Airway management in complex tracheobronchial surgery(TBS)remains a challenge in thoracic sur-gery.The use of extracorporeal membrane pulmonary oxygenation(ECMO)in thoracic surgery is rather rare,except for lung transplantation.To report the safety and efficacy of ECMO in complex TBS,a total of 5 patients with tracheobronchial and bronchial reconstructive surgery supported by ECMO in the Department of Thoracic Surgery of Tangdu Hospital,Air Force Medical University from May 2019 to June 2024 were collected.Among them,4 cases of tracheal tumor(including long-segment trachea resection and reconstruction,or carinal resection and reconstruction)and 1 case of acute airway obstruction caused by tracheal rupture were included,all of which were performed in veno-venous ECMO(V-V ECMO)mode.Systemic heparinization was used in 2 patients,and anticoagulation was not performed in 3 patients,which were maintained only by ECMO heparin-coated lines.4 patients recovered well after surgery,and 1 patient died 1 month after surgery due to immune-related pneumonia.For complex TBS,or in emergency situations(tracheal stenosis with risk of asphyxiation),ECMO can pro-vide adequate support and safeguard.

Objective:To explore the types of pre-diagnosis symptom clusters in patients with acute coronary syndrome (ACS) and identify bridge symptoms between symptom clusters.Methods:From May to October 2023, convenience sampling was used to select 243 ACS patients who visited Shanxi Provincial People's Hospital as participants. The General Information Questionnaire and Chinese version of the McSweeney Acute and Prodromal Myocardial Infarction Symptoms Survey were used for the survey. Exploratory factors were used to analyze symptom clusters, while network analysis was used to identify bridge symptoms between symptom clusters. A total of 243 questionnaires were distributed, and 230 valid questionnaires were collected, with a valid response rate of 94.7% (230/243) .Results:Before diagnosis, ACS patients had four symptom clusters, namely typical chest symptom cluster, typical shoulder and back symptom cluster, fatigue related symptom cluster, and cardiopulmonary symptom cluster. In symptom network analysis, fatigue and anxiety were bridge symptoms between symptom clusters, with fatigue having the highest expected impact coefficient ( rbei=0.387 3), followed by close centrality ( rbc=0.024 2). The bridge mediation ( rbb=35.000) and close centrality ( rbc=0.024 8) of anxiety were the highest. Conclusions:Fatigue and anxiety are bridge symptoms in ACS patients, connecting different symptom clusters. Identifying bridge symptoms is beneficial for improving the efficiency and accuracy of symptom management. Research needs to consider patient heterogeneity and conduct subgroup studies on symptom clusters to further explore the practical significance of core and bridge symptoms in clinical practice.

Objective:To establish the biology reference interval (RI) of peripheral blood procalcitonin (PCT) for children between 3 days and 6 years old in China.Methods:Totally 3 353 reference individuals with apparent health or no specific diseases were recruited in 18 hospitals throughout the country during October 2020 to May 2021. Reference individuals were divided into four groups: 3-28 days, 29 days - 1 year, 1-3 years and 4-6 years. Vein blood or capillary blood were collected by percutaneous puncture from every reference individual. The PCT level in serum and the capillary whole blood were assayed by Roche Cobas e601 and Norman NRM411-S7 immunoanalyzer. Outliers were deleted and 95th percentiles of every group were provided as RIs. Man-Whitney U test or Kruskal-Wallis test were used performed to assess the difference among different gender, age or method groups. Results:The difference of PCT distribution between male and female is not statistically significant, but the difference between serum and capillary whole blood is statistically significant. The differences between age groups are significant too. For Roche e601, serum PCT RI of 3-28 days group is <0.23 μg/L, 29 days - 6 years are <0.11 μg/L. For NRM411, Serum PCT RI of 3-28 days group is <0.21 μg/L, 29 days - 1 year: <0.09 μg/L, 1 - 6 years: <0.10 μg/L. For whole blood PCT, RI of 3-28 days group is <0.26 μg/L, 29 days - 6 years is <0.15 μg/L.Conclusions:Serum and capillary whole blood PCT have different RIs, however, capillary whole blood PCT testing is valuable in pediatric application. Children in 3-28 days show higher PCT levels than other age group. To establish the RIs and understand the differences among different groups are essential for the interpretation and clinical application of peripheral blood PCT testing results.

Objective : To investigate the expression differences of helix⁃loop⁃helix hand domain family member D 1/2(EFhd1/2) in Alzheimer′s disease (AD) patients and model mice. Methods : The expression changes of EFhd1/2 in AD patients were compared by using data from Alzheimer′s disease database (AlzData), and the changes in mRNA levels and protein levels of EFhd1/2 in brain tissues of AD patients and healthy control group were detected by qPCR and Western blot. The changes of EFhd1/2 mRNA and protein expression in brain tissues of AD models and wild⁃type mice of 3⁃month⁃old and 6⁃month⁃old were detected. Microglia were isolated from AD models and detected the changes of EFhd1/2 by RNA⁃sequencing. Results : The Analysis of Alzheimer′s Disease Database data showed that the mRNA levels of EFhd1 in AD patients increased, while EFhd2 decreased. AD patients brain tissue samples showed an upward trend in the expression of EFhd1 in different brain regions of AD patients compared with healthy controls, while EFhd2 was not different. In the AD mice model, the mRNA levels of EFhd1 were similar in both 3⁃month⁃old and 6⁃month⁃old AD mice compared with wild⁃type mice, but the protein levels of EFhd1 increased; the mRNA levels of EFhd2 increased in 3⁃month⁃old AD mice, and protein levels remained similar in the brain tissue from AD mice aged 3 months and 6 months. However, EFhd2 increased in microglia from 6⁃month old AD mice. Conclusion EFhd1 increased in both AD model mice and brain tissue of AD patients, suggesting that EFhd1 might play an important role in the development of AD, while EFhd2 increased in microglia in AD model mice, indicating that EFhd2 might be involved in AD related microglia activation and neuroinflammation.

Objective:To examine treatment outcomes of breast phyllodes tumors and the prognosis factors of local recurrence.Methods:This retrospective cohort study included 276 patients who underwent surgical resection at Breast Center, Peking University People′s Hospital from January 2011 to December 2019. Tumor subtype and histopathological features were determined from pathology reports, and the deadline of follow-up was September 30 th, 2020. All 276 patients underwent open surgery, including 17 patients of mastectomy, and 259 patients of lumpectomy. The enrolled patients were all female, with age of (41.5±11.3) years (rang: 11 to 76 years), and tumor diameter of 35(28) mm ( M( Q R)). The Kaplan-Meier method and Log-rank test were used for survival analysis. The multivariate analysis was implemented using the Cox proportional hazard model. Results:According the pathologic test, there were 191 patients of benign phyllodes tumor, 67 patients of borderline tumor and 18 patients of malignant tumor. There were 249 patients with a follow-up of more than 6 months, and 14.1% (35/249) had local recurrence. The time-to-recurrence was (28.6±22.2) months (range: 2 to 96 months), (29.1±18.1) months (range: 2 to 80 months), (32.1±30.1) months (range: 5 to 96 months) and (12.0±6.9) months (range: 8 to 20 months) for benign, borderline and malignant phyllodes tumors. Tumor diameter (≥100 mm vs.<50 mm, HR=3.968, 95%CI: 1.550 to 10.158, P=0.004) and malignant heterologous element (yes vs. no, HR=26.933, 95%CI: 3.105 to 233.600, P=0.003) were prognosis factors of local recurrence. One death from malignant phyllodes occurred after distant metastasis. The 3-year disease-free survival rates of benign, borderline and malignant phyllodes tumor were 88.2%, 81.7% and 81.4% ( P=0.300). Conclusion:Phyllodes tumors have a considerable local recurrence rate, which may be associated with tumor diameter and malignant heterologous element.

Objective:To examine treatment outcomes of breast phyllodes tumors and the prognosis factors of local recurrence.Methods:This retrospective cohort study included 276 patients who underwent surgical resection at Breast Center, Peking University People′s Hospital from January 2011 to December 2019. Tumor subtype and histopathological features were determined from pathology reports, and the deadline of follow-up was September 30 th, 2020. All 276 patients underwent open surgery, including 17 patients of mastectomy, and 259 patients of lumpectomy. The enrolled patients were all female, with age of (41.5±11.3) years (rang: 11 to 76 years), and tumor diameter of 35(28) mm ( M( Q R)). The Kaplan-Meier method and Log-rank test were used for survival analysis. The multivariate analysis was implemented using the Cox proportional hazard model. Results:According the pathologic test, there were 191 patients of benign phyllodes tumor, 67 patients of borderline tumor and 18 patients of malignant tumor. There were 249 patients with a follow-up of more than 6 months, and 14.1% (35/249) had local recurrence. The time-to-recurrence was (28.6±22.2) months (range: 2 to 96 months), (29.1±18.1) months (range: 2 to 80 months), (32.1±30.1) months (range: 5 to 96 months) and (12.0±6.9) months (range: 8 to 20 months) for benign, borderline and malignant phyllodes tumors. Tumor diameter (≥100 mm vs.<50 mm, HR=3.968, 95%CI: 1.550 to 10.158, P=0.004) and malignant heterologous element (yes vs. no, HR=26.933, 95%CI: 3.105 to 233.600, P=0.003) were prognosis factors of local recurrence. One death from malignant phyllodes occurred after distant metastasis. The 3-year disease-free survival rates of benign, borderline and malignant phyllodes tumor were 88.2%, 81.7% and 81.4% ( P=0.300). Conclusion:Phyllodes tumors have a considerable local recurrence rate, which may be associated with tumor diameter and malignant heterologous element.

The aim of this study was to evaluate the safety and immunogenicity of the first domestic ACYW135 meningococcal conjugate vaccine and a control vaccine named AC group meningococcal conjugate vaccine for 3 months (90-119 days) infants. From February 2017 to June 2018, a randomized, blinded, and similar vaccine-controlled clinical trial design was adopted at the Henan Vaccine Clinical Research Base. The subjects were 3 months old healthy infants, a total of 720, based on a 1∶1 ratio. The random allocation table for entry was randomly assigned to the experimental group and the control group. According to the 3, 4, and 5 month-old vaccination procedures, the subjects were vaccinated with test vaccine (ACYW135 group meningococcal conjugate vaccine) and control vaccine (group A group C meningococcal polysaccharide conjugate vaccine), of which 720 were given the first dose, 696 were given the second dose (test group: 346; control group: 350), and 692 were given the third dose (test group: 344; Control group: 348). The overall adverse reaction rate of the test vaccine was 21.90% (230 cases), which was lower than the 32.04% (339 cases) of the control vaccine (<0.001). The incidence of systemic adverse reactions was 19.52% (205 cases), which was lower than that of the control vaccine (27.69%) (293 cases) (<0.001). The local adverse reaction rate was 3.04% (32 cases), which was lower than the control group (7.84%) (83 cases) (<0.001). The graded adverse reaction test vaccine was 0.57% (6 cases), which was lower than the control group of 2.36% (25 cases) (<0.001). The positive conversion rate of anti-bacterial serum antibodies showed that there was no significant difference between the test vaccine group A (91.42%), C (88.76%) and the control vaccine (92.92%) (87.02%) (>0.05). Group Y and W135 was 88.17% (298 cases), 99.41% (336 cases), respectively. The GMT results showed that the test vaccine group A was 56.24, the control vaccine was 57.43 (>0.05); the group C test vaccine (43.53) was higher than the control group (27.28) (<0.001). The group Y and W135 are 89.22 and 140.66, respectively. Among them, the proportion of the group C GMT antibody ≥ 1∶128 for test vaccine (31.07%, 105 cases) was higher than the control vaccine (16.22%, 55 cases) (<0.001). ACYW135 group meningococcal conjugate vaccine has more safety and immunogenicity after application to 3 month old infants.
Antibodies, Bacterial ; Humans ; Infant ; Meningococcal Vaccines ; adverse effects ; immunology ; Vaccines, Conjugate

Objective To investigate the effects of early continuous renal replacement thempy(CRRT)on acute lung injury and prognosis in severe acute pancreatitis (SAP)patients.Methods 46 SAP patients were divided into the two groups randomly:the control group and CRRT treatment group.The levels of IL-1β,IL-6,TNF-α,the APACHEⅡscore,oxygenation index,the incidence of acute lung injury(ALI)/acute respiratory distress syndrome (ARDS),ICU stay were compared between the two groups.Results The level of interleukin-6(IL-6)in the con-trol group was significantly higher than that in CRRT group in day 1(t=2.265,P<0.05);The levels of interleukin-1β(IL-1β),interleukin-6 (IL-6 ),tumor necrosis factor-α(TNF -α)in the control group were significantly higher than that in CRRT group in day 3(t=2.305,2.471,2.293,all P<0.05);the oxygenation index in the control group was significantly lower than that in CRRT group in day 3(t=2.386,P<0.05);the incidence of ALI/ARDS, the ICU stay days,the fatality rate in the control group were significantly higher than that in CRRT group(P<0.05);there was no significant differences between late group than that early group in gender,age,APACHE Ⅱ score (all P>0.05).Conclusion Early CRRT therapy can eliminate the IL-1β,IL-6 and TNF-αin SAP patients,which can improve the oxygenation index and reduce the incidences of ALI/ARDS,may provide more clinical benefits in the early phase of SAP.

Background and objective Screen dierentially expressed proteins in patients with non-small cell lung cancer (NSCLC), and aim to identify biomarkers for early screening, monitoring prognosis and evaluating therapy of NSCLC. Methods Urinary samples were collected from 40 newly diagnosed NSCLC patients, 8 patients with lung benign disorders and 22 healthy people. 0.9% sodium dodecylsulfate- polyacrylamide gel electrophoresis (1D SDS-PAGE) and MS-ermo-Orbi-trap-Velos were applied to separate, extract and identify proteins in urinary samples from non-neoplastic groups and NSCLC patients, in order to find out dierentially expressed proteins in patients with NSCLC. en, sensitivity and specificity of can-didate proteins were tested by certain experiments. Finally, biomarkers related to NSCLC could be determined. Results e dierences of urinary proteins between non-neoplastic groups and NSCLC patients mainly focused on 90 kDa, 60 kDa and 20 kDa-30 kDa stripes. Four dierently expressed proteins were found in urinary proteins in NSCLC group, including LRG1, CA1 (up-regulating proteins) and VPS4B, YWHAZ (down-regulating proteins). e sensitivity of these four proteins for biomarker of NSCLC was relatively low when they were used to screen or diagnose independently. e sensitivity and specificity of LRG1 was 83.0% (25/30) and 90.0% (18/20), respectively; 60.0% (18/30) and 90.0% (18/20) for CA1; 73.3% (22/30) and 90.0%(18/20) for VPS4B; 60.0% (18/30) and 95.0% (19/20) for YWHAZ. However, the sensitivity and specificity would increase to 96.7% (29/30) and 85% (17/20) aer the four biomarkers were combined. Conclusion LRG1 and CA1 are abundant in urine in patients with NSCLC, while VPS4B and YWHAZ are low-abundance proteins. ey could be regarded as biomarkers for early screening, monitoring prognosis and evaluating therapy of patients with NSCLC because of dierential expression. e sensitivity of the four biomarkers of NSCLC is relatively low when they are used to screen or diagnose independently, while significantly improvement if they were in combined paern, which will be of excellent applications to clinical diagnosis and treatment.

Objective To investigate changes in lengths of the wrist ligaments during wrist radioulnar deviation. Methods Six volunteers were included in the study. CT scans was used to detect the changes under different positions of the wrist in the volunteers. The wrists were scanned from the position of radial deviation of 20° to the one of ulnar deviation of 40° at an interval of 20°. The 3-dimensional carpal and distal radioulnar joint structures were reconstructed with customized software and chauges in length of the palmar and dorsal wrist ligaments in radioulnar deviation were computed. Results From wrist radial deviation to neutral position, the lengths of the radioscaphocapitate ligament, the long radiolunate ligament and the dorsal intercarpal ligament increased significantly (P ＜ 0.05), they increased (2.4±0.3) mm, (2.3±0.8) mm,(1.2±0.6) mm, (1.2±1.2)mm and (2.6±1.0) mm respectively. While from wrist ulnar deviation to neutral position, ulnocapitate ligament and the dorsal radiocarpal ligament increased significantly (P ＜ 0.05), they increased (0.8 ±0.6) nm and (1.0±0.5) mm respectively. Conclusion At wrist radial deviation, the radioscaphocapitate, long radiolunate and dorsal intercarpal ligaments are slack. At wrist ulnar deviation, the ulnocapitate ligament and the dorsal radiocarpal ligament are slack. These positions may be favorable to healing of these ligaments.