[Ameliorative effect of rare ginsenosides on reproductive injury induced by cyclophosphamide in female rats: based on metabonomics].

Objective: To investigate the effect of rare ginsenosides (RGS) on reproductive injury induced by cyclophosphamide (CP) in female rats. Methods: Twenty-four female rats were divided into four groups [normal control (NC), RGS, CP, and CP+RGS group] with 6 rats in each group. CP group (the model group) and CP+RGS group (the treatment group) were intraperitoneally injected with CP 30 mg/kg for 5 days for modeling, and CP+RGS group was given RGS intragastric intervention. General growth status of rats in each group was observed, the organ index was calculated, and the pathological changes of ovary, uterus, liver and kidney were observed by hematoxylin-eosin staining. Serum levels of estradiol, follicle stimulating hormone (FSH), luteinizing hormone (LH), pro-inflammatory factors interleukin (IL) 6, IL-1ß, tumor necrosis factor-α were detected. The urine samples were collected after RGS treatment for metabonomics analysis. Metabolomic profiling based on ultra performance liquid chromatography (UPLC) coupled with mass spectrometry (MS) was used to analyze and determine the urine metabolites of rats in each group. Results: Compared with NC group, the ovary index of CP group [(0.054±0.015) %] was significantly decreased (P<0.05), the uterus index [(0.293±0.036) %] and estradiol level [(62.9±6.4) pmol/L] were significantly decreased (all P<0.01), serum levels of FSH, LH, IL-6 and IL-1ß [(20.4±1.0) U/L, (29.0±3.0) U/L, (185.4±28.6) ng/L, (72.9±2.0) ng/L, respectively] were significantly increased (all P<0.01). Compared with CP group, the ovary index in CP+RGS group [(0.075±0.010) %] was significantly increased (P<0.05), serum estradiol level [(122.1±16.2) pmol/L] was significantly increased (P<0.01), serum FSH, IL-1ß and IL-6 levels [(16.7±1.0) U/L, (111.8±17.4) ng/L, (60.1±2.2) ng/L, respectively] were significantly decreased (all P<0.01). Metabonomics analysis results showed that, a total of 352 metabolites were detected in urine, of which 12 were found to be potential markers associated with reproductive injury according to the screening standard. After treatment with RGS, differential metabolites were improved in the direction of NC group. Pathway enrichment suggests that the therapeutic effect of RGS was related to multiple metabolic pathways, including purine metabolism and taurine and hypotaurine metabolism. Conclusion: RGS might reduce inflammation and thus ameliorate the damage caused by CP to the reproductive system of female rats by affecting purine metabolism and other pathways.

A fast radio burst source at a complex magnetized site in a barred galaxy.

Fast radio bursts (FRBs) are highly dispersed, millisecond-duration radio bursts1-3. Recent observations of a Galactic FRB4-8 suggest that at least some FRBs originate from magnetars, but the origin of cosmological FRBs is still not settled. Here we report the detection of 1,863 bursts in 82 h over 54 days from the repeating source FRB 20201124A (ref. 9). These observations show irregular short-time variation of the Faraday rotation measure (RM), which scrutinizes the density-weighted line-of-sight magnetic field strength, of individual bursts during the first 36 days, followed by a constant RM. We detected circular polarization in more than half of the burst sample, including one burst reaching a high fractional circular polarization of 75%. Oscillations in fractional linear and circular polarizations, as well as polarization angle as a function of wavelength, were detected. All of these features provide evidence for a complicated, dynamically evolving, magnetized immediate environment within about an astronomical unit (AU; Earth-Sun distance) of the source. Our optical observations of its Milky-Way-sized, metal-rich host galaxy10-12 show a barred spiral, with the FRB source residing in a low-stellar-density interarm region at an intermediate galactocentric distance. This environment is inconsistent with a young magnetar engine formed during an extreme explosion of a massive star that resulted in a long gamma-ray burst or superluminous supernova.

Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience.

Peroral endoscopic myotomy (POEM) in patients with achalasia who are status post bariatric surgery may be technically challenging due to postsurgical scarring and altered anatomy. The aim of the study was to assess the efficacy and safety of POEM for achalasia in patients with prior bariatric surgery. A review of prospectively maintained databases at three tertiary referral centers from January 2015 to January 2021 was performed. The primary outcome of interest was clinical success, defined as a post-treatment Eckardt score ≤ 3 or improvement in Eckardt score by ≥ 1 when the baseline score was <3, and improvement of symptoms. Secondary outcomes were adverse event rates and symptom recurrence. Sixteen patients status post Roux-en-Y gastric bypass (n = 14) and sleeve gastrectomy (n = 2) met inclusion criteria. Indications for POEM were achalasia type I (n = 2), type II (n = 9), and type III (n = 5). POEM was performed either by anterior or posterior approach. The pre-POEM mean integrated relaxation pressure was 26.2 ± 7.6 mm Hg. The mean total myotomy length was 10.2 ± 2.7 cm. The mean length of hospitalization was 1.4 ± 0.7 days. Pre- and postprocedure Eckardt scores were 6.1 ± 2.1 and 1.7 ± 1.8, respectively. The overall clinical success rate was 93.8% (15/16) with mean follow-up duration of 15.5 months. One patient had esophageal leak on postprocedure esophagram and managed endoscopically. Dysphagia recurred in two patients, which was successfully managed with pneumatic dilation with or without botulinum toxin injection. POEM appears to be safe and effective in the management of patients with achalasia who have undergone prior bariatric surgery.

[Clinical experiences of laparoscopic radical cystectomy and urinary diversion in the elderly patients with bladder cancer].

Objective: To optimize the surgical procedures of laparoscopic radical cystectomy and urinary diversion for the elderly patients with bladder cancer, generalize operating technique, summarize clinical experiences. Methods: From July 2004 to October 2016, laparoscopic radical cystectomy (LRC) and urinary diversion was performed in 68 elderly patients (≥75 years old) diagnosed with bladder cancer in urology department of Beijing Chaoyang Hospital, Capital Medical University, and the relevant clinical and follow-up data were retrospectively reviewed. All the patients were pathologically diagnosed and their perioperative data, postoperative pathological results, postoperative complications and follow-up outcomes were recorded and analyzed. Results: Among 68 elderly patients with bladder cancer, fifty patients were male and 18 were female, the age of whom were (79±4) (range 75 to 91) years old. The Charlson comorbidity index (CCI) score was 6±1 (range 5 to 7). All the 68 operations were successfully performed without conversion to open surgery. There were 26 cases receiving cutaneous ureterostomy, 34 cases receiving ileal conduit (intracorporeal for 16 cases and extracorporeal for 18 cases) and 8 cases receiving orthotopic ileal neobladder (intracorporeal for 4 cases and extracorporeal for 4 cases; Xing's technique for 4 cases, T-Pouch for 2 cases and Studer-Pouch for 2 cases) respectively, and the operation time of these three groups were (221±47) min, (315±70) min and (358±90) min respectively, the estimated blood loss were 100 (87, 200)ml, 300 (250, 500) ml and 250 (113, 725) ml respectively, the time of intake of liquid diet were 3 (2, 4) d, 6 (5, 7) d and 9 (5, 12) d respectively, and the postoperative hospital stay were (12±6) d, (24±11) d, and (27±11) d respectively. Postoperative pathological results showed urothelial carcinoma in 64 patients, squamous cell carcinoma in 2 patients and adenocarcinoma in 2 patients. Sixty patients received laparoscopic pelvic lymphadenectomy and the number of dissected lymph nodes was 17.1±7.0. There were 46 cases with T stage greater than or equal to T2 (46/68, 67.6%), 4 cases of low grade (4/68, 5.9%) and 60 cases of high grade (60/68, 88.2%). All the early postoperative (within 30 days after the operation) complications were grade Ⅰ-Ⅱ mainly manifested as fever, pain and infection that could get better with symptomatic treatment, and the incidence rate were 30.8% for cutaneous ureterostomy, 29.4% for ileal conduit and 37.5% for orthotopic ileal neobladder. The patients were followed up for a median period of 93.5 months without obvious hydronephrosis and impaired renal function. The 5-year cancer specific survival rate and overall survival rate were 57% and 50% respectively. There was significant difference between the preoperative and postoperative QOL (quality of life) score (56.0±10.0 and 47.4±5.8 respectively, P<0.05) which indicated that the patients' postoperative quality of life was greatly improved. Conclusions: Laparoscopic radical cystectomy and urinary diversion for the elderly patients with bladder cancer is safe and feasible, and owns great therapeutic value.

[Expression of matrix metalloproteinase-3 in patients with reheumatoid arthritis and its correlation with chronic periodontitis and rheumatoid arthritis].

Objective: To detect the expression of matrix metalloproteinase-3 (MMP-3) in serum and gingival crevicular fluid in patients with rheumatoid arthritis (RA) and its correlation with chronic periodontitis (CP). Methods: From March 2017 to July 2018, 26 patients with RA and CP [CP+RA group, (54.9±6.5) years old, 4 males and 22 females], 22 patients with RA only [RA group, (49.6±11.7) years old,5 males and 17 females] in the Department of Rheumatology and Immunology, Shengjing Hospital Affiliated to China Medical University, 22 patients with simple CP in the Department of Stomatology, Shengjing Hospital Affiliated to China Medical University [CP group, (51.4±12.5) years old, 8 males and 14 females] and 18 generally healthy controls in Physical Examination Center of Shengjing Hospital Affiliated to China Medical University [group H, (49.4±9.1) years old, 8 males and 10 females] were recruited. There were no significant differences in age and sex ratio amongst 4 groups. Patient's general status, probing depth (PD) , clinical attachment loss (CAL), sulcus bleeding index (SBI), simplified calculus index (CI-S) and simplified debris index (DI-S) were recorded in 4 groups. Samples of serum and gingival crevicular fluid were collected from patients of each group, and the expression levels of MMP-3 in serum and gingival crevicular fluid samples were detected by using enzyme-linked immunosorbent assay. Erythrocyte sedimentation rate, rheumatoid factor, anti-cyclic citrulline peptide antibody and C-reactive protein were detected in the serum of subjects in RA group and CP+RA group. Correlation analysis was conducted between MMP-3 expression level and periodontal indices amongst 4 groups. The results were statistically analyzed using the SPSS 20.0 software package. Results: The indices of CAL [(4.12±1.13) mm], SBI (2.58±0.64) and DI-S (2.65±0.69) in CP+RA group were significantly higher than indices of CAL [(3.00±0.00) mm], SBI (2.59±1.05) and DI-S, (2.36±0.49) in CP group (P<0.05); The expression levels of MMP-3 in serum samples of CP+RA group [(1 1645.6±6 903.4) µg/L] and CP group [(9 337.0±6 719.0) µg/L] were significantly higher than that of RA group [(2 389.9±1 320.3) µg/L] and H group [(1 493.5±292.1) µg/L] (P<0.05). The expression level of MMP-3 in gingival crevicular fluid samples of CP+RA group [(164.4±45.3) µg/L] was significantly higher than that of CP group [(84.6±92.5) µg/L], RA group [(49.0±18.1) µg/L] and H group [(20.4±6.3) µg/L] (P<0.05), respectively. The erythrocyte sedimentation rate, rheumatoid factor and anti-cyclic cirullinated peptide antibodies levels in the CP+RA group were significantly higher than those in the RA group (P<0.05). The expression level of MMP-3 in serum is positively correlated with PD (r=0.45, P=0.04) and the expression level of MMP-3 in gingival crevicular fluid is positively correlated with CAL (r=0.58, P<0.01). Conclusions: The levels of MMP-3 in serum and gingival crevicular fluid of patients with RA and CP were significantly increased. MMP-3 may be associated with the development of CP and RA.

[Clinical applications of intelligent pressure control flexible ureteroscope for the treatment of renal calculi ≤2 cm].

Objective: To evaluate the effectiveness and safety of intelligent pressure control flexible ureteroscope for management of renal stones ≤2 cm. Methods: The clinical data of 267 cases of renal calculi treated with flexible ureteroscope lithotripsy at Department of Urology, Ganzhou People's Hospital from June 2015 to December 2017 were analyzed retrospectively. There were 129 male and 138 female patients, with a mean age of 51.2 years (ranging from 19 to 76 years). Among them, 145 patients underwent intelligent pressure control flexible ureteroscope (intelligent control group) and 122 patients underwent flexible ureteroscope ordinary (ordinary group). The t test, χ2 test or Fisher exact test were used for statistical analysis. The success rate of stone seeking, the stone free rates, the incidence of complications, the average operation time, the average hospital stay after operation were compared between the two groups. Results: The average mean operative time of the patients with intelligent control group was (26.17 ± 8.64) minutes, significantly shorter than (47.23±18.35) minutes of the ordinary group (t=1.968, P=0.000). The stone free rate of the patients with intelligent control group was 97.2%, it was higher than 86.0% of ordinary group (χ2=0.069, P=0.004). The complication rate of the patients with intelligent control group was 2.7%, which was significantly shorter than 18.0% of the ordinary group (χ2=17.586, P=0.000). However, there was no significant difference between the two groups in the success rate of stone seeking and postoperative hospital stay (P>0.05). Conclusion: Intelligent controlled pressure ureteral flexible ureteroscope has the advantages of short operation time, high stone free rate and less complications in the treatment of renal calculi ≤2 cm compared with flexible ureteroscope ordinary.

[The relationships between researchers and subjects in epidemiological studies].

The relationship between the researchers and the subjects would influence the data collection process in epidemiological studies. It would be conducive to obtain more in-depth and effective research data and find the problems or related influencing factors if we reflect on the relationship between the researchers and the subjects.

[Schwannoma of the ethmoid sinus in children: a case report].

A ten years old male patient，the main symptom was prsented as the left nasal obstruction, repeated hemorrhage with hyposmia. Large translucent neoplasm can be seen in the left side of the nasal cavity. CT and MRI of the nasal sinus showed that the soft tissue density shadow in the left side of the ethmoid sinus and the surrounding bone with no damage. He was treated with nasal endoscopic surgery. Postoperative pathology showed schwannoma. The tumor recurred three years later, and the patient underwent nasal endoscopic surgery again. In the literature we reviewed the case to analyze the reasons of recurrence.

Utility of endoscopic therapy in the management of Boerhaave syndrome.

Background/aims: The optimal intervention for Boerhaave perforation has not been determined. Options include surgical repair with/without a pedicled muscle flap, T tube placement, esophageal resection or diversion, or an endoscopic approach. All management strategies require adequate drainage and nutritional support. Our aim was to evaluate outcomes following Boerhaave perforation treated with surgery, endoscopic therapy, or both. Patients and methods: We performed a 10-year review of our prospectively maintained databases of adult patients with Boerhaave perforations. We documented clinical presentation, extent of injury, primary intervention, "salvage" treatment (any treatment for persistent leak), and outcome. Results were analyzed using the Fisher's exact and Kruskal - Wallis tests. Results: Between October 2004 and October 2014, 235 patients presented with esophageal leak/fistula with 17 Boerhaave perforations. Median age was 68 years. Median length of perforation was 1.25 cm (range 0.8 - 5 cm). Four patients presented with systemic sepsis (two treated with palliative stent and two surgically). Primary endotherapy was performed for eight (50 %) and primary surgery for eight (50 %) patients. Two endotherapy patients required multiple stents. Median stent duration was 61 days (range 56 - 76). "Salvage" intervention was required in 2/8 (25 %) endotherapy patients and 1/8 (13 %) surgery patient (stent). All patients healed without resection/reconstruction. There were no deaths in the surgically treated group and two in the endotherapy group (stented with palliative intent due to poor systemic condition). Readmission within 30 days occurred in 3/6 of alive endotherapy patients (50 %) and 0/8 surgery patients. Re-intervention within 30 days was required for one endotherapy patient. Conclusion: Endoscopic repair of Boerhaave perforations can be useful in carefully selected patients without evidence of systemic sepsis. Endoscopic therapy such as stenting is particularly valuable as a "salvage" intervention. The benefits of endoscopic therapy and esophageal preservation are offset against an increased risk of readmission in patients primarily treated endoscopically.

[Effect of 2-methoxyestradiol combined with quercetin on prostate cancer in vitro].

OBJECTIVE: To detect the effects of quercetin (Que) combined with 2-methoxyestradiol (2-ME) on the proliferation of androgen-dependent LNCaP human prostate cancer cells line and androgen-independent PC-3 human prostate cancer cells line, and to evaluate the antitumor effects of different combos of the two drugs. METHODS: After LNCaP and PC-3 cells were treated with different concentration of quercetin (0, 3.125, 6.25, 12.5, 25, 50, 100, 200 µmol/L) or 2-ME (0, 0.312 5, 0.625, 1.25, 2.5, 5, 10 µmol/L) for 48 h, the inhibitory rates of cell growth were tested using trypan blue staining method respectively. Then the concentration-effect curves were drawn and IC(50) values were calculated. According to the fitted dose-effect curves and IC(50) values, appropriate concentrations of quercetin and 2-ME were selected to compose 16 different combos. Then cells were treated with different combos of Que and 2-ME for 48 h, and then the growth inhibitory rates of cell growth were detected. According to the equation and median-effect principle, the CI values of 16 different combos of Que and 2-ME were calculated to evaluate their antitumor effects. RESULTS: The inhibition rate of LNCaP or PC-3 cell growth treated with varying doses of quercetin or 2-ME alone showed a dose-dependent increase respectively. The IC(50) values of quercetin and 2-ME were 23.29 µmol/L and 1.89 µmol/L for LNCaP cells; and 22.12 µmol/L and 1.74 µmol/L for PC-3 cells respectively. After treated with 16 combos of Que (5, 10, 20, 40 µmol/L) and 2-ME (0.5, 1, 3, 5 µmol/L) for 48 h, for LNCaP cells, lower dose of Que (5 and 10 µmol/L) with higher dose of 2-ME (3 and 5 µmol/L) showed synergistic activity, whereas for PC-3 cells, besides the above combination of Que 10 µmol/L and 2-ME 3 µmol/L, higher dose of quercetin (20 and 40 µmol/L) with higher dose of 2-ME (3 and 5 µmol/L) also showed synergistic activity. CONCLUSIONS: Both quercetin and 2-methoxyestradiol could inhibit the growth of LNCaP and PC-3 human prostate cancer cells in a dose dependent manner. We confirmed that combinations of quercetin and 2-ME at appropriate concentrations have the potential for synergetic antiproliferative activity in vitro.

[The expericence of diagnosis and treatment of foreign body within the pharyngeal soft tissue(3 cases)].

Through the diagnosis and treatment of the foreign body in the soft tissue of phargnx,reduce missed diagnosis. Flexible using of imaging methods for diagnosis and localization,and selecting the best surgical approach are important.

Endoscopic diagnosis and treatment of esophageal verrucous squamous cell cancer.

Verrucous squamous cell cancer (VSCC) of the esophagus is a variant of squamous cell carcinoma. This rare entity has been described in only a handful of case reports in the literature. We sought to evaluate the endoscopic features, treatment, and outcomes related to esophageal VSCC. The medical records of all patients with esophageal VSCC seen at our institution from January 1995 to December 2010 were reviewed retrospectively. A total of 11 patients (6 men; mean age 66 years [range 57-75 years]) were identified, with a mean follow up of 4 years (range 0.5-10 years) available in nine patients after diagnosis. About half the patients smoked or consumed alcohol on a regular basis. The median time interval from onset of symptoms to diagnosis of esophageal VSCC was 2.5 years (range 1-20 years), with dysphagia being present in all patients. The majority of tumors (8 of 11) exhibited a white, warty, plaque-like appearance with superimposed Candida at endoscopy, which led solely to a diagnosis of Candida esophagitis on initial presentation. The disease was either extensive (n = 5) throughout the esophagus or localized (n = 6) often by tumor nodules or projections, with the lower third of the esophagus being most commonly involved. Initial pinch biopsies were nondiagnostic in eight (73%) of the patients. Six patients underwent esophagectomy; neoadjuvant chemoradiation therapy was provided in two. In patients treated solely with surgery and who had a preoperative endoscopic ultrasound, the latter tended to overestimate staging of the lesion relative to surgical pathologic staging. Two patients were deemed to be poor operative candidates and received only chemoradiation treatment. One patient with a T2N0 tumor by endoscopic ultrasound staging was managed symptomatically with intermittent endoscopic dilation because of significant comorbidities that precluded surgery and oncologic therapy. There has been no evidence for residual or recurrent neoplastic disease in the eight patients who received treatment with surgery and/or chemoradiation therapy. Five of six patients who underwent surgery have required intermittent endoscopic dilation of anastomotic strictures during follow up. One of the two patients who received only chemoradiation therapy has required periodic endoscopic dilation for radiation-induced esophageal stricture. Two of the nine (22%) patients have died of causes unrelated to VSCC or its treatment at last follow up. In conclusion, a high index of suspicion for esophageal VSCC should be raised by the presence of long-standing symptoms coupled with white, warty esophageal lesions seen on endoscopic evaluation. Candida overgrowth can be expected to confound the diagnosis. Despite the long duration of symptoms, surgical resection typically shows relatively low-grade tumors, consistent with the rare propensity of this variant of esophageal squamous cell carcinoma to metastasize.

Single-session ERCP in patients with previous Roux-en-Y gastric bypass using percutaneous-assisted transprosthetic endoscopic therapy: a case series.

Endoscopic retrograde cholangiopancreatography (ERCP) remains technically challenging following Roux-en-Y gastric bypass (RYGB). Various techniques have been described to access the excluded stomach. We describe our experience using percutaneous-assisted transprosthetic endoscopic therapy (PATENT) to perform antegrade ERCP. Balloon enteroscopy was used to access the excluded stomach. Direct retrograde percutaneous endoscopic gastrostomy (RPEG) was performed and an esophageal self-expandable metal stent (SEMS) was deployed within the gastrostomy tract. A duodenoscope was advanced through the SEMS and antegrade ERCP was performed. Following ERCP, a gastrostomy tube was placed through the SEMS to maintain patency. Five patients underwent successful antegrade ERCP using PATENT. All patients had a diagnosis of sphincter of Oddi dysfunction. Biliary sphincterotomy was performed in all patients and liver enzymes normalized in four patients with preprocedural elevations. In conclusion, antegrade ERCP employing PATENT is feasible and can be performed during a single endoscopic session in patients with previous RYGB.

Endoscopic retrograde cholangiopancreatography using a single-balloon enteroscope in patients with altered Roux-en-Y anatomy.

BACKGROUND AND STUDY AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is challenging to perform in patients with postsurgical gastrointestinal anatomy. We assessed the diagnostic and therapeutic success rates using single-balloon enteroscopy in patients with Roux-en-Y anastomosis. PATIENTS AND METHODS: Patients who underwent single-balloon ERCP between April 2008 and February 2010 were retrospectively identified using a computerized endoscopy database. Diagnostic success was defined as successful duct cannulation or securing the diagnosis, and therapeutic success was defined as the ability to successfully carry out endoscopic therapy. Complications of ERCP were defined according to standard criteria. RESULTS: A total of 50 patients (34-male, mean age 57 years, range 19 - 85 years) with Roux-en-Y anastomosis underwent ERCP using a single-balloon enteroscope on 56 occasions. Indications for ERCP were cholestasis, acute cholangitis, recurrent primary sclerosing cholangitis with strictures, and choledocholithiasis. Overall diagnostic success was achieved in 39 / 56 cases (70 %). Therapeutic success was achieved in 21/23 cases (91 %). In 16 cases therapeutic intervention was not required. Therapeutic interventions included balloon dilation of strictures (n = 14), retrieval of retained biliopancreatic stents (n = 5), biliary stone extraction (n = 2), insertion of biliopancreatic stents (n = 4), and biliary and pancreatic sphincterotomy (n = 5). No major complications occurred. Importantly, in 22 / 56 procedures (39 %) a prior attempt at ERCP failed using conventional colonoscopes; single-balloon ERCP was successful in 15 / 22 (68 %) of these cases. CONCLUSIONS: Single-balloon ERCP is feasible in patients with complex postsurgical Roux-en-Y anastomosis, allows diagnostic evaluation and therapeutic intervention in patients with pancreaticobiliary disease, and is a useful salvage technique in the majority of patients in whom ERCP using colonoscopies has failed.