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 investigate the effect of flipped classroom teaching based on effective teaching theory in the clinical teaching of otolaryngology and head and neck surgery.Methods:A total of 35 nursing students who received clinical teaching in Department of Otolaryngology and Head and Neck Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University Medical College, from June 2019 to June 2020 were selected as control group, and 35 nursing students who received clinical teaching from July 2020 to July 2021 were selected as study group. The students in the control group received traditional teaching, and those in the observation group received flipped classroom teaching based on effective teaching theory. The two groups were compared in terms of the scores of theoretical knowledge and practical operation after teaching, abilities of self-learning, analysis and problem-solving, innovative thinking, teamwork, and nurse-patient communication before and after treatment, and the degree of satisfaction with teaching among nursing students. SPSS 24.0 was used to perform the t-test and the chi-square test. Results:After teaching, the study group had significantly higher scores of theoretical knowledge and practical operation than the control group (94.24±3.25/94.65±3.41 vs. 89.54±3.36/88.76±3.37, P < 0.05). After teaching, both groups had significant increases in the scores of self-study ability, analysis and problem-solving ability, innovative thinking ability, teamwork ability, and nurse-patient communication ability, and the study group had significantly higher scores of these abilities than the control group ( P < 0.05). The study group had a significantly higher satisfaction rate of teaching than the control group [94.29% (33/35) vs. 71.43% (25/35)]. Conclusion:In the clinical teaching of nursing students in otolaryngology and head and neck surgery, the application of flipped classroom teaching based on effective teaching theory can improve the understanding of theoretical knowledge and practical operation ability, with significant increases in comprehensive ability and degree of satisfaction with teaching, and therefore, it has a good application value.

Objective:To establish neurodevelopmental mice model of schizophrenia(SZ) with prepulse inhibition(PPI) deficits and investigate the effectiveness of olanzapine on PPI disruption.Methods:On the 9th day of pregnancy of SPF grade C57BL/6 mice, female mice were injected with polyinosinic acid poly (I∶C) (6 mg/kg) through tail vein for immune stimulation. The stress model was constructed by chronic unpredictable mild stress 30-40 d after birth (PND30-40). The offspring mice were divided into pregnancy immune stimulation + adolescent stress group (P + S + group), pregnancy immune stimulation group (P + S- group), adolescent stress group (P-S+ group) and non stimulation group (P-S-group), with 18 mice in each group. The mice in P+ S+ group were divided into OLZ intervention group (OLZ group) and non-OLZ intervention group (non-OLZ group), with 9 mice in each group. The PPI function of mice was detected by acoustic startle reflex test after modeling and OLZ intervention. Adopt StatView Version 5.0 software for data analysis, and multi factors analysis of variance was used to test the main effect, interactive effect and simple effect of each factor.Results:The main effects of maternal Poly(I: C) immune activation and pubertal chronic unpredictable stress were significant( F(1, 330)=47.72, P<0.01), and there was a significant interaction between the two factors( F(1, 330)=14.80, P<0.01), simple effect analysis showed that average percent prepulse inhibition (PPI%) in P+ S+ group((15.42±6.13)%) was significantly decreased compared with groups of P+ S-((27.33±4.58)%), P-S+ ((31.17±3.97)%) and P-S-((47.14±12.28)%)(all P<0.01). There was significant gender difference in Prepulse inhibition(PPI)score( F(1, 396)=61.94, P<0.01), in male and female mice, average startle reactivity of Pulse under Prepulse+ Pulse influence of distinct intensities was significantly different( F(1, 198)=18.68, 18.44, P<0.01), and the maternal Poly(I∶C) immune activation had a significant main effect( F(1, 198)=32.18, 12.58, P<0.01) and interaction with pubertal chronic unpredictable stress( F(1, 198)=34.54, 11.39, P<0.01), simple effect analysis suggested that the average startle reactivity of Prepulse+ Pulse in P+ S+ group(0.47±0.12) was significantly higher than other three groups(P+ S-: 0.36±0.11, P-S+ : (0.25±0.22), P-S-: (0.31±0.19)) in male mice( P<0.01) and in P-S+ group was significantly higher than the other three groups in female mice ( P<0.01). OLZ treatment could efficiently reverse the deficits on PPI by increasing PPI%( F(1, 165)=18.24, P<0.01), OLZ could reduce PPI score in male "dual-hit" model mice( F(1, 102)=21.81, P<0.01)and raise it in female( F(1, 102)=4.88, P<0.05). Conclusion:OLZ can reverse PPI deficits in schizophrenic neurodevelopmental model mice, and in the evaluation of PPI function in the model mice through PPI of acoustic startle reflex, PPI% has better stability and reactivity to OLZ intervention.

SARS-CoV-2 infection causes complicated clinical manifestations with variable multi-organ injuries, however, the underlying mechanism, in particular immune responses in different organs, remains elusive. In this study, comprehensive transcriptomic alterations of 14 tissues from rhesus macaque infected with SARS-CoV-2 were analyzed. Compared to normal controls, SARS-CoV-2 infection resulted in dysregulation of genes involving diverse functions in various examined tissues/organs, with drastic transcriptomic changes in cerebral cortex and right ventricle. Intriguingly, cerebral cortex exhibited a hyperinflammatory state evidenced by significant upregulation of inflammation response-related genes. Meanwhile, expressions of coagulation, angiogenesis and fibrosis factors were also up-regulated in cerebral cortex. Based on our findings, neuropilin 1 (NRP1), a receptor of SARS-CoV-2, was significantly elevated in cerebral cortex post infection, accompanied by active immune response releasing inflammatory factors and signal transmission among tissues, which enhanced infection of the central nervous system (CNS) in a positive feedback way, leading to viral encephalitis. Overall, our study depicts a multi-tissue/organ transcriptomic landscapes of rhesus macaque with early infection of SARS-CoV-2, and provides important insights into the mechanistic basis for COVID-19-associated clinical complications.
Animals ; COVID-19/genetics* ; Macaca mulatta ; SARS-CoV-2/genetics* ; Transcriptome

Bronchopulmonary dysplasia(BPD)is one of the most common respiratory diseases in premature infants, and many factors affect the development of premature lung.Recent studies have shown that pulmonary macrophages play an important role in the occurrence of BPD.The number of macrophages in the lung increases in the process of BPD, and classically activated M1 cells dominate, which causes excessive production of pro-inflammatory cytokines such as interleukin-1 and oxidation substances such as reactive oxygen species, promotes the apoptosis of lung cells, and affects the development of alveolar structure and pulmonary microvasculature.Besides, the decrease of autophagy activity of neonatal alveolar macrophages contributes to the occurrence of BPD, but the mechanism is still unclear.This article reviews research progress on the role of pulmonary macrophages in bronchopulmonary dysplasia, in order to further explore the significance of them in diagnosis and treatment of BPD and improve the quality of life of children with BPD.

Gallbladder cancer is a biliary malignant disease with difficulty in early diagnosis, high malignancy and poor prognosis. Radical resection is the most effective approach to improve the prognosis of patients. With the update of minimally invasive devices and the accumulation of surgeon experience, laparoscopic surgery has achieved satisfactory results in the treatment of malignant tumors of the digestive tract, but there is still controversy in its application in gallbladder cancer treatment, mainly due to lack of reliable evidence for improved survival outcomes. The current studies indicated that laparoscopic surgery could benefit some patients with early gallbladder cancer in perioperative period and survival. For advanced gallbladder cancer, although there is still no consensus on the resection extent, laparoscopic staging can prevent patients from unnecessary expanded resection. The minimally invasive process of radical cholecystectomy needs to be promoted through a high-quality diagnosis and treatment process. Only in this way can there be practical clinical evidence to guide the best clinical practice.

Objectives: To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer. Methods: The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ² test, survival analysis was carried by Kaplan-Meier and Log-rank test. Results: Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ²=288.60,P<0.01),N stage(χ²=68.10, P<0.01), vascular invasion(χ²=128.70, P<0.01)and neural invasion(χ²=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ²=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05). Conclusion With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.

ObjectiveTo investigate the clinical application value of early enteral nutrition after laparoscopic hepatectomy for hepatocellular carcinoma (HCC).MethodsA total of 49 patients with HCC undergoing laparoscopic hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between November 2013 and June 2014 were included in this prospective study. These patients were divided into the enteral nutrition group and the parenteral nutrition group according to the random number table method. Twenty-five patients were divided into the enteral nutrition group, among them, 20 were males and 5 were females with the average age of (49±17) years old. Twenty-four patients were divided into the parenteral nutrition group, among them, 18 were males and 6 were females with the average age of (51±14) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients in the enteral nutrition group were given Ensure nutrient solution orally 24 h after operation for 7 d and the patients in the parenteral nutrition group were given parenteral nutrition 24 h after operation for 7 d. The total human albumin supplemented volume, recover time of gastrointestinal function, length of hospital stay after operation and hospitalization expenses of the two groups were compared. The nutritional support associated complications were observed. The data of the two groups were compared usingt test or Wilcoxon rank-sum test.ResultsThe total human albumin supplemented volume after operation of the enteral nutrition group was (40±11) g, which was signiifcantly lower than (45±10) g of the parenteral nutrition group(t=-16.089,P<0.05). The recovery time of gastrointestinal function after operation of the enteral nutrition group was (25±8) h, which was signiifcantly shorter than (43±11) h of the parenteral nutrition group (t=-36.928,P<0.05). The length of hospital stay after hepatectomy of the enteral nutrition group was (8±2) d, which was signiifcantly lower than (10±3) d of parenteral nutrition group (t=-12.025,P<0.05). The total hospitalization expenses of the enteral nutrition group were RMB 45,000 (37,000-61,000) yuan, which were signiifcantly lower than RMB 49,000 (42,000-67,000) yuan of the parenteral nutrition group (Z=-18.495,P<0.05). Five patients in the enteral nutrition group and 8 patients in the parenteral nutrition group developed abdominal distention and diarrhea, which were alleviated by adjusting doses or infusion speed. ConclusionsEarly enteral nutrition after laparoscopic hepatectomy for HCC is beneifcial to the postoperative recovery of gastrointestinal function and may effectively reduce the ifnancial burden of patients. Moreover, its overall curative effect is better than that of parenteral nutrition.

ObjectiveTo investigate the safety and curative effect of laparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with hepatocellular carcinoma (HCC).MethodsClinical data of 58 patients with liver cirrhosis complicated with HCC diagnosed and treated in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between Janunary 2009 and November 2013 were retrospectively studied. The patients were divided into the microwave coagulation combined with hepatectomy group (the combination group) and the simple microwave coagulation group (the coagulation group) according to different treatment methods. Among the 37 patients in the combination group, 29 were males and 8 were females with average age of (54±9) years old. Among the 21 patients in the combination group, 17 were males and 4 were females with average age of (58±10) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients in the coagulation group only underwent laparoscopic microwave coagulation, while the patients in the combination group underwent hepatectomy after marking a incision line 1-2 cm from the tumor edge and undergoing microwave coagulation. The intraoperative blood loss and the duration of operation of two groups were observed. The comparison of the intraoperative blood loss and the duration of operation were conducted using Wilcoxon rank-sum test and the survival analysis was conducted using Log-rank test and Z test.ResultsThe intraoperative blood loss of the combination group was 146 (58-250) ml, which was signiifcantly higher than 13 (10-25) ml of the coagulation group (Z=7.824,P<0.05). The duration of operation of the combination group was 177 (83-275) min, which was signiifcantly longer than 93 (36-135) min of the coagulation group (Z=8.650,P<0.05). The 3-year cumulative survival rate and 1-, 3-year disease free survival of the combination group were respectively 97%, 83%, 92%, which were signiifcantly higher than 64%, 71%, 43% of the coagulation group (Z=10.054, 9.011, 7.112;P<0.05).ConclusionsLaparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with HCC is safe and effective. The long-term curative effect is better than that of simple laparoscopic microwave coagulation.

OBJECTIVETo investigate the safety and feasibility of simultaneous laparoscopic resection of colorectal carcinoma and synchronous liver metastasis.

METHODSClinical data of 11 patients undergoing simultaneous laparoscopic resection of colorectal carcinoma and synchronous liver metastasis in our hospital from January 2011 to October 2013 were reviewed retrospectively. Feasibility, safety and efficacy of this procedure were investigated.

RESULTSProcedure was completely successful in all the cases without conversion. The mean operation time was (284.6 ± 28.8) min and the mean blood loss was (322.7 ± 75.4) ml. The mean time to intestinal function recovery was (2.9 ± 0.7) d and the mean hospital stay was (12.3 ± 1.9) d. There were no anastomosis leakage, bile leakage, abdominal massive bleeding or infection, and liver failure after operation. During follow-up of 3-35 months, only one patient died of tumor progression.

CONCLUSIONLaparoscopic approach for colorectal carcinoma and synchronous liver metastasis is safe and feasible in selected patients.

Adult ; Aged ; Colectomy ; methods ; Colorectal Neoplasms ; pathology ; surgery ; Female ; Hepatectomy ; Humans ; Laparoscopy ; methods ; Liver Neoplasms ; secondary ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome