Comprehensive analysis of gene mutations and mismatch repair in Chinese colorectal cancer patients

BACKGROUND RAS,BRAF,and mismatch repair(MMR)/microsatellite instability(MSI)are crucial biomarkers recommended by clinical practice guidelines for colorectal cancer(CRC).However,their characteristics and influencing factors in Chinese patients have not been thoroughly described.AIM To analyze the clinicopathological features of KRAS,NRAS,BRAF,and PIK3CA mutations and the DNA MMR status in CRC.METHODS We enrolled 2271 Chinese CRC patients at the China-Japan Friendship Hospital.MMR proteins were tested using immunohistochemical analysis,and the KRAS/NRAS/BRAF/PIK3CA mutations were determined using quantitative polymerase chain reaction.Microsatellite status was determined using an MSI detection kit.Statistical analyses were conducted using SPSS software and logistic regression.RESULTS The KRAS,NRAS,BRAF,and PIK3CA mutations were detected in 44.6%,3.4%,3.7%,and 3.9% of CRC patients,respectively.KRAS mutations were more likely to occur in patients with moderate-to-high differentiation.BRAF mutations were more likely to occur in patients with right-sided CRC,poorly differentiated,or no perineural invasion.Deficient MMR(dMMR)was detected in 7.9% of all patients and 16.8% of those with mucinous adenocarcinomas.KRAS,NRAS,BRAF,and PIK3CA mutations were detected in 29.6%,1.1%,8.1%,and 22.3% of patients with dMMR,respectively.The dMMR was more likely to occur in patients with a family history of CRC,aged<50 years,right-sided CRC,poorly differentiated histology,no perineural invasion,and with carcinoma in situ,stage I,or stage II tumors.CONCLUSION This study analyzed the molecular profiles of KRAS,NRAS,BRAF,PIK3CA,and MMR/MSI in CRC,identifying key influencing factors,with implications for clinical management of CRC.

Anesthesia management in a pediatric patient with complicatedly difficult airway:A case report

BACKGROUND Reports on perioperative anesthesia management in pediatric patients with difficult airways are scarce.In addition to relatively more difficulties in the technique of endotracheal intubation,the time for manipulation is restricted compared to adults.Securing the airways safely and avoiding the occurrence of hypoxemia in these patients are of significance.CASE SUMMARY A 9-year-old boy with spastic cerebral palsy,severe malnutrition,thoracic scoliosis,thoracic and airway malformation,laryngomalacia,pneumonia,and epilepsy faced the risk of anesthesia during palliative surgery.After a thorough preoperative evaluation,a detailed scheme for anesthesia and a series of intu-bation tools were prepared by a team of anesthesiologists.Awake fiberoptic intubation is the widely accepted strategy for patients with anticipated difficult airways.Given the age and medical condition of the patient,we kept him sedated with spontaneous breathing during endotracheal intubation.The endotracheal intubation was completed on the second attempt after the failure of the first effort.Fortunately,the surgery was successful without postoperative complications.CONCLUSION Dealing with difficult airways in the pediatric population,proper sedation allows time to intubate without interrupting spontaneous breathing.The appropriate endotracheal intubation method based on the patient’s unique characteristics is the key factor in successful management of these rare cases.

Psychiatrists’occupational stigma conceptualization,measurement,and intervention:A literature review

Psychiatrists require frequent contact with and treatment of patients with mental illnesses.Due to the influence of associative stigma,psychiatrists may also be targets of stigma.Occupational stigma warrants special consideration because it significantly affects psychiatrists'career advancement,well-being,and their patients’health.Given that there is no complete summary of this issue,this study reviewed the existing literature on psychiatrists'occupational stigma to clearly synthesize its concepts,measurement tools,and intervention strategies.Herein,we emphasize that psychiatrists’occupational stigma is a multifaceted concept that simultaneously encompasses physically,socially,and morally tainted aspects.Currently,standardized methods to specifically measure psychiatrists’occupational stigma are lacking.Interventions for psychiatrists’occupational stigma may consider the use of protest,contact,education,comprehensive and systematic methods,as well as the use of psychotherapeutic approaches.This review provides a theoretical basis for the development of relevant measurement tools and intervention practices.Overall,this review seeks to raise public awareness of psychiatrists'occupational stigma,thereby promoting psychiatric professionalism and reducing its stigma.

Effects of Rare Earth,Titanium,and Magnesium Additions on Microstructures and Properties of High-boron Medium-carbon Alloy

In order to improve the toughness and wear resistance of high-boron medium-carbon alloy （HBMCA）, a novel wear-resistant HBMCA comprising granular borocarbide was obtained by titanium, magnesium, and rare earth modifications. These modifications gave rise to greatly refined as-cast eutectic borocarbide structures and a less interconnected continuous borocarbide network. Heat treatment mostly produced broken and spheriodized borocarbides that tended to exist as isolated particles in modified HBMCA. The heat treated modified HBMCA exhibited enhanced hardness than pristine and impact toughness was improved significantly to 12.5 J/cm^2. In addition, it displayed 2.39 and 1.7 times greater wear resistance than high-speed steel （HSS） and high nickel-chromium alloy steel （Cr25） at high temperature （500℃）, respectively. Here, the modification mechanisms involving Re2O3, TiN, and MgO/ MgS heterogeneous nuclei were discussed.

Long-term safety and absorption assessment of a novel bioresorbable nitrided iron scaffold in porcine coronary artery

This study aimed to investigate the long-term biocompatibility, safety, and degradation of the ultrathin nitrided iron bioresorbable scaffold (BRS) in vivo, encompassing the whole process of bioresorption in porcine coronary arteries. Fifty-two nitrided iron scaffolds (strut thickness of 70 μm) and 28 Vision Co–Cr stents were randomly implanted into coronary arteries of healthy mini-swine. The efficacy and safety of the nitrided iron scaffold were comparable with those of the Vision stentwithin 52 weeks after implantation. In addition, the long-term biocompatibility, safety, and bioresorption of the nitrided iron scaffold were evaluated by coronary angiog-raphy, optical coherence tomography, micro-computed tomography, scanning electron microscopy, energy dispersive spectrometry and histopathological evaluations at 4, 12, 26, 52 weeks and even at 7 years after im-plantation. In particular, a large number of struts were almost completely absorbed in situ at 7 years follow-up, which were first illustrated in this study. The lymphatic drainage pathway might serve as the potential clearance way of iron and its corrosion products.