Construction and practice of medical alliance referral system based on blockchain / 中华医院管理杂志

Hierarchical diagnosis and treatment system is an important measure to rationally allocate medical resources and promote the homogenization of basic medical services. The medical alliance is an important service mode and service system of hierarchical diagnosis and treatment, whose role is to perfect the up-down linkage and meet the patient′s medical needs. Informatization construction is an important starting point to promote the services of the medical alliance. In order to solve the problem of connectivity, the medical alliance needs to establish a regional referral platform and realize the integrated service of all medical institutions. Renji Hospital, Shanghai Jiaotong University School of Medicine, has built a blockchain based referral system for hierarchical diagnosis and treatment, incorporating the S2B2C mode concept, and using the traceability, tamper proof and distributed accounting features of blockchain technology, realized independent storage of data in hospitals, realized real-time information sharing and interconnection, and provided a feasible solution for medical alliance management.

Three dimensional nephrometry system for partial nephrectomy: Our initial exploration / 北京大学学报(医学版)

OBJECTIVE@#To construct a preoperative evaluation system for partial nephrectomy using CT three-dimensional visualization technology and to explore its practical value.@*METHODS@#The clinical data of the patients who underwent partial nephrectomy for renal tumors in Department of Urology, Peking University First Hospital were collected retrospectively. At the same time, the homogenized standard data of patients who underwent partial nephrectomy for renal tumors were collected in 16 clinical centers in China. The CT three-dimensional visualization system was applied (IPS system, Yorktal) to evaluate tumor anatomy, blood supply, perirenal fat and other information. The parameters were summarized to build a three-dimensional nephrometry system, on the basis of which virtual surgery design and intraoperative navigation were completed.@*RESULTS@#A three-dimensional visualization image was established based on the enhanced CT urography. The nephrometry system included the longest diameter and volume of the tumor, proportion volume of tumor invading the parenchyma, maximum depth of the tumor invading the parenchyma, contact surface area, flatness of the tumor surface, renal segment where the tumor was located, vascular variation, and perirenal fat. The average two-dimensional diameter of the tumor was (2.78±1.43) cm, the average three-dimensional maximum diameter was (3.09±1.35) cm, and the average postoperative pathological size was (3.01±1.38) cm. The maximum tumor diameter in the three-dimensional image was significantly related to the prolonged renal artery clamping time and intra-operative blood loss (r=0.502, P=0.020; r=0.403, P=0.046). The three-dimensional and pathological tumor volume were (25.7±48.4) cm3 and (33.0±36.4) cm3, respectively (P=0.229). The tumor volume was significantly related to the intraoperative blood loss (r=0.660, P < 0.001). The proportion volume of the tumor invading into renal parenchyma was significantly related to the prolongation of renal artery clamping and the occurrence of postoperative complications (r=0.410, P=0.041; r=0.587, P=0.005). The tumor contact surface area and the presence of vascular variation did not show correlation with the perioperative data and postoperative complications. While the preoperative evaluation was completed, the reconstructed three-dimensional image could be zoomed, rotated, combined display, color adjustment, transparency, and simulated cutting on the Touch Viewer system. The process generally consisted of showing or hiding the tissue, adjusting the transparency of the interested area, rotating and zooming the image to match the position of the surgical patient. Together, these functions met the requirements of preoperative virtual surgery plan and intraoperative auxiliary navigation.@*CONCLUSION@#Three-dimensional images can provide a more intuitive anatomical structure. The CT three-dimensional visua-lization system clearly displays tumor anatomical parameters, blood supply and perirenal fat. The three-dimensional nephrometry system for renal tumors can help predict the difficulty of partial nephrectomy and perioperative complications. Importing the reconstructed three-dimensional visualization image into the specified program or robot operating system can complete virtual surgery and intraoperative navigation, helping the surgeon to better grasp the surgical process. The indexes included in the nephrometry system and the score weights of each index need to be confirmed and perfected by multi-center study with large samples.

Robot-assisted laparoscopic upper urinary tract reconstruction surgery: A review of 108 cases by a single surgeon / 北京大学学报(医学版)

OBJECTIVE@#To summarize the experiences and outcomes of 108 robot-assisted laparoscopic upper urinary tract reconstruction surgeries conducted by a single surgeon.@*METHODS@#We consecutively and retrospectively reviewed 108 patients who underwent robot-assisted laparoscopic upper urinary tract reconstruction surgeries by a single surgeon from November 2018 to January 2020. The patient demographics, perioperative variables, postoperative complications and follow-up data were recorded. Fifty-three modified dismembered pyeloplasties (MDP), 11 spiral flap pyeloplasties (SFP), 11 ure-teroureterostomies (UUT), 4 lingual mucosal onlay graft ureteroplasties (LMU), 5 appendiceal onlay flap ureteroplasties (AU), 11 ureteral reimplantations (UR), 6 Boari flap-Psoas hitch surgeries (BPS) and 7 ileal ureter replacements (IUR) were enrolled finally. The success was defined as the improvement in subjective pain levels, and the improvement in the degree of hydronephrosis at ultrasound.@*RESULTS@#All the surgeries were successfully completed without open or laparoscopic conversion. The median operative time was 141 min (range: 74-368 min), median blood loss was 20 mL (range: 10-350 mL) and median hospital stay was 4 d (range: 3-19 d) in MDP group, with the success rate of 94.3%. The median operative time was 159 min (range: 110-222 min), median blood loss was 50 mL (range: 20-150 mL) and median hospital stay was 5 d (range: 3-8 d) in SFP group, with the success rate of 100%. The median operative time was 126 min (range: 76-160 d), median blood loss was 20 mL (range: 10-50 mL) and median hospital stay was 5 d (range: 4-9 d) in UUT group, with the success rate of 100%. The median operative time was 204 min (range: 154-250 min), median blood loss was 30 mL (range: 10-100 mL) and median hospital stay was 6 d (range: 4-7 d) in LMU group, with the success rate of 100%. The median operative time was 164 min (range: 135-211 min), median blood loss was 75 mL (range: 50-200 mL) and median hospital stay was 8.5 d (range: 6-12 d) in AU group, with the success rate of 100%. The median operative time was 149 min (range: 100-218 min), median blood loss was 20 mL (range: 10-50 mL) and median hospital stay was 7 d (range: 5-10 d) in UR group, with the success rate of 90.9%. The median operative time was 166 min (range: 137-205 min), median blood loss was 45 mL (range: 20-100 mL) and median hospital stay was 5 d (range: 4-41 d) in BPS group, with the success rate of 83.3%. The median operative time was 270 min (range: 227-335 min), median blood loss was 100 mL (range: 10-100 mL) and median hospital stay was 7 d (range: 5-26 d) in IUR group, with the success rate of 85.7%.@*CONCLUSIONS@#The surgeon performed and modified numerous complicated upper urinary tract reconstruction surgeries by the robotic platform, which facilitated the development of the standardized upper urinary tract reconstruction surgical technique.

Application of preoperative three-dimensional image reconstruction in the treatment of ureteropelvic junction obstruction / 北京大学学报(医学版)

OBJECTIVE@#To investigate the value of preoperative three-dimensional image reconstruction in the treatment of ureteropelvic junction obstruction (UPJO).@*METHODS@#We reviewed data on 40 patients (22 male cases, and 18 female cases) diagnosed with UPJO in Peking University First Hospital from May 2017 to April 2019. The median age was 26.5 years (IQR 23.25-38.75) years. There were 11 patients complicated with ectopic vessels, 14 patients with kidney stones, 3 patients with horseshoe kidney, and 6 patients with obstruction after pyeloplasty. All the patients underwent preoperative enhanced CT scan, and the CT data were reconstructed into three-dimensional image models. The obstruction position of ureteropelvic junction and the relationship between ureteropelvic junction and blood vessels and organs were observed by three-dimensional models to assist planning surgery. Thirty-seven patients underwent laparoscopic pyeloplasty (including 3 cases combined with pyelolithotomy with flexible cystoscope, 1 case combined with pyelolithotomy by sun-style cystoscope, 1 case with laparoscopic ureter resection and anastomosis, 3 cases of laparoscopic pyeloplasty of horseshoe kidney), 2 patients underwent laparoscopic ventral onlay lingual mucosal graft ureteroplasty, and 1 patient underwent robot-assisted laparoscopic pyeloplasty.@*RESULTS@#Three-dimensional CT image clearly showed the relationship between the obstruction of ureteropelvic junction and blood vessels and organs after three-dimensional reconstruction. The type, diameter, position and direction of the ectopic vessels could be observed clearly before operation according to the three-dimensional reconstruction model, and the number, size, location and shape of renal calculi or other masses, the number of involved renal calyces and the anatomical distribution in the renal pelvis and calyces could be also evaluated preoperatively. After comprehensive analysis of the above information, individualized operation plans were performed on the patients, all the 40 cases were successfully completed with the surgery without any transfer to open surgery. The average operative time was (129.91±37.90) min (range: 75 to 273), the average blood loss was (48.1±78.0) mL (range: 10 to 400), the average hospitality was (5.04±1.99) d (range: 2 to 10), and the average postoperative drainage time was (3.8±1.4) d (range: 2 to 8).@*CONCLUSION@#The preoperative three-dimensional image reconstruction has a high clinical value in the treatment of ureteropelvic junction obstruction, and it is of great help to assist surgery planning and is worthy of further clinical promotion and application.

Comparison of transcriptome characteristics of human tumor cell lines with identical backgrounds from different sources / 国际药学研究杂志

Objective To understand the influence of different conditions to the potential phenotypes of cells, through the transcriptome sequencing and analysis for two cancer cell lines with identical genetic background from different sources, so as to provide an experimental basis for rigorous cell model-based drug screening. Methods Human cervical cancer (HeLa) cell and human liver cancer (HepG2) cell lines, newly introduced from ATCC (HeLa-ATCC and HepG2-ATCC) and a previously laboratory-stored (HeLa-PLS and HepG2-PLS) cell lines were used in the present study. The second generation high-throughput sequencing platform Illumina Novoseq was used for transcriptome sequencing, and the Gene Ontology (GO) function and pathway enrichment analysis based on the GO data base and the Kyoto Encyclopedia of Genes and Genomes (KEGG) data base, fusion gene analysis and analysis of mutation sites were performed for the differentially expressed genes (DEG). Meanwhile, the sequencing and analytical work was also performed for evaluating the effect of different culture times on the transcriptome of the ATCC-sourced HeLa cells. Results Total 7366 and 8786 DEGs in the HeLa and HepG2 cell lines were found between the HeLa-ATCC and HeLa-PLS cells and between the HepG2-ATCC and HepG2-PLS cells, respectively, HeLa and HepG2 cells, which were classified into 519 and 778 metabolic pathways by the GO function and pathway enrichment analysis, respectively. The DEGs in the HeLa cells were mainly enriched in the extracellular matrix tissues, metabolic pathways, cancer signaling pathways, cytokines and their interaction systems with receptors. The DEGs in the HepG2 cells were mainly enriched in the extracellular matrix tissues, neural active ligands and their interaction systems with receptors, cancer signaling pathways and mitogen-activated protein kinase (MAPK) signaling pathways. The cancer signaling pathway was attenuated in the HeLa-PLS cell line, while the cancer signaling pathway was enhanced in the HepG2-PLS cell line, accompanied with changes in the neuroactive factor-receptor binding activity and cytokine-receptor binding activity. On the other hand, significant changes on the genes related to the ion channels, the cell membrane receptors, such as G protein-coupled receptors, and the intracellular calcium signaling pathways found in the HeLa-ATCC cells within 6-24 hours after the cells were fully adhered. Conclusion Compared with the HeLa-ATCC and HepG2-ATCC cells, the transcriptome of the HeLa-PLS and HepG2-PLS cells showed significant changes, involving a wide range of cellular functions. Cell transcriptome sequencing might likely provide useful informations for understanding cell identity and controlling experimental conditions for drug screening and evaluation.

The discovery of synergistic anti-tumor effect of the cannabinoid receptor agonists in combination with WIN55212-2 and exemestane / 国际药学研究杂志

Objective To discover antitumor drugs showing a synergistic effect with the cannabinoid receptor agonist sildenafil mesylate (WIN55212-2), so as to provide a new strategy for potential drug combinations for improving the life quality of cancer patients. Methods Firstly, the antitumor activity was tested for the combination of cannabinoid receptor 1 (CB1R) receptor agonist WIN55212-2 with each of 25 antitumor drugs using three tumor cell lines with high CB1R, HepG2, DU145 and HCT-8, by highthroughput assay. Then, the in vitro tumor colony-forming assay and 3D tumor spheroid assay were conducted to confirm the synergistic effect for the effective drug combination. Flow cytometry was used to investigate the effect of the synergistic drug combination on the apoptosis and cell cycle progression. Results Three drugs showed a synergistic inhibitory effect on the proliferation of tested tumor cells by combining with WIN55212-2, and among them, the combination of exemestane with WIN55212-2 displayed best effect, which showed a dose-dependent synergistic antitumor effect in the in vitro tumor colony-forming test and 3D tumor spheroid assay (CI＜1).Compared with the single-exemestane treatment, the combination of exemestane with WIN55212-2 significantly increased the apoptosis of HepG2 cells (P＜0.01) and caused G2/M phase arrest of the HepG2 cells. Conclusion The study is the first to report that the combination of exemestane with WIN55212-2 showed a synergistic anti-tumor activity on HepG2 cells, which was likely related to the promotion of apoptosis and induction of cell cycle arrest.

Correlation between TCM syndrome types and clinical symptoms of benign prostatic hyperplasia with chronic prostatitis / 中华男科学杂志

Objective@#To investigate the correlation between the syndrome types of traditional Chinese medicine (TCM) and clinical symptoms of benign prostatic hyperplasia (BPH) with chronic prostatitis (BPH-CP).@*METHODS@#We selected 150 cases of BPH-CP in this study and divided them into 7 TCM syndrome types. Using univariate and multivariate logistic regression analyses, we studied the correlation of each TCM syndrome type with the age, disease course, prostate volume, postvoid residual urine volume (PVR), prostate-specific antigen (PSA) level, maximum urinary flow rate (Qmax), and International Prostate Symptoms Score (IPSS).@*RESULTS@#Kidney-yin deficiency was correlated positively with the prostate volume but negatively with Qmax and IPSS; kidney-yang deficiency positively with the age and prostate volume but negatively with IPSS; the damp heat syndrome positively with the PSA level but negatively with the disease course, prostate volume and Qmax; the spleen-qi deficiency syndrome positively with the prostate volume but negatively with the disease course; liver-qi stagnation positively with the disease course but negatively with the age, prostate volume and PVR; the syndrome of qi stagnation and blood stasis positively with the disease course and IPSS but negatively with PVR; the syndrome of lung-heat and qi blockage positively with the age, Qmax and IPSS but negatively with the disease course.@*CONCLUSIONS@#The TCM syndrome types of BPH-CP are closely correlated to their clinical symptoms. The analysis of the clinical objective indexes of BPH-CP can provide some reliable evidence for accurate identification of the TCM syndrome type of the disease.

Modified Jujing No.2 Decoction for varicocele-induced male infertility / 中华男科学杂志

<p><b>Objective</b>To investigate the clinical effect of Jujing No.2 Decoction on male infertility induced by varicocele.</p><p><b>METHODS</b>We equally randomized 70 male patients with varicocele-induced infertility into a treatment group and a control group, the former treated with modified Jujing No.2 Decoction (1 dose a day, bid) and the latter given Danshen Tablets (4 tablets once, tid) plus Liu Wei Di Huang Wan (8 pills once, tid), both for 3 months. We examined the spermatic veins of the patients by ultrasonography and performed seminal analysis before and after medication.</p><p><b>RESULTS</b>Compared with the controls, the patients in the treatment group showed significant improvement after medication in sperm concentration (［12.35±2.12］ vs ［18.56±4.16］ ×10⁶/ml, P<0.05), progressively motile sperm (［16.18±6.34］ vs ［24.63±8.51］ %, P<0.05), and morphologically normal sperm (［11.59±5.31］ vs ［14.17±6.02］ %, P<0.05). In the control group, sperm concentration was increased from (12.29±2.07) ×10⁶/ml at the baseline to (13.13±3.13) ×10⁶/ml after medication, progressively motile sperm from (16.13±6.45) % to (20.55±7.30) % (P<0.05), and morphologically normal sperm from (11.62±5.35) % to (12.69±5.77) %. The total effectiveness rate was significantly higher in the treatment than in the control group (71.88% vs 46.67%, P<0.05). The inner diameter of the left spermatic vein was decreased from (0.32±0.05) mm at the baseline to ［0.26±0.05］ mm after medication in the treatment group (P<0.05) and from (0.32±0.03) mm to (0.29±0.04) mm in the control (P<0.05), with statistically significant difference between the two groups after medication (P<0.05).</p><p><b>CONCLUSIONS</b>Jujing No.2 Decoction is effective in the treatment of varicocele-induced male infertility.</p>

Yiqi Zhujing granule for idiopathic oligoasthenozoospermia: a clinical study / 中华男科学杂志

<p><b>OBJECTIVE</b>To assess the efficacy of Yiqi Zhujing Particle in the treatment of idiopathic oligoasthenozoospermia.</p><p><b>METHODS</b>We equally randomized 78 patients with idiopathic oligoasthenozoospermia to a control group and a Yiqi Zhujing group, the former treated with oral medication of zinc gluconate liquid (10 ml, bid) and vitamin E (100 mg, bid), and the latter given Yiqi Zhujing Granule (1 packet, bid) in addition, both for 3 months. We compared the semen parameters and biochemical indexes of the seminal plasma obtained before and after medication between the two groups of patients.</p><p><b>RESULTS</b>After 3 months of treatment, remarkable improvement was observed in the percentage of progressively motile sperm and sperm viability in the control group (P < 0.05) as well as in the total sperm count, sperm concentration, percentage of progressively motile sperm, and sperm viability in the Yiqi Zhujing group (P < 0.05). The total sperm count, sperm concentration, percentage of progressively motile sperm, and sperm viability were even more significantly improved in the Yiqi Zhujing than in the control group (P < 0.05). Besides, both groups showed different degrees of improvement in the biochemical indexes of the seminal plasma, and the Yiqi Zhujing group exhibited even more significant improvement in seminal plasma zinc, alpha-glucoside enzyme, seminal plasma fructose, and acid phosphatase than the control (P < 0.05). The improvement of sperm concentration was correlated positively with the change of seminal plasma zinc (r = 0.201, P < 0.05) but negatively with that of seminal plasma fructose after treatment (r = -0.136, P < 0.05). There was a positive correlation between the alpha-glucoside enzyme level and sperm viability (r = 0.314, P < 0.05).</p><p><b>CONCLUSION</b>Yiqi Zhujing Particle is effective for idiopathic oligoasthenozoospermia by significantly improving the total sperm count, sperm concentration, percentage of progressively motile sperm, sperm viability, seminal plasma zinc, seminal plasma fructose, and alpha-glucoside enzyme.</p>

Evaluation on implementing postgraduate psychological mentor scheme in clinical hospitals of ;colleges and universities / 中华医学教育探索杂志

Objective To analyze the psychological condition of postgraduates in clinical hos-pitals of colleges and universities before and after the implementation of psychological mentor scheme so as to evaluate the effect. Methods Quantitative questionnaire (SCL-90 scale) and qualitative fo-cus interview were used to compare psychological condition of postgraduates. Totally 182 copies of questionnaires were sent to two hospitals (A and B) respectively. Then, psychological mentor scheme was carried out in A hospital. Afterwards, 206 and 140 copies of questionnaires were sent again to the hospitals respectively to compare the results. Eight student psychological consultants, 12 postgraduates and 5 postgraduate management staff were enrolled in qualitative focus interview. Excell2003 software was adopted to establish the database and SPSS 11.0 software was used for statistical analysis. Descrip-tive analysis, frequency analysis, t test, chi-square test and variance analysis were adopted for data analysis. P<0.05 signifies for statistically significant difference. Results Mental health status of both groups was better than the national level before the implementation (total SCL score: A hospital=118 . 08 ±36.20; B hospital =100.33 ±22.90). However, SCL-90 score of A hospital was decreased (total SCL score: 102.58 ±25.23) and that of B hospital (total SCL score:134.01 ±38.92) was in-creased (part of items higher than the adult national norm) at one year after conducting psychological mentor scheme. Conclusions Psychological mentor scheme can effectively relieve stress and interper-sonal stress so as to reduce the general psychological problems and can help to improve mental health of the students.

Effect of hypoxia training on serum testosterone(T), corticosterone(C) and T/C value in rats / 第二军医大学学报

Objective: To observe the changes of serum testosterone (T), corticosterone (C), and testosterone/ corticosterone (T/C) values in SD rats trained under different hypoxic conditions, so as to provide an experimental evidence for correct hypoxia training. Methods: A total of 60 SD rats (8-week-old) were randomly divided into 6 groups: normal control (C), normal exercise(E), 15% oxygen control (15C), 15% oxygen exercise (15E), 11% oxygen control(11C), and 11% oxygen exercise (11E) groups. The animals received treadmill running for exercise, and the levels of serum T and C were examined by ELISA. Results: (1) Testosterone level in group 11C was significantly lower than that in group C(P<0.05); testosterone level in group 11E was significantly lower than that in group E(P<0.01). (2) Corticosterone level in group E was significantly higher than that in group C(P<0.05); corticosterone levels in group 11E and 15E were significantly lower than that in group E(P<0.05). (3) The ratio of T/C in group 11C was significantly lower than that in group C(P<0.05). Conclusion: The 11% oxygen may cause negative effects on the T/C balance, but exercise may compensate the negative effect to some extent; the 15% oxygen causes no noticeable influence to T/C balance.

A preliminary study of serum free testosterone and testosterone secreting index in men with erectile dysfunction / 中华男科学杂志

<p><b>OBJECTIVE</b>To observe the changes of serum free testosterone (FT) and testosterone secreting index (TSI) in ED patients, and to assess the contribution of these two indexes to the diagnosis of ED caused by endocrine factors.</p><p><b>METHODS</b>We studied 120 ED patients and 30 healthy men undergoing pre-marital medical check-up in Jiangsu Province Hospital of TCM by analyzing the scores on erectile function and desire domain in IIEF, testing the serum total testosterone, luteinizing hormone by chemiluminescent enzyme immunoassay (CLIA), measuring free testosterone by radioimmunoassay( RIA), and calculating TSI.</p><p><b>RESULTS</b>Of the 120 ED patients, 5% and 1538% were below the reference norm of TT and FT values respectively. TT, FT and TSI decreased with age, with statistical with FT and TSI, but not with TT. FT and TSI statistically declined with lower IIEF score on ED domain, but this was not the case with TT. There were no significant differences in TI, FT and TSI among different sexual desire groups the ED patients.</p><p><b>CONCLUSION</b>FT is much more valuable than TF in the diagnosis of ED with hypogonadism. Both FT and TSI are important parameters in assessing the severity of ED.</p>

Study on the preparation of resveratrol chitosan nanoparticles with free amino groups on the surface / 中国中药杂志

<p><b>OBJECTIVE</b>To prepare resveratrol chitosan nanoparticles with free amine groups on the surface so as to conjugate ligands, which will actively target to special tissues or organs.</p><p><b>METHOD</b>The chitosan nanoparticles with free amine on the surface was prepared by sodium chloride precipitation. Nanoparticles with different solidification degrees were studied on turbidity, in vitro release, encapsulation efficiency, drug loading and diameter.</p><p><b>RESULT</b>The turbidity of nanoparticles with various solidification degrees decreased at different rates after ultrasonic or water bath heating treatment. All nanoparticles mentioned above obviously shew sustained release. The rate of release was slowed down with the increase of solidification agents. Solidification had no obvious effects on the encapsulation efficiency and drug loading. The diameter of chitosan nanoparticles with 200 microL solidification agents was 487 nm. The polydispersion was 0.144.</p><p><b>CONCLUSION</b>The diameter of the prepared nanoparticles was relatively small. The amine on the surface was free, which offered the possibility of designing the acive target drug delivery system.</p>