Objective To investigate the effect and safety of administering magnesium sulphate as a technique of controlled hypotension during functional endoscopic sinus surgery. Methods Seventy-five patients arranged for selective functional endoscopic sinus surgery under general anesthesia, were randomly assigned into three groups: control group, magnesium sulphate group and nitroglycerin group(n=25). The patients of magnesium sulphate group received 10% magnesium sulphate 40 mg/kg before the induction of anaesthesia, and then 15 mg·kg~(-1)·h~(-1) by continuous infusion during the operation. The same volume of 5% glucose was administered to the patients in control group. Constant infusion of nitroglycerin beginning with 1 μg·kg~(-1)·min~(-1) was administered to the patients in nitroglycerin group. The hemodynamic indexes, amount of bleeding, fluid intake, operation time, recovery time, quality of surgery field, muscle relaxation and adverse reaction were recorded. Concentration of Mg~(2+) in magnesium sulphate group were compared before and after surgery.Results The patients in the magnesium sulphate group maintained balanced heart rates during the operation, while the heart rates of patients in control group and nitroglycerin group increased significantly (P<0.01). The patients of magnesium sulphate group had lower amount of bleeding and shorter operation time compared with control group (P<0.01). The quality of surgery field in magnesium sulphate group was significantly better than that in control group (P<0.01). Time for 75% recovery of myokymia and recovery index in magnesium sulphate group was higher than those in control group and nitroglycerin group(P<0.01). No adverse reaction was observed in all groups. Conclusion Magnesium sulphate can be effective and safe for controlled hypotension during functional endoscopic sinus surgery.

AIM: To investigate the effects of antagonistic peptide specifically binding to the second extracellular loop of CC chemokine receptor 5 (CCR5) on inflammatory cell infiltration and TNF-α expression in lung tissues of asthmatic mice.METHODS: The asthmatic model of BALB/c mice was induced by ovalbumin (OVA) and the optimal sensitization concentration of OVA was screened.After modeling, the mice were intervened by gradual concentrations of antagonistic peptide via tail-vein injection.The pathocytological analysis and grading were performed in the lung tissues with HE staining.The expression of TNF-α at mRNA and protein levels in the lung tissues was determined by real-time PCR and Western blot.RESULTS: The optimal concentration of OVA was 500 mg/L (0.1 mL) as this concentration of OVA stably induced moderate degree of inflammation in the BALB/c mice.Treatment with different concentrations (1.5 g/L, 2.5 g/L and 3.5 g/L) of antagonistic peptide at 0.2 mL through tail-vein injection inhibited the expression of TNF-α, and markedly reduced the degree of inflammation in the lung tissues.The optimal concentration of antagonistic peptide was 2.5 g/L as the lung inflammation degree in 2.5 g/L group alleviated by 2 grades, and the number of inflammatory cells was also significantly reduced.Moreover, the mRNA expression abundance of TNF-α was nearly decreased by 90%, and the protein expression of TNF-α was decreased by 70% compared with model group.Meanwhile, the use of antagonistic peptide at 2.5 g/L before OVA stimulation confirmed the preventive function to some degree.In this group, the lung inflammation degree alleviated by 1 grade, and the expression of TNF-α at both mRNA and protein levels decreased by nearly 50%.CONCLUSION: The antagonistic peptide of CCR5 effectively inhibits the expression of TNF-α and relieves the inflammation in the asthmatic mouse lung tissues in a concentration-dependent manner.

A growing number of people with unilateral breast cancer have chosen to undergo contralateral prophylactic mastectomy in order to prevent the occurrence of second primary breast cancer and thus avoid associated treatment and death. Contralateral prophylactic mastectomy has been considered beneficial in high-risk populations, such as premenopausal BRCA1/2 mutation carriers. As a result, contralateral prophylactic mastectomy acceptance in patients with no such mutation is controversial. Contralateral prophylactic mastectomy can reduce the risk by up to 95%. Therefore, it is very important to evaluate the risk of contralateral breast cancer and to make appropriate surgical treatment. A review of risk factors for contralateral breast cancer and the benefits of contralateral prophylactic mastectomy in patients with unilateral breast cancer is presented.

Objective To evaluate the prostate imaging reporting and data system(PI-RADS) version 1 and version 2 for detection of prostate cancer (PCa) by multiparametric magnetic resonance imaging (MpMRI) in a consecutive cohort of patients with magnetic resonance imaging/transrectal ultrasonography (MRI-TRUS) fusion-guided biopsy.Methods 30 suspicious lesions including 15 prostate cancer and 15 non cancer at 3.0 T MpMRI were scored according to the PI-RADS V1(≥ 3 scores in at least one MRI sequence)system before MRI-TRUS fusion guided biopsy and correlated to histopathology results.PI-RADS V2 and Likert scores were determined retrospectively,diagnostic accuracy was determined using receiver operating characteristic curve analysis.Results The PI-RADS score of the dominant lesion was significantly higher in patients with PCa compared to patients with negative histopathology (PI-RADS V1:12.10±2.60 vs 7.47±1.98,P<0.05;PI-RADS V2:4.21±1.18 vs 2.79±0.92,P<0.05);Using a Likert score cut-off ≥ 4,a sensitivity of 73.7%,a specificity of 78.9%, positive predictive value of 77.74% and a negative predictive value of 75.00% (AUC=0.778,95%CI:0.63-0.93), a PI-RADS V1 cut-off ≥ 10,a sensitivity of 73.7%,a specificity of 94.7%,positive predictive value of 93.29% and a negative predictive value of 78.26% (AUC=0.911,95%CI:0.82-1.00) and PI-RADS V2 cut-off ≥ 4,a sensitivity of 57.9%, a specificity of 100%, positive predictive value of 100% and a negative predictive value of 73.37% (AUC=0.837,95%CI:0.70-0.97) were achieved.Conclusion The described fusion system is dependable and efficient for targeted MRI-TRUS fusion-guided biopsy.MpMRI PI-RADS scores combined with a novel real-time MRI-TRUS fusion system facilitate sufficient diagnosis of PCa with high sensitivity and specificity,PI-RADS scores appears to be the preferable method for the evaluation of prostate cancer than Likert score, while V2 does not perform better than V1.

AIM:To study the effects of antagonistic peptides binding specifically with the first and second extracellular loops (ECL1 and ECL2) of C-C chemokine receptor 5 (CCR5) on the colitis rats induced by trinitrobenzenesulfonic acid (TNBS) and the mechanisms.METHODS:The colitis model of SD rats was induced by TNBS (100 mg/kg).The effects of 2 antagonistic peptides at different doses (ECL1:25, 35 and 45 mg/kg;ECL2:15, 25 and 35 mg/kg) on the model rats including the changes of disease activity index (DAI), colon macroscopic damage index (CMDI) and histological grading were observed.The mRNA and protein expression levels of TNF-α and COX-2 in the colonic mucosa were detected by real-time PCR and Western blot, respectively.RESULTS:Compared with model group, the changes of DAI, CMDI and histopathological injury of the rats treated with ECL2 antagonistic peptide HY at an appropriate dose were significantly reduced (P<0.05), and the protein and mRNA expression levels of TNF-α and COX-2 were significantly decreased (P<0.05).However, the effects of ECL1 antagonistic peptide GH on all scores and the expression levels of TNF-α and COX-2 were not obvious.CONCLUSION:ECL2 antagonistic peptide HY relieves TNBS-induced colitis in SD rats via down-regulating the expressions of TNF-α and COX-2 in the colonic mucosa, while the effect of ECL1 antagonist peptide GH was not obvious.

Pathology rotation is an important part in resident standardization training. Impor-tance should be attached to the residents' learning during the standardization training in Pathology De-partment, such as standardizing training and strict departmental rotation examination, developing the residents' thinking ability of the relationship between clinical and pathology with the main line of spe-cialty pathology learning , and improving clinical research capacity through pathology technical methods and principles, and training pathology literacy from pathology requisition filled to interpreta-tion of the pathology report, which will also help to improve the medical service quality of the hospital.

AIM:To analyze the expression of CCR5 and correlation with the expression ofβ-arrestin 2 in the intestinal mucosa of the patients with inflammatory bowel disease ( IBD) , so as to study the role of CCR5 andβ-arrestin 2 in the pathogenesis of IBD.METHODS:Paraffin sections of the colonic mucosa were prepared from 53 patients with active IBD, 26 patients with remissive IBD and 30 healthy people.Immunohistochemical EnVision two-step method was used to test the expression of CCR5 andβ-arrestin 2 in the biopsic intestinal mucosa.RESULTS:The positive rate, strongly posi-tive rate and immunohistochemical score of CCR5 expression in active IBD were significantly higher than those in normal controls or remissive IBD (P<0.05).No correlation of CCR5 expression with clinical severity, lesion distribution, and endoscopic grade in active IBD was observed.The expression ofβ-arrestin 2 was significantly lower in active IBD than that in the remissive IBD and normal controls, and there was a negative correlation ofβ-arrestin 2 expression with CCR5 expres-sion (P<0.05).CONCLUSION:The expression of CCR5 is higher, and expression ofβ-arrestin 2 is lower, and there is a negative correlation of expression of CCR5 with expression ofβ-arrestin 2 in intestinal mucosa of the active IBD.

Objective To evaluate the diagnostic value of prostate imaging reporting and data system version 1 (PI-RADS V1) and version 2 (PI-RADS V2) for detection of prostate cancer (PCa) in the transition zone (TZ).Methods Seventy-seven patients with suspicious lesions in TZ on mpMRI were scored according to the PI-RADS system (V1 and V2) before MR-TRUS fusion guided biopsy prospectively.In all of the patients with suspicious tumors,respectively at least one lesion with a PI-RADS V1 assessment category of ≥3,was selected for biopsy.Independent sample t test was used to compare scores of PI-RADS V1 and V2 between PCa and benign prostatic hyperplasia (BPH).The diagnostic performance of PI-RADS V 1 and V2 for detection of PCa in the transition zone was compared by analyzing ROC basing on the results of MR-TRUS fusion guided biopsy.Results A cohort of 77 patients was performed including 31 cases of PCa (32 cores) and 46 cases of BPH (51 cores).PCa (V1:1 1.50±2.79;V2:4.28±0.99) had significantly higher scores of both PI-RADS V1 and PI-RADS V2 than BPH(V1:7.51± 1.63;V2∶2.61 ±0.67) (P＜0.05).Using a PI-RADS V1 score cut-off ≥ 11,sensitivity and specificity in group PCa and BPH were calculated,which were 68.8％(22/32) and 96.1％(49/51) with a area under curve of 0.869;using a PI-RADS V2 score cut-off ≥4,which were 75.0％ (24/32) and 90.2％ (46/51) with a area under curve of 0.888,respectively.Conclusions PI-RADS system can indicate the likelihood of PCa of suspicious lesions in TZ on Mp-MRI.PI-RADS V2 perform better than V 1 for the assessment of prostate cancer in TZ.

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.