Descending necrotizing mediastinitis: a clinical analysis based on 10 years of published data in China / 口腔疾病防治

Objective@#To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.@*Methods@#Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.@*Results@#The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.@*Conclusion@#The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.

Fascin actin-bundling protein 1 regulates non-small cell lung cancer progression by influencing the transcription and splicing of tumorigenesis-related genes.

Background: High mortality rates are prevalent among patients with non-small-cell lung cancer (NSCLC), and effective therapeutic targets are key prognostic factors. Fascin actin-bundling protein 1 (FSCN1) promotes NSCLC; however, its role as an RNA-binding protein in NSCLC remains unexplored. Therefore, we aimed to explore FSCN1 expression and function in A549 cells. Method: We screened for alternative-splicing events and differentially expressed genes (DEGs) after FSCN1 silence via RNA-sequencing (RNA-seq). FSCN1 immunoprecipitation followed by RNA-seq were used to identify target genes whose mRNA expression and pre-mRNA alternative-splicing levels might be influenced by FSCN1. Results: Silencing FSCN1 in A549 cells affected malignant phenotypes; it inhibited proliferation, migration, and invasion, and promoted apoptosis. RNA-seq analysis revealed 2,851 DEGs and 3,057 alternatively spliced genes. Gene ontology-based functional enrichment analysis showed that downregulated DEGs and alternatively splicing genes were enriched for the cell-cycle. FSCN1 promoted the alternative splicing of cell-cycle-related mRNAs involved in tumorigenesis (i.e., BCCIP, DLGAP5, PRC1, RECQL5, WTAP, and SGO1). Combined analysis of FSCN1 RNA-binding targets and RNA-seq data suggested that FSCN1 might affect ACTG1, KRT7, and PDE3A expression by modulating the pre-mRNA alternative-splicing levels of NME4, NCOR2, and EEF1D, that were bound to long non-coding RNA transcripts (RNASNHG20, NEAT1, NSD2, and FTH1), which were highly abundant. Overall, extensive transcriptome analysis of gene alternative splicing and expression levels was performed in cells transfected with FSCN1 short-interfering RNA. Our data provide global insights into the regulatory mechanisms associated with the roles of FSCN1 and its target genes in lung cancer.

Relative efficacy and safety of several regional analgesic techniques following thoracic surgery: a network meta-analysis of randomized controlled trials.

BACKGROUND: This network meta-analysis was performed to assess the relative efficacy and safety of various regional analgesic techniques used in thoracic surgery. MATERIALSAND METHODS: Randomized controlled trials evaluating different regional analgesic methods were retrieved from databases, including PubMed, Embase, Web of Science, and the Cochrane Library, from inception to March 2021. The surface under the cumulative ranking curve) was estimated to rank the therapies based on the Bayesian theorem. Moreover, sensitivity and subgroup analyses were performed on the primary outcomes to obtain more reliable conclusions. RESULTS: Fifty-four trials (3360 patients) containing six different methods were included. Thoracic paravertebral block and erector spinae plane block (ESPB) were ranked the highest in reducing postoperative pain. As for total adverse reactions and postoperative nausea and vomiting, postoperative complications, and duration of hospitalization, ESPB was found to be superior to other methods. It should be noted that there were few differences between various methods for all outcomes. CONCLUSIONS: Available evidence suggests that ESPB might be the most effective and safest method for relieving pain after thoracic surgery, shortening the length of hospital stay and reducing the incidence of postoperative complications.

A methodology for energy dissipation prediction of the bolt group with non-uniform preload.

The bolted joints exhibit typical nonlinear hysteresis under tangential loading, and the deviations of the preload in the bolt group add to the complexity of the model describing this behavior. In this paper, based on the mechanical analysis of the bolt group, a new methodology for predicting hysteresis behavior under non-uniform preload was proposed. Firstly, based on the moment equilibrium within the framework of material mechanics and the tangential stiffness model of the joint interface, a new coordination equation of displacement and force between the bolted joints was deduced, which could realize the calculation of the bolt group loading curve. Then, the PCOM (Preload Co-Occurrence Matrix) was constructed considering the arrangement of the joints, and the indices related to the spatial distribution of the preload were extracted from PCOM. The results of GCA (Grey Correlation Analysis) showed that the indices of PCOM were closely related to the hysteresis behavior of the bolt group. Finally, the prediction of energy dissipation could be realized by using the indices extracted from PCOM and the SVM(Support Vector Machine) regression model. The prediction results were in good agreement with the simulation and experiment, which verified the validity of the methodology proposed in this paper.

Effects of Different Treatment Regimens on Primary Spontaneous Pneumothorax: A Systematic Review and Network Meta-Analysis.

PURPOSE: The best treatment strategy for primary spontaneous pneumothorax is controversial and varies widely in practice. METHODS: Literatures were searched from databases till 24 August 2021. A Bayesian network meta-analysis was conducted to compare the outcomes of various treatments with the following endpoints: recurrence rate, postoperative chest tube duration, postoperative air leakage duration, length of hospital stay, and complications rate. RESULTS: In all, 7210 patients of 20 randomized controlled trials and 17 cohort studies were included. Surgery had a significantly lower recurrence rate compared to other treatments. Besides, bullectomy (BT) combined with chemical pleurodesis (CP), mechanical pleurodesis, or staple line coverage (SLC) can reduce the recurrence rate compared to BT alone, but none of them were statistically significant. In terms of reducing chest tube duration, BT with tubular Neoveil outperformed BT + pleural abrasion (mean difference [MD], 95% confidence interval [CI]: -2.5 [-4.63, -0.35]) and BT + apical pleurectomy (MD, 95% CI: -2.72 [-5.16, -0.27]). CONCLUSIONS: Surgical methods were superior to manual aspiration (MA), chest tube drainage (CTD), and conservative treatment in terms of recurrence reduction. There was no significant difference between MA and CTD in reducing the recurrence rate. Among surgical methods, CP is more effective than mechanical pleurodesis and SLC among the additional procedures based on BT.

Prognostic Value and Oncogenic Effects of Ubiquitin-Specific Protease 43 in Lung Squamous Cell Carcinoma.

Dysregulated expression of ubiquitin-specific protease 43 (USP43) has been recently discovered in malignancies. This study aimed to investigate the expression pattern of USP43 protein in lung squamous cell carcinoma (LUSC) and to explore its correlation with patients' clinicopathological characteristics as well as clinical outcomes. Expression of USP43 protein was determined by immunohistochemistry staining in a retrospective cohort containing 157 LUSC cases who underwent curative surgery in our hospital. Accordingly, USP43 protein was positively correlated with tumor size, depth of invasion, and lymph node metastasis. Patients with increased USP43 expression or positive lymph nodes exhibited a poorer overall survival. In addition, cellular assays elucidated that USP43 can promote LUSC growth and invasion. Taken together, our study demonstrated that USP43 may act as a proto-oncogene, which could be a promising biomarker and therapeutic target in the survival prediction and treatment of LUSC.

A High Precision Modeling Technology of Material Surface Microtopography and Its Influence on Interface Mechanical Properties.

In order to accurately and effectively obtain the contact performance of the mating surface under the material surface topography characteristics, a numerical simulation method of rough surface based on the real topography characteristics and a multi-scale hierarchical algorithm of contact performance is studied in this paper. Firstly, the surface topography information of materials processed by different methods was obtained and characterized by a measuring equipment; Secondly, a non-Gaussian model considering kurtosis and skewness was established by Johnson transform based on Gaussian theory, and a rough surface digital simulation method based on real surface topography was formed; Thirdly, a multi-scale hierarchical algorithm is given to calculate the contact performance of different mating surfaces; Finally, taking the aeroengine rotor as the object, the non-Gaussian simulation method was used to simulate the mating surfaces with different topographies, and the multi-scale hierarchical algorithm was used to calculate the contact performance of different mating surfaces. Analysis results showed that the normal contact stiffness and elastic-plastic contact area between the mating surfaces of assembly 1 and assembly 2 are quite different, which further verifies the feasibility of the method. The contents of this paper allow to perform the fast and effective calculation of the mechanical properties of the mating surface, and provide a certain analysis basis for improving the surface microtopography characteristics of materials and the product performance.

Numerical Simulation and Accuracy Verification of Surface Morphology of Metal Materials Based on Fractal Theory.

This paper presents a numerical simulation method to determine the surface morphology characteristics of metallic materials. First, a surface profiler (NV5000 5022s) was used to measure the surface, and the morphology data thereof were characterized. Second, fractal theory was used to simulate the surface profile for different fractal dimensions D and scale coefficients G, and statistical analyses of different surface morphologies were carried out. Finally, the fractal dimension D of the simulated morphology and the actual morphology were compared. The analysis showed that the error of fractal dimension D between the two morphologies was less than 10%; meanwhile, the comparison values of the characterization parameters of the simulated morphology and the actual morphology were approximately equal, and the errors were below 6%. Therefore, the current method used to evaluate the surface morphologies of parts processed by the grinding/milling method can be replaced by the simulated method using the corresponding parameters. This method makes it possible to theorize about the surface morphologies of machined parts, and provides a theoretical basis and reference value for the surface morphology design of materials, with the potential to improve the assembly quality of products.

Ginsenoside Rg3 promotes the antitumor activity of gefitinib in lung cancer cell lines.

Lung cancer is one of the most common types of cancer with one of the highest incidence and mortality rates. Gefitinib is widely used for the treatment of non-small cell lung cancer (NSCLC). However, issues regarding drug resistance, toxicity and limited applicability have been associated with gefitinib. The aim of the present study was to investigate whether ginsenoside Rg3 enhances the anticancer activity of gefitinib in NSCLC cells. MTT assay demonstrated that ginsenoside Rg3 increased the cytotoxic effect of gefitinib in NSCLC cell lines in a dose- and time-dependent manner. In addition, flow cytometric analysis revealed that the combined treatment with gefitinib and ginsenoside Rg3 significantly increased apoptosis in NSCLC cell lines. Transwell migration assays demonstrated that the combined treatment with gefitinib and ginsenoside Rg3 significantly decreased NSCLC cell migration compared with gefitinib or ginsenoside Rg3 treatment alone. Furthermore, western blot analysis revealed that in NSCLC cell lines, the combined treatment with gefitinib and ginsenoside Rg3 increased protein expression levels of pro-apoptotic proteins Bax and cleaved-caspase-3, whilst the expression level of anti-apoptotic protein Bcl-2 decreased. In addition, western blot analysis revealed that, in NSCLC cell lines, the combined treatment with gefitinib and ginsenoside Rg3 decreased the protein expression levels of pro-migration factors SNAIL and SLUG, whilst the expression level of anti-migration protein E-cadherin increased. In conclusion, ginsenoside Rg3 may be able to enhance the anticancer activity of gefitinib, making NSCLC cells more sensitive to gefitinib.

Increased expression of circRNA_102231 in lung cancer and its clinical significance.

Circular RNAs (circRNAs) are a type of endogenous non-coding RNAs which implicated in the progression of cancers. However, the role of circRNA_102231 in lung cancer remains unclear. Gene Expression Omnibus (GEO) datasets were used to investigate aberrantly expressed circRNAs in lung cancer. CircRNA_102231 expression in lung adenocarcinoma (LAC) tissues was dertermined by qRT-PCR. Furthermore, we explored the functions of circRNA_102231 on lung cancer cells progression. In the present study, circRNA_102231 was found to be one of the most significantly upregulated circRNAs in the GEO datasets analysis (GSE101586). QRT-PCR showed that circRNA_102231 expression was significantly upregulated in LAC tissues and associated with the advanced TNM stage, lymph node metastasis, and poor overall survival of lung cancer patients. The area under the receiver operating characteristic curve (ROC) was 0.897. in addition, function assays showed that circRNA_102231 inhibition significantly suppressed lung cancer cells proliferation and invasion ability in vitro. In conclusion, our study demonstrated that circRNA_102231 could act as a potential biomarker and therapeutic target for lung cancer patients.

A 10­microRNA prognosis scoring system in esophageal squamous cell carcinoma constructed using bioinformatic methods.

MicroRNA (miR) signatures may aid the diagnosis and prediction of cancer; therefore, miRs associated with the prognosis of esophageal squamous cell carcinoma (ESCC) were screened. miR­sequencing (seq) and mRNA­seq data from early­stage ESCC samples were downloaded from The Cancer Genome Atlas (TCGA) database, and samples from subjects with a >6­month survival time were assessed with Cox regression analysis for prognosis­associated miRs. A further two miR expression datasets of ESCC samples, GSE43732 and GSE13937, were downloaded from the Gene Expression Omnibus database. Common miRs between prognosis­associated miRs, and miRs in the GSE43732 and GSE13937, datasets were used for risk score calculations for each sample, and median risk scores were applied for the stratification of low­ and high­risk samples. A prognostic scoring system of signature miRs was subsequently constructed and used for survival analysis for low­ and high­risk samples. Differentially­expressed genes (DEGs) corresponding to all miRs were screened and functional annotation was performed. A total of 34 prognostic miRs were screened and a scoring system was created using 10 signature miRs (hsa­miR­140, ­33b, ­34b, ­144, ­486, ­214, ­129­2, ­374a and ­412). Using this system, low­risk samples were identified to be associated with longer survival compared with high­risk samples in the TCGA and GSE43732 datasets. Age, alcohol and tobacco use, and radiotherapy were prognostic factors for samples with different risk scores and the same clinical features. There were 168 DEGs, and the top 20 risk scores positively­correlated and the top 20 risk scores negatively­correlated DEGs were significantly enriched for six and 10 functional terms, respectively. 'Tight junction' and 'melanogenesis' were two significantly enriched pathways of DEGs. miR­214, miR­129­2, miR­37a and miR­486 may predict ESCC patient survival, although further studies to validate this hypothesis are required.

Treatment of spontaneous pneumothorax by mechanical pleurodesis / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical efficacy of video-assisted thoracoscopic surgery (VATS) and pleurodesis for spontaneous pneumothorax. Methods    A retrospective analysis of 157 patients with spontaneous pneumothorax undergoing VATS from January 2012 to March 2016 in our hospital was done. According to different treatments, patients were divided into two groups: a group A (65 patients receving pleurodesis, 52 males and 13 females with a mean age of 34.77 years ranging from 17 to 73 years) and a group B (92 patients without pleurodesis, 76 males and 16 females with a mean age of 34.66 years ranging from 16 to 72 years). In the group A 29 patients underwent closed thoracic drainage; while in the group B there were 39 patients. Results    The patients were followed up for 3 months to 4 years. The recurrence rate of the group A was lower than that of the group B, but the difference was not statistically significant. For patients receving closed thoracic drainage preoperatively, intraoperative drainage volume at postoperative 24 h in the group A was more than that of the group B, but postoperative hospital stay was less than that of the group B (P<0.05). For patients not receving closed thoracic drainage preoperatively, drainage volume at postoperative 24 h, total drainage volume, postoperative hospital stay in the group A were more than those of the group B (P<0.05). Conclusion    Pleurodesis can not reduce the recurrence rate of spontaneous pneumothorax. Preoperative closed thoracic drainage combined with intraoperative pleurodesis can effectively reduce postoperative hospitalization; therefore pleurodesis is recommended. If preoperative closed thoracic drainage is not adopted, surgery without pleurodesis can effectively reduce thoracic drainage at postoperative 24 h, total drainage volume and hospital stay and the perioperative results are better; therefore mechanical pleurodesis is not recommended.

[Risk Factors for Post-surgery Recurrence of Multiple Pulmonary Cystic Echinococcosis].

Clinical information of patients with multiple pulmonary cystic echinococcosis who received surgery in the Department of Thoracic Surgery of the Hospital from January 2005 to October 2014 was collected. Multivariate logistic regression analysis was used to analyze the predisposing factors for post-surgery recurrence of multiple pulmonary cystic echinococcosis. Among the 73 cases of multiple pulmonary cystic echinococcosis, 40 were males and 33 were females, with a male-to-female ratio of 1.21 : 1. The average age of patients was 37.6 years. All the patients reported a living history in pastoral areas or contacts with dogs. Thirty-eight patients were administered with albendazole tablets or liposomal albendazole for 3 to 12 months after surgery. Recurrence occurred in 6 cases, with a rate of 8.2%. Multivariate logistic regression analysis revealed the preoperative rupture of hydatid cyst to be the risk factor for post-surgery recurrence. The administration of anti-hydatid drugs after surgery plays a protective role against recurrence, and may reduce the risk of recurrence.

[Application of serum proteomic patterns for the detection of esophageal carcinoma in Kazakh in Xinjiang].

OBJECTIVE: To detect the serum protein profiles of Kazakh's esophageal carcinoma (EC) patients in Xinjiang by SELDI-TOF-MS (surface enhanced laser desorption & ionization time-of-flight mass spectrometry) and build up a diagnostic model of Kazakh's EC in Xinjiang. METHODS: The serum samples from 41 Kazakh's EC patients and 20 Kazakh's healthy controls were collected and analyzed on weak cation exchange and hydrophobic surface protein chip by SELDI-TOF-MS technology. The differentially expressed markers of esophageal carcinoma were detected. RESULTS: The values of M/Zs were significantly different between Kazakh's EC patients and controls (P < 0.05). Among these, 6 proteins peaks were up-regulated (5495.2265, 15 964.6951, 16 152.0872, 4488.4818, 8164.7652, 4979.4223) and 4 down-regulated (6900.3285, 13 790.9241, 8790.8130, 8714.7915) in the Kazakh's EC group. According to cross validation, the model of Kazakh's EC made up of 7 proteins (M/Z 6900.3285, 13 790.9241, 8790.8130, 15 964.6951, 16 152.0872, 4488.4818, 4979.4223) was established. The sensitivity and specificity of this model were 100% (41/41) and 100% (20/20) respectively. CONCLUSION: The model with 7 proteins markers has a higher sensitivity and specificity for Kazakh's EC patients in Xinjiang. It may provide a new serum diagnostic tool for Kazakh's EC patients in Xinjiang.

[The clinical analysis of 93 children with pulmonary echinococcus].

OBJECTIVE: To approach the clinical characteristics and surgical treatment of children with pulmonary echinococcus. METHODS: Retrospective analysis of child patients with pulmonary echinococcus from January 1980 to December 2008 was carried out, associated with clinical manifestations, diagnosis and treatment, operation methods (complete removal of endocyst and cystectomy with needle aspiration), prognosis and recurrence. There were 93 patients (54 male and 39 female) aged from 2 to 14 years. There were 82 cases lived in the echinococcosis pulmonary endemic areas, accounting for 88.1% (82/93), and 79 cases of patients had obvious contact with dogs or sheep, accounting for 84.9% (79/93). There were 68 cases with simple pulmonary echinococcus accounted for 73.1% (68/93), 25 cases suffered from complexity pulmonary hydatid, accounting for 26.9% (25/93). RESULTS: All patients were cured or improved after surgery except one dead. Six cases got postoperative pulmonary infection, 3 cases had wound infection, 1 case suffered from bile-pleura fistula. There were 76 patients (81.7%) followed up for 1 to 10 years after surgery. Five cases had recurrence, the recurrence rate was 5.4% (5/93). CONCLUSIONS: The clinical symptoms of pulmonary echinococcus in children is not typical, misdiagnosis and missed diagnosis take place easily. Complete removal of endocyst has low postoperative complications and lower relapse rate.