With the optimization of surgical technologies and postoperative management regimens, the number of lung transplantation has been significantly increased, which has become an important treatment for patients with end-stage lung disease. However, due to the impact of comprehensive factors, such as bronchial ischemia and immunosuppression, the incidence of airway stenosis after lung transplantation is relatively high, which severely affects postoperative survival and quality of life of lung transplant recipients. In recent years, with the improvement of perioperative management, organ preservation and surgical technologies, the incidence of airway stenosis after lung transplantation has been declined, but it remains at a high level. Early diagnosis and timely intervention play a significant role in enhancing clinical prognosis of patients with airway stenosis. In this article, the general conditions, diagnosis, treatment and prevention of airway stenosis after lung transplantation were reviewed, aiming to provide reference for comprehensive management of airway stenosis after lung transplantation and improving clinical prognosis of lung transplant recipients.

Objective To investigate the immediate brain effect of acupuncture at Fengchi using amplitude of low-frequency fluctuation(ALFF)and functional connectivity by the resting-state functional magnetic resonance imaging(rs-fMRI)in patients with posterior circulation ischemia vertigo(PCIV).Methods Twenty patients with PCIV were enrolled.The dizziness handicap inventory(DHI)was used to evaluate the severity of vertigo.The patients were randomly divided into acupuncture group and sham acupoint acupuncture group.Rs-fMRI scan was performed before and after acupuncture.MATLAB-based DPABI 6.1 software was used to analyze rs-fMRI data.Correlation analysis was used between the altered ALFF values and DHI scores.The regions of altered ALFF were taken as seeds to analyze functional connectivity.Results Compared with the sham acupoint acupuncture group,the increased ALFF values were mainly located on the left precuneus,left superior frontal gyrus and left caudate nucleus after acupuncture in the acupuncture group;the decreased ALFF values were mainly located on the left cerebellum and right inferior occipital gyrus.The ALFF value of the left superior frontal gyrus was negatively correlated with the DHI score(P=0.04).The increased functional connectivity was mainly found between left precuneus and the right middle frontal gyrus,the right superior frontal gyrus,the decreased functional connectivity was mainly found between left precuneus and the bilateral paracentral lobule and right cerebellum.Conclusion The ALFF value and functional connectivity are different before and after acupuncture,indicating that the vestibular network,visual and motor brain regions functional activities are changed after needling at Fengchi,which may be the brain functional basis of Fengchi for vertigo in PCIV.

Objective:To systematically evaluate the clinical efficacy of melatonin for neonatal hypoxic-ischemic encephalopathy (HIE).Methods:From the inception of the databases to December 1, 2022, randomized controlled trials (RCTs) and cohort studies on the use of melatonin for HIE were searched in the following databases: PubMed, Web of Science, Cochrane library, Embase, Chinese Medical Journal Full-text Database, CNKI, Wanfang Database and VIP Database. Meta-analysis, literature risk assessment and sensitivity analysis were conducted using R4.2.2 software and RevMan5.4 software.Results:A total of 4 eligible RCTs were found, including 155 patients. Meta-analysis showed that melatonin could reduce the mortality rate ( RR=0.336, 95% CI0.157-0.718, P=0.005) and white blood cell count in HIE infants ( MD=-1.74, 95% CI -3.404--0.079, P=0.040). Sensitivity analysis showed that the Meta-analysis results were generally stable after excluding the studies one by one. Conclusions:Current evidence shows that melatonin can reduce mortality in HIE infants. However, the included studies have high risk of bias and small sample sizes. More high-quality studies are still needed.

Objective To explore the efficacy of debridement combined with antibiotic-loaded artificial bone in the treatment of clavicular osteomyelitis.Methods The data of 45 patients with clavicle osteomyelitis admitted to Luoyang Orthopedic Hospital(Henan Orthopedic Hospital)in Henan Province from January 2012 to June 2022 were retrospectively analyzed.They were divided into treatment group(n = 24)treated with debridement combined with antibiotic-loaded artificial bone,and control group(n = 21)treated with debridement.We compared the operation time,the duration of drainage tube placement,wound healing time,white blood cells(WBC),C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR)in the two groups.Preoperative visual analog scores(VAS)and VAS 1 month after operation,and preoperative Constant-Murley score(CMS)and CMS 12 months after operation were observed.Infections,recurrence and complications in the two groups were recorded in the follow-up.Results All the 45 patients completed the surgery successfully and were followed up for 13 to 35 months,with an average of(23.53±5.11)months.The operation time and the duration of drainage tube place-ment of the treatment group were longer than those of the control group(P<0.05),and there was no significant difference in the wound healing time(P>0.05);preoperative and 14-day postoperative WBC,CRP,and ESR,VAS 1 month after operation,and CMS 12 months after operation were all significantly improved in the two groups.The differences were all statistically significant(P<0.05),and the CMS of the treatment group was higher than that of the control group(P<0.05).During the follow-up,there were less cases of infection recurrence in the treatment group when compared with that in the control group(2/24,8.33%vs.5/21,23.81%).There were 2 cases of aseptic exudation in the treatment group.There were 1 case of bone defect in the treatment group and 5 in the control group,all of which had healed after the second-stage iliac implantation,and the rest did not have the complication of aseptic exudation,bone defects and pathologic fracture.Conclusion Debridement and antibiotic-loaded artificial bone can effectively control the infection and preserve the shape and function of the clavicle,with a low recurrence rate of postoperative infection,simple surgical operation,and no serious complications.It is wor-thy of clinical promotion.

【Objective】 To explore the clinical value of thromboelastogram (TEG) in monitoring coagulation function in patients with COVID-19. 【Methods】 Patients diagnosed with COVID-19 in our hospital from January 20 to March 1, 2020 were enrolled and divided into mild group (mild type, common type) and severe group (severe type, critical group). The TEG, platelet count and routine blood coagulation function were compared between the two groups to analyze the coagulation characteristics of the patients. 【Results】 A total of 66 cases were studied, including severe (n=33) and mild (n=33), male(n=39)and female(n=27), hypertension (n=9) and diabetes mellitus (n=11) cases. 28 (84.8%) severe and 24 (72.7%) mild patients had at least one hypercoagulable TEG parameter. K value of TEG in the severe group was lower than that in the mild group (P<0.05), Angel and CI increased (P<0.05). The fibrinogen (Fib) and D-dimer increased in routine coagulation function test (P<0.05). 【Conclusion】 Patients with COVID-19 showed hypercoagulability in TEG parameter, which was related to the severity of this disease. TEG may be more valuable for COVID-19 patients with hypercoagulable status and thrombosis risk, and help to develop anticoagulation strategies.

Objective:To explore the application value of artificial intelligence-assisted diagnosis system for TBS report in cervical cancer screening.Methods:A total of 16 317 clinical samples and related data of cervical liquid-based thin-layer cell smears, which were obtained from July 2020 to September 2020, were collected from Southern Hospital, Guangzhou Huayin Medical Inspection Center, Shenzhen Bao′an People′s Hospital(Group) and Changsha Yuan′an Biotechnology Co., Ltd. The TBS report artificial intelligence-assisted diagnosis system of cervical liquid-based thin-layer cytology jointly developed by Southern Medical University and Guangzhou F. Q. PATHOTECH Co., Ltd. based on deep learning convolution neural network was used to diagnose all clinical samples. The sensitivity,specificity and accuracy of both artificial intelligence-assisted diagnosis system and cytologists using artificial intelligence-assisted diagnosis system were analyzed based on the evaluation standard(2014 TBS). The time spent by the two methods was also compared.Results:The sensitivity of artificial intelligence-assisted diagnosis system in predicting cervical intraepithelial lesions and other lesions (including endometrial cells detected in women over 45 years old and infectious lesions) under different production methods, different cytoplasmic staining and different scanning instruments was 92.90% and 83.55% respectively, and the specificity of negative samples was 87.02%, while that of cytologists using artificial intelligence-assisted diagnosis system was 99.34%, 97.79% and 99.10%, respectively. Moreover, cytologists using artificial intelligence-assisted diagnosis system could save about 6 times of reading time than manual.Conclusions:Artificial intelligence-assisted diagnosis system for TBS report of cervical liquid-based thin-layer cytology has the advantages of high sensitivity, high specificity and strong generalization. Cytologists can significantly improve the accuracy and work efficiency of reading smears by using artificial intelligence-assisted diagnosis system.

Objective: To investigate the role of methyl-CpG-binding protein 2 (MeCP2) in the regulation and epithelial-mesenchymal transition (EMT) of human lens epithelial cells (LECs) and its possible mechanism. Methods: Human LEC lines (SRA01/04) were divided into MeCP2-mimic group, MeCP2-NC group and small interferening RNA-MeCP2 (si-MeCP2) group, and MeCP2 analog plasmid, blank plasmid and MeCP2 si-RNA plasmid was used respectively to transfect the cells.The expression of MeCP2 mRNA in the cells was detected by using real-time PCR 24 hours after transfection.At 48 hours after transfection, the migration rate of the cells was evaluated by scratching test, and the expression of Wnt3a protein in the cells was detected by immunofluorescence stainning.The relative expressions of β-catenin, E-cadherin, Vimentin, matrix metallo proteinase (MMP)-9, MMP-7 and secreted frizzled-related protein 5 (SFRP5) proteins in the cells were detected by Western blot. Results: After 24 hours of transfection, the relative expression of MeCP2 mRNA in the cells was significantly different among the MeCP2-mimic group, MeCP2-NC group and si-MeCP2 group (F=4 773.00, P<0.00 1). The migrating rate of the cells in the MeCP2-mimic group, MeCP2-NC group and si-MeCP2 group was (57.45±5.20)%, (32.71±10.02)% and (17.77±9.22)%, respectively, showing a significant difference among the three groups (F=124.00, P<0.001), and the migrating rate of the cells in the si-MeCP2 group was significantly lower than that of the MeCP2-mimic group or MeCP2-NC group (both at P<0.001). The relative expressing intensity (absorbance) of Wnt3a in the cells of the MeCP2-mimic group, MeCP2-NC group and si-MeCP2 group was 75.92±6.10, 52.03±5.22 and 28.75±3.39, respectively, with a significant difference among three the groups (F=221.30, P<0.001), and the relative expressing intensity (absorbance) of Wnt3a in the cells was significantly lower in the si-MeCP2-mimic group than that of the MeCP2-NC group and MeCP2-mimic group (both at P<0.001). The relative expressing level of E-cadherin protein was significantly elevated and the expressions of β-catenin, Vimentin, MMP-9 and MMP-7 were significantly reduced in the si-MeCP2 group compared with the MeCP2-mimnic group and MeCP2-NC group (all at P<0.01). The relative expressing level of SFRP5 protein in the MeCP2-mimic group, MeCP2-NC group and si-MeCP2 group was 27.19±0.03, 47.54±0.05 and 74.93±0.05, respectively, showing a statistical difference among the three groups (F=183.49, P<0.001), and the relative expressing level of SFRP5 in the si-MeCP2 group was significantly higher than that in the MeCP2-mimic group and MeCP2-NC group (both at P<0.001). Conclusions MeCP2C can promote EMT of human LECs by down-regulating the expression of SFRP5 and therefore activating the Wnt3a/β-catenin signal pathway.

Artificial tracheal grafts are required when repairing extensive tracheal defects that exceed 50％ of total length in adults and 30％ in infants.Alternative options for trachea replacement now are being developed,including autografts,allografts,and prosthetics,or a combination of these,but they have limitations including inflammation,infection.With the advancements made in tissue engineering (TE) in recent years,researchers are focusing their attention on using a tracheal scaffold made from a synthetic polymer or a cadaveric allotransplant.Considering the critical role of epithelium in the trachea,the repithelialization of tracheal grafts has gradually become the focus of tissue engineering tracheal reconstruction.This article will make a summary of the researches on the correlation of tissue-engineered tracheal re-epithelialization.

Objective To assess the gender-related differences of upper tract urothelial carcinoma and analyze the causes of the gender-related differences.Methods We retrospectively studied 942 patients underwent radical nephroureterectomy for upper tract urothelial carcinoma between January 2000 and December 2014 in our hospital.The mean age of the entire cohort was 64.5 years,with 424 males (45.0％)and518 females (55.0％).Compared with male patients,female patients tended to had a history of aristolochic acids exposure (5.2％ vs.11.1％,P =0.001),infrequent smoking (29.7％ vs.5.2％,P ＜0.001) and showed poorer renal function (P =0.023).We reviewed clinicopathologic data from these patients and used univariate analysis to determine the gender-related differences.The Kaplan-Meier method was adopted to investigate the gender differences of cancer specific survival,bladder recurrence-free survival and contralateral upper tract recurrence-free survival of patients.Results When compared with males,females were less likely to have high-stage disease (33.7％ vs.24.9％,P =0.003).The mean follow-up for the entire cohort was 70.2 months (4-193 months).The cancer specific survival rate (x2 =14.116,P ＜0.001)and the contralateral upper urinary tract recurrence rate(x2 =7.362,P =0.007)in females were both higher than those in males.The 5-year cancer specific survival rates were 72.0％ in the males and 83.5％ in females,respectively.In addition,the 5-year contralateral UTUC-free survival rates were 98.6％ in the males and 92.9％ in females.Conclusions Female patients in our cohort were more common and they were more likely to be exposed to aristolochic acids.Females were less likely to have high-stage disease but had significantly worse contralateral upper tract recurrence-free survival.

Objective:To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications.Methods:From August 2013 to June 2008,five patients with chyluria were admitted. All the patients were female,aged from 26 to 73 years,and disease course from 1 to 10 years.All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss,and fa-tigue,of whom two presented with flank pain and one with anemia.Their urine chyle tests were con-firmed to be positive.Preoperative cystoscopy found that chyluria was from the left side in 3 cases,and from the right side in 2 cases.Their proteinuria ranged from +to ++++.All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extra-adiposecapsule without disconnection of perirenal fat tissues.The operation time,intraoperative blood loss,postoperative intestinal function recovery,catheter time,drainage tube removal time and com-plications during operation were collected.Results:All the five cases were performed successfully.The operation time ranged from 75 to 170 minutes,mean (126.0 ±39.6)minutes,with the intraoperative blood loss 20 to 60 mL,mean (38.0 ±16.4)mL,and the postoperative intestinal function recovery time 1 to 3 days,mean (1.9 ±0.4)days.The catheter time was 1 to 4 days,mean (2.1 ±0.3)days and the drainage tube removal time ranged from 3 to 15 days,mean (9.3 ±1.8)days.Postoperatively lym-phorrhagia was found in two cases.No renal vessels injury occurred during operation.Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery.Furthermore,urine test revealed that proteinuria was totally negative.No recurrence was detected in our patients in the 9 to 31 months’follow-up.Conclusion:This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation.It was characterized with shorter operation time,definitive effect and fewer complications.