Case report of a young male, with recurrent pneumothorax, hemoptysis and intrapulmonary cavitary lesions.

RATIONALE: Primary spontaneous pneumothorax (PSP) is a manifestation of Vascular Ehlers-Danlos syndrome (vEDS) caused by heterozygous mutations in the COL3A1 gene. vEDS is a rare inherited disorder with an prevalence of one in 150,000. It can causes PSP and severe fragility of connective tissues with arterial but it remains poorly defined on clinical grounds and diagnose. Through this report, we hoped to help clinicians further understand the characteristics of vEDS. PATIENT CONCERNS: A 22-year-old man presented with recurrent pneumothorax, hemoptysis, and chest pain. Physical examination revealed remarkable hypermobility of the small joints and translucent skin with visible veins. Chest computed tomography (CT) showed pneumothorax and multiple pulmonary cavities. INTERVENTION AND OUTCOME: Genomic deoxyribonucleic acid (DNA) was extracted from patients. Heterozygosity was observed in all 3 novel variants. The main variant is COL3A1, c.3256-43T > G(NM_000090.3), which represents a missense mutation in collagen type III alpha 1 that can lead to vEDS. The other 2 mutations were FLNB c.4814G > A(NM_001457.3) and TSC2 c.3145G > A (NM_000548.3). These variants were validated by Sanger sequencing of their parents. COL3A1was not detected in either of the parent strains. FLNB and TSC2 were detected in his mother. DIAGNOSES: Vascular Ehlers-Danlos syndrome. LESSONS: Both COL3A1 and TSC2 gene mutations can cause PSP; however, to the best of our knowledge, there are no reports on these 2 gene mutations in 1 patient at the same time.

Application of robot-assisted lung basal segmentectomy: A retrospective study / 中国胸心血管外科临床杂志

@#Objective    To summarize the experience of robot-assisted lung basal segmentectomy, and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S9 and/or S10 segmentectomy. Methods    The clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed. There were 32 males and 46 females with a median age of 50 (33-72) years. The patients who underwent S9 and/or S10 segmentectomy were divided into a single-direction group (pulmonary ligament approach, n=19) and a bi-direction group (intersegmental tunneling, n=19) according to different approaches, and the perioperative outcomes between the two groups were compared. Results    All patients successfully completed the operation, without conversion to thoracotomy and lobectomy, serious complications, or perioperative death. The median operation time was 100 (40-185) min, the blood loss was 50 (10-210) mL, and the median number of dissected lymph nodes was 3 (1-14). There were 4 (5.1%) patients with postoperative air leakage, and 4 (5.1%) patients with hydropneumothorax. No patient showed localized atelectasis or lung congestion at 6 months after the operation. Further analysis showed that there was no significant difference in the operation time, blood loss, thoracic drainage time, complications or postoperative hospital stay between the single-direction and bi-direction groups (P>0.05). However, the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group [6 (1-13) vs. 5 (1-9), P=0.040]. Conclusion    The robotic lung basal segmentectomy for pulmonary nodules is safe and effective. The  perioperative results of robotic S9 and/or S10 complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.

Application of PBL teaching guided by anesthesia plan in the teaching of anesthesia undergraduate interns / 中华医学教育探索杂志

Objective:To explore the application effect of PBL teaching guided by anesthesia plan in clinical teaching of anesthesia undergraduate practice.Methods:A total of 34 anesthesiology undergraduates who practiced in Daqing Oilfield General Hospital/The Tenth Affiliated Hospital of Qiqihar Medical University from January 2020 to September 2020 were selected and randomly divided into experimental group ( n=17) and control group ( n=17). The experimental group adopted PBL teaching guided by anesthesia plan, while the control group adopted traditional teaching. The theoretical assessment results, case analysis assessment results, and clinical skills assessment results of the two groups of undergraduate interns were compared and analyzed. Additionally, a questionnaire survey was conducted to evaluate the students' comprehensive ability. SPSS 22.0 was used for t test. Results:The scores and total scores of theoretical knowledge and anesthesia skills in the experimental group were higher than those in the control group, and the difference was statistically significant ( P<0.05). Before learning, there was no significant difference in scores and total scores of comprehensive ability between the two groups ( P>0.05); after learning, the comprehensive ability of the two groups of students were improved, and those of the experimental group were higher than those of the control group ( P<0.05). Conclusion:PBL teaching guided by anesthesia plan can effectively improve the mastery of theoretical knowledge, clinical operation skills and case analysis ability of anesthesia undergraduate interns, and the teaching effect is good, which is worthy of further promotion.

An improved Vision Transformer model for the recognition of blood cells / 生物医学工程学杂志

Leukemia is a common, multiple and dangerous blood disease, whose early diagnosis and treatment are very important. At present, the diagnosis of leukemia heavily relies on morphological examination of blood cell images by pathologists, which is tedious and time-consuming. Meanwhile, the diagnostic results are highly subjective, which may lead to misdiagnosis and missed diagnosis. To address the gap above, we proposed an improved Vision Transformer model for blood cell recognition. First, a faster R-CNN network was used to locate and extract individual blood cell slices from original images. Then, we split the single-cell image into multiple image patches and put them into the encoder layer for feature extraction. Based on the self-attention mechanism of the Transformer, we proposed a sparse attention module which could focus on the discriminative parts of blood cell images and improve the fine-grained feature representation ability of the model. Finally, a contrastive loss function was adopted to further increase the inter-class difference and intra-class consistency of the extracted features. Experimental results showed that the proposed module outperformed the other approaches and significantly improved the accuracy to 91.96% on the Munich single-cell morphological dataset of leukocytes, which is expected to provide a reference for physicians' clinical diagnosis.

Will the patient's double eyelid shape be like that of the surgeon performing the procedure? A study of surgeons' aesthetics in East Asian Blepharoplasty.

BACKGROUND: No reports of the potential areas of surgeons' aesthetics in blepharoplasty. AIMS: To explore the association between the surgeons' own double eyelid morphology and their aesthetics and surgical outcome. METHODS: An investigation of 1605 patients was carried collecting the data of double eyelid shape, based on which to propose a preliminary double eyelid classification for analyzing the aesthetics of surgeons. Ten double eyelid surgical cases were randomly collected from each surgeon according to the inclusion criteria, whose double eyelid shape, ideal shape, the selection tendency of surgical approach, most cared factor during surgery, and design concept of eyelid shape were collected. Structural equation modeling (SEM) was performed to assess the association between participants' double eyelid shape, aesthetics, and blepharoplasty outcome. RESULTS: Fifty-three double eyelid surgeons were enrolled for study, whose double eyelids shapes mostly were obviously fan-shaped (37.74%) and low-parallel eyelid (26.42%), and the ideal shapes were obviously fan-shaped (41.51%) and high-parallel eyelid (24.53%). 54.72% of the subjects preferred to use the full-incisional method. 45.28% cared for long-term outcome most. Regarding blepharoplasty outcome style, 49.06% of the subjects preferred obviously fan-shaped type and 24.53% for high-parallel type. SEM showed that aesthetics rank increased by 0.692 points for surgeons' shape (P < .001), and surgical outcome rank increased by 0.861 points for aesthetics (P < .001). However, their eyelid shape had no direct contribution to surgical outcome (P = .96). CONCLUSIONS: The findings indicated that surgeons' double eyelid shape positively affected their aesthetics, which affected their surgical outcomes further, but their double eyelid shape failed to affect the surgical outcomes directly.

A set of interesting sequoiatones stereoisomers from a wetland soil-derived fungus

Four interesting sequoiatones stereoisomers (-) were isolated from a wetland soil-derived fungusby chiral HPLC. On the basis of comprehensive NMR and mass analyses, their planar structures were elucidated as the same as that of sequoiatone B. Among them,and(orand) were a pair of enantiomers, andand(orand) were a pair of stereoisomers with epimerization at C-12, which indicated that sequoiatione-type metabolites exist as enantiomers rather than as optically pure compounds in some strains. With the quantum chemical ECD calculations, the absolute configurations of C-8 in-were determined, which is the first report to establish the absolute configuration of C-8 in sequoiatones. However, the absolute configurations of C-12 in sequoiatones are still unsolved.

Effect of pregnancy factor on T line corresponding to vertebral level：a multicenter clinical compar-ative study / 中华麻醉学杂志

Objective To investigate the effect of the pregnancy factor on the line drawn between the highest points of the two iliac crests ( T line) corresponding to the vertebral level in a multicenter clini?cal comparative study. Methods Hospitalized patients selected from the obstetric department or gynecolog?ical department, of American Society of Anesthesiologists physical statusⅠorⅡ, were divided into preg?nancy group ( group P ) and non?pregnancy group ( group NP ) . The patients were placed in the lateral posi?tion with their back vertical to the bed surface, the patient′s thighs were at an angle of approximately 90 de?grees to the trunk, and hip flexion was employed by flexing the patient′s knees to the chest. To determine the highest points of the two iliac crests, a line ( T line) was drawn between the highest points using a wire?reinforced epidural catheter. And another vertical line ( T′line) was made between the highest point of the iliac crest on the upper side ( not the side in the lateral position) and the ground. Ultrasonography was per?formed to identify and record the level of T line and T′line corresponding to the spinous process and lumbar interspace. Results A total of 1 763 cases completed the study, and there were 905 cases in group P, and 858 cases in group NP. Compared with group NP, the rate of T line at L3 spinous process and L3,4 in?terspace was significantly increased in group P ( P<0.05) . Compared with T′line, the rate of T line at L2,3 interspace and L3 spinous process was significantly decreased, and the rate of T line at L4 spinous process, L4,5 interspace and L5 spinous process was significantly increased in group P, and the rate of T line at L3 spinous process, L2,3 interspace and L3,4 interspace was significantly decreased, and the rate of T line at L4 spinous process and L4,5 interspace was significantly increased in group NP (P<0.01). Conclusion The level of T line corresponding to the vertebral level is significantly higher in the pregnant patients than in the nonpregnant patients.

Diagnosis and surgical treatment of pulmonary sequestration in adults / 局解手术学杂志

Objective To explore the diagnosis and surgical treatment of pulmonary sequestration in adults. Methods Clinical data of 21 cases of pulmonary sequestration whose diagnosis was confirmed by surgical biopsy in our department from March 2009 to February 2016 were retrospectively analyzed. Divided the patients into the thoracotomy group (n=9) and the thoracoscope group (n=12) according to dif-ferent surgical methods, and compared the diagnosis and surgery of the two groups. Results Among the patients, 8 cases were diagnosed as pulmonary sequestration and the remaining 13 cases were misdiagnosed,with the misdiagnosis rate of 61. 9%. Intraoperative exploration dem-onstrated that the abnormal blood vessels were originated from thoracic aorta (n=14,66. 7%),abdominal aorta (n=4,19%),phrenic artery (n=3,14. 3%) and aortic arch (n=1,4. 8%), and there were 20 cases (95. 2%) of intralobar sequestration and 1 case (4. 8%) of ex-tralobar sequestration. Patients underwent thoracotomy and patients underwent video-assisted thoracoscopic surgery were of no significant differences in operative time (P=0. 104),blood loss (P=0. 209),chest tube duration (P=0. 511),drainage volume (P=0. 135) and postoperative hospital stay (P=0. 450). All the patients recovered well after surgery. Conclusion As pulmonary sequestration lacks specific clinical manifestations,missed diagnosis and misdiagnosis are very common in patients. Chest enhanced CT and CT angiography are effective diagnostic methods at present. Both thoracotomy and VATS can achieve good therapeutic effects.

Guasha combined with bleeding therapy for mild hypertension / 中国针灸

<p><b>OBJECTIVE</b>To observe the immediate antihypertensive effect of guasha combined with bleeding therapy for mild (grade I) hypertension.</p><p><b>METHODS</b>Thirty patients with mild (grade I) hypertension and 30 cases with normal blood pressure were compared. Areas and acupoints in governor vessel, meridian of foot-taiyang, meridian of hand-yangming and meridian of foot-yangming were scraped for 3 times, which was followed by bleeding therapy. The blood pressures after each guasha and bleeding therapy were recorded as well as the skin temperature in Dazhui (GV 14) after each guasha. The treatment was given once a week and totally 4 treatments were given.</p><p><b>RESULTS</b>There were significant antihypertensive effects after the first guasha, the second guasha and the third guasha and bleeding therapy (all P<0.01), in which guasha combined with bleeding therapy had the most significant antihypertensive effect (P<0.01). The skin temperature in Dazhui (GV 14) was obviously increased after three times of guasha (all P<0.01).</p><p><b>CONCLUSION</b>Guasha or combined with bleeding therapy has better antihypertensive effect for mild hypertension, which is likely to be related with warming stimulation on meridians and acupoints.</p>

Correlation between overexpression of PC4 in lung adenocarcinoma with lymph node metastasis / 重庆医学

Objective To investigate the promotion effect of human transcriptional positive cofactor 4 (PC4) overexpression on lymphatic metastasis in lung adenocarcinoma .Methods 96 samples of lung adenocarcinoma tissue were collected .The immuno‐histochemistry(IHC) and real‐time quantitative polymerase chain reaction (qRT‐PCR) were adopted for detecting the expression levels of PC4 protein and mRNA .The correlation of PC4 expression with lymphatic metastasis and TNM stage was analyzed .Re‐sults The expression of PC4 protein was positively correlated mRNA in lung adenocarcinoma (r=0 .63 ,P<0 .01);the expression of PC4 protein was positively correlated with lymph node metastasis (χ2 =8 .29 ,P<0 .01) and TNM stage (χ2 =4 .71 ,P<0 .05);the expression of PC4 mRNA was also positively correlated with lymph node metastasis (χ2 = 8 .40 ,P< 0 .01) and TNM stage (χ2 =5 .10 ,P<0 .05) .Conclusion PC4 overexpression is found to be closely associated with the lymph node metastasis and TNM stage .PC4 may facilitate the lymph node metastasis of lung adenocarcinoma .