Affiliated Hospital Of Zhengzhou University Research Articles

Investigation of the mechanism of ambivalent professional identity formation: A directed content analysis of reflective assignments

Background Ambivalent professional identity (API)—the coexistence of identification and dis-identification with one’s profession—undermines motivation and satisfaction. Research on API among medical interns remains limited. This study applies social cognitive theory (SCT) to explore the formation mechanism of API in Chinese medical interns and proposes strategies to enhance professional identity. Methods Conducted at the First Affiliated Hospital of Zhengzhou University, the study involved 1,054 medical interns from six institutions and five specialties. In October 2023, all interns submitted reflective writings during the early internship phase. Directed content analysis was used to examine 772 valid submissions. Results Six common themes were identified and categorized into three SCT-based stages: conflictive learning experiences, ambivalent reinforcements, and API formation. Through observation and practice, interns encountered contrasting experiences related to patient outcomes, professional behavior, automation, feedback, task performance, and risk. These shaped mixed perceptions of their roles. Reinforcement processes triggered ambivalent emotions—achievement alongside self-doubt—culminating in API marked by increased responsibility and career interest, yet coupled with anxiety and powerlessness. Conclusion SCT effectively explains API formation in medical interns. Ambivalent learning experiences, mediated by contradictory reinforcements, shape identity development, highlighting SCT’s relevance in healthcare education.

Clinicopathological features of primary thoracic synovial sarcoma: a study of 42 cases

Objective: To investigate the clinical and pathological characteristics of primary thoracic synovial sarcoma (PTSS). Methods: Forty-two PTSS cases diagnosed at the Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China from October 2011 to April 2024 were analyzed. All cases were retrospectively studied using hematoxylin-eosin staining and immunohistochemistry. Their clinicopathological features were also reviewed. SS18 rearrangement was assessed in 28 cases using fluorescence in situ hybridization (FISH). Next generation sequencing (NGS) was performed on 8 cases. Results: Among the 42 cases, there were 23 biopsies and 19 surgically-removed specimens. One case was a specimen resected after neoadjuvant chemotherapy. There were 22 males and 20 females, with an age ranging from 6 to 68 years. Twenty-nine cases occured in the lung, 6 in mediastinum, 4 in pericardium, 1 in visceral pleura, and 1 in right atrium. One case did not show any unequivocal primary site. Computed tomography showed the tumors were manifested as a cystic mass, a solid mass, or thickening of the pleura and pericardium. Thirty-two cases had respiratory symptoms, while 19 had pleural effusion. One case had a history of radiotherapy for papillary thyroid carcinoma. Nineteen patients were treated with surgery, while 19 were treated with chemotherapy without surgery. Four patients were diagnosed and discharged, without specific treatment on the record. Morphologically, 1 case was biphasic type, 39 cases were monophasic type, and 2 cases were poorly differentiated type. In addition to the typical morphology of synovial sarcoma, tumors also showed pulmonary bullous changes, stromal collagen hyalinization, hemangiopericytoma-like vasculature, stromal edematous myxoid changes, and microcystic structure. Immunohistochemically, all cases were diffusely positive for TRPS1 (22/22), TLE1 (21/22), CD99 (26/26), SS18-SSX (25/25) and INI1 (12/12), including 3 cases with decreased expression of INI1. Twenty-one cases were focally positive for EMA (21/30), 4 cases for SMA (4/23), 2 cases for S-100 (2/28), and 2 cases (2/35) for CKpan. Twenty-eight cases (28/28) had SS18 rearrangement displaying a split signal on FISH analysis. Eight cases were found to have mutations in SMC1A, NOTCH2, CDK12, SPRY4, BRCA1, STK11, NF2, and PDGFRα genes using NGS. Eighteen of the 29 patients survived and 16 showed disease progression. Conclusions: PTSS is more commonly found in the lungs than other sites and has non-classical morphological features of various types, which need to be differentiated from other tumors. TRPS1 is highly expressed in PTSS and has certain diagnostic values. The diagnosis of PTSS also requires combination of patient's medical history with thorough imaging studies.

Endoscopic versus laparoscopic resection of gastrointestinal stromal tumors at the esophagogastric junction using propensity score matching analysis

The esophagogastric junction (EGJ) has a complex anatomy and critical physiological functions, making postoperative quality of life an important consideration in the surgical resection of gastrointestinal stromal tumors at this location (EGJ-GISTs). We conducted a propensity score-matched (1:1) analysis to compare the safety and efficacy of endoscopic resection (ER) and laparoscopic resection (LR) for patients with EGJ-GIST treated at the First Affiliated Hospital of Zhengzhou University, China, from December 2013 to November 2023. We reviewed 176 patients (ER 82; LR 94) with EGJ-GIST, of whom 85 patients with a tumor size of 2–5 cm met the matching criteria (ER 42; LR 43), yielding 20 pairs of patients. ER showed advantages over LR, with a shorter postoperative nil per os time (4.0 days (IQRs, 3.0–5.0) vs. 5.5 days (IQRs, 4.3–7.8), p = 0.005) and postoperative hospitalization time (6.0 days (IQRs, 5.0−6.8) vs. 8.5 days (IQRs, 6.0−11.8, p = 0.002). Long-term adverse events were significantly lower in the ER group (15% vs. 55%, p = 0.005). No recurrence or metastasis was observed in either group during a mean follow-up of 42.3 months. These findings suggest that for 2–5 cm EGJ-GISTs, ER is a safe and effective alternative, offering minimal invasiveness, faster recovery, fewer complications, and improved long-term quality of life.

Characteristic Analysis of Ultrasound Diagnosis of Limb Body Wall Complex in Early Pregnancy.

This study aims to explore the diagnostic value of prenatal ultrasound in limb body wall complex (LBWC) during pregnancy and to improve the understanding of LBWC for early ultrasound diagnosis. The ultrasound data and follow-up results of 107 cases of LBWC (predominantly diagnosed in the first trimester) from the Third Affiliated Hospital of Zhengzhou University between 2014 and 2024 were retrospectively analyzed. The ultrasonographic features and fetal karyotype of LBWC were evaluated. The cohort included 107 LBWC fetuses (90 singletons and 17 twins). The typical ultrasonographic features were a major abdominal wall defect, severe kyphoscoliosis, limb abnormalities, neural tube defects, and a malformed short umbilical cord with a single artery. Notably, 38 cases clearly demonstrated fetal extruded organs located within the extraembryonic celom. Genetic testing (7 CNV-seq, 12 CMA, 1 karyotype only) in 20 cases revealed normal results in 18 without clear cause and effect in the remaining two. Selective fetal reduction was performed in four twin pregnancies, resulting in successful delivery of healthy neonate; all remaining cases underwent pregnancy termination. LBWC is a severe developmental malformation with a very poor prognosis. Ultrasonography enables early detection during the first trimester, demonstrating critical diagnostic value in prenatal screening and pregnancy management.

Survival Outcome of Thoraco-Laparoscopic McKeown Esophagectomy Versus Endoscopic Submucosal Dissection for Early-Stage Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis.

To evaluate thoraco-laparoscopic McKeown esophagectomy (TLME) versus endoscopic submucosal dissection (ESD) for clinical-T1N0 esophageal squamous cell carcinoma (ESCC) depending on invasion depth. Early-stage ESCC has been widely treated by endoscopic resection. While ESD is safer than esophagectomy perioperatively, its survival benefits for clinical-T1N0M0 ESCC, especially high-risk T1b tumors, are unclear. A retrospective study was conducted on clinical-T1N0 ESCC patients at the First Affiliated Hospital of Zhengzhou University comparing TLME (cT1a, n = 352; cT1b, n = 205) with ESD (cT1a, n = 499; cT1b, n = 62). Overall survival (OS), disease-specific survival (DSS), relapse-free survival (RFS), and metastasis-free survival (MFS) were analyzed depending on invasion depth after propensity score matching to account for selection bias. ESD group had better OS (hazard ratio: 0.54, p = 0.029) but worse RFS (hazard ratio: 6.83, p < 0.001) than TLME group in general terms. T1a cancers showed no difference in DSS and MFS between groups. T1b subgroup with ESD had lower DSS (hazard ratio: 5.65, p = 0.036) and MFS (hazard ratio: 3.54, p = 0.069). R1-resection in ESD group linked to poorer OS (hazard ratio: 5.89, p = 0.006) and DSS (hazard ratio: 3.67, p = 0.006). ESD can be safe in the treatment of clinical-T1aN0 ESCC. However, concerning oncologic curability, TLME should be recommended for patients with clinical-T1bN0 ESCC in terms of favorable DSS, RFS, and MFS.

Comparative outcomes of interventional embolization and laparoscopic tubal ligation on frozen-thawed embryo transfer success in women with hydrosalpinx.

Comparative outcomes of interventional embolization and laparoscopic tubal ligation on frozen-thawed embryo transfer success in women with hydrosalpinx.

The features and risk factors of thrombotic thrombocytopenic purpura in systemic lupus erythematosus

ObjectiveThis study aimed to investigate clinical features and risk factors for the development of thrombotic thrombocytopenic purpura (TTP) in systemic lupus erythematosus (SLE) patients.MethodsA cohort of 32 SLE-TTP patients in the first affiliated hospital of Zhengzhou University from 2017 to 2023 were included, and 128 SLE patients without TTP admitted to the hospital during the same period were randomly selected as the control group. The demographic data, clinical and laboratory findings of these patients were statistically analyzed. Stepwise regression and logistic regression were used to identify the risk factors related to TTP development. The SLE-TTP patients were divided into two groups based on treatment outcomes, and the differences between the clinical data were compared between the two groups. Independent risks of short-term death in SLE-TTP patients were determined by logistic regression analysis.ResultsOur study demonstrated that independent risk factors associated with the occurrence of TTP in patients with SLE included higher SLEDAI-2K score (OR = 1.96; 95%CI: 1.197–3.211; P = 0.007), high baseline total cholesterol (T-CHO) levels (OR = 8.19; 95%CI: 0.98–68.48; P = 0.048), and renal involvement (OR = 14.73; 95%CI: 1.250-173.64; P = 0.033). Multivariate logistic regression analysis showed that older age (OR = 1.02;95%CI: 0.94–1.119; P = 0.05) and non-nulliparous female (OR = 8.12; 95%CI: 0.484-136; P = 0.017) were independent risks factor for short-term death for SLE-TTP patients.ConclusionSLE patients with higher SLEDAI-2K score, high baseline T-CHO levels, and renal involvement were predisposed to TTP development. The short-term mortality is increased for SLE-TTP patients of advanced age and in non-nulliparous females. Close monitoring and active treatments of these patients are needed for this life-threatening situation.

Efficacy and prognostic analysis of the oXiris® filter in sepsis-associated acute kidney injury.

This study aimed to assess the efficacy of the oXiris® filter in CRRT for SA-AKI and its effects on short- and medium-term mortality. A retrospective cohort study was conducted at the Blood Purification Center of the First Affiliated Hospital of Zhengzhou University from November 2019 to November 2024. Patients with SA-AKI undergoing CRRT were divided into two groups: the M150 group (n = 135) and the oXiris group (n = 126). Laboratory indices, clinical characteristics, and mortality rates at 7, 14, 30, 60, and 90days were compared between groups to assess the impact of the oXiris filter. Following CRRT, the oXiris group showed a significant increase in MAP (76.24 ± 13.21 vs. 82.34 ± 14.38mmHg, p < 0.001), with a decrease in SI (0.96 [0.75, 1.15] vs. 0.80 [0.64, 1.00], p < 0.001), Lac (3.00 [1.70, 6.55] vs. 2.00 [1.40, 3.10] mmol/L, p < 0.001), and IL-6 (174.40 [51.21, 1474.44] vs. 127.20 [35.29, 655.30] pg/ml, p = 0.045) compared to baseline, whereas no such changes were observed in the M150 group. Additionally, the total norepinephrine dose was lower in the oXiris group (108.00[16.00,295.50] vs. 194.00[18.00,500.00] mg, p = 0.020). No significant differences in 7-day, 14-day, 30-day, 60-day, or 90-day mortality were observed between the groups after CRRT initiation. The oXiris filter improves short-term hemodynamics, inflammation, and microcirculatory dysfunction in SA-AKI, but does not reduce short- or medium-term mortality compared to the M150 group.

Effectiveness of PBL Combined with Seminar Teaching Method in Teaching Clinical Internship in Hematology

Objective: To explore the application effect of PBL combined with Seminar teaching method in hematology clinical internship teaching. Methods: 116 medical students who were interned in the Department of Hematology of the First Affiliated Hospital of Zhengzhou University from September 2023 to September 2024 were selected and grouped with reference to the randomized numerical table method, of which 58 were in the control group (traditional teaching) and 58 were in the observation group (PBL combined with Seminar teaching method). After 24 hours of internship teaching, the students were tested on theoretical knowledge, practical skills and comprehensive analytical ability, and filled in the self-developed teaching satisfaction questionnaire to evaluate the recognition of the teaching method, and the test scores of the two groups and the students' recognition of the teaching method were statistically compared. Results: The examination scores (theoretical knowledge, practical skills and comprehensive analysis ability) of the observation group were higher than those of the control group; the total recognition of the observation group was higher than that of the control group, P&lt;0.05. Conclusion: The use of PBL combined with Seminar teaching method in the teaching of clinical internship in hematology is conducive to improving the performance of the students and enhancing their recognition of the teaching method.翻译搜索复制

Effectiveness of Snare Traction-Facilitated Endoscopic Resection for Gastric Submucosal Tumors ≥ 2 cm: A Propensity Score-Matched Study.

Aim: The aim of this study was to assess the efficacy of the snare traction technique in assisting the endoscopic resection (ER) procedure in gastric submucosal tumors (SMTs) ≥ 2 cm. Methods: Between January 2015 and December 2022, we retrospectively reviewed data from patients with gastric SMTs ≥ 2 cm who were treated by ER at the first affiliated hospital of Zhengzhou University. Then, propensity score matching (PSM) (1:3) between snare traction-assisted and conventional ER procedures was used to overcome selection bias. The success rate, en bloc resection rate, dissection time, dissection speed, and perioperative complications were compared. Results: A total of 314 patients were included in this study. After PSM, 34 patients were enrolled in the snare traction-assisted endoscopic resection group (STAER) and 102 patients were enrolled in the conventional endoscopic resection group (CER). STAER group had a higher dissection speed (6.60 vs. 5.20 mm2/min; P = .030) and shorter dissection time (76.00 vs. 76.50 minutes, P = .003). There were no significant differences in technique success rate, en bloc resection rate, and perioperative complications between the two groups. In subgroup analysis, the dissection speed of STAER was significantly higher than that of CER when the lesion length was 2-5 cm, underwent endoscopic full-thickness resection, and was located in the gastric antrum. Conclusions: STAER demonstrated a higher efficiency for gastric SMTs ≥ 2 cm, without increasing the perioperative complications. Further prospective studies are needed to assess the efficiency and safety of the STAER method.

The relationship between state anxiety of surrogate decision-makers and decision-making duration in acute ischemic stroke thrombolysis

Intravenous thrombolysis is the preferred treatment for acute ischemic stroke (AIS). In China, obtaining written informed consent from patients or their surrogates is mandatory before administering thrombolysis, often leading to delays in treatment. This study aims to explore the relationship between the decision-making characteristics and psychological states of surrogates during thrombolysis for AIS patients. A total of 383 AIS patients and their surrogate decision-makers were recruited from the Emergency Department of the First Affiliated Hospital of Zhengzhou University between September 2021 and December 2023. Comprehensive sociodemographic and disease-related data were collected for both patients and surrogates. Surrogate decision-makers were assessed using the State-Trait Anxiety Inventory (STAI), Control Preference Scale(CPS), Wake Forest Physician Trust Scale (WFPTS), and Perceived Social Support Scale (PSS). Data were analyzed using SPSS 26.0 software. The average score of state anxiety of surrogates was 49.47 ± 9.04, indicating a relatively high level of anxiety. Specifically, the average state anxiety score of the surrogate decision-makers has already reached a moderate level, indicating significant anxiety. Additionally, 18.2% (70/383) of surrogates took more than 15 minutes to decide. There was a significant positive correlation between state anxiety scores and decision duration (r = 0.189, p < 0.001). Factors influencing surrogate anxiety included sociodemographic factors, psychological factors, patient-related factors, and decision-making process characteristics (all p < 0.05). In conclusion, the anxiety is influenced by various factors related to the decision-making process. Medical staff should address these emotional factors to reduce decision time, enhance decision quality, and expedite informed consent, thereby minimizing treatment delays.

Clinical characteristics and risk factors of late-stage lung adenocarcinoma patients with bacterial pulmonary infection and its relationship with cellular immune function.

To research the clinical characteristics, risk factors, the correlation between bacterial pulmonary infection and immune function of advanced lung adenocarcinoma patients complicated with bacterial pulmonary infection. 334 stage III and IV lung adenocarcinoma patients admitted to the first affiliated hospital of Zhengzhou University from January 2020 to March 2023 were selected and divided into an infection group (n = 240) and a control group (n= 72) according to whether complicated with bacterial pulmonary infection. The clinical characteristics were analyzed. The pulmonary microbiota and human T lymphocyte subsets (CD3+, CD4+, CD8+) were detected. Multivariate logistic regression analysis was performed to explore the risk factors for pulmonary bacterial infection in advanced lung adenocarcinoma patients. Among 334 patients, 264 cases were complicated with pulmonary bacterial infection, and 70 cases had no pulmonary bacterial infection. In total, 544 pathogenic bacteria were isolated from the patients. Of these, 170 strains (31.25%) were Gram-negative bacilli, 162 strains (29.78%) were Gram-positive cocci, 27 strains (4.96%) Gram-positive bacilli. There were statistically significant differences in age, smoking, combined diseases, TNM staging, CD3+ T cell percentage, and CD4+ T cell percentage between the two groups (P < 0.05). Multivariate logistic regression analysis revealed smoking, bronchiectasis, and diabetes were independent risk factors leading to late-stage lung adenocarcinoma patients with bacterial pulmonary infection (P < 0.05). In those patients on immune checkpoint inhibitors, the lung Gram-positive group has a higher number of CD4+ T cells and CD4+/CD8+ T cell ratio than the Gram-negative group (P < 0.05). Smoking, bronchiectasis, and diabetes are risk factors for lung bacterial infection in patients with advanced lung adenocarcinoma. The effect of immune checkpoint inhibitor treatment on T cells is more pronounced in Gram positive bacteria.

Association between insulin resistance and uterine volume in girls with idiopathic central precocious puberty

To investigate the association between insulin resistance and uterine volume in girls with idiopathic central precocious puberty (ICPP). A retrospective study was conducted involving 61 girls diagnosed with ICPP who visited the pediatric growth and development clinic of the Third Affiliated Hospital of Zhengzhou University between January 2022 and September 2024, designated as the ICPP group, and 61 normally developing girls as the control group. The differences in insulin resistance index (homeostasis model assessment of insulin resistance, HOMA-IR), uterine volume, and other indicators between the two groups were compared, and the relationship between insulin resistance and uterine volume in these girls was analyzed. The uterine volume and HOMA-IR level in the ICPP group were significantly higher than those in the control group (P<0.05). Correlation analysis revealed that there was a positive correlation between HOMA-IR level and uterine volume in the ICPP group (rs=0.643, P<0.001). Multiple linear regression analysis indicated that as HOMA-IR increased,uterine volume in the girls tended to increase (P<0.05). There is an association between insulin resistance and uterine volume in girls with ICPP, and as HOMA-IR increases, uterine volume in the girls also increases.

Development of machine learning models to predict the risk of fungal infection following flexible ureteroscopy lithotripsy

BackgroundThe flexible ureteroscopy lithotripsy (F-URL) is an important treatment for upper urinary tract stones. However, urolithiasis, surgical procedures, and catheter placement are risk factors for fungal infections. Our study aimed to construct a machine learning algorithm predictive model to predict the risk of fungal infection following F-URL.MethodsThis study retrospectively collected the clinical data of patients who underwent F-URL at the Second Affiliated Hospital of Zhengzhou University from January 2016 to March 2024. The patients were divided into a non-fungal infection group and a fungal infection group based on whether a fungal infection occurred within three months post-surgery. The patient data from January 2016 to December 2023 were used as training data, and the patient data from January 2024 to March 2024 were used as testing set. The training data was randomly divided into a training set and validation set at a ratio of 90:10. Use LASSO regression to screen clinical features based on the training set. Nine machine learning algorithms, Logistic Regression (LR), k-Nearest Neighbours (KNN), Support Vector Machines (SVM), Random Forest (RF), Categorical Boosting (CatBoost), eXtreme Gradient Boosting (XGBoost), Adaptive Boosting (AdaBoost), Gradient Boosting Machines (GBM), and Neural Network (NNet), were used to construct models. The performance of these nine models was evaluated and the best predictive model was selected based on the validation set, and evaluate the best predictive model’s generalization ability using the testing set. Visualize the constructed optimal machine learning model using the SHapley additive interpretation (SHAP) value method. SHAP force plots were established to show the application of the prediction model at the individual level.ResultsA total of 13 clinical features were used to construct predictive models: age, diabetes mellitus (DM), history of malignancy, being bedridden, admission white blood cells (WBC), preoperative ureteral stenting, operation time, postoperative fever, postoperative Neu, carbapenem antibiotics use, duration of antibiotic therapy, length of hospital stay (LOS), and postoperative stent duration. Comparing the performance of 9 prediction models, we found that the model constructed using XGBoost algorithm had the best performance. The model constructed using XGBoost algorithm shows good discrimination, generalization and clinical applicability in the testing set.ConclusionsThe XGBoost model developed in this study has good predictive ability and clinical applicability for evaluating the risk of fungal infection following F-URL.

Long transparent cap-assisted clip closure technique: a new choice for gastrointestinal defect closure

ObjectiveTo evaluate the safety and effectiveness of the novel long transparent cap-assisted clip closure technique in closing gastrointestinal defects.MethodsA retrospective analysis was performed on clinical data of patients who underwent endoscopic resection for gastric submucosal tumors at the First Affiliated Hospital of Zhengzhou University from January 2020 to November 2023. Patients were categorized into the Long Transparent Cap-Assisted Clip Closure group (LTCCC group) and the Purse-String Suture group (PSS group) based on the method of wound closure after ER. Primary outcomes included closure success rates and closure time, and secondary outcomes covered postoperative hospital stays, occurrence of adverse events, tumor characteristics, and follow-up status.ResultsThe closure success rate was 100% in both groups. The closure time in the LTC group was shorter than that in the PSS group (17.44 ± 7.71 min vs. 28.81 ± 9.20 min, P < 0.001). There were no statistically significant differences in postoperative hospital stays and adverse event rates between the two groups (P > 0.05). Good wound healing was observed during follow-up. No residual lesions, tumor recurrence, metastasis, gastrointestinal fistulae, or sinuses were found during a median follow-up of 32 (5 ~ 73) months.ConclusionThe long transparent cap-assisted clip closure technique is a simple, safe, and effective method for closing gastrointestinal defects, and can be considered as a treatment option for endoscopic closure of such defects.

Comparison between transoral minimally invasive surgery and Sistrunk surgery for the treatment of lingual thyroglossal duct cyst

Objective: To evaluate the feasibility and efficacy of transoral minimally invasive surgery for the treatment of lingual thyroglossal duct cyst(LTGDC) by comparison with Sistrunk surgery. Methods: The clinical data of 34 patients with LTGDC were analyzed retrospectively at the First Affiliated Hospital of Zhengzhou University from March 2019 to August 2023. Among these patients, comprising 26 males, 8 females, aged from 1 year and 11 months to 76 years old, with a mean age of 31 years old, 22 patients underwent transoral minimally invasive surgery and 12 patients underwent Sistrunk surgery. The operation time, intraoperative blood loss volume, recovery time and follow-up information of the two groups were analyzed. The follow-up period ranged from 12 to 65 months. An independent sample t-test was used to analyze the surgical duration between the two groups, while the Mann-Whitney U test was employed to analyze data on age, cyst size, intraoperative blood loss, and length of hospital stay between the two groups. Results: There were no significant differences in gender, age and size of the cysts between the two groups(all P>0.05). For the transoral minimally invasive group, the mean operation time was (75.5±20.2) minutes, median intraoperative blood loss volume was 5.0(5.0, 10.0)ml and median recovery time was 9.0(8.0, 10.0)days. The data of Sistrunk group were (131.7±16.8) min, 27.5(20.0, 40.0)ml, 11.0(10.0, 15.0)days respectively. There was a statistically significant difference between the two groups(Z=-8.192, -4.539, -3.71, all P<0.001). In the transoral group, there were three recurrences, two patients subsequently underwent Sistrunk surgery, while one opted for continuous observation. Additionally, one patient experienced partial loss of epiglottic cartilage.Four patients in the Sistrunk group developed a pharyngeal fistula, but there were no reported recurrences. Conclusions: Compared to Sistrunk surgery, transoral surgery for lingual thyroglossal duct cyst provides several benefits, such as reduced complication rates, accelerated recovery, and the absence of neck scarring.

Identification of endothelial cell key genes associated with pathogenesis and invasion of human venous malformations using single-nucleus RNA sequencing-based co-expression network analysis

Objective: This study aimed to identify key genes in endothelial cell (EC) associated with the pathogenesis and progression of human venous malformations (VMs) through bioinformatics analysis, providing potential biomarkers for early screening and targeted therapy of VMs. Methods: A case-control study was conducted using surgically resected tissue specimens from VMs patients at the Third Affiliated Hospital of Zhengzhou University (from September 2021 to September 2023), with malformed venous tissues as the experimental group and distal normal venous tissues as controls. Single-nucleus RNA sequencing (snRNA-seq) was performed on paired experimental and control samples from four VM patients. High-dimensional weighted gene co-expression network analysis (hdWGCNA), combined with gene ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG), and protein-protein interaction (PPI) network analysis, identified critical genes. Validation experiments included 15 additional VM cases and controls using reverse transcription quantitative polymerase chain reaction (RT-qPCR), immunohistochemistry (IHC), and Western blot. Results: A total of 55 430 nuclei were captured using snRNA-seq, with 30 391 nuclei from the experimental group and 25 039 nuclei from the control group. Cluster analysis identified 22 distinct cell populations, which were annotated into 8 cell types. hdWGCNA revealed four modules associated with invasion, which were enriched in angiogenesis, integrin signaling, and cell adhesion according to GO analysis. KEGG pathway analysis indicated that the PI3K-AKT signaling pathway and focal adhesion are key regulatory mechanisms. PPI network analysis combined with cytoscape identified EGFL7, TEK, and FLT1 as key genes. RT-qPCR results demonstrated that the relative mRNA expression levels of these three genes in the experimental group (6.66±2.31, 1.86±0.62, 3.49±0.58) were significantly higher than those in the control group (1.05±0.14, 1.00±0.14, 1.06±0.25), with statistically significant differences (t=9.37, 4.27, 11.20, P<0.05). Immunohistochemical analysis showed that the relative protein expression levels of these three genes in the cytoplasm of the experimental group (0.84±0.15, 0.68±0.14, 0.85±0.12) were also significantly higher than those in the control group (0.19±0.05, 0.23±0.06, 0.30±0.05), with statistically significant differences (t=16.62, 5.93, 11.68, P<0.05). Western blot analysis confirmed that the relative protein expression levels of these three genes in the experimental group (0.35±0.04, 0.36±0.09, 0.31±0.04) were significantly higher than those in the control group (0.19±0.01, 0.13±0.02, 0.14±0.04), with statistically significant differences (t=7.05, 4.61, 5.93, P<0.05). Conclusion: EGFL7, FLT1, and TEK in EC may play crucial roles in the occurrence and invasion of VMs.

A Comparative Study on Copy Number Variation in Subtypes of Breast Phyllodes Tumors.

Breast phyllodes tumor (PT) is a biphasic tumor and constitutes about 0.3% to 1% of all breast tumors. The PT is histologically classified as benign, borderline, and malignant subtypes. Unlike epithelial breast cancers, PT is derived from breast fibroepithelial tissues, and the genomic information of PT subtypes is still limited. The objectives were to gain a deeper understanding of genomic changes in the progression of PTs from benign and borderline to malignant. In this study, we used an Affymetrix OncoScan Array to analyze the genome-wide copy number variations (CNVs) and nucleotide point mutations from 3 benign PTs, 3 borderline PTs, and 3 malignant PTs collected from the First Affiliated Hospital of Zhengzhou University. DNA was extracted from formalin-fixed paraffin-embedded (FFPE) specimens using the TIANamp FFPE DNA Kit. The DNA was profiled for genome-wide CNV using the Affymetrix OncoScan Array and analyzed using the Nexus Express Chromosome Analysis Suite. Our in silico variation analysis indicated copy number loss in Xp11.22 to q22.1 of all benign PTs (χ2 = 9, P = .0027) and 22q11.23 and Xq23 in all malignant PTs (χ2 = 12, P = .0005). A copy number gain was observed in 1p13.3 of all borderline PTs (χ2 = 9, P = .0027) and 7p11.2 of all malignant PTs (χ2 = 9, P = .0027). We also found consistent loss of heterozygosity (LOH) in 32 loci of benign PTs, 32 loci of borderline PTs, and 23 loci of malignant PTs. Among the 87 LOH, there were 15 overlapping loci across all PT subtypes. We observed missense mutations of NRAS, KRAS, IDH2, TP53, and a frameshift deletion in PTEN of sequenced PT samples, irrespective of their subtype. Interestingly, a point mutation in EGFR/EGFR-AS1 was only observed in malignant PTs. Our data suggested that CNV at 7p11.2, 22q11.23, and Xq23 together with a point mutation in EGFR/EGFR-AS1 uniquely presented in malignant PTs may correlate with the progression of PTs.

Prognosis and fertility of stage II to IV borderline ovarian tumors after fertility-sparing surgery.

To evaluate the prognosis and fertility of patients with stage II to IV borderline ovarian tumors who underwent fertility-sparing surgery. This retrospective single-institution study included patients aged <40 years with stage II to IV borderline ovarian tumors at the First Affiliated Hospital of Zhengzhou University between January 2007 and March 2023. The primary outcome was disease-free survival. The association of disease-free survival was assessed using the Kaplan-Meier and Cox proportional hazards methods. A total of 144 patients were included in this study. Based on whether fertility-sparing surgery was performed, the patients were categorized into 2 groups: a fertility-sparing surgery group with 96 patients (66.67%) and a radical surgery group with 48 patients (33.3%). There were differences between the 2 groups in terms of age (27.36 ± 6.42 vs 34.67 ± 5.43, p < .001), pregnancy history (53.1%; 51/96) vs 81.2% (39/48), p = .001), maximum tumor diameter (103.00 [76.25, 148.25] vs 88.50 [60.25, 124.75], p = .011), involvement of bilateral ovaries (45.83%; [44/96] vs 66.67% [32/48], p = .018), and whether postoperative adjuvant chemotherapy (15.6% [15/96] vs 31.2% [15/48], p = .030). The median follow-up time after primary cytoreduction was 67.0 months (interquartile range; 44.0-101.75). At the end of the observation period, 32 (22.2%) patients experienced recurrence. There were 3 (2.1%) deaths and 2 cases (1.4%) of survival with tumors. Multivariate Cox proportional hazards regression analysis showed that fertility-sparing surgery, incomplete cytoreduction, micropapillary subtype, International Federation of Gynecology and Obstetrics stage III, and invasive implants were independent risk factors for poor disease-free survival. Among the patients with fertility intentions (41 cases), 34 (82.9%) had successful pregnancies. Twenty-nine patients (70.7%) had successful births, and 3 patients were pregnant at the time of study completion. Fertility-sparing surgery may be feasible and considered for patients lacking other significant risk factors for disease-free survival, including incomplete cytoreduction, micropapillary subtype, International Federation of Gynecology and Obstetrics stage III, and invasive implants.

Development and validation of a nomogram for a prognostic model for resected pancreatic ductal adenocarcinoma.

Development and validation of a nomogram for a prognostic model for resected pancreatic ductal adenocarcinoma.