Surgical Options for Appropriate Length of J-Pouch Construction for Better Outcomes and Long-term Quality of Life in Patients with Ulcerative Colitis after Ileal Pouch-Anal Anastomosis

Background/Aims@#Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is widely accepted as a radical surgery for refractory ulcerative colitis (UC). Definite results on the appropriate pouch length for an evaluation of the risk-to-benefit ratio regarding technical complications and long-term quality of life (QOL) are still scarce. @*Methods@#Data on UC patients who underwent IPAA from 2008 to 2022 in four well-established pouch centers affiliated to China UC Pouch Center Union were collected. @*Results@#A total of 208 patients with a median follow-up time of 6.0 years (interquartile range, 2.3 to 9.0 years) were enrolled. The median lengths of the patients’ short and long pouches were 14.0 cm (interquartile range, 14.0 to 15.0 cm) and 22.0 cm (interquartile range, 20.0 to 24.0 cm), respectively. Patients with a short J pouch configuration were less likely to achieve significantly improved long-term QOL (p=0.015) and were prone to develop late postoperative complications (p=0.042), such as increased defecation frequency (p=0.003) and pouchitis (p=0.035). A short ileal pouch was an independent risk factor for the development of late postoperative complications (odds ratio, 3.100; 95% confidence interval, 1.519 to 6.329; p=0.002) and impaired longterm QOL improvement (odds ratio, 2.221; 95% confidence interval, 1.218 to 4.050, p=0.009). @*Conclusions@#The length of the J pouch was associated with the improvement in long-term QOL and the development of late post-IPAA complications. A long J pouch configuration could be a considerable surgical option for pouch construction.

Advances in the treatment of KPC-producing Klebsiella pneumoniae infec-tion / 中国感染控制杂志

In recent years,the isolation rate of carbapenem-resistant Klebsiella pneunoniae(CRKP)in China has increased year by year.Due to its multidrug resistance and high mortality in patients,CRKP brings severe challen-ges to the clinical treatment.The major mechanism of drug resistance in CRKP is the production of carbapenemases,with Ambler A,B,and D being the common types while Ambler type C comparativly rare.Klebsiella pneumoniae carbapenemase(KPC)is the most common carbapenemase,which belongs to type A.KPC-producing Klebsiella pneumoniae(KPC-KP)widely spreads in the world,with very limited number of effective clinical drugs.In this re-view,advances in the treatment KPC-KP were summarized to provide reference for clinical treatment.

Laparoscopic surgery contributes to a decrease in short-term complications in surgical ulcerative colitis patients during 2008–2017: a multicenter retrospective study in China

Background/Aims@#The aim of this study was to analyze the chronological changes in postoperative complications in surgical ulcerative colitis patients over the past decade in China and to investigate the potential parameters that contributed to the changes. @*Methods@#Ulcerative colitis patients who underwent surgery during 2008–2017 were retrospectively enrolled from 13 hospitals in China. Postoperative complications were compared among different operation years. Risk factors for complications were identified by logistic regression analysis. @*Results@#A total of 446 surgical ulcerative colitis patients were analyzed. Fewer short-term complications (24.8% vs. 41.0%, P=0.001) and more laparoscopic surgeries (66.4% vs. 25.0%, P<0.001) were found among patients who received surgery during 2014–2017 than 2008–2013. Logistic regression suggested that independent protective factors against short-term complications were a higher preoperative body mass index (odds ratio [OR], 0.870; 95% confidence interval [CI], 0.785–0.964; P=0.008), laparoscopic surgery (OR, 0.391; 95% CI, 0.217–0.705; P=0.002) and elective surgery (OR, 0.213; 95% CI, 0.067–0.675; P=0.009). The chronological decrease in short-term complications was associated with an increase in laparoscopic surgery. @*Conclusions@#Our data revealed a downward trend of short-term postoperative complications among surgical ulcerative colitis patients in China during the past decade, which may be due to the promotion of minimally invasive techniques among Chinese surgeons.

Establishment and validation of a nomogram-based predictive model for idiopathic aldosteronism / 中华内科杂志

Objective: To establish and validate a nomogram-based predictive model for idiopathic hyperaldosteronism (IHA). Methods: This cross-sectional study was conducted with the collected clinical and biochemical data of patients with primary aldosteronism (PA) including 249 patients with unilateral primary aldosteronism (UPA) and 107 patients with IHA, who were treated at the Department of Endocrinology of the First Affiliated Hospital of Chongqing Medical University from November 2013 to November 2022. Plasma aldosterone concentration (PAC) and plasma renin concentration (PRC) were measured by chemiluminescence. Stepwise regression analysis was applied to select the key predictors of IHA, and a nomogram-based scoring model was developed. The model was validated in another external independent cohort of patients with PA including 62 patients with UPA and 43 patients with IHA, who were diagnosed at the Department of Endocrinology, First Affiliated Hospital of Zhengzhou University. An independent-sample t test, Mann-Whitney U test, and χ2 test were used for statistical analysis. Results: In the training cohort, in comparison with the UPA group, the IHA group showed a higher serum potassium level [M(Q1, Q3), 3.4 (3.1, 3.8) mmol/L vs. 2.7 (2.1, 3.1) mmol/L] and higher PRC [4.0 (2.1, 8.2) mU/L vs. 1.5 (0.6, 3.4) mU/L] and a lower PAC post-saline infusion test (SIT) [305 (222, 416) pmol/L vs. 720 (443, 1 136) pmol/L] and a lower rate of unilateral adrenal nodules [33.6% (36/107) vs. 81.1% (202/249)]; the intergroup differences in these measurements were statistically significant (all P<0.001). Serum potassium level, PRC, PAC post-SIT, and the rate of unilateral adrenal nodules showed similar performance in the IHA group in the validation cohort. After stepwise regression analysis for all significant variables in the training cohort, a scoring model based on a nomogram was constructed, and the predictive parameters included the rate of unilateral adrenal nodules, serum potassium concentration, PAC post-SIT, and PRC in the standing position. When the total score was ≥14, the model showed a sensitivity of 0.65 and specificity of 0.90 in the training cohort and a sensitivity of 0.56 and specificity of 1.00 in the validation cohort. Conclusion: The nomogram was used to successfully develop a model for prediction of IHA that could facilitate selection of patients with IHA who required medication directly.

Prognostic Model Based on Preoperative FAR and SII Versus TNM Staging System in Evaluating Prognosis of Patients with Pancreatic Cancer After Radical Resection / 肿瘤防治研究

Objective To investigate the predictive value of preoperative fibrinogen/albumin ratio (FAR) and systemic immune inflammation index (SII) on the postoperative prognosis of patients with pancreatic ductal adenocarcinoma. Methods An ROC curve was used in determining the best cutoff values of FAR and SII and then grouped. The Cox proportional hazards model was used in analyzing the prognostic factors of radical pancreatic cancer surgery, and then a Nomogram prognostic model was established. C-index, AUC, and calibration curve were used in evaluating the discrimination and calibration ability of the Nomogram. DCA curves were used in assessing the clinical validity of the Nomograms. Results The optimal cutoff values for preoperative FAR and SII were 0.095 and 532.945, respectively. FAR≥ 0.095, SII≥ 532.945, CA199≥ 450.9 U/ml, maximum tumor diameter≥ 4 cm, and the absence of postoperative chemotherapy were independent risk factors for the poor prognosis of pancreatic cancer (P<0.05). The discrimination ability, calibration ability, and clinical effectiveness of Nomogram prognostic model were better than those of the TNM staging system. Conclusion The constructed Nomogram prognostic model has higher accuracy and level of discrimination and more clinical benefits than the TNM staging prognostic model.

The predictive value of preoperative lymphocyte-to-monocyte ratio combined with platelet-to-lymphocyte ratio scoring model for prognosis of pancreatic ductal adenocarcinoma after radical resection / 中华消化外科杂志

Objective:To investigate the predictive value of preoperative lymphocyte-to-monocyte ratio (LMR) combined with platelet-to-lymphocyte ratio (PLR) (LMR-PLR) scoring model for prognosis of pancreatic ductal adenocarcinoma (PDAC) after radical resection.Methods:The retrospective cohort study was conducted. The clinicopathological data of 116 patients with PDAC who were admitted to the Second Hospital of Lanzhou University from January 2015 to December 2019 were collected. There were 73 males and 43 females, aged 61.5(range, 29.0-75.0)years. All patients underwent radical resection for PDAC. Observation indicators: (1) optimal cut-off value of LMR and PLR; (2) clinicopathological features of patients with different scores of preoperative LMR-PLR scoring model; (3) follow-up and survival; (4) influencing factors for prognosis of PDAC patients; (5) construction and verification of nomogram prediction model. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Mann-Whitney U test. The Graphpad prism 8 was used to draw survival curve, the Kaplan-Meier method was used to calculate survival rate, and the Log-Rank test was used for survival analysis. The COX proportional hazard regression model was used for univariate and multivariate analyses. The X-tile software was used to determine the optimal cut-off values of LMR and PLR. The nomogram prediction model was conducted based on the results of multivariate analysis, and the receiver operating characteristic (ROC) curve was drawn. The area under curve (AUC) was used to evaluate the discrimination of nomogram prediction model. The calibration curve was used to evaluate the consistency of nomogram prediction model and the decision curve was used to evaluate the clinical benefits. Results:(1) Optimal cut-off value of LMR and PLR. The optimal cut-off values of LMR and PLR were 1.9 and 156.3. (2) Clinicopathological features of patients with different scores of preoperative LMR-PLR scoring model. Cases with LMR-PLR scoring as 0, 1, 2 were 11, 42, 63. Cases with CA125 <12.4 U/mL, cases postoperative with vascular invasion, cases with postoperative chemotherapy in patients with 0, 1, 2 of LMR-PLR scoring were 1, 8, 24, 9, 27, 27, 3, 26, 43, showing significant differences among them ( χ2=6.73, 8.37, 6.68, P<0.05). (3) Follow-up and survival. All 116 patients were followed up for 39(range, 2-86)months. The 1-, 2-, 3-year survival rate of 116 PDAC patients was 50.9%, 37.9%, 19.3%, respectively, with a survival time of 13(range, 1-85)months. The survival time of patients with LMR-PLR scoring as 0, 1, 2 was 3(range, 1-9)months, 7(range, 2-56)months, 26(range, 2-85)months, respectively, showing a significant difference among them ( χ2=48.78, P<0.05). (4) Influencing factors for prognosis of PDAC patients. Results of multivariate analysis showed that carcinoembryonic antigen (CEA), CA19-9, LMR-PLR score, tumor diameter were independent factors affecting prognosis of patients ( hazard ratio=1.61, 1.88, 0.27, 1.87, 95% confidence interval as 1.02-2.54, 1.18-3.00, 0.19-0.39, 1.13-3.09, P<0.05). (5) Construction and verification of nomogram prediction model. The nomogram prediction model was constructed based on CEA, CA19-9, LMR-PLR score and tumor diameter. The AUC of ROC curve in predicting 1-, 2-, 3-year survival rate of patients was 0.86 (95% confidence interval as 0.79-0.93, P<0.05), 0.86 (95% confidence interval as 0.79-0.92, P<0.05), 0.87 (95% confidence interval as 0.78-0.95, P<0.05), respectively. Results of calibration curve showed that the predicted survival rate of nomogram prediction model was consistent with the actual survival rate, with the consistency index as 0.74. Results of decision curve showed that the predictive performance of nomogram prediction model was superior to that of a single factor at a risk threshold of 0.12-0.85. Conclusions:CEA, CA19-9, LMR-PLR score, tumor diameter are independent factors affecting prognosis of patients undergoing radical resection for PDAC, and the nomogram prediction model can predict postoperative survival rate. The predicted survival rate of nomogram prediction model is consistent with the actual survival rate, and the predictive performance of nomogram prediction model is superior to that of a single factor at a risk threshold of 0.12-0.85.

Detection performance of Al 18F-PSMA-BCH PET/CT in early relapsed prostate cancer after radical prostatectomy / 中华核医学与分子影像杂志

Objective:To assess the performance of Al 18F-prostate specific membrane antigen (PSMA)-BCH PET/CT in the detection and localization of early recurrent prostate cancer after radical prostatectomy. Methods:From July 2021 to July 2022, a cohort of 51 patients (age: 49-80(64.8±6.9) years) who underwent Al 18F-PSMA-BCH for biochemical recurrence with the prostate specific antigen (PSA) level less than 2 μg/L in Peking University Cancer Hospital & Institute were retrospectively analyzed. The patients were stratified into 4 groups (PSA<0.2 μg/L, 0.2 μg/L≤PSA<0.5 μg/L, 0.5 μg/L≤PSA<1 μg/L, 1 μg/L≤PSA<2 μg/L groups) according to different PSA levels. Lesions detected by Al 18F-PSMA-BCH PET/CT were recorded as prostate bed (including bed of seminal vesicles); pelvic, paraaortic, mediastinal/supraclavicular and axillary lymph nodes; bone lesions and visceral lesions. The detection rates among different groups were compared by Fisher exact test. Results:Of 51 patients, 30(58.8%) had evidence of abnormal uptake suggestive of recurrent prostate cancer, with 60.0%(18/30) had disease confined to the pelvis, including 26.7%(8/30) had prostate bed recurrence, 26.7%(8/30) had pelvic lymph nodes, 6.6%(2/30) had prostate bed recurrence with pelvic lymph nodes, while 40.0%(12/30) had extra pelvic disease. The detection rates of Al 18F-PSMA-BCH PET/CT in PSA<0.2 μg/L, 0.2 μg/L≤PSA<0.5 μg/L, 0.5 μg/L≤PSA<1 μg/L and 1 μg/L≤PSA<2 μg/L groups were 39.1%(9/23), 6/11, 8/9 and 7/8, respectively. There were no significant differences of detection rates between PSA<0.2 μg/L group and 0.2 μg/L≤PSA<0.5 μg/L group ( P=0.397) and also between 0.5 μg/L≤PSA<1 μg/L group and 1 μg/L≤PSA<2 μg/L group ( P=0.929). Conclusion:Al 18F-PSMA-BCH has a high detection rate for early recurrent prostate cancer, even at low PSA levels less than 0.2 μg/L.

Shear stress regulateing the phosphorylation of endothelial nitric oxide synthase Ser633 and Ser1177 in human umbilical vein endothelial cells through Pim1 / Akt pathway / 解剖学报

[Abstract] Objective To explore the effect of different modes of blood flow shear stress on the Pim1 expression in human umbilical vein endothelial cells (HUVECs) and the regulation of phosphorylation at Ser1177 and Ser633 of endothelial nitric oxide synthase (eNOS). Methods HUVECs were isolated from fresh human umbilical cord. The parallel plate flow chamber system was used to load 15 dyn/ cm

Establishment of evaluation method for disinfection efficacy of positive pressure bio-protective hood / 医疗卫生装备

Objective To establish a method for evaluating the disinfecting effect of positive-pressure protective hoods by testing the disinfecting effect of canine influenza virus(CIV)on the positive-pressure protective hood with 1％Virkon S disinfectant.Methods The neutralizer was selected considering the characteristics of 1％Virkon S disinfectant in accordance with"Disinfection technical specifications"(2002 edition),and the effectiveness of the neutralizer was verified by determining median tissue culture infectious dose(TTCID50)of different samples inoculated with canine renal cells;in the same environment the effects of viral vectors and environment on viral activity were detected by measuring the TCID50 at different time points when CIV acted on the positive pressure protective hood;the optimal disinfection time was determined by establishing a viral vector model and a viral infiltration and sampling method,combining the results of viral recovery rates by real-time quantitative polymerase chain reaction and enzyme-linked immunosorbent assay and viral titer measurements by TCID50 and 50％egg infectious dose(EID50).Results The phosphate buffer solution of 0.1％lecithin,2％Tween 80 and 0.5％sodium thiosulfate could be used as a neutralizer for 1％Virkon S disinfectant;the viral vectors and environment had no effects on CIV activity at different time points;the average recover rate was 96.12％for the samples inoculated with canine renal cells and 95.98％for the chicken eggs,and 1％Virkon S disinfectant behaved the best 4 min after its action on CIV on the positive-pressure protective hood.Conclusion The method proposed for evaluating the disinfection effect of the positive-pressure protective hood is effective in establishing optimal disinfection conditions for the positive-pressure protective hood.[Chinese Medical Equipment Journal,2023,44(9):33-37]

Study on the efficacy and safety of FOLFOX4 regimen hepatic arterial infusion chemotherapy combined with 125I seed implantation in patients with primary liver cancer and type Ⅲ portal vein tumor thrombus / 中国医师进修杂志

Objective:To explore the efficacy and safety of FOLFOX4 regimen hepatic arterial infusion chemotherapy (HAIC) combined with 125I seed implantation or gamma knife in patients with primary liver cancer and type Ⅲ portal vein tumor thrombosis (PVTT). Methods:The clinical data of 116 patients with primary liver cancer and type Ⅲ PVTT from January 2016 to June 2018 in the Sixth Medical Center of PLA General Hospital were retrospectively analyzed. Among them, 56 patients were treated with FOLFOX4 regimen HAIC combined with 125I seed implantation in PVTT (observation group), and 56 patients were treated with FOLFOX4 regimen HAIC combined with gamma knife in PVTT (control group). The clinical efficacy, adverse reactions, liver function, tumor serum markers, quality of life and portal venous pressure were compared between 2 groups. The patients were followed up to June 2021, the progression-free survival (PFS) time, overall survival (OS) time and 1-, 3-year survival rate were recorded. Results:The objective response rate and disease control rate in observation group were significantly higher than those in control group: 21.43% (12/56) vs. 7.14% (4/56) and 50.00% (28/56) vs. 30.36% (17/56), and there were statistical differences ( P<0.05). The aspartate transaminase (AST), alanine transaminase (ALT), total bilirubin, alpha fetoprotein (AFP), carcinoembryonic antigen (CEA) and tumor supplied group of factor (TSG) after treatment in observation group were significantly lower than those in control group: (58.24 ± 7.16) U/L vs. (67.81 ± 8.39) U/L, (56.39 ± 5.42) U/L vs. (62.87 ± 6.83) U/L, (21.21 ± 4.32) μmol/L vs. (25.88 ± 4.71) μmol/L, (32.98 ± 6.15) μg/L vs. (45.06 ± 7.24) μg/L, (2.39 ± 0.22) μg/L vs. (3.17 ± 0.26) μg/L and (57.81 ± 5.67) kU/L vs. (66.19 ± 5.45) kU/L, and there were statistical differences ( P<0.01). The quality of life questionnaire core-30 (QLQ-C30) score after treatment in observation group was significantly higher than that in control group: (68.13 ± 6.95) scores vs. (64.49 ± 6.73) scores, the portal venous pressure after treatment in observation group was significantly lower than that in control group: (31.85 ± 3.89) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (35.37 ± 4.23) cmH 2O, and there were statistical differences ( P<0.01). There was no statistical difference in incidence of adverse reactions between 2 groups ( P>0.05). Two cases were lost in observation group and 3 cases in the control group; the PFS time and OS time in observation group were significantly longer than those in control group: (13.36 ± 2.85) months vs. (11.76 ± 2.60) months and (23.36 ± 4.37) months vs. (20.72 ± 3.96) months, and there were statistical differences ( P<0.01); the 1-year survival rate in observation group was significantly higher than that in control group: 70.37% (38/54) vs. 50.94% (27/53), and there was statistical difference ( P<0.05); there was no statistical difference in 3-year survival rate between 2 groups ( P>0.05). Conclusions:The anti-tumor effect and the improvement effect on liver function in patients with primary liver cancer and type Ⅲ PVTT treated with FOLFOX4 regimen HAIC combined with 125I seed implantation are better than combined gamma knife, and it has high safety and longer survival time.

HPLC assay of epinephrine sulfonate in epinephrine injection / 药学学报

An HPLC method was established for the assay of epinephrine sulfonate (impurity F) in epinephrine injection. The determination was performed on an AQUASIL C18 (100 mm × 4.6 mm, 3 μm) column with a gradient elution system, and the mobile phase was consisted of monopotassium phosphate solution (mobile phase A) and acetonitrile (mobile phase B). The injection volume was 40 μL. The detection wavelength was at 210 nm and the column temperature was 25 ℃. The total analytical time was 40 min. The results showed that the standard cure of epinephrine sulfonate (impurity F) between peak area and concentration exhibited good linear relationship within the ranges of 0.520-12.480 μg·mL-1 and the R2 = 0.999 8. The average recovery rate was 103.04% and the RSD was 2.00%. The limit concentration of detection was 0.104 μg·mL-1 and the limit concentration of quantitation was 0.520 μg·mL-1. The method could be applied to the determination of epinephrine sulfonate in epinephrine injection with high accuracy and precision, as well as good sensitivity. It could also enhance the quality standards of epinephrine-related products.

Research Progress on Pharmacological Action and Pharmacokinetics of Hydroxytyrosol / 中国实验方剂学杂志

Hydroxytyrosol as one of natural anti-oxidants，extracted from the fruits and leaves of Olea europaea，is a natural polyphenol compound in the form of esters. Recently，considerable studies showed that hydroxytyrosol demonstrated intrinsic biological activity for metabolic syndromes， cardiovascular- and neurodegenerative-related diseases，and it was revealed to play the roles in the anti-activities of cancerous，inflammatory as well as depressing issues. In addition，hydroxytyrosol is an oleophilic and hydrophilic compound with high bioavailability and low cellular cytotoxicity. It could be absorbed by various tissues and could easily passe through blood brain barrier. Therefore，hydroxytyrosol was introduced as one of the key subjects targeted by innovative drug development. However，it has a short half-life in vivo and non-tissue specific，which lead to its limitation in clinical application， so further in-depth studies are still needed. The authors had a literature review of hydroxytyrosol，and summarized the basic properties of its pharmacokinetic，pharmacological effects and molecular mechanisms. This article mainly focused on it’s pharmacological activity and the mechanism involved in treating damages induced by the oxidative stress，in alleviating cardiovascular diseases and in inhibition of neurodegenerative diseases. In this article， its anti-inflammatory，anti-tumor，anti-depressant effects，other biological activities，and pharmacokinetics were also briefly reviewed. The authors put forward some personal thoughts on its future research direction，hoping to provide ideas and inspirations for the vast number of researchers，and provide references for its further development，research and application.

Study on the correlation between the prevalence of thyroid nodule and blood glucose, lipid metabolism and iodine nutrient level / 中国综合临床

Objective:To analyze the correlation between simple thyroid nodule and blood lipid and glucose metabolism and iodine nutrition level.Methods:A cross-sectional study was conducted by collecting data of the population undergoing epidemiological investigation in Jinshan District, Shanghai from July to December 2015, to calculate the prevalence of thyroid nodules and analyze relevant functional indicators.Results:Simple thyroid nodules were detected in 603 subjects, with a prevalence of 22.6% (603/2 669). There were 358 female patients with simple thyroid nodules, with a prevalence rate of 26.9%, and 245 male patients with simple thyroid nodules, with a prevalence rate of 18.3%. The prevalence of simple thyroid nodule in female was higher than that in male, and the difference was statistically significant (χ 2=27.686, P<0.001). In addition, the prevalence of simple thyroid nodules increased with age (13.1% (92/704) and 20.2% (104/514) and 25.1% (145/578) and 24.4% (107/439) and 36.3% (98/270) and 34.8% (57/164), χ 2=83.872,P<0.001). In the ≤30 years group (8.0% (30/704) vs. 18.8% (62/331), χ 2=35.716, P<0.001), >30 to ≤40 years old group (14.1% (37/263) vs. 26.7% (67/251), χ 2=12.683, P<0.001), >60 to ≤70 years old group (26.2% (33/126) vs. 45.1% (65/144), χ 2=10.435, P<0.001), and the 70-year-old group (24.4% (21/86) vs. 46.2% (36/78), χ 2=8.521, P<0.001). The prevalence of simple thyroid nodules in males was lower than that in females. In the simple positive thyroid nodule group, Fasting blood glucose (5.12 (4.80, 5.69) and 5.02 (4.72, 5.48)), total cholesterol (1.24 (0.85, 1.86) and 1.13 (0.77, 1.76)), triglyceride (4.77 (4.09, 5.48) and 4.49 (3.92, 5.16)), low density lipoprotein((2.79 (2.26, 3.36) and 2.63 (2.19, 3.16)), and high density lipoprotein cholesterol (1.41 (1.18, 1.66) and 1.35 (1.13, 1.61)) were higher than those in the negative group ( U values were 554 818, 578 468, 535 622, 556 067 and 567 960, respectively, all P<0.01). The BMI index grade distribution of thyroid nodule positive group was higher than that of negative group, and the difference was statistically significant (3.7% (77/2 066), 50.1% (1 034/2 066), 32.4% (669/2 066), 13.8% (286/2 066), 3.2% (19/603), 43.6% (263/603), 38.1% (230/603), 15.1% (91/603), χ2=9.5201, P=0.023). The prevalence of simple thyroid nodules was significantly lower in the iodized salt group than in the non-iodized salt group (20.7% (436/2 102) vs. 29.5% (167/567), χ 2=19.376, P<0.001). The urinary iodine level in the positive thyroid nodule group was significantly lower than that in the negative group (148.4(100.2, 213.7) vs. 169.5(115.4, 241.75), U=545 129.5, P<0.001). After Logistic regression screening, age ( OR=1.57, 95% CI: 1.292-1.908, P<0.001), gender ( OR=1.278, 95% CI: 1.193-1.368, P<0.001), BMI grade ( OR=1.166, 95% CI: 1.022-1.330, P=0.022), total cholesterol ( OR=1.105, 95% CI: 1.005-1.214, P=0.040), iodized salt ( OR=0.689, 95% CI: 0.556-0.854, P=0.001) were independent influencing factors of thyroid nodule. Conclusion:The prevalence of simple thyroid nodules in Shanghai is relatively low. Age, sex, BMI level, total cholesterol and iodized salt are independent factors causing thyroid nodules. In addition, blood glucose level may also be related to the prevalence of thyroid nodules.

Advances in finite element analysis of rotator cuff tears / 中华创伤骨科杂志

Rotator cuff tears are one of the three most prevalent musculoskeletal disorders, with the supraspinatus tendon as the most common lesion site. It may lead to chronic shoulder pain, weakness and limited joint motion, and eventually to secondary degeneration of the shoulder. As traditional biomechanical experiments are limited by measurement techniques and ethical issues, it is almost impossible to clarify the stress distributions at the rotator cuff under physiological and pathological conditions. Recently, advances in computer science, software development and image processing have rapidly improved finite element models of shoulder joint which promote the researches into pathogenesis of rotator cuff tears and their surgical techniques, making finite element analysis an indispensable means in the biomechanic research of rotator cuff. This paper reviews the recent literature available in China and abroad to expound on the element models of shoulder joint applied in the researches into pathogenesis and surgery of rotator cuff tear.

The risk factors associated with apex or basal positive surgical margins after radical prostatectomy / 中华泌尿外科杂志

Objective:To analyze the risk factors associate with apex or basal positive surgical margins in patients after radical prostatectomy.Methods:During the period from January 2013 to December 2017, data was collected in 180 patients undergoing radical prostatectomy in Urological department of Peking University Cancer Hospital. Surgical margins were stated negative, positive, apex positive, basal positive. Dichotomous logistic regression analysis was used to evaluate the age, total prostate volume, biopsy positive cores, D’Amico risk classification, tumor pathology stage, Gleason score, tPSA, f/tPSA and pelvic lymph nodes metastasis with the PSMs.Results:PSMs were detected in 97 cases, including 78 cases with positive apex, 51 cases with positive basal, and 83 cases with negative margin, the PSMs proportion was 53.9%. In univariable analysis, pT 3b( OR=6.871, P=0.010), pT 4( OR=12.13, P<0.05), Gleason≥8( OR=4.989, P=0.005), pelvic lymph nodes metastasis( OR=9.516, P=0.043) associated with higher proportion of PSMs. In multivariable analysis, pT 3b( OR=5.782, P=0.030), pT 4( OR=10.15, P<0.05), Gleason≥8( OR=11.13, P=0.012) were the independent factors positively associated with higher proportion of PSMs. In univariable analysis, pT 3b( OR=4.040, P=0.026), Gleason≥8( OR=2.390, P=0.010) associated with higher proportion of apex positive. In multivariable analysis, Gleason≥8 ( OR=1.980, P=0.030) was the only independent factor associated with higher proportion of apex positive. In univariable analysis, D’Amico high risk ( OR=1.847, P=0.035), pT 4 ( OR=1.780, P=0.001) associated with higher proportion of basal positive. In multivariable analysis, D’Amico high risk ( OR=1.540, P=0.041) was the only independent factor associated with higher proportion of basal positive. Conclusions:In patients radical prostatectomy, pathology staging and Gleason score were associated with positive surgical margins.Gleason score was associated with positive apex margins, and D’Amico risk classification was associated with positive basal margins.

Androgen downregulation of miR-760 promotes prostate cancer cell growth by regulating IL6 / 亚洲男科学杂志(英文版)

Prostate cancer (PCa) is one of the most common malignancies in Western countries. Studies have shown that androgen contributes to the progression of PCa, but how androgen promotes PCa remains largely unknown. Here, we demonstrated that androgen suppressed the expression of miR-760 depending on the interaction between androgen and androgen receptor (AR). miR-760 was downregulated in prostate cancer tissues compared with normal tissues. Functional experiments showed that miR-760 downregulation promoted the proliferation and growth of LNCaP and 22rv1 cells. In contrast, miR-760 ectopic expression inhibited the proliferation of LNCaP and 22rv1 cells. DNA synthesis was suppressed by miR-760. Mechanistically, miR-760 bound to the 3'UTR of interleukin 6 (IL6 ). A mutation in the binding site disrupted their interaction. In addition, silencing ofIL 6 suppressed the proliferation of LNCaP and 22rv1 cells. IL6 was upregulated in PCa tissues. Our study reveals that androgen downregulates miR-760 to promote the growth of PCa cells by regulating IL6.

Laparoscopic microwave ablation combined with partial nephrectomy for the treatment of cystic renal masses: initial experience / 中华泌尿外科杂志

Objective:To explore the safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy in the treatment of cystic renal masses.Methods:The 19 patients with cystic renal masses undergoing laparoscopic microwave ablation combined with partial nephrectomy from November 2017 to December 2019 were retrospectively analyzed. There were 13 males and 6 females. The average age was 46.2 years. The mean body mass index was (25.8±3.1) kg/m 2. The masses located in the left kidney in 7 cases and the right kidney in 12 cases. The ECOG scores were 0. The mean maximum diameter of the tumors was (2.8±1.3) cm. Five cases were diagnosed with Bosniak Ⅲ and 14 cases with Bosniak Ⅳ. According to R. E.N.A.L. scoring, 11 cases were of low difficulty (4-6 points), 7 cases of medium difficulty (7-9 points) and 1 case of high difficulty (10-12 points). The cystic renal masses were ablated by laparoscopic microwave ablation, then followed by partial nephrectomy. Postoperative complications were observed and the prognosis was assessed by CT or MRI. Results:The mean duration of operation was (84.0±20.8) min. The median intraoperative blood loss was 20 (10-50) ml. The median duration of postoperative hospitalization was 3 (2-6) d, and no complications such as bleeding, infection, gross hematuria or urine leakage were observed. According to the malignant degree of cystic renal masses, the patients were divided into low-risk group and high-risk group. The patients with benign cystic kidney tumors or with low biological malignancy were considered as the low-risk group, while the patients with high malignant pathology were considered as the high-risk group. In the low-risk group, there were 4 patients, including 1 patient with papillary adenoma, 1 patient with renal angiomyolipoma, 1 patient with low-grade malignant potential multilocular cystic renal tumor, and 1 patient with renal chromophobe carcinoma (stage T 1a). In the high-risk group, there were 15 cases, including 14 cases of clear cell renal cell carcinoma (AJCC pathological stage: T 1a stage 11 cases, T 1b stage 3 cases; WHO/ISUP classification: 7 cases in grade 1, 6 cases in grade 2, and 1 case in grade 3); 1 case of Type 2 papillary renal cell carcinoma (stage T 1b, grade 2). The median follow-up was 20 months (12-37 months). Both groups survived, and no signs of tumor recurrence, implantation or metastasis were found in chest and abdomen imaging. Blood tests were performed regularly, and no significant abnormalities occurred. Conclusions:The safety and efficacy of laparoscopic microwave ablation combined with partial nephrectomy for the treatment of cystic renal masses is satisfactory, and postoperative pathology is clear, providing a potential option for cystic renal masses treatment.

Clinical application of 3D visualization and mixed reality technique in surgical resection of renal tumor / 中华泌尿外科杂志

Objective:To investigate the clinical feasibility and effectiveness of 3D visualization and mixed reality technique in the partial nephrectomy of renal tumor, and to evaluate its role in the communication between doctors and patients.Methods:82 patients with renal tumors confirmed by imaging examination including 33 patients in our hospital and 49 patients admitted to the Beijing Cancer Hospital from June 2018 to December 2020, all of whom were single tumors without local or distant metastasis, and in line with the indications of endoscopic partial nephrectomy, but without other systemic serious diseases. These patients were randomly divided into observation group (n=41) and control group (n=41). Both groups were scanned with 64-slice spiral CT before operation, while the CT images in the observation group were generated by DICOM data, modeled by three-dimensional reconstruction software and uploaded to mixed reality glasses for the preoperative planning, doctor-patient communication and intraoperative guidance. In this study, 82 patients underwent laparoscopic partial nephrectomy. Questionnaires and scales were used to compare the awareness of disease and/or satisfaction with 3D visual images between the two groups. The intraoperative time of tumor detection, operative time, renal heat ischemia time and intraoperative blood loss in 2 groups were recorded to evaluate preoperative planning and intraoperative guidance. In addition, the recovery time of gastrointestinal function, indwelling time of urinary catheter, indwelling time of drainage tube in operation area, length of hospital stays after surgery and pathological type, as well as serum creatinine level and glomerular filtration rate (GFR) value in patients at 6 months after operation were used to evaluate the postoperative recovery.Results:Before surgery, the concentrations of serum creatinine in patients with the observation group and control group were (66.8±17.5) μmol/L and (70.5±13.7) μmol/L, and the GFR were (40.8±7.6) ml/min and (38.9±6.8) ml/min, respectively. All the 82 cases were operated successfully. The number of correct responses of patients in the observation group and control group about basic kidney physiology, kidney anatomy and surgical plan was (5 vs.4), (2 vs.1), (7 vs.4), the difference among which was statistically significant ( P<0.05). In the observation group, the points of patients in understanding their own kidney, disease, specific surgical plan, and risk of surgical complications were 9.5±1.61, 9.3±0.84, 9.7±0.53, and 8.5±2.21 respectively. The tumor detection time was (35.2±5.6) min, the operation time was (100.2±20.1) min, and the renal warm ischemia time was (22.7±8.6) min in the observation group, which was significantly shorter than that in the control group (43.2±6.7) min, (123.2±23.50) min, (33.2±7.8) min. However, there was no significant difference in the amount of bleeding (103.2±22.8 ml vs.112.5±19.5 ml), postoperative recovery time of gastrointestinal function (1.7±0.8 d vs.1.8±1.2 d), indwelling time of urinary catheter (3.9±1.6 d vs.4.2±1.0 d), indwelling time of drainage tube in operation area (4.6±1.3 d vs.4.9±1.7 d), length of hospital stays (6.9±1.5 d vs.7.2±1.3 d), pathological type, and the changes of serum creatinine (10.1±19.0 vs.9.6±11.3) and the amplitude of GRF (19.4±9.5 vs.18.5±10.7) fluctuation in the affected side 6 months after operation (19.4±9.5 vs.18.5±10.7) ( P>0.05). Conclusions:The application of 3D visualization and mixed reality technology in preoperative planning and intraoperative guidance of partial nephrectomy could improve patients' cognitive understanding of renal anatomy, tumor characteristics and surgical operation, and make doctor-patient communication smoother. It can reduce the risk of surgery to a certain extent, reduce the renal heat ischemia and the operation time, and remove the tumor more accurately.

Intensities of Transcranial Direct Current Stimulation for Dysphagia after Cerebral Infarction / 中国康复理论与实践

Objective:To study the effects of transcranial direct current stimulation (tDCS) in different intensities on dysphagia after cerebral infarction and its neurological mechanism. Methods:From January, 2016 to December, 2018, 60 inpatients with dysphagia after cerebral infarction were randomly equally divided into low-, medium- and high-intensity groups, in which the intensities of tDCS were 1.0 mA, 1.5 mA and 2.0 mA, respectively, for 30 days. They were observed with video fluoroscopic swallowing study and α waves of electroencephalography before and after treatment. Results:The score of oral stage increased in the high-intensity group after treatment (t = -2.196, P < 0.05), while the dominant frequency of α wave increased (t = -6.488, P < 0.001). Conclusion:High-intensity tDCS may improve the excitability of the brain for patients with dysphagia after cerebral infarction, to improve the swallowing.

The role of miRNA-181 targeting phosphatase and tensin homologue deleted on chromosome ten in the regulation of phosphatidylinositol-3-kinase/Akt signaling pathway in renal injury of hyperuricemia rats / 中华风湿病学杂志

Objective:To investigate the role of miRNA-181 targeting phosphatase and tensin homologue deleted on chromosome ten (PTEN) in regulating phosphatidylinositol-3-kinase/Akt signaling pathway (PI3K/Akt) signaling pathway in renal injury of hyperuricemia rats.Methods:Forty male Wistar rats were randomly divided into control group, model group, negative control group and miRNA-181 inhibition group. Their serum uric acid, creatinine and urea nitrogen were tested. HE staining was used to observe the renal histopathological changes in each group. The expression of miRNA-181, PTEN, PI3K and Akt mRNA in renal tissue of rats in each group was detected by quantitative real time-polymerase chain reaction (qRT-PCR). Western blotting analysis of PTEN, PI3K, Akt and p-Akt protein expression in renal tissue of rats in each group. The targeting relationship between miRNA-181 and PTEN was confirmed by double luciferase reporter gene experiment. One-way analysis of variance (ANOVA) was used for the comparison between multiple groups, with the same variance. LSD- t test was used for further comparison between the two groups. If the variance was not the same, Tamhane's T2 test was used for further comparison between the two groups. Independent sample t-test was used to compare between the two groups. Results:Compared with the control group (135±21) mmol/L; (27.8±2.1) μmol/L; (6.8±0.5) μmol/L, the contents of uric acid [(213±28) mmol/L, (214±23) mmol/L, creatinine (49.2±2.3) μmol/L, (48.6±2.2) μmol/L and urea nitrogen (11.5±2.7) μmol/L; (11.7±2.5) μmol/L] in the model group and the negative control group were significantly increased ( Furic acid=26.739, Fcreatinine=259.055, Furea nitrogen=12.921, all P<0.05); compared with the nega-tive control group, the contents of uric acid (169±21) mmol/L, creatinine (33.7±1.8) μmol/L and urea nitrogen (9.1±1.7) μmol/L in the miRNA-181 inhibition group were decreased (LSD- turic acid=4.356, LSD- tcreatinine=15.773, LSD- turea nitrogen=2.858, all P<0.05). The expression level of miRNA-181 in renal tissue of the model group and the negative control group (1.88±0.16, 1.84±0.18) was significantly higher than that of the control group (0.53±0.08) ( F=193.554, P<0.05), while the expression level of PTEN protein (0.18±0.02, 0.16±0.02) and mRNA (0.48±0.08, 0.44±0.07) were lower than that of the control group (1.27±0.06, 1.27±0.16) ( Fprotein=515.116, FmRNA=141.470, all P<0.05) ); after inhibiting miRNA-181, the expression level of miRNA-181 (1.35±0.58) in renal tissue increased significantly (LSD- t=10.341, P<0.05), and the expression level of PTEN protein (0.84±0.05) and mRNA (0.90±0.08) increased on average (LSD- tprotein=20.471, Tamhane's T2 mRNA=13.881, all P<0.05). The results of double luciferase reporter gene analysis showed that PTEN was the target gene of miRNA-181. Compared with the control group (0.18±0.02, 0.09±0.01, 0.05±0.02, 1.06±0.07, 0.96±0.06), the expression level of PI3K (1.01±0.06, 1.00±0.06), Akt (0.90±0.05, 0.95±0.04), p-Akt protein (0.99±0.07, 0.97±0.05) and the expression level of PI3K (3.63±0.18, 3.68±0.22), Akt mRNA (2.38±0.05, 2.34±0.12) in the renal tissue of the model group and the negative control group were significantly increased ( FPI3K protein=169.979, FAkt protein=393.411, Fp-Akt protein=164.201, FPI3K mRNA=563.944, FAkt mRNA=141.470, all P<0.05); after inhibiting the expression of miRNA-181, the expression level of PI3K (0.69±0.06), Akt (0.42±0.03), p-Akt protein (0.50±0.05) and the expression level of PI3K (2.40±0.09), Akt mRNA (1.40±0.12) in the renal tissue of the rats were decreased (LSD- tPI3K protein=7.432, LSD- tAkt protein=18.291, LSD- tp-Akt protein=9.595, Tamhane's T2 PI3K mRNA=17.070, Tamhane's T2 Akt mRNA=17.357, all P<0.05). Conclusion:Inhibition of miRNA-181 expression can target PTEN to inhibit PI3K / Akt signaling pathway to protect renal injury in hyperuricemia rats.