ObjectiveTo investigate the risk factors for pyogenic liver abscess （PLA） comorbid with sepsis by analyzing clinical features， and to construct a predictive model. MethodsA retrospective analysis was performed for 489 patients who were hospitalized and diagnosed with PLA in The Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2023， and according to the presence or absence of sepsis， they were divided into sepsis group with 306 patients and non-sepsis group with 183 patients. Related data were collected， including general information， laboratory markers， and outcome measures. The patients were further divided into a training set of 342 patients and a validation set of 147 patients at a ratio of 7∶3， and the training set was used for screening of variables and construction of a predictive model， while the validation set was used to test the performance of the model. An LASSO regression analysis was used for the screening of variables， and a multivariate Logistic regression analysis was used to construct the predictive model and plot a nomogram. The calibration curve， the receiver operating characteristic （ROC） curve， and the decision curve analysis were used for the validation of the model， and internal validation was performed for assessment. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical variables between groups. ResultsThere were significant differences between the sepsis group and the non-sepsis group in pulse rate， mean arterial pressure， duration pf symptoms， comorbidity of liver cirrhosis or malignant tumor， leukocyte count， neutrophil count， lymphocyte count， platelet count （PLT）， activated partial thromboplastin time， fibrinogen， C-reactive protein， aspartate aminotransferase， alanine aminotransferase， albumin， total bilirubin （TBil）， creatinine， potassium， and prognostic nutritional index （PNI） （all P<0.05）. In the training set， the LASSO regression analysis identified four predictive factors of pulse rate， PLT， TBil and PNI， and the multivariate Logistic regression analysis showed that pulse rate （odds ratio ［OR］=1.033， 95% confidence interval ［CI］： 1.006‍ ‍—‍ ‍1.061， P=0.018）， PLT （OR=0.981， 95%CI： 0.975‍ ‍—‍ ‍0.987， P<0.001）， TBil （OR=1.086， 95%CI： 1.053‍ ‍—‍ ‍1.125， P<0.001）， and PNI （OR=0.935， 95%CI： 0.882‍ ‍—‍ ‍0.988， P=0.019） were independent influencing factors for the risk of sepsis in patients with PLA. The model constructed based on these factors showed a good predictive ability， with an area under the ROC curve of 0.948 （95%CI： 0.923‍ ‍—‍ ‍0.973） in the training set and 0.912 （95%CI： 0.848‍ ‍—‍ ‍0.976） in the validation set. The decision curve analysis showed that the model has a good net benefit within the range of 0.3‍ ‍—‍ ‍0.9 for threshold probability. ConclusionThe nomogram prediction model constructed based on pulse rate， PLT， TBil， and PNI has a certain clinical value and can well predict the risk of sepsis in patients with PLA.

【Objective】 To evaluate the clinical efficacy and safety of platelet-rich plasma(PRP) in acute achilles tendon injury by meta-analysis. 【Methods】 Literature on clinical randomized controlled trial of PRP in the treatment of acute achilles tendon injury from Wanfang database, CNKI, VIP database, The Chinese Biological Literature Database, The Chinese Clinical Trials Registry, PubMed, Embase, Cochrane and The US Clinical Trials Registry as of August 2023 were retrieved. The control group received conventional treatment for acute achilles tendon injury, while PRP treatment group received additional PRP treatment. The primary outcome measure was visual analogue pain scale, and the secondary outcome measures were the achilles tendon fracture score, maximum heel rise height, calf circumference and ankle range of motion. The quality of the literature was assessed using the Cochrane manual, and a meta-analysis of qualified literature was performed using RevMan 5.3 software. 【Results】 Seven articles were finally included, involving 421 patients with acute achilles tendon injury, including 212 patients in the PRP treatment group, and 209 patients in the conventional treatment group. The results of meta-analysis showed that there was no difference between the conventional treatment group and the PRP treatment group in terms of the visual analogue pain scale(SMD=-0.44, 95%CI: -0.94~0.06, P>0.05), calf circumference (MD=1.14, 95% CI: -1.56-3.84, P>0.05), ankle joint toe flexion range of motion (SMD=1.85, 95%CI: -1.38-5.09, P>0.05), ankle dorsiflexion range of motion(SMD=2.61, 95%CI: -0.95-6.17, P>0.05), achilles tendon fracture score (MD=-5.60, 95%CI: -15.36-4.16, P>0.05) and the maximum heel rise height (MD=-2.48, 95%CI: -5.30-0.33, P>0.05). And there was no difference in the incidence of adverse reactions between the two groups (X²=2. 455, P>0.05). 【Conclusion】 PRP injection for acute achilles tendon injury does not improve the biomechanical and clinical outcomes of patients, and the use of PRP does not increase the occurrence of adverse reactions.

Objective To explore the influencing factors for Hook-wire precise positioning under CT guidance, determine the best positioning management strategy, and develop Nomogram prediction model. Methods Patients who underwent CT-guided Hook-wire puncture positioning in our hospital from July 2018 to November 2022 were selected. They were randomly divided into a training set and a validation set with a ratio of 7 : 3. Clinical data of the patients were analyzed, and the logistic analysis was used to screen out the risk factors that affected CT-guided Hook-wire precise positioning for the training set. The Nomogram prediction model was constructed according to the risk factors, and the goodness of fit test and clinical decision curve analysis were performed. Results A total of 199 patients with CT-guided Hook-wire puncture were included in this study, including 72 males and 127 females, aged 25-83 years. There were 139 patients in the training set and 60 patients in the validation set. In the training set, 70 patients were accurately located, with an incidence of 50.36%. Logistic regression analysis showed that height [OR=3.46, 95%CI (1.44, 8.35), P=0.006], locating needle perpendicular to the horizontal plane [OR=3.40, 95%CI (1.37, 8.43), P=0.008], locating needle perpendicular to the tangent line of skin surface [OR=6.01, 95%CI (2.38, 15.20), P＜0.001], CT scanning times [OR=3.03, 95%CI (1.25, 7.33), P=0.014], occlusion [OR=10.56, 95%CI (1.98, 56.48), P=0.006] were independent risk factors for CT-guided Hook-wire precise localization. The verification results of the Nomogram prediction model based on these independent risk factors showed that the area under the receiver operating characteristic curve (AUC) was 0.843 [95%CI (0.776, 0.910)], and the predicted value of the correction curve was basically consistent with the measured value. The AUC of the model in the validation set was 0.854 [95%CI (0.759, 0.950)]. The decision curves showed that when the threshold probability was within the range of 8%-85% in the training set and 18%-99% in the validation set, there was a high net benefit value. Conclusion Height, the locating needle perpendicular to the horizontal plane, the locating needle perpendicular to the tangent line of skin surface, number of CT scans, and occlusion are independent risk factors for CT-guided Hook-wire accurate localization. The Nomogram model established based on the above risk factors can accurately assess and quantify the risk of CT-guided Hook-wire accurate localization.

Objective To examine the application effectiveness of dual 8F ultrafine pigtail drainage tubes versus a single 28F large-bore chest tube in single-port thoracoscopic lobectomy/segmentectomy. Methods Clinical data of patients who underwent single-port video-assisted thoracoscopic lobectomy/segmentectomy within our medical group from January 2020 to August 2023 were retrospectively analyzed. They were categorized into two groups based on postoperative drainage methods: a dual 8F ultrafine pigtail tubes group and a single 28F large-bore chest tube group. Comparative analysis was performed on perioperative data for the two groups of patients. Results The dual 8F ultrafine pigtail tubes group comprised of 68 patients, with 41 females and 27 males, and an average age of (54.72±13.34) years, while the single 28F large-bore chest tube group comprised of 80 patients, with 40 females and 40 males, and an average age of (57.60±11.04) years. There were statistical differences between the two groups in terms of postoperative drainage volume on day 1, day 2, and day 3, total postoperative drainage volume, postoperative tube placement time, postoperative pain score at 48 hours, maximum postoperative pain score, postoperative hospital stay, postoperative complications related to drainage tubes, and emergency use of pain-relieving medication after surgery (P＜0.05). Conclusion After single-port thoracoscopic lobectomy/segmentectomy, the application of dual ultrafine 8F pigtail drainage tubes can lead to a reduction in postoperative drainage volume and shorten the duration of postoperative drainage tube placement and hospital stay, thereby decreasing postoperative pain and the frequency of emergency pain-relieving medication. Moreover, it lowers the incidence of drainage tube-related complications. In alignment with current enhanced recovery after surgery principles, this approach is advantageous for postoperative recovery.

With the widespread adoption of low-dose computed tomography(LDCT)and advancements in computed tomography image resolution,the detection rate of pulmonary nodules,especially smaller ones,has significantly improved.The risk of developing malignant tumors increases with the pulmonary nodule diameter.Video-assisted thoracoscopic surgery(VATS)stands out as the preferred surgical method.The accurate localization of pulmonary nodules is crucial for the success of VATS and remains a significant challenge for thoracic surgeons.Currently,commonly employed localization methods include CT-guided percutaneous positioning,bronchoscope-guided positioning,intraoperative ultrasound positioning,augmented reality(AR),and 3D print-assisted positioning.This review explores recent research progress,highlights the strengths and weaknesses of various pulmonary nodule localization methods.The aim is to provide valuable insights for clinical applications and guide future developments in this field.

Objective:To explore the clinical and genetic characteristics of a fetus diagnosed with Congenital myasthenic syndrome type 16 (CMS16).Methods:A couple who had visited Tianjin Medical University General Hospital in February 2018 due to "adverse outcome of two pregnancies" was selected as the study subject. Clinical data was gathered. Peripheral blood and amniotic fluid samples were collected and subjected to whole exome sequencing (WES). Candidate variant was verified by Sanger sequencing. Low-depth whole-genome sequencing was carried out to detect copy number variation (CNV) in the fetus.Results:The couple′s first pregnancy had resulted in a miscarriage at 27 + 5 weeks, when ultrasound had revealed pleural effusion and polyhydramnios in the fetus. Their second pregnancy was terminated at 30 + 5 weeks due to fetal hand malformations, polyhydramnios and pleural fluid. Both couple had denied family history of genetic conditions. For their third pregnancy, no CNV abnormality was detected, whilst a compound heterozygous variants, including a maternally derived c. 3172C>T (p.R1058W) and paternal c. 1431delG (p.K477fs*89) in the SCN4A gene were detected. Based on the guidelines from the American College of Medical Genetics and Genomics, the c. 3172C>T (p.R1058W) was predicted as a likely pathogenic variant (PM1+ PM2_supporting+ PP3+ PP4), whilst the c. 1431delG (p.K477fs*89) was predicted as a pathogenic variant (PVS1+ PM2_supporting+ PP4). Conclusion:The c. 3172C>T (p.R1058W) and c. 1431delG (p.K477fs*89) compound heterozygous variants of the SCN4A gene probably underlay the CMS16 in the third fetus.

Objective:To explore the clinical and molecular basis for a Chinese pedigree affected with Complete androgen insensitivity syndrome (CAIS).Methods:A CAIS pedigree presented at Tianjin Medical University General Hospital between 2019 and 2021 was selected as the study subject. Clinical data of the proband was collected, along with peripheral blood samples from the proband and her family members. Chromosomal karyotyping, sex-determining region of the Y chromosome ( SRY) testing, and next-generation sequencing (NGS) were carried out for the proband, and candidate variant was verified by Sanger sequencing of her family members. Prenatal diagnosis was provided for the sister of the proband. This study was approved by Medical Ethics Committee of the Tianjin Medical University General Hospital (Ethics No. IRB2023-WZ-070). Results:The 18-year-old proband, who has a social gender of female, underwent laparoscopic examination, which showed no presence of uterus and ovaries. The karyotype of peripheral blood sample was 46, XY, with SRY gene detected. NGS indicated that the proband has harbored a heterozygous c. 1988C>G (p.Ser663Ter) variant of the AR gene. Sanger sequencing confirmed that her mother and sister had both harbored the same variant, whilst her father and younger sister were of the wild-type. Prenatal diagnosis revealed that her sister′s first fetus had harbored carried the same variant, which had led to termination of pregnancy. Her second fetus did not carry the variant, and a healthy boy was born. Based on guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was classified as likely pathogenic (PM2_Supporting+ PM4+ PP3_Moderate+ PP4). Conclusion:The c. 1988C>G (p.Ser663Ter) variant of the AR gene probably underlay the CAIS in the proband. The accurate diagnosis of sex development disorders will rely on the physicians′ thorough understanding of the clinical symptoms and pathogenic genes. Genetic testing and counseling can enable precise diagnosis, prenatal diagnosis, and guidance for reproduction

AIM:This study aims to examine the ependymin-related protein 1(EPDR1)expression in various tissues from wild-type C57BL/6 mice and type 2 diabetes(db/db)mice.The impact of EPDR1 on lipid accumulation in al-pha mouse liver 12(AML12)hepatocytes was also investigated.METHODS:Western blot was used to detect EPDR1 protein expression in the heart,liver,spleen,lung,kidney,gastrocnemius,brown adipose and brain tissues of C57BL/6 mice.Western blot and immunohistochemical(IHC)staining were also used to compare EPDR1 protein expression in the liver,gastrocnemius muscle,heart and kidney tissues of db/db and C57BL/6 mice.To develop an AML12 cell lipid deposi-tion model,palmitic acid(PA)+oleic acid(OA)was used,and the cells were transfected with adenovirus overexpressing EPDR1 or treated with exogenous recombinant EPDR1 protein(rEPDR1).ELISA was conducted to determine intracellu-lar triglyceride(TG)content,and oil red O staining was employed to assess the effect of EPDR1 on lipid accumulation in AML12 cells.RESULTS:Western blot and IHC staining results revealed that EPDR1 was widely expressed in various tis-sues of wild-type mice,with the liver exhibiting the highest protein expression level.However,EPDR1 expression was down-regulated in the liver,gastrocnemius muscle,heart and kidney tissues in diabetic db/db mice compared with wild-type mice.Oil red O staining revealed that overexpression of EPDR1 in AML12 liver cells or rEPDR1 treatment led to re-duced lipid accumulation.Furthermore,the TG content significantly decreased compared with the model group(P<0.05).CONCLUSION:EPDR1 is expressed in various tissues of wild-type mice,but showed diminished expression in the liver tissues of diabetic mice.Nevertheless,enhancing the expression of EPDR1 can aid in reducing lipid accumula-tion in hepatocytes.These findings provide an experimental foundation for further exploration of the role of EPDR1 in the development of fatty liver in diabetic liver tissue.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To evaluate the prognostic value of C-reactive protein (CRP), performance status (PS), lactate dehydrogenase (LDH), albumin (ALB) and derived neutrophil-to-lymphocyte ratio (dNLR) composite index (C-PLAN) as a prognostic indicator in advanced esophageal cancer patients treated with immune checkpoint inhibitor (ICI). Methods Hematologic indexes of 147 patients with advanced esophageal cancer treated by ICI in the Affiliated Hospital of Yangzhou University were collected before the first immunotherapy. CRP, PS, LDH, ALB and dNLR were scored and added to obtain C-PLAN index. Chi-square test was used to analyze the correlation between C-PLAN index and clinicopathological features; Kaplan-Meier survival curve was used to analyze the effects of C-PLAN index on overall survival (OS) and progression-free survival (PFS). Univariate and multifactor Cox proportional regression models were used to analyze whether C-PLAN index could be used as an independent factor affecting prognosis. Results A total of 147 patients with advanced esophageal cancer were divided into low-risk group (scored < 2, n=46) and high-risk group (scored ≥2, n=101) according to C-PLAN index. C-PLAN index was not correlated with age, sex, PS score, smoking, clinical stage, body mass index, pathological type, treatment strategy and operation (P>0.05). PFS and OS in the low-risk group were significantly better than those in the high-risk group (P < 0.001). In univariate Cox regression analysis, C-PLAN index was the influencing factor of PFS (P < 0.001) and OS (P=0.002). In multivariate Cox analysis, C-PLAN index was an independent prognostic factor of PFS (P=0.001) and OS (P=0.006). Conclusion C-PLAN index can be used as a reliable clinical index to predict the prognosis of patients with advanced esophageal cancer treated by ICI.