Objective To compare the clinical application value of medical glue and a new-type medical anchor positioning needle in thoracoscopic resection of pulmonary nodules.Methods A total of 182 patients with pulmonary nodules,who received video-assisted thoracic surgery(VATS)at the Department of Thoracic Surgery of Affiliated Hospital of Shaoxing University of China between January 2020 and December 2022,were enrolled in this study.Preoperative CT-guided localization of the pulmonary nodule was performed in all patients,including medical glue positioning in 89 patients(medical glue group)and anchor needle positioning in 93 patients(anchor needle group).The incidences of pneumothorax and bleeding,the time spent for positioning,the interval between localization and operation,the time spent for operation,and the radiation dose during localization process were recorded and the data were statistically analyzed.Results The success rate of positioning was 100％(93/93)in the anchor needle group and 96.7％(86/89)in the medical glue group.There was no statistically significant difference between the two groups(P>0.05).The incidence of bleeding was 31.2％(29/93)in the anchor needle group and 15.7％(14/89)in the medical glue group,and the difference between the two groups was statistically significant(P<0.05).The incidence of pneumothorax was 30.1％(28/93)in the anchor needle group and 20.2％(18/89)in the medical glue group,and there was no significant difference between the two groups(P>0.05).No statistically significant difference in the time spent for operation existed between the two groups(P>0.05).The time spent for positioning and the interval between localization and operation in the medical glue group were longer than those in the anchor needle group,and the radiation dose in the medical glue group was higher than that in the anchor needle group,and the differences between the two groups were statistically significant(P<0.05).Conclusion For the preoperative localization of ground glass opacity(GGO)or solitary pulmonary nodule(SPN),both medical glue positioning method and anchor needle positioning method have high clinical application value.The clinical and interventional physicians should adopt appropriate positioning method according to the patient's condition.

Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.

Objective:To analyze the characteristics of infectious pathogens in burn patients with sepsis based on metagenomic next-generation sequencing (mNGS) technology.Methods:This study was a retrospective observational study. From July 2021 to December 2023, 109 burn patients with sepsis who met the inclusion criteria were admitted to the Department of Burns of the First People's Hospital of Zhengzhou, including 68 males aged 57 to 92 years and 41 females aged 48 to 83 years. Blood, bronchoalveolar lavage fluid, cerebrospinal fluid, sputum, or other fluid specimens were collected from the patients during their hospital stay for microbiological culture (86 patients) and mNGS technology detection (109 patients). The types of specimens and pathogens detected by mNGS technology were counted. Patients were divided into intensive care unit (ICU) group (78 cases) who were admitted to the ICU and non-ICU group (31 cases) who were not admitted to the ICU, and the pathogens for infection in the two groups of patients were analyzed. In addition, the detection of pathogens in the specimens of 86 patients who underwent both mNGS technology detection and microbiological culture detection was analyzed.Results:Among the 109 specimens detected by mNGS technology, there were 42 blood specimens, 17 bronchoalveolar lavage fluid specimens, 4 sputum specimens, 6 cerebrospinal fluid specimens, 16 pus specimens, and 24 tissue fluid specimens; a total of 39 pathogens were detected, including 13 bacteria, 12 fungi, 10 viruses, 2 parasites, and 2 mycoplasmas. The overall positive rate of pathogen detection was 88.99% (97/109). Ranked by the detection rate, the top three Gram-negative bacteria were Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas spp, the top three Gram-positive bacteria were Streptococcus pneumoniae, Staphylococcus aureus, and Enterococcus faecalis; the top three viruses were human herpesvirus, cytomegalovirus, and circovirus; the top three fungi were Aspergillus fumigatus, Candida albicans, and Aspergillus flavus. Twenty-seven patients were infected with one pathogen, 45 patients with two pathogens, and 25 patients with three or more pathogens. Compared with those in non-ICU group, the proportions of Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas spp, Streptococcus pneumoniae, Aspergillus fumigatus, and cytomegalovirus detected in the patients in ICU group were significantly higher (with χ2 values of 8.62, 7.93, 3.93, 5.48, 4.28, and 5.58, respectively, P<0.05). In the pathogens detected by mNGS technology and microbiological culture method, the most common bacteria were Klebsiellapneumoniaeand Acinetobacter baumannii, and the most common fungi were strains of Aspergillus and Candida. There were 19 pathogens those could only be detected by mNGS technology, such as Lichtheimia ramosa, Pneumocystis jirovecii, Mycobacterium tuberculosis, viruses, etc.; there were no pathogens detected by microbiological culture method that couldn't be detected by mNGS technology. Compared with those detected by microbiological culture method, the overall positive rate, bacterial positive rate, and fungal positive rate detected by mNGS technology were significantly increased (with χ2 values of 45.52, 5.88, and 4.94, respectively, P<0.05). The 27.91% (24/86) of patients were detected positive by both methods, and 72.09% (62/86) of the patients were detected positive by mNGS technology but negative by microbiological culture method. The consistency test of the results obtained by the two detection methods showed that the difference was not statistically significant ( κ=0.02, P>0.05). Conclusions:The positive rate of pathogen detection in specimens using mNGS technology is higher than that detected by using conventional microbiological culture method, and it can detect pathogens those cannot be detected by the latter, such as Lichtheimia ramosa, Pneumocystis jirovidii, Mycobacterium tuberculosis, viruses, etc. Detection using mNGS technology can help clarify the types of infectious pathogens in burns patients with sepsis, and provide basis and guidance for clinical medication.

Purpose: We aimed to evaluate whether the addition of pemetrexed is effective in improving progression-free survival (PFS) in epidermal growth factor receptor (EGFR)–mutated patients with or without concomitant alterations. Materials and Methods: This multicenter clinical trial was conducted in China from June 15, 2018, to May 31, 2019. A total of 92 non–small cell lung cancer (NSCLC) patients harboring EGFR-sensitive mutations were included and divided into concomitant and non-concomitant groups. Patients in each group were randomly treated with EGFR–tyrosine kinase inhibitor (TKI) monotherapy or EGFR-TKI combined with pemetrexed in a ratio of 1:1. PFS was recorded as the primary endpoint. Results: The overall median PFS of this cohort was 10.1 months. There were no significant differences in PFS between patients with and without concomitant and between patients received TKI monotherapy and TKI combined with pemetrexed (p=0.210 and p=0.085, respectively). Stratification analysis indicated that patients received TKI monotherapy had a significantly longer PFS in non-concomitant group than that in concomitant group (p=0.002). In concomitant group, patients received TKI combined with pemetrexed had a significantly longer PFS than patients received TKI monotherapy (p=0.013). Molecular dynamic analysis showed rapidly emerging EGFR T790M in patients received TKI monotherapy. EGFR mutation abundance decreased in patients received TKI combined chemotherapy, which supports better efficacy for a TKI combined chemotherapy as compared to TKI monotherapy. A good correlation between therapeutic efficacy and a change in circulating tumor DNA (ctDNA) status was found in 66% of patients, supporting the guiding role of ctDNA minimal residual disease (MRD) in NSCLC treatment. Conclusion EGFR-TKI monotherapy is applicable to EGFR-sensitive patients without concomitant alterations, while a TKI combined chemotherapy is applicable to EGFR-sensitive patients with concomitant alterations. CtDNA MRD may be a potential biomarker for predicting therapeutic efficacy.

Objective:To explore the impact of negation effect on color judgment of the color-word pairs and the impairment of cognitive inhibition function of the patients with schizophrenia (SCH) through embedding negation into the Stroop task.Methods:From January to December 2021, " Affirmative/ negative + color words" as the experimental materials, classical Stroop paradigm as the experimental paradigm, a mixed experimental design of 2 (groups: the SCH group vs the normal control group)×2(phrase polarity: affirmative phrases vs negative phrases)×2 (word-color congruence: consistency vs inconsistency) was designed to explore the inhibition function of negative phrases of the SCHs under bipolar negation conditions (Experiment 1) and multi-polar negation conditions (Experiment 2) respectively. The schizophrenic patients in Experiment 1(28 patients and 28 normal controls) and Experiment 2(30 patients and 30 normal controls) were sampled from the inpatients of Tangshan Kailuan Mental Health Center and Suzhou Guangji Hospital respectively, and the healthy controls were recruited from the community. SPSS 25.0 software was adopted as statistical analysis, and accuracy, response time of Stroop and the Stroop effect were analyzed by repeated measurement analysis of variance. Results:(1) The group main effects of response time were both significant in bipolar negation conditions(Experiment 1) ( F=49.22, P<0.001, ηp2=0.48) and multi-polar negation conditions (Experiment 2) ( F=37.58, P<0.001, ηp2=0.39). In bipolar negation (Experiment 1) conditions, as for the Stroop effect of response time, there was a significant interaction between the groups and polarities( F=4.42, P<0.05, ηp2=0.08), and there was a statistically significant difference between the affirmative Stroop effect (-0.137±0.522)and the negative Stroop effect(0.082±0.169) in the schizophrenia group( F=7.15, P<0.05, ηp2=0.12). In multi-polar negation conditions (Experiment 2), there was a marginal significant of the interaction between Stroop conditions and polarities in accuracy( F=3.81, P=0.056, ηp2=0.06). The accuracy under the word color consistency condition was higher than that under inconsistency condition((96.51±1.55)%, (90.00±2.54)%) ( F=5.15, P<0.05, ηp2=0.08). (3)In bipolar negation (Experiment 1) conditions, as for the accuracy, the interaction among groups, word color consistencies, and polarities was significant( F=6.66, P<0.05, ηp2=0.11). The interaction between word color consistencies and polarities was significant in the schizophrenia group( F=9.16, P<0.05, ηp2=0.15). In the normal group, the interaction between Stroop conditions and polarities was not significant( P>0.05). Conclusion:The impairment of cognitive inhibition function in schizophrenia is severe, which is reflected in negative processing; negation functions as cognitive inhibition, which is particularly prominent in bipolar negation.

Objective:To explore the value of competency-oriented training mode in the training of professional postgraduate students of thoracic surgery.Methods:A total of 71 professional postgraduate students, who entered thoracic surgery department for rotation training, were divided into experimental group and control group. Among them, 33 students in experimental group accepted competency-oriented training, including medical theoretical knowledge, clinical skills, clinical thinking, scientific information and interpersonal communication, while 38 students in control group received traditional training. Before leaving the department, the two groups of students had a unified assessment, and their results were compared and analyzed. SPSS 19.0 was used to make statistical analysis on the students' assessment results, and the comparison of the two groups of students' results was made by two independent samples t test. Results:The experimental group performed better in theoretical knowledge, clinical skills, clinical thinking and total scores than control group [(14.21±2.03) points vs. (12.97±2.06) points, (24.30±2.35) points vs. (22.37±3.10) points, (24.00±1.85) points vs. (22.71±3.17) points, (78.09±3.53) points vs. (73.34±5.25) points], with significant differences (all P<0.05). Conclusion:Competency-oriented training model can significantly enhance the training quality of professional postgraduates of thoracic surgery. We should make rational use of new media means and various teaching platforms, and give full play to the characteristics and advantages of the discipline, which facilitates to improving the clinical post competence of trainees.

Chest trauma is one of the most common injuries. Venous thromboembolism (VTE) as a common complication of chest trauma seriously affects the quality of patients′ life and even leads to death. Although there are some consensus and guidelines on the prevention and treatment of VTE at home and abroad, the current literatures lack specificity considering the diagnosis, treatment and prevention of VTE in patients with chest trauma have their own characteristics, especially for those with blunt trauma. Accordingly, China Chest Injury Research Society and editorial board of Chinese Journal of Traumatology organized relevant domestic experts to jointly formulate the Chinese expert consensus on the diagnosis, treatment and prevention of chest trauma venous thromboembolism associated with chest trauma (2022 version). This consensus provides expert recommendations of different levels as academic guidance in terms of the characteristics, clinical manifestations, risk assessment, diagnosis, treatment, and prevention of chest trauma-related VTE, so as to offer a reference for clinical application.

Objective:To summarize the clinical experience of changing the membranous pulmonary system during extracorporeal membrane oxygenation(ECMO) in infants after congenital heart disease opration with cardiopulmonary bypass.Methods:From January to September in 2019, 6 cases of congenital heart disease with cardio-pulmonary bypass in our hospital were analyzed retrospectively, whose membrane obstruction occurred during ECMO treatment and replaced successfully.The hemodynamics and blood gas before and after replacement of ECMO system were observed, and the experience was summarized.Results:Six patients(3 males and 3 females), aging from 1 to 3 months and weighing from 3.0 to 4.9 kg, were received VA-ECMO adjuvant therapy.The ECMO system replacement process was smooth and took 175-209 s. The hemodynamic of the children was stable.The ECMO support time was 134-249 h. After the improvement of cardiac systolic function, all children were successfully withdrawn and survived.Conclusion:The improved method of liquid replacement in ECMO system can make full use of the blood components in the original system and avoid the loss of blood tangible components.According to the plan of rapid replacement, the risk of replacement will not be increased.

Objective:To investigate the application value of standard operation procedure (SOP) of thoracentesis in clinical skills training for undergraduates.Methods:In this study, 63 undergraduates were randomized into two groups, with 29 students in experimental group receiving SOP training, and 34 students in control group trained by traditional teaching methods. The performance of the two groups at different stages of thoracentesis were compared after the training. SPSS 19.0 was used to analyze the assessment data.Results:The experimental group was significantly superior to the control group in the stages of "puncture operation" and "post-puncture operation" [(33.76±2.46) points vs. (31.91±3.60) points, P=0.02; (7.93±1.53) points vs. (6.79±1.84) points, P=0.01], as well as the total scores [(82.59±4.14) points vs. (79.26±4.94) points, P=0.01]. Conclusion:It's suggested that application of SOP may improve the effectiveness of thoracentesis training, and organized teaching methods are essential for clinical skills training.

[Abstract] Objective: To investigate the expression of lncRNA linc01503 in esophageal squamous cell carcinoma (ESCC) tissues and cell lines, as well as its effect on the proliferation, invasion and epithelial-mesenchymal transition (EMT) of ESCC cells. Methods: A total of 119 pairs of tumor tissues and corresponding para-cancerous tissues of ESCC patients were obtained from the Fourth Affiliated Hospital of Hebei Medical University between Jan. 2012 and Dec. 2014. The expression of linc01503 in ESCC tissues and cell lines (Kyse150, Kyse170, Eca109, TE1 and TE13) was detected by qPCR. The ESCC cells were transfected with pGPU6-shRNA-linc01503 or treated with TGF-β. The expressions of EMT related genes before and after transfection as well as linc01503 expression before and after TGF-β treatment were detected with qPCR. MTS and Transwell assay were performed to assess the effect of linc01503 on proliferation and invasion of ESCC cells. Results: The expression of linc01503 was significantly elevated in ESCC tissues and cell lines (all P<0.05). High expression of linc01503 was correlated with lymph node metastasis, depth of infiltration, TNM stage and the survival of ESCC patients (all P<0.05). Treatment with TGF-β promoted EMT of ESCC cells and induced a significant up-regulation of linc01503 expression. Knockdown of linc01503 significantly inhibited proliferation and invasion ability of ESCC cells; Meanwhile, the low expression of linc01503 increased the expression of E-cadherin but decreased the expressions of N-cadherin and vimentin (all P<0.05). Conclusion: lncRNA linc01503, as one of the downstream effect genes of TGF- β, promotes the proliferation, invasion and EMT process of ESCC cells.