Background and objective Cystic lung cancer,a special type of lung cancer,has been paid more and more attention.The most common pathological type of cystic lung cancer is adenocarcinoma.The invasiveness of cystic lung adenocarcinoma is vital for the selection of clinical treatment and prognosis.The aim of this study is to analyze the multiple clinical features of cystic lung adenocarcinoma,explore the independent risk factors of its invasiveness,and establish a risk pre-diction model.Methods A total of 129 cases of cystic lung adenocarcinoma admitted to the Department of Thoracic Surgery of the First Affiliated Hospital of Nanjing Medical University from January 2021 to July 2022 were retrospectively analyzed and divided into pre-invasive group[atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS)and minimally invasive adenocarcinoma(MIA)]and invasive group[invasive adenocarcinoma(IAC)]according to pathological findings.There were 47 cases in the pre-invasive group,including 19 males and 28 females,with an average age of(51.23±14.96)years.There were 82 cases in the invasive group,including 60 males and 22 females,with an average age of(61.27±11.74)years.Mul-tiple clinical features of the two groups were collected,including baseline data,imaging data and tumor markers.Univariate analysis,LASSO regression and multivariate Logistic regression analysis were used to screen out the independent risk factors of the invasiveness of cystic lung adenocarcinoma,and the risk prediction model was established.Results In univariate analysis,age,gender,smoking history,history of emphysema,neuron-specific enolase(NSE),number of cystic airspaces,lesion di-ameter,cystic cavity diameter,nodule diameter,solid components diameter,cyst wall nodule,smoothness of cyst wall,shape of cystic airspace,lobulation,short burr sign,pleural retraction,vascular penetration and bronchial penetration were statisti-cally different between the pre-invasive group and invasive groups(P<0.05).The above variables were processed by LASSO regression dimensionality reduction and screened as follows:age,gender,smoking history,NSE,number of cystic airspaces,lesion diameter,cystic cavity diameter,cyst wall nodule,smoothness of cyst wall and lobulation.Then the above variables were included in multivariate Logistic regression analysis.Cyst wall nodule(P=0.035)and lobulation(P=0.001)were found to be independent risk factors for the invasiveness of cystic lung adenocarcinoma(P<0.05).The prediction model was established as follows:P=e^x/(1+e^x),x=-7.927+1.476* cyst wall nodule+2.407* lobulation,and area under the curve(AUC)was 0.950.Conclusion Cyst wall nodule and lobulation are independent risk factors for the invasiveness of cystic lung adenocarcinoma,which have certain guiding significance for the prediction of the invasiveness of cystic lung adenocarcinoma.

Background::Copper and zinc are involved in the development of multiple malignancies; yet, epidemiological evidence on hepatocellular carcinoma (HCC) is limited. This study aimed to investigate the association between dietary intake and serum levels of copper and zinc with the risk of HCC.Methods::A total of 434 case-control pairs matched for sex and age (±1 year) were included in this study. Cases with newly diagnosed HCC were from the Guangdong Liver Cancer Cohort (GLCC) study, and healthy controls were from the Guangzhou Nutrition and Health Study (GNHS). A semi-quantitative 79-item food frequency questionnaire (FFQ) was used to assess habitual dietary intakes of copper and zinc. Serum levels of copper and zinc were measured by using inductively coupled plasma mass spectrometry. The copper (Cu)/ zinc (Zn) ratio was computed by dividing copper levels by zinc levels. Conditional logistic regression models were performed to calculate the odds ratio (OR) and 95% confidence intervals (CI) for per 1 standard deviation increase (per-SD increase) in copper and zinc levels.Results::Higher dietary intake (OR per-SD increase = 0.65, 95% CI: 0.44, 0.96, Ptrend = 0.029) and serum levels of zinc (OR per-SD increase = 0.11, 95% CI: 0.04, 0.30, Ptrend <0.001) were both associated with a lower risk of HCC. Subgroup analyses showed that the inverse association was only pronounced in men but not in women ( Pinteraction = 0.041 for dietary zinc intake and 0.010 for serum zinc levels). Serum copper levels (OR per-SD increase = 2.05, 95% CI: 1.39, 3.03, Ptrend = 0.020) and serum Cu/Zn ratio (OR per-SD increase = 6.53, 95% CI: 2.52, 16.92, Ptrend <0.001) were positively associated with HCC risk, while dietary copper intake and dietary Cu/Zn ratio were not associated with HCC risk. Conclusion::Zinc may be a protective factor for HCC, especially among men, but the effects of copper on HCC risk are not clear.

Objective:To carry out evidence-based nursing for postoperative exercise rehabilitation of patients with vertebral fractures, develop review indicators, analyze obstacles and facilitators in evidence-based nursing practice, and formulate reform strategies.Methods:Guided by the evidence-based nursing practice model of the Joanna Briggs Institute, this study incorporated evidence of postoperative exercise rehabilitation in patients with vertebral fractures and developed review items. Based on baseline review, the obstacles and facilitators in evidence-based nursing practice were analyzed, and reform strategies were formulated.Results:A total of 29 evidence items were included, and 16 review indicators were formulated. Only seven indicators had a compliance rate of 100%, two indicators had a compliance rate of 0, and the compliance rate of the remaining indicators was between 11% and 95%. The obstacles in evidence-based nursing practice came from three levels: system, practitioner, and patient. The facilitators included strong leadership and organizational abilities, close cooperation between medical and nursing teams, and so on. Corresponding change strategies were developed based on obstacles and facilitators.Conclusions:There is a certain gap between the evidence of exercise rehabilitation and evidence-based nursing practice in postoperative patients with vertebral fractures. We should make full use of facilitators to overcome obstacles and implement reform strategies.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To analyze the diagnostic value of sex hormone combined with carcinoembryonic antigen on lymph node metastasis in breast cancer patients.Methods:52 cases of breast cancer patients who underwent surgical resection were collected and divided into non-metastasis group and metastases group after axillary lymph node ultrasonography. The blood samples was collected from patients and the levels of serum estradiol, testosterone, progesterone and carcinoembryonic antigen were detected; The diagnostic value of the above indexes in patients with lymph node metastasis was analyzed; Logistic risk regression model was used to analyze the independent risk factors for lymph node metastasis after surgical resection.Results:There were significant differences between the non-metastatic group and the metastatic group in the largest tumor diameter and menopause (all P<0.05), but there were no significant differences among other general data (all P>0.05). The serum estradiol level in the non-metastatic group was (153.97±35.55) pg/ml, the progesterone level was (0.33±0.05) ng/ml, and the carcinoembryonic antigen level was (11.44±3.77) ng/ml, while the estradiol level in the metastatic group was (207.19±52.11) pg/ml ( t=4.13, P<0.001), progesterone level (0.38±0.04) ng/ml ( t=4.01, P<0.001), carcinoembryonic antigen level (15.41±3.46) ng/ml ( t=3.94, P<0.001). The above three indicators were significantly increased in patients in the transfer group. The area under the curve of estradiol was 0.83, the area under the curve of progesterone was 0.80, the area under the curve of carcinoembryonic antigen was 0.77, the area under the curve of the combination of the three was 0.85, and the area under the curve of the combination of the three was the largest. Logistic risk regression model showed that estradiol, progesterone, and carcinoembryonic antigen levels were independent risk factors affecting lymph node metastasis in breast cancer patients (all P<0.05) . Conclusion:The sex hormone estradiol, progesterone combined with carcinoembryonic antigen has a high diagnostic value for lymph node metastasis in patients with breast cancer, and can independently predict the occurrence of lymph node metastasis in breast cancer patients.

Objective:To investigate the expression of DNA damage repair factor DNA damage-binding protein 1 (DDB1) in hepatocellular carcinoma tissues, and the effect of DDB1 gene silencing on DNA repair and targeted killing in human hepatocellular carcinoma SMMC-7721 cells.Methods:The UALCAN platform was used to perform bioinformatics analysis on the expression of DDB1 in hepatocellular carcinoma tissues (371 cases) and paracancerous tissues (50 cases) in The Cancer Genome Atlas (TCGA) database and the correlation of DDB1 expression with the overall survival of liver cancer patients were analyzed by bioinformatics using the UALCAN platform. SMMC-7721 cells were transfected with small interfering RNA (siRNA) targeting DDB1 and negative control siRNA, which were DDB1 silencing group and negative control group, respectively. X-ray irradiation induced exogenous DNA double strand break (DSB) damage in the two groups of cells. Immunofluorescence staining (γH2AX was used for assessing cellular DSB damage, RPA32s33 and Rad51 were used for assessing homologous recombination repair) and Western blotting (were used to detect the level of RPA32s33 protein) were used to analyze the effect of DDB1 gene silencing on DSB damage repair. Sister chromosome exchange (SCE) experiment was used to analyze the frequency of SCE of homologous recombination of cells in DDB1 silencing group and negative control group. Tetramethylazozolium salt (MTT) method was used to analyze the killing effect of PARP inhibitor olapani (10 μmol/L), cisplatin (1 μg/ml) and olapani combined with cisplatin on SMMC-7721 cells in DDB1 silencing group and negative control group.Results:Bioinformatics analysis showed that the level of DDB1 mRNA in liver cancer tissues was higher than that in paracancerous tissues ( P < 0.001), and the overall survival of patients with high expression of DDB1 was worse than that of patients with low expression of DDB1 ( P = 0.029). When cultured for 4 hours after X-ray irradiation, the number of γH2AX foci in cells of the negative control group had mostly disappeared, and there were still more cells in DDB1 silencing group [(5.1±2.0) per cell vs. (13.4±2.0) per cell, t = -5.08, P = 0.007]. When cultured for 4 hours after X-ray irradiation, the number of RPA32s33 foci in the negative control group [(30.8±5.0) per cell vs. (13.2±1.6) per cell] and the number of Rad51 foci [(19.5±1.8) per cell vs. (8.3±3.3) per cell] were higher than those in the DDB1 silencing group, and the differences between the two groups were statistically significant (both P < 0.01). The frequency of SCE in the negative control group was higher than that in the DDB1 silencing group [(21.2±3.0)% vs. (11.2±1.6)%, t = 5.07, P = 0.007]. MTT assay showed that after olaparib treatment, the survival rate of cells in the DDB1 silencing group was lower than that in the negative control group [(40.3±3.6)% vs. (79.8±1.3)%, t = 17.94, P < 0.001]. When treated with olapani combined with cisplatin, the survival rate of cells in the two groups further decreased, and the survival rate of cells in the DDB1 silencing group was lower than that in the negative control group [(10.2±2.8)% vs. (29.6±3.4)%, t = 7.72, P = 0.002]. When treated with cisplatin alone, there was no significant difference in cell survival between DDB1 silencing group and negative control group [(41.9±5.1)% vs. (49.8±3.3)%, t = 2.71, P = 0.054]. Conclusions:The high expression of DDB1 in hepatocellular carcinoma tissues may be an important factor in the treatment resistance and poor prognosis of hepatocellular carcinoma. Knockdown of DDB1 gene expression can promote the sensitivity of SMMC-7721 cells to PARP inhibitors, and its mechanism may be related to the homologous recombination repair defect of SMMC-7721 cells caused by DDB1 silencing.

Objective:The effect of intermedin (IMD) on ATP-induced activation of inflammatory bodies and pyroptosis of cells and its mechanism were studied using lipopolysaccharide (LPS)-sensitized mouse macrophage line RAW 264.7.Methods:The cells were divided into the control groups, the LPS groups, LPS+IMD groups, and LPS+IMD+LY294002 groups. The expression of interleukin (IL)-1β and IL-18 and the activation of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammatory cells were detected by real-time PCR and western blotting, and the pyroptosis of cells was detected by propidium iodide (PI) staining. The measurement data was represented by MS± SD, and the inter-group difference was compared with ANOVA calculations, and P<0.05 represented the difference with statistical significance. Results:Compared with the control group [(0.83±0.09) vs (0.49±0.04)], the ratio of phosphorylated phosphatidylinositol-3-kinase, p-PI3K)/phosphatidylinositol-3-kinase (PI3K) (0.44±0.05) and p-Akt/Akt (0.27±0.06) in the LPS group was significantly decreased. The ratios of p-PI3K/PI3K (1.22±0.18) and pAkt/Akt (0.83±0.09) in LPS+IMD group was significantly increased ( F=31.40, P<0.001; F=50.88, P<0.001). Compared with the control group, the mRNA and protein expressions of IL-1β, IL-18 and NLRP3 inflammasome (NLRP3, caspase-1, ASC) in RAW264.7 cells were up-regulated in the LPS group (LPS and ATP). Compared with LPS group, IMD treatment inhibited the expression of inflammatory cytokines IL-1β, IL-18 and NLRP3 inflammasome, which was blocked by LY294002, a blocker of PI3K/Akt pathway. The results of real-time PCR showed that the relative expression of IL-1β mRNA was (1.00±0.11) in the control group, (8.32±0.61) in the LPS group, (8.32±0.55) in the LPS+IMD group, and (7.23±0.41) in the LPS+IMD+LY group ( F=15.42, P<0.001). The relative expression of IL-18 mRNA in the control group was (1.00±0.17), (1.82±0.21) in the LPS group, (1.14±0.15) in the LPS+IMD group, and (1.53±0.11) in the LPS+IMD+LY group respectively ( F=18.16, P<0.001). The relative expression of NLRP3 mRNA in the control group was (1.00±0.13), (2.58±0.18) in the LPS group, (1.07±0.17) in the LPS+IMD group, and (1.33±0.32) in the LPS+IMD+LY group respectively ( F=15.98, P< 0.001); The relative expression of caspase-1 mRNA in the control group was (1.00±0.09), (6.20±0.19) in the LPS group, (3.43±0.06) in the LPS+IMD group, and (5.50±0.45) in the LPS+IMD+LY group respectively ( F=18.39, P<0.001). The relative expression of ASC mRNA in the control group was (1.00±0.21), (4.58±0.48) in the LPS group, (2.07±0.51) in the LPS+IMD group, and (3.33±0.32) in the LPS+IMD+LY group respectively ( F=15.19, P<0.001). Western blotting results showed that the relative expression of IL-1β protein was as follows: (100%) in the control group, [(188±14)%] in the LPS group, [(112±11)%] in the LPS+IMD group, and [(171±27)%] in the LPS+IMD+LY group respectively ( F=21.25, P<0.001). The relative expression of IL-18 protein in the control group was 100%, [(183±16)%] in the LPS group, [(115±19)%] in the LPS+IMD group, and [(179±23)%] in the LPS+IMD+LY group respectively ( F=19.62, P<0.001). The relative expression of NLRP3 protein was 100% in the control group, [(149±15)%] in the LPS group, [(106±10)%] in the LPS+IMD group, and [(144±15)%] in LPS+IMD+LY group respectively ( F=14.35, P<0.001). The relative expression of ASC protein was 100% in the control group, [(188±12)%] in the LPS group, [(110±18)%] in the LPS+IMD group, and [(192±8)%] in the LPS+IMD+LY group ( F=15.79, P<0.001). Conclusion:IMD inhibits the activation of NLRP3 inflammasome and cell pyroptosis by regulating PI3K/Akt activity.

Objective:To explore the mediating role of psychological resilience on perceived social support and gratitude in patients with first-ever ischemic stroke.Methods:Using the convenient sampling method, a total of 240 patients with first-ever ischemic stroke who were admitted to Department of Neurology in Tenth People's Hospital of Tongji University were selected as the research objects from November 2020 to April 2021. The general information questionnaire, the Gratitude Questionnaire-6 (GQ-6), Perceived Social Support Scale (PSSS) and Connor-Davidson Resilience Scale (CD-RISC) were used to conduct a cross-sectional survey. AMOS 26.0 software was used to construct the structural equation model. In this study, 240 questionnaires were sent out and 232 valid questionnaires were returned.Results:The gratitude score of 232 patients with first-ever ischemic stroke was (27.26±3.76). Gratitude of patients was positively correlated with psychological resilience and perceived social support ( r=0.612, 0.657; P<0.01). Psychological resilience played a mediating role between perceived social support and gratitude in patients with first-ever ischemic stroke, accounting for 23.19% of the total effect. Conclusions:The gratitude level of patients with first-ever ischemic stroke is low. Resilience is the mediating variable between perceived social support and gratitude. Medical staff should timely assess psychological resilience of patients and formulate individualized psychological intervention plans, so as to improve the gratitude level of patients and buffer the harm of negative emotions on physical and mental health.

Objective: To analyze the status of serum 25 hydroxyvitamin D[25 (OH)D] in children aged 0-6 years in Gansu Province, and to analyze the relationships between 25 (OH)D and age, seasonal characteristics and physical development, so as to provide a scientific reference for supplementing vitamin D for children in due time. Methods: Stratified random cluster sampling method was used to select a total of 9 790 children aged 0-6 years from 6 cities and prefectures maternity and child health institutions in Gansu Province for health examination from January 2019 to December 2020. Serum 25 (OH)D concentration from 1 mL peripheral blood was tested by enzyme linked immunoassay. Subjects were classified into overweight and normal figure groups based on weight for height. Results: the serum 25 (OH)D level M(P 25 ,P 75 ) of the children aged 0-6 was 81.31(63.14, 95.86)nmol/L. The detection rate of 25 (OH)D deficiency and insufficiency was 45.11%. The serum 25 (OH)D level of children 4- 6 years old was significantly lower than that of infants <1 year old and children 1-<4 years old, and the detection rate of 25 (OH)D deficiency and insufficiency was highest among 4-6 years old( χ 2=83.67, P <0.05). In winter the proportion of 25 (OH)D insufficiency and deficiency was highest (55.82%) ( χ 2=194.12, P <0.01). For overweight children, the abnormal rate of 25 (OH)D (19.83%) was significantly higher in autumn ( P <0.01). Conclusion Children s vitamin D levels were associated with age, season and physical development. Vitamin D surveillance should be focused on ages less than 1 year old and above 4 years old, winter should be an important season. For overweight children, autumn should be the focus period for vitamin D deficiency prevention.

Objective:To study the effects of broad-spectrum antibiotics and induced antibiotic-resistant bacteria on the efficacy of 5-fluorouracil (5-FU) chemotherapy for mice with colon cancer and to investigate the underlying mechanisms associated with anti-tumor immune responses.Methods:BALB/c mice were subcutaneously injected with CT26 colon cancer cells and randomized into four groups: tumor-bearing control group, antibiotic group treated with ampicillin, streptomycin and colistin, 5-FU group and anitibiotic+ 5-FU group. Tumor volumes and body weights were measured and recorded. Seven days after the last 5-FU treatment, the percentages of splenic immune cell subpopulations and proliferated CD8 + T cells after co-culturing with CT26 were analyzed by flow cytometry. Gut microbiota composition was detected by 16S rRNA sequencing and the bacteria in mesenteric lymph nodes (mLN) were isolated and cultured. Bone marrow-derive macrophages were stimulated with identified bacteria and the expression of M1 and M2 polarization markers were assessed by quantitative PCR. The proliferation of CD8 + T cells co-cultured with bacteria-treated macrophages was analyzed by flow cytometry. In addition, tumor-bearing mice were treated with 5-FU and oral gavage of bacteria isolated from antibiotic+ 5-FU group or PBS. Tumor volumes, gut microbiota composition and the percentages of proliferated CD8 + T cells co-cultured with CT26 were assessed. Results:Tumor volumes were larger and body weights were lower in the antibiotic+ 5-FU group than in the 5-FU group. The percentages of CD4 + T cells, CD8 + T cells and neutrophils did not varied significantly after using antibiotics, however, the percentage of monocytes was increased in the antibiotic group. The percentage of proliferated tumor-specific CD8 + T cells in the antibiotic+ 5-FU group was decreased compared with that in the 5-FU group. Compared with the control group and 5-FU group, antibiotic usage was associated with the changes in gut microbiota composition with decreased α diversity indexes. Escherichia coli, Klebsiella pneumonia, and Proteus mirabilis were isolated from mLNs of the antibiotic group, 5-FU group and antibiotic+ 5-FU group, respectively. Bone marrow-derived macrophages stimulated with Proteus mirabilis expressed arginase at a high level, which was a M2 polarization marker of macrophage, and associated with the decreased percentage of proliferated CD8 + T cells after co-culturing. Bacteria of the genus Proteus were enriched in the gut microbiota of 5-FU-treated tumor-bearing mice with the oral gavage of Proteus mirabilis. Although no significant inhibitory effect on tumor growth was observed, the oral gavage of Proteus mirabilis was associated with the decreased percentage of proliferated tumor-specific CD8 + T cells in vitro. Conclusions:Broad-spectrum antibiotics inhibited the efficacy of chemotherapy and the proliferation of tumor-specific CD8 + T cells, in which antibiotic-resistant bacteria might be involved.