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 explore the distribution of airborne pollen in summer and autumn in Taiyuan, analyze the correlation between pollen characteristics, meteorological factors and allergic sensitization, and provide for the prevention and treatment of allergic diseases in this. Methods:The gravity sedimentation method was used to investigate the types, quantities and dispersion patterns of airborne pollen in Taiyuan City from July 21, 2022 to October 20, 2022. he meteorological and patient information was collected during the same period SPSS 26.0 software. Results:①A total of 17 118 pollen grains were collected, and identified as 14 families, 10 genera, and 4 species. The peak period for pollen dispersal in summer and autumn in Taiyuan City from late August to early September. airborne pollen Artemisia（66.62%）, Cannabis/Humulus（17.79%）, Sophora japonica（8.18%）, Chenopodiaceae/Amaranthaceae（2.83%）, Gramineae（2.11%）. ②The concentration of airborne pollen in Taiyuan City positively correlated with the average temperature（5-20℃） and maximum temperature（11-30℃） within a certain range（r=0.547, 0.315, P<0.05）. ③The content of airborne pollen in Taiyuan City positively correlated with the number of visits and allergen positive rate of patients with allergic rhinitis（AR） in our hospital（r=0.702, 0.747, P<0.05）. Conclusion:The peak period for airborne pollen dispersal during the summer and autumn seasons in Taiyuan City from late August to early September. The dominant pollen is Artemisia, Cannabis/Humulus, Sophora japonica, Chenopodiaceae/Amaranthaceae, Gramineae, and the absolute advantage pollen is Artemisia. Meteorological factors pollen content. Within a certain range, temperature the diffusion and transportation of pollen. The number of pollen grains the number of visits, which can serve as an environmental warning indicator for AR patients to take preventive, thereby reducing the risk of allergies.
Male ; Humans ; Seasons ; Pollen ; Rhinitis, Allergic ; Allergens ; Cities

Objective:Anatomical study of the cross-donor flap pedicled with the peroneal artery and the discussion of the effect of clinical application, so as to describe a new method for the repair of large-area soft tissue defects in the foot and ankle.Methods:From June 2016 to August 2019, 12 specimens of adult lower limbs were studied. The popliteal arteries were perfused with perchloroethylene-ethyl acetate-lead oxide and red perchloroethylene-ethyl acetate. The origin, number, outer diameter, course and distribution of perforating branches of the peroneal artery were anatomically observed. The source, distribution and anastomosis of the skin nutrient vessels in the posterolateral area of the calf were also studied. Relationship of the blood supply between the peroneal arteries and veins and the nutritional vessels of the sural nerve were observed. In 9 patients, the peroneal artery and vein were designed as the pedicle of cross-donor flap in the repair of large soft tissue defects of foot and ankle. The patients were entered follow-up through outpatient visits and telephone interviews.Results:Among the 12 adult specimens of lower limbs, there were 65 perforating branches from the peroneal artery, 4-7 branches on each side, with an average of (5.41±1.00) branches. The diameter of the penetrating deep fascia was(1.07±0.36) mm. The perforator branches were mostly distributed in 3 sections of 4.0-11.0 cm, 16.0-21.0 cm and 24.0-27.0 cm away from the lateral malleolus, accounting for 48%, 24% and 17% of the total number of perforators, respectively. The outer diameters of the perforator vessels were (0.92±0.26)(0.56-1.68) mm, (1.32±0.38)(0.60-2.14) mm, and (0.98±0.28)(0.62-1.36) mm. The length of the pedicle of the perforator vessels were (3.91±0.96)(2.15-5.78) cm, (5.34±0.50)(4.01-5.85) cm, and (3.31±1.15)(2.16-5.66) cm. The perforating branches in the 3 sections appeared constantly. The diameter of the vessels was≥0.5 mm with an average length of at(4.19±1.16)(2.15-5.85) cm. The vascular network of the flap in the posterolateral area of the calf was mainly composed of subdermal vascular network and deep fascial vascular network. The deep fascia vascular network in the posterolateral area of the calf had 3 obvious longitudinal chains, including the medial sural neurotrophic vascular chain, the small saphenous vein-sural nerve communicating branch vascular chain and the lateral sural neurotrophic vascular chain, which took the nutrient blood supply from the perforating branches of the peroneal artery also formed a longitudinal and transverse anastomosis between the perforating branches of the peroneal artery. In the clinical trials performed on 9 patients, all soft tissue defects of foot and ankle were repaired. The composite tissue flap survived without infection or necrosis. The follow-up was lasted for 12 months to 3 years. The postoperative function and the donor site appearance were good and the patients walked normally. According to the American Orthopaedic Foot and Ankle Association(AOFAS) foot scoring standard, the function of affected feet were evaluated. Five patients were excellent and 4 were good.Conclusion:The cross-donor flaps pedicled with peroneal arteries and veins has sufficient blood supply and a large area. It provides a method for the repair of large-area soft tissue defects in the foot and ankle.

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on emergence agitation in the patients undergoing thoracoscopic surgery.Methods:Eighty patients of both sexes, aged 25-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective thoracoscopic surgery under general anesthesia, were divided into 2 groups ( n=40 each) by a random number table method: TEAS group (group T) and control group (group C). In group T, the Hegu (L14), Zusanli (ST36) and Sanyinjiao (SP6) were stimulated starting from 30 min before induction of anesthesia until the end of operation, with a frequency of 2/100 Hz and disperse-dense waves.The intensity of stimulation was the maximum current that patients could tolerate.In group C, stimulating electrodes were placed at the same acupoints before induction, but no electrical stimulation was applied.Ramsay sedation score and VAS score were recorded.and emergence agitation was assessed using RSS agitation score.Blood samples from the median cubital vein or internal jugular vein were collected before anesthesia induction (T 1), at the end of surgery (T 2), immediately after removal of tracheal tube (T 3) and at 15 min after removal of tracheal tube (T 4) for determination of serum interleukin-6 (IL-6) and IL-10 concentrations by enzyme-linked immunosorbent assay.The intraoperative consumption of propofol, remifentanil and sufentanil was recorded.Adverse reactions such as tachycardia, bradycardia, hypertension, hypotension, respiratory depression, delay of awakening and nausea and vomiting were recorded after operation. Results:Compared with group C, the amount of intraoperative remifentanil consumed was significantly decreased, serum IL-6 concentrations were decreased, and the serum IL-10 concentration was increased T 2-4, Ramsay sedate score was increased, and the incidence of agitation was decreased in group T ( P<0.05). There was no significant difference in VAS score and incidence of postoperative adverse reactions between the two groups ( P>0.05). Conclusions:TEAS can reduce the development of emergence agitation in the patients undergoing thoracoscopic surgery, which is related to inhibition of inflammatory responses.

Purpose: This study aims to comprehensively evaluate the clinical efficacy of chemotherapy or endocrine therapy maintenance in metastatic breast cancer (MBC) patients. Materials and Methods: The meta-analysis of randomized clinical trials (RCTs) and propensity score matching of multicenter cohort study evaluated MBC patients who underwent first-line chemotherapy or endocrine therapy maintenance. This study is registered with PROSPERO: CRD42017071858 and ClinicalTrials.gov: NCT04258163. Results: A total of 2,867 patients from 15 RCTs and 760 patients from multicenter cohort were included. The results from meta-analysis showed that chemotherapy maintenance improved progression-free survival (PFS) (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.54 to 0.73; p < 0.001; moderate-quality evidence) and overall survival (OS) (HR, 0.87; 95% CI 0.78 to 0.97; p=0.016; high-quality evidence) than observation. In the cohort study, for hormone receptor–positive MBC patients, chemotherapy maintenance improved PFS (HR, 0.67; 95% CI, 0.52 to 0.85; p < 0.001) and OS (HR, 0.55; 95% CI 0.42 to 0.73; p < 0.001) compared with observation, and endocrine therapy maintenance also improved PFS (HR, 0.65; 95% CI, 0.53 to 0.80; p < 0.001) and OS (HR, 0.55; 95% CI, 0.44 to 0.69; p < 0.001). There were no differences between chemotherapy and endocrine therapy maintenance in PFS and OS (all p > 0.05). Regardless of the continuum or switch maintenance therapy, showed prolonged survival in MBC patients who were response to first-line treatment. Conclusion This study provided evidences for survival benefits of chemotherapy and endocrine therapy maintenance in MBC patients, and there was no difference efficacy between chemotherapy and endocrine therapy maintenance for hormone receptor–positive patients.

Objective:To evaluate the effect of nimodipine on postoperative cognitive function in elderly patients undergoing carotid endarterectomy.Methods:Eighty-two American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 65-80 yr, scheduled for elective carotid endarterectomy under general anesthesia, were divided into 2 groups ( n=41 each) using a random number table method: control group (group C) and nimodipine group (group N). Nimodipine 7.5 μg·kg -1·h -1 was intravenously infused starting from the beginning of surgery until the end of surgery in group N, while the equal volume of normal saline was given in group C. Before infusing nimodipine (T 1), before placing the the shunt (T 2), at 10 min after placing the the shunt (T 3) and at 10 min after releasing carotid artery (T 4), blood samples were taken from the radial artery and jugular bulb for blood gas analysis.Jugular venous blood oxygen content, arterio-jugular difference of oxygen content, and cerebral oxygen extraction ratio were calculated.The concentrations of S100β protein in serum of the jugular bulb were measured by enzyme-linked immunosorbent assay.Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) Scale (Chinese version) at 1 day before surgery and 1, 3 and 7 days after surgery, and the occurrence of cognitive dysfunction (MoCA score<26) was recorded within 7 days after operation. Results:Compared with group C, MoCA scores were significantly increased at each time point after surgery, and the incidence of cognitive dysfunction was decreased (27% vs.17%), and the jugular venous blood oxygen content was increased, and arterio-jugular difference of oxygen content, cerebral oxygen extraction ratio, and concentrations of serum S100β protein were decreased at T 2-4 in group N ( P<0.05). Conclusions:Nimodipine can improve the cognitive function after carotid endarterectomy, which may be related to the improvement in intraoperative cerebral oxygen metabolism and reduction of brain injury in elderly patients.

Objective:To evaluate the improved efficacy of ultrasonography-guided superior laryngeal nerve block (SLNB) in elderly patients undergoing short surgery with general anesthesia.Methods:Sixty-four patients of both sexes, aged≥65 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective percutaneous balloon compression under general anesthesia, were divided into 2 groups ( n=32 each) using a random number table method: control group (group C) and ultrasound-guided SLNB group (group S). The patients received bilateral SLNB under ultrasound guidance, and 1% lidocaine 3 ml was injected on each side in group S, while the equal volume of normal saline was given instead in group C. Anesthesia was induced with midazolam, sufentanil, etomidate and mivacurium, and then the patients were mechanically ventilated after endotracheal intubation.Anesthesia was maintained with propofol, remifentanil, and sevoflurane.Cardiovascular response to endotracheal intubation was defined as SBP or HR increased by more than 30% of baseline from the time point immediately after intubation to 2 min after intubation, and the occurrence was recorded.Venous blood samples were collected to detect the plasma concentrations of norepinephrine and cortisol before anesthesia induction and at 5 min after intubation.The development of bucking was recorded during emergence, and the time of tracheal extubation and occurrence of sore throat, throat numbness and hoarseness after tracheal extubation were recorded. Results:Compared with group C, the incidence of cardiovascular response to endotracheal intubation was significantly decreased, the plasma concentrations of norepinephrine and cortisol were decreased at 5 min after intubation, and the incidence of bucking during emergence and sore throat after tracheal extubation was decreased in group S ( P<0.05). Conclusions:Ultrasound-guided SLNB can inhibit the stress response during endotracheal intubation and reduce the occurrence of adverse events during emergence in elderly patients undergoing short surgery with general anesthesia.

Objective To study the effect of three kinds of commonly used liquid culture media for in vitro cell experiments on elastic modulus of breast cancer cells, so as to provide references for developing novel diagnosis and treatment approach of tumour based on mechanics principles. Methods The elastic modulus and adhesion force of breast cancer cells MCF7 to atomic force microscopy (AFM) probes in phosphate buffered solution(PBS), Dulbecco’s modified eagle media (DMEM) and DMEM+10% fetal bovine serum (FBS) were measured using AFM technology. Results The elastic moduli of breast cancer cells in PBS, DMEM and DMEM+10% FBS were 2.59, 2.11 and 1.59 kPa, respectively. The cell adhesion forces in the above three kinds of liquid medium environment were 63.81, 66.09 and 121.97 pN, respectively. Cell adhesion force in DMEM+10%FBS was significantly different from that of the other two kinds of liquid media. Conclusions There are significant differences in elastic modulus of breast cancer cells in three kinds of liquid media. The difference between DMEM and DMEM+10%FBS might be caused by the different adhesion force caused by serum proteins in the media, and the difference between DMEM and PBS might be attributed to the difference in pH of the media.

Objective:To evaluate the role of G protein-coupled receptor 30 (GPR30) in reduction of ketamine-induced long-term cognitive dysfunction by 17β estradiol in neonatal rats.Methods:Thirty healthy male Sprague-Dawley rats, aged 7 days, weighing 11-18 g, were divided into 5 groups ( n=6 each) using a random number table method: control group (group C), ketamine group (group K), 17β estradiol plus ketamine group (group KE), GPR30 agonist G1 plus ketamine group (group G1K) and GPR30 inhibitor G15 plus 17β estradiol plus ketamine group (group G15EK). Ketamine 75 mg/kg was intraperitoneally injected in group K. In group EK, 17β estradiol 600 μg/kg was subcutaneously injected, and ketamine 75 mg/kg was intraperitoneally injected.In group G1K, G1 200 μg/kg was subcutaneously injected, and ketamine 75 mg/kg was intraperitoneally injected.In group G15EK, G15 300 μg/kg and 17β estradiol 600 μg/kg were subcutaneously injected, and ketamine 75 mg/kg was intraperitoneally injected.The equal volume of normal saline was intraperitoneally given in group C. The injection was performed every 24 h for 3 consecutive days.All the rats were allowed to grow up till postnatal day 60, and then Morris water maze test was performed to evaluate their spatial learning and memory function.The rats were sacrificed after the end of Morris water maze test, and hippocampi were removed for determination of contents of acetyl cholinesterase (AChE) and acetylcholine (ACh) by enzyme-linked immunosorbent assay. Results:Compared with group C, the escape latency was significantly prolonged on the 3-5 training days, the frequency of crossing the platform and percentage of time of staying at the target quadrant were decreased, the content of AChE was increased, and the content of ACh was decreased in group K ( P<0.05). Compared with group K, the escape latency was significantly shortened on the 3-5 training days, the frequency of crossing the platform and percentage of time of staying at the target quadrant were increased, the content of AChE was decreased, and the content of ACh was increased in EK and G1K groups ( P<0.05). Compared with EK and G1K groups, the escape latency was significantly prolonged on the 3-5 training days, the frequency of crossing the platform and percentage of time of staying at the target quadrant were decreased, the content of AChE was increased, and the content of ACh was decreased in group G15EK ( P<0.05). Conclusion:GPR30 is involved in reduction of ketamine-induced long-term cognitive dysfunction by 17β estradiol, which is related to regulating the contents of AChE and ACh in hippocampi of neonatal rats.

Objective:To compare the effects of different acupoint compatibility on the efficacy of acupuncture-drug balanced anesthesia in the patients undergoing laparoscopic cholecystectomy.Methods:A total of 140 patients of both sexes, aged 18-64 yr, with body mass index of 18.5-24.0 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic cholecystectomy under general anesthesia, were divided into 4 groups ( n=35 each) by a random number table method: general anesthesia group (group A), Hegu plus Neiguan group (group B), Hegu plus Neiguan plus Zusanli group (group C), and Hegu plus Neiguan plus Zusanli plus Sanyinjiao group (group D). Group B, group C and group D underwent percutaneous electrical stimulation of the corresponding acupoints from 30 min before induction of anesthesia to the end of operation, with a frequency of 2/100 Hz and disperse-dense waves.The intensity of stimulation was the maximum current that patients could tolerate.The intraoperative consumption of propofol and remifentanil and requirement for rescue analgesia were recorded.Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at 24 h before surgery and 24, 48 and 72 h after surgery.The extubation time and postoperative length of hospital stay were recorded.Adverse events such as intraoperative hypertension, hypotension, bradycardia and tachycardia were recorded. Results:Compared with group A, the intraoperative consumption of propofol and remifentanil and postoperative requirement for rescue analgesia were significantly reduced, the extubation time and postoperative length of hospital stay were shortened, and PSQI was decreased at 24 and 48 h after surgery in B, C and D groups ( P<0.05). Compared with group B and group C, PSQI was significantly decreased at 24 and 48 h after surgery, and postoperative hospitalization time was shortened in group D ( P<0.05). There was no significant difference in the PSQI and incidence of intraoperative hypertension, hypotension, bradycardia and tachycardia among the four groups ( P>0.05). Conclusion:Combination of Hegu, Neiguan, Zusanli and Sanyinjiao has a better effect on the efficacy of acupuncture-drug balanced anesthesia in the patients undergoing laparoscopic cholecystectomy.