Reappraisals of biological behaviors of PDGFRA mutant gastrointestinal stromal tumor / 中华病理学杂志

Objective: To investigate the biological behavior spectrum of platelet-derived growth factor alpha receptor (PDGFRA)-mutant gastrointestinal stromal tumor (GIST), and to compare the clinical values of the Zhongshan method of benign and malignant evaluation with the modified National Institutes of Health (NIH) risk stratification. Methods: A total of 119 cases of GIST with PDGFRA mutation who underwent surgical resection at Zhongshan Hospital, Fudan University from 2009 to 2020 were collected. The clinicopathological data, follow-up records, and subsequent treatment were reviewed and analyzed statistically. Results: There were 79 males and 40 females. The patients ranged in age from 25 to 80 years, with a median age of 60 years. Among them, 115 patients were followed up for 1-154 months, and 13 patients progressed to disease. The 5-year disease-free survival (DFS) and overall survival (OS) were 90.1% and 94.1%, respectively. According to the modified NIH risk stratification, 8 cases, 32 cases, 38 cases, and 35 cases were very-low risk, low risk, intermediate risk, and high risk, and 5-year DFS were 100.0%, 95.6%, 94.3%, and 80.5%, respectively. There was no significant difference in prognosis among the non-high risk groups, only the difference between high risk and non-high risk groups was significant (P=0.029). However, the 5-year OS was 100.0%, 100.0%, 95.0% and 89.0%, and there was no difference (P=0.221). According to the benign and malignant evaluation Zhongshan method, 43 cases were non-malignant (37.4%), 56 cases were low-grade malignant (48.7%), 9 cases were moderately malignant (7.8%), and 7 cases were highly malignant (6.1%). The 5-year DFS were 100.0%, 91.7%, 77.8%, 38.1%, and the difference was significant (P<0.001). The 5-year OS were 100.0%, 97.5%, 77.8%, 66.7%, the difference was significant (P<0.001). Conclusions: GIST with PDGFRA gene mutation shows a broad range of biological behavior, ranging from benign to highly malignant. According to the Zhongshan method, non-malignant and low-grade malignant tumors are common, the prognosis after surgery is good, while the fewer medium-high malignant tumors showed poor prognosis after surgical resection. The overall biological behavior of this type of GIST is relatively inert, which is due to the low proportion of medium-high malignant GIST. The modified NIH risk stratification may not be effective in risk stratification for PDGFRA mutant GIST.

Clinicopathological features of gastric alpha-fetoprotein-producing adenocarcinoma with SWI/SNF complex deletion / 中华病理学杂志

Objective: To investigate the clinicopathological features and treatment of gastric alpha-fetoprotein (AFP)-producing adenocarcinoma with SWI/SNF complex deletion. Methods: Four cases of gastric AFP-producing adenocarcinoma with SWI/SNF complex deletion diagnosed in Zhongshan Hospital of Fudan University from January 2021 to December 2022 were collected, and their histomorphological characteristics, immunohistochemical (IHC), in situ hybridization of Epstein-Barr virus-encoded RNA (EBER), next-generation sequencing results, clinicopathological features and treatment were summarized, and literature review was conducted. Results: Among the 4 patients, there were three males and one female. They presented with abdominal pain, belching and melena. Serum AFP was significantly elevated in three patients, and endoscopy showed ulcerative lesions. Microscopically, the tumor cells showed mainly diffuse flaky or nest-like growth and typical characteristics of hepatoid adenocarcinoma. In two cases there were adenoid growth, and the tumor cells in these areas possessed clear cytoplasm, suggesting enteroblastic differentiation. The tumor cell nuclei were pleomorphic with large nucleoli and brisk mitoses. The IHC results showed that the tumor cells expressed AFP, GPC3 and SALL4, and there was retained expression of broad-spectrum keratin (CKpan) and E-cadherin. IHC detection of SWI/SNF complex subunits, namely INI1 (SMARCB1), BRG1 (SMARCA4), BRM (SMARCA2), ARID1A protein was performed. In all four cases the hepatoid adenocarcinoma region and enteroblastic differentiation region showed SMARCA2 deletion, and one case with enteroblastic differentiation also showed ARID1A deletion. SMARCB1 and SMARCA4 deletions were not seen. All the four cases were diffusely positive for p53 protein, and the Ki-67 proliferation index was 80%-90%. There were no mismatch repair deletion detected; one cases showed HER2 was strongly positive (3+), and EBER was negative. None of the four cases had mutations in the SWI/SNF complex-related subunits detected by next-generation sequencing. Among the four patients, two underwent palliative surgery due to distant metastasis at the time of surgery, two underwent radical resection. Postoperative adjuvant chemotherapy was given to three patients. Conclusions: AFP-producing adenocarcinoma is a rare subtype of gastric cancer, which can be combined with SWI/SNF complex deletion, and the pathomorphological manifestations are different from the classical SWI/SNF complex deletion of undifferentiated carcinoma with rhabdoid phenotype.

Pharmacokinetics and tissue distribution of tetrahydropalmatine, nobiletin, and costunolide in rats after oral administration of Dalitong extract / 中国临床药理学与治疗学

AIM: To investigate the pharmacokinetic properties of the main active components of Dalitong extract in SD rats after oral administration using UPLC-MS / MS. METHODS: An UPLC-MS / MS method was established to simultaneously detect tetrahydropalmatine, nobiletin and costunolide in the plasma and tissues of SD rats. The method was applied to investigate the pharmacokinetic characteristics and tissue distribution. RESULTS: After a single oral administration, the three active components were rapidly absorbed into the body, with a peak concentration (Cmax) of (13.73 ± 7.50), (27.01 ± 17.69) and (6.73 ± 29.94) ng / mL for tetrahydropalmatine, nobiletin, and costunolide, respectively. The time to reach the peak concentration (Tmax) was (1.40 ± 0.93), (0.63 ± 0.28) and (2.38 ± 8.81) h, respectively. The area under the curve (AUC) was (80.43±40.03), (41.30±28.69) and (303.90 ± 136.69) ng · h · mL

Analysis of the effect of 12week highintensity fitness exercises on improving metabolic disorders among obese adolescents / 中国学校卫生

Objective@#To analyze the effects of 12week highintensity fitness exercise on body composition,lipid metabolism and gut microbiota in obese adolescents, so as to provide references for improving the health levels of obese adolescents.@*Methods@#From January to June 2023, 20 obese adolescents from Huaifeng Vocational and Technical School in Huaian City were recruited for the study. Participants were assigned to an exercise group (n=10) and a control group (n=10) for a 12week exercise intervention by random number table method, and both groups had the same diet during the intervention period. The exercise group engaged in three exercises every week, mainly consisting of moderate to highintensity aerobic exercise combined with highintensity intervals. In the first week, there was a 30 minutes of aerobic exercise, followed by 10 minutes of highintensity interval training in the total intervention time each week, and the rest of the time was aerobic exercise with a total intervention time of 60 minutes to maintain; the control group did not receive specific interventions. Body composition was measured using bioelectrical impedance analysis, and lipid levels were determined using an automatic biochemical analyzer. The expression levels of serum inflammatory factors were measured at baseline and after 12 weeks of intervention, and gut microbiota was analyzed using 16S rRNA gene sequencing. Statistical analysis was performed using t test and Chisquare test.@*Results@#After 12 weeks of intervention, the levels of triglycerides (TG), and lowdensity lipoprotein cholesterol (LDL-C) in obese adolescents in the exercise group decreased from (1.7±0.6, 3.5±0.8) mmol/L to (0.9±0.3, 2.6±0.4) mmol/L, while highdensity lipoprotein cholesterol (HDL-C) increased from (1.1±0.2) mmol/L to (1.4±0.2) mmol/L; and serum interleukin-1 receptor antagonist(IL-1Rn) decreased from (8.4±1.6) to (4.5±0.4) ng/mL in the exercise group (t=7.34,2.49,-3.05,2.56, P<0.05). The α-diversity results showed that the Chao index (268.00±22.67) and Ace index (243.98±38.64) in the exercise group were higher than those in the control group (184.52±19.28, 171.43±23.33), and the differences were statistically significant (t=2.48, 2.53, P<0.05). The Shannon index (5.36±1.41) in the exercise group was higher than that in the control group (4.73±1.12), and the Simpson index (0.78±0.10) was lower than that in the control group (0.89±0.10), but the differences were not statistically significant (t=1.83, -2.10, P>0.05). The β-diversity results showed that the intergroup differences in gut microbiota structure between the exercise group and the control group were greater than the intragroup differences, and the differences in gut microbiota structure between the exercise group and the control group were statistically significant (R2=0.083，P<0.05). After intervention, there were significant differences in the relative abundances at the levels of phylum, class, genus, and species in gut microbiota among obese adolescents between the exercise group and the control group (P<0.05).@*Conclusion@#The 12week highintensity fitness exercise can alleviate obesity symptoms in obese adolescents through the gut microbiota-lipid metabolism pathway and improve mild chronic inflammatory status.

Effect of TIMBER on post-traumatic stress symptoms in rehabilitation patients with limb dysfunction after accidental trauma / 陆军军医大学学报

Objective To explore the impact of trauma interventions using mindfulness based extinction and reconsolidation(TIMBER)on post-traumatic stress symptoms in rehabilitation patients with limb dysfunction after accidental trauma.Methods Convenient sampling was used to select 46 rehabilitation patients with limb dysfunction after accidental trauma(impact of event scale-revised,IES-R total score ≥33)admitted to Department of Rehabilitation Medicine of the First Affiliated Hospital from March 2022 to May 2023.They were randomly divided into an intervention group(TIMBER intervention)and a control group(health education of knowledge about mental health).IES-R,Hospital Anxiety and Depression Scale(HADS),and Self-Rating Scale of Sleep(SRSS)were employed to survey the participants before(T1),at the end of(T2),and 1 month after intervention(T3).The changes in post-traumatic stress symptoms,anxiety symptoms,depression symptoms,and sleep were compared between the 2 groups of patients.Results There were no statistically differences in demographic information and various psychological variables between the 2 groups at T1(P＞0.05).The intervention group got their total and various dimensional scores of IES-R,and scores of anxiety,depression,and sleep at T2 and T3 significantly decreased when compared with these scores at T1(P＜0.01),and all the scores at T2 and T3 were obviously lower in the intervention group than the control group(P＜0.05).Compared with T1,the avoidance and intrusion scores and total IES-R score were declined in the control group at T2 and T3,with statistical significance(P＜0.05),while no such differences were observed in the scores of high alertness,anxiety,depression,and sleep(P＞0.05).Conclusion TIMBER significantly improves the post-traumatic stress symptoms,anxiety symptoms,depression symptoms,and sleep in rehabilitation patients with limb dysfunction after accidental trauma.

To construct a prediction model of central lymph node metastasis in thyroid cancer by combining elastography parameters and ultrasound image features / 中华内分泌外科杂志

Objective:To establish a nomogram model based on elastic imaging parameters and ultrasound image features, and evaluate its predictive value in central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) .Methods:The clinical data of 168 patients (the research group) with papillary thyroid carcinoma who underwent thyroid surgery in our hospital from Jan. 2019 to Dec. 2021 were retrospectively collected, including gender, age, ultrasound elastography parameters (elasticity ratio, blue area ratio), and ultrasound examination indicators (nodule diameter, nodule number, internal echo, border, edge, aspect ratio, microcalcification, capsule invasion). Another 150 patients who underwent thyroid surgery in our hospital during the same period were selected as the validation group.According to the results of postoperative pathological examination, the the research group were divided into two groups: 64 cases (38.10%) of CLNM and 104 cases (61.90%) of non-CLNM. Binary logistic regression analysis was used to explore the influencing factors of CLNM in PTC patients, and a nomogram model based on elastic imaging parameters and ultrasound image features was established. The nomogram model was drawn to predict the receiver operating characteristic (ROC) curve of CLNM in PTC patients.Results:There were statistically significant differences in nodule diameter, edge, microcalcification, capsule invasion, blue area ratio, and elasticity ratio ( P<0.05). Most of the nodules in the CLNM group were ≥10 mm in diameter, with uneven margins, an aspect ratio of <1, microcalcifications and capsular invasion. Logistic regression analysis showed that nodule diameter, capsule invasion, blue area ratio and elastic ratio were risk factors for CLNM ( P<0.05). The AUC of the combined detection was 0.857 (0.777-0.937), and the sensitivity and specificity were 78.1% and 86.5%, respectively, and the AUC and sensitivity were significantly higher than the individual detection of each index ( P<0.05). In the research group, the sensitivity and specificity of the ultrasound parameter prediction model in predicting CLNM were 81.25% (52/64) and 84.62% (88/104), respectively. In the validation group, the sensitivity and specificity of the ultrasound parameter prediction model in predicting CLNM were 79.17% (38/48) and 85.29% (87/102), respectively. Conclusion:Elastography parameters (blue area ratio, elasticity ratio) and ultrasound image features (nodule diameter, capsular invasion) are the influencing factors of CLNM in PTC patients, and the combined prediction based on the above four indicators has good application value.

Application of mobile medical intelligence software combined with OBE-CBCL dual-track teaching method in standardized training of orthopaedic residents / 沈阳医学院学报

Objective:To explore the effect of mobile medical intelligent software combined with OBE-CBCL dual-track teaching method in standardized training of orthopaedic residents.Methods:The orthopedic residents who received resident standardized training in our hospital from Jan 2022 to Sep 2022 were selected as the study subjects.The orthopedic residents who received regular teaching method from Jan 2022 to Mar 2022 were group A,orthopedic residents who received mobile medical intelligent software + regular teaching method from Apr 2022 to Jun 2022 were group B,and the orthopedic residents who received mobile medical intelligent software + OBE-CBCL dual-track teaching method from Jul 2022 to Sep 2022 were group C.All three groups participated in the relevant professional theoretical knowledge assessment,Mini-CEX,and satisfaction survey at the time of discharge.Results:The scores of professional theoretical knowledge assessment in groups B and C were higher than that in groups A,and it was higher in group C than that in group B(P＜0.05).The scores of each item of Mini-CEX in groups B and C were higher than those in group A(P＜0.05).Except for clinical judgment ability,the scores of the other items of Mini-CEX in group C was higher than those in group B(P＜0.05).In the satisfaction survey,the scores of deepening knowledge mastery in groups B and C were higher than that in group A,and that in group C was higher than that in group B(P＜0.05).The scores of improving clinical thinking and stimulating learning interest in groups B and C were higher than those in group A(P＜0.05),and the scores of improving team assistance and overall satisfaction in group C were higher than those in groups A and B(P＜0.05).Conclusion:Mobile medical intelligent software combined with OBE-CBCL dual-track teaching can significantly improve teaching effect of orthopaedic resident standardized training.

Robot-assisted partial nephrectomy for large complex renal cancer: step-by-step segmental artery unclamping

ABSTRACT Introduction Main renal artery clamping and selective arterial clamping are two conventional devascularization methods for robot-assisted partial nephrectomy (RAPN) (1, 2). Decreasing warm ischemic (WI) time (3, 4) and improving clear surgical visualization (5) are the main surgically modifiable factors for RAPN, especially in large complex renal cancer (6). In this study, we described our surgical technique, focusing on gradual segmental artery unclamping on patients with large renal tumors. Material and methods Two patients (R.E.N.A.L score 10 and 11) underwent RAPN with gradual segmental artery unclamping (Figures 1 and 2). The unclamping included five key steps. First, all renal segmental arteries were identified as tumor feeding vessel(s) and the vessels for normal kidney parenchyma under the guidance of CT angiography (CTA) 3-division (3D) reconstruction. Second, all segmental arteries were isolated, and the feeding one(s) should be blocked before other arteries were blocked. Third, the tumor was resected outside the pseudocapsule, and the deep resection bed was sutured for initial hemostasis. Fourth, the segmental arteries were reopened except for the tumor feeding one(s), and normal kidney parenchyma restored blood supply. And fifth, the resection bed was completely sutured, and the feeding vessel supplying the tumor was opened after the suture. Warm ischemia time (WIT) was defined as the time measured between clamping and unclamping of the renal artery. WIT1 was the time for normal kidney parenchyma and WIT2 was the time for resection area. Patient demographics, perioperative variables, and warm ischemic time were included in our study. And we presented the details of gradual segmental artery unclamping in the video. Results In both cases, the total operation times were 215 and 130 mins for patient 1 and patient 2, respectively. WIT1 and WIT2 for patient 1 were 15 min and 33 min., and WIT1 and WIT2 for patient 2 were 21 min and 32 min, respectivelly. The maximum diameters of the masses resected were 10.8 and 7.3 cm, and surgical margins were negative. No patient had complications after operation. Preoperative and postoperative eGFR did not change significantly. Pre- and postoperative eGFR were 111 and 108 mL/min for patient 1, 91 and 83 mL/min for patient 2, respectively. Key hints for outcomes optimization during RAPN on patients with large complex renal tumors: 1) Each segmental renal artery is precised clamped before we excise the tumor, and an excellent surgical vision is essential for precising excision and shortening clamping time, 2) Other segmental renal arteries are unclamped except tumor feeding branch after suturing deep layer of parenchyma, and most normal parenchyma restores blood supply, 3) Preoperative high-resolution computed tomography angiography (CTA) and 3D reconstructive renal structure serve as a guide to clear the approach to find the tumor and segmental arteries (7, 8). Conclusions Gradual segmental artery unclamping is feasible and efficient to excise large complex renal cancer. Compared with main renal artery clamping, it can shorten the warm ischemic time of normal parenchyma; On the other hand, compared with selective segmental arterial clamping, the technique can reduce bleeding from the deep resection bed, keep a clear surgical vision, and decrease the incidence of positive margin.

Study on the influencing factors and mechanism of cholesterol polyps and cholesterol calculus in gallbladder / 中华肝胆外科杂志

Objective:To explore the pathogenesis of gallbladder cholesteryl polyps (GCP) and gallbladder cholesterol calculus (GCC) by studying the different changes of mucin (MUC) expression and reverse cholesterol transporter (RCT) in gallbladder mucosa epithelium.Methods:The data of 10 GCP patients (GCP group), 10 GCC patients (GCC group) and 5 patients with normal gallbladder resection (control group) were retrospectively analyzed, who underwent cholecystectomy in the Department of General Surgery, Xuanwu Hospital, Capital Medical University from January to December 2021. Among the 10 patients in the GCP group, there were 5 males and 5 females, aged (43.40±9.59) years old. Among the 10 patients in the GCC group, 5 males and 5 female, aged (45.00±8.13) years old. Among the 5 patients in the control group, there were 3 males and 2 females, aged (43.80±6.01) years old. Immunohistochemical analysis was used to investigate the expression differences of various subtypes of MUC and RCT [ATP binding cassette transporter G1 (ABCG1) and B group type I scavenger receptor (SR-BI)] among each group.Results:Compared with the control group, the expression of MUC1 (3.40±0.70 vs. 0), MUC5AC (1.50±0.53 vs. 0), MUC6 (4.70±0.48 vs. 0), and ABCG1 (3.50±0.53 vs. 1.60±0.55) in the gallbladder mucosa of the GCP group increased, while the expression score of SR-BI decreased (1.70±0.48 vs. 3.40±0.55), with statistical significance (all P<0.001). Compared with the control group, the expression of MUC1 (4.80±0.42 vs. 0), MUC5AC (4.70±0.48 vs. 0), MUC6 (3.30±0.67 vs. 0), and ABCG1 (3.40±0.52 vs. 1.60±0.55) in the gallbladder mucosa of the GCC group increased, while the expression score of SR-BI decreased (0 vs. 3.40±0.55), with statistically significant differences (all P<0.001). Conclusion:The different expression levels of MUC1, MUC5AC, MUC6, and RCT proteins lead to the differential formation of GCP and GCC on the basis of the co-pathogenesis in high cholesterol in bile.

Path analysis of mediating effect of perceived stress affecting impact of event in rehabilitation patients with traumatic injury / 中国康复理论与实践

ObjectiveTo explore the effect of perceived stress on the impact of event in rehabilitation patients with traumatic injury, and the mediating role of difficulties in emotion regulation, rumination and sleep. MethodsFrom March, 2022 to March, 2023, using the convenient sampling method, a questionnaire survey was conducted on 192 rehabilitation patients with traumatic injury from Southwest Hospital, Xinqiao Hospital and Daping Hospital. Assessment tools included Perceived Stress Scale, Difficulties in Emotion Regulation Scale, Brief Ruminative Response Scale, Self-Rating Scale of Sleep, and Impact of Event Scale-revised. ResultsPerceived stress, difficulties in emotion regulation, rumination, sleep and the impact of event were correlated with each other in rehabilitation patients with traumatic injury (r = 0.447~0.684, P < 0.01). Perceived stress significant positively predicted the impact of event (β = 0.49, P < 0.001), as well as difficulties in emotion (β = 0.70, P < 0.001), rumination (β = 0.21, P < 0.05) and sleep (β = 0.29, P < 0.001). The direct effect of perceived stress on the impact of event was not significant, but it affected the impact of event through seven mediation paths, among which the independent mediation effect size of difficulties in emotion regulation, rumination and sleep accounted for 24.41%, 11.91% and 24.82%, respectively; the chain mediation effect size of difficulties in emotion regulation and rumination accounted for 13.88%, the chain mediation effect size of difficulties in emotion regulation and sleep accounted for 18.08%, the chain mediation effect size of rumination and sleep accounted for 3.17%, and the chain mediation effect size of difficulties in emotion regulation, meditation and sleep accounted for 3.70%. ConclusionPerceived stress affected the impact of event in rehabilitation patients with traumatic injury through the independent mediation and chain mediation of difficulties in emotion regulation, rumination and sleep.

Textual research on the name and reality of edible and medicinal Zisu / 药学实践与服务

Objective To make a textual research on Zisu about the name, origin, morphology and efficacy, a dual-purpose medicinal and edible plant, in order to make the original clear and provide reference basis for clinical application. Methods Textual research was carried out from the aspects of synonym, distribution, morphology, efficacy, toxicity and side effects of the plants. Results Zisu，Baisu and Su in the herbal medicine of past dynasties belong to the Ren category, which are species or varieties of Perilla frutescens（L.）Britt. Zisu has purple leaves, and its stems, leaves and seeds are used as medicine to mainly lower Qi. While Baisu has green leaves, which could cure wind cold. Conclusion There are significant differences in botanical morphology and pharmacological efficacy between Zisu and Baisu, which should be distinguished and used separately. Zisu is a dual-purpose traditional Chinese medicine with a long application history. Baisu is not suitable for edible consumption.

How Job Stress and Psychological Adaptation Predicting Interpersonal Needs Among Female Migrant Manufacturing Workers in China: A Structural Equation Model

Background@#This study aimed to explore relationships between job stress and psychological adaptation and how they related to interpersonal needs through mood states among female migrant manufacturing workers. @*Methods@#A cross-sectional survey was conducted in 16 factories in Shenzhen, China. Sociodemographic, job stress, psychological adaptation and other psychological information of was collected. Structural equation modeling was performed to delineate the internal relationship between variables. @*Results@#The hypothetical structural equation model exhibited acceptable model fit among female migrant manufacturing workers (χ2 = 11.635, df = 2, χ2/df = 5.82, p = 0.003, RMSEA = 0.090, CFI = 0.972, SRMR = 0.020). Job stress was directly associated with mood states and interpersonal needs; Psychological adaptation was directly associated with mood states and indirectly associated with interpersonal needs; Bootstrapping tests demonstrated mediation effect of mood states in the way from psychological adaptation to interpersonal needs. @*Conclusion@#Female migrant manufacturing workers who suffered stress from job and the process of psychological adaptation may have worse mood states and workers with worse mood states are more likely to develop unmet interpersonal needs, a proximal factor of suicidal ideation.

A qualitative study of the difficulties faced by adolescents with depression in the treatment and rehabilitation / 中国学校卫生

Objective@#Based on a qualitative research method, the present study aims to explore the negative experiences and real dilemmas of adolescent with depression in the treatment and rehabilitation process, so as to provide references to promote the improvement of the treatment system for adolescent depression in China.@*Methods@#From August 2022 to November 2022, 30 adolescents with depression were selected for in-depth interviews in the inpatient department of child and adolescent psychiatry at Beijing An Ding Hospital affiliated with Capital Medical University by using the purposive sampling method, and the interview data were analyzed by using the Colaizzi method to summarize the themes.@*Results@#The real dilemmas faced by depressed adolescent during treatment and recovery included three aspects:inappropriate family coping (caregivers lacking of correct disease cognition; caregivers lacking of effective coping methods), difficulties in disease diagnosis and treatment (low rate of identification and adverse effect of treatment; medical service failing to satisfy the demands), and barriers to continued schooling (barriers to academic progress and interpersonal communication).@*Conclusion@#Adolescents with depression face real dilemmas in the process of disease treatment and rehabilitation at home, school and medical care. Caregivers disease literacy and caregiving skills should be improved. A collaborative disease management system among family, school, community and medical institutions should be established to promote adolescent depression treatment and social function recovery.

Clinicopathological features and prognostic factors of gastric intermediate-risk gastrointestinal stromal tumor after surgical resection: a retrospective study / 中华病理学杂志

Objective: To investigate the clinicopathological features, treatment and prognosis of gastric intermediate-risk gastrointestinal stromal tumor (GIST), so as to provide a reference for clinical management and further research. Methods: A retrospective observational study of patients with gastric intermediate-risk GIST, who underwent surgical resection between January 1996 and December 2019 at Zhongshan Hospital of Fudan University, was carried out. Results: Totally, 360 patients with a median age of 59 years were included. There were 190 males and 170 females with median tumor diameter of 5.9 cm. Routine genetic testing was performed in 247 cases (68.6%, 247/360), and 198 cases (80.2%) showed KIT mutation, 26 cases (10.5%) showed PDGFRA mutation, and 23 cases were wild-type GIST. According to "Zhongshan Method"(including 12 parameters), there were 121 malignant and 239 non-malignant cases. Complete follow-up data were available in 241 patients; 55 patients (22.8%) received imatinib therapy, 10 patients (4.1%) experienced tumor progression, and one patient (PDGFRA mutation, 0.4%) died. Disease-free survival (DFS) and overall survival rate at 5 years was 96.0% and 99.6%, respectively. Among the intermediate-risk GIST, there was no difference in DFS between the overall population, KIT mutation, PDGFRA mutation, wild-type, non-malignant and malignant subgroups (all P>0.05). However, the non-malignancy/malignancy analysis showed that there were significant differences in DFS among the overall population (P<0.01), imatinib treatment group (P=0.044) and no imatinib treatment group (P<0.01). Adjuvant imatinib resulted in potential survival benefit for KIT mutated malignant and intermediate-risk GIST in DFS (P=0.241). Conclusions: Gastric intermediate-risk GIST shows a heterogeneous biologic behavior spectrum from benign to highly malignant. It can be further classified into benign and malignant, mainly nonmalignant and low-grade malignant. The overall disease progression rate after surgical resection is low, and real-world data show that there is no significant benefit from imatinib treatment after surgery. However, adjuvant imatinib potentially improves DFS of intermediate-risk patients with tumors harboring KIT mutation in the malignant group. Therefore, a comprehensive analysis of gene mutations in benign/malignant GIST will facilitate improvements in therapeutic decision-making.

Advances in colonic manometry in adults with colonic motility disorders / 中华胃肠外科杂志

In recent years, colonic manometry has been gradually introduced into clinical practice. It helps clinicians to gain a better understanding of the physiology and pathophysiology of colonic contractile activity in healthy adults and patients with colonic dysfunction. More and more patterns of colonic motility are being discovered with the help of colonic manometry. However, the clinical significance of these findings still needs to be further investigated. This review enhances our understanding of colonic motility and the current state of development and application of colonic manometry, as well as the limitations, future directions and potential of the technique in assessing the impact of treatment on colonic motility patterns, by analyzing and summarizing the literature related to colonic manometry.

Yifei Jianpi recipe improves cigarette smoke-induced inflammatory injury and mucus hypersecretion in human bronchial epithelial cells by inhibiting the TLR4/NF-κB signaling pathway / 南方医科大学学报

OBJECTIVE@#To explore the mechanism of Yifei Jianpi recipe for improving cigarette smoke- induced inflammatory injury and mucus hypersecretion in cultured human bronchial epithelial cells.@*METHODS@#Serum samples were collected from 40 SD rats treated with Yifei Jianpi recipe (n=20) or normal saline (n=20) by gavage. Cultured human bronchial epithelial 16HBE cells were stimulated with an aqueous cigarette smoke extract (CSE), followed by treatment with the collected serum at different dilutions. The optimal concentration and treatment time of CSE and the medicated serum for cell treatment were determined with CCK-8 assay. The expressions of TLR4, NF-κB, MUC5AC, MUC7, and muc8 at both the mRNA and protein levels in the treated cells were examined with RT- qPCR and Western blotting, and the effects of TLR4 gene silencing and overexpression on their expressions were assessed. The expressions of TNF-α, IL-1 β, IL-6 and IL-8 in the cells were detected using ELISA.@*RESULTS@#At the optimal concentration of 20%, treatment with the medicated serum for 24 h significantly lowered the mRNA and protein expressions of TLR4, NF- κB, MUC5AC, MUC7, and MUC8 in CSE- exposed 16HBE cells, and these effects were further enhanced by TLR4 silencing in the cells. In 16HBE cells with TLR4 overexpression, the expressions of TLR4, NF-κB, MUC5AC, MUC7, and MUC8 were significantly increased after CSE exposure and were lowered following treatment with the medicated serum (P < 0.05). The medicated serum also significantly lowered the levels of TNF-α, IL-1β, IL-6 and IL-8 in CSE-exposed 16HBE cells (P < 0.05).@*CONCLUSIONS@#In the 16HBE cell model of chronic obstructive pulmonary disease (COPD), treatment with Yifei Jianpi recipe-medicated serum improves inflammation and mucus hypersecretion possibly by reducing MUC secretion and inhibiting the TLR4/NF-κB signaling pathway.

Disputes and thinking on the clinical diagnosis and treatment of asymptomatic gallstones / 国际外科学杂志

Cholecystolithiasis is a common clinical disease, which can be secondary to cholecystitis, cholangitis, pancreatitis and gallbladder cancer. Many patients with gallstone have no obvious clinical symptoms such as biliary colic. Some patients are indeed asymptomatic because there are not obstruction and inflammation. However, some patients have no symptoms due to ignorance, mistaken for stomach pain, enteritis, etc. Some patients have no symptoms because of insensitivity and insufficient perception. For other patients with abnormal gallbladder morphology and structure, non-functional gallbladder must be no pain. To clarify the concept, diagnosis and classification of asymptomatic gallstones according to pathophysiological stages is conducive to the development of personalized management strategies. According to guidelines formulated by different periods, different regions and different medical institutions, there are many controversies regarding the management of asymptomatic gallstones, including regular follow-up, drug treatment, surgical resection or gallblades-saving lithotomy. Reasonable personalized diagnosis and treatment requires more in-depth basic research evidence.

Progress in risk factors for gallstone formation and prevention strategies for stony stage / 国际外科学杂志

Gallstone is a common and frequent disease and frequent incidence, secondary infection and cancer seriously affect the health of patients. Academic organizations in different regions have issued multiple guidelines and consensus to promote the normative diagnosis and treatment of gallstones. However, in clinical practice, most symptomatic gallstones are treated, while the formation and prevention process of gallstones are ignored, making the concept of treating without a disease has not been strengthened.This article reviews the risk factors and mechanisms of gallstone formation, and points out the importance of effective prevention during stone formation. In the stage of gallstone formation, the high risk factors of stone formation can be analyzed through two aspects of injury factors and protective factors, and the high risk groups of stone formation can be screened out. According to the pathophysiological progression of gallstones, personalized prevention and follow-up strategies can be developed for the stone formation stage of gallstones.

Study on application of ultrasonic bone curette in anterior cervical spine surgery / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effect of ultrasonic bone curette in anterior cervical spine surgery.@*METHODS@#A clinical data of 63 patients with cervical spondylosis who were admitted between September 2019 and June 2021 and met the selection criteria was retrospectively analyzed. Among them, 32 cases were operated with conventional instruments (group A) and 31 cases with ultrasonic bone curette (group B). There was no significant difference between the two groups (P>0.05) in gender, age, surgical procedure, surgical segment and number of occupied cervical space, disease type and duration, comorbidities, and preoperative Japanese Orthopaedic Association (JOA) score, cervical dysfunction index (NDI), and pain visual analogue scale (VAS) score. The operation time, intraoperative bleeding, postoperative drainage, postoperative hospital stay, and the occurrence of postoperative complications were recorded in both groups. Before operation and at 1, 3, and 6 months after operation, the JOA score and NDI were used to evaluate the function and the postoperative JOA improvement rate was calculated, and VAS score was used to evaluate the pain improvement. The anteroposterior and lateral cervical X-ray films were taken at 1, 3, and 6 months after operation to observe whether there was any significant loosening and displacement of internal fixators.@*RESULTS@#Compared with group A, group B had shorter operation time and postoperative hospital stay, less intraoperative bleeding and postoperative drainage, and the differences were significant (P<0.05). All incisions healed by first intention in the two groups, and postoperative complications occurred in 5 cases (15.6%) in group A and 2 cases (6.5%) in group B, showing no significant difference (P>0.05). All patients were followed up 6-12 months (mean, 7.9 months). The JOA score and improvement rate gradually increased in groups A and B after operation, while the VAS score and NDI gradually decreased. There was no significant difference in VAS score between 3 months and 1 month in group B (P>0.05), and there were significant differences between the other time points of each indicator in the two groups (P<0.05). At 1, 3, and 6 months after operation, the JOA score and improvement rate in group B were better than those in group A (P<0.05). X-ray films examination showed that there was no screw loosening or titanium plate displacement in the two groups after operation, and the intervertebral cage or titanium mesh significantly sank.@*CONCLUSION@#Compared with traditional instruments, the use of ultrasonic bone curette assisted osteotomy in anterior cervical spine surgery has the advantages of shorter operation time, less intraoperative bleeding, less postoperative drainage, and shorter hospital stay.

Early effectiveness of Ti-Robot assisted femoral neck system for minimally invasive treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures / 中国修复重建外科杂志

OBJECTIVE@#To investigate the early effectiveness of the Ti-Robot assisted femoral neck system (FNS) in the treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures.@*METHODS@#A retrospective analysis was conducted on the clinical data of 41 elderly patients with Garden type Ⅱ and Ⅲ femoral neck fractures who were admitted between December 2019 and August 2022 and met the selection criteria. Among them, 21 cases were treated with Ti-Robot assisted FNS internal fixation (study group), and 20 cases were treated solely with FNS internal fixation (control group). There was no significant difference in baseline data, including gender, age, side, cause of injury, time from injury to surgery, fracture Garden classification, and fracture line classification, between the two groups ( P>0.05). Surgical effectiveness was evaluated based on parameters such as operation time (including incision time and total operation time), reduction level, number of dominant pin insertions, intraoperative fluoroscopy frequency, incision length, whether to extend the incision, need for assisted reduction, postoperative hospital stay, fracture healing time, incidence of osteonecrosis of the femoral head, postoperative visual analogue scale (VAS) score at 1 day, and Harris hip score at last follow-up.@*RESULTS@#The study group showed significantly shorter incision time, fewer dominant pin insertions, fewer instances of extended incisions, fewer intraoperative fluoroscopy frequency, and smaller incisions than the control group ( P<0.05). There was no significant difference in total operation time, reduction level, and assisted reduction frequency between the two groups ( P>0.05). Both groups achieved primary wound healing postoperatively, with no complications such as incision leakage or skin infection. All patients were followed up 12-24 months with an average of 14.6 months. Fractures healed in both groups, with no significant difference in healing time ( P>0.05). There was no significant difference in postoperative hospital stay between the two groups ( P>0.05). The study group showed significantly better VAS score at 1 day after operation and Harris hip score at last follow-up when compared to the control group ( P<0.05). No complication such as internal fixation failure, fracture displacement, or hip joint varus occurred in both groups during the follow-up. Osteonecrosis of the femoral head occurred in 1 patient of the control group, while no was observed in the study group, and the difference in the incidence of osteonecrosis of the femoral head between the two groups was not significant ( P=0.488).@*CONCLUSION@#Compared to sole FNS internal fixation treatment, Ti-Robot assisted FNS internal fixation for elderly Garden typeⅡ and Ⅲ femoral neck fractures can reduce incision time, achieve minimally invasive and accurate nail implantation, and decrease intraoperative fluoroscopy frequency, leading to improved postoperative hip joint function recovery.