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The cancer staging system of the American Joint Committee on Cancer (AJCC) is the most widely used clinical basis for tumor staging. In October 2023, AJCC released the staging system (ninth version) for the neuroendocrine tumors of stomach (NET), which has been implemented in January 2024. The ninth version of NET staging system mainly updated the histopathologic classification, diagnosis and staging methods, clinical and pathological staging, prognosis grade, tumor and non-tumor prognostic features. The update and implementation of the staging system provide a more detailed reference for the accurate diagnosis, staging and precise treatment of gastric neuroendocrine tumors. Moreover, it is convenient for clinicians to carry out clinical practice. The purpose of our article is to provide a high-level overview of the major changes in AJCC staging system (version 9) for gastric NET based on the latest evidence-based medical research.

Objective: To summarize mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations., Methods: Between January 2018 and October 2020, 30 patients with recurrent anterior shoulder dislocations were treated with modified arthroscopic suture button fixation Latarjet procedure. There were 19 males and 11 females with an average age of 27.3 years (range, 18-41 years). The shoulder dislocation occurred 3-7 times, with an average of 4.9 times. The time from the last dislocation to operation was 3-10 days, with an average of 4.1 days. Glenoid defects exceeded 20% in all cases. There were 27 cases of Hill-Sachs lesions. The joint pain and function were estimated by visual analogue scale (VAS) score, University of California, Los Angeles (UCLA) score, Rowe score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction of shoulder before operation and at 1 month, 6 months, and last follow-up. The X-ray film, CT scan and three-dimensional reconstruction were reviewed to observe the position, healing, and absorption of the coracoid graft, correction of glenoid defect, and joint degeneration., Results: The operation time ranged from 51 to 79 minutes, with an average of 68.4 minutes. All incisions healed without complications such as nerve or blood vessel injury. All patients were followed up 36-60 months with an average of 44.6 months. The VAS score, UCLA score, Rowe score, ASES score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction after operation significantly improved when compared with preoperative values ( P< 0.05). All indicators further improved with time, and the differences between different time points after operation were significant ( P <0.05). Imaging review showed that the coracoid graft was located in the anteroinferior glenoid at 1 day after operation, and no occurrence of shoulder osteoarthritis was found during follow-up. The anatomical structure of the glenoid was normal, and no delayed healing or non-union of the coracoid graft occurred. At 20 months after operation, arthroscopic re-exploration was performed in 1 case due to fracutre caused by falling injury revealed the good shaping of the coracoid graft, smooth glenoid, and no bone resorption or osteoarthritis., Conclusion: For recurrent anterior shoulder dislocations, the modified arthroscopic suture button fixation Latarjet procedure can obtain good recovery of shoulder function and low incidence of complications and has a good mid-term effectiveness.

Objective: To investigate the feasibility and accuracy of computer vision-based artificial intelligence technology in detecting and recognizing instruments and organs in the scenario of radical laparoscopic gastrectomy for gastric cancer. Methods: Eight complete laparoscopic distal radical gastrectomy surgery videos were collected from four large tertiary hospitals in China (First Medical Center of Chinese PLA General Hospital [three cases], Liaoning Cancer Hospital [two cases], Liyang Branch of Jiangsu Province People's Hospital [two cases], and Fudan University Shanghai Cancer Center [one case]). PR software was used to extract frames every 5-10 seconds and convert them into image frames. To ensure quality, deduplication was performed manually to remove obvious duplication and blurred image frames. After conversion and deduplication, there were 3369 frame images with a resolution of 1,920×1,080 PPI. LabelMe was used for instance segmentation of the images into the following 23 categories: veins, arteries, sutures, needle holders, ultrasonic knives, suction devices, bleeding, colon, forceps, gallbladder, small gauze, Hem-o-lok, Hem-o-lok appliers, electrocautery hooks, small intestine, hepatogastric ligaments, liver, omentum, pancreas, spleen, surgical staplers, stomach, and trocars. The frame images were randomly allocated to training and validation sets in a 9:1 ratio. The YOLOv8 deep learning framework was used for model training and validation. Precision, recall, average precision (AP), and mean average precision (mAP) were used to evaluate detection and recognition accuracy. Results: The training set contained 3032 frame images comprising 30 895 instance segmentation counts across 23 categories. The validation set contained 337 frame images comprising 3407 instance segmentation counts. The YOLOv8m model was used for training. The loss curve of the training set showed a smooth gradual decrease in loss value as the number of iteration calculations increased. In the training set, the AP values of all 23 categories were above 0.90, with a mAP of 0.99, whereas in the validation set, the mAP of the 23 categories was 0.82. As to individual categories, the AP values for ultrasonic knives, needle holders, forceps, gallbladders, small pieces of gauze, and surgical staplers were 0.96, 0.94, 0.91, 0.91, 0.91, and 0.91, respectively. The model successfully inferred and applied to a 5-minutes video segment of laparoscopic gastroenterostomy suturing. Conclusion: The primary finding of this multicenter study is that computer vision can efficiently, accurately, and in real-time detect organs and instruments in various scenarios of radical laparoscopic gastrectomy for gastric cancer.

Objective: To evaluate the safety of early enteral nutrition (EEN) support in patients with severe intra-abdominal infection and intestinal fistulas. Methods: This was a retrospective cohort study. We collected relevant clinical data of 204 patients with severe intra-abdominal infection and intestinal fistulas who had been managed in the No. 1 Department of General Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University between 1 January 2017 and 1 January 2020. The patients were allocated to EEN or delayed enteral nutrition (DEN) groups depending on whether enteral nutrition had been instituted within 48 hours of admission to the intensive care unit. The primary outcome was 180-day mortality. Other outcomes included rates of intraperitoneal hemorrhage, septic shock, open abdominal cavity, bloodstream infection, mechanical ventilation, and continuous renal replacement therapy. Risk factors for mortality were analyzed by logistic regression. Results: There were no significant differences in hematological data or other baseline characteristics between the two groups at the time of admission to the intensive care unit (all P >0.05). However, septic shock (31.2% [15/48] vs. 15.4% [24/156], χ 2 =4.99, P =0.025), continuous renal replacement therapy (27.1% [13/48] versus 9.0% [14/156], χ 2 =8.96, P =0.003), and 180-day mortality (31.2% [15/48] vs. 7.7% [12/156], χ 2 =15.75, P <0.001) were significantly more frequent in the EEN than the DEN group (all P <0.05). Multivariate regression analysis showed that older age (OR=1.082, 95%CI:1.027-1.139, P =0.003), worse Acute Physiology and Chronic Health Evaluation (APACHE) II scores (OR=1.189, 95%CI: 1.037-1.363, P =0.013), higher C-reactive protein (OR=1.013, 95%CI:1.004-1.023, P =0.007) and EEN (OR=8.844, 95%CI:1.809- 43.240, P =0.007) were independent risk factors for death in patients with severe intra-abdominal infection and intestinal fistulas. Conclusion: EEN may lead to adverse events and increase mortality in patients with both enterocutaneous fistulas and severe abdominal infection. EEN should be implemented with caution in such patients.

Objective: To investigate whether the Runx2 gene can induce the differentiation of human amniotic mesenchymal stem cells (hAMSCs) to ligament fibroblasts in vitro and promote the tendon-bone healing in rabbits., Methods: hAMSCs were isolated from the placentas voluntarily donated from healthy parturients and passaged, and then identified by flow cytometric identification. Adenoviral vectors carrying Runx2 gene (Ad-Runx2) and empty vector adenovirus (Ad-NC) were constructed and viral titer assay; then, the 3rd generation hAMSCs were transfected with Ad-Runx2 (Ad-Runx2 group) or Ad-NC (Ad-NC group). The real-time fluorescence quantitative PCR and Western blot were used to detect Runx2 gene and protein expression to verify the effectiveness of Ad-Runx2 transfection of hAMSCs; and at 3 and 7 days after transfection, real-time fluorescence quantitative PCR was further used to detect the expressions of ligament fibroblast-related genes [vascular endothelial growth factor (VEGF), collagen type Ⅰ, Fibronectin, and Tenascin-C]. The hAMSCs were used as a blank control group. The hAMSCs, hAMSCs transfected with Ad-NC, and hAMSCs were mixed with Matrigel according to the ratio of 1 : 1 and 1 : 2 to construct the cell-scaffold compound. Cell proliferation was detected by cell counting kit 8 (CCK-8) assay, and the corresponding cell-scaffold compound with better proliferation were taken for subsequent animal experiments. Twelve New Zealand white rabbits were randomly divided into 4 groups of sham operation group (Sham group), anterior cruciate ligament reconstruction group (ACLR group), anterior cruciate ligament reconstruction+hAMSCs transfected with Ad-NC-scaffold compound group (Ad-NC group), and anterior cruciate ligament reconstruction+hAMSCs transfected with Ad-Runx2-scaffold compound group (Ad-Runx2 group), with 3 rabbits in each group. After preparing the ACL reconstruction model, the Ad-NC group and the Ad-Runx2 group injected the optimal hAMSCs-Matrigel compunds into the bone channel correspondingly. The samples were taken for gross, histological (HE staining and sirius red staining), and immunofluorescence staining observation at 1 month after operation to evaluate the inflammatory cell infiltration as well as collagen and Tenascin-C content in the ligament tissues., Results: Flow cytometric identification of the isolated cells conformed to the phenotypic characteristics of MSCs. The Runx2 gene was successfully transfected into hAMSCs. Compared with the Ad-NC group, the relative expressions of VEGF and collagen type Ⅰ genes in the Ad-Runx2 group significantly increased at 3 and 7 days after transfection ( P <0.05), Fibronectin significantly increased at 3 days ( P <0.05), and Tenascin-C significantly increased at 3 days and decreased at 7 days ( P <0.05). CCK-8 detection showed that there was no significant difference ( P >0.05) in the cell proliferation between groups and between different time points after mixed culture of two ratios. So the cell-scaffold compound constructed in the ratio of 1∶1 was selected for subsequent experiments. Animal experiments showed that at 1 month after operation, the continuity of the grafted tendon was complete in all groups; HE staining showed that the tissue repair in the Ad-Runx2 group was better and there were fewer inflammatory cells when compared with the ACLR group and the Ad-NC group; sirius red staining and immunofluorescence staining showed that the Ad-Runx2 group had more collagen typeⅠ and Ⅲ fibers, tending to form a normal ACL structure. However, the fluorescence intensity of Tenascin-C protein was weakening when compared to the ACLR and Ad-NC groups., Conclusion: Runx2 gene transfection of hAMSCs induces directed differentiation to ligament fibroblasts and promotes tendon-bone healing in reconstructed anterior cruciate ligament in rabbits.

Curcuma wenyujin, as one of the eight Daodi-herbs in Zhejiang province, is widely used. It has the effects of eliminating stasis and dissipating mass, moving Qi and activating blood, and clearing heart and relieving depression. Modern studies have shown that it has anti-tumor, anti-inflammatory, anti-oxidation, anti-thrombus and liver-protecting effects and mainly contains sesquiterpenoids, monoterpenoids, diterpenoids, and curcumins. This paper reviews the research progress in the chemical constituents and pharmacological effects of C. wenyujin in the last decade, discusses the modern clinical applications combined with the traditional efficacy, and predicts its quality markers(Q-markers) from plant consanguinity, medicinal properties, efficacy, processing and measurability of chemical components based on the theory of Q-markers, so as to provide a reference for the establishment of a scientific quality evaluation system and the research and application of this herb in the future.

Purpose: To investigate the oral health and hygiene behavior of chronic renal failure(CRF) patients in Shenzhen, so as to provide basis for formulating education for them., Methods: The history of renal failure, oral health status and oral health care behavior of 336 patients with chronic renal failure(CRF) in the hemodialysis center of Shenzhen Second People's Hospital were investigated by questionnaire and oral examinations., Results: At an average, dialysis was required for 3.2 years. The main cause of renal failure was glomerulonephritis in 49.11% of patients, hypertensive kidney lesion in 19.35% and diabetic nephropathy in 15.77% of patients; 77.8% of them kept brushing teeth two or more than two times every day; 72.9% patients suffered from oral problems such as toothache in recent 12 months. The rate of visiting a dentist when having complaints was 21.7%., Conclusions: The state of oral health of CRF is worse than the general population of comparable age in China, while their hygiene behavior is better than the corresponding reference general population. However, their consciousness of dental treatment is poor. Therefore, health education for CRF patients should include knowledge about oral diseases complicated with CRF and correct medical philosophy.

Objective: To assess the impact of Friday surgery on clinical outcomes in elderly patients with hip fracture under multidisciplinary treatment. Methods: A retrospective cohort study. The clinical data of 414 geriatric patients with hip fractures admitted to Zhongda Hospital Affiliated with Southeast University from January 2018 to March 2021 were analyzed retrospectively, including 126 males and 288 females with a mean age of (81.3±7.6) years. The patients were divided into two groups based on whether they underwent surgery on Friday or not. The Friday group( n =69) and the non-Friday group( n =345) were compared in terms of general information, American Society of Anesthesiologists(ASA) classification, fracture type, injury to admission time, preoperative waiting time, surgical method, anesthesia type and use of intensive care unit (ICU) fast track. Propensity score matching (PSM) was performed based on age, ASA grade, time from injury to admission, preoperative waiting time, hemoglobin and albumin levels at admission. Clinical outcomes were collected and compared between the two groups, including length of hospital stay, total hospitalization cost and 30-day, 90-day and 1-year mortality rates, and postoperative complications. Multivariate logistic regression analyses were conducted to identify influencing factors for 1-year mortality in geriatric patients with hip fracture. Results: Baseline data showed statistically significant differences in hemoglobin, albumin and preoperative waiting time between the two groups (all P <0.05). After PSM matching, 69 patients were included in each group, and no significant differences were observed in baseline data between the two groups (all P >0.05). There was no significant differences in 30-day mortality rate (4.3% vs 0, P =0.080), 90-day mortality rate (7.2% vs 1.4%, P =0.095), length of hospital stay [(10.85±4.45)d vs (10.92±3.68)d, P =0.919], total hospitalization cost [(60.9±15.4) thousands yuan vs (59.1±15.4) thousands yuan, P =0.489], postoperative complications [pneumonia (11.6% vs 13.0%, P =0.796), cardio-cerebrovascular complications (11.6% vs 8.7%, P =0.573) and delirium (5.7% vs 2.9%, P =0.245)] between the Friday group and the non-Friday group (all P >0.05). However, the 1-year mortality rate was higher in the Friday group than that in the non-Friday group(18.8% vs 4.3%, P =0.008). Multivariate analysis revealed that surgery on Friday ( OR =11.222, 95% CI : 2.198-57.291, P =0.004), low hemoglobin levels at admission ( OR =0.920, 95% CI : 0.875-0.967, P =0.001), hemiarthroplasty treatment ( OR =5.127, 95% CI : 1.308-20.095, P =0.019) and longer surgery duration ( OR =0.958, 95% CI : 0.927-0.989, P =0.009) were influencing factors for 1-year mortality in geriatric patients with hip fracture. Conclusions: In the context of multidisciplinary treatment, Friday surgery does not increase short-term mortality, length of hospital stay, total hospitalization cost or incidence of complications in geriatric patients with hip fracture. However, it remains a influencing factor for 1-year mortality in those patients.

Tuberculosis (TB) is an infectious disease that poses a serious threat to human health. About a quarter of the world's population were infected with Mycobacterium tuberculosis in 2020, and the majority of them were latently infected. Approximately 5%-10% of the population with latent tuberculosis infection may progress to active TB disease. Identifying latent TB infection from active TB by biomarkers and screening people with latent TB infection at high risk of progression for preventive treatment by biomarkers that can reliably predict the progression is one of the most effective strategies to control TB. This article reviews the progress of research on transcriptional and immunological biomarkers for identifying TB infection and predicting the progression from latent infection to active TB, with the aim of providing new ideas for tuberculosis control.

Objective To investigate the treatment outcomes,prognosis,and risk factors of treatment failure of peritoneal dialysis associated peritonitis (PDAP) caused by Klebsiella pneumoniae ,and thus provide clinical evidence for the prevention and treatment of this disease. Methods The clinical data of PDAP patients at four peritoneal dialysis centers from January 1,2014 to December 31,2019 were collected retrospectively.The treatment outcomes and prognosis were compared between the patients with PDAP caused by Klebsiella.pneumoniae and that caused by Escherichia coli. Kaplan-Meier method was employed to establish the survival curve of technical failure,and multivariate Logistic regression to analyze the risk factors of the treatment failure of PADP caused by Klebsiella pneumoniae . Results In the 4 peritoneal dialysis centers,1034 cases of PDAP occurred in 586 patients from 2014 to 2019,including 21 cases caused by Klebsiella pneumoniae and 98 cases caused by Escherichia coli .The incidence of Klebsiella pneumoniae caused PDAP was 0.0048 times per patient per year on average,ranging from 0.0024 to 0.0124 times per patient per year during 2014-2019.According to the Kaplan-Meier survival curve,the technical failure rate of Klebsiella pneumoniae caused PDAP was higher than that of Escherichia coli caused PDAP ( P =0.022).The multivariate Logistic regression model showed that long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP ( OR =1.082,95% CI =1.011-1.158, P =0.023). Klebsiella pneumoniae was highly sensitive to amikacin,meropenem,imipenem,piperacillin,and cefotetan,and it was highly resistant to ampicillin (81.82%),cefazolin (53.33%),tetracycline (50.00%),cefotaxime (43.75%),and chloramphenicol (42.86%). Conclusion The PDAP caused by Klebsiella pneumoniae had worse prognosis than that caused by Escherichia coli ,and long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP.

Objective: To examine the efficacy and safety of laparoscopic surgery for gallbladder carcinoma. Methods: The data of 197 gallbladder carcinoma patients admitted at Peking Union Medical College Hospital between January 2012 and September 2022 were analyzed retrospectively. There were 86 males and 111 females,with age of (64.4±9.8)years(range:35 to 89 years). Patients were divided into laparoscopic group( n =53) and open group( n =144) according to different surgical methods. The general information of the two groups were matched by propensity score matching,and the clinical data and prognosis were compared between the two groups. Categorical variables were analyzed using χ 2 test or Fisher's exact test,as appropriate. Continuous variables with and without normal distribution were analyzed using t -test and Mann-Whitney U test,respectively. Kaplan-Meier curves with Log-rank test were used to analyze the cumulative survival rates. Results: Forty-eight pairs of patients were matched successfully. There was no difference in general information,cholecystolithiasis,partial hepatectomy,and tumor stage between two groups(all P >0.05). The laparoscopic group had shorter operation time( t =-3.987, P <0.01),less bleeding( Z =-4.862, P <0.01),shorter total( Z =-5.009, P <0.01) and postoperative( Z =-5.412, P <0.01) hospital stay. Seventeen patients had postoperative complications. According to the Clavien-Dindo system,there were 4,11,1,and 1 patient with grade Ⅰ,Ⅱ,Ⅲa,and Ⅲb,respectively. All complications were improved after active treatment. After a median follow-up of 24(36) months(range:3 to 130 months),56 patients(58.3%) survived without tumor,7 patients(7.3%) survived with tumor,and 33 patients(34.4%) died. According to the Kaplan-Meier curves,there was no significant difference between laparoscopic and open groups in disease free(χ 2 =0.399, P =0.528) and overall(χ 2 =0.672, P =0.412) survival rates. Conclusions: The laparoscopic surgery is safe and effective in selected patients with gallbladder carcinoma. It can reduce surgical trauma and enhance patient recovery without increasing complication. Its prognosis is similar to that of open surgery.

In order to explore the composition and source characteristics of non-polar organic compounds (NPOCs) in atmospheric fine particulate matter in the Yangtze River Delta region, 129 PM 2.5 samples were collected at the Regional Atmospheric background station in Lin'an from December 2019 to November 2020. Including polycyclic aromatic hydrocarbons (PAHs), n -alkanes, and hopanes, the main sources of organic aerosols were investigated using molecular tracers, eigen ratios, and orthogonal matrix factorization models. The results showed that the average annual mass concentration of PM 2.5 in Lin'an was approximately (32.36±20.44) μg·m -3 , and the average annual mass concentration of NPOCs was approximately (59.05±40.39) ng·m -3 , showing the seasonal characteristics of being high in winter and low in summer. n -alkanes mainly came from fossil fuels and biomass (grass, wood, etc.) burning, followed by cuticle wax emission from higher plants. PAHs mainly came from the mixed contribution of non-fossil sources such as coal burning motor vehicle emissions and biomass combustion. Hopanes were mainly derived from motor vehicle emissions, which were also affected by coal burning in winter. Backward trajectory cluster analysis and potential source analysis showed that Lin'an was mainly affected by external air mass transport. Combined with the orthogonal matrix-factor decomposition model, NPOCs observed during the sampling period were analyzed, and non-fossil sources such as coal burning sources, transportation emission sources, and biomass combustion were obtained. In winter, transportation sources were the main source, accounting for 59%. In spring and summer, coal burning was the main source, accounting for 58% and 57%, respectively. In autumn, biomass combustion and other non-fossil sources dominated, accounting for 64%.

This paper summarizes Professor ZHANG Jian - bin 's experience in "moving cupping therapy on the back" in clinical practice. Professor ZHANG Jian - bin is good at applying the theory of governor vessel to the clinical diagnosis and treatment. He believes that the moving cupping therapy is the supplementation of "spinal therapy" in clinical diagnosis and treatment. He emphasizes that during the moving cupping therapy exerted, the physicians should observe carefully to in-time obtain the perceived feedback of treatment in patients. Afterward, the cupping marks left should be inspected to discover the location of disorder in the body, thus, a targeted treatment can be provided. Besides, the prognosis of the disease can be judged by the feedback after many treatments with the moving cupping therapy. The moving cupping therapy displays its important value in the diagnosis and treatment of disease, as well as the evaluation of the prognosis.

Objective To establish the eukaryotic expression vector of Y-box-binding protein 1 (YB-1) with FLAG-tagged and transfect it into hepatocellular carcinoma HepG2 cells to identify the effects of YB-1 on the proliferation and migration. Methods Human YB-1 gene was amplified from the human ovary library by PCR. YB-1 fraction was double enzyme digested and connected with pcDNA3.0-FLAG vector to construct eukaryotic expression vector pcDNA3.0-FlAG-YB-1, which was transfected into HepG2 cells. The expression of YB-1 was detected by Western blotting, and the effect of YB-1 on the proliferation of HepG2 cells was determined by CCK-8 assay and clone formation. The effect of YB-1 on the migration of HepG2 cells was analyzed by wound healing assays. Results The eukaryotic expression vector pcDNA3.0-FLAG-YB-1 was successfully established. YB-1 protein can be expressed in HepG2 cells, and YB-1 promoted the proliferation and migration of HepG2 cells. Conclusion YB-1 promotes the proliferation and migration of HepG2 cells.

The corticospinal tract (CST), descending from the frontoparietal cortex and traveling down to terminate at the anterior horn of the spinal cord to mediate voluntary movements, is frequently injured from the infarcted or hemorrhagic cerebrovascular insults due to stroke. Under the circumstances, motor dysfunction seriously affects the patient's quality of life. Acupuncture therapy has a sequelae, especially in improving motor deficits. In the present paper, we reviewed the current development of researches on acupuncture treatment of poststroke motor dysfunction and its biological mechanisms from 1) delaying patients' development of neuronal degeneration and white matter fibrosis (Wallerian degeneration), 2) improving patients' upper limb motor function and daily life ability by promoting the repair of white matter tracts and CST on the affected side, 3) promoting the compensation of CST on the healthy side, 4) reconstructing the motor conduction pathway to strengthen the bilateral brain connection in ex-perimental animals, and 5) strengthening the sprouting of the contralateral CST to dominate the affected side again across the midline. In addition, acupuncture stimulation induced improvement of axonal rewiring for corticospinal innervation is also possibly related to its functions in accelerating the synthesis and release of neurotrophic factors, down-regulating Nogo-A/RhoA signaling and activating vascular epithelial growth factor/Dll4/Notch signaling pathways.

Objective: To explore the feasibility on the preparation of novel negative pressure materials for constructing new matrix of full-thickness skin defect wounds in rats. Methods: The experimental research method was applied. The microstructure of polyurethane foam dressing which was commonly used in negative pressure treatment was observed under scanning electron microscope, and its pore diameter was detected ( n =5). Polycaprolactone (PCL) and polybutylene succinate (PBS) were used respectively as raw materials for the preparation of PCL and PBS negative pressure materials by melt spinning technology, with the measured pore diameter of polyurethane foam dressing as the spinning spacing at the spinning rates of 15, 25, and 35 mm/s, respectively. The microstructures of the prepared negative pressure materials were observed under scanning electron microscope, and their fiber diameters were measured. The tensile strength and tensile modulus of the prepared negative pressure materials and polyurethane foam dressing were measured by tensile testing machine and composite testing machine, respectively ( n =5), to screen the spinning rate for subsequent preparation of negative pressure materials. Human skin fibroblasts (Fbs) in logarithmic growth phase were co-cultured with PCL negative pressure material and PBS negative pressure material prepared at the selected spinning rate, respectively. After 1, 4, and 7 day (s) of co-culture, the cell activity and adhesion in the materials was detected by living/dead cells detection kit, and the cell proliferation level in the materials was detected by cell counting kit 8 method ( n =5). A full-thickness skin defect wound was prepared on the back of 18 5-6 weeks old Sprague-Dawley rats (gender unlimited). Immediately after injury, the injured rats were divided into PCL+polyurethane group, PBS+polyurethane group, and polyurethane alone group according to the random number table (with 6 rats in each group). The wounds were covered with materials containing corresponding component and performed with continuous negative pressure suction at the negative pressure of -16.7 kPa. The wound tissue along with materials directly contacted to the wound (hereinafter referred to as wound specimens) were collected from 3 rats in each group after 7 and 14 days of negative pressure treatment (NPT), respectively. The growth of granulation tissue and the attachment of material to wound surface were observed after hematoxylin-eosin staining, the collagen fiber deposition was observed after Masson staining, and CD34 and interleukin-6 (IL-6) positive cells were detected and counted by immunohistochemical staining. Data were statistically analyzed with one-way analysis of variance, analysis of variance for factorial design, least significant difference- t test, Kruskal-Wallis H test, Mann-Whitney U test, and Bonferroni correction. Results: The microstructure of polyurethane foam dressing was loose and porous, with the pore diameter of (815±182) μm. The spinning spacing for the subsequent negative pressure material was set as 800 μm. The microstructures of PBS negative pressure material and PCL negative pressure material were regular, with vertically interconnected layers and continuous fibers in even thickness, but the fibers of PBS negative pressure material were straighter than those of PCL negative pressure material. There was no obvious difference in the microstructure of negative pressure materials prepared from the same raw material at different spinning rates. The fiber diameters of PCL negative pressure materials prepared at three spinning rates were similar ( P >0.05). The fiber diameters of PBS negative pressure materials prepared at spinning rates of 25 mm/s and 35 mm/s were significantly smaller than the fiber diameter of PBS negative pressure material prepared at the spinning rate of 15 mm/s (with t values of 4.99 and 6.40, respectively, P <0.01). Both the tensile strength and tensile modulus of PCL negative pressure materials prepared at three spinning rates were similar ( P >0.05). The tensile strength of PBS negative pressure materials prepared at spinning rates of 15 mm/s and 25 mm/s was significantly lower than that of PBS negative pressure materials prepared at the spinning rate of 35 mm/s (with t values of 9.20 and 8.92, respectively, P <0.01), and the tensile modulus was significantly lower than that of PBS negative pressure materials prepared at the spinning rate of 35 mm/s (with t values of 2.58 and 2.47, respectively, P <0.05). Subsequently, PCL negative pressure material was prepared at the spinning rate of 35 mm/s, and PBS negative pressure material was prepared at the spinning rate of 15 mm/s. After 1, 4, and 7 day (s) of co-culture, the number of human skin Fbs that adhered to PCL negative pressure material and PBS negative pressure material increased with time, and there was no significant difference between the two materials. After 1 and 7 day (s) of co-culture, the proliferation levels of human skin Fbs between the two negative pressure materials were similar ( P >0.05). After being co-cultured for 4 days, the proliferation level of human skin Fbs in PBS negative pressure material was significantly higher than that in PCL negative pressure material ( t =6.37, P <0.01). After 7 days of NPT, the materials were clearly identifiable and a small amount of collagen fibers were also observed in the wound specimens of rats in the three groups; a small amount of granulation tissue was observed in the wound specimens of rats in polyurethane alone group. After 14 days of NPT, a large number of granulation tissue and collagen fibers were observed in the wound specimens of rats in the three groups; the materials and wound tissue in the wound specimens of rats in PCL+polyurethane group could not be clearly distinguished. After 7 and 14 days of NPT, the collagen fibers in the wound specimens of rats in polyurethane alone group were denser than those in the other two groups. After 7 days of NPT, the number of CD34 positive cells in the wound specimens of rats in PBS+polyurethane group was 14.8±3.6 per 400 times visual field, which was significantly less than 27.8±9.1 in polyurethane alone group ( t =3.06, P <0.05); the number of IL-6 positive cells was 60 (49, 72), which was significantly more than 44 (38, 50) in polyurethane alone group ( Z =2.41, P <0.05). After 14 days of NPT, the number of IL-6 positive cells in the wound specimens of rats in PBS+polyurethane group was 19 (12, 28) per 400 times visual field, which was significantly more than 3 (1, 10) in PCL+polyurethane group and 9 (2, 13) in polyurethane alone group (with Z values of 2.61 and 2.40, respectively, P <0.05). Conclusions: The prepared PCL negative pressure material and PBS negative pressure material have good biocompatibility, and can successfully construct the new matrix of full-thickness skin defect wounds in rats. PCL negative pressure material is better than PBS negative pressure material in general.

Carbonaceous aerosol is an important component of atmospheric fine particles that has an important impact on air quality, human health, and climate change. In order to explore the long-term changes in carbonaceous aerosol under the background of emission reduction, this study measured the mass concentrations of organic carbon (OC) and elemental carbon (EC) of PM 2.5 , which collected in the northern suburbs of Nanjing for five years (December 17, 2014 to January 5, 2020). The results showed that the five-year average ρ (OC) and ρ (EC) were (10.2±5.3) μg·m -3 and (1.6±1.1) μg·m -3 , accounting for 31.1% and 5.2% of PM 2.5 , respectively. OC and EC concentrations were both high in winter and low in summer. According to the nonparametric Mann-Kendall test and Sen's slope, the mass concentrations of OC and PM 2.5 decreased significantly[OC: P <0.0001, -0.79 μg·(m 3 ·a) -1 , -0.29%·a -1 ; PM 2.5 : P <0.0001, -4.59 μg·(m 3 ·a) -1 , -1.58%·a -1 ]. Although EC had an upward trend, the significance and range of change were not obvious[ P =0.02, 0.05 μg·(m 3 ·a) -1 , 0.02%·a -1 ]. OC and EC decreased significantly during winter from 2014 to 2019[OC: P <0.0001, -2.05 μg·(m 3 ·a) -1 , -0.74%·a -1 ; EC: P =0.001, -0.15 μg·(m 3 ·a) -1 , -0.05%·a -1 ], and the decline was more obvious than the whole. The correlation between OC and EC showed that the sources in winter and summer were more complex than those in spring and autumn. According to the characteristic ratio of OC and EC, the contribution of coal combustion and biomass burning decreased from 2015 to 2019, whereas the impact of industrial sources and vehicle emissions became more significant. Corresponding to this was the obvious decline in OC and the slight recovery of EC. The OC/EC ratio was over 2.0, indicating that there was secondary pollution in the study area. Further calculation revealed that the variation in SOC was consistent with that in OC, showing a significant decrease[ P <0.0001, -0.47 μg·(m 3 ·a) -1 , -0.17%·a -1 ]. The average mass concentration of SOC was (5.0±3.5) μg·m -3 , accounting for 49.2% of OC. These changes indicate clear effects of the prevention and control of air pollution in Nanjing in recent years. Furthermore, future control can focus on the emissions of VOCs to reduce secondary pollution.

Ecological risk assessment of soil in contaminated sites provides the scientific basis for accurately developing soil quality standards, confirming remediation targets, and making safe use of contaminated soil. It thus is a critical mean to protect soil health and safety. "Weight-of-Evidence" (WoE) has been widely used in ecological risk assessment due to its systematic, integrated and scientific properties. However, most current WoE approaches are poor in objectivity and comparability because they rely too much on expertise scoring in weighing and the difficulty to collect complete evidence bodies with quantitative and comprehensive information. Focusing on those issues above, we developed an improved framework of WoE approach for ecological risk assessment of contaminated site soil based on the "Four-Step" framework of EPA coupled with the concept of hierarchy. Assessment methods and procedures for each tier were unified. Weights were weighed quantitatively through multiple criteria decision analysis. The relative independence among bodies of evidence was assured by the pre-establishment of hierarchy. The "site specific" was stressed based on matrix trails and field investigation. Finally, a case study in an electroplating site in Jingjiang was conducted to verify the approach. Results of the case study suggested that the approach was practical and that the assessment results were objective, scientific, and accurate.

By arranging Mr. LU Shan - zhong 's papers and works, his academic contributions to acupuncture and moxibustion were summarized. It mainly includes standardizing the clinical diagnosis and treatment of acupuncture and moxibustion, and finding the fusion point of the western and traditional medicine; building the acupuncture and moxibustion education system, innovating acupuncture and moxibustion talent training programs; exploring the academic connotation of acupuncture and moxibustion, and promoting acupuncture and moxibustion therapy.

Work-related musculoskeletal disorders (WMSDs) refer to musculoskeletal disorders caused by work or work as the main cause, which are characterized by high prevalence and heavy burden of disease as a global problem. The classification and catalog of occupational diseases is of great significance for guiding the prevention and control of occupational diseases and safeguarding the rights and interests of workers. The types of WMSDs included in the list of occupational diseases vary greatly from country to country, and the regulations on specific pathogenic factors are also inconsistent. By sorting out and analyzing the lists and characteristics of WMSDs at home and abroad, and using the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in occupational health to standardize of WMSDs in various countries, which would lay the foundation for future multi-country WMSDs occupational health registration and disease burden research, and provide a reference for China to revise the WMSDs list.

HUANG Xue-long is a direct disciple of CHENG Dan-an . He is the second-generation representative heir of Chengjiang school. Through research on his practice and achievements of acupuncture and moxibustion scientization, we found that his main contributions were as follows. He has carried out beneficial explorations along with the scientific thinking of Chengjiang school, elucidated the theory of acupoints, clarified acupuncture and moxibustion manipulations, and explained the mechanism of acupuncture and moxibustion. His explorations promote the scientific process of acupuncture and moxibustion and enrich the academic system of acupuncture and moxibustion.

Objective: To compare the effectiveness of locking plate and intramedullary nail in treatment of Neer two- and three-part fractures of the proximal humerus in the elderly., Methods: A retrospective analysis was conducted on 86 elderly patients with Neer two- and three-part fractures of the proximal humerus met the selection criteria between January 2015 and December 2018. Forty-six patients were treated with locking plate fixation (locking plate group), and 40 patients with intramedullary nail fixation (intramedullary nail group). There was no significant difference in gender, age, cause of injury, fracture side and type, time from injury to operation, and comorbidities between the two groups ( P >0.05). Visual analogue scale (VAS) score, American Shoulder and Elbow Surgery (ASES) score, Constant-Murley score, and shoulder range of motion (forward flexion, abduction, and external rotation) were compared between the two groups. X-ray films were taken to assess the fracture healing, and the neck-shaft angle was measured at 2 days after operation and at last follow-up, and the difference between the two time points was calculated., Results: Patients in both groups were followed up 18-40 months, with an average of 30.4 months. There was no significant difference in follow-up time between the two groups ( t =-0.986, P =0.327). X-ray films reexamination showed that the fractures of two groups healed, and the healing time was (11.3±2.1) weeks in locking plate group and (10.3±2.0) weeks in intramedullary nail group, which had significant difference between the two groups ( t =2.250, P =0.027). The difference of neck-shaft angle was (7.63±7.01)° in locking plate group and (2.85±2.82)° in intramedullary nail group, which had significant difference between the two groups ( t =4.032, P <0.001). There was no significant difference in Constant-Murley score, ASES score, VAS score, and shoulder range of motion between the two groups at last follow-up ( P >0.05). Complications occurred in 13 cases (28.3%) of locking plate group and in 4 cases (10.0%) of intramedullary nail group, and the difference between the two groups was significant ( χ 2 =4.498, P =0.034)., Conclusion: Both locking plates and intramedullary nails can be used for the treatment of Neer two- and three-part fractures of the proximal humerus in the elderly. The intramedullary nail fixation surgery is more minimally invasive, which has fewer postoperative complications and faster fracture healing.

Objective: To explore the independent risk factors of lymph node metastasis (LNM) in early gastric cancer, and to use nomogram to construct a prediction model for above LNM. Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) primary early gastric cancer as stage pT1 confirmed by postoperative pathology; (2) complete clinicopathological data. Exclusion criteria: (1) patients with advanced gastric cancer, stump gastric cancer or history of gastrectomy; (2) early gastric cancer patients confirmed by pathology after neoadjuvant chemotherapy; (3) other types of gastric tumors, such as lymphoma, neuroendocrine tumor, stromal tumor, etc.; (4) primary tumors of other organs with gastric metastasis. According to the above criteria, 1633 patients with early gastric cancer who underwent radical gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital First Medical Center from December 2005 to December 2020 were enrolled as training set, meanwhile 239 patients with early gastric cancer who underwent gastrectomy at the Department of General Surgery of the Chinese PLA General Hospital Fourth Medical Center from December 2015 to December 2020 were enrolled as external validation set. Risk factors of LNM in early gastric cancer were identified by using univariate and multivariate logistic regression analyses. A nomogram prediction model was established with significant factors screened by multivariate analysis. Area under the receiver operating characteristic curve (AUC) was used for assessing the predictive value of the model. Calibration curve was drawn for external validation. Results: Among 1633 patients in training set, the mean number of retrieved lymph nodes was 20 (13-28), and 209 patients (12.8%) had lymph node metastasis. Univariate analysis showed that gender, resection range, tumor location, tumor morphology, lymph node clearance, vascular invasion, lymphatic cancer thrombus, tumor length, tumor differentiation, microscopic presence of signet ring cells and depth of tumor invasion were associated with LNM (all P <0.05). Multivariate analysis revealed that females, tumor morphology as ulcer type, vascular invasion, lymphatic cancer thrombus, tumor length≥3 cm, deeper invasion of mucosa, and poor differentiation were independent risk factors for LNM in early gastric cancers (all P <0.05). Receiver operating characteristic curve indicated that AUC of training set was 0.818 (95%CI: 0.790-0.847) and AUC of external validation set was 0.765 (95%CI: 0.688-0.843). The calibration curve showed that the LNM probability predicted by nomogram was consistent with the actual situation (C-index: 0.818 in training set and 0.765 in external validation set). Conclusions: Females, tumor morphology as ulcer type, vascular invasion, lymphatic cancer thrombus, tumor length≥3 cm, deeper invasion of mucosa and poor differentiation are independent risk factors for LNM of early gastric cancer. The establishment of a nomogram prediction model for LNM in early gastric cancer has great diagnostic value and can provide reference for treatment selection.

Objective: To explore the differences of health hazards between acetylenogen dust as two different occupational hazards of "particles not otherwise regulated" and "calcium carbide"., Methods: A calcium carbide production enterprise in northwest China was selected. The occupational health survey was used to obtain the spatial distribution and population distribution of calcium carbide dust. Occupational health testing was performed to determine the time-weighted average exposure concentration(C&#95;(TWA)) and excursion limits of calcium carbide dust in the workplace and the main exposure positions. The Singapore semi-quantitative risk matrix was used for occupational risk assessment. The "Classification of Occupational Disease Hazards in the Workplace Part 1: Productive Dust"(GBZ/T 229.1-2010) was used for the operation classification. The calcium carbide dust was regarded as two different occupational hazards: "particles not otherwise regulated" and "calcium carbide", the differences of health hazards between which were compared. PC-TWA of calcium carbide was performed at 2.28 mg/m~3. The heat amount of CaC&#95;2 and CaO released after reacting with water was compared by using Hess&apos; s law, and the reaction rates of the two reactions are compared., Results: The concentrations of calcium carbide dust in the workplace of belt inspection position and the calcium carbide crusher was higher(14.3-15.7 mg/m~3), and the concentrations of the driver in the calcium carbide loader was higher(13.8 mg/m~3). The result of the risk assessment show that the health risks of calcium carbide dust in various positions are basically low risk. Only when the type of damage was "calcium carbide", the risk of the driver of calcium carbide loader increase to medium. The operation classification result show that the hazard classification of calcium carbide dust in each post is basically relatively harmless. Only the type of damage was "calcium carbide", the classification of the driver of the calcium carbide crusher loader increased to moderately hazardous operations. As for the "calcium carbide", the operation classification index of calcium carbide were higher than that of "particles not otherwise regulated". CaC&#95;2 reacting with water released more heat than that of equal amount CaO., Conclusion: In the current production process of calcium carbide dust, except for the crushing section, its occupational health risk was low, but the health risk level of calcium carbide as "calcium carbide" was higher, indicating that the evaluation of calcium carbide dust as "particles not otherwise regulated" may underestimate its occupational hazard.

The security risks of heavy metal pollution in agro-products are becoming increasingly serious. This paper investigated the heavy metal contamination of farmland soils and agro-products around a typical mining smelter in Hunan province, and explored the influencing factors based on principal component and correlation analyses. The results showed that the soils were significantly contaminated by heavy metals, with a mean concentrations of Cd, Cu, Pb, and Zn of 9.12, 358, 303, and 185 mg·kg -1 , respectively, pH range from 4.67 to 7.22. All the sites included were under strict control. With regards to the agro-products, the concentration of heavy metal elements were different, and the order of heavy metal concentrations was Zn>Cu>Pb>Cd, with an order of biological enrichment factor(BCF) of Cd>Zn>Cu>Pb. Over-the-standard elements in agro-products included Pb and Cd at 78% and 41%, respectively, which indicated a higher security risk from these products. The accumulation of the same heavy metals in leaf vegetables were generally higher than sweet potatoes and solanaceous vegetables. The heavy metal concentrations in soils corresponded to the first principal component( P <0.01), with the variance reaching 88.0%, which dominated the sources of Cd, Cu, Pb, and Zn in agro-products. The enrichment characteristics were mainly affected by the type of crops, and was also regulated by the soil pH, cation exchange capacity, and soil organic matter(the correlation coefficients of r were -0.407- -0.641, P <0.05). In conclusion, there was a combined heavy metal pollution and high risk in soils and agro-products. Therefore, the planting of crops in the study area should be avoided, and soil remediation measures should be implemented to reduce security risks.

Objectives: A study was conducted to investigate the clinical effects of oral digital design on the aesthetic restoration of anterior teeth of cleft lip/palate patients., Methods: Nine adult cleft lip/palate patients who need aesthetic restoration of anterior teeth were recruited. Digital information of patients' dental arches, the surrounding soft tissue and face were captured by digital camera and scanner. The aesthetic analysis and design were conducted using keynote and 3shape software and were demonstrated to the patients. The optimized treatment plan was ensured by communicating with the patients. Digital wax-up models were exported and printed into resin diagnostic models, which were then utilized in the treatment process to guide the doctors and the technicians in tooth preparation and in making the final restorations, respectively. The adhesive procedure was completed after satisfactory try-in. Aesthetics assessment was conducted in accordance with the anterior esthetic evaluation form. The scores of patient's satisfaction were recorded on a questionnaire containing six items of aesthetic index and doctor-patient communication. Patients were interviewed and examined after 1, 3, 6, and 12 months, respectively, and the clinical effects of restorations were evaluated., Results: All nine patients had satisfactory clinical results. The aesthetic defects of the patients were effectively addressed. All treatments met the requirements of the preoperative digital designs. The patients' scores were all above 90 on the satisfaction scale. At 12 months after the operation, the clinical effects of restorations of all cases achieved A class in each evaluation indicator., Conclusions: For cleft lip/palate patients with esthetic defect in the anterior teeth, the digital design plays an important role in optimizing the treatment plan and guides the whole treatment process. This design can help clinicians achieve predictable satisfactory aesthetic results.

Objective: To summarize the advances in research on Cage subsidence following lumbar interbody fusion, and provide reference for its prevention., Methods: The definition, development, clinical significance, and related risk factors of Cage subsidence following lumbar interbody fusion were throughout reviewed by referring to relevant domestic and doreign literature in recent years., Results: At present, there is no consensus on the definition of Cage subsidence, and mostly accepted as the disk height reduction greater than 2 mm. Cage subsidence mainly occurs in the early postoperative stage, which weakens the radiological surgical outcome, and may further damage the effectiveness or even lead to surgical failure. Cage subsidence is closely related to the Cage size and its placement location, intraoperative endplate preparation, morphological matching of disk space to Cage, bone mineral density, body mass index, and so on., Conclusion: The appropriate size and shape of the Cage usage, the posterolateral Cage placed, the gentle endplate operation to prevent injury, the active perioperative anti-osteoporosis treatment, and the education of patients to control body weight may help to prevent Cage subsidence and ensure good surgical results.

Objective: To explore the reliability and effectiveness of soft tissue defect reconstruction using the lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle., Methods: Between December 2014 and December 2019, 13 patients underwent the reconstruction of soft tissue defects in various sites using the lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle. There were 10 males and 3 females, with an average age of 52.1 years (range, 29-83 years). Twelve wounds were resulted from resection of various malignant tumor, including 6 cases of head and neck tumors, 5 cases of shoulder and back tumors, 1 case of chest and back tumors. Among the 12 cases, 4 cases were complicated with wound infection and bone exposure, 1 case with skull defect and cerebral dura exposure, and 1 case with wound infection, skull necrosis, and cerebrospinal fluid leakage. One case was injured in a traffic accident, which resulted in infection wound in the back and shoulder and bone exposure. The sizes of the defect and musculocutaneous flap ranged from 11 cm×7 cm to 23 cm×15 cm and 25 cm×8 cm to 40 cm×14 cm, respectively. According to the spatial relationship between the donor and recipient sites, propeller flaps (8 cases) or percutaneous tunnel island flaps (5 cases) were used to transfer the myocutaneous flap to the recipient area to repair the wound. The donor site was directly closed and sutured in 9 cases, and those with excessive tension were repaired with free skin grafts in 2 cases or transferred flaps in 2 cases., Results: After the operation, necrosis of the distal 4-cm of the musculocutaneous flap occurred in 2 cases. After debridement, the resultant wounds were reconstructed using a local flap and a posterior intercostal artery perforator flap, respectively. The remaining 11 myocutaneous flaps survived completely without arteries and veins crisis. The wounds in the donor and recipient areas healed by first intention. All the patients were followed up 1 to 48 months (mean, 7.4 months). The color and texture of the flap were good. During the follow-up, 1 patient underwent tumor resection again due to tumor recurrence, and 1 patient with a scalp hemangiosarcoma died due to unexplained thoracic hemorrhage. Tumor recurrence was not found in the remaining patients. The musculocutaneous flap coverage was stable and the infection was controlled., Conclusion: The lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle can be an alternation option to reconstruct refractory wounds with exposure of vital structures and organs and infection.

Objectives: To explore the GAA varient spectrum and the genotype-phenotype correlations in patients with glycogen storage disease type Ⅱ (Pompe disease, PD), as well as to estimate the disease incidence based on carrier rate of GAA varients in Guangzhou population. Methods: A total of 57 PD cases were retrospectively enrolled at Guangzhou Women and Children's Medical Center from January 1, 2010 to May 31, 2020. All patients presented symptoms before the age of 18 years. Each diagnosis was further confirmed by GAA enzyme activity and GAA variants. The carrier rate of GAA varients was calculated based on variants detected by whole exon sequencing among 2 395 healthy children in Guangzhou. Results: Among the 57 PD patients (including male 26, female 31),twenty-eight patients with infantile onset PD (IOPD) presented with progressive general muscle weakness and cardiomyopathy. The mean ages of symptom onset and diagnosis were (2.5±1.4) and (5.0±3.0) months, respectively. Twenty-six cases died in the first year after birth.Twenty-three patients with late onset PD (LOPD) presented with progressive muscle weakness. Seven of them had respiratory failure at diagnosis. The mean ages of symptom onset and diagnosis were (12.0±5.0) and (17.0±7.5) years, respectively. Six children with atypical IOPD showed motor delay, muscle weakness and cardiomyopathy. Their diagnosis was confirmed at 2.5-7.0 years of age. Among the 57 patients, 47 different variants were identified in the GAA gene. Three variants: c.797C>T, c.1109G>A and c.1757C>T were novel. c.1935C>A (25/114, 21.9%) and c.2238G>C (15/114, 13.2%) were the most common variants, detected in 57.1% of IOPD and 65.2% (15/23) of LOPD patients, respectively. Among the 28 IOPD patients, 26 cases (92.9%) carried at least one missense variant which indicated positive cross-reactive immunologic material (CRIM). The carrier rate of pathogenic variants in GAA gene among healthy children was 24/2 395. The estimated incidence of PD in this population is about 1/40 000. The frequencies of pseudodeficiency variants c.1726G>A and c.2065G>A homozygotes were 26.3% (15/57) and 35.1% (20/57) in PD patients, which were significantly higher than those (1.7% (40/2 395) and 3.9% (94/2 395)) in healthy children (χ²=151.2, 121.9; both P <0.01). Conclusions: PD presents as a spectrum, some as atypical IOPD. The c.1935C>A and c.2238G>C are common variants, correlated with IOPD and LOPD respectively. The c.796C>T and c.1082C>T are usually found in atypical IOPD. The majority of IOPD patients is predicted to be CRIM positive. The estimated incidence of PD is about 1/40 000.

Objective: At present, there are few studies focusing on the factors short-term complications after total gastrectomy in patients with advanced gastric cancer receiving neoadjuvant chemotherapy (NACT). The purpose of this study is to provide a reference for clinical prevention of complications in these patients. Methods: A retrospective case-control study was conducted. Case inclusion criteria: (1) clinical stage II-III gastric cancer diagnosed by preoperative gastroscopy, pathology, abdominal CT, EUS or PET-CT; (2) evaluated suitable for NACT by MDT discussion; (3) no previous history of other malignant tumors and no concurrent tumor; (4) undergoing total gastrectomy+ D2 lymphadenectomy after NACT. Exclusion criteria: (1) age <18 or >80 years old; (2) severe concurrent diseases, and ASA classification>grade III; (3) stump gastric cancer or history of gastric surgery; (4) incomplete clinicopathological data. According to the above criteria, clinicopathological data of 140 advanced gastric cancer patients who underwent total gastrectomy after NACT in Chinese PLA General Hospital between June 2012 and June 2019 were collected, including 109 males and 31 females with mean age of (56.9±11.4) years and body mass indey (BMI) of (23.3±3.1) kg/m(2). Logistic analysis was used to analyze the relationship between postoperative complication and clinicopathological data. Factors in univariate analysis with P <0.05 were included in the multivariate analysis. Results: Postoperative complications (Clavien-Dindo classification ≥ II) occurred in 35 cases (25.0%) and severe complications (Clavien-Dindo classification ≥ IIIa) occurred in 4 cases (2.9%), including 1 case of esophago-jejunal anastomotic leakage, 1 case of vena cava thrombosis, 1 case of pleural effusion, 1 case of septic shock during perioperative days resulting in death. Univariate analysis showed that BMI ( P =0.011), cycle of NACT ( P =0.027), tumor diameter ( P =0.021), and vascular invasion ( P =0.033) were associated with postoperative complication within 30 days, while open/laparoscopic total gastrectomy were not associated with postoperative complication ( P =0.926). Multivariate analysis revealed that BMI ≥ 25 kg/m(2) (OR=3.294, 95% CI: 1.343-8.079, P =0.009) and < 4 cycles of NACT (OR=2.922, 95% CI: 1.217-7.016, P =0.016) were independent risk factors for postoperative complication. The 3-year overall survival rates of patients with or without complication were 54.4% and 64.0%, respectively ( P =0.395), and 3-year disease-free survival rates were 47.4% and 52.9%, respectively ( P =0.587). Conclusions: Higher BMI and fewer cycles of NACT are independent risk factors of postoperative complication in advanced gastric cancer patients undergoing total gastrectomy after NACT. No obvious association is found between postoperative complication and surgical approaches.

Objective: To analyze the risk factors for postoperative mortality of the elderly patients with femoral neck fracture undergoing hemiarthroplasty., Methods: Patients who underwent hemiarthroplasty for femoral neck fractures between January 2011 and December 2015 were enrolled as object. One hundred and nine patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, time from admission to surgery, comorbidities, and preoperative hemoglobin level and nutritional status. Univariate analysis and Cox proportional hazard regression model were used to screen the risk factors for postoperative mortality., Results: The 1-year and 2-year mortalities were 6.4% (7/109) and 17.4% (19/109), respectively. Univariate analysis showed that the age, preoperative hemoglobin level and nutritional status were the influencing factors of postoperative mortality in the elderly patients with femoral neck fractures treated with hemiarthroplasty ( P <0.05). Multivariate analysis showed that the age≥80 years and malnutrition were the independent risk factors for postoperative mortality ( P <0.05)., Conclusion: To improve the clinical outcomes, perioperative risk should be comprehensively evaluated by multidisciplinary and perioperative management should be strengthened in the elderly patients with femoral neck fracture, especially those with advanced age and malnutrition, for the high postoperative mortality.

Objective: To explore the feasibility of using indocyanine green (ICG) angiography to detect brachial artery perforators, and the clinical application of brachial artery perforator propeller (BAPP) flaps to repair soft tissue defects of the trunk and upper limbs., Methods: Between August 2016 and February 2019, ICG angiography was used to detect the perforating vessels of the brachial artery muscle septum, and the BAPP flaps were cut out with the detected perforating vessels as the pedicle to repair 19 cases of trunk and upper limb soft tissue defects. There were 12 males and 7 females, with an average age of 28.6 years (range, 5-66 years). Etiologies included the post-burn scar in 10 cases, soft-tissue sarcoma in 5 cases, congenital melanocytic nevi in 2 cases, chronic chest wall ulcer in 1 case, and malignant melanoma in 1 case. Defects located in axilla in 8 cases, chest wall in 4 cases, elbow in 5 cases, and shoulder in 2 cases. The area of the defect ranged from 15 cm×3 cm to 20 cm×8 cm. Pre-transfer tissue expansion was used in 11 patients. Thirteen flaps were pedicled with 1 perforator vessel, and 6 flaps were pedicled with 2 perforator vessels. The length of the vascular pedicle was 2.5-4.5 cm, with an average of 3.08 cm. The area of the skin flap ranged from 11 cm×5 cm to 22 cm×10 cm. The flap rotation angle was 110° in 1 case, 120° in 1 case, and 180° in 17 cases. Except for one donor site repaired by skin graft, the other donor sites were directly sutured., Results: A total of 24 perforating vessels of the brachial artery muscle septum were detected by ICG angiography, 26 were identified during the operation, with an accuracy rate of 92.31%. Eighteen flaps survived without arteriovenous crisis. Venous congestion was observed in the distal 3-cm of one flap and the flap survived after conservative management. Intraoperative analysis showed that the blood perfusion of the distal 4-cm of one flap was poor, the relative value was less than 32%, the flap survived after removing the poor perfusion area. All the patients were followed up 3 to 23 months (mean, 8.6 months). The color and texture of the flap were similar to those of the recipient area. Flap debulking was not needed in all patients owing to the thinness of the flap. The contracture symptoms of patients with scar contracture on the medial of the elbow joint and axilla were significantly improved; a patient with malignant melanoma underwent tumor resection at 1 year and 5 months after operation due to tumor recurrence, and additional surgery was done to remove the recurrent tumor. No tumor recurrence was found in other patients., Conclusion: The ICG angiography technique can be used to explore the perforating vessels of the brachial artery muscle septum. The BAPP flap pedicled with the perforating vessels can be used for the repair of skin and soft tissue defects in the chest wall, axilla, shoulder, and elbow joint.

Objective: To investigate the receptor pathways of glycated basic fibroblast growth factor (bFGF) on proliferation and vascularization of human dermal microvascular endothelial cells (HDMECs). Methods: The experimental research method was used. Glycated bFGF stimulating solution was prepared with glucose and bFGF. HDMECs of the third to sixth passages were used in the experiment. Cells were divided into small interfering RNA (siRNA)-positive control group, siRNA-negative control group, siRNA-receptor for advanced glycation end product (RAGE) group, and siRNA-receptor for fibroblast growth factor (FGFR) group and transfected with siRNA-positive control glyceraldehyde-3-phosphate dehydrogenase, siRNA-negative control, siRNA-RAGE, and siRNA-FGFR for 4 to 6 hours, and then were added into HDMEC culture medium for routine culture. The transfection effect of siRNA was identified by reverse transcription polymerase chain reaction. The cells were divided into normal control group, glycated bFGF alone group, siRNA-RAGE alone group, and siRNA-RAGE+ glycated bFGF group, and seeded into 96-well plate and 6-well plate. Cells in siRNA-RAGE alone group and siRNA-RAGE+ glycated bFGF group were transfected with siRNA-RAGE and then were added into HDMEC culture medium for routine culture. After two days, the original HDMEC culture medium was discarded, and cells in siRNA-RAGE alone group were routinely cultured in HDMEC culture medium, cells in siRNA-RAGE+ glycated bFGF group were routinely cultured in glycated bFGF stimulating solution. Cells in normal control group were routinely cultured in HDMEC culture medium, and cells in glycated bFGF alone group were routinely cultured in glycated bFGF stimulating solution. After transfection with siRNA-RAGE, cells were seeded into 48-well plate and divided into siRNA-RAGE alone group and siRNA-RAGE+ glycated bFGF group. Another cells were directly seeded into 48-well plate without transfection and divided into normal control group and glycated bFGF alone group. Cells in the 4 groups were conducted with the corresponding treatment as above. Cells were divided into normal control group, glycated bFGF alone group, siRNA-FGFR alone group, and siRNA-FGFR+ glycated bFGF group and seeded into 96-, 6-, and 48-well plates, respectively, with the corresponding treatment the same as above. Only siRNA-RAGE was replaced by siRNA-FGFR. Cell counting kit 8 method was used to determine the proliferation of cells after 2 days of culture (sample number was 6), flow cytometry was used to detect the apoptosis of cells after 2 days of culture (sample number was 3), tube forming test was used to detect the angiogenesis of cells after 6 hours of culture (sample number was 4). Data were statistically analyzed with one-way analysis of variance and least significant difference t test. Results: At the 200 bp band, there were no target genes in siRNA-positive control group, siRNA-RAGE group, or siRNA-FGFR group, but target genes were detected in siRNA-negative control group, indicating the success of siRNA transfection. After 2 days of culture, the absorbance value of cells in glycated bFGF alone group was significantly lower than that of normal control group ( t =2.359, P <0.05); absorbance value of cells in siRNA-RAGE+ glycated bFGF group was significantly higher than that of glycated bFGF alone group ( t =3.858, P <0.01), which was similar to that of siRNA-RAGE alone group ( t =2.148, P >0.05). The absorbance value of cells in siRNA-FGFR+ glycated bFGF group was similar to that of glycated bFGF alone group ( t =0.805, P >0.05), but significantly lower than that of siRNA-FGFR alone group ( t =4.201, P <0.01). After 2 days of culture, the apoptotic rate of cells in glycated bFGF alone group was significantly higher than that of normal control group ( t =2.416, P <0.05). The apoptotic rate of cells in siRNA-RAGE+ glycated bFGF group was significantly lower than the rates in glycated bFGF alone group and siRNA-RAGE alone group ( t =3.861, 2.724, P <0.05 or P <0.01). There were no statistically significant differences in apoptosis rate of cells among normal control group, glycated bFGF alone group, siRNA-FGFR alone group, and siRNA-FGFR+ glycated bFGF group ( F =2.218, P >0.05). After 6 hours of culture, the number of tubules of cells in normal control group (636±5) was significantly more than that of glycated bFGF alone group (580±8, t =10.825, P <0.01), and the number of tubules of cells in siRNA-RAGE+ glycated bFGF group (647±10) was significantly more than those of glycated bFGF alone group and siRNA-RAGE alone group (628±4, t =13.040, 3.641, P <0.01). After 6 hours of culture, the number of tubules of cells in siRNA-FGFR+ glycated bFGF group (619±5) was more than that of glycated bFGF alone group ( t =9.000, P <0.01), but less than that of siRNA-FGFR alone group (632±3, t =2.814, P <0.05). Conclusions: Glycated bFGF affects the proliferation and angiogenesis of HDMEC through RAGE pathway, which may be one of the reasons for impaired wound healing of diabetic skin.

Objectives: A clinical case caused by Chikungunya virus (CHIKV) was introduced into Tianjin, China from Myanmar. The current study is aimed to phylogenetically analyzing this imported strain and to reveal the relationship between this virus and other circulating CHIKV strains. Methods: RNA was extracted from serum of the suspected patient presenting with symptoms compatible with CHIKV infections. Real-time reverse transcription PCR (RT-PCR) assay was used for diagnoses of the patient. For phylogenetic analysis, envelope glycoprotein 1 (E1) gene of CHIKV was amplified by two-step RT-PCR and the products were sequenced. Results: The phylogenetic analyses revealed that the imported CHIKV belong to Indian Ocean Lineage (IOL) derived from ECSA genotype and sharing the same cluster with the Aede albopitus -adapted strains that triggered the outbreaks in Pakistan (2016), Italy (2017) and Bangladesh (2017). Conclusion: The imported CHIKV strain has the potential to cause explosive outbreaks in China and this event happened in Tianjin calls for strengthening the monitoring programs on mosquito-borne diseases in China.

With the rapid urbanization and industrial structure adjustment in China, many contaminated sites have been left for remediation. It is essential to develop and implement ecological risk assessment (ERA) before remediating contaminated sites at a large scale as well as sequential management. In this review, we discussed the key problems in ecological risk assessment of soils in contaminated sites focusing on scientific principles, frameworks, techniques, and approaches, including 1) the site-specific framework, 2) uncertainty of conceptual model, 3) toxic mechanisms of combined contamination in soil, 4) screening of assessment endpoints, and 5) development of assessing approaches and frameworks. Then, two perspectives were addressed: the toxicological mechanism of soil combined pollution including bioavailability of contaminants in soil and their joint effect is the scientific problem in ecological risk assessment of soil in contaminated site; and weight of evidence approach based on USEPA four-step approach and EU Tier approach is applicable for ecological risk assessment in field conditions. Future studies should focus on: 1) the coordination of ecological risk assessment (ERA) framework and risk management framework, 2) conceptual mo-del, 3) process-based reactive transport models for exposure evaluation, 4) ecotoxicological mechanism of combined contamination in site soil, and 5) high ecological level endpoints. The aim of this review was to provide theoretical base and framework for the establishment of local guideline of ecological risk assessment in China.

Objective: To investigate the respiratory pathogens and clinical features in children with acute exacerbation of bronchial asthma., Methods: Nasopharyngeal swabs were collected from 225 children with acute exacerbation of bronchial asthma, aged <14 years, who attended the outpatient service or were hospitalized from August 2017 to August 2019. Quantitative real-time PCR was used to detect 12 pathogens, i.e., respiratory syncytial virus (RSV), human rhinovirus (HRV), influenza virus A (IFVA), influenza virus B (IFVB), parainfluenza virus types 1-3 (PIV1-3), human metapneumovirus (HMPV), adenovirus (ADV), Bordetella pertussis (BP), Chlamydia pneumoniae (CP), and Mycoplasma pneumoniae (MP)., Results: The overall detection rate of virus was 46.2% (104/225), and 7 kinds of viruses were detected, i.e., HRV (19.6%, 44/225), ADV (16.0%, 36/225), IFVB (5.8%, 13/225), RSV (4.9%, 11/225), IFVA (3.6%, 8/225), PIV3 (1.8%, 4/225), and HMPV (0.4%, 1/225). Of all pathogens, BP had the highest detection rate of 28.4% (64/225), and the detection rates of MP and CP were 16.4% (37/225) and 0.4% (1/225), respectively. The mild exacerbation group had a higher detection rate of BP than the severe exacerbation group (P<0.05), while the severe exacerbation group had significantly higher detection rates of RSV and MP than the mild exacerbation group (P<0.05). There were significant differences in the proportion of children with paroxysmal cough, spasmodic cough, fever, lung rales and abnormal lung imaging findings among the simple BP infection, simple virus infection and simple MP infection groups (P<0.05)., Conclusions: BP, HRV, and MP are common respiratory pathogens detected in children with acute exacerbation of bronchial asthma, and respiratory virus infection is an important pathogen of acute exacerbation of asthma in children. Acute exacerbation of asthma caused by different pathogens has different clinical features and severities.

Objective: To develop a fast track transfer to intensive care unit (ICU) for the perioperative high-risk elderly patients after hip fracture surgery and analyze the preliminary clinical effect of the application. Methods: From January 2014 to December 2017, before the application of postoperative fast track transfer to ICU, the clinical data of 195 elderly patients with hip fracture were included in a retrospective analysis. Among 195 hip fracture patients, 18 were transferred to ICU post operation (non-fast track group). Multivariate logistic regression analysis was applied to investigate relevant risk factors for transferring to ICU after hip fracture surgery. Based on risk factors acquired from the analysis and clinical experience, the fast track transfer to ICU for the perioperative high-risk elderly patients after hip fracture surgery was constructed according to the preliminary and experiential criteria. From January 2018 to December 2019, the clinical data of 70 patients (fast track group) who were transferred to ICU after hip fracture surgery through the fast track were collected and compared with non-fast track group. Results: Multivariate regression analysis revealed that American Society of Anesthesiologists classification(≥Ⅲ) ( OR =4.260, 95% CI :1.157-15.683, P =0.029), pre-hospital stage (≥48 h) ( OR =4.301, 95% CI :1.212-15.266, P =0.024), hemoglobin concentration at admission(<90 g/L) ( OR =7.979, 95% CI :1.936-32.889, P =0.004), coronary heart disease as one comorbidity( OR =6.063, 95% CI :1.695-21.693, P =0.006) were independent risk factors for transferring to ICU after hip fracture surgery. There were no significant difference in gender, age, fracture type, hemoglobin concentration at admission and time of pre-hospital stage between the non-fast track group and fast track group(all P >0.05). However, the number of comorbidities in the fast track group was significantly higher than that in the non-fast track group ( Z =-1.995, P =0.046). The time to surgery, postoperative hospital stay, and length of hospital stay in fast track group were all significantly less than those in non-fast track group ( Z =-2.121, -2.726, -3.130, all P <0.05). Also, there were fewer medical consultations needed and fewer patients who stayed in ICU more than or equal to 2 nights in fast track group than that in non-fast track group(all P <0.05). There were no significant difference in the rate of patients who transferred from the general ward to ICU after transferring from ICU to the general ward, the proportion of patients who received more than or equal to 4 departments, operation time, hospitalization expense, mortality during hospitalization, 30-day mortality and 90-day mortality after operation between the two groups(all P >0.05). Conclusions: The fast track constructed in this study can reduce time to surgery, postoperative hospitalization stay and length of hospitalization stay for the perioperative high-risk elderly patients with hip fractures and is a specific clinical application of eras concept based on multidisciplinary team.

Objective: To establish a prognostic Nomogram model for predicting the risk of early death in polytrauma patients., Methods: Data extracted from a polytrauma study on Dryad, an open access database, was selected for secondary analysis. Patients from 18 to 65 years old with polytrauma in the original data were included. All patients with missing variables, such as blood lactic acid (Lac), Glasgow coma score (GCS) and injury severity score (ISS) at admission, were excluded. The differences of gender, age, Lac, ISS and GCS scores between the patients who died within 72 hours and those who survived were analyzed. The risk factors for 72-hour death were analyzed by Logistic regression, and the Nomogram prediction model was established using R software. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of the model, and the Bootstrap method was used for internal verification by repeating sample for 1 000 times. Decision curve (DCA) was applied to analyze the clinical practical value of the model., Results: A total of 2 315 polytrauma patients were included. Logistic regression analysis showed that Lac, GCS score and age > 55 years old were the risk factors for early death in polytrauma patients [Lac: odds ratio (OR) = 1.36, 95% confidence interval (95%CI) was 1.29-1.42, P < 0.001; GCS score: OR = 0.76, 95%CI was 0.73-0.79, P < 0.001; age > 55 years old: OR = 1.92, 95%CI was 1.37-2.66, P < 0.001]. The prediction model was established by using the above risk factors and displayed by Nomogram. ROC curve analysis showed that the area under the ROC curve (AUC) of Nomogram model to predict the risk of death within 72 hours was 0.858, and the predictive ability of Nomogram model was significantly higher than that of Lac (AUC = 0.743), GCS score (AUC = 0.774) and ISS score (AUC = 0.699), all P < 0.05. The model calibration chart showed that the predicting probability was consistent with the actual occurrence probability, and the DCA showed that Nomogram model presented excellent clinical value in predicting the 72-hour death risk for polytrauma patients., Conclusions: The prognostic Nomogram model presents significantly predictive value for the risk of death within 72 hours in polytrauma patients. Prognostic Nomogram model could offer individualized, visualized and graphical prediction pattern, and provide physicians with practical diagnostic tool for triage system and management of polytrauma according to precision medicine.

Patients with lung adenocarcinoma (ADC) who harbor drive gene mutation will inevitably develop drug resistance after receiving targeted therapy. The common mechanisms of drug resistance include secondary mutation of driver gene, change of non-driver gene, histological transformation and epithelial mesenchymal transformation. Histological transformation includes the transformation from lung ADC to small cell lung cancer (SCLC), squamous cell carcinoma (SCC), and large cell neuroendocrine carcinoma (LCNEC) and so on. Histological transformation not only has a negative impact on the quality of patients' life, but also poses great challenges to the follow-up treatment of patients. However the mechanism of transformation is still incomplete. This article will review the research results on the mechanism of histological transformation and the selection of treatment strategies.

As a new method, immunotherapy which is targeting programmed cell death protein 1 (PD-1) and programmed cell death ligand 1 (PD-L1) plays a more and more important role in the treatment of malignant tumors. Immunotherapy is more effective than traditional chemotherapy. However, there are also many adverse events during the application of immunocheckpoint inhibitors targeting PD-1/PD-L1, and the incidence rate of these adverse events among different drugs is different. Because the molecular structure of these drugs is an important indicator to distinguish them, this paper will analyze the correlation between molecular structure and adverse events of PD-1/PD-L1 immunocheckpoint inhibitors through reviewing some meta-analyses and retrospective analyses from the perspective of different structures.

A new method was established for the sensitive determination of artificial synthetic sweetener acesulfame-K in soy sauce by capillary electrophoresis (CE) with field-amplified sample injection (FASI)and capacitively coupled contactless conductivity detection (C 4 D). Liquid-liquid extraction (LLE) technology was employed to eliminate the complex matrix interference co-existing in soy sauce. Ethyl acetate was used as the extraction solution. The pH of the sample solution was adjusted to 1.7, and both inorganic salts and organic compounds causing interferences were effectively removed by LLE. The type and volume of the extraction solvents, pH of the sample solutions, extraction method and extraction time were investigated in detail. Under the optimized experimental conditions, acesulfame-K in soy sauce was well separated and sensitively detected. The limit of detection and limit of quantification were 0.15 mg/kg and 0.48 mg/kg, respectively. The accuracy was tested by spiking acesulfame-K into soy sauce samples, and the recoveries ranged from 92.3% to 108.1%. The relative standard deviations were below 8.0%. The proposed method can meet the requirements for the fast screening and sensitive detection of acesulfame-K in soy sauce samples.

Objective To investigate the effects of sodium arsenite (NaAsO 2 ) on p14 alternative reading frame (p14ARF), murine double minute 2 (MDM2) and p53 expressions in L-02 hepatocytes. Methods L-02 hepatocytes were cultured in medium containing (0, 5, 10, 15, 20, 25) μmol/L NaAsO 2 for 48 hours. The cell morphology was evaluated by phase-contrast microscopy and cell proliferation was detected by CCK-8 assay. The apoptosis of hepatocytes was detected by annexin V/propidium iodide (annexin V-FITC/PI) double staining followed by flow cytometry. The mRNA and protein expressions of p14ARF, MDM2 and p53 were detected by real-time fluorescence quantitative PCR and Western blotting. Results Compared with the control group, the proliferation activity of L-02 hepatocytes decreased and the apoptotic rate of L-02 hepatocytes increased significantly. With the increase of NaAsO 2 concentration, p14ARF mRNA and protein levels decreased gradually, while MDM2 mRNA and protein levels increased gradually. There was no significant difference in the expression of p53 mRNA, but the relative expression level of p53 protein increased gradually. Conclusion The injury of L-02 hepatocytes induced by NaAsO 2 may be related to the down-regulation of p14ARF expression and the up-regulation of p53 and MDM2 expression.

Objective: To compare short-term efficacy of robotic versus 3D laparoscopic-assisted D2 radical distal gastrectomy in gastric cancerpatients and those with different body mass index (BMI). Method: A retrospective cohort study was performed. Inclusion criteria:(1) gastric cancer proved by preoperative pathological results and tumor location was suitable for D2 radical distal gastrectomy; (2) no distal metastases such as in liver, kidney or abdominal cavity, and no direct invasion to the pancreas or colon on preoperative imaging; (3) postoperative pTNM stage ranged from I to III; (4) no conversion to open surgery or change of surgical procedure during operation; (5) complete clinicopathological data. Patients with severe chronic diseases, other malignant tumors, tumor invasion of other organs or distant metastases, benign gastric tumors, gastrointestinal stromal tumors and recurrent gastric cancer were excluded. According to the above criteria, 531 patients who underwent robotic or 3D laparoscopic-assisted distal gastrectomy at the General Surgery Department of Chinese PLA General Hospital from January 2016 to December 2019 were enrolled. Among them, 344 patients underwent 3D laparoscopic-assisted distal gastrectomy (3D-LADG group), including 250 males, 94 females, 66 cases (19.2%) with a BMI ≥ 25 kg/m(2), and 278 cases (80.8%) with a BMI < 25 kg/m(2), and 187 patients underwent robotic-assisted distal gastrectomy (RADG group), including 122 males, 65 females, 69 cases (36.9%) with a BMI≥25 kg/m(2) and 118 cases (63.1%) with a BMI < 25kg/m(2). There were no significant differences in baseline characteristics between the two groups (all P > 0.05). Operative indicators, postoperative recovery, pathological characteristics and complication rate were compared between the two groups. Subgroup analysis stratified BMI was also performed. Results: Compared with RADG group, 3D-LADG group presented more harvested lymph nodes (29.1±12.4 vs. 25.2±9.0, t =4.238, P <0.001), shorter postoperative hospital stay [8.0 (7.0 to 10.0) days vs. 10.0 (9.0 to 11.0) days, Z =-6.205, P <0.001], less operative cost [(3.6×10(4)±1.1×10(4)) yuan vs. (6.2×10(4)±3.5×10(4)) yuan, t =-9.727, P <0.001], less cost of hospitalization [8.6×10(4)(7.5×10(4) to 10.0×10(4)) yuan vs. 12.8×10(4)(11.7×10(4) to 14.1×10(4)) yuan, Z =-15.997, P <0.001] and longer first flatus time [(3.9±1.0) days vs. (3.4±1.2) days, t =4.271, P <0.001], whose differences were all statistically significant (all P <0.05). While there were no statistically significant differences in operation time, intraoperative blood loss, overall complication rate [10.8%(37/344) vs. 12.8%(24/187), χ(2)=0.515, P =0.473] and severe complications rate [2.0%(7/344) vs. 3.2%(6/187), χ(2)=0.294, P =0.588] between 3D-LADG group and RADG group (all P >0.05). In BMI<25 kg/m(2) group, propensity score matching (PSM) was used to reduce bias of baseline characteristics. After PSM, 3D-LADG group presented higher proportion of intraoperative blood loss <50 ml [26.7% (31/116) vs. 8.6% (10/116), χ(2)=13.065, P <0.001], more harvested lymph nodes [30.3±12.2 vs. 25.3±9.5, t =-3.192, P =0.002] and shorter postoperative hospital stay [9.0 (7.0 to 10.0) days vs. 10.0 (9.0 to 11.0) days, Z =-4.275, P <0.001] compared with RADG group, while other perioperative indicators showed no statistically significant differences between the two groups (all P >0.05). In BMI≥25 kg/m(2) group, 3D-LADG group presented higher proportion of intraoperative blood loss >200 ml [18.2% (12/66) vs. 1.4% (1/69), χ(2)=10.853, P =0.001] and shorter postoperative hospital stay [8.0 (6.0 to 10.0) days vs. 9.0 (8.0 to 10.5) days, Z =-3.039, P =0.002] compared with RADG group, while other perioperative indicators also showed no statistically significant differences between the two groups (all P >0.05). Conclusion: It is safe and feasible to perform 3D-LADG and RADG for patients with gastric cancer. The short-term efficacy of both is similar.

Objective: To investigate the surgical options for splenic lymph node dissection in patients with advanced gastric cancer undergoing radical total gastrectomy, and to evaluate the sentinel effect of No. 4s lymph node on splenic lymph node metastasis. Methods: A prospective, single-center, randomized and controlled study was carried out (Trial registration, No.NCT02980861). Enrollment criteria: (1) >18 years old and <65 years old; (2) gastric adenocarcinoma locating in the proximal or corpus; (3) preoperative clinical staging as cT2-4aN0-3M0; (4) D2 radical total gastrectomy feasible judged before operation; (5) physical ability score 0 to 1; (6) I to III of ASA classification. Pregnant or lactating women, patients with severe mental illness or previous history of upper abdominal surgery, those suffered from other malignant tumors in the past 5 years, or heart and lung system diseases judged to affect surgery before operation, those receiving preoperative chemotherapy, radiotherapy or targeted therapies, and distant metastases being found during surgery were excluded. According to above criteria, 222 patients at The First Medical Center of Chinese PLA General Hospital from December 2016 to December 2017 were enrolled prospectively and were randomly divided into the laparoscopic splenic hilar lymph node dissection group (laparoscopic group, n =114) and the open splenic hilar lymph node dissection group (open group, n =108). The result of rapid frozen immunohistochemistry of harvested No.4s lymph nodes was used to evaluate the sensitivity and specificity of sentinel effect on splenic hilar lymph node metastasis. The surgical parameters, postoperative recovery parameters, and complication rates were compared between the two groups. Results: There were 80 males and 34 females in the lapascopic group with a mean age of (56.1±10.2) years, and 69 males and 39 females in the open group with a mean age of (58.4±10.9) years. There were no significant differences in baseline data between the two groups (all P >0.05). Total blood loss was less in the laparoscopic group [(96.3±82.4) ml vs. (116.6±101.9) ml, t =1.124, P< 0.001], and the amount of bleeding from the splenic hilar lymph nodes dissected was also less than that in the open group [(25.3±17.8) ml vs. (59.5±36.4) ml, t =1.172, P <0.001]. However, the operation time, the time of splenic hilar lymph node, the number of lymph node dissected and number of splenic hilar lymph node dissected were not significantly different between the two groups (all P >0.05). As compared to the open group, the laparoscopic group had shorter time to the first flatus [(1.3±1.2) days vs. (1.6±1.5) days, t =1.665, P =0.021], shorter time to fluid diet [(4.6±1.4) days vs. (4.9 ± 1.6) days, t =1.436, P= 0.007], shorter time to remove nasogastric tube [(3.9±2.6) days vs. (4.3±2.4) days, t =0.687, P <0.001] and shorter hospital stay [(10.3±6.6) days vs. (12.1±7.2) days, t =0.697, P <0.001]. Complication rate was 14.0% (16/114) and (12.0%) ((1)3/108) in the laparoscopic group and the open group, respectively, without significant difference (χ(2)=6.723, P =0.331). The sensitivity of the No. 4s lymph node for the prediction of splenic hilar lymph node metastasis reached 89.5%, and the specificity reached 99.6%. Conclusions: Laparoscopic technique is safe and feasible in the treatment of splenic hilar lymph node dissection in advanced gastric cancer. The No.4s lymph node examination has good sentinel effect on predicting the metastasis of splenic hilar lymph nodes.

Abstract: Traditional forensic identification relies on forensic experts to manually extract information and provide identification opinions based on medicine, biology and other fields of knowledge combined with personal work experience, which is not only time-consuming and require great effort, but also affected by subjective factors that are difficult to overcome. In the era of big data, the booming development of artificial intelligence brings new ideas to forensic medicine. In recent years, forensic researchers at home and abroad have conducted many studies based on artificial intelligence technology, such as face recognition, age and gender identification, DNA analysis, postmortem interval estimation, injury and cause of death identification, showing the feasibility and advantages of using artificial intelligence technology to solve forensic identification problems. As a new means of technology that has adapted to the development of the times, artificial intelligence has brought new vitality to forensic medicine, but at the same time also some new challenges. How to deal with these challenges scientifically and form a new mode of 'artificial intelligence plus forensic medicine' with artificial intelligence and forensic medicine developing collaboratively is a new direction for the development of forensic medicine in the era of big data., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Forensic Medicine.)

Objective: To explore the long-term efficacy of laparoscopic-assisted anorectoplasty and conventional anorectoplasty in the treatment of children with high and middle anal atresia. Methods: A retrospective cohort study was used. Inclusion criteria: (1) children with high and middle anal atresia; (2) complicated with rectourethral or rectovesical fistula; (3) complete follow-up data. Exclusion criteria: (1) complicated with 21-trisomy; (2) cerebral palsy and other mentaldisabilities; (3) Currarino syndrome; (4) FG syndrome. Clinical data of 88 patients with middle and high anal atresia, who complicated with rectourethral fistula or rectovesical fistula, and underwent anoplasty at Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from January 2009 to June 2014 were enrolled in the study and analyzed. There were 24 cases with middle atresia and 64 cases with high atresia. All the cases were divided into 2 groups based on the operative method: laparoscopic group (laparoscopic-assisted anorectoplasty, 49 cases), pena group (posterior sagittal anorectoplasty, 39 cases). The demographic features of two groups were comparable. There were no statistically significant differences in gender, age, body mass, classification of anomaly types and sacral ratio (all P >0.05). Student t test and Chi square tests were used to compare the surgical conditions (operative time, postoperative hospital stay and complications), anal function (Kelly score), constipation (Krickenbeck constipation score) and anorectal pressure. Results: Children of both groups all completed operation ssuccessfully. There were no statistically significant differences between laparoscopic group and pena group in the operative time [(120±31) minutes vs. (112±23) minutes, t =1.343, P =0.091] and postoperative hospital stay [(7.1±2.3) days vs. (10.7±3.3) days, t =6.021, P =1.000]. Complications were more common in the pena group [16.3% (8/49) vs. 35.9% (14/39), χ(2)=4.436, P =0.035]. The main complications in laparoscopic group were anal prolapse (8.2%, 4/49) and anal stenosis (6.2%, 3/49), while in pena group were anal stenosis (12.8%, 5/39) and perioperative perianal skin erosion (10.3%, 4/39). As for the anal function, the degree of feces, defecation control and sphincter contractility, the single scoring differences of Kelly scoring system were not statistically significant between the two groups, but the proportion of good function in the laparoscopic group was higher than that in the pena group [67.3% (8/49) vs. 38.5% (15/39), χ(2)=7.308, P =0.007]. Constipation occurred in 6 (12.2%) patients in the laparoscopic group, of whom 5 were improved by diet regulation and 1 required laxatives, while 9 (23.1%) patients developed constipation in the pena group, of whom 4 were improved by diet regulation and 5 required long-term laxatives. The difference of constipation ratio was not statistically significant (χ(2)=1.802, P= 0.180). There were no cases of Krickenbeck constipation grade 3. Compared to the pena group, the laparoscopic group had higher anal resting pressure [(33.35±9.69) mmHg vs. (27.68±10.74) mmHg, t= 2.599, P =0.011], higher dilating pressure [(9.00±5.61) mmHg vs.(6.51±3.24) mmHg, t= 2.462, P =0.016], higher maximal squeeze pressure [(65.80±17.23) mmHg vs. (56.74±18.93) mmHg, t =2.389, P =0.019] and longer maximal contraction time [(21.16±5.02) seconds vs. (18.44±7.24) seconds, t =2.079, P =0.041]. The rectal resting pressure [(5.36±3.00) mmHg vs. (4.61±3.93) mmHg, t =1.015, P =0.312] was not statistically significantly different. Conclusions: Compared with posterior sagittal anorectoplasty, laparoscopic-assisted anorectoplasty in the treatment of high and middle anal atresia has better long-term efficacy with less perioperative complications.

With rapid urbanization and industrialization, more attention has been paid to atmosphere quality in China. PM 2.5 , an important atmospheric pollutant, has attracted widespread public attention. Urban greenspace as a semi-natural surface landscape can affect the concentration and distribution of PM 2.5 . Current studies mainly focus on micro-scale, with few on landscape scale. In this study, land use regression (LUR) model was used to densify monitoring points. Based on ordinary Kriging interpolation method, the spatial distribution of PM 2.5 concentration was simulated with high precision. We quantitatively analyzed the impacts of urban greenspace landscape characteristics and quality on PM 2.5 concentration by coupling urban greenspace interpreted by remote sensing. The results showed that PM 2.5 concentration decreased from central area to periphery. The impacts of greenspace on PM 2.5 concentration varied with greenspace types. The shape of greenspace had no effect on PM 2.5 concentration, while the area and quality of greenspace were significantly negatively correlated with PM 2.5 concentration. In general, the greenspace had an obvious PM 2.5 reduction effect in the distance of less than 100 m. Within the reduction distance, the closer to the greenspace, the lower the PM 2.5 concentration was. The reduction distance of the affiliated and park greenspace was larger than other greenspace types.

Objective: To observe the clinical application of multidisciplinary team (MDT) treatment in the management of geriatric hip fractures and evaluate its effectiveness., Methods: The clinical data of 76 elderly patients with hip fracture managed by MDT approach between August 2016 and February 2018 (MDT group) were retrospectively analyzed and compared with 102 patients managed by traditional orthopedics approach between January 2014 and December 2015 (conventional group). There was no significant difference in gender, age, fracture type, surgical procedure, and other general data between the two groups ( P >0.05). However, the number of comorbidities in the MDT group was significantly higher than that in the conventional group ( t =6.295, P =0.000), and the proportion of the number of comorbidities between the two groups was also significantly different ( χ 2 =28.442, P =0.000). The consultation rate and transfer rate, time to surgery, rate of surgery within 2 or 3 days, operation time, postoperative hospitalization stay, length of hospitalization stay, hospitalization expense, rate of loss to follow-up, and mortality during hospitalization, 30-day mortality, 90-day mortality, and 1-year mortality after operation were compared between the two groups., Results: The rates of total consultations of the conventional group and the MDT group were 56.86% (58/102) and 56.58% (43/76), respectively, and the rates of total transferred patients were 15.69% (16/102) and 15.79% (12/76), respectively, with no significant differences ( P >0.05). Among them, the proportion of patients who transferred into intensive care unit (ICU) in conventional group was significantly higher than that in MDT group and the rates of patients who received geriatric consultation or transferred into geriatric department in MDT group were both significantly higher than those in conventional group ( P <0.05). There was no significant difference in rates of other department consultation or transfer between the two groups ( P >0.05). The time to surgery, operation time, postoperative hospitalization stay, and length of hospitalization stay in MDT group were significantly less than those in conventional group, but the proportion of patients who received surgery within 3 days in MDT group was significantly higher than that in conventional group ( P <0.05). There was no significant difference in the proportion of patients who received surgery within 2 days ( χ 2 =2.027, P =0.155). The hospitalization expenses of total patients, femoral neck fracture, and intertrochanteric fracture subgroups in MDT group were all significantly higher than those in conventional group ( P <0.05). However, there was no significant difference in hospitalization expense of subtrochanteric fracture subgroup between the two groups ( Z =-1.715, P =0.086). The rate of loss to follow-up in conventional group and MDT group was 6.86% (7/102) and 3.95% (3/76), respectively, with no significant difference ( χ 2 =0.698, P =0.403). The mortalities at hospitalization, 1 month, 3 months, and 1 year after operation in conventional group were 0, 1.05% (1/95), 3.16% (3/95), and 7.37% (7/95), respectively, and in MDT group were 0, 0, 2.74% (2/73), 6.85% (5/73), respectively, showing no significant differences in mortalities between the two groups ( P >0.05)., Conclusion: MDT model in the management of geriatric hip fractures has been shown to reduce time to surgery, postoperative hospitalization stay, length of hospitalization stay, operation time, and the proportion of patients who received ICU consultation or transferred into ICU. Furthermore, MDT can improve the capacity for developing operations for patients with complex medical conditions and make medical resources used more rationally.

Abstract: Objective To explore the genetic background and structure of Urumqi Mongolians, the previously developed 39-AIM-InDels panel for ancestry inference was utilized in the present study. Methods The blood samples of 145 unrelated healthy Urumqi Mongolian individuals were collected and genotyped. The compositions of ancestry information of Urumqi Mongolians were studied with 17 different populations from three continents （East Asia, Europe and Africa） as reference populations. Then, multiple population genetics and bioinformatics analysis methods were applied, the Fst and DA values between matched populations were compared and analyzed, PCA analysis was performed and a phylogenetic tree was constructed. The proportions of ancestry information components of Urumqi Mongolians were analyzed with Structure software, etc. Results The ancestry information components of Urumqi Mongolian group in different intercontinental populations accounted for 89%, 7%, and 3% of East Asian, European, and African populations, respectively. Compared with other intercontinental populations, Urumqi Mongolian group and East Asian populations have lower Fst and DA values, and they were in the same cluster in PCA analysis as well. In a phylogenetic tree, the Urumqi Mongolian group was in the same branch as East Asian populations. Conclusion Urumqi Mongolian group had relatively close genetic relationships with East Asian populations, and the proportion of its East Asian ancestry was about 89%., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Forensic Medicine.)

Artemisinin is a kind of sesquiterpene lactone containing endoperoxide bridge,which is the most effective anti-malarial drug at present. However,low content of artemisinin in Artemisia annua,ranging from 0. 1%-1. 0% of dry weight,as well as the complicated extraction process have resulted in low yield and high cost of artemisinin,making it difficult to meet market demand.Based on the development of high-throughput sequencing and molecular biology,the related enzyme genes and transcription factors involved in the artemisinin metabolic pathway were cloned and identified. Metabolic engineering and synthetic biology methods to modify the original metabolic pathway of A. annua and genetic engineering in heterologous host cells have become one of the hotspots in this field. Therefore,the molecular mechanism of artemisin biosynthesis,different strategies of genetic modifications of A. annua,and the research status and application prospect of artemisinin synthesis in heterologous host cells( Nicotiana benthamiana,Physcomitrella patens) were summarized in our review,hoping to provide molecular basis and theoretical basis for breeding new varieties of A. annua with high artemisinin output.