[Efficacy of omalizumab in the treatment of eosinophilic granulomatous polyangiitis with asthma as the first symptom].

Objective: To investigate the efficacy, and safety of omalizumab in the treatment of eosinophilic granulomatous with polyangiitis (EGPA) with asthma as the first symptom. Method: The clinical characteristics of 22 EGPA patients with asthma as the first symptom treated with omalizumab in the First Affiliated Hospital of Guangzhou Medical University from March 2018 to December 2020 were retrospectively analyzed. The asthma control test (ACT) score, the frequency of asthma exacerbation (AE), the Birmingham Vasculitis Activity Score (BVAS), the variation rate of peak expiratory flow (PEF), the percentage of PEF to predicted value of PEF (PEFpred%), the percentage of forced expiratory volume in first second (FEV1) to predicted value of FEV1 (FEV1pred%), the dosage of oral corticosteroid (OCS) and other clinical data [M(Q1, Q3)] were collected before and after treatment, to observe the efficacy and adverse reactions of omalizumab. Results: There were 22 subjects recruited in this study. The median age was 42 (22-70) years. Eleven of the patients were males. After treated with omalizumab for 4 months, there were 68.2%(15/21) of patients who responded to the treatment. In the response group (n=15), the patients' ACT score increased from 19.0 (16.5, 21.0) to 23.0 (21.5, 24.0) (P=0.001). The frequency of AE decreased from 0.7 (0.3, 1.0) to 0 (0, 0.7) per four mouths (P<0.001). The BVAS decreased from 4.0 (2.0, 6.0) to 2.0 (2.0, 4.0) (P=0.007). The variation rate of PEF decreased from 18.8% (14.0%, 27.7%) to 9.2% (6.8%, 11.9%) (P=0.007). The PEFpred% increased from 80.8% (73.5%, 90.7%) to 100.5% (79.4%, 114.0%) (P=0.005). The maintenance dosage of OCS reduced from 15.0 (10.0, 20.0) mg/d to 8.8 (5.0, 10.0) mg/d (P=0.005). The level of baseline eosinophil in peripheral blood of patients in non-response group was higher than that in response group [11.4% (9.2%, 22.6%) vs 3.4% (1.1%, 6.5%), P<0.05]. A total of 190 injections were performed in 22 patients, and only 4 patients (2.1%) had adverse reactions after a single injection of omalizumab, such as dizziness, swelling of injection site and pruritus. The adverse reactions were tolerable. Conclusions: Omalizumab has certain curative effect on EGPA, can reduce asthmatic symptoms and OCS maintenance dosage, and has a good safety profile. The rate of response to the treatment is higher in patients with mild eosinophilic inflammation.

[Measurement of corneal nerve fiber parameters in patients with Parkinson's disease].

Objective: To analyze the characteristic changes of corneal nerve fibers in patients with Parkinson's disease (PD) by corneal confocal microscopy (CCM) and investigate the association of corneal nerve fiber parameters with disease severity and motor symptoms. Methods: Forty-two patients with PD were recruited from the Department of Neurology, Henan University People's Hospital from June 2018 to October 2019. Meanwhile, 40 healthy controls who visited the hospital for physical examination at the same period were enrolled. Corneal nerve fibers in both eyes of all participants were detected by using CCM. The differences of corneal nerve fibers were comparatively analyzed between PD group and healthy controls. Associations of corneal nerve parameters with clinical characteristics such as course of disease, Hoehn and Yahr stage (H-Y stage), unified Parkinson disease rating scale (UPDRS), levodopa equivalent daily dosage (LEDD) were analyzed by using partial correlations. The receiver operating characteristic (ROC) curve was used to analyze the capability of corneal nerve fibers for distinguishing patients with PD from healthy controls. Results: Corneal nerve fiber density (CNFD) in PD group ((19±3)/mm2) was significantly decreased compared with healthy controls ((28±4)/mm2) (t=10.798, P<0.001). However, corneal nerve branch density (CNBD) was significantly increased in PD group ((25±11)/mm2) compared with healthy controls ((18±6)/mm2) (t=-3.427, P=0.001). Meanwhile, corneal nerve fiber length (CNFL) was decreased in PD group ((11.0±2.5) mm/mm2) in comparison with healthy controls ((12.5±1.6) mm/mm2) (t=3.139, P=0.002). ROC curve analysis revealed that CNFD could discriminate PD patients from healthy controls, with an area under the curve of 0.961 3 (95%CI: 92.42-99.84, P<0.000 1). CNFD was negatively correlated with H-Y stage and UPDRS-Ⅲ (r=-0.501 and -0.399, both P<0.05). CNBD was significantly negatively associated with H-Y stage, UPDRS-Ⅲ and UPDRS-Total (r=-0.622, -0.394 and -0.354, respectively, all P<0.05). CNFL was negatively correlated with H-Y stage, UPDRS-Ⅲ and UPDRS-total (r=-0.574, -0.484 and -0.422, respectively, all P<0.05). Conclusion: Small nerve fiber injuries exist in PD patients. Corneal nerve fibers negatively correlates with motor symptoms. CNFD have a good discriminative power to distinguish PD patients from healthy controls and may serve as a marker for PD.

[Effectiveness and safety of robotic assisted-bronchoscopy system in locating and removing spring coils placed in the peripheral lung of beagle dogs: a pilot study].

Objective: To evaluate the effectiveness and safety of the robotic assisted bronchoscope system for localizing and removing the spring coils that placed in the peripheral lung of beagle dogs. Methods: The study was conducted from June 18th to June 20th, 2021. Metallic lung coils were placed as the simulated lesions to the periphery of the lungs of two adult male beagle dogs using a bronchoscope under general anesthesia. The navigation path was planned by the navigation function that built in the robotic bronchoscope system. After training, the doctors operated the robotic bronchoscope system to locate and remove the coils from the lung. The navigation success rate, sampling success rate, position of the coil, navigation time, sampling time, and operation time were evaluated. The damage to the airway mucosa during the operation and the vital signs of the beagles during and post-operation were accessed. Chest computerized tomography (CT) was performed post-operation to detect if there were complications such as pneumothorax and bleeding. Results: A total of 12 spring coils were successfully inserted into the two beagles. All the navigation paths of the simulated lesions were successfully planned. The navigation success rate was 12/12. The navigation time was (43.9±19.8) seconds. The distance between the tip of the flexible endoscope arm and the target point measured by the navigation system was (6.93±2.15) mm. The locations of the simulated lesions were distributed in the 6th-8th generation of bronchi. The sampling success rate was 12/12. The sampling time was (42.4±11.3) seconds. There was no pneumothorax or mediastinal emphysema after the placement of the coil. The vital signs of the beagle dogs were stable throughout the operation, and no operation-related or postoperative complications occurred. Conclusions: The robotic bronchoscope system can be used to locate and remove the spring coils from the peripheral lung of beagle dogs, and the procedure is simple and safe. It suggests that the robotic bronchoscopy system has great clinical significance in the sampling and diagnosis of peripheral lung lesions.

[Preliminary clinical observation of omalizumab therapy for moderate to severe asthma].

Objective: To observe the effectiveness, safety and management of omalizumab therapy for moderate to severe asthma in real-world clinical practice in China. Methods: This retrospective analysis involved 79 patients with moderate to severe asthma who received omalizumab therapy for at least 4 months in the First Affiliated Hospital of Guangzhou Medical University from March 2018 to April 2020. All participants were between 14 to 76 years old(median 50 years),including 30 males and 49 females. Data regarding the patients' clinical manifestations, eosinophil count, fractional exhaled nitric oxide (FeNO), lung function, oral corticosteroid dosage, and adverse reactions were collected before and after treatment. Paired t-test or non-parametric paired Wilcoxon analysis was used for pairwise comparison, Mann Whitney analysis for inter-group comparison, and Chi square test or Fisher test for inter-group comparison of count data. Results: The following changes were noted after 4 months of omalizumab thearpy. The patients' Asthma Control Test (ACT) scores increased from 17.0 (13.0-19.0) to 20.0 (18.0-24.0) points (P<0.001). The frequency of acute exacerbations(AE) decreased from 1.0 (0-1.0) to 0 (0-1.0) episodes every 4 months (P<0.001). The variation rate of the peak expiratory flow (PEF) decreased from 16.5 (13.8-27.3)% to 10.4 (6.0-16.2)% (P<0.001). The percent predicted value of PEF (PEFpred%) increased from 71.7 (51.4-91.6)% to 87.5 (65.2-105.5)% (P<0.001). The percent predicted value of the forced expiratory volume in 1 second(FEV1%pred) increased from 73.6 (53.9-90.8)% to 80.6 (68.7-91.8)% (P=0.007). The maintenance dose of oral corticosteroids (OCS) decreased from 12.0 (10.0-20.0) to 5.0 (0-17.5) mg/day (P=0.001). After 4 months of treatment, the response rate of the 79 patients with asthma was 74.7%. The response rate of patients with allergic asthma (77.3%) was higher than that of patients with non-allergic asthma (25.0%) (P=0.019). Among 5 patients who completed 1 year of treatment, the ACT score, frequency of AE, PEFpred%, variation rate of PEF and OCS maintenance dose were still improved after 1 year of treatment. Adverse reactions occurred in 3 patients (3.8%), for a total of 3 (0.6%) times. Stratified analysis showed that after 4 months of treatment, the improvement in the ACT score and the decrease in the PEF variation rate among patients who reached the recommended treatment dose (full dose) [3.0 (1.0-8.0) points, 6.5 (3.5-15.8) %] were significantly higher than those among patients who did not reach the recommended treatment dose (insufficient dose) [1.0 (-0.3-3.0) points, 2.9 (1.5-5.0) %] (P<0.05). Additionally, the treatment response rate in patients with a sufficient dose (80.0%) was higher than that in patients with an insufficient dose (50.0%) (P=0.019).The main factors associated with stopping treatment within 1 year despite a response to omalizumab was economic burden (70.3%), followed by satisfactory improvement by self-evaluation (21.9%) and less improvement in symptoms than expected (7.8%). Conclusion: Omalizumab was an effective treatment for moderate to severe allergic asthma with few adverse effects. The response rate was higher when the recommended injection dose was achieved. Financial difficulty was the main reason for stopping treatment within 1 year despite a good therapeutic response.

[The association between mesenteric fat hypertrophy and behavior and activity of Crohn's disease].

Objective: Mesenteric fat hypertrophy is present in about a quarter of Crohn's disease (CD) patients and it can be easily detected by bowel ultrasound (US). The purpose of this research was to assess the correlation between mesenteric fat hypertrophy and behavior and activity of CD. Methods: A total of 89 CD patients who admitted to the First Affiliated Hospital of Nanjing Medical University from August 2018 to November 2019 were recruited in this study. The total CD patients were divided into two groups depending on with or without mesenteric fat hypertrophy by US tests. Crohn's disease activity index (CDAI), simplified endoscopic score for Crohn's disease (SES-CD), serum inflammatory indicators and fecal calprotectin were assessed. Results: Mesenteric fat hypertrophy was significantly associated with stricturing behavior (B2, P<0.01). CDAI (P=0.002) , blood platelet (P=0.001) , C-reactive protein (P=0.024) , fecal calprotectin (P=0.004) and bowel wall thickness (P<0.01) in patients with mesenteric fat hypertrophy were significantly higher than those without, but not the erythrocyte sedimentation rate (P=0.110) and SES-CD (P=0.115) . Serum albumin (P=0.001) in patients with mesenteric fat hypertrophy was lower than that in patients without mesenteric fat hypertrophy. Conclusion: Mesenteric fat hypertrophy is correlated with intestinal stenosis and disease activity in patients with Crohn's disease.

[Clinical effect analysis of 146 cases of ipsilateral simultaneous pancreas and kidney transplantation].

Objective: To investigate the clinical effect of ipsilateral simultaneous pancreas and kidney transplantation (SPK). Methods: A total of 146 cases of SPK surgeries completed in the Second Affiliated Hospital of Guangzhou Medical University from September 2016 to June 2020 were selected to summarize the outcome, curative effect and complications of the operation. Results: The patients were followed up for 1 to 45 months. Good clinical results were obtained in 146 patients. Renal function indicators suggest that on the 7th day after operation, the serum creatinine returned to normal level [142.4 (108.6, 213.4)µmol/L]. The index of pancreatic function decreased to the normal level as expected. The level of blood amylase was 160.5(109.3, 249.8) U/L within 7 days after operation, and then decreased. The trend of urinary amylase was similar to that of blood amylase, which was 240(121.0, 370.0) U/L 7 days after operation, and glycosylated hemoglobin decreased to the normal level (5.8%±1.4%) 1 month after operation. The main medical complications were infection including pulmonary infection (26.03%, 38/146), urinary tract infection (26.03%,38/146), and abdominal infection (4.79%,7/146), acute rejection including renal graft rejection (5.8%,8/146), pancreas/duodenum rejection (18.49%,27/146), and renal graft combined pancreatic graft rejeciton (6.85%,10/146), as well as gastrointestinal bleeding (30.82%,45/146), of which 5 cases were severe bleeding (3.42%, 5/146). The main surgical complications were poor incision healing (10.27%, 15/146), serious surgical complications including arteriovenous thrombosis of the transplanted pancreas (2.05%, 3/146) and intestinal leakage (0.68%,1/146). The 1-year and 3-year patient, renal and pancreatic survival rates were both 92.5%, 91.5% and 89.5%, respectively, and despite the death, the 1-year, 3-year transplanted kidney survival rate was both 99.3%, and 95% for the the 1-year, 3-year pancreas survival rate. Conclusion: Strict preoperative evaluation of the function of large organs, reasonable surgical methods, perioperative anticoagulation, and prompt diagnosis of complications can achieve good clinical results for patients with SPK.

Subtype-specific inherited predisposition to pemphigus in the Chinese population.

BACKGROUND: Pemphigus is a group of rare life-threatening mucocutaneous autoimmune diseases, presenting mainly as two subtypes: pemphigus vulgaris (PV) and pemphigus foliaceus (PF). Inherited predispositions to pemphigus have long been speculated but they remain poorly understood. OBJECTIVES: To identify common and specific nongenetic and genetic factors associated with pemphigus and its subtypes in the Chinese population. METHODS: A genome-wide association study (GWAS) was performed in 496 unrelated patients with pemphigus (including 365 with PV and 104 with PF) and 1105 controls without pemphigus. RESULTS: A sex preference was observed only in PV (57·5% female) and not in PF (47·1% female). For male patients only, the mean age at diagnosis was significantly lower for PV than for PF (P < 0·001). The strongest associated single-nucleotide polymorphisms are in the human leucocyte antigen (HLA) region: rs70993900 (PV; P = 1·5 × 10-45 ) and rs9469220 (PF; P = 1·1 × 10-8 ). HLA-DQB1*05:03 ranks at the top (P = 4·7 × 10-40 ; odds ratio 12·4) in both subtypes, with significantly different risk allele frequency (RAFPV = 34·2% vs. RAFPF = 18·8% vs. RAFcontrol = 4·4%), whereas HLA-DRB1*14:01 and HLA-DRB1*04:06 are PV specific. HLA-DQB1*03:03 and HLA-DQB1*03:02 show significant subtype specificity in opposite directions. All of these associations were validated in the replication series with 147 cases of pemphigus and 604 controls. Multiple novel non-HLA susceptibility loci were also identified in the GWAS. CONCLUSIONS: This study represents the largest GWAS on pemphigus in the Chinese population published to date, and has allowed us to identify HLA haplotypes significantly shared between or specific to the two main subtypes of pemphigus.

First case of Rubinstein-Taybi syndrome with desquamation associated with a novel mutation in the bromodomain of the CREBBP gene.

Rubinstein-Taybi syndrome (RSTS) is a rare congenital disorder, mainly characterized by postnatal growth retardation, intellectual disability, and facial and limb abnormalities. Although not considered as characteristic manifestations, numerous cutaneous anomalies have also been reported in patients with RSTS while there has been no report of desquamation so far in any patients with RSTS. We report an unusual case of RSTS in an 8-year-old boy who presented with the typical facial and limb abnormalities of RSTS accompanied with apparent hirsutism and desquamation, but without apparent intellectual disability. Whole exome sequencing identified a novel mutation in the bromodomain of CREBBP (c.3503A>G, p.N1168S), which was further confirmed by targeted Sanger sequencing in comparison with healthy controls. Our findings expand the spectra of genetic mutations and clinical presentations associated with RSTS, and underline the importance of maintaining high awareness of rare presentations and diagnostic difficulties in management of rare genetic diseases such as RSTS.

[Evaluation of carotid plaque neovascularization in carotid stenosis by contrast-enhanced ultrasound].

Objective: The identification of neovascularization in carotid plaque in carotid artery stenosis by contrast-enhanced ultrasound (CEUS) provides other risk markers for stroke besides carotid artery stenosis -intraplaque neovascularization. Methods: From January 2017 to September 2017, 40 patients with carotid atherosclerosis plaque were examined by contrast-enhanced ultrasound in China-Japanese Friendship Hospital. The enhancement intensity (EI) measured by contrast-enhanced ultrasound was compared with the micro-vessel density (MVD) measured by histopathology after carotid endarterectomy (CEA). Contrast-enhanced ultrasound was used to observe whether there was enhancement in the plaque and the enhancement was divided into 0-2 grades. The EI in plaque, the ratio of EI in plaque to EI in carotid artery lumen were calculated by time intensity curve quantitative analysis software. Pathological sections of carotid plaques after CEA were stained with CD34 and neovascularization density was measured. Results: There were significant differences in age, EI1, EI1/EI2 and CD34 among patients with different grades of plaque enhancement (P<0.05), but no significant differences in gender and EI2 (P>0.05). The density of neovascularization obtained by CD34 staining was highly positively correlated with EI1 (r=0.836, P<0.001), EI1/EI2 (r=0.955, P<0.001), but not with age (r=0.066, P=0.684), EI2 (r=0.159, P=0.328). Conclusions: Contrast-enhanced ultrasound can observe the neovascularization in carotid plaque, which is a simple and non-invasive method to evaluate the stability of carotid plaque. CEUS may also help to extract features of vulnerable plaques, such as acute intraplaque hemorrhage.

[Clinical application of renal autotransplantation in complex urological diseases].

Objective: To summarize the experience of renal autotransplantation for severe iatrogenic proximal ureteral damage and renal artery aneurysms in eight patients and to explore the clinical application value of renal autotransplantation. Methods: Two patients of renal artery aneurysms and six patients of severe iatrogenic proximal ureteral damage between January 2010 and March 2018 in our center were retrospectively reviewed. Results: The procedures of eight cases were successful, with immediate return of renal function in the patients. The warm ischemia time was (3±1) minutes, the total operation time was (340±164) min, and the estimated blood loss was (180±60) ml, respectively. For renal artery anastomosis, six patients of severe iatrogenic proximal ureteral damage received end-to-end anastomosis between the internal iliac artery and renal artery, and two patients of renal artery aneurysms were treated with renal artery and internal iliac artery for reconstruction, then end-to-side anastomosis to recipien external iliac artery. A direct ureterovesical anastomosis was performed in seven patients, one patient was received pyeloureteroplasty. No serious complications of blood vessel and ureter were found during perioperative and long-term follow-up. All cases follow-up hitherto have normal renal function and blood pressure. Conclusions: Renal autotransplantation can be appropriate for patients with proximal ureteral loss and complex hilar renal artery aneurysms. In addition, it is able to protect renal functions to the most extent and provides a surgical alterative for complex renal diseases.

[Clinical efficacy and safety of combined induction therapy with rituximab and ATG in highly sensitized kidney transplant recipients].

Objective: To summarize the efficacy and safety of the combination of rituximab and ATG as induction therapy in highly sensitized kidney transplant recipients. Methods: Clinical data of patients who received kidney transplantation from donation after cardiac death(DCD) in Organ Transplant Center of Second Affiliated Hospital of Guangzhou Medical University from January 1st 2015 to December 31th 2016 was retrospectively analyzed. Highly sensitized patients with over 30% active panel reactive antibody (PRA>30%) received rituximab, while non-sensitized recipients as controlled group. All selected patients were observed in the renal function, urine protein, hemogram and the variation of PRA at each time point. Acute rejection, infection required hospitalization, delayed graft function(DGF), primary nonfunction (PNF), graft dysfunction, the mortality rate of patients with good allograft function and the graft survival rate were also observed. Results: 46 groups of patients were selected into highly-sensitized group and non-sensitized group. In both groups, there was no statistical difference in the renal function, urine protein and WBC (all P>0.05). Highly sensitized recipients at day 7 and day 14 following the surgery, had a significantly lower percentage of lymphocyte counts and lymphocyte proportion compared to other groups, with statistical differences(all P<0.05). Both groups had a similar incidence of DGF(2.2%) and no occurrence of PNF. 19.5% of highly sensitized recipients experienced acute rejection and 13% in control group. More specifically, no statistical difference was noted in the rate of infection required hospitalization(30.4% vs 22.2%), graft loss(2.2% vs 0) and the mortality rate of patients with good allograft function(4.3% vs 2.2%)(all P>0.05). The graft survival rate was 97.8% in the highly-sensitized group, while 100% in the control group. And the rate of patient survival in these two groups was 95.7% and 97.8%, with no statistical differences(all P>0.05). Conclusions: Immune-induction therapy that combines Rituximab with ATG can significantly inhibit lymphocyte proliferation. It is effective and safe in treating hypersensitive patients. The survival rate of human/kidney of hypersensitive patients in the short and medium term is comparable to those with low immune risk.

[Distribution and drug resistance of pathogens in infected organ donors from donation after the citizen death].

Objective: To investigate the distribution and drug resistance of pathogens in infected organ donors from donation after the citizen death (DCD). Methods: Clinical data of 217 DCD donors from January 2013 to June 2017 were retrospectively analyzed.The phlegm, urine, blood and drainage fluid from all of the donors were routinely cultured.The infection rate of the donors, the composition ratio of pathogens and the distribution of specimen sources were observed and the drug resistance was analyzed. Results: Of all the 217 donors, 128 were infected and the infection rate was 59%.A total of 218 pathogens were isolated from these infected donors, including 55.5% (121/218) of gram-negative pathogens, 33.5% (73/218) of gram-positive pathogens followed by 11.0% (24/218) of fungi.The pathogenic specimens were mainly derived from sputum samples (72.5%), followed by urine (15.6%). The mainly two gram-negative pathogens were Klebsiella pneumonia and Acinetobacter baumannii.Klebsiella pneumonia exhibited varying degree of resistance to commonly used antibiotics, whereas susceptible to imipenem and meropenem.Acine-tobacterbaumannii was highly resistant to most of the antibiotics, and the drug resistance rate of imipenem and meropenem was over 60%, displaying a tendency of multi-drug resistance.Staphylococcus aureus, as the mainly gram-positive pathogen, was generally resistant to penicillin and clindamycin, but still sensitive to tovancomycin, teicoplanin and linezolid. Conclusions: DCD donors have a high infection rate, and respiratory infection is most common. Gram-negative pathogens are the primary pathogens causing infection in DCD donors.Klebsiella pneumonia maintain susceptible to imipenem and meropenem, while Acinetobacter baumannii reveals a tendency of multi-drug resistance.Gram-positive pathogens are still sensitive to vancomycin, teicoplanin and linezolid.

[The clinical value of SUDOSCAN in diagnosis of diabetic distal symmetrical peripheral neuropathy].

Objective: To evaluate the clinical value of SUDOSCAN in diagnosis of diabetic distal symmetrical peripheral neuropathy. Methods: According to the diagnostic criteria for multiple diabetic distal symmetrical peripheral neuropathy, a total of 130 patients with type 2 diabetes mellitus (T2DM) in Department of Endocrinology, the Affiliated Hospital of Qingdao University between August 2015 and July 2016 were divided into two groups, diabetic peripheral neuropathy group (DPN group, 50 cases) and non-diabetic peripheral neuropathy group (NDPN group, 80 cases). Additional 80 healthy volunteers were selected as healthy control group (NC group). SUDOSCAN was employed to detect electrochemical skin conductance (ESC, the unit was µS) of subjects' hands and feet, and the correlation between sensory nerve conduction velocity (SCV) and ESC was analyzed as well. Results: The average hands ESC in NC and T2DM group were (79.1±10.4) µS and (59.7±18.1) µS, respectively; the average feet ESC were (82.0±8.2) µS and (62.1±21.8) µS, respectively (both P<0.01). The average hands ESC in DPN and NDPN group were (53.2±18.9) µS and (63.7±16.5) µS; the average feet ESC were (53.5±24.4) µS and (67.4±18.2) µS, respectively (both P<0.05). The hands and feet ESC were positively correlated with SCV, and the correlation coefficient were 0.425 and 0.445, respectively (both P<0.01). The area under the receiver operating characteristic curve (ROC) of hands and feet ESC to evaluate diabetic symmetrical peripheral polyneuropathy were 0.785 and 0.768 (both P<0.01). Conclusion: SUDOSCAN is a promising tool for the diagnosis of diabetic symmetrical peripheral polyneuropathy.

miR-218 tissue expression level is associated with aggressive progression of gastric cancer.

The aim of the present study was to investigate the clinical significance of microRNA-218 (miR-218) in gastric cancer. We enrolled 112 patients having undergone surgery for gastric cancer between May 2008 and June 2014. Expression of miR-218 was determined by real-time quantitative reverse transcription-polymerase chain reaction. Survival curves were plotted using the Kaplan-Meier method and compared by the log-rank test. We found that miR-218 expression was significantly downregulated in gastric cancer tissues compared to adjacent normal tissues (P < 0.001). Low miR-218 expression was significantly associated with tumor differentiation (P < 0.001), depth of tumor invasion (P = 0.006), and tumor node metastasis stage (P < 0.001). Kaplan-Meier survival analysis revealed that patients with low miR-218 levels showed significantly lower 5-year overall survival than those demonstrating high expression (P = 0.04). Multivariate Cox regression analyses indicated that low miR-218 expression constitutes an independent molecular biomarker for prediction of poor overall survival of gastric cancer patients (hazard ratio = 3.187, 95% confidence interval = 1.551-8.365, P = 0.037). In conclusion, miR-218 was remarkably downregulated in gastric cancer tissues and may serve as a prognostic biomarker for patients suffering from this disease.

Relationship between urinary protein changes in lupus nephritis and renal pathology.

This study investigated the relationship between urinary protein excretion in lupus nephritis New Zealand black mice and renal pathology. A total of 328 lupus nephritis New Zealand black mice were established by a backcross hybridization method, and renal pathology was determined. The urinary protein excretion of the backcross mice over 24 h was compared and analyzed. Urinary protein excretion over 24 h differed significantly across different pathological types (1.9, 2.4, 2.9 and 4.9 g in types II, III, IV, and V, respectively) in the backcross mice (P < 0.05). Moreover, it correlated with pathology grade (r = 0.391, P = 0.0001) as well as activity index, chronic index, renal tubular interstitial activity index, and renal tubular interstitial lesions (P < 0.05) but not with vascular lesions (P = 0.683). Urinary protein excretion from lupus nephritis is closely associated with renal pathology. Urinary protein changes can be used to determine lupus nephritis pathology and have some clinical significance for treatment and prognosis.

[Three decades of progress in China's laparoscopic colorectal surgery techniques].

Laparoscopic colorectal surgery has been carried out in China for more than 30 years and has experienced a three-stage high-speed development of "exploring and designing,optimising and standardising, perfecting and re-innovating" at the technical level. Based on the support and assistance of laparoscopic technology, colorectal surgery has made rapid progress in sub-microscopic anatomy, surgical procedures, surgical concepts, instruments and equipment. Nowadays, the technology and efficacy of laparoscopic colorectal surgery have gradually reached the ceiling, and in view of the existing pain points and the future direction of development, where will we go? This article summarised the past three decades of experience and consolidate the results to guide the future practice and the way forward.

[Application value of artificial intelligence in surgical precision diagnosis and treatment of rectal cancer].

Colorectal cancer is the most common malignant tumor of digestive tract, and the incidence of colorectal cancer in China is especially characterized by middle and low rectal cancer. In recent years, with the progress of computer science, artificial intelligence technology has developed rapidly, and has achieved a lot of application results in the medical field. At present, artificial intelligence technology has covered various stages of colorectal cancer, including screening, individualized assessment, auxiliary diagnosis and treatment decision-making, refined surgery and prognosis judgment, providing help for the accurate and individualized treatment of rectal cancer. However, the lack of standardized, systematic, and scalable AI models remains a major pain point for the field. Therefore, it is necessary to carry out large-scale prospective clinical studies on artificial intelligence model to further confirm its application value in the clinical diagnosis and treatment of rectal cancer.

[Small steps to thousands of miles: a tribute to Chinese laparoscopic gastric cancer surgery].

Laparoscopic surgery for gastric cancer has been developed in China for more than 20 years. It has gone through the initial stage of exploration in the 1990s, the stage of learning and accumulation in the early 21st century, the stage of development and expansion in the 2010s, and the current stage of standardization, and innovation. Laparoscopic gastric cancer surgery in China has developed from less to more, from more to popular. Surgical techniques have gradually become mature, innovated, and standardized, medical evidence has accumulated, and academic exchanges have become increasingly active and valued by the world. In the future, it is expected to make new progress and breakthrough in tumor specific laparoscopic navigation surgery system, intelligent robotic gastric cancer surgery platform, functional preservation surgery for early gastric cancer under the integration of gastroenterologists and surgeons, and laparoscopic comprehensive treatment for peritoneal metastasis. By reviewing the development of laparoscopic gastric cancer surgery in China, the authors draw inspiration from the depths of history, inherit and innovate, look forward to the future, and pay tribute to the predecessors.

[Medial border of D3 lymphadenectomy for right colon cancer].

The extent of D3 lymphadenectomy for right colon cancer, especially the medial border of central lymph node dissection remains controversial. D3 lymphadenectomy and complete mesocolon excision (CME) are two standard procedures for locally advanced right colon carcinoma. D3 lymphadenectomy determines the medial border according to the distribution of the lymph nodes. The mainstream medial border should be the left side of superior mesenteric vein (SMV) according to the definition of D3, but there are also some reports that regards the left side of superior mesenteric artery (SMA) as the medial border. In contrast, the CME procedure emphasizes the beginning of the colonic mesentery and the left side of SMA should be considered as the medial border. Combined with the anatomical basis, oncological efficacy and technical feasibility of D3 lymph node dissection, we think that it is safe and feasible to take the left side of SMA as the medial boundary of D3 lymph node dissection. This procedure not only takes into account the integrity of mesangial and regional lymph node dissection, but also dissects more distant lymph nodes at risk of metastasis. It has its anatomical basis and potential oncological advantages. However, at present, this technical concept is still in the exploratory stage in practice, and the related clinical evidence is not sufficient.

[Digestive tract reconstruction after laparoscopic proximal gastrectomy for adenocarcinoma of esophagogastric junction].

The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing in recent years. Its diagnosis, lymph node metastasis and digestive tract reconstruction are all different from those of upper gastric cancer. With the development of the concept of function preserving surgery for gastric cancer, the clinical application of laparoscopic proximal gastrectomy in AEG is increasing. In this kind of operation, in addition to ensuring sufficient radical cure of tumor, the short-term smooth recovery and long-term quality of life of patients are also important. The reconstruction of digestive tract after proximal stomach operation is of great significance. According to the author's own practical experience, in clinical work, the author selects different surgical resection scope and digestive tract reconstruction methods according to Siewert classification of AEG. For Siewert Ⅱ AEG, laparoscopic PG is mostly used, and laparoscopic esophageal tubular gastric side-to-side anastomosis or double channel anastomosis is mostly used for digestive tract reconstruction. It is believed that with the emergence of long-term follow-up results and the development of multicenter randomized controlled research, some controversial questions will be better answered. We should pay attention to the individual differences of patients. For different individuals, combined with the operator's experience, on the basis of ensuring the radical cure of tumor, we should adopt appropriate surgical resection scope and digestive tract reconstruction, so as to bring better long-term quality of life for patients.