Objective To externally validate a prediction model based on clinical and CT imaging features for the preoperative identification of high-grade patterns (HGP), such as micropapillary and solid subtypes, in early-stage lung adenocarcinoma, in order to guide clinical treatment decisions. Methods This study conducted an external validation of a previously developed prediction model using a cohort of patients with clinical stage ⅠA lung adenocarcinoma from the Fourth Hospital of Hebei Medical University. The model, which incorporated factors including tumor size, density, and lobulation, was assessed for its discrimination, calibration performance, and clinical impact. Results A total of 650 patients (293 males, 357 females; age range: 30-82 years) were included. The validation showed that the model demonstrated good performance in discriminating HGP (area under the curve>0.7). After recalibration, the model's calibration performance was improved. Decision curve analysis (DCA) indicated that at a threshold probability>0.6, the number of HGP patients predicted by the model closely approximated the actual number of cases. Conclusion This study confirms the effectiveness of a clinical and imaging feature-based prediction model for identifying HGP in stage ⅠA lung adenocarcinoma in a clinical setting. Successful application of this model may be significant for determining surgical strategies and improving patients' prognosis. Despite certain limitations, these findings provide new directions for future research.

Objective:To compare the patient-reported outcomes and short-term clinical outcomes between robotic-assisted and laparoscopic-assisted radical gastrectomy for locally advanced gastric cancer.Methods:This single-center prospective randomized controlled trial was conducted in the Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University from October 2020 to August 2022. Patients with locally advanced gastric cancer who were to undergo radical gastrectomy were selected and randomly divided into two groups according to 1∶1, and received robotic surgery and laparoscopic surgery, respectively. Patient-reported outcomes and short-term clinical outcomes (including postoperative complications, surgical quality and postoperative short-term recovery) were compared between the two groups by independent sample t test, Mann-Whitney U test, repeated ANOVA, generalized estimating equation, χ2 test and Fisher′s exact test. Results:A total of 237 patients were enrolled for modified intention-to-treat analysis (120 patients in the robotic group, 117 patients in the laparoscopic group). There were 180 males and 59 females, aged (63.0±10.2) years (range: 30 to 85 years). The incidence of postoperative complications was similar between the robotic group and laparoscopic group (16.7% (20/120) vs. 15.4% (18/117), χ2=0.072, P=0.788). The robotic group had higher patient-reported outcomes scores in general health status, emotional, and social domains compared to the laparoscopic group, differences in time effect, intervention effect, and interaction effect were statistically significant (general health status: χ2 value were 275.68, 3.91, 6.38, P value were <0.01, 0.048, 0.041; emotional: χ2 value were 77.79, 6.04, 6.15, P value were <0.01, 0.014, 0.046; social: χ2 value were 148.00, 7.57, 5.98, P value were <0.01, 0.006, 0.048). However, the financial burden of the robotic group was higher, the differences in time effect, intervention effect and interaction effect were statistically significant ( χ2 value were 156.24, 4.08, 36.56, P value were <0.01, 0.043,<0.01). Conclusion:Compared to the laparoscopic group, the robotic group could more effectively relieve postoperative negative emotions and improve recovery of social function in patients.

Objective:To compare the patient-reported outcomes and short-term clinical outcomes between robotic-assisted and laparoscopic-assisted radical gastrectomy for locally advanced gastric cancer.Methods:This single-center prospective randomized controlled trial was conducted in the Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University from October 2020 to August 2022. Patients with locally advanced gastric cancer who were to undergo radical gastrectomy were selected and randomly divided into two groups according to 1∶1, and received robotic surgery and laparoscopic surgery, respectively. Patient-reported outcomes and short-term clinical outcomes (including postoperative complications, surgical quality and postoperative short-term recovery) were compared between the two groups by independent sample t test, Mann-Whitney U test, repeated ANOVA, generalized estimating equation, χ2 test and Fisher′s exact test. Results:A total of 237 patients were enrolled for modified intention-to-treat analysis (120 patients in the robotic group, 117 patients in the laparoscopic group). There were 180 males and 59 females, aged (63.0±10.2) years (range: 30 to 85 years). The incidence of postoperative complications was similar between the robotic group and laparoscopic group (16.7% (20/120) vs. 15.4% (18/117), χ2=0.072, P=0.788). The robotic group had higher patient-reported outcomes scores in general health status, emotional, and social domains compared to the laparoscopic group, differences in time effect, intervention effect, and interaction effect were statistically significant (general health status: χ2 value were 275.68, 3.91, 6.38, P value were <0.01, 0.048, 0.041; emotional: χ2 value were 77.79, 6.04, 6.15, P value were <0.01, 0.014, 0.046; social: χ2 value were 148.00, 7.57, 5.98, P value were <0.01, 0.006, 0.048). However, the financial burden of the robotic group was higher, the differences in time effect, intervention effect and interaction effect were statistically significant ( χ2 value were 156.24, 4.08, 36.56, P value were <0.01, 0.043,<0.01). Conclusion:Compared to the laparoscopic group, the robotic group could more effectively relieve postoperative negative emotions and improve recovery of social function in patients.

Objective:To investigate the effect of antidepressant therapy on cellular immunity and quality of life of patients with depression after thoracoscopic radical resection of esophageal cancer.Methods:Between June 2015 to March 2019, our hospital during the period of line thoracoscope comorbid depressive patients, 186 cases of esophageal cancer radical, according to the indicator method were randomly divided into treatment group and the control group (n=93), the treatment group after surgery for antidepressant treatment, the control group did not give any postoperatively in patients with depressive drugs treatment, routine for psychological counseling. Self-rating Depression Scale SDS and Generic Quality of Life Inventory-74 (GQoli-74) were used to evaluate the changes of depression status and Quality of Life in 2 groups before and after treatment. Flow cytometry was used to detect the levels of CD 4+ and CD 8+ subsets in peripheral blood to evaluate the changes of immune system function in 2 groups before and after treatment. Results:After treatment, the SDS score of the treatment group was significantly lower than that before treatment, the difference was statistically significant( P<0.05), while the SDS score of the control group was not significantly changed before and after treatment, the difference was not statistically significant( P>0.05). After antidepressant treatment, CD 4+ and CD 4+ /CD 8+ levels in the immune system in the treatment group were significantly increased, and CD 8+ levels were significantly decreased, with statistical significance ( P<0.05), while CD 4+ , CD 8+ and CD 4+ /CD 8+ levels in the control group were not significantly changed before and after treatment. There was no significant difference ( P>0.05). After treatment, the body function, psychological function, social function, material state and total score of quality of life of patients in the treatment group were significantly improved compared with before treatment, the difference was statistically significant ( P<0.05), while the score of quality of life of patients in the control group was not significantly changed before and after treatment, the difference was not statistically significant ( P>0.05). Conclusion:Antidepressant therapy can significantly improve the depression status of postoperative esophageal cancer patients, and improve the immune system function and quality of life.

Objective:To explore the safety, efficacy and preliminary clinical application of the single plantar approach or in combination with the dorsalis pedis approach in the treatment of Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions.Methods:(1) Six fresh cadaveric specimens of adult foot were collected and dissected through the plantar approach in order to determine the skin incision of the plantar approach and the safe area for plate-screw internal fixation, including start-stop points and courses of plantar nerves, blood vessels, tendons and ligaments, followed by plate-screw fixation on the specimens. (2) After feasibility of the plantar approach was confirmed by our anatomical study, it was used to treat the 3 patients who were admitted to Department of Orthopedics, The Third Hospital Affiliated to Southern Medical University between September 2020 and November 2021 for Lisfranc injury with severe necrosis due to dorsalis pedis skin contusion or metatarsal base avulsion fracture. They were 2 males and one female, with an average age of 51 years (from 34 to 68 years). The preliminary clinical efficacy was evaluated in terms of visual analogue scale (VAS), midfoot score of American Orthopaedic Foot and Ankle Surgeons (AOFAS), Maryland score, Kofoed score, fracture healing at the last follow-up and postoperative complications.Results:(1) Regarding the anatomical exposure range, the metatarsal side of the first metatarsal wedge joint was exposed medially and the metatarsal side of the third metatarsal wedge joint was exposed laterally; the peroneus longus tendon, Lisfranc plantar ligament and interosseous ligament were explored. X-ray films after the simulated operation showed satisfactory plate positions. (2) As for the preliminary clinical application, all patients were followed up for 6 to 14 months (mean, 11 months). At the last follow-up, the VAS score ranged from 0 to 1 (mean, 0.5), AOFAS score from 85 to 92 (mean, 89), Maryland score from 93 to 96 (mean, 95), and Kofoed score from 92 to 95 (mean, 94). There were no early complications such as fascial compartment syndrome, skin necrosis or infection. All fractures got united, with no complications like traumatic arthritis, muscle atrophy or screw loosening.Conclusion:Testified by the anatomical study, the plantar approach can be used to treat Lisfranc injury with poor dorsalis pedis soft tissue, metatarsal avulsion fracture or complicated multi-column lesions, leading to safe, effective and satisfactory clinical outcomes.

Objective: To investigate the role of miR-15 a-5 p in DOX resistance of lung cancer cells, and to elucidate the relationship between miR-15 a-5 p and DOX resistance. Methods: miR-15 a-5 p inhibitor and miR-15 a-5 p mimics were used to transfect A549 and A549/DOX resistant cells(A549/D). MTT assay was used to detect cell viability, flow cytometry was used to detect cell apoptosis, Western blot was used to detect the expression of EMT related protein and P53 protein, and QRT PCR was used to detect the expression of miR-15 a-5 p. The potential target genes of miR-15 a-5 p were analyzed by bioinformatics prediction, dual luciferase reporter. A549/D cells were used to establish the xenograft tumor model in nude mice, and the effect of miR-15 a-5 p overexpression on DOX in vivo was analyzed. Results: MTT analysis showed that the knockdown of miR-15 a-5 p increased the cell viability of A549 cells(IC50value: 8.86±0.32 μmol/L), and the overexpression of miR-15 a-5 p decreased the cell viability of A549/D cells(IC50value: 1.92±0.11 μmol/L). Blocking miR-15 a-5 p in A549 cells reduced apoptosis(P<0.001), and increasing the expression of miR-15 a-5 p in A549/D cells promoted apoptosis(P<0.001). The role of DOX in regulating the EMT was reversed by the transfection of miR-451 a inhibitor through Western blot. Bioinformatics prediction showed that there was a specific binding site between P53 and miR-15 a-5 p. miR-15 a-5 p inhibition reduced the expression of P53 protein in A549 cells(P<0.001), and miR-15 a-5 p over-expression increased the expression of P53 protein in A549/D cells(P<0.01). In vivo experiments showed that combination of agomir-miR-15 a-5 p and DOX could reduce the tumor volume and the expression level of N-cadherin, and enhance the expression levels of P53 and E-cadherin. Conclusion miR-15 a-5 p over-expression may inhibit EMT by targeting P53 and enhance the sensitivity of lung cancer cells to DOX therapy.

Objective:To investigate the safety and feasibility of modified pararectus abdominis approach in the anterior plate fixation of sacral fractures.Methods:In 5 fresh adult cadavers (3 males and 2 females), gross anatomy was performed on one pelvic side using a modified pararectus abdominis approach to clarify the anatomical structures around the approach. On the other side of the pelvis, the anterior structures of the sacrum were exposed in simulated anterior plate fixation of sacral fracture via the modified pararectus abdominis approach. The exposed anatomic range of the approach, and the locations and courses of lumbosacral trunk nerve and iliac vessels were observed and recorded.Results:(1) The modified pararectus abdominis approach exposed the whole S1 vertebral body from the sacroiliac joint to the medial side, the L5 vertebral body cephalally, the S1 foramina in the true pelvis, and the same structures laterally as a traditional pararectus abdominis approach did. (2) Via the modified pararectus abdominis approach, exploration and decompression of the lumbosacral plexus (from L4 to S1) (including S1 foraminoplasty) were performed under direct vision to decompress the nerve entrapment from anterior compressed fracture fragments and hyperplastic callus. (3) There was a safe surgical area in anterior L5 and S1 where a plate could be safely fixed to the S1 vertebral body. (4) Since the maximum vertical distance from the lumbosacral trunk nerve lifted above the periost to the sacral ala was 1.4 cm (range, from 1.2 to 1.5 cm), a plate could be safely placed from the subperiosteum to the S1 vertebral body to fix the fracture.Conclusions:The modified pararectus abdominis approach is safe and feasible for exploration and decompression of lumbosacral nerves in the anterior sacral region (from L4 to S1) because it has significant advantages in vision and operation. It also broadens the range of anterior sacral plate fixation because a sacral fracture displacement can be reduced under direct vision and a plate can be fixated to the S1 vertebral body along the alae sacralis and across the sacroiliac joint to the iliac bone.

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[Abstract] Objective:ToinvestigatetheroleofmiR-125a-5pininducingthegefitinib(Gef)-resistance of non-small cell lung carcinoma (NSCLC) cells and its possible mechanism. Methods: Human NSCLC drug-resistant cell line A549/GR and NSCLC cell line A549 were chosen for this study. miR-125a-5p mimic, miR-125a-5p inhibitor, pcDNA3.1-APAF1 and empty vector pcDNA3.1 were transfected into A549/GR cells. The expression level of miR-125a-5p in cell lines was detected by qPCR. MTT, Transwell and Flow cytometry were used to detect the effects of Gef on proliferation, migration and apoptosis of cell lines, respectively. The targeting relationship between miR-125a-5p and APAF1 (apoptotic peptidase activating factor 1) was verified by Dual-luciferase reporter gene system. In addition, the expression of APAF1 protein in A549/GR cells was detected by Western blotting. The expression levels of caspase-3 and caspase-9 were assessed by colorimetry. Results: Expression level of miR-125a-5p was upregulated significantly in Gefresistant A549/GR cells (P<0.01). AndtheinfluencesofGefonA549/GRcellswereenhancedby knockdown of miR-125a-5p, including inhibiting cell proliferation and migration (all P<0.05) and inducing apoptosis (P<0.01). Dual luciferase reporter gene assay confirmed that miR-125a-5p targeted APAF1 and negatively regulated its expression. Furthermore, by targetedly downregulating APAF1, miR-125a-5p alleviated the inhibition of proliferation and migration (all P<0.05) and promotion of apoptosis (P<0.05) of A549/GR cells caused by Gef, and attenuated Gef-induced upregulation of apoptosis-related proteins caspase-3 and caspase-9 (all P<0.05). Conclusion: miR-125a-5p promotes Gef-resistance of A549/GR cells, and the underlying mechanisms are promotion of proliferation, migration and inhibition of apoptosis of non-small cell lung cancer cells by targetingAPAF1.

Isatis indigotica Fort. (Ban-Lan-Gen) is an herbal medicine prescribed for influenza treatment. However, its active components and mode of action remain mostly unknown. In the present study, erucic acid was isolated from Isatis indigotica Fort., and subsequently its underlying mechanism against influenza A virus (IAV) infection was investigated in vitro and in vivo. Our results demonstrated that erucic acid exhibited broad-spectrum antiviral activity against IAV resulting from reduction of viral polymerase transcription activity. Erucic acid was found to exert inhibitory effects on IAV or viral (v) RNA-induced pro-inflam-matory mediators as well as interferons (IFNs). The molecular mechanism by which erucic acid with antiviral and anti-inflammatory properties was attributed to inactivation of NF-kB and p38 MAPK signaling. Furthermore, the NF-kB and p38 MAPK inhibitory effect of erucic acid led to diminishing the transcriptional activity of interferon-stimulated gene factor 3 (ISGF-3), and thereby reducing IAV-triggered pro-inflammatory response amplification in IFN-β-sensitized cells. Additionally, IAV- or vRNA-triggered apoptosis of alveolar epithelial A549 cells was prevented by erucic acid. In vivo, erucic acid administration consistently displayed decreased lung viral load and viral antigens expression. Meanwhile, erucic acid markedly reduced CD8+cytotoxic T lymphocyte (CTL) recruitment, pro-apoptotic signaling, hyperactivity of multiple signaling pathways, and exacerbated immune inflammation in the lung, which resulted in decreased lung injury and mortality in mice with a mouse-adapted A/FM/1/47-MA(H1N1) strain infection. Our findings provided a mechanistic basis for the action of erucic acid against IAV-mediated inflammation and injury, suggesting that erucic acid may have a therapeutic potential in the treatment of influenza.