Objective To introduce an innovative technique, the "balance-shaped sternal elevation device" and its application in the subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for anterior mediastinal masses resection. Methods Patients who underwent single-port thoracoscopic assisted anterior mediastinal tumor resection through the xiphoid process at the Department of Thoracic Surgery, West China Hospital, Sichuan University from May to June 2024 were included, and their clinical data were analyzed. Results A total of 7 patients were included, with 3 males and 4 females, aged 28-72 years. The diameter of the tumor was 1.9-17.0 cm. The operation time was 62-308 min, intraoperative blood loss was 5-100 mL, postoperative chest drainage tube retention time was 0-9 days, pain score on the 7th day after surgery was 0-2 points, and postoperative hospital stay was 3-12 days. All patients underwent successful and complete resection of the masses and thymus, with favorable postoperative recovery. Conclusion The "balance-shaped sternal elevation device" effectively expands the retrosternal space, providing surgeons with satisfactory surgical views and operating space. This technique significantly enhances the efficacy and safety of minimally invasive surgery for anterior mediastinal masses, reduces trauma and postoperative pain, and accelerates patient recovery, demonstrating important clinical significance and application value.

Objective To investigate risk factors of medication non-adherence in elderly patients with hypertension through Meta-analysis.Methods Literatures on medication non-adherence in elderly patients with hypertension were systematically reviewed across various databases,from inception to September 1st 2023,including CNKI,VIP,Wangfong Database,SinoMed,PubMed,Web of Science,Cochrane Library、EMbase.Meta-analysis was conducted using RevMan 5.4.Results A total of 19 articles were included,comprising a total of 18 220 patients in sample size.Meta analysis identified 10 risk factors,showed significant association(P<0.05)with:age[OR=1.36,95%CI=(1.00,1.86)],place of residence[OR=1.91,95%CI=(1.33,2.75)],method of payment for medical expenses[OR=1.60,95%CI=(1.38,1.86)],income level[OR=1.68,95%CI=(1.45,1.95)],occupational status[OR=1.79,95%CI=(1.37,2.36)],social support[OR=1.43,95%CI=(1.27,1.60)],comorbidity[CI=0.33,95%(0.19,0.58)],frequency of blood pressure measurement[CI=1.53,95%(1.14,2.05)],disease awareness[OR=1.70,95%CI=(1.44,2.00)]and dedication frequency[OR=1.44,95%CI=(1.16,1.79)].In addition,the number of influencing factors such as gender,marital status,depression,cognitive impairment,and complications was included in<3 articles,and only descriptive analysis was conducted.Conclusion Healthcare providers should focus on the identification and management of the risk factors associated with medication non-adherence in elderly patients with hypertension,therefore to reduce the incidence of medication non-adherence.

Objective:To investigate the change of chemical exchange saturation transfer (CEST) imaging in the bilateral substantia nigra (SN) and red nucleus (RN) of Parkinson disease (PD), and to explore the value of CEST-MRI for the clinical application of PD.Methods:This was a cross-sectional study. A total of 45 PD patients (PD group) and 21 sex-, age-, and cognitive-function matched normal control subjects (NC group) were retrospectively enrolled from December 2012 to July 2015 in Beijing Hospital. All subjects underwent brain CEST-MRI and routine MRI. Based on the MATLAB software package, the 4-pool Lorentz fitting model was applied to analyze the signal change of CEST imaging, which could acquire the mean amplitudes of the 4-pool parameters including Amide, nuclear overhauser enhancement (NOE), direct water saturation (DS) and magnetization transfer (MT) in the bilateral SN and RN. Independent samples t test and Mann-Whitney U test were used to compare CEST parameters between the PD group and the NC group and controlled by Bonferroni correction. The combined model was constructed based on parameters with inter-group differences after correction. The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the diagnostic efficiency of the CEST parameters and the combined model. Results:Compared with the NC group, the left SN Amide value, left RN Amide value, and right SN NOE value were reduced in the PD group, and the difference was statistically significant ( t=-3.59, corrected P=0.026; t=-3.77, corrected P=0.016; Z=-3.27, corrected P=0.017). The left SN Amide value, the left RN Amide value, the right SN NOE value, and the combined model all had good diagnostic efficacy in the differentiation of the PD group from the HC group (AUCs of 0.78, 0.79, 0.75, and 0.81, respectively). The combined model had the highest AUC value (0.81) and specificity (97.78%), the Amide value of left SN had the highest sensitivity (93.33%). Conclusions:Quantitative analysis of CEST-MRI based on the 4-pool Lorentz fitting model shows significant differences in the CEST quantitative indicators of the SN and RN between the PD group and the NC group, demonstrating good potential for clinical application in the diagnosis of PD.

Objective:To investigate the influencing factors for lymph node metastasis and prognosis in stage T1 and T2 esophageal squamous cell carcinoma after radical surgery and construct nomogram prediction models.Methods:The retrospective cohort study was conducted. The clinico-pathological data of 672 patients with T1 and T2 esophageal squamous cell carcinoma who were admitted to the Affiliated Hospital of North Sichuan Medical College from January 2014 to December 2019 were collected. There were 464 males and 208 females, aged (65±8)years. All patients under-went radical esophagectomy+2 or 3 field lymph node dissection. Observation indicators: (1) lymph node dissection, metastasis and follow-up. (2) risk factors for lymph node metastasis of esophageal cancer after radical resection. (3) prognostic factors of esophageal cancer after radical resection. (4) construction and evaluation of the prediction models of lymph node metastasis and prognosis of esophageal cancer after radical resection. Follow-up was conducted using outpatient examination, telephone and internet consultations to detect survival of patients up to April 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Kaplan-Meier method was used to calculate survival rate and draw survival curve. Log-Rank test was used for survival analysis. Logistic regression model was used for univariate and multivariate analyses of risk for lymph node metastasis, and COX regression model was used for univariate and multivariate analyses of prognosis. Based on the results of multi-variate analysis, the nomogram prediction models for lymph node metastasis and prognosis predic-tion were constructed. The prediction discrimination of the nomogram models were evaluated using the area under curve (AUC) of the receiver operating characteristic curve (ROC). The calibration curve was used to evaluate the prediction consistency of the models. Results:(1) Lymph node dissection, metastasis and follow-up. The number of lymph node dissected was 14±8 and the number of lymph node metastasis was 2(range, 1?19) in 672 patients. Of the 672 patients, there were 182 cases had lymph node metastasis, including 58 cases in T1 stage and 124 cases in T2 stage. All 672 patients were followed up for 38 (range, 1?85)months. The average overall survival time of 672 patients was 65 months, with the 1-, 3-, 5-year overall survival rate as 89.0%, 74.3%, 66.0%, respectively. The average overall survival time of 325 patients in T1 stage and 347 patients in T2 stage were 70 months and 61 months. The 1-, 3-, 5-year overall survival rate of 325 patients in T1 stage and 347 patients in T2 stage were 95.0%, 83.5%, 73.4% and 87.4%, 69.9%, 59.2%, respectively, showing a significant difference in survival between them ( χ2=14.51, P<0.05). (2) Risk factors for lymph node metastasis of esophageal cancer after radical resection. Results of univariate analysis showed that tumor location, tumor histological grade, tumor T staging were related factors affecting lymph node metastasis of esophageal cancer after radical resection ( odds ratio=1.40, 1.54, 2.56, 95% confidence interval as 1.07?1.85, 1.20?1.99, 1.79-3.67, P<0.05). Results of multivariate analysis showed that tumor location, tumor histological grade, tumor T staging were independent factors affecting lymph node metastasis ( odds ratio=1.42, 1.61, 2.63, 95% confidence interval as 1.07?1.89, 1.25?2.09, 1.82?3.78, P<0.05). (3) Prognostic factors of esophageal cancer after radical resection. Results of univariate analysis showed that preoperative comorbidities, postoperative complications, tumor histological grade (G3), tumor T staging, tumor N staging (N1 stage, N2 stage, N3 stage), tumor TNM staging (Ⅲ stage, Ⅳ stage) were related factors affecting prognosis of esophageal cancer after radical resection ( hazard ratio= 1.48, 1.64, 2.23, 1.85, 2.09, 4.48, 4.97, 3.54, 5.53, 95% confidence interval as 1.08?2.03, 1.20?2.23, 1.47?3.39, 1.34?2.54, 1.44?3.04, 2.89?6.95, 1.57?15.73, 2.48?5.05, 1.73?17.68, P<0.05). Results of multivariate analysis showed that preoperative comorbidities, G3 of tumor histological grade, T2 stage of tumor T staging, N1 stage, N2 stage, N3 stage of tumor N staging were independent risk factors affecting prognosis of esophageal cancer after radical resection ( hazard ratio=1.57, 1.89, 1.63, 1.71, 3.72, 3.90, 95% confidence interval as 1.14?2.16, 1.23?2.91, 1.17?2.26, 1.16?2.51, 2.37?5.83, 1.22?12.45, P<0.05). (4) Construction and evaluation of the prediction models of lymph node metastasis and prognosis of esophageal cancer after radical resection. Based on the results of multivariate analysis, tumor location, tumor histological grade, tumor T staging were applied to construct a nomo-gram model for lymph node metastasis prediction of esophageal cancer after radical resection, the score of tumor location, tumor histological grade, tumor T staging were 82, 100, 100, respectively, and the sum of the scores corresponding to the lymph node metastasis rate. Preoperative comor-bidity, tumor histological grade, tumor T staging, tumor N staging were applied to construct a nomo-gram model for 1-, 3-, 5-year overall survival rate prediction of esophageal cancer after radical resection, the score of preoperative comorbidity, tumor histological grade, tumor T staging, tumor N staging were 23, 38, 27, 100, respectively, and the sum of the scores corres-ponding to the 1-, 3-, 5-year overall survival rate. Results of ROC showed that the AUC of nomogram model for lymph node metastasis prediction after radical esophagectomy was 0.66 (95% confidence interval as 0.62?0.71, P<0.05). The AUC of nomogram model for 1-, 3-, 5-year overall survival rate prediction after radical esophagectomy were 0.73, 0.74, 0.71 (95% confidence intervals as 0.66?0.80, 0.68?0.79, 0.65?0.78, P<0.05). Results of calibration curve showed that the predicted lymph node metastasis rate and the predicted 1-, 3-, 5-year overall survival rate by nomogram models were consistent with the actual lymph node metastasis rate and 1-, 3-, 5-year overall survival rate. Conclusions:Tumor location, tumor histological grade, tumor T staging are independent factors affecting lymph node metastasis in T1 and T2 esophageal squamous cell carcinoma after radical surgery and nomogram model constructed by these indicators can predict the lymph node metas-tasis rate. Preoperative comor-bidities, G3 of tumor histological grade, T2 stage of tumor T staging, N1 stage, N2 stage, N3 stage of tumor N staging are independent risk factors affecting prognosis and nomogram model constructed by these indicators can predict the overall survival rate of patients after surgery.

Objective:To evaluate the prevention effect of low dose pre-irradiation on irradiation-induced lung injury and its possible mechanism.Methods:Totally 320 6-week-old female C57BL/6j mice were divided into control (0 Gy), low-dose (0.5 Gy), high-dose (20 Gy) and low-dose pre-radiation(0.5 Gy+ 20 Gy)groups by the random number method, with 80 mice in each group. The mice in the low-dose and low-dose pre-irradiation groups were placed in the immobilization device under full consciousness and subjected to 0.5 Gy X-ray whole-body irradiation. 2 weeks later, the 0.5 Gy pre-irradiated mice were anesthetized and subjected to 20 Gy X-rays on chest, as the pre-radiation plus high dose radiation group. The mice in the control group were irradiated with mock irradiation (0 Gy). All mice were terminated at designed time points (24 h, 1 month, 3 months and 5 months) after completion of the irradiation schedule, with 20 mice/group at each time point. Then, lung tissues were taken from mice, and pathological changes were observed by hematoxylin-eosin (HE) staining and Masson′s trichrome staining. RT-qPCR and Western blot were used to detect the expressions of mRNAs and proteins of pulmonary fibrosis-related factors.Results:Pathological changes were observed in the lung tissues 1 month after a single high-dose 20 Gy irradiation, mainly including radiation pneumonitis and a small amount of collagen accumulation, which was more serious than low-dose pre-irradiation group, and these pathological changes became more severe when the time after irradiation increased. Meanwhile, the mRNA and protein levels of proSP-C and HOPX in the low-dose pre-irradiation group were higher than those in the high-dose group, except for proSP-C protein expression at 3 and 5 months post-irradiation. A more significant change was that the mRNA level of TGF-β1 in the high-dose group was 5.8-13.6 times higher than that in the other groups at 5 months after irradiation, as well as β-catenin mRNA ( t=4.22, 5.11, P<0.05). At the same time, in the early period (24 h and 1 month) post-irradiation, the level of vimentin protein in the low-dose pre-irradiation group was significantly higher than that in the high-dose group ( t=6.54, 4.28, P<0.05). Conclusions:When the mice were pre-irradiated with 0.5 Gy X-rays, an adaptive protective response was induced in lung tissues, resulting in the tolerance to subsequent high dose irradiation.

Objective:To investigate the clinical significance of grip strength, three simple lung functions[functional volume capacity(FVC), forced expiratory volume in the first second(FEV1)and peak expiratory flow(PEF)], 6-minute walking distance test(6MWD)and left ventricular ejection fraction(LVEF)for assessing overall integrative function in elderly versus non-elderly patients with coronary artery disease(CAD).Methods:A total of 35 hospitalized CAD patients aged 70.4±10.6 years from January 2017 to December 2018 were retrospectively enrolled.Patients were divided into the non-elderly group(<65 years, n=8)and the elderly group(≥65 years, n=27). FVC, FEV1 and PEF were tested by a portable lung function machine.The grip strength, 6MWD, three simple lung functions(FVC, FEV1, PEF), LVEF and echocardiography were detected after admission.The above indexes were re-examined in outpatient clinic at 3 months after discharge.The results of above indexes were compared at admission versus at three months after discharge.The consistency and correlation between FVC, FEV1, PEF, 6MWD, grip strength and LVEF were analyzed.Results:The detected results of FVC, FEV1, PEF, 6MWD, left-hand grip strength, right-hand grip strength and LVEF showed no significant difference at admission versus at 3 months after discharge( P>0.05)in a total of 35 hospitalized CAD patients.Pearson bivariate correlation analysis showed that FVC, FEV1, PEF, left-hand and right-hand grip strength had pairwise correlation between them( P<0.01).6MWD had no correlation with LVEF.And LVEF was related with FVC and FEV( P<0.01), but not related with PEF, 6MWD and grip strength( P>0.05). The detective values of FVC, FEV1, PEF, 6MWD, left-hand and right-hand grip strength were lower in the elderly group than in the non-elderly group[(2.11±0.66 )L vs.(2.88±0.55) L, (1.74±0.46 )L vs.(2.62±0.49 )L, (5.50±1.79 )m/s vs.(8.22±1.59) m/s, (332.07±115.58)m vs.(446.14±99.81 )m, (25.14±7.87) vs.(35.15±8.30), (27.37±8.39 )kg vs.(38.37±10.20)kg, P<0.01]. LVEF had no significant difference between the two age groups. Conclusions:FVC, FEV1, PEF, 6MWD and grip strength are lower in elderly group than in non-elderly group.A comprehensive set of tests of grip strength, three simple lung function and 6MWT is helpful to evaluate the overall integrative function in elderly CHD patients.

Gliomas are the most common primary intracranial neoplasms among all brain malignancies, and the microtubule affinity regulating kinases (MARKs) have become potential drug targets for glioma. Here, we report a novel dual small-molecule inhibitor of MARK3 and MARK4, designated as PCC0208017. PCC0208017 strongly inhibited kinase activity against MARK3 and MARK4, and strongly reduced proliferation in three glioma cell lines. This compound attenuated glioma cell migration, glioma cell invasion, and angiogenesis. Molecular mechanism studies revealed that PCC0208017 decreased the phosphorylation of Tau, disrupted microtubule dynamics, and induced a G2/M phase cell cycle arrest. In an glioma model, PCC0208017 showed robust anti-tumor activity, blood-brain barrier permeability, and a good oral pharmacokinetic profile. Molecular docking studies showed that PCC0208017 exhibited high binding affinity to MARK3 and MARK4. Taken together, our study describes for the first time that PCC0208017, a novel MARK3/MARK4 inhibitor, might be a promising lead compound for treatment of glioma.

The low expression rate of exogenous genes in cyanobacteria is one of the bottlenecks of cyanobacteria genetic engineering. The T7 RNA polymerase expression system has achieved the efficient expression of exogenous genes in Escherichia coli. Cyanobacteria and E. coli are both Gram-negative bacteria with high genetic homology. The construction of T7 RNA polymerase expression system in cyanobacteria may improve the expression of foreign genes. In order to construct the T7 RNA polymerase expression system in Anabaena sp. PCC 7120, methods such as overlapping extension PCR and digestion-ligation technique were used to construct a site-specific integration vector pEASY-T1-F1-TacT7RNAPCmR-F2 and a shuttle expression vector pRL-T7-hG-CSF. The site-specific integration vector is capable of expressing T7 RNA polymerase, and the shuttle expression vector expresses hG-CSF driven by the T7 promoter. Then we introduced the site-specific integration vector into the wild type cyanobacteria by electroporation and transferred the shuttle expression vector into the site-integrated transgenic cyanobacteria by triparental conjugative transfer. In the end, we identified the presence of foreign genes in cyanobacteria by PCR, tested the transcription level of foreign genes in cyanobacteria by RT-PCR, and detected the protein expression of foreign genes in cyanobacteria by Western blotting. The two vectors were successfully constructed, the T7 RNA polymerase gene and hG-CSF gene were transferred into cyanobacteria well, and both genes were also expressed in cyanobacteria. In summary, the T7 RNA polymerase expression system was successfully constructed in cyanobacteria, and the expression rate of hG-CSF gene was doubled than the traditional cyanobacteria expression systems. This expression system will provide a better tool for the application of cyanobacteria genetic engineering and will promote the development of cyanobacteria as a chassis cell in the fields of synthetic biology in the future.
Anabaena/genetics* ; Cloning, Molecular ; DNA-Directed RNA Polymerases ; Escherichia coli/genetics* ; Gene Expression ; Mercury ; Plasmids ; Viral Proteins

Objective: To explore and analyze the correlation between nurses' willingness to stay in the operating room and job stressor, job burnout and work-family conflict. Methods: A total of 128 nurses from Mianyang Central Hospital, Third People′s Hospital of Mianyang, Mianyang People′s Hospital were selected as the research objects. The questionnaire of nurses' retention intention, the scale of nurses' job stressor, the scale of nurses' occupational fatigue and the scale of work stress conflict were used to investigate and analyze the correlation between nurses' retention intention and work stressor, occupational fatigue and family conflict. Results: The average retention intention of the nurses surveyed in this study was (3.16±0.71), and the retention intention of the nurses was in the middle level. Operating room nurses' total score of work stress was (95.27±15.28). Among them, the scores of time allocation and workload, nursing specialty and work were the highest (2.86 ± 0.73) and (2.75 ± 0.64), respectively. The highest score of personal achievement was (33.26 ± 8.39). The total score of work family conflict of nurses in operating room was (58.32 ± 11.29), and the total score was (3.09 ± 0.58). The average score of work family conflict based on time was the highest, which was (3.91 ± 0.64), which was the main source of work family conflict of nurses. Pearson correlation analysis showed that nurses' intention to stay was negatively correlated with work pressure, job burnout and work family conflict (r value was-0.374,-0.400,-0.327, P < 0.05). Conclusions Nurses' willingness to stay in the operating room is at a medium level. Nursing managers can reduce the pressure of occupational fatigue by reducing work stress and improve the willingness of nursing staff to stay.

One hundred and eighty three patients with esophageal cancer admitted from September 2015 to September 2016 were randomly divided into two groups:91 patients received clinician-involving pre-discharge and postoperative follow-up health education (study group) and 92 patients received traditional health education (control group).The quality of life and the compliance rate of comprehensive treatment within 3 months after discharge were evaluated and compared between two groups.The overall scores of quality of life in study group was significantly better than those of the control group (P＜ 0.05),and the compliance rate of comprehensive treatment after discharge in study group was significantly higher than that of control group [82.4％(75/91) vs.67.4％(62/92),x2=5.49,P=0.02].It is suggested that clinician participating in the pre-discharge and follow-up health education can improve the quality of life of patients,and improve the compliance of comprehensive treatment after discharge.