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Objective·To summarize the clinical features, imaging features, and diagnosis and treatment experience of primary mediastinal yolk sac tumor (YST).Methods·Data of 29 patients with primary mediastinal YST, who attended Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine from September 2016 to May 2023, were collected and comprehensively analyzed, including imaging examination results, serum indicators, pathology reports and treatment methods.Results·There were 22 cases of pure YST and 7 cases of mixed YST comprising 28 males and 1 female. The mean age of onset was (24.5±5.9) years. The initial symptoms were chest tightness (34.5%), chest pain (27.8%), cough (34.5%), expectoration (34.5%) and no specific symptoms (24.1%). Chest computerized tomography (CT) enhancement showed that all the 29 lesions were located in the anterior mediastinum. The maximum diameter of the lesions ranged from 5.6 cm to 18.2 cm. The lesions were irregular in shape, uneven in density, partially cystic and solid in density. The enhancement scan showed the solid part was slightly and moderately enhanced, and the low-density area was not enhanced. Tumor boundary was not clear because tumors often compressed and invaded surrounding tissues. Among the 29 newly diagnosed patients, serum alpha-fetoprotein (AFP) was significantly increased in 28 cases (1 case was not tested). Patients received multidisciplinary comprehensive treatment, including chemotherapy (25/29), surgery (26/29), and radiotherapy (8/29). Seven patients directly received surgery after diagnosis. Nineteen patients received chemotherapy first and then surgery; 16 (84.2%) cases were evaluated as lesion shrinkage after chemotherapy. After surgery, 73.1% (19/26) patients had a significant decrease in serum AFP. After chemotherapy, 56.0% (14/25) patients had decreased serum AFP.Conclusion·Primary mediastinal YST usually occurs in middle-aged and young men, with certain clinical and radiographic features and elevated serum AFP, which requires multidisciplinary comprehensive treatment.

This study aimed to explore the interactions among genetic determinants influencing ciprofloxacin resistance in Salmonella. Treatment with PAβN, an efflux pump inhibitor, resulted in a 4–32-fold reduction in the minimum inhibitory concentration (MIC) across all 18 ciprofloxacin-resistant Salmonella isolates. Notably, isolates without point mutations reverted from resistance to sensitivity. The efflux pump played a crucial role in resistance development, particularly in serovar Enteritidis, where PAβN treatment caused a more significant MIC reduction (16–32-fold) in five strains carrying the GyrA (Asp87Tyr) mutation, which initially exhibited high MICs (8 μg/mL). Several resistance genes were identified on transferable plasmids: oqxAB and aac(6′)-Ib-cr were associated with IncF plasmids in S. Enteritidis, IncA/C plasmids in S. Typhimurium, and IncHI2 plasmids in S. Virchow. Additionally, qnrS1 and/or qepA were carried by IncA/C plasmids in S. Thompson. Whole-genome sequencing revealed the presence of an oqxAB module integrated into the chromosomal DNA of S. Derby. Although the MICs of ciprofloxacin in transconjugants and transformants remained low (1–4 μg/mL), they exceeded the clinical breakpoint for susceptibility. These findings highlight the synergistic impact of efflux pumps and plasmid-mediated resistance mechanisms, contributing to the increasing prevalence of ciprofloxacin resistance and posing a significant threat to food safety. [ABSTRACT FROM AUTHOR]

As an effective method for uncertain knowledge discovery and decision-making, the three-way decisions model has attracted extensive attention from scholars. However, in practice, the existing sequential three-way decision model often faces challenges due to factors such as missing data and unbalanced attribute granularity. To address these issues, we propose an intuitionistic fuzzy sequential three-way decision (IFSTWD) model, which introduces several significant contributions: (1) New intuitionistic fuzzy similarity relations. By integrating possibility theory, our model defines similarity and dissimilarity in incomplete information systems, establishing new intuitionistic fuzzy similarity relations and their cut relations. (2) Granulation method innovation. We propose a density neighborhood-based granulation method to partition decision attributes and introduce a novel criterion for evaluating attribute importance. (3) Enhanced decision process. By incorporating sequential three-way decision theory and developing a multi-level granularity structure, our model replaces the traditional equivalent relation in the decision-theoretic rough sets model, thus advancing the model's applicability and effectiveness. The practical utility of our model is demonstrated through an example analysis of "Chinese + vocational skills" talent competency and validated through simulation experiments on the UCI dataset, showing superior performance compared to existing methods. [ABSTRACT FROM AUTHOR]