Research on the regulation of electronic prescription circulation under the mode of “medical science + pharmacy” / 中国药房

OBJECTIVE To provide reference for the regulation of electronic prescription circulation under the mode of “medical science + pharmacy”. METHODS Based on evolutionary game theory， a tripartite evolutionary game model was constructed for related parties of electronic prescription circulation （government agencies， internet hospitals and third-party drug platforms） under the mode of “medical science + pharmacy”. The influential factors of the three parties’ strategy selection were analyzed and verified by simulation. RESULTS & CONCLUSIONS The strategic choices of all parties in the game were affected by the other two parties. Reducing the cost of strict supervision or increasing the punishment for the other two parties would increase the probability of strict supervision of government agencies. Enhancing reputation losses， increasing penalties， and reducing the cost difference when choosing different strategies would have regulatory and binding effects on internet hospitals and third-party drug platforms. It is suggested that government agencies can introduce diversified supervision mode and establish an integrated “intelligent supervision + traceability” system； pay attention to the construction of reputation mechanism， and promote the coordinated linkage of all parties； increase the punishment for violations， provide policy support， reduce the cost of compliance behavior to promote the high-quality development of electronic prescription circulation under the mode of “medical science + pharmacy”.

Recognition of abnormal changes in echocardiographic videos by an artificial intelligence assisted diagnosis model based on 3D CNN / 中华心血管病杂志

Objective: To investigate the diagnostic efficiency and clinical application value of an artificial intelligence-assisted diagnosis model based on a three-dimensional convolutional neural network (3D CNN) on echocardiographic videos of patients with hypertensive heart disease, chronic renal failure (CRF) and hypothyroidism with cardiac involvement. Methods: This study is a retrospective study. The patients with hypertensive heart disease, CRF and hypothyroidism with cardiac involvement, who admitted in Henan Provincial People's Hospital from April 2019 to October 2021, were enrolled. Patients were divided into hypertension group, CRF group, and hypothyroidism group. Additionally, a simple random sampling method was used to select control healthy individuals, who underwent physical examination at the same period. The echocardiographic video data of enrolled participants were analyzed. The video data in each group was divided into a training set and an independent testing set in a ratio of 5 to 1. The temporal and spatial characteristics of videos were extracted using an inflated 3D convolutional network (I3D). The artificial intelligence assisted diagnosis model was trained and tested. There was no case overlapped between the training and validation sets. A model was established according to cases or videos based on video data from 3 different views (single apical four chamber (A4C) view, single parasternal left ventricular long-axis (PLAX) view and all views). The statistical analysis of diagnostic performance was completed to calculate sensitivity, specificity and area under the ROC curve (AUC). The time required for the artificial intelligence and ultrasound physicians to process cases was compared. Results: A total of 730 subjects aged (41.9±12.7) years were enrolled, including 362 males (49.6%), and 17 703 videos were collected. There were 212 cases in the hypertensive group, 210 cases in the CRF group, 105 cases in the hypothyroidism group, and 203 cases in the normal control group. The diagnostic performance of the model predicted by cases based on single PLAX view and all views data was excellent: (1) in the hypertensive group, the sensitivity, specificity and AUC of models based on all views data were 97%, 89% and 0.93, respectively, while those of models based on a single PLAX view were 94%, 95%, and 0.94, respectively; (2) in the CRF group, the sensitivity, specificity and AUC of models based on all views data were 97%, 95% and 0.96, respectively, while those of models based on a single PLAX view were 97%, 89%, and 0.93, respectively; (3) in the hypothyroidism group, the sensitivity, specificity and AUC of models based on all views data were 64%, 100% and 0.82, respectively, while those of models based on a single PLAX view were 82%, 89%, and 0.86, respectively. The time required for the 3D CNN model to measure and analyze the echocardiographic videos of each subject was significantly shorter than that for the ultrasound physicians ((23.96±6.65)s vs. (958.25±266.17)s, P<0.001). Conclusions: The artificial intelligence assisted diagnosis model based on 3D CNN can extract the dynamic temporal and spatial characteristics of echocardiographic videos jointly, and quickly and efficiently identify hypertensive heart disease and cardiac changes caused by CRF and hypothyroidism.

Exosomes secreted by hypoxia-preconditioned BMSCs promote cartilage regeneration / 中华骨科杂志

Objective:Observing the effect of exosomes derived from hypoxic Bone marrow mesenchymal stem cells (BMSCs) on the function of chondrocytes, and exploring the role and mechanism of exosomal miR-196b-5p. Evaluating the application prospects of hypoxic BMSCs exosomes and miR-196b-5p for cartilage regeneration.Methods:Chondrocytes were cultured in the supernatant of BMSCs cultured under normoxia or hypoxia, respectively. The proliferation of chondrocytes was detected by CCK-8 assay and the expressions of Collagen type 2 (Col2), Col1, Aggrecan and SOX9 were detected by qPCR to evaluate the effect of hypoxic BMSCs paracrine on chondrocyte functions. Obtaining normoxic and hypoxic exosomes through ultracentrifugation, and testing their effects on the proliferation and anabolic-related genes of chondrocytes through CCK-8 assay and qPCR. Verifying the expression of miR-196b-5p in hypoxic exosomes based on exosomal miRNA array. Knocking out miR-196b-5p in hypoxic BMSCs, and detecting the effect of hypoxic exosomal miR-196b-5p on the functions of chondrocytes by loss-of-function assay. Predicting the downstream of miR-196b-5p through bioinformatics tools, and exploring the mechanism of hypoxic exosomal miR-196b-5p by gain-of-function assays. Hypoxic exosomes and miR-196b-5p-knockout hypoxic exosomes were loaded on silk fibroin hydrogel and subcutaneously into nude mice. After 4 weeks of culture, histological staining of saffron O, Masson and biochemical content of sGAG and collagen were performed to assess the application prospect of hypoxic exosomes and hypoxic exosomal miR-196b-5p on cartilage regeneration. Results:The results of CCK-8 assay and qPCR indicated that the supernatant of hypoxic BMSCs significantly promoted the proliferation of chondrocytes 1.20±0.07 and the expression of cartilage-related markers (Col2 2.95±0.17, Aggrecan 2.45±0.27, SOX9 2.92±0.29) compared to normoxic BMSCs (0.94±0.04, 1.89±0.09, 1.67±0.21, 1.76±0.16), the differences were statistically significant ( P<0.05). The result of CCK-8 assay showed that hypoxic exosomes (1.28±0.04) promoted the proliferation of chondrocytes compared to normoxic exosomes 1.05±0.06, the differences were statistically significant ( P<0.05). CCK-8 assay revealed that the down-regulation of miR-196b-5p in hypoxic exosomes 0.99±0.06 attenuated the proliferation of chondrocytes compared to control group 1.20±0.07, the differences were statistically significant ( P<0.05); the expression of Col2 0.56±0.04, Aggrecan 0.74±0.09, and SOX9 0.45±0.05 in chondrocytes was reduced in the miR-196b-5p knockdown group compared to the control group (1.00±0.09, 1.00±0.12, 1.00±0.07), the differences were statistically significant ( P<0.05). Co-transfection of pmirGLO-BACH1-WT reporter vector with miR-196b-5p mimics decreased the luciferase activity 0.73±0.06, the differences were statistically significant ( P<0.05). Co-transfection of pmirGLO-BACH1-MUT reporter vector with miR-196b-5p mimics showed no change in luciferase activity. BACH1 is the target of miR-196b-5p. Subcutaneous culture in nude mice showed that hypoxic exosomes significantly promoted the deposition of sGAG 383.2±21.54 and collagen 67.40±3.45, while reducing the expression of miR-196b-5p in hypoxic exosomes weakened the deposition of sGAG 258.4±19.50 and collagen 57.15±4.95, the differences were statistically significant ( P<0.05). Conclusion:Hypoxic exosomes promoted the functions of chondrocytes by inhibiting the expression of BACH1 through miR-196b-5p. Hypoxic exosomes can be applied in cartilage regeneration.

Effects of internet plus continuous rehabilitation nursing on older patients after lumbar fusion / 中国康复理论与实践

ObjectiveTo observe the effects of Internet plus continuous rehabilitation nursing on older patients after lumbar fusion. MethodsFrom January, 2018 to August, 2021, 157 older patients after transforaminal lumbar interbody fusion (TLIF) in Department of Orthopedics, Chongqing General Hospital were retrospectively studied. A total of 66 patients accepting routine continuous rehabilitation nursing care were as control group, and 91 patients accepting internet plus continuous rehabilitation nursing care were as intervention group. They were assessed with Visual Analog Scale for pain (VAS), Oswestry Disability Index (ODI), Huaxi Emotional-distress Index (HEI) and Adult Health Self-management Skill Rating Scale (AHSMSRS) before, and one and three months after intervention. The compliance and nursing satisfaction were investigated with self-made questionnaire three months after intervention, and the postoperative complications were recorded. ResultsA total of 148 patients finished follow-up of three months, including 61 patients for the control group and 87 patients for the intervention group. The VAS, ODI, HEI and AHSMSRS scores improved in both groups one and three months after intervention (F > 85.4, P < 0.001), and improved more in the intervention group than in the control group (|t| > 3.645, P < 0.001). Both the compliance and nursing satisfaction were better in the intervention group than in the control group (χ2 > 5.478, P < 0.05), and no postoperative complication was observed in both groups. ConclusionInternet plus continuous rehabilitation nursing can promote the recovery of function, pain and psychological emotion, ability of self-management, compliance, and nursing satisfaction.

Conversion therapy in patients with metastatic gastric cancer / 中华普通外科杂志

Objective:To investigate clinicopathological characteristics and efficacy of conversion therapy in patients with metastatic gastric cancer.Methods:The clinicopathological and follow-up data of metastatic gastric cancer patients at the Department of Gastrointestinal Surgery of Peking University People's Hospital from Jan 2018 to Jun 2021 were retrospectively studied. Multivariate Logistic regression analysis was used to identify independent characteristics for pathological complete response (PCR). The influence of stage of metastatic gastric cancer and pathological response on prognosis were analyzed by Kaplan-Meier curve.Results:A total of 31 patients were enrolled, and 13 tumors located at the cardia or fundus, 8 at body, other 10 at pylorus or antrum . Baseline CT evaluation showed retroperitoneal lymph node metastasis in 10 cases, intraperitoneal metastasis in 10 cases, liver metastasis in 2 cases, adrenal and splenic metastasis in 1 case respectively, and multiple metastasis in 5 cases. After conversion therapy, 8 (26%) cases had pathological T0, 16 cases (52%) had pathological N0 and 7 cases (22%) had pathological complete response. Multivariate Logistic regression analysis showed retroperitoneal lymph node metastasis ( OR: 20.082, 95% CI: 2.141-188.315, P=0.009) was the only independent risk factor of PCR. Meanwhile, Kaplan-Meier curve showed pT0 improved disease-free survival significantly ( P=0.021). Conclusions:Metastatic gastric cancer patients with retroperitoneal lymph node metastasis alone had a tolerable conversion therapy effect. pT0 is a significant factor in improving prognosis.

Bioinformatics analysis of differently expressed genes in osteoblastic sarcoma and screening of key genes / 中华肿瘤杂志

Objective: To screen the different expressed genes between osteosarcoma and normal osteoblasts, and find the key genes for the occurrence and development of osteosarcoma. Methods: The gene expression dataset GSE33382 of normal osteoblasts and osteosarcoma was obtained from Gene Expression Omnibus (GEO) database. The different expressed genes between normal osteoblasts and osteosarcoma were screened by limma package of R language, and the different expressed genes were analyzed by Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis. The protein interaction network was constructed by the String database, and the network modules in the interaction network were screened by the molecular complex detection (MCODE) plug-in of Cytoscape software. The different expressed genes contained in the first three main modules screened by MCODE were analyzed by gene ontology (GO) using the BiNGO module of Cytoscape software. The MCC algorithm was used to screen the top 10 key genes in the protein interaction network. The gene expression and survival dataset GSE39055 of osteosarcoma was obtained from GEO database, and the survival analysis was performed by Kaplan-Meier method. The data of 48 patients with osteosarcoma treated in the First Affiliated Hospital of Fujian Medical University from January 2005 to December 2015 were selected for verification. The expression of STC2 protein in osteosarcoma was detected by immunohistochemical method, and the survival analysis was carried out combined with the clinical data of the patients. Results: A total of 874 different expressed genes were identified from GSE33382 dataset, including 402 down-regulated genes and 472 up-regulated genes. KEGG enrichment analysis showed that different expressed genes were mainly related to p53 signal pathway, glutathione metabolism, extracellular matrix receptor interaction, cell adhesion molecules, folate tolerance, and cell senescence. The top 10 key genes in the interaction network were GAS6, IL6, RCN1, MXRA8, STC2, EVA1A, PNPLA2, CYR61, SPARCL1 and FSTL3. STC2 was related to the survival rate of patients with osteosarcoma (P<0.05). The results showed that the expression of STC2 protein was related to tumor size and Enneking stage in 48 cases of osteosarcoma. The median survival time of 25 cases with STC2 high expression was 21.4 months, and that of 23 cases with STC2 low expression was 65.4 months. The survival rate of patients with high expression of STC2 was lower than that of patients with low expression of STC2 (P<0.05). Conclusions: Bioinformatics analysis can effectively screen the different expressed genes between osteosarcoma and normal osteoblasts. STC2 is one of the important predictors for the prognosis of osteosarcoma.

The value of myocardial work in detecting the reduction of left ventricular global systolic function in acute myocardial infarction patients with preserved ejection fraction / 中华心血管病杂志

Objective: To investigate the diagnosis value of myocardial work (MW) in evaluating left ventricular global systolic function among acute myocardial infarction (AMI) patients with preserved ejection fraction (LVEF). Methods: This study was a diagnostic trial in a prospective case-control design. AMI patients with preserved LVEF were enrolled as AMI(LVEF>50%) group and age and sex-matched healthy individuals undergoing healthy checkup in our hospital were collected as control group. Two-dimensional dynamic images, including standard apical two-chamber, long-axis and four-chamber views in 3 consecutive cardiac cycles were acquired. General clinical data, routine echocardiography and myocardial work parameters were obtained from all subjects. The indices were compared between the two groups. Intra-observer and inter-observer repeatability of myocardial work parameters were evaluated by intra-group correlation coefficient (ICC). Receiver operator characteristic (ROC) curve was used to determine the diagnostic value of global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) and global work index (GWI) on the reduction of left ventricular global systolic function in AMI(LVEF>50%) group. Results: There were 30 patients in AMI(LVEF>50%) group, the age was (67.3±9.7)years, and 14 cases were female(46.7%). Thirty participants were included in the control group, the age was (68.1±8.6)years, and 12 cases were female (40.0%). Compared with the control group, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), interventricular septum thickness (IVSD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), peak early diastolic velocity of mitral orifice/tissue Doppler velocity of posterior mitral annulus (E/e), left ventricular mass (LVM), left ventricular mass index (LVMI) were significantly higher, while E and e values were significantly lower in AMI (LVEF>50%) group (all P<0.05). Compared with the control group, GCW ((1 145.9±440.1)mmHg% (1 mmHg=0.133 kPa) vs. (1 425.7±355.4)mmHg%), GWE ((80.9±9.5)% vs. (87.3±5.5)%), GWI ((1 001.3±416.2)mmHg% vs. (1 247.6±341.7)mmHg%) and the absolute value of long axis integral strain (GLS) ((8.5±3.4)% vs. (11.4±3.7)%) were significantly lower, while peak strain dispersion(PSD)((101.3±66.4)ms vs. (74.7±31.9)ms) was significantly higher in AMI(LVEF>50%) group (P all<0 05). There was no significant difference in GWW((177.2±71.1)mmHg% vs. (155.7±64.6)mmHg%) between the two groups (P>0.05). The reproducibility of GCW, GWW, GWE and GWI within and between observers were satisfactory (all ICC>0.75). ROC curve analysis showed that all four parameters, GCW, GWW, GWE, and GWI, could be used for the diagnosis of reduced left ventricular systolic function in patients with AMI (LVEF>50%), and their areas under the ROC curve were 0.896,0.929,0.808,0.862. Conclusion: Myocardial work assessment is valuable on diagnosing left ventricular global systolic function reduction in AMI patients with preserved LVEF.

Meta-analysis of efficacy of primary tumor resection for asymptomatic metastatic colorectal cancer with unresectable metastases / 国际外科学杂志

Objective:To evaluate the efficacy and safety of primary tumor resection for asymptomatic metastatic colorectal cancer with unresectable metastases.Methods:A literature search was conducted in PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure and WanFang databases to identify studies comparing primary tumor resection and systemic treatment for asymptomatic metastatic colorectal cancer with unresectable metastases until March 31, 2021 (inchuding RCTs and non-RCTs) . The search strategy was: (((colorectal cancer) OR (colorectal neoplasms) OR (colon cancer) OR (colon neoplasms) OR (rectal cancer) OR (rectal neoplasms)) AND ((metastatic) OR (stage Ⅳ)) AND (asymptomatic) AND (primary tumor resection)). Review manager (RevMan) (Version 5.3.0, Cochrane Collaboration, Oxford, UK) was used to perform the statistical analysis.Results:A total of 14 original studies (RCT: 1; cohort study: 13) were included in this analysis with a total of 2123 patients (primary tumor resection: 1162 cases, systemic treatment: 961 cases). The results of this Meta-analysis showed that PTR group had a significantly improved overall survival in 1-year overall survival ( HR=0.80, 95% CI: 0.67~0.95, P=0.01), 2-year overall survival ( HR=0.81, 95% CI: 0.71~0.93, P=0.002), 3-year overall survival ( HR=0.82, 95% CI: 0.72~0.92, P=0.001), 4-year overall survival ( HR=0.86, 95% CI: 0.75~0.98, P=0.02) and 5-year overall survival ( HR=0.85, 95% CI: 0.74~0.97, P=0.02). The median survival time of PTR group was 4.35 months longer than that of systemic treatment group ( MD=4.35, 95% CI: 0.99~7.72, P=0.015). Conclusions:The current evidence suggests that primary tumor resection may be a potentially safe and feasible treatment strategy for asymptomatic metastatic colorectal cancer with unresectable metastases. Large sample size prospective randomized controlled trials are needed to validate our findings in the future.

Research on Optimization of Drug Supervision Strategy of Guangdong-Hong Kong-Macao Greater Bay Area Based on Tripartite Evolutionary Game / 中国药房

OBJECTIVE：To provide reference for improving the mechanism of drug supervision in Guangdong-Hong Kong-Macao Greater Bay Area. METHODS ：Based on the evolutionary game theory ，the stakeholders of Guangdong-Hong Kong-Macao Greater Bay Area in the stage of drug safety supervision were identified ；the evolutionary game model was established so as to obtain the behavioral selection and evolutionary stability strategy of the each party through and put forward the suggestions for improving the mechanism of drug supervision in Guangdong-Hong Kong-Macao Greater Bay Area. RESULTS & CONCLUSIONS：Based on evolutionary game theory ，the three-party evolutionary game model of drug administration ，drug inspection and manufacturing enterprises was established. According to the model established in this study ，it could be concluded that：when the compliance cost of the production enterprise was less than the sum of the violation cost and the bribery cost minus the additional income ，or less than the sum of violation cost and punishment and reputation lossminus the additional income ，the manufacturing enterprises could achieve the equilibrium state of compliance production ；the supervision probability was inversely proportional to the supervision cost ，and strict inspection was inversely proportional to inspection cost ；compliance productivity rate and strict detection rate were in direct proportion to the intensity of supervision and penalties ；the higher the supervision probability was，the higher the strict detection rate was ，and the compliance productivity would gradually increase. It is proposed to link enterprise information files ，lay the foundation of four party cogovernance ；introduce the “cost-benefit”supervision system ，make reasonable use of the third-party inspection institutions ；clarify the boundary of personnel responsibility ，and use the intelligent system for real-time supervision so as to promote the improvement of drug safety supervision in Guangdong-Hong Kong-Macao Greater Ba y Area.

Effects of Nicorandil on the Proliferation ，Migration Ability and Hippo/YAP Signaling Pathway of Pulmonary Artery Smooth Muscle Cells / 中国药房

OBJECTIVE：To evaluate the effects of nicorand il on the proliferation ，migration ability and Hippo/YAP signaling pathway of pulmonary artery smooth muscle cells （PASMCs）. METHODS ：Human primary PASMCs were divided into normal control group ，model group ，nicorandil low ，medium and high concentration groups （50，100，200 μmol/L），with 3 holes in each group. In addition to the normal control group ，the rest of the cells were inoculated on the gel coated medium to simulate the pulmonary hypertension environment ，so as to establish AS cell model. Then ，each drug group was added with corresponding drugs，and the normal control group and model group were added with the same volume of normal saline ，and cultured for 48 h. CCK-8 assay and Transwell assay were used for the examination of cell proliferation （by light density ）and migration ability ， respectively. mRNA expression of YAP target factors （CTGF and AREG ）were examined by qRT-PCR. Western blotting assay was used to detect the protein expression of CTGF and AREG. RESULTS ：Compared with normal control group ，light density of cells was increased significantly in model group ；the number of migration cells per field of view increased significantly ；mRNA and protein expression of CTGF and AREG were significantly increased （P＜0.01）. Compared with model group ，light density ，the number of migration cells per field of view ，mRNA and protein expression of CTGF and AREG in nicorandil low ，medium and high concentration groups were decreased significantly ， in concentration-dependent manner （P＜0.05 or P＜0.01）. CONCLUSIONS：Nicorandil can inhibit the proliferation and migration of PASMCs in AS model ，the mechanism of which cstc2019jscx-msxmX0174） may be associated with the Hippo/YAP signaling pathway.

Outcomes of perisurgery and short-time follow-up of pelvic exenteration for 17 cases with locally recurrent cervical cancer / 中华妇产科杂志

Objective:To investigate the perioperative situation and recent effect of pelvic exenteration for patients with locally recurrent cervical cancer.Methods:A total of 17 patients with locally recurrent cervical cancer who underwent pelvic exenteration in Peking University People's Hospital from October 2015 to May 2018 were retrospectively analyzed for their clinical and pathological characteristics, surgical conditions, hospitalization costs, postoperative complications, and survival situation.Results:(1) The median age of 17 patients with locally recurrent cervical cancer was 51 years (range 27-64 years). Pathological type: 13 cases of squamous cell carcinoma, 2 cases of adenocarcinoma, and 2 cases of adenosquamous carcinoma. Thirteen patients received radiotherapy during the initial treatment and 4 patients did not receive radiotherapy. (2) Pelvic exenteration was performed in 17 patients with locally recurrent cervical cancer, of which 9 cases were performed with total pelvic exenteration (operation range including radical cystectomy, partial urethrectomy rectectomy and partial vaginalectomy), and 8 cases with anterior pelvic exenteration operation (operation range including: radical cystectomy, part of urethrectomy and part of vaginalectomy). Of the 17 patients successfully completed the operation. The median operation time was 450 minutes (range 240-760 minutes), the median intraoperative blood loss was 2 200 ml (range 200- 8 400 ml), the median postoperative hospital stay was 17 days (range 9-55 days), the median hospital cost was 83 857 yuan (range 41 588-296 354 yuan). (3) Of the 17 patients underwent pelvic exenteration, 16 of them had early complications, the most common one was fever (14 cases). Fourteen of them had late complications, and the most common one was a urinary system infection (12 cases). (4) The median overall survival time was 26.0 months (range 3-44 months), the median progression-free survival (PFS) time was 9.0 months (range 2-44 months). Among them, 13 patients received radiation therapy during the initial treatment, the median PFS time was 9.0 months (range 2-30 months); 4 patients did not receive radiation therapy in the initial treatment, the median PFS time was 10.5 months (range 2-44 months).Eleven patients received adjuvant therapy after pelvic exenteration, the median PFS time was 12.0 months (range 2-44 months); 6 patients did not receive adjuvant therapy, the median PFS time was 5.0 months (range 2-9 months).Conclusions:Pelvic exenteration has a wide range of operations, many postoperative complications, and high hospitalization costs. Adjuvant treatment after pelvic exenteration could improve the PFS time for some patients. Its clinical value and health economic value need to be further explored.

Procedure for prolapse and hemorrhoids versus stapled transanal rectal resection in the treatment of grade IV hemorrhoids / 中华胃肠外科杂志

Objective@#To compare the efficacy and safety of two procedures in the treatment of hemorrhoid: the procedure for prolapse and hemorrhoids (PPH) and stapled transanal rectal resection (STARR).@*Methods@#A retrospective cohort research was conducted. Clinical data of 263 patients undergoing the first elective surgery for grade IV hemorrhoids by the same team of surgeons at our department from January 2015 to December 2016 were analyzed retrospectively, while those had other anorectal diseases, emergency surgery, inflammatory bowel disease, tumor and incomplete clinical data were excluded. PPH was performed in 129 patients and STARR was performed in 134 patients. PPH procedure: a circular purse 2-0 string suture was made at 4 cm above the dentate line; in accordance with the standard protocol, the PPH circular stapling devicewas introduced; the suture was closed, and a pull-through followed; the traction was continued; the stapler was fired; the prolapsed mucosa and submucosa were removed. STARR procedure: 3-5 needles were sutured in the anterior rectal mucosa, protecting the posterior wall mucosa; with the help of a finger the PPH stapler was inserted into the vaginal lumen; the sutures were hooked from both sides of the stapler to maintain traction; according to the disease condition, the suturewas tightened appropriately; stapler was screwed and activated; the anterior wall mucosa was removed; the joint of the both ends of anastomosis was cut; the posterior wall mucosa was removed as well. The short-term efficacy, surgical safety and prognosis of the two groups were compared.@*Results@#There were 67 males (51.9%) in the PPH group and 57 (42.5%) males in the STARR group. The median age of the two groups was 51.0 (22.0, 80.0) years and 49.0 (24.0, 74.0) years, respectively. There were no significant differences in the baseline data between the two groups (all P>0.05). No significant differences in the intraoperative bleeding, length of hospital stay, postoperative analgesic drug use, postoperative bleeding, postoperative infection, etc. were found between two groups (all P>0.05). As compared to PPH group, STAAR group had longer operation time and higher hospitalization cost with significant differences [(44.0±19.3) minutes vs. (26.3±8.5) minutes, t=9.701, P=0.001; (11 047±473) yuan vs. (7674±309) yuan, t=32.826, P=0.001]. One case in STAAR group developed rectovaginal fistula. The median follow-up period of the whole group was 40 (33, 52) months. A total of 108 cases in STARR group and 114 cases in PPH group completed the follow-up. The 3-year disease-relapse rate was 0 in STARR group and 4.2% in PPH group (P=0.042).@*Conclusion@#STARR procedure can improve the prognosis in the treatment of grade IV hemorrhoid, but attention should be paid to the development of complications.

Analysis of mismatch repair status in relation to clinicopathological characteristics and prognosis in colon cancer / 中华普通外科杂志

Objective To investigate the influence of mismatch repair status on clinicopathological characteristics and prognosis in patients with colon cancer.Methods Patients who underwent radical excision for colon cancer between Nov 2012 and Mar 2016 at Peking University People's Hospital were enrolled.Clinicopathological data and prognosis were collected.Multivariate analysis were used to identify independent characteristics of MMR-deficient colon cancer.The influence of MMR-deficient on prognosis of colon cancer were analyzed through Kaplan-Meier curve.Results The overall rate of MMR-deficient in colon cancer was 17.1％ (51/299).Multivariate logistic regression analysis showed that low differentiation (OR =3.555,95％ CI:1.685-7.640,P ＜ 0.001),right-sided colon cancer (OR =5.645,95％ CI:2.483-14.715,P ＜ 0.001) and UICC Stage Ⅰ-Ⅱ (OR =4.099,95％ CI:1.863-9.840,P ＜0.001) were associated with MMR-deficient colon cancer.Conclusion Low differentiation,right-sided colon cancer and UICC Stage Ⅰ-Ⅱ were more common in MMR-deficient colon cancer.

Role of microRNA-373 in tumor / 国际肿瘤学杂志

MicroRNAs are non-coding small RNAs that participate in the regulation of post transcriptional gene expression.MicroRNAs play the roles of inhibiting cancer or promoting cancer in different tumors.MicroRNA-373 is one of the members of the microRNA-520/373 family,which is involved in cancer anoxic response and DNA damage repair.MicroRNA-373 is abnormal expressed in breast cancer,glioma,lung cancer,prostate cancer and other tumors,which may play an important role in tumor development process,especially in tumor invasion and migration.

Mechanism of lnc-AC079612.1.1-1∶1 in hepatic metastasis of colon cancer / 国际外科学杂志

Objective To investigate the mechanism of lnc-AC079612.1-1∶1 in the metastasis of colorectal cancer by regulating miR-1915 expression and provide a theoretical basis for new therapeutic targets of colon cancer.Methods Continuously harvested 3 pairs of primary tumor and hepatic metastases of patients with synchronous colon cancer with liver metastasis.LncRNA + mRNA Human Gene Expression Microarray V4.0 and 4 × 180K Expression Microarray were used to detect the Expression profile of LncRNA in primary colon cancer and matched liver metastases.The detection of expression profile chip was used to find some lncRNAs that may be closely associated with colon cancer liver metastasis,and through the literature retrieval,the author preliminarily analyzed the co-expression encoding genes of lncRNAs,in order to find lncRNAs that may play key roles in the process of colon cancer liver metastasis.The effect of lnc-AC079612.1.1-1∶1 on the proliferation capacity of colon cancer cell lines was detected in SW480 cell lines and SW620 cell lines of colon cancer through CCK-8 experiment.Effects of lnc-AC079612.1.1-1∶1 on the migration and invasion of colon cancer cells were examined by Transwell cell invasion assay.Through TargetScan,Miranda,LNCipedia and other web tools,miRNAs that may bind to lncRNA and o-6-methylguanine-DNA methyl transferase (MGMT) were predicted.Double luciferase reporter gene assay was used to detect the interaction between miR-1915 andlnc-AC079612.1.1-1 ∶ 1.SPSS 22.0 statistical software was used to analyze the data.The measurement data were expressed as ((x) ± s).T test was compared between the two groups,and multiple groups were compared with F test.Results The expression of lnc-AC079612.1-1 ∶ 1 was 3.94 times higher in the liver metastases than in the primary tumor,and expression of MGMT was 3.74 times higher in the liver metastases than in the primary tumor.The results showed that there was a significant co-expression relationship between the lncRNA and o-6-methylguanine DNA transferase (MGMT) gene,and the co-expression correlation coefficient was 0.994 (P ＜ 0.001).The over expression of lnc-ac079612.1.1-1∶1 could significantly enhance the proliferation capacity of SW480 and SW620 cell lines of colon cancer through the CCK-8 experiment.The over expression of lnc-ac079612.1.1-1:1 could promote the invasion and metastasis of SW480 and SW620 cell lines of colon cancer through Transwell cell invasion experiment.MirR-1915-3p was the only miRNA that predicted to be combined with lnc-ac079612.1-1∶1 and MGMT through TargetScan,Miranda,LNCipedia and other web tools.Lnc-ac079612.1.1-1∶1 was found to bind to miR-1915 by double luciferase assay.Conclusion Lnc-ac079612.1.1-1∶ 1 may participate in the liver metastasis process of colon cancer by regulating MGMT,and may play a role in the liver metastasis of colon cancer through the action of mir-1915 on MGMT.

Effects of unilateral and bilateral diffusion of cement on osteoporotic vertebral compression fractures treated with percutaneous kyphoplasty / 中华创伤杂志

Objective To evaluate the effects of unilateral and bilateral diffusion of cement on osteoporotic vertebral compression fractures treated with percutaneous kyphoplasty (PKP). Methods A retrospective case control study was conducted on the clinical data of 127 patients with single segment osteoporosis vertebral compression fracture (OVCF) treated by unilateral puncture PKP between July 2013 and July 2015. According to whether the diffusion of bone cement crossed the median, all cases with OVCF were divided into unilateral and bilateral diffusion groups. The unilateral diffusion group (72 cases) included 29 males and 43 females, with an average age of 69.5 ± 2.6 years (range, 63-76 years). In terms of the injured segment, there were 38 cases of L1, 20 L2, 11 L3, two L4, and one L5. In the unilateral diffusion group, the preoperative visual analog score (VAS) was (7.8 ±0.9) points, the preoperative anterior vertebral height compression ratio was (32.5 ±6. 3)％, and the preoperative Cobb's angle of the injured vertebra was (9.2±1.3)°. The bilateral diffusion group (55 cases) included 22 males and 33 females, with an average age of 71.2 ±2.9 years (range, 61-80 years). In terms of the injured segment, there were 32 cases of L1, 13 L2, six L3, three L4, and one L5. In the bilateral diffusion group, the preoperative VAS was (7.6 ±0. 9)points, the preoperative anterior vertebral height compression ratio was (34.5 ±5.8)％, and the preoperative Cobb's angle of the injured vertebra (9.8± 1.5)°. The VAS, anterior vertebral height compression ratio of the injured vertebra, Cobb's angle of the injured vertebra, and injured and non-injured vertebra refracture 1 month and 1 year after operation were recorded. Results The patients were followed up for 12-16 months (mean, 14.6 ± 0.6 months) in unilateral diffusion group and for 13- 16 months (mean, 15.2 ±0.2 months) in bilateral diffusion group. The VAS score of the unilateral diffusion group was (3.0 ±0.4) points at 1 month after the operation and (2.2±0. 4) points at 1 year after the operation, respectively. The VAS score of the bilateral diffusion group was (2.1 ±0.4) points at 1 month after the operation and (1.5 ± 0.4) points at 1 year after the operation, respectively. The VAS score decreased significantly 1 year after operation compared with that before operation (P ＜0.05), and significant difference was noted between two groups (P ＜0.05). The anterior vertebral height compression ratio of the unilateral diffusion group was (15.2±3.9)％ at 1 month after the operation and (16.3 ±3.4)％ at 1 year after the operation, respectively. The anterior vertebral height compression ratio of the bilateral diffusion group was (15.6±3.5)％ at 1 month after the operation and (16.8 ±3.9)％ at 1 year after the operation, respectively. The Cobb's angle of the injured vertebra of the unilateral diffusion group was (2.9±0.7)° at 1 month after the operation and (3.0±0.6)°at 1 year after the operation, respectively. The Cobb's angle of the injured vertebra of the bilateral diffusion group was (3.0 ± 0.7) ° at 1 month after the operation and (3.2 ± 0.7) ° at 1 year after the operation, respectively. The anterior vertebral height compression ratio and Cobb's angle of the injured vertebra decreased significantly after surgery (P ＜ 0.05), but no statistically significant differences were observed between two groups (P＞0.05). The injured vertebra refracture ratio was 6.9％ in unilateral diffusion group and 0 in bilateral diffusion group. The non-injured vertebra refracture ratio was 5.6％ in unilateral diffusion group and 5.5％ in bilateral diffusion group. No nerve root injury, cerebrospinal fluid leakage, pulmonary embolism, anaphylactic shock and postoperative infection were found in the two groups. Paravertebral bone cement leakage occurred in two cases of the unilateral diffusion group and anterior vertebral bone cement leakage occurred in one case of the bilateral diffusion group. Conclusion Compared with unilateral diffusion, bilateral diffusion of bone cement has better analgesic effect and can reduce the incidence of re fracture of injured vertebra, without increasing the risk of re-fracture of the non-injured vertebrae.

α7 Nicotinic acetylcholine receptor agonistinhibits bone cement particles stimulated secretion of inflammatory cytokinesin peripheral blood monocytes of mice / 基础医学与临床

Objective To investigate the effect of α7 nicotinic acetylcholine receptor(α7nAChR) agonist agent PNU282987 on bone cement particles stimulated secretion of inflammatory cytokines in peripheral blood monocytes and its molecular mechanism.Methods Mouse peripheral blood monocytes were isolated and the inflammatory response were induced by PMMA particles.TNF-α, IL-1β and IL-6 concentration in culture supernatant were measured by ELISA.TNF-α, IL-1β and IL-6 mRNA expression were measured by RT-PCR.p-p65, p65, p-JAK2, JAK2, p-STAT3, STAT3, and β-actin expression were detected by Western blot.NF-κB DNA binding activity were measured by ELISA.ResultsAfter stimulation of PMMA particles, TNF-α, IL-1β and IL-6 concentration in culture supernatant was significantly increased(P<0.05), TNF-α, IL-1β and IL-6 mRNA expression was significantly increased (P<0.05), p-p65, p-JAK2 and p-STAT3 expression and NF-κB DNA binding activity was also increased significantly (P<0.05).However, after PNU282987 treatment, TNF-α, IL-1β and IL-6 concentration in culture supernatant decreased(P<0.05), TNF-α, IL-1β and IL-6 mRNA expression decreased in a concentration gradient way(P<0.05), p-p65, p-JAK2 and p-STAT3expression and NF-κB p65 DNA binding activity was also decreased(P<0.05).Conclusions α7nAChR agonist PNU282987 significantly inhibites PMMA bone cement particles induced secretion of inflammatory cytokines in peripheral blood monocytes of mice.

da Vinci robotic system versus laparoscopic surgery for colorectal cancer / 中华普通外科杂志

Objective To compare the surgical outcomes of RAC versus LAC for the surgery of sigmoid-rectal cancer.Methods In this study,19 patients received robotic assisted colectomy (RAC)and 37 patients received laparoscopic assisted colectomy (LAC).Results The duration of surgery was longer in the RAC group (240 ± 76) min vs.(177 ± 74) min,t =3.006,P =0.004.The blood loss was less in the RAC group (67 ±40) vs.(153 ±151) ml,t =-2.422,P=0.019.The time to tolerate solid food was shorter in the RAC group (6.1 ±2.2)d vs.(7.4 ±4.4)d,t =-1.329,P =0.189 and the postoperative hospital stay was shorter in the RAC group (8.5 ± 2.6) d vs.(10.0 ± 3.6) d,t =-1.577,P =0.121.Mobidity and number of lymph nodes harvested were similar in both groups.7 cases were converted to open surgery in LAC group but none in RAC group.Conclusion Compared to laparoscopic surgery,Robotic-assisted colorectomy was safe and associated with less blood losses,lower conversion rate to open surgery and faster recovery of bowel function.

Application of transperineal single-port access assisted extralevator abdominoperineal excision in low rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility and safety of transperineal single-port laparoscopy assisted exralevator abdominoperineal excision(TPSP-ELAPE).</p><p><b>METHODS</b>Three cases (2 males and 1 female) who underwent TPSP-ELAPE at lithotomy position in the Peking University People's Hospital from January to February 2016 were analyzed retrospectively. The mean age was(55.3±7.2) years. Mean body mass index (BMI) was (23.0±1.3) kg/m(2). Mean distance between tumor and anal verge was (1.8±0.3) cm. Abdominal procedure was done firstly and then perineal procedure under lithotomy position. Abdominal procedure was performed by routine laparoscopy with 5 trocars. TPSP-ELAPE procedure was performed in perineal procedure. The perineal defect was closed by purse string, followed by spindle incision around the anus. Perianal skin and subcutaneous tissue was dissected until the junction between extra anal sphincter and levator ani muscle under direct vision. Perineal skin was sutured with double purse string by 2-0 prolene, and single port canal was placed inside in order to close perineal defect. The pneumoperitoneal pressure was set to 10 mmHg and laparoscopy and instrument was placed through the single-port canal. Space between isochioanal fossa and levator ani muscle was exposed by the contraction of laparoscopic clam. Lateral and posterior side was mobilized firstly. The anterior was dissected under the help of vaginal examination and contraction by abdominal group. The levator ani muscle was divided near the initial site, and negative resection margin was confirmed in the operation. Specimen was exteriorized through the perineum.</p><p><b>RESULTS</b>The mean intraoperative blood loss of three cases was (123.3±25.2) ml. The total operative time was (296.7±25.1) minutes. The time used by the perineal group was (196.7±20.8) minutes. The volume of drainage was (39.0±10.1) ml at the third day after operation. The time to first stoma output was (2.3±0.6) days. The perineal drainage removal time was (7.7±0.6) days. The circumferential resection margins were negative in all specimens, and there were no perioperative complications.</p><p><b>CONCLUSION</b>TPSP-ELAPE is feasible and safe, which could avoid turning over the patient and facilitate anesthesia. It follows the anatomic plane of open ELAPE procedure with minimally invasive advantage.</p>

Efficacy comparison of laparoscopy and open resection for gastrointestinal stromal tumor at the esophagogastric junction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the clinical outcomes between laparoscopy and open resection for gastrointestinal stromal tumor at the esophagogastric junction.</p><p><b>METHODS</b>Clinicopathological data of 42 patients with gastrointestinal stromal tumor (GIST) of esophagogastric junction undergoing resection in our department between October 2004 and October 2014 were retrospectively analyzed. Among them, 22 patients underwent laparoscopic resection (LR group) and 20 patients underwent open resection (OR group). Short-term efficacy and long-term outcomes were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences between the two groups in common data of patients. The recovery time in the LR group was significantly shorter than that in the OR group, including bowel function recovery, ambulation, resumption of oral intake, and postoperative hospital stay (all P<0.05). The incidence of postoperative complications in the LR group was lower than that in the OR group(0 vs. 10%, P=0.221). Meanwhile difference of 5-year disease-free-survival between the two groups (LR 100% vs. OR 89%, P=0.384) was not statistically significant.</p><p><b>CONCLUSION</b>Laparoscopic resection for gastrointestinal stromal tumor at the esophagogastric junction is superior to open resection in short-term efficacy, and similar to open resection in long-term outcomes.</p>