Bethune Second Hospital

This study aims to analyze the epidemiological characteristics of thoracic surgical diseases systematically. Based on chest CT data from 2,036 inpatients admitted to the thoracic surgery department of a tertiary-level general hospital in Northeast China from January to December 2024, a retrospective study was conducted to investigate the distribution patterns of thoracic surgical diseases across different gender and age groups, identify the composition of major disease types, and assess differences in diagnostic and therapeutic resource requirements. The results showed that malignant tumors accounted for the highest proportion (64.2%) of thoracic surgical diseases, with males being the primary patient group (54.7%) and an average age of 58.93 years. Significant differences were observed in the distribution of different disease types across gender and age groups. This study provides scientific evidence for optimizing clinical treatment pathways in thoracic surgery and informing public health decision-making.

Currently, validated biomarkers for assessing hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) are lacking. We aimed to validate a test combining GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin C-terminal hydrolase-L1) to indicate the absence of HT after IVT. We prospectively enrolled consecutive patients with stroke treated with IVT from 16 hospitals. Serum GFAP and UCH-L1 levels were measured 24 hours after IVT. Cases from 1 hospital were randomly assigned to the training (70%) and testing (30%) cohorts for internal validation. The external validation cohort included patients from the other 15 hospitals. Cutoff levels of GFAP and UCH-L1 for assessing the absence of HT were established in the training cohort and subjected to internal and external verification. A total of 1063 patients were included. Both GFAP and UCH-L1 levels were independently associated with HT, infarct volume, and 3-month outcome; levels lower than cutoff (12.6 and 63.1 pg/mL, respectively) excluded patients with HT with a negative predictive value of 98.31% (95% CI, 89.70%-99.91%) and detection sensitivity of 98.08% (95% CI, 88.42%-99.90%) in the training cohort. In the testing and validation cohorts, negative predictive value was 100% (95% CI, 75.93%-100%) and 100% (95% CI, 82.19%-100%), respectively, and the sensitivity was 100% (95% CI, 80.76%-100%) and 100% (95% CI, 77.08%-100%), respectively. Serum GFAP and UCH-L1 levels exhibit high sensitivity and negative predictive value for indicating the absence of HT 24 hours after IVT, which supports their potential role in assessing patients' condition after IVT.

To solve the issue of diagnosis accuracy of diabetic retinopathy (DR) and reduce the workload of ophthalmologists, in this paper we propose a prior-guided attention fusion Transformer for multi-lesion segmentation of DR. An attention fusion module is proposed to improve the key generator to integrate self-attention and cross-attention and reduce the introduction of noise. The self-attention focuses on lesions themselves, capturing the correlation of lesions at a global scale, while the cross-attention, using pre-trained vessel masks as prior knowledge, utilizes the correlation between lesions and vessels to reduce the ambiguity of lesion detection caused by complex fundus structures. A shift block is introduced to expand association areas between lesions and vessels further and to enhance the sensitivity of the model to small-scale structures. To dynamically adjust the model’s perception of features at different scales, we propose the scale-adaptive attention to adaptively learn fusion weights of feature maps at different scales in the decoder, capturing features and details more effectively. The experimental results on two public datasets (DDR and IDRiD) demonstrate that our model outperforms other state-of-the-art models for multi-lesion segmentation.

BackgroundDespite improvements in PCI techniques and equipment, there are still cases where traditional PCI is insufficient to manage complex and high-risk lesions. Patients with these lesions have increased rates of major adverse cardiac events, including myocardial infarction, cardiogenic shock, and death. In recent years, the use of extracorporeal membrane oxygenation (ECMO) during PCI has emerged as a potential solution to managing complex and high-risk lesions.MethodsThis retrospective study included patients who underwent elective complex and high-risk percutaneous coronary interventions with hemodynamic support provided by Veno-Arterial external membrane oxygenation (VA-ECMO) from 2018 to 2022. Complications related to VA-ECMO rates, Complications related to PCI, death, and major cardiovascular, cerebral events (MACCE) during hospitalization and after one-year follow-up were analyzed.ResultsThis retrospective study overall included 81 patients in which Males (N=60, 74.1%) and females (N=21, 25.9%) having (Average age: 62.74 ±10.807 years) underwent complex and high-risk percutaneous coronary intervention assisted ECMO. The VA-ECMO support was provided for an average of 21.0 hours (With a range of 1-312). Intra-aortic Balloon Pump IABP support was done in 32.1% of patients. The pre-and post-PCI SYNTAX scores of the patients were 39.92 ± (6.4) and 6.04 ± (9.25) respectively. (P <0.001). Most of the patients had triple vessel coronary disease which was the common coronary lesion (47%). Interoperated complications include Cardiac Tamponade (N=1,1.2%), Acute Myocardial Infarction (N=6,7.2%), Cardiogenic Shock (N=2,2.4%), Cardiac Arrest (N=2,2.4%), Arrhythmias malignant in nature which required electro cardioversion (2,2.4%), Ventricular tachycardia (N=1,1.2%), Non-infectious multiple organ failure MODS(N=1,1.2%), Aortic Dissection Type-A (N=1,1.2%). Blood hemoglobin Pre-CHIP assisted VA-ECMO PCI and Post-procedure were 136.17 ± 21.479 g/L and 106.67 ± 19.103 g/L respectively P<0.001). eGFR pre and post-PCI were 67.22 ± 26.85 and 60.09 ± 27.78 respectively (<0.002), Pre and Post PCI EF were 38.69 ± 13.65 and 43.55 ± 13.72 respectively (<0.001), During hospitalization the outcomes for the CHIP assisted by ECMO procedure include Death(N=16,19.8%), Inguinal Hematoma (N=2,2.5%), Bleeding from the punctured site (N=2,2.5%), Peudoaneurysm (N=1,1.2%), Cerebral Infarction(N=1,1.2%), Subarachnoid hemorrhage (N=1,1.2%), No lower limb ischemia, No acute renal injury, Bacteremia, were noted in any of the hospitalization. Patient Hb decline requiring blood transfusion therapy was (N=59, 72.8%). Survival at discharge (Healthy) was (N=65, 80.2%). After one year of post-operation death (N=6, 7.2%)ConclusionIn conclusion, ECMO-assisted high-risk PCI proves to be a safe and effective strategy for complex procedures in patients who are not candidates for Coronary artery bypass grafting (CABG). The use of VA-ECMO resulted in minimal complications and low rates of MACCE during hospitalization and one-year follow-up. Further research is needed to determine the optimal timing for VA-ECMO initiation.

ObjectiveTo evaluate the changes of the mitral valve geometrics and the degrees of moderate mitral regurgitation (MR) in patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS).MethodsA retrospective analysis study of intraoperative transesophageal echocardiography (TEE) and postoperative transthoracic echocardiography (TTE) was performed in 49 patients diagnosed with pure AS combined with moderate MR, who underwent AVR from January 2013 to December 2017. TEE was used to evaluate the direct geometric changes of the mechanical effects on mitral annulus after AVR. TTE was used to evaluate the changes of MR after operation. All patients underwent TTE during the midterm follow-up. The mean follow-up time was 40.21 months.ResultsAll of the 49 patients had moderate MR. Anterolateral-posteromedial diameter, anterior-posterior diameter, and mitral annular area were significantly reduced after AVR, while no significant changes were found in the intraoperative left ventricular loading conditions before and after AVR. The degree of mitral valve regurgitation, left ventricular size, left atrial size, left ventricular end-diastolic volume, and left ventricular to aortic pressure gradient were significantly reduced before discharge, and midterm follow-up showed good results.ConclusionThis study supports the belief that aortic outflow tract obstruction and an actual mechanical compression of the anterior mitral annulus after AVR would cause reduction in MR. Ventricular remodeling would also cause reduction in MR with time going on. Patients with AS, especially young patients with moderate MR, were most likely to benefit from AVR in early time.

Tubeimoside-1 (TBMS1), a triterpenoid saponin extracted from the Chinese herbal medicine Bolbostemma paniculatum (Maxim) Franquet (Cucurbitaceae), has shown anticancer activities in various cancer cell lines. The aim of this study was to investigate the anticancer activity and molecular targets of TBMS1 in human prostate cancer cells in vitro. DU145 and P3 human prostate cancer cells were treated with TBMS1. Cell viability and apoptosis were detected. ROS generation, mitochondrial membrane potential and cell cycle profile were examined. Western blotting was used to measure the expression of relevant proteins in the cells. TBMS1 (5-100 μmol/L) significantly suppressed the viability of DU145 and P3 cells with IC50 values of approximately 10 and 20 μmol/L, respectively. Furthermore, TBMS1 dose-dependently induced apoptosis and cell cycle arrest at G0/G1 phase in DU145 and P3 cells. In DU145 cells, TBMS1 induced mitochondrial apoptosis, evidenced by ROS generation, mitochondrial dysfunction, endoplasmic reticulum stress, modulated Bcl-2 family protein and cleaved caspase-3, and activated ASK-1 and its downstream targets p38 and JNK. The G0/G1 phase arrest was linked to increased expression of p53 and p21 and decreased expression of cyclin E and cdk2. Co-treatment with Z-VAD-FMK (pan-caspase inhibitor) could attenuate TBMS1-induced apoptosis but did not prevent G0/G1 arrest. Moreover, co-treatment with NAC (ROS scavenger), SB203580 (p38 inhibitor), SP600125 (JNK inhibitor) or salubrinal (ER stress inhibitor) significantly attenuated TBMS1-induced apoptosis. TBMS1 induces oxidative stress-mediated apoptosis in DU145 human prostate cancer cells in vitro via the mitochondrial pathway.