Objective To investigate the predictive value of the combined tumor burden score (TBS) and platelet-albumin-bilirubin (PALBI) score model for postoperative tumor recurrence in liver transplant recipients with hepatocellular carcinoma (HCC). Methods The general information of 158 recipients diagnosed with HCC and underwent liver transplantation at the 900th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from 2008 to 2021 was collected. Lasso regression analysis combined with multivariate Cox regression analysis were used to identify independent risk factors for postoperative tumor recurrence after liver transplantation with HCC. A nomogram prediction model was constructed based on variables selected by Lasso regression analysis, and the predictive performance of the model was verified by calibration curve and clinical decision curve. The optimal cut-off values for postoperative tumor recurrence in liver transplant recipients with HCC were determined by receiver operating characteristic (ROC) curve, and Kaplan-Meier analysis was used to compare survival differences among different groups. Results Among the 158 liver transplant recipients with HCC, 82 experienced tumor recurrence, with a recurrence rate of 51.9% and a median tumor-free survival time of 10 (4, 25) months. Results of Lasso regression analysis and multivariate Cox regression analysis showed that alpha-fetoprotein (AFP) ≥400 ng/mL, TBS and PALBI score were all independent risk factors for postoperative tumor recurrence in liver transplant recipients with HCC (all P<0.05). The combined high TBS-high PALBI score showed the highest predictive value (hazard ratio 6.909, 95% confidence interval 3.067-15.563, P<0.001). A nomogram prediction model was constructed based on six variables selected by Lasso regression analysis. Calibration curve showed good consistency between the model's predicted results and the ideal curve. Decision curve analysis indicated that the nomogram prediction model provided the highest clinical benefit for predicting 1-year tumor-free survival after liver transplantation with HCC. Time-dependent ROC curves at 1, 3 and 5 years after surgery showed that TBS-PALBI model had good predictive performance, with no significant difference in area under the curve (AUC) compared with TBS-PALBI-AFP model. The optimal cut-off values for predicting postoperative tumor recurrence were determined by ROC curve, with a PALBI score cut-off of −2.334 and a TBS cut-off of 5.305. Recipients were divided into a low TBS-low PALBI score group (n=47) and a low/high TBS-low/high PALBI score group (at least one score was high) (n=111). Kaplan-Meier survival analysis showed that the low TBS-low PALBI score group had a higher tumor-free survival rate than the low/high TBS-low/high PALBI score group, with a significant difference (P<0.05). Conclusions TBS-PALBI model provides a novel, simple and effective tool for assessing the prognosis of liver transplant recipients with HCC. The nomogram model constructed based on this has significant advantages in predictive performance and may serve as a reference for guiding individualized treatment plans and improving clinical outcomes.

In recent years， the incidence of pulmonary nodules has kept rising. To give full play to the advantages of traditional Chinese medicine （TCM） in the treatment of pulmonary nodules and identify the breakthrough points of integrating TCM with Western medicine， the China Association of Chinese Medicine organized medical experts in TCM and western medicine to carry out in-depth discussion regarding this disease. The discussion encompassed the modern medical advances， TCM theories of etiology and pathogenesis， the role and advantages of TCM in the whole course management of pulmonary nodules， contents and methods of research on pulmonary nodules， and science popularization work， aiming to provide a reference for clinical practice and scientific research. After discussion， the experts concluded that the occurrence of pulmonary nodules was rooted in the deficiency of the lung and spleen and triggered by phlegm dampness， blood stasis， and Qi stagnation. TCM can treat pulmonary nodules by controlling and reducing nodules， improving physical constitution， ameliorating multi-system nodular diseases， reducing anxiety and avoiding excessive diagnosis and treatment， and serving as an alternative for patients who are unwilling or unfit for surgical treatment. At present， the optimal diagnosis and treatment strategy for pulmonary nodules has not been formed， which needs to be further studied from multiple perspectives such as clinical epidemiology， biology， and evidence-based medicine. The primary task of current research is to find out the advantages， effective prescriptions， and target populations and determine the effective outcomes of TCM in the treatment of pulmonary nodules. At the same time， basic research should be carried out to explore the etiology and biological behaviors of pulmonary nodules. The expert consensus on the diagnosis and treatment of pulmonary nodules with integrated TCM and Western medicine needs to be continuously revised to guide clinicians to conduct standardized， scientific， and accurate effective diagnosis and treatment.

Objective:To explore the recovery of abdominal function and and satisfaction rate in patients who received lower abdominal skin flap repair of extensive soft tissue defects in the limbs based on three-dimensional computed tomography angiography(3D-CTA) technology.Methods:A retrospective study was performed to analyze clinical data from patients with extensive skin and soft tissue defects in the limbs, who were admitted to Shandong Provincial Third Hospital between March 2017 and February 2022. Patients were categorized into two groups: the superficial inferior epigastric artery (SIEA) group and the deep inferior epigastric perforator (DIEP) group, with SIEA flaps and DIEP flaps utilized respectively for tissue defect repair. Based on 3D-CTA imaging, the distribution range and vessel diameters of bilateral SIEA, superficial inferior epigastric veins (SIEV), and DIEP were delineated, facilitating the design and harvest of SIEA and DIEP flaps. Comparisons were drawn between preoperative 3D-CTA findings on the course and distribution of SIEA and SIEV, and intraoperative anatomical observations. In addition, the concordance between vessel diameters and pedicle lengths determined via preoperative 3D-CTA and intraoperative measurements was assessed. The flap survival, wound healing and surveyed patients’ satisfaction with wound repair were analyzed. A customized evaluation scale was utilized to assess abdominal contour one year post-surgery, scoring from 5 to 25, with higher scores indicating better outcomes. The abdominal health module of the BREAST-Q scale evaluated patients’ satisfaction with abdominal function preoperatively, three months postoperatively, and one year postoperatively, scoring from 20 to 100, with increasing scores indicating greater satisfaction. The measurement data that conform to the normal distribution were expressed as Mean±SD, and the comparison between the two groups was performed using independent samples t-test. The comparison were conducted at multiple time points, repeated measures analysis of variance was performed, and for the comparison of scores within the group, paired t-test was applied. Results:A total of 21 patients were included, 3 males and 18 females, with an age range of 21 to 60 years and a mean age of 41 years. The range of skin and soft tissue defects was from 10.0 cm × 5.0 cm to 22.0 cm × 14.0 cm, and the range of skin flap harvesting was from 11.0 cm × 6.0 cm to 23.0 cm × 15.0 cm. There were 11 cases in the SIEA group and 10 cases in the DIEP group. Preoperative 3D-CTA examination showed that the course and distribution of SIEA and SIEV were consistent with intraoperative anatomical observations. There was no statistically significant difference in the comparison of vessel diameters, pedicle lengths, and actual measurements between preoperative 3D-CTA examination and intraoperative measurements (all P > 0.05). No flap necrosis occurred postoperatively, wound healing was uneventful in all cases. At 1 year postoperatively, there was no statistically significant difference in abdominal contour scores between the SIEA and DIEP groups [(21.96±3.51) points vs. (21.62±3.17) points, P > 0.05]. Comparison of preoperative abdominal function satisfaction scores between the SIEA and DIEP groups showed no statistically significant difference [(87.56 ± 5.70) points vs. (85.79 ± 6.33) points, P > 0.05]. However, at 3 months and 1 year postoperatively, the SIEA group had higher scores than the DIEP group [at 3 months postoperatively, (77.62 ± 7.68) points vs. (65.21 ± 8.27) points; at 1 year postoperatively, (86.93 ± 5.65) points vs. (77.59 ± 5.92) points; both P < 0.01], indicating higher abdominal function satisfaction of the SIEA group postoperatively. The scores of both the SIEA and DIEP groups decreased at 3 months postoperatively compared to preoperative scores (both P < 0.01). At 1 year postoperatively, the score of the SIEA group was similar to preoperative levels, with no statistically significant difference ( P > 0.05), while the score of the DIEP group remained lower than preoperative levels ( P < 0.01). Conclusion:Reconstruction of extensive skin and soft tissue defects in the limbs using SIEA flaps, without injury to the deep tissues of the abdominal wall, allows for near-complete restoration of abdominal function and appearance to preoperative levels, with minimal impact on the donor site. Preoperative 3D-CTA reveals the anatomical variations in the vascular supply of SIEA flaps among individuals, achieving comparable wound repair outcomes to other lower abdominal flaps.

Objective To screen and analyze the differentially expressed genes(DEGs)in basal cell carcinoma(BCC)of the eyelid using RNA sequencing technology.Methods Six patients who underwent extended resection and primary eyelid reconstruction for BCC of the eyelid in Hebei Eye Hospital from July to November 2021 were selected.Part of the excised cancer tissues and the adjacent normal tissues trimmed during the repair of the defect were sampled for the study.The library construction for sequencing was performed using RNA sequencing technology.The threshold for DEGs was set using the DESeq2 software:P＜0.05 and|log2(foldchange)|＞1,to identify DEGs.Gene Ontology(GO)and Kyo-to Encyclopedia of Genes and Genomes(KEGG)enrichment analyses were performed using the clusterProfiler software,and the biological significance of these DEGs was further analyzed.Results DESeq2 software was used to analyze the differential expression between cancer tissues and adjacent tissues,and 1 317 DEGs were screened out.In the cancer tis-sues of the 6 patients,906 DEGs were up-regulated,and 411 DEGs were down-regulated.GO enrichment analysis showed that the top 30 up-regulated DEGs were mainly concentrated in humoral immune response,immunoglobulin complex,B cell receptor signaling pathway,extracellular matrix,antigen binding,and receptor modulator activity,and the top 10 down-regulated genes were mainly related to epidermal development in biological process,cell composition,and molecular func-tion.KEGG pathway analysis revealed that DEGs were mainly enriched in the melanogenesis signaling pathway,WNT sig-naling pathway,and immune-related signaling pathway,and there were 8 related gene pathways.According to the signifi-cance of gene up-regulation,the core genes identified finally were FZD2,PTCH1,WNT7B,TCF3,MMP-9,and TEAD2.Conclusion The occurrence of BCC is closely related to the interaction and synergy of various pathways.Among the highly expressed genes,the up-regulation of FZD2,PTCH1,WNT7B,TCF3,MMP-9,and TEAD2 expression in the tissues of patients with BCC of the eyelid is the most significant,which is closely related to the occurrence and development of BCC of the eyelid.

Malocclusion,identified by the World Health Organization(WHO)as one of three major oral diseases,profoundly impacts the dental-maxillofacial functions,facial esthetics,and long-term development of～260 million children in China.Beyond its physical manifestations,malocclusion also significantly influences the psycho-social well-being of these children.Timely intervention in malocclusion can foster an environment conducive to dental-maxillofacial development and substantially decrease the incidence of malocclusion or reduce the severity and complexity of malocclusion in the permanent dentition,by mitigating the negative impact of abnormal environmental influences on the growth.Early orthodontic treatment encompasses accurate identification and treatment of dental and maxillofacial morphological and functional abnormalities during various stages of dental-maxillofacial development,ranging from fetal stages to the early permanent dentition phase.From an economic and societal standpoint,the urgency for effective early orthodontic treatments for malocclusions in childhood cannot be overstated,underlining its profound practical and social importance.This consensus paper discusses the characteristics and the detrimental effects of malocclusion in children,emphasizing critical need for early treatment.It elaborates on corresponding core principles and fundamental approaches in early orthodontics,proposing comprehensive guidance for preventive and interceptive orthodontic treatment,serving as a reference for clinicians engaged in early orthodontic treatment.

Objective:To explore the recovery of abdominal function and and satisfaction rate in patients who received lower abdominal skin flap repair of extensive soft tissue defects in the limbs based on three-dimensional computed tomography angiography(3D-CTA) technology.Methods:A retrospective study was performed to analyze clinical data from patients with extensive skin and soft tissue defects in the limbs, who were admitted to Shandong Provincial Third Hospital between March 2017 and February 2022. Patients were categorized into two groups: the superficial inferior epigastric artery (SIEA) group and the deep inferior epigastric perforator (DIEP) group, with SIEA flaps and DIEP flaps utilized respectively for tissue defect repair. Based on 3D-CTA imaging, the distribution range and vessel diameters of bilateral SIEA, superficial inferior epigastric veins (SIEV), and DIEP were delineated, facilitating the design and harvest of SIEA and DIEP flaps. Comparisons were drawn between preoperative 3D-CTA findings on the course and distribution of SIEA and SIEV, and intraoperative anatomical observations. In addition, the concordance between vessel diameters and pedicle lengths determined via preoperative 3D-CTA and intraoperative measurements was assessed. The flap survival, wound healing and surveyed patients’ satisfaction with wound repair were analyzed. A customized evaluation scale was utilized to assess abdominal contour one year post-surgery, scoring from 5 to 25, with higher scores indicating better outcomes. The abdominal health module of the BREAST-Q scale evaluated patients’ satisfaction with abdominal function preoperatively, three months postoperatively, and one year postoperatively, scoring from 20 to 100, with increasing scores indicating greater satisfaction. The measurement data that conform to the normal distribution were expressed as Mean±SD, and the comparison between the two groups was performed using independent samples t-test. The comparison were conducted at multiple time points, repeated measures analysis of variance was performed, and for the comparison of scores within the group, paired t-test was applied. Results:A total of 21 patients were included, 3 males and 18 females, with an age range of 21 to 60 years and a mean age of 41 years. The range of skin and soft tissue defects was from 10.0 cm × 5.0 cm to 22.0 cm × 14.0 cm, and the range of skin flap harvesting was from 11.0 cm × 6.0 cm to 23.0 cm × 15.0 cm. There were 11 cases in the SIEA group and 10 cases in the DIEP group. Preoperative 3D-CTA examination showed that the course and distribution of SIEA and SIEV were consistent with intraoperative anatomical observations. There was no statistically significant difference in the comparison of vessel diameters, pedicle lengths, and actual measurements between preoperative 3D-CTA examination and intraoperative measurements (all P > 0.05). No flap necrosis occurred postoperatively, wound healing was uneventful in all cases. At 1 year postoperatively, there was no statistically significant difference in abdominal contour scores between the SIEA and DIEP groups [(21.96±3.51) points vs. (21.62±3.17) points, P > 0.05]. Comparison of preoperative abdominal function satisfaction scores between the SIEA and DIEP groups showed no statistically significant difference [(87.56 ± 5.70) points vs. (85.79 ± 6.33) points, P > 0.05]. However, at 3 months and 1 year postoperatively, the SIEA group had higher scores than the DIEP group [at 3 months postoperatively, (77.62 ± 7.68) points vs. (65.21 ± 8.27) points; at 1 year postoperatively, (86.93 ± 5.65) points vs. (77.59 ± 5.92) points; both P < 0.01], indicating higher abdominal function satisfaction of the SIEA group postoperatively. The scores of both the SIEA and DIEP groups decreased at 3 months postoperatively compared to preoperative scores (both P < 0.01). At 1 year postoperatively, the score of the SIEA group was similar to preoperative levels, with no statistically significant difference ( P > 0.05), while the score of the DIEP group remained lower than preoperative levels ( P < 0.01). Conclusion:Reconstruction of extensive skin and soft tissue defects in the limbs using SIEA flaps, without injury to the deep tissues of the abdominal wall, allows for near-complete restoration of abdominal function and appearance to preoperative levels, with minimal impact on the donor site. Preoperative 3D-CTA reveals the anatomical variations in the vascular supply of SIEA flaps among individuals, achieving comparable wound repair outcomes to other lower abdominal flaps.

A 19-year-old male patient was admitted to a community hospital in Yangpu District of Shanghai in September 2023 due to diarrhea (4 times per day, watery stool) for 3 consecutive days. The patient had a history of eating out at a barbecue restaurant the night before the onset. The case accorded with diarrhea disease surveillance, and the pathogen was isolated as "non-A-F serogroup Salmonella" by the public health laboratory in the area where the patient′s feces swab was collected. The strain was identified as Salmonella Urbana ST512 by serological typing, antimicrobial resistance phenotype, and whole genome sequencing analysis in the Reference Lab, and then compared with the regional serotype database of Salmonella in China. At last, the patient was cured after taking levofloxacin orally for 3 days.

ObjectiveTo investigate the effects of Yanghetang （YHT） on breast cancer 4T1 cells and their mitogen-activated protein kinase （MEK）/extracellular signal-regulated kinase （ERK） signaling pathway. MethodThe YHT-containing serum was prepared from SD rats. The rats were randomly assigned into a blank group （normal saline） and low-， medium-， and high-dose （5.8， 11.6， 23.2 g·kg^-1， respectively） YHT groups. The serum containing 10% YHT in each group was mixed with 90% RMPI 1640 complete medium， and the mixture was used to interfere with the cells. Cell counting kit-8 （CCK-8） method was used to detect the proliferation of the 4T1 cells treated with YHT for 24， 48， 72 h. The apoptosis， migration， and invasion of 4T1 cells were detected by flow cytometry， scratch test， and Transwell assay， respectively. Western blot was employed to determine the expression levels of MEK1/2， phosphorylation （p）-MEK1/2， ERK1/2， p-ERK1/2， and rat sarcoma virus （RAS） protein. ResultCompared with the blank group， the intervention with YHT-containing serum for 24， 48， and 72 h had significant inhibitory effect on 4T1 cell proliferation （P<0.05， P<0.01）. After intervention with YHT-containing serum for 48 h， the apoptosis rate of cells increased （P<0.01）. Compared with the blank group， the intervention with YHT for 24 h and 48 h decreased the healing ability of cells in the scratch test （P<0.01）. The invasive ability of cells treated with the low， medium， and high-dose YHT containing serum showed a decreasing trend （P<0.01）. Compared with the blank group， YHT-containing serum did not change the expression of MEK1/2 and ERK1/2 while down-regulating the expression of p-MEK1/2， p-ERK1/2， and RAS protein （P<0.01）. ConclusionYHT can inhibit the proliferation， migration， and invasion and promote the apoptosis of breast cancer 4T1 cells. In may promote the apoptosis by inhibiting the MEK/ERK signaling pathway and down-regulating the expression of p-MEK1/2， p-ERK1/2， and RAS protein.

ObjectiveTo observe the regulation of Qigongwan on the expression of proliferation and apoptosis-related factors programmed cell death 4 （PDCD4） and proliferating cell nuclear antigen （PCNA） in ovarian granulosa cells （GCs） in patients with polycystie ovarian syndrome （PCOS） infertility with phlegm-dampness syndrome， and to explore the effect of Qigongwan on the quality of oocytes and embryonic development potential. MethodSixty-six patients with PCOS with phlegm-dampness syndrome who underwent in vitro fertilization and embryo transfer （IVF-ET） were randomly selected and divided into an observation group （Qigongwan + western medicine） and a control group （western medicine）， with 33 patients in each group. Antagonist regimen was used to promote ovulation in the two groups. The observation group was given Qigongwan one cycle before IVF based on the treatment of conventional western medicine， while the control group was not given Chinese medicine. The improvement of phlegm and dampness syndrome， the dosage and the number of days of using gonadotropins （Gn）， the levels of luteinizing hormone （LH）， estradiol （E₂）， and progesterone （P） on the day of human chorionic gonadotropin（HCG） injection， the 2PN fertilization rate， and the high-quality embryo rate of patients in the two groups were compared. Real-time polymerase chain reaction （Real-time PCR） and Western blot technology were used to detect the expression of PCNA and PDCD4 in GCs. ResultAs compared with groups before treatment， the score of phlegm-dampness syndrome in both groups was significantly lower （P<0.01）. The score of phlegm and dampness syndrome in the observation group was significantly lower than that of the control group （P<0.01）. As compared with the control group， the levels of LH， E₂， and P in the observation group was higher， but only the difference in the level of E₂ was statistically significant （P<0.01）. The 2PN fertilization rate ［82.25% （556/676） vs 69.92% （365/522）， χ²=25.172， P<0.01］ and high-quality embryo rate ［44.19% （190/430） vs 34.23% （102/298）， χ²=7.266， P<0.01］ in the observation group were significantly higher than that of the control group （P<0.01）. As compared with the control group， the mRNA and protein expression of PDCD4 in ovarian GCs was down-regulated in the observation group and that of PCNA was up-regulated （P<0.05）. ConclusionBy down-regulating the expression of PDCD4 and up-regulating the expression of PCNA， Qigongwan may interfere with follicle development， adjust hormone levels， improve the symptomatic manifestations of patients with PCOS with phlegm-dampness syndrome， inhibit the apoptosis of GCs， and promote growth， thus improving the quality of oocytes and embryonic development potential.

Objective:To investigate the appropriate pretreatment methods for single cell RNA sequencing of airway aspirate cells.Methods:Four fresh airway aspirate specimens were collected from four patients with acute respiratory tract infections. These specimens were digested with airway aspirate digester and prepared into single cell suspension. The cells were used for library construction directly (DE), or fixed with 10×Genomics Chromium Next GEM Single Cell Fixed RNA Sample Preparation Kit and then mixed to construct the library (DF), or cryopreserved, thawed, fixed (FF) before mixed to construct the library. All three methods were treated with oil emulsion using 10 4 cells and subjected to single-cell sequencing using the 10×Genomics platform. The number of obtained cells, data quality, annotated cell types and expression of marker genes were analyzed. Differences in the expression of highly variable genes (HVGs) of the same cell subsets obtained by the three pretreatment methods were compared using Pearson correlation. Expression of the differentially expressed genes in the same cell subpopulation obtained by different pretreatment methods was also compared. The correlation of the expression of differentially expressed genes between the same cell subsets obtained by the three pretreatment methods was analyzed by Pearson correlation. Results:The median numbers of single cells obtained using DE, FF and DF methods were 2 733, 1 140 and 5 897 ( P>0.05). The unique molecular identifiers were higher than 500. The median numbers of genes obtained using the three methods were 801, 887 and 1 259 ( P>0.05). The cells with novelty score over 0.8 accounted for 99%, 87% and 93%, respectively. There were nine cell subsets obtained by the three methods, including squamous cells, secretory cells, ciliated cells, T cells, B cells, macrophages, plasma cells and neutrophils. DF and FF methods could obtain more basal cells with specific high expression of keratin 5 than DE method. The differentially expressed and highly variable genes in the same cell subsets obtained by the three pretreatment methods showed high consistency in their expression with a significant correlation ( P<0.001). Conclusions:Under the same sequencing data volume, the quality of data obtained from fixed airway aspirate single-cell suspensions using the method of probe hybridization and transcriptome sequencing was comparable to that obtained directly from fresh cells. This method was more suitable for the pretreatment of clinical samples used for single-cell RNA sequencing.