[Clinical effects of flaps or myocutaneous flaps transplantation after titanium mesh-retaining debridement in repairing the wounds with exposed titanium mesh after cranioplasty].

Objective: To explore the clinical effects of flaps or myocutaneous flaps transplantation after debridement to repair the wounds with exposed titanium mesh after cranioplasty on the premise of retaining the titanium mesh. Methods: This study was a retrospective observational study. From February 2017 to October 2022, 22 patients with titanium mesh exposure after cranioplasty who met the inclusion criteria were admitted to the Department of Plastic, Aesthetic & Maxillofacial Surgery of the First Affiliated Hospital of Xi'an Jiaotong University, including 15 males and 7 females, aged from 19 to 68 years. After admission, treatments such as bacterial culture of wound exudate sample, anti-infection, and dressing change were carried out. Thorough surgical debridement was performed when the wound improved, and the wound area was 3.0 cm×2.0 cm to 11.0 cm×8.0 cm after debridement. The wound was repaired with local flaps, expanded flaps, or free latissimus dorsi myocutaneous flaps according to the size, location, severity of infection, and surrounding tissue condition of the wounds, and the areas of flaps or myocutaneous flaps were 5.5 cm×4.0 cm to 18.0 cm×15.0 cm. The donor areas of flaps were sutured directly or repaired by split-thickness skin grafts from head. The wound repair method was recorded. The survivals of flaps or myocutaneous flaps after surgery and wound healing in 2 weeks after surgery were recorded. During postoperative follow-up, recurrence of infection or titanium mesh exposure in the implanted area of titanium mesh was observed; the head shapes of patients, scar formation of the operative incision, and baldness were observed. At the last follow-up, the satisfaction of patients with the treatment effect (dividing into three levels: satisfied, basically satisfied, and dissatisfied) was evaluated. The total treatment costs of patients during their hospitalization were calculated. Results: The wounds in 11 cases were repaired with local flaps, the wounds in 5 cases were repaired with expanded flaps, and the wounds in 6 cases were repaired with free latissimus dorsi myocutaneous flaps. All flaps or myocutaneous flaps survived completely after surgery, and all wounds healed well in 2 weeks after surgery. Follow up for 6 to 48 months after operation, only one patient with local flap grafting experienced a recurrence of infection in the titanium mesh implanted area at more than one month after surgery, and the titanium mesh was removed because of ineffective treatment. Except for one patient who had a local depression in the head after removing the titanium mesh, the rest of the patients had a full head shape. Except for myocutaneous flap grafting areas in 6 cases and skin grafting area in 1 case with local flaps grafting had no hair growth, the other patients had no baldness. All the scars in surgical incision were concealed. At the last follow-up, 19 cases were satisfied with the treatment effects, 2 cases were basically satisfied, and 1 case was dissatisfied. The total treatment cost for patients in this group during hospitalization was 11 764-36 452 (22 304±6 955) yuan. Conclusions: For patients with titanium mesh exposure after cranioplasty, on the premise of adequate preoperative preparation and thorough debridement, the wound can be repaired with appropriate flaps or myocutaneous flaps according to the wound condition. The surgery can preserve all or part of the titanium mesh. The postoperative wound healing is good and the recurrence of infection or titanium mesh exposure in the titanium mesh implanted area is reduced, leading to good head shape, reduced surgical frequency, and decreased treatment costs.

[Research progress on the role of hepatitis B virus DNA integration in chronic hepatitis B].

Chronic hepatitis B virus (HBV) infection will greatly contribute to raising the occurrence probability of cirrhosis and hepatocellular carcinoma in patients. Although existing antiviral treatment regimens have a certain effect on delaying disease progression and improving prognosis, it is still not effective in attaining functional cures. Hepatitis B virus DNA integration may be one of the reasons for this phenomenon. Therefore, this paper reviews the possible mechanisms of HBV DNA integration in maintaining chronic inflammation of the liver, evading existing antiviral treatment methods, and inducing hepatocellular carcinoma so as to further deepen the understanding of the role of HBV DNA integration in the occurrence and development of chronic hepatitis B, providing ideas and references for formulating better treatment strategies.

[HCV antigen detection method and clinical application].

Hepatitis C is distributed worldwide and possesses a hidden characteristic. The traditional methods of screening and diagnosis of hepatitis C infection commonly used in clinics are based on anti-HCV antibody and HCV RNA detection. Advances in HCV antigen detection technologies can apparently reduce the window period for anti-HCV antibodies, providing new clinical evidence for the early detection, diagnosis, and treatment of HCV infection. This article is a current review of HCV antigen detection methodologies, clinical applications, and detection strategies.

[Thinking and strategy selection on the quality control of early gastric cancer].

With the developing technique of the diagnosis and treatment of early gastric cancer, the quality of early gastric cancer diagnosis and treatment is coming into focus, and is crucial to improve the overall management of gastric cancer. It is necessary to establish a quality control system to ensure the quality of diagnosis and treatment for EGC. Based on the summary of the diagnosis and treatment status and technological progress of early gastric cancer, this paper proposes the quality control strategy, content and plan for the diagnosis and treatment process of EGC from the aspects of multidisciplinary diagnosis and treatment, clinical diagnosis technology, endoscopic and surgical treatment, pathological diagnosis and follow-up, with a view to expound the rationality, standardization and quality guarantee of the diagnosis and treatment process for early gastric cancer.

Deciphering the in situ phonon evolution of potassium sodium niobate under varying temperature and electric fields.

The application of in situ Raman spectroscopy under multiple fields is widely recognized as an effective approach for investigating the physical mechanism of phase transitions in ferroelectrics, because it can directly provide the detailed information about the vibration evolution of various phonon modes within lattices, such as bond stretching and rotation. Based on this technique, our work aims to thoroughly probe the dynamics of phase transitions in traditional ferroelectric potassium sodium niobate [(K,Na)NbO3, KNN] under external fields, by analyzing the in situ dependence of wavenumber and intensity of phonon modes under the varying temperature and electric fields. The results indicate that different vibration modes respectively relating to the A-site ions and NbO6 octahedra in KNN exhibit distinct and abrupt distortion behavior during the orthorhombic-tetragonal and tetragonal-cubic transitions. Moreover, a certain degree of distortion can still be observed in the cubic phase above the Curie temperature. With an applied electric field, KNN presents quite different electrostriction in orthorhombic and tetragonal phases. Particularly, more than one kind of phonon mode undergoes non-linear variations under the varying electric fields, accompanied by the mutations at some fixed fields. These findings will be conducive to further understanding the phase transition mechanism in KNN from the perspective of phonon evolution. Simultaneously, it will also give crucial guidance for the design and development of KNN-based ferroelectrics as well as functional devices.

[Current status of global colorectal cancer prevalence, prevention and control].

Objective: This paper provides a brief overview of the epidemiology of colorectal cancer in China and around the world, and discusses how to prevent colorectal cancer to reduce its disease burden. Method: Using the official database of GLOBOCAN 2020, the China Cancer Registry Annual Report compiled by the National Cancer Center, and data from CONCORD-3.Data management was performed by Microsoft Excel 2016 and R 4.2.1 Relevant graphs were generated using the ggplot2 package for result visualization. Result: An estimated 1 931 590 people were diagnosed with colorectal cancer worldwide in 2020 with an age-standardized incidence rate of 19.5 per 100 000. There were about 935 173 deaths caused by colorectal cancer internationally, with an age-standardized mortality rate of 9.0 per 100 000. Overall, colorectal cancer was the fourth most commonly diagnosed cancer and the third leading cause of cancer-related death worldwide in 2020. In China, the age-standardized incidence rate and mortality rate of colorectal cancer was 17.3 per 100 000 and 7.8 per 100 000, respectively. Gender differences in trends were observed, with a decreasing trend in incidence and mortality among females and an increasing trend in incidence and mortality among males. The primary risk factors for colorectal cancer include age, genetic factors, gastrointestinal disorders, dietary habits, and lifestyle et al. Conclusions: Colorectal cancer poses a significant burden globally and in China. The occurrence of colorectal cancer is closely related to physiology, genetics, behavioral habits, lifestyle, and disease factors. To better control the colorectal cancer burden with the lowest cost, specific measures should be taken to reduce exposure to established risk factors. By combining the disease prevention and control strategies of tertiary prevention in China with the characteristic factors of colorectal cancer, the incidence and mortality of colorectal cancer may be effectively controlled.

[Cost-effectiveness of pharmaceutical smoking cessation intervention in China primary cancer prevention].

Objectives: To evaluate the cost-effectiveness of typical pharmaceutical smoking cessation intervention strategies in China in the context of primary cancer prevention. Methods: Markov cohort simulation models were established to simulate the burden of 12 smoking caused cancer, including lung cancer, oral cancer, nasopharyngeal cancer, laryngeal cancer, esophageal cancer, gastric cancer, pancreatic cancer, liver cancer, kidney cancer, bladder cancer, cervical cancer, and acute myeloid leukemia. Taking incremental cost effectiveness ratio (ICER) as the main indicator, the model sets one year as the cycling period for 50 periods and simulates the cohort of 10 000 thirty-five-year-old current smokers with various smoking cessation strategies. To ensure the robustness of conclusion, univariate sensitivity analysis, probability sensitivity analysis, and age-group sensitivity analysis were conducted. Results: The results showed that varenicline intervention was the most cost-effective intervention. Compared to the next most effective option, incremental cost of each additional quality-adjusted life year is 11 140.28 yuan, which is below the threshold of willingness to pay (1 year GDP per capita). The value of ICER increased as the increasing age group of adopting intervention, but neither exceeded the threshold of willingness to pay. One-way sensitivity analysis showed that the value of discount rate, the hazard ratio and cost of intervention strategy had a greater impact on the result of ICER. Conclusion: In China, the use of varenicline to quit smoking is highly cost effective in the context of cancer primary prevention, especially for younger smokers.

Adverse birth outcomes related to concentrations of per- and polyfluoroalkyl substances (PFAS) in maternal blood collected from pregnant women in 1960-1966.

BACKGROUND: Prior animal and epidemiological studies suggest that per- and polyfluoroalkyl substances (PFAS) exposure may be associated with reduced birth weight. However, results from prior studies evaluated a relatively small set of PFAS. OBJECTIVES: Determine associations of gestational PFAS concentrations in maternal serum samples banked for 60 years with birth outcomes. METHODS: We used data from 97 pregnant women from Boston and Providence that enrolled in the Collaborative Perinatal Project (CPP) study (1960-1966). We quantified concentrations of 27 PFAS in maternal serum in pregnancy and measured infant weight, height and ponderal index at birth. Covariate-adjusted associations between 11 PFAS concentrations (>75% detection limits) and birth outcomes were estimated using linear regression methods. RESULTS: Median concentrations of PFOA, PFNA, PFHxS, and PFOS were 6.189, 0.330, 14.432, and 38.170 ng/mL, respectively. We found that elevated PFAS concentrations during pregnancy were significantly associated with lower birth weight and ponderal index at birth, but no significant associations were found with birth length. Specifically, infants born to women with PFAS concentrations ≥ median levels had significantly lower birth weight (PFOS: ß = -0.323, P = 0.006; PFHxS: ß = -0.292, P = 0.015; PFOA: ß = -0.233, P = 0.03; PFHpS: ß = -0.239, P = 0.023; PFNA: ß = -0.239, P = 0.017). Similarly, women with PFAS concentrations ≥ median levels had significantly lower ponderal index (PFHxS: ß = -0.168, P = 0.020; PFHxA: ß = -0.148, P = 0.018). CONCLUSIONS: Using data from this US-based cohort study, we found that 1) maternal PFAS levels from the 1960s exceeded values in contemporaneous populations and 2) that gestational concentrations of certain PFAS were associated with lower birth weight and infant ponderal index. Additional studies with larger sample size are needed to further examine the associations of gestational exposure to individual PFAS and their mixtures with adverse birth outcomes.

[A randomized controlled trial on the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns].

Objective: To explore the effect of exercise prescription based on a progressive mode in treating elderly patients with lower limb dysfunction after deep burns. Methods: A randomized controlled trial was conducted. From January 2021 to January 2023, 60 elderly patients with lower limb dysfunction after deep burns who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University. The patients were divided into conventional rehabilitation group (30 cases, 17 males and 13 females, aged (65±3) years) and combined rehabilitation group (30 cases, 16 males and 14 females, aged (64±3) years) according to the random number table. For patients in both groups, the red-light treatment was started after the lower limb wounds healed or when the total area of scattered residual wounds was less than 1% of the total body surface area. After 2 weeks of red-light treatment, the patients in conventional rehabilitation group were given conventional rehabilitation treatments, including joint stretching, resistance, and balance training; in addition to conventional rehabilitation treatments, the patients in combined rehabilitation group were given exercise prescription training based on a progressive mode three times a week, mainly including dumbbell press, Bobath ball horizontal support, and high-level pulldown trainings. The training time for patients in both groups was 12 weeks. Before training (after 2 weeks of red-light treatment) and after 12 weeks of training, the upper limb and lower limb motor functions of the patients were evaluated using the simple Fugl-Meyer scale, the physical fitness of patients was evaluated using the simple physical fitness scale, and the patient's risk of falling was evaluated by the time consumed for the timed up and go test. The adverse events of patients that occurred during training were recorded. After 12 weeks of training, a self-designed satisfaction survey was conducted to investigate patients' satisfaction with the training effect. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test, and chi-square test. Results: Before training, the scores of upper limb and lower limb motor functions of patients between the two groups were similar (P>0.05). After 12 weeks of training, the scores of upper limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -11.42 and -13.67, respectively, P<0.05), but there was no statistically significant difference between the two groups (P>0.05). The score of lower limb motor function of patients in combined rehabilitation group was 28.9±2.6, which was significantly higher than 26.3±2.6 in conventional rehabilitation group (t=-3.90, P<0.05), and the scores of lower limb motor function of patients in conventional rehabilitation group and combined rehabilitation group were significantly higher than those before training (with t values of -4.14 and -6.94, respectively, P<0.05). Before training, the individual and total scores of physical fitness of patients between the two groups were similar (P>0.05). After 12 weeks of training, the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in conventional rehabilitation group and combined rehabilitation group were significantly increased compared with those before training (with Z values of -4.38, -3.55, -3.88, -4.65, -4.58, -4.68, -4.42, and -4.48, respectively, P<0.05), and the balance ability score, walking speed score, chair sitting score, and total score of physical fitness of patients in combined rehabilitation group were significantly increased compared with those in conventional rehabilitation group (with Z values of -3.93, -3.41, -3.19, and -5.33, P<0.05). Before training, the time consumed for the timed up and go test for patient's risk of falling in the two groups was close (P>0.05). After 12 weeks of training, the time consumed for the timed up and go test for patient's risk of falling in combined rehabilitation group was (28.0±2.1) s, which was significantly shorter than (30.5±1.8) s in conventional rehabilitation group (t=4.94, P<0.05). Moreover, the time consumed for the timed up and go test for patient's risk of falling in both conventional rehabilitation group and combined rehabilitation group was significantly shorter than that before training (with t values of 14.80 and 15.86, respectively, P<0.05). During the training period, no adverse events such as muscle tissue strain, edema, or falling occurred in any patient. After 12 weeks of training, the satisfaction score of patients with the training effect in combined rehabilitation group was 13.5±1.2, which was significantly higher than 8.5±1.4 in conventional rehabilitation group (t=21.78, P<0.05). Conclusions: The exercise prescription training based on a progressive mode can significantly promote the recovery of lower limb motor function and physical fitness of elderly patients with lower limb dysfunction after deep burns, and effectively reduce the patient's risk of falling without causing adverse events during the training period, resulting in patient's high satisfaction with the training effect.

[Research progress on Mycobacterium tuberculosis acetyltransferase].

The protein acetylation of Mycobacterium tuberculosis(MTB) plays an important role in virulence, drug resistance, regulation of metabolism and host anti-tuberculosis immune response. The proteins acetylation of MTB and host protein could be induced by the MTB acetyltransferase, which is related to the occurrence, development and prognosis of tuberculosis (TB). A clear understanding of the function of MTB acetyltransferase and identification of its targeted regulatory protein acetylation modification is critical to elucidate the pathogenic mechanism and drug resistance mechanism of TB, and then this could then provide new targets for the development of anti-tuberculosis drugs. This article systematically reviewed the research progress on MTB acetyltransferase related functions, which will provide a theoretical basis for further research on its mediated protein acetylation modification, further development of new anti-tuberculosis drugs and elucidation of drug resistance mechanism.

Partial replacement of soybean meal with full-fat black soldier fly larvae meal in plant-based nursery diets did not influence fecal Escherichia coli colony forming units or improve fecal consistency when pigs were weaned into non-disinfected pens.

At weaning, one hundred pigs (21 d of age; 6.96 ±â€…0.23 kg BW) were used to determine the effect of partially replacing soybean meal (SBM) in corn- and SBM-based nursery diets on growth performance, fecal scores, Escherichia coli (E. coli) colony forming units (CFU), and cecal mucosal microbial profile when weaned into non-disinfected nursery pens. Pens were randomly assigned to one of four dietary treatments (n = 5): high-complexity (contained highly digestible animal proteins and 10.8% SBM) with and without 3,000 ppm ZnO (HC + and HC-, respectively; representative of commercial diets), low-complexity (corn- and SBM-based; 31.8% SBM; LC), or LC with 30% inclusion of full-fat black soldier fly larvae meal (BSFLM) to partially replace SBM (LCFL; 8.0% SBM). Diets were fed for 14 d (phase I), followed by 4 wk of a common corn-SBM diet (phase II). Fecal E. coli CFU and cecal mucosal microbial 16s rRNA community profiles were assessed 7 d after weaning. During phase I, pigs fed LC and LCFL had lower average daily gains (P < 0.05) than pigs fed HC + and HC-, which were not different. Average daily feed intake was not different for pigs fed LC and LCFL, but lower than for pigs fed HC- (P < 0.001); pigs fed HC + had greater feed intake in phase I vs. all other treatment groups (P < 0.001). Upon nursery exit, only pigs fed LCFL had lower BW than pigs fed HC- (P < 0.05), with intermediate values observed for HC + and LC. Day 3 fecal scores were greater for pigs fed LCFL vs. HC + (P < 0.05) and day 7 E. coli CFU were greater for all treatment groups vs. HC + (P < 0.001). Pigs fed HC- (P < 0.01), LC (P < 0.05), and LCFL (P < 0.05) had lower alpha diversity for cecal mucosal microbiota compared to HC+. At the genus level, pigs fed LC had lower Lactobacillus relative abundance vs. pigs fed HC + (P < 0.01). Therefore, BSFLM can partially replace SBM without sacrificing growth performance vs. nursery pigs fed corn- and SBM-based diets, but both groups had reduced phase I growth performance vs. pigs fed highly digestible diets containing animal proteins when weaned into non-disinfected pens. The BSFLM did not influence fecal E. coli CFU or improve fecal consistency after weaning and therefore, is less effective at minimizing digestive upsets vs. HC + diets.

[Metformin mitigates doxorubicin-induced cardiotoxicity via the AMPK pathway].

OBJECTIVE: To explore whether metformin reduces cardiotoxicity of doxorubicin through the AMPK pathway. METHODS: We analyzed the data of 123 patients with myeloid leukemia, non-Hodgkin's lymphoma, or breast cancer receiving doxorubicin for phased chemotherapy, including 43 patients receiving combined treatment with metformin (test group) and 80 without metformin treatment (control group). The changes in plasma levels of CK-MB, LDH, and BNP, left ventricular ejection fraction (EF) and left ventricular fractional shortening (FS) of the patients were observed. The effect of treatments with metformin and doxorubicin, alone or in combination, on myocardial damage, cardiac function and myocardial cell apoptosis were also observed in C57BL/6 mice with AMPKα2 gene knockout (AKO). RESULTS: CK-MB, LDH and BNP levels increased and EF and FS decreased significantly in the control group after chemotherapy (P<0.05). In the test group, CK-MB, LDH and BNP levels were significantly lowered after the combined treatment (P<0.05), while EF and FS did not undergo obvious changes (P>0.05). CK-MB, LDH and BNP levels were lower and EF and FS were higher significantly in the test group than in the control group after the treatment (P<0.05). Doxorubicin treatment reduced FS in both wild-type and AKO mice, but the reduction was less obvious in AKO group (P<0.05). The combined treatment restored FS in wild-type mice (P<0.05) but not in AKO mice. Doxorubicin significantly increased LDH and cTnI levels in both wild-type and AKO mice, but with smaller increments in the latter (P<0.05); The combined treatment with metformin reduced doxorubicin-induced elevation of LDH and cTnI levels in the wild-type mice (P<0.05) but not in AKO group (P>0.05). Doxorubicin increased myocardial cell apoptosis in both mice (P<0.01) but less strongly in AKO mice (P<0.05). CONCLUSION: Chemotherapy with doxorubicin causes cardiotoxicity, which can be mitigated by combined treatment with metformin possibly through a mechanism involving the AMPK pathway.

[Clinical effects of free pre-expanded internal thoracic artery perforator pedicled deltopectoral flap transfer in facial scar reconstruction].

Objective: To explore the clinical effects of free pre-expanded deltopectoral flap transfer in facial scar reconstruction by selecting appropriate internal thoracic artery perforator as the pedicle through preoperative color Doppler ultrasonic vascular assessment. Methods: A retrospective observational study was conducted. From September 2017 to March 2021, 11 patients with facial scar who met the inclusion criteria were admitted to the First Affiliated Hospital of Xi'an Jiaotong University, including 6 males and 5 females, aged 16-58 (31±12) years. The scar with area ranging from 7 cm×5 cm to 14 cm×9 cm was reconstructed by free pre-expanded internal thoracic artery perforator pedicled deltopectoral flap transfer. The operation was performed in 2 or 3 stages. Before operation, color Doppler ultrasonography was performed to evaluate the internal thoracic artery perforator. In the first stage, skin and soft tissue expander (hereinafter referred to as expander) implantation was performed, and a cylindrical expander with rated capacity of 400 to 600 mL was placed in the chest wall. The expansion time was 3 to 4 months, and the water injection volume reached 1.2-1.5 times of the rated capacity of expander. In the second stage, scar excision+free pre-expanded deltopectoral flap transfer was performed, with harvested flap area ranging from 9 cm×7 cm to 16 cm×10 cm. The vascular pedicle of flap (intercostal perforator of internal thoracic artery) was anastomosed end-to-end to the facial artery and vein or superficial temporal artery and vein. The wound in donor site was closed directly. Third stage operation thinning was performed at 3-6 months after the second stage operation in 5 patients because of bloated flap pedicle. At 6 months after the last operation, the flap survival and complications were recorded, the sensation of flap was evaluated by Semmes-Weinstein monofilament test, the color of flap was evaluated by color contrast of the flap to surrounding normal skin, and the curative effect satisfaction degree of patients was evaluated by 5-grade Likert scale. Results: At 6 months after the last operation, all the flaps of 11 patients survived well. One patient experienced venous congestion after flap transplantation, but the flap survived after re-anastomosis. One patient experienced hematoma after the first stage operation of expander implantation, but the rest treatment was not influenced after hematoma removal. No complications such as infection or expander exposure occurred in any patient. At 6 months after the last operation, the sensation of flap of patient was as follows: 9 cases recovered to protective sensation decrease or better, 1 case had protective sensation defect, and 1 case only had deep touch and pressure sensation; the color of flap of patient was as follows: 3 cases were very close to the color of surrounding normal skin, 6 cases were close to the color of surrounding normal skin, and 2 cases were different to the color of surrounding normal skin; the curative effect satisfaction degree of patients was as follows: 2 patients were very satisfied, 6 patients were satisfied, 2 patients were somewhat satisfied, and 1 patient was a little not satisfied. Conclusions: The large area facial scar can be treated safely and effectively by free pre-expanded deltopectoral flap with appropriate single internal thoracic artery perforator as vascular pedicle selected through vascular assessment by color Doppler ultrasonography before operation. After operation, the color of flap of patients is close to the surrounding normal skin and the sensation of flap can be partially recovered, with high curative effect satisfaction degree of patients.

Cost and related factors analysis for patients undergoing colon polyp surgery based on DRG mode.

OBJECTIVE: The aim of the study was to analyze the hospitalization costs of patients with intestinal polyps undergoing colonic polyp surgery and associated influencing factors and to explore the entry point of cost control and the way of fine management. PATIENTS AND METHODS: One year before (2021) and one year after (2022) the implementation of the Diagnosis Related Grouping (DRG), the patients receiving APC, CSP and EMR in GK39 (colonoscopy operation) group were included in a second Affiliated Hospital in Nanjing according to the Nanjing grouping scheme. Descriptive analysis method and multiple linear regression method were used for analysis. RESULTS: After the implementation of DRG in 2022, the average hospitalization cost of patients decreased by 19.46% compared with the same period last year. Before and after the implementation of DRG, medical technology costs accounted for the highest proportion of hospitalization costs. Age, hospitalization days, number of polyps, number of clamps and clinical pathway had statistically significant effects on hospitalization cost (p<0.05), among which hospitalization days, number of polyps, and number of clamps had the greatest impact on hospitalization cost, followed by age and clinical pathway. CONCLUSIONS: The implementation of DRG has a positive effect on guiding hospitalization cost control. It is suggested to realize accurate cost control by analyzing the cost structure of the disease group. Clinical pathway completion rate has a direct impact on the implementation effect of DRG, including cost control. It is suggested to refine clinical pathway management and achieve scientific cost control through continuous optimization and improvement of clinical pathway management.

[Efficacy of different doses of magnesium isoglycyrrhizinate in the treatment of chronic liver disease with elevated ALT: a meta-analysis].

Objective: To investigate the efficacy and safety profile of different doses of magnesium isoglycyrrhizinate in the treatment of chronic liver disease with elevated alanine aminotransferase (ALT). Methods: Computer retrieval of literature was conducted in the CNKI, Wanfang, and PubMed databases from the establishment of the databases until February 2023. The Cochrane risk of bias assessment tool was used to evaluate the quality of the included literature after screening the literature and extracting the data. RevMan 5.4 and Stata 15.0 software were used to analyze the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), total effective rate, and incidence of adverse events. Results: Finally, 10 articles were selected, including a total of 1 522 cases. All the included studies were of good quality and at low risk of bias. Meta-analysis results showed that compared with 100 mg/d magnesium isoglycyrrhizinate injection, 200 mg/d magnesium isoglycyrrhizinate injection had significantly reduced patients' ALT [MD = -30.73, 95% confidence interval (CI): -52.52 ~ -8.94, Z = 2.76, P = 0.006; I (2) = 98%, P < 0.001], AST (MD = -34.30, 95% CI: -57.78 ~ -10.82, Z = 2.86, P = 0.004; I (2) = 99%, P < 0.001) and TBil (MD = -15.37, 95% CI: -27.66 ~ -3.09), Z = 2.45, P = 0.01; I (2) = 98%, P < 0.001) levels. The total effective rate reported in seven articles showed no heterogeneity among the studies (I (2) = 0.0%, P = 0.98). The total effective rate was higher in 200 mg/d magnesium isoglycyrrhizinate injection than that of 100 mg/d magnesium isoglycyrrhizinate injection (OR = 3.49, 95% CI: 2.05 ~ 5.95, Z = 4.59, P < 0.001), and there was no statistically significant difference in adverse reactions. Conclusion: 200 mg/d magnesium isoglycyrrhizinate injection can more rapidly and effectively improve the levels of ALT, AST, and TBil in patients with chronic liver disease, with an increased total effective rate and a good safety profile.

Different sedation profiles with ciprofol compared to propofol represented by objective sedation level assessments by BIS and its acute hemodynamic impact in 3 escalated doses of ciprofol and propofol in healthy subjects: a single-center, open-label, randomized, 2-stage, 2-way crossover trial.

OBJECTIVE: To compare the sedation profiles and the pharmacokinetic, pharmacodynamic and safety characteristics of ciprofol and propofol at 3 escalated dose levels in healthy Chinese male subjects. PATIENTS AND METHODS: Eighteen subjects were planned to be enrolled into 3 dose groups in turn: group 1 (ciprofol-0.4 mg/kg vs. propofol-2.0 mg/kg), group 2 (ciprofol-0.6 mg/kg vs. propofol-3.0 mg/kg) and group 3 (ciprofol-0.8 mg/kg vs. propofol-4.0 mg/kg). They were randomly assigned into a ciprofol or propofol group in a ratio of 1:1, with sequences of ciprofol-propofol or propofol-ciprofol, separated with a washout period of at least 48 h. RESULTS: A total of 19 subjects were enrolled and 18 completed the trial. The median time to being fully alert after induction by ciprofol was longer than for propofol. The bispectral index (BIS) recovered significantly slower with ciprofol than with propofol 5 min and 10 min after reaching its lowest points. Systolic blood pressure (group 1: p=0.041; group 2: p=0.015; group 3: p=0.004) and mean arterial pressures (group 1: p=0.026; group 2: p=0.015; group 3: p=0.004) measured by the area under the curve below the baseline during the 2 min after induction were significantly less for ciprofol compared to propofol, but a significant change in diastolic blood pressure was only observed in group 3 (p=0.002). Eighteen (100.0%) subjects experienced 47 ciprofol-related treatment emergent adverse events (TEAEs) and 17 (94.4%) subjects had 54 propofol-related TEAEs, which were mainly hypotension, involuntary movements, respiratory depression, and pain at the injection site with severity of grade 1 or 2. CONCLUSIONS: Ciprofol may be well tolerated at higher doses in the clinical practice and exhibited significantly different sedation profiles to propofol.

HER2-low expression in patients with advanced or metastatic solid tumors.

BACKGROUND: Human epidermal growth factor receptor 2 (HER2)-low is a newly defined category with HER2 1+ or 2+ expression by immunohistochemistry (IHC) and lack of HER2 gene amplification measured by in situ hybridization (ISH). Much remains unknown about the HER2-low status across tumor types and changes in HER2 status between primary and metastatic samples. PATIENTS AND METHODS: HER2 expression by IHC was evaluated in 4701 patients with solid tumors. We have evaluated the HER2 expression by IHC and amplification by ISH in paired breast and gastric/gastroesophageal (GEJ) primary and metastatic samples. HER2 expression was correlated with ERBB2 genomic alterations evaluated by next-generation sequencing (NGS) in non-breast, non-gastric/GEJ samples. RESULTS: HER2 expression (HER2 IHC 1-3+) was found in half (49.8%) of the cancers, with HER2-low (1 or 2+) found in many tumor types: 47.1% in breast, 34.6% in gastric/GEJ, 50.0% in salivary gland, 46.9% in lung, 46.5% in endometrial, 46% in urothelial, and 45.5% of gallbladder cancers. The concordance evaluation of HER2 expression between primary and metastatic breast cancer samples showed that HER2 3+ remained unchanged in 87.1% with a strong agreement between primary and metastatic samples, with a weighted kappa (Κ) of 0.85 (95% confidence interval 0.79-0.91). ERBB2 alterations were identified in 117 (7.5%) patients with non-breast, non-gastric/GEJ solid tumors who had NGS testing. Of 1436 patients without ERBB2 alterations, 512 (35.7%) showed any level HER2 expression by IHC. CONCLUSION: Our results show that HER2-low expression is frequently found across tumor types. These findings suggest that many patients with HER2-low solid tumors might benefit from HER2-targeted therapies.

[Transanal drainage tube for prevention of anastomotic leak after anterior resection for rectal cancer: a meta-analysis].

Objective: To assess the effectiveness of transanal drainage tube (TDT) in reducing the incidence of anastomotic leak following anterior resection in patients with rectal cancer. Methods: We conducted a systematic search for relevant studies published from inception to October 2022 across multiple databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and VIP. Meta-analysis was performed using Review Manager 5.4 software. The primary outcomes included total incidence of anastomotic leak, grade B and C anastomotic leak rates, reoperation rate, anastomotic bleeding rate, and overall complication rate. Results: Three randomized controlled trials involving 1115 patients (559 patients in the TDT group and 556 in the non-TDT group) were included. Meta-analysis showed that the total incidences of anastomotic leak and of grade B anastomotic leak were 5.5% (31/559) and 4.5% (25/559), respectively, in the TDT group and 7.9% (44/556) and 3.8% (21/556), respectively, in the non-TDT group. These differences are not statistically significant (P=0.120, P=0.560, respectively). Compared with the non-TDT group, the TDT group had a lower incidence of grade C anastomotic leak (1.6% [7/559] vs. 4.5% [25/556]) and reoperation rate (0.9% [5/559] vs. 4.3% [24/556]), but a higher incidence of anastomotic bleeding (8.2% [23/279] vs. 3.6% [10/276]). These differences were statistically significant (P=0.003, P=0.001, P=0.030, respectively). The overall complication rate was 26.5%(74/279) in the TDT group and 27.2% (75/276) in the non-TDT group. These differences are not statistically significant (P=0.860). Conclusions: TDT did not significantly reduce the total incidence of anastomotic leak but may have potential clinical benefits in preventing grade C anastomotic leak. Notably, placement of TDT may increase the anastomotic bleeding rate.

[Association between depression and chronic diseases among middle-aged and older Chinese adults].

OBJECTIVE: To examine the association between depressive symptoms and chronic diseases among middle-aged and older Chinese adults within a national investigation. METHODS: Data used in current analysis were obtained from a nationally representative, cross-sectional population-based survey of China health and retirement longitudinal study, which were conducted in 2011 using four-stage probability-proportional-to-size sampling methods. A total of 10 420 participants who were aged 45 years and above from 28 provinces in mainland China were included. Information on demographic characteristics (e.g., age, gender, education level), lifestyle factors (e.g., smoking status and drinking frequency) and chronic diseases (e.g., hypertension, diabetes, and stroke) were collected by well-trained interviewers at the interviewees' homes using a standardized questionnaire. Depressive symptoms were measured using the 10-item version of the center for epidemiological studies depression scale (CESD-10, which was a widely used standard tool in Chinese population, and elevated depressive symptoms were defined by a cut-off ≥10. Multivariate Logistic regression analysis was carried out to assess the association between depressive symptoms and chronic diseases (including hypertension, diabetes, heart disease, dyslipidemia and stroke), adjusting for age, gender, education level, marital status, ethnicity, place of residence, bady mass index (BMI) and other potential confounding factors. RESULTS: Among the 10 420 participants, the mean age was (59.2±9.4) years, and 48.2% of them were men. There were 3 900 (37.4%) participants who had a depression rating score of 10 or greater, indicative of elevated depressive symptoms. The results of multivariate Logistic regression analysis demonstrated that diabetes (OR=1.230, 95%CI: 1.080-1.401), hypertension (OR=1.335, 95%CI: 1.205-1.480), heart disease (OR=1.953, 95%CI: 1.711-2.229), and stroke (OR=2.269, 95%CI: 1.704-3.020) were significantly associated with depressive symptoms (P < 0.05), after full adjustment of age, gender, education level, marital status, ethnicity, residency and other potential confounders. While no significant relationship was found between dyslipidemia and depressive symptoms (P>0.05). The prevalence of elevated depressive symptoms increased parallel with the number of chronic diseases (Ptrend < 0.001). CONCLUSION: Depressive symptoms were significantly associated with chronic diseases (including diabetes, hypertension, heart disease, and stroke), which suggests that psychological factors, such as depressive symptoms should be taken into consideration in the prevention and control of chronic diseases.