The medical consulting service, disease inquiry and seeking medical advice functions of 10 commonly available APP software in China for seeking medical advice, such asRapid Asking Doctors,Handholding Doc-tor Selection, andChunyu Handholding Doctors, were compared, which showed that although the functions of APP software in China for seeking medical advice could meet the requirement of people for seeking medical advice, importance should be further attached to their accurate and integrative information and establishment of profit-making model in order to promote the sustainable development of medical APP software.

Objective To explore the clinical users′experience on using the intelligent laboratory test system so as to provide reference for its optimization.Methods Fifteen laboratory staff with different sub specialty was selected for in-depth interviews and data were analyzed using phenomenological approach.Results Intelligent laboratory system could improve the quality of test result verification and interpretation,shorten the turnaround time and improve the work efficiency.It took about 1-2 months for users to accept the automatic verification function.After that,the users could believe in the system and used it in their daily work.The sys-tem could reduce the work stress and verification duty,while balancing the technical gap between laboratory technicians.Users could only understand the general rule of the intelligent system and it was difficult for them to manage the rule repository.Conclu-sion The intelligent laboratory system is one of the artificial intelligent system used for the medical laboratory,it can provide com-prehensive clinical decision support for the laboratory staff.

Objective:To investigate the prognostic significance of the lymphovascular invasion (LVI) in patients with upper tract urothelial carcinoma(UTUC) after radical nephoureterectomy (RNU) and Gemcitabine and Cisplatin combination Chemotherapy (GC).Methods:The clinical data of 95 patients with UTUC admitted to Beijing Friendship Hospital, Capital Medical University from March 2013 to March 2019 were analyzed retrospectively. There were 50 males and 45 females; the average age was 63 years, ranged from 36 to 81 years. According to the situation of LVI, they were divided into LVI positive group ( n=25) and LVI negative group ( n=70). Chi-square test was used to analyze the clinicopathological parameters of the two groups of patients. Kaplan-Meier method was used to draw the survival curves of the overall survival (OS) time and recurrence-free survival (RFS) time of the two groups of patients. The difference between the two groups was used Log-Rank test. The risk factors related to OS and RFS were evaluated using univariate and multivariate Cox regression models. Results:All patients were followed up for 2-82 months, with an average follow-up time of 36 months. Among them, 20(21.1%) died and 36(37.9%) relapsed. There were significant differences in T stage ( P=0.046), lymph node metastasis ( P=0.032), and tumor location ( P=0.019) between LVI negative group and LVI negative group. Univariate analysis showed that hydronephrosis ( P=0.026), lymph node metastasis( P=0.001), LVI ( P=0.001), chemotherapy cycle ( P=0.045) were correlated with OS; hydronephrosis ( P=0.031), tumor T stage ( P=0.013), lymph node metastasis ( P=0.004), LVI ( P=0.001) were significantly correlated with RFS. Multivariate analysis showed that hydronephrosis ( P=0.016), lymph node metastasis ( P=0.016), and LVI( P=0.003) were significantly correlated with OS. Lymph node metastasis ( P=0.018), LVI ( P=0.003) were significantly correlated with RFS. In conclusion, LVI was an independent risk factor for OS and RFS. The OS [(40.7±6.5) months for LVI positive group, (68.5±3.2) months for LVI negative group, χ2=15.750, P<0.001] and RFS [(31.0±5.7) months for LVI positive group, (58.0±8.8) months for LVI negative group, χ2=10.986, P=0.001] of patients with LVI positive group were worse than those with LVI negative group, the differences were statistically significant. Conclusions:LVI is more likely to be possitive in patients with high T stage, lymph node metastasis and single renal pelvis cancer, which provides a basis for risk stratification of patients with UTUC. After radical resection and adjuvant chemotherapy, the benefit of OS and RFS in patients with positive LVI was significantly worse than that in patients with negative LVI.

Objective:To explore the risk factors of tumor recurrence after radical nephroureterectomy combined with Gemcitabine and Cisplatin(GC) systemic intravenous chemotherapy for upper tract urothelial carcinoma (UTUC), establish a recurrence risk prediction model, and conduct preliminary verification.Methods:One hundred and one cases of UTUC were analyzed from January 2013 to October 2019 in Beijing Friendship Hospital, Capital Medical University retrospectively. All patients underwent radical nephroureterectomy+ bladder cuff resection, and were treated with GC intravenous adjuvant chemotherapy, among which 19 underwent preoperative neoadjuvant chemotherapy. The study collected general information and clinical characteristics of the patients, and follow up the patient's recurrence. Tumor recurrence and relapse free survival (RFS) were the main observation indexes. The patients were divided into the recurrent group and the non-recurrent group according to their recurrence. Kaplan-Meier and Log-rank methods were used to estimate and compare the RFS rates of the two groups. Univariate difference analysis was used to identify the indicators that were significantly different between patients in the recurrence group and the non-recurrence group, and the COX proportional hazard model was further used to explore the correlation between each factor and the tumor recurrence. According to the weights of relevant risk factors, an individual prognostic index (PI) equation was established, a recurrence prediction model was constructed, and the receiver operating characteristic (ROC) curve was used for verification.Results:One hundred and one patients were followed up for 2-82 months, with median 22 months. 40 patients had recurrence, including 32 in the bladder and 8 in the contralateral upper urinary. One-year RFS was 82.10%, two-year RFS was 68.90% and 5-year RFS was 42.10%. COX proportional risk model results showed that tumor hydronephrosis (X1), lymphovascular invasion (X2) and tumor T stage (X3) were independent risk factors, while neoadjuvant chemotherapy (X4) and chemotherapy cycle (X5) were independent protective factors. Individual PI equation =0.964X1+ 0.688X2+ 0.508X3-1.566 X4-0.675X5. The ROC curve was drawn to show that the optimal pointcut value was 179.5 when the Youden index was 0.537, the sensitivity of the model was 0.750, the specificity was 0.787, and the area under the curve (AUC) was 0.838(95% CI: 0.758-0.918). Conclusions:Hydronephrosis, tumor T stage, lymphovascular invasion, neoadjuvant chemotherapy and chemotherapy cycle are independent factors affecting the recurrence of UTUC patients. The multi-factor risk prediction model is suitable for evaluating the possibility of tumor recurrence after radical surgery combined with GC chemotherapy in UTUC patients, which can provide scientific evidence for the prognosis assessment of patients.

Objective:To evaluate the effect of preoperative plasma D-dimer level on the risk of cardiac surgery-associated acute kidney injury (CSA-AKI). Methods:The clinical data of patients who underwent cardiac surgery with cardiopulmonary bypass in the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2018 were collected retrospectively. All patients were distributed into two groups (normal D-dimer group with D-dimer level≤0.55 mg/L and elevated D-dimer group with D-dimer level>0.55 mg/L) according to the D-dimer threshold of 0.55 mg/L and the differences of clinical data between the two groups were compared. Kaplan-Meier survival analysis method was used to analyze the difference of the cumulative incidence of CSA-AKI between the two groups. Logistic regression analysis and restricted cubic splines analysis were used to analyze the association between serum D-dimer and the incidence of CSA-AKI. Results:There were 871 patients enrolled in the study with 427 females (49.0%) and age of (56.6±12.3) years, including 215 patients (24.7%) with high D-dimer and 259 patients (29.7%) with CSA-AKI. Compared with the normal D-dimer group, patients with elevated D-dimer had higher baseline serum creatinine, proportion of chronic kidney disease stage 3, international normalized ratio, fibrinogen, proportion of receiving renal replacement therapy and incidence of CSA-AKI (all P<0.05). The prothrombin time, operation time, extracorporeal circulation time, aortic occlusion time and hospital stay in the elevated D-dimer group were longer (all P<0.05), and the preoperative estimated glomerular filtration rate (eGFR) and hemoglobin levels were lower than those in the normal D-dimer group (both P<0.05). There was no statistical difference between the two groups in terms of age, gender, comorbid diseases, cardiac function classification, and hospital mortality (all P>0.05). Kaplan-Meier survival curve results showed that compared with the normal D-dimer group, the risk of CSA-AKI in the elevated D-dimer group was significantly increased (Log-rank χ2=14.227, P<0.001). The multivariate logistic regression showed that after adjusting variables including gender, age, diabetes mellitus, preoperative eGFR, cardiopulmonary bypass time and so on, the higher level of preoperative D-dimer (>0.55 mg/L) was still related to CSA-AKI ( OR=1.476, 95% CI 1.038-2.098, P=0.030). Restricted cubic splines analysis showed that the incidence of CSA-AKI raised when preoperative serum D-dimer concentration increased (non-linear P=0.262). Conclusion:Patients with high preoperative serum D-dimer have an increased risk of CSA-AKI.