 1.88, P = 0.035). The K trans, K ep, and D* values were (0.29 ± 0.09), (0.53 ± 0.13), and (39.08 ± 7.30), respectively, all of which were lower than those in patients with cervical cancer at stage III and above [(0.39 ± 0.12), (0.69 ± 0.18), (49.04 ± 6.72), t = -2.64, -2.85, -3.94, all P < 0.01]. The ADC values in G1 grade patients were higher than those in G2 and G3 grade patients ( F = 4.26, P < 0.05), while the K trans, K ep, and D* values were all lower than those in G2 and G3 grade patients ( F = 8.14, 6.83, 6.81, all P < 0.05). Pearson correlation analysis showed that the histological grade of patients with cervical cancer was negatively correlated with the ADC value ( r = -0.32, P = 0.003) and positively correlated with the K trans, K ep, and D* values ( r = 0.43, 0.35, 0.28, all P < 0.05). Conclusion:Multimodal imaging technology has good application value in evaluating the clinical staging and pathological differentiation of cervical cancer, making them worthy of clinical reference and application.

On May 14, 2020, a 37 year old female patient with unilateral breast cancer was admitted to Hunan Cancer Hospital. She underwent modified radical mastectomy for right breast cancer and free transplantation of bilateral superficial inferior epigastric artery perforator flap (weighed 305 g) for breast reconstruction. During the operation, the right inferior epigastric vascular pedicle was anastomosed with the proximal end of the right internal mammary vessel, and the left inferior epigastric vascular pedicle was anastomosed with the distal end of the right internal mammary vessel; the blood flow of the flap was good; the wound in the donor site of the abdominal flap was closed directly. The operation lasted for 9 hours. In the first 48 hours post operation, the flap showed mild elevation in perfusion over drainage, but no obvious edema or blister was observed, flap temperature was consistent with the surrounding skin, and the drainage volume out of drainage tube was only 40 mL. The blood supply of the flap was completely restored to normal 3 days post operation, the flap survived well, the donor site incision had no obvious tension, and the healing was smooth. After 2 months of follow-up, the donor site incision of abdomen healed completely, only linear scar was left, and the reconstructed breast had a natural appearance; the patient planned to perform further nipple reconstruction and contralateral breast mastopexy. This case suggests that autologous breast reconstruction can be performed using bilateral superficial inferior epigastric artery perforator flaps under certain circumstances to minimize donor site injury to the greatest extent.
Female ; Humans ; Adult ; Epigastric Arteries/surgery* ; Perforator Flap/blood supply* ; Breast Neoplasms/surgery* ; Mastectomy ; Unilateral Breast Neoplasms/surgery* ; Mammaplasty

Background: Post - stroke constipation is a commonly seen complication, which can reduce the quality of life of patients. Therefore, it is particularly important to explore the treatment of post-stroke constipation. Aims: To explore the effect of gastrointestinal rehabilitation (visceral fascial manipulation plus middle - frequency electrical stimulation) on quality of life, substance P (SP) and 5-hydroxytryptamine (5-HT) in constipation patients after stroke. Methods: Seventy constipation patients after stroke from Oct. 2020 to Oct. 2011 at Shanghai Tongren Hospital were enrolled and randomly divided into control group (lactulose treatment) and treatment group (gastrointestinal rehabilitation treatment). Montreal cognitive assessment (MoCA), Barthel index (BI), self-rating anxiety/depression scale (SAS/SDS), gastrointestinal symptom rating scale (GSRS), Wexner constipation scale, and patient assessment of constipation-quality of life (PAC-QOL) were performed before and after treatment. Serum SP, 5 - HT were determined by ELISA. Results: After the treatment, no significant difference in MoCA score was found in both two groups, and SAS score, SDS score, GSRS score, Wexner score and PAC-QOL score were significantly decreased (P<0.05). Repeated measures ANOVA showed that significant differences in SAS score, SDS score were found between the two groups (P<0.05), and the decreases of SAS score and SDS score were more obvious in treatment group. No significant differences in MoCA score, BI score, GSRS score, Wexner score and PAC- QOL score were found between the two groups (P>0.05). Serum SP, 5-HT levels in treatment group were significantly higher than those in control group (P<0.05). Conclusions: In the treatment of constipation after stroke, the gastrointestinal rehabilitation therapy of‘visceral fascial manipulation plus middle-frequency electrical stimulation’has the therapeutic effects equivalent to drug therapy, and is worthy for promoting in clinical treatment.