Objective To investigate whether 3D-guided cone-shaped segmentectomy can achieve comparable long-term outcomes with lobectomy for deep early-stage lung cancer with diameter≤2 cm. Methods We retrospectively screened patients with deep early-stage non-small cell lung cancer (NSCLC) with diameter≤2 cm who underwent lobectomy or segmentectomy in the First Affiliated Hospital of Nanjing Medical University from 2012 to 2018. All pulmonary segmentectomy was performed using 3D-guided cone-shaped segmentectomy with segment or subsegment as the resection unit. Univariate and multivariate regression analyses were performed by Cox proportional hazard regression model. The patients who underwent segmentectomy and lobectomy were matched 1∶1 by propensity-score matching analysis. The oncological outcomes of two groups were compared. Results Our cohort was divided into a segmentectomy group (n=222) and a lobectomy group (n=127). The age, total nodule size, solid component size and proportion of pure solid nodule in the lobectomy group were significantly higher than those in the segmentectomy group. The median follow-up time was 49 months. Surgical margins were negative in all patients. The local recurrence rate of segmentectomy was 0.45%. The disease-free survival (DFS) rate and overall survival (OS) rate of patients in the segmentectomy group were significantly better than those in the lobectomy group (5-year DFS rate: 98.64% vs. 89.77%, P<0.001; 5-year OS rate: 99.55% vs. 92.10%, P<0.001). Multivariate regression analysis showed that the differences between two groups were not significant [DFS rate: HR=0.52. 95%CI (0.11, 2.59), P=0.427; OS rate: HR=0.08. 95%CI (0.00, 3.24), P=0.179] after adjusting for other factors. After propensity score matching, 77 patients were preserved in both segmentectomy group and lobectomy group, with the mean nodule size of 1.44 cm and 1.49 cm and the mean consolidation tumor ratio (CTR) of 0.46 and 0.52, respectively. There was no statistical difference in DFS rate (P=0.640) or OS rate (P=0.310) between the two groups. Conclusion 3D-guided cone-shaped segmentectomy can be an acceptable treatment for low-grade malignant NSCLC deep in lung parenchyma with diameter≤2 cm, and its oncology effect is not inferior to lobectomy.

Background and objective Current studies suggest that for early-stage lung cancers with a component of ground-glass opacity measuring ≤2 cm,sublobar resection is suitable if it ensures adequate margins.However,lobectomy may be necessary for some cases to achieve this.The aim of this study was to explore the impact of size and depth on surgical techniques for wedge resection,segmentectomy,and lobectomy in early-stage lung cancer ≤2 cm,and to determine methods for ensuring a safe resection margin during sublobar resections.Methods Clinical data from 385 patients with early-stage lung can-cer ≤2 cm,who underwent lung resection in 2022,were subject to a retrospective analysis,covering three types of procedures:wedge resection,segmentectomy and lobectomy.The depth indicator as the OA value,which is the shortest distance from the inner edge of a pulmonary nodule to the opening of the corresponding bronchus,and the AB value,which is the distance from the inner edge of the nodule to the pleura,were measured.For cases undergoing lobectomy and segmentectomy,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was performed to statistically determine the number of subsegments required for segmentectomy.The cutting margin width for wedge resection and segmentectomy was recorded,as well as the specific subsegments and their quantities removed during lung segmentectomy were documented.Results In wedge resection,segmentectomy,and lobectomy,the sizes of pulmonary nodules were(1.08±0.29)cm,(1.31±0.34)cm and(1.50±0.35)cm,respectively,while the depth of the nodules(OA values)was 6.05(5.26,6.85)cm,4.43(3.27,5.43)cm and 3.04(1.80,4.18)cm for each procedure,showing a progressive increasing trend(P＜0.001).The median resec-tion margin width obtained from segmentectomy was 2.50(1.50,3.00)cm,significantly greater than the 1.50(1.15,2.00)cm from wedge resection(P＜0.001).In wedge resections,cases where AB value＞2 cm demonstrated a higher proportion of cases with resection margins less than 2 cm compared to those with margins greater than 2 cm(29.03％vs 12.90％,P=0.019).When utilizing the size of the nodule as the criterion for resection margin,the instances with AB value＞2 cm continued to show a higher proportion in the ratio of margin distance to tumor size less than 1(37.50％vs 17.39％,P=0.009).The median number of subsegments for segmentectomy was three,whereas lobectomy cases requiring segmentectomy involved five subsegments(P＜0.001).Conclusion The selection of the surgical approach for lung resection is influenced by both the size and depth of pulmonary nodules.This study first confirms that larger portions of lung tissue must be removed for nodules that are deeper and larger to achieve a safe margin.A distance of ≤2 cm from the inner edge of the pulmonary nodule to the nearest pleura may be the ideal indication for performing wedge resection.

Objective:To explore the clinical characteristics and medical nutritional therapy of 6 patients with late-onset ornithine transcarbamylase (OTC) deficiency.Methods:The clinical features, biochemical data, gene variations and treatment outcomes of 6 children with late-onset OTC deficiency admitted to the Department of Clinical Nutrition, Children′s Hospital of Nanjing Medical University from January 2020 to April 2022 were retrospectively analyzed.The 6 patients were all intervened by a long-term medical nutrition management.Results:Liver dysfunction and hyperammonemia (172.1-348.0 μmol/L) were found in all the 6 children with late-onset OTC deficiency.Serum citrulline decreased in 3 patients (3.95-5.43 μmol/L). Three patients showed increased urine orotic acid (123.48-342.60 mmol/mol Cr). Urine uracil increased in 4 patients (106.77-1 207.26 mmol/mol Cr). Variations of the OTC gene [c.364G>C p. (E122Q), c.1028C>G p. (T343R), c.664-2(IVS6)A>C, c.635G>T p. (G212V), c.929_c.931delAAG p. (E310del), c.829C>T p. (R277W)] were identified in all patients.The 6 children were all managed by individualized medical nutrition program and followed up for a long time.During the follow-up period, 3 cases developed hypoproteinemia, acute metabolic crisis and growth retardation, 3 cases had normal growth and laboratory indicators, and 1 case received liver transplantation after 3 months of nutritional management. Conclusions:The clinical manifestations of OTC deficiency are non-specific.Blood amino acids, urine organic acids and genetic tests are important for the diagnosis.Long-term regular medical nutrition management is helpful to improve the prognosis and quality of life of children.

Objective:To detect the expression of MYBL2 gene in gastric adenocarcinoma tissue and its effects on cell proliferation and invasion. Methods:A total of 100 cases of gastric adenocarcinoma tissue and 100 cases of paracancerous tissue were selected from patients who received surgery in The People's Hospital of Yuhuan between January 2017 and December 2020. Gastric adenocarcinoma cell lines MGC-803 were transfected with MYBL2 siRNA and siRNA control. The cells not transfected were used as controls. MYBL2 gene expression in gastric adenocarcinoma tissue and paracancerous tissue as well as MGC-803 were determined by quantitative real time-polymerase chain reaction. MGC-803 cell proliferation was determined by MTT. The invasive ability of MGC-803 cells was determined by Transwell assay. The migration ability of MGC-803 cells was determined by Scratch testing. MYBL2 protein expression in gastric adenocarcinoma tissue and paracancerous tissue as well as MGC-803 cells was determined by western blotting. Results:The relative mRNA expression of MYBL2 in gastric adenocarcinoma tissue was significantly higher than that in paracancerous tissue [(0.65 ± 0.17) vs. (0.18 ± 0.05), t = 26.52, P < 0.05). The relative mRNA expression of MYBL2 in the MYBL2 siRNA group (0.29 ± 0.07) was significantly lower than that in the control group (0.73 ± 0.12) and siRNA group (0.71 ± 0.16, t = 5.48, 4.16, both P < 0.05). MTT assay showed that after 24 and 48 hours of culture, MGC-803 cell proliferation rate in the MYBL2 siRNA group [(40.95 ± 5.46)%, (52.12 ± 12.27)%] was significantly lower than that in the control group [(67.84 ± 6.45)%, (87.83 ± 9.96)%] and siRNA group [(66.98 ± 7.85)%, (85.98 ± 10.24)%, t = 5.51, 3.91, 4.71, 3.67, all P < 0.05]. MGC-803 cell invasion rate in the MYBL2 siRNA group [ (62.12 ± 6.43)%] was significantly lower than that in the control group [(89.74 ± 6.56)%] and siRNA group [(88.83 ± 7.85)%, t = 5.20, 4.55, both P < 0.05]. The number of MGC-803 cells migrated in the MYBL2 siRNA group [(4.32 ± 0.84) × 10 3] was significantly lower than that in the control group [(8.95 ± 1.64) × 10 3] and siRNA group [(8.83 ± 1.78) × 10 3, t = 4.35, 3.96, both P < 0.05]. The gray value of MYBL2 protein in the gastric adenocarcinoma tissue was (0.56 ± 0.15), which was significantly higher than that in the paracancerous tissue [(0.23 ± 0.07), t = 19.93, P < 0.001]. The gray value of MYBL2 protein in the MYBL2 siRNA group was (0.21 ± 0.03), which was significantly lower than that in the control group (0.67 ± 0.15) and siRNA group (0.65 ± 0.19) ( t = 5.20, 3.96, both P < 0.05). Conclusion:MYBL2 gene is highly expressed in gastric adenocarcinoma tissue. siRNA silencing MYBL2 can decrease the ability of MGC-803 cells to proliferate, invade and migrate and downregulate MYBL2 expression. This study is highly innovative and scientific.

ObjectiveTo study the relationship between scarlet fever and meteorological factors in Minhang District， Shanghai， and provide scientific basis for prevention and control of scarlet fever and establishment of a scarlet fever early warning system. MethodsData of thea scarlet fever epidemic were obtained from China Disease Control and Prevention Information System， and the meteorological data were obtained from Shanghai Minhang Meteorological Bureau. A generalized additive model was used to explore the relationship between scarlet fever incidence and meteorological factors in the R3.6.1 software. ResultsBetween 2009 and 2020， there was a rapid increase in the incidence of scarlet fever starting from 2011. There was a negative correlation between scarlet fever and wind velocity： the higher the wind velocity， the fewer cases. The correlation of number of cases with air temperature and atmospheric pressure was non-linear. The number of scarlet fever cases was positively correlated with air temperature below 17 degrees Celsius， and negatively correlated with air temperature above 17 degrees Celsius. The number of cases decreased with the increase of atmospheric pressure when atmospheric pressure was less than 1 017 MPa， and increased with the increase of atmospheric pressure when atmospheric pressure was more than 1 017 MPa. ConclusionThe incidence of scarlet fever is negatively correlated with wind speed， which can be reduced by opening windows for ventilation. The incidence of scarlet fever has a nonlinear relationship with air temperature and air pressure. The findings of this study provide scientific information for better understanding the epidemic trend of scarlet fever in Minhang District， contribute to the establishment of an early warning system， improve the active prevention and intervention of risk factors of the disease， and reduce its social burden.

Objective    To explore the feasibility and clinical value of free-of-puncture positioning in three-dimension-guided anatomical segmentectomy for ground-glass nodule (GGN) compared with percutaneous positioning. Methods    Clinical data of 268 enrolled patients undergoing anatomical pulmonary segmentectomy from October 2018 to June 2019 were retrospectively collected, including 75 males and 193 females with an average age of 56.55±12.10 years. The patients were divided into two groups, including a percutaneous positioning group (n=89) and a free-of-puncture positioning group (n=179). Perioperative data of the two groups were compared. Results    The average CT scan times of the percutaneous positioning group was 3.01±0.98 times, and the numerical rating scale (NRS) score of puncture pain was 3.98±1.61 points. Pulmonary compression pneumothorax (≥30%) occurred in 7 (7.87%) patients and intercostal vascular hemorrhage occurred in 8 (8.99%) patients after puncture. Lung nodules were successfully found and removed in both groups. There was no statistically significant difference between the two groups in the location of nodules (P=0.466), operation time (151.83±39.23 min vs. 154.35±33.19 min, P=0.585), margin width (2.07±0.35 cm vs. 1.98±0.28 cm, P=0.750), or the number of excised subsegments (2.83±1.13 vs. 2.73±1.16, P=0.530). Conclusion    Anatomical segmentectomy with three-dimensional navigation avoids the adverse consequences of puncture, which has the same clinical efficacy and meets the requirements of oncology compared with percutaneous positioning. The free-of-puncture positioning method can be used for GGN located in the central region of pulmonary segment/subsegment or adjacent to   intersegment veins instead of percutaneous positioning.

Objective:To understand the spatial-temporal distribution and spatial clusters of measles cases in China.Methods:Measles incidence data was collected from the National Notifiable Disease Reporting System of Chinese Center for Disease Control and Prevention. The global and local spatial autocorrelation analyses were conducted by using software ArcGIS 10.2 and spatial-temporal scan was conducted by using software SaTScan 9.6.Results:A total of 1 012 537 cases of measles were reported in China from 2001 to 2016 and the annual incidence showed a sharp downward trend. There was global spatial clustering of measles cases during 2001-2004, 2005-2008, and 2009-2012, and their Moran's I coefficients were 0.29, 0.26, and 0.31, respectively. The results of local spatial autocorrelation analysis showed that there were high- high clustering areas of measles at all time periods, especially in western China. Guangdong province was detected as a separate high-low scattered area from 2005 to 2008 and no low-low clustering area was detected. The spatial-temporal scan statistics showed that there was a wide clustering area covering western, central and northern China, and Shanxi province and Guangxi Zhuang Autonomous Region from 2001-2008. Conclusion:The incidence of measles in China has a certain clustering in both space and time during 2001-2016, the results provide evidence for the development of future strategy of measles prevention and control in China.

Objective:To explore the time series characteristics of 5 types of viral hepatitis in China and predict their incidence through effective models.Methods:The monthly incidence data of 5 types of viral hepatitis (A, B, C, D and unspecified) in China from 2009 to 2018 were collected for descriptive and time series analyses, decomposition methods were used to explore the seasonality in the form of seasonal indices and the long-term trend in the form of a linear regression model. Autoregressive integrated moving average (ARIMA) models were established for each type of viral hepatitis.Results:From 2009 to 2018, a total of 14 856 990 cases of viral hepatitis were reported, the seasonal index range of 5 types of viral hepatitis were all lower than 1, the seasonality of hepatitis E was significant, and its incidence was unimodal, but no obvious seasonality characteristics were observed for other four types of viral hepatitis. The incidences of hepatitis A, hepatitis E and unspecified hepatitis remained at lower levels, showing slow declines. Although the cases of hepatitis B accounted for the highest proportion (79.59%, 11 824 262/14 856 990) among 5 types of viral hepatitis, the decline was fastest (-0.01/100 000). The incidence of hepatitis C was on rise, and the rate of increase remained stable (0.005/100 000). The predicted incidences of 5 types of viral hepatitis in China from January 2009 to December 2018 fitted by ARIMA model were consistent with the actual incidences, and the mean absolute error percentage (MAPE) ranged from 3.756 8 to 8.068 3.Conclusions:Time series analysis on surveillance data is useful for better understanding the incidence of the viral hepatitis. The ARIMA model has good application value in the short-term prediction of viral hepatitis incidence in China.

Thoracoscopic pulmonary segmentectomy is one of the important treatment methods for early lung cancer. Only the premise of surgical precision can make the radical resection of lesions and maximum reservation of healthy lung tissue be simultaneously guaranteed. As a representative of the precise lung operation, the “cone-shaped lung segmentectomy” focuses on the lesion, and combines the anatomical characteristic of the patient to design individualized operation scheme. The technological core consists of three parts, three dimensional-computed tomography bronchography and angiography (3D-CTBA) surgery path planning, accurate definition of intersegmental demarcation and anatomic dissection of intersegmental borders along the demarcation. This paper aims to explore the technical process and quality control of the key techniques of thoracoscopic precise segmentectomy, so as to standardize the segmentectomy procedure under the principle of radical and minimally invasive therapy.

Objective This study applied " modified inflation-deflation" to identify the intersegmental plane and explored a method to remove pulmonary segments from the lobe on the basis of cone-shaped principle."Cone-shaped" Segmentectomy includes anatomical separation of the hilum(conical tip) and the intersegmental plane(undissociative conical surface).The feasibility was evaluated.Methods We retrospectively reviewed 146 patients with peripheric pulmonary nodules who underwent cone-shaped segmentectomy between September 2013 and August 2016.Under the guidance of preoperative 3D-CTBA (three-dimensional computed tomography bronchography and angiography)the targeted bronchi and arteries were dissected.The intersegmental plane was identified by " modified inflation-deflation" method.The inflation-deflation interface was anatomically separated from hilum to distal region along the intersegmental veins,while leaving 1-2 cm in thickness from far end.The residual intersegmental parenchyma was then dissected using endo staplers.Mean folhow-up was 20.4 months.Results Sixty two single segmentectomies,38 combined segmentectomies,43 subsegmentectomies and 3 subsubsegmentectonies were performed.Twelve diagnoses of benign nodule,15 diagnoses of atypical adenomatous hyperplasia,6 diagnoses of metastatic carcinona and 113 diagnosis of primary puhmonary cancer were confirmed pathologically." Modified inflation-deflation" spent (12.5 ±6.4)minutes to show the clear inflation-deflation line.All the targeted bronchi and arteries were dissected precisely and the intersegmental veins were preserved.All the preserved adjacent segments kept approximately original shape after inflated.The tumor size was(1.4 ±0.7)cm,the surgical margin width was(2.5 ± 1.6)cm.The depth of the separated intersegmental plane was(4.2 ±1.7)cm,and the width of the plane was(6.5 ± 2.2)cm.The operative time was(158.5 ± 42.6)min,the volume of hemorrhage was(25.2 ± 15.7) ml,the postoperative hospital stay was (5.2 ± 2.2) days.The total incidence of complications was 5.5％ (8/146).No death within 30 days occurred.Among 113 primary pulmonary cancers,there were 35 T0 N0M0(adenocarcinoma in situ) and 78 T1a No M0 non-small-cell lung cancers.One patient had local recurrence,and no death occurred during follow-up period.Conclusion Modified inflation-deflation can show clear inflation-deflation line to identify the intersegmental plane.Thoracscopic cone-shaped segmentectomy can achieve a complete anatomical segmentectomy.