Objective To review the clinical data of the first 100 consecutive robotic-assisted laparoscopic radical prostatectomy ( RALRP) performed by a single surgeon , and to provide our experience in passing the learning curve of RALRP .Methods The retrospective study enrolled 100 consecutive patients diagnosed with prostate cancer from June 2012 to November 2014, who had undertaken RALRP , performed by Prof.Gao Xu.The patients aged 67 (50 to 87) years, with a mean PSA level of 20.3 (1.3 to 214.0)μg/L, among which 89 had a clinical staging of T1a to T2b, 4 staged T2c, and 7 staged T3a to T4.Of the patients, 16, 37, and 47 patients were categorized as low , intermediate, and high risk level , respectively. The operation time and blood loss volume were analyzed by moving average method .Results RALRP in all 100 cases were carried out successfully , with no conversion to open prostatectomy .The mean operation time was 221 (120 to 480) min, with an average intraoperative blood loss of 207 (50 to 800) ml; 2 cases received blood transfusion.Positive surgical margin rate was 26%.Eighty (89%) of 90 cases had recovery of continence ( equal to or less than 1 pad used daily ) 3 months postoperatively;10 cases had a follow-up time less than 3 months, and 5 had gained recovery of continence .The operation time and blood loss volume were stable at the 85th -90th case.Conclusion RALRP has a short learning curve , with a promising overall treatment outcome in the early phase of learning .

Objective: To explore the clinical effects of electroacupuncture (EA) at Zusanli (ST 36) and Fenglong (ST 40) in treating senile dementia. Methods:A total of74 patients were randomly divided into an EA group and a medication group based upon the random digital table, 37 cases in each group. EA at Zusanli (ST 36) and Fenglong (ST 40) was given in the EA group, once every day, for six treatments per week. Donepezil Hydrochloride Tablets were given to the medication group, 5 mg per time and once a day in the former four weeks, 10 mg per time and once a day after 4 weeks, oral administration before sleep at night. The courses of the treatment were 12 weeks in both groups. The scores of mini-mental state examination (MMSE) and Barthel index (BI) were observed before and after the treatment, for processing the comparative analysis of the clinical effects after the course of the treatment. Results:The total effective rate was 86.5% in the EA group and 70.3% in the medication group. The therapeutic effect was better in the EA group than that in the medication group, and the difference between the two groups was statistically significant (P<0.05). MMSE and BI scores after the treatment in the two groups were all elevated than those of the same groups before the treatment (P<0.05,P<0.01). The improving situation was obviously better in the EA group than that in the medication group, and the difference between the two groups was statistically significant (P<0.05). Conclusion:EA at Zusanli (ST 36) and Fenglong (ST 40) is affirmative in the therapeutic effect for senile dementia and can also improve the cognitive function and enhance the patients’ quality of life .

Objective:To explore the application of OTSU-based self-attenuation correction PET (sacPET) reconstruction technology in 18F-florbetapir (AV45) imaging. Methods:From November 2018 to December 2019, 7 confirmed Alzheimer′s disease (AD) patients (4 males, 3 females, age (69.6±4.5)years) and 3 healthy controls (HC; 1 male, 2 females, age (68.0±4.6) years) were recruited prospectively for 18F-AV45 PET imaging in the First Affiliated Hospital of Sun Yat-Sen University. Original data collected by PET acquisition was processed with sacPET reconstruction and then compared with standard PET images by visual analysis and semi-quantitative analysis. Fisher exact test, Kappa test and Pearson correlation analysis were used to analyze data. Results:In HC group and AD group, the radioactive distribution showed by sacPET images and that by standard PET images were similar, and the contrast of gray-white matter in sacPET images was weaker than that in standard PET images. Moreover, the positive uptake area of the cortex in the AD group was smaller than that in standard PET images. Visual analysis showed 19 positive regions in sacPET images and 22 in standard PET images, with no statistical difference of positive rates of the sub-regions in the cortex between the two PET images (all P>0.05), and the overall consistency of 88.00% (44/50; Kappa=0.75 (95% CI: 0.57-0.94), P<0.05). Semi-quantitative analysis showed that the standardized uptake value ratio (SUVR) of frontal lobe and cingulate gyrus measured by sacPET was lower than that measured by standard PET (0.93±0.06 vs 0.96±0.06 and 0.99±0.04 vs 1.01±0.04; t values: 5.30 and 5.10, both P<0.01), while SUVR of parietal lobe, temporal lobe and occipital lobe measured by sacPET was higher than that measured by standard PET (0.78±0.08 vs 0.68±0.07, 0.97±0.07 vs 0.91±0.08 and 0.94±0.11 vs 0.71±0.12; t values: 6.27, 7.36 and 16.90, all P<0.01). The overall SUVR of sacPET images was significantly correlated with the standard PET images ( r=0.75, P<0.001). Conclusion:For 18F-AV45 imaging, sacPET reconstruction technology can obtain reliable and effective PET images without CT data, but its accuracy and precision still need to be improved.

Objective:To observe the clinical effect of wheat grain-sized cone moxibustion combined with fire needle therapy in the treatment of dorsal wrist ganglion (DWG). Methods:A total of 63 patients with DWG were randomized into a treatment group (n=32) and a control group (n=31). Cases in the control group were treated with fire needle therapy. Based on the therapy given to the control group, cases in the treatment group were additionally given wheat grain-sized cone moxibustion therapy. Then the therapeutic efficacies and recurrence rate were evaluated. Results:After treatment, the overall effective rate was 93.8% in the treatment group, versus 77.4% in the control group, and the between-group comparison showed a statistical significance (P<0.05); 6 months after the treatment, the recurrence rate in the treatment group was obviously lower than that in the control group (P<0.05). Conclusion:The long-term and short-term effects of wheat grain-sized cone moxibustion combined with fire needle therapy in the treatment of DWG are better than those of fire needle therapy alone, and therefore, worth popularizing.

Objective: To explore the correlation between moxibustion sensation and distance of moxa stick and provide reference for clinical practice. Methods: A total of 16 healthy volunteers aged 18-35 years old in college were recruited and given mild moxibustion at Shousanli (LI 10), Zusanli (ST 36), Shenshu (BL 23) and Tianshu (ST 25) with moxa stick, and the occurrence and frequency of moxibustion sensation were recorded at distances of 5 cm, 4 cm, 3 cm and 2 cm. Mild moxibustion scale was used to count the score. Results: Warm was the main moxibustion sensation, burning pain and soreness decreased with the rise of distance; for the same acupoint, score of mild moxibustion scale increased with the decrease of distance; score ranged between 5.5 and 6.5 at distance 3 cm, which was the most comfortable distance for volunteers. Conclusion: The distance of 3 cm is the most comfortable distance in mild moxibustion.

Objective:To screen the endoplasmic reticulum stress (ERS) signature-related differentially expressed genes (DEG) in gastric cancer and to construct a prognostic risk model based on a bioinformatics.Methods:Transcriptome sequencing data (RNA-seq) of 375 gastric cancer and 32 paracancerous tissue samples downloaded from The Cancer Genome Atlas (TCGA) database and the corresponding clinical information were obtained as training set samples; data of 387 gastric cancer patients (GSE84437) from Gene Expression Omnibus (GEO) database were downloaded as validation set samples. All data were obtained on December 25, 2021. A total of 785 ERS signature-related genes (ERS-RG) were obtained from the GeneCards database. DEG between gastric cancer tissues and paracancerous tissues in the TCGA database was analyzed. The identified gastric cancer DEG were intersected with ERS-RG from the GeneCards database to obtain gastric cancer ERS signature-related DEG, which were analyzed for gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Univariate Cox proportional risk model was used to screen ERS signature-related DEG with prognostic value in gastric cancer, and LASSO regression analysis was performed to construct a polygenic prognostic risk model, and to calculate the prognostic risk score. The patients in training set and validation set were divided into high-risk group and low-risk group according to the median of the prognostic risk score (2.369); Kaplan-Meier survival analysis was used to compare the overall survival (OS) and to draw time-dependent receiver operating characteristic (ROC) curves of patients in the two groups; nomogram was drawn based on the prognostic independent influencing factors of gastric cancer. The characteristic immune cell infiltration abundance between the two groups was analyzed by using the inverse convolution-based CIBERSORT algorithm. Cytolytic activity scores were calculated by using the geometric mean of granzyme A and perforin 1 expression. According to the median prognostic risk score (2.369) and median tumor mutation burden (TMB) (3.000), all patients with gastric cancer were divided into high risk score-high TMB group, high risk score-low TMB group, low risk score-high TMB group and low risk score-low TMB group to compare the OS of patients in each group.Results:A total of 444 ERS signature-related DEG in gastric cancer including 168 down-regulated genes and 276 up-regulated genes were obtained, which were mainly enriched in biological processes such as protein processing in the endoplasmic reticulum, extracellular matrix (ECM) receptor interactions and unfolded protein responses (all P < 0.05). Univariate Cox regression analysis showed that 12 prognostic-related ERS signature-related DEG in gastric cancer were screened out. LASSO regression analysis was performed to obtain a prognostic risk score = 0.052×NOS3+0.137×PON1+0.067×CXCR4+0.131×MATN3+0.116×ANXA5+0.090×SERPINE1. The results of Kaplan-Meier analysis showed that the OS of the low-risk group in both the training and validation sets was better than that of the high-risk group (all P < 0.01). The results of the time-dependent ROC curve analysis showed that the AUC for the 3-year, 5-year, 8-year OS rates was 0.695, 0.786, 0.698, respectively in the training set, while the AUC for the 3-year 5-year, 8-year OS rates was 0.580, 0.625, 0.627, respectively in the validation set. Multivariate Cox regression analysis showed that prognostic risk score ( HR = 3.598, 95% CI 2.290-5.655, P < 0.001) and tumor stage ( HR = 1.344, 95% CI 1.057-1.709, P < 0.05) were independent factors influencing the prognosis of gastric cancer. Among 375 gastric cancer patients in the TCGA database, the expression levels of ATF6, HSPA5, XBP1 and ATF4 in the high-risk group were higher than those in the low-risk group (all P < 0.05); CIBERSORT results showed that the abundance of activated CD4 memory T cells in the high-risk group was lower than that in the low-risk group, and the abundance of both M0 and M2 macrophages in the high-risk group was higher than that in the low-risk group (all P < 0.05). The expression levels of common immune checkpoints (CD274, CTLA4, TNFRSF9, TIGIT, PDCD1, LAG3) in the high-risk group were all higher than those in the low-risk group (all P < 0.05). Cytolytic activity score in the high-risk group was higher than that in the low-risk group ( P < 0.05). The prognostic risk score was negatively correlated with TMB ( r = -0.20, P < 0.001). Patients in the low-risk score-high TMB group had the best OS and those in the high-risk score-low TMB group had the worst OS (both P < 0.001). Conclusions:The prognostic risk score model is established based on 6 ERS signature-related DEG in gastric cancer and its prognostic risk score may be effective as an independent prognostic factor to predict the prognosis of gastric cancer patients.

China ; Education, Medical ; methods ; Humanities ; Humans

Accurately predicting the risk of mediastinal lymph node metastasis before surgery is of great significance for tumor staging, treatment plan decision, and prognosis evaluation in patients with non-small cell lung cancer(NSCLC). Traditional imaging methods such as CT, MRI and PET/CT are currently the most commonly used clinical methods in clinical evaluation of lymph node status. However, it is subjective to judge lymph node metastasis only by the change of image morphological characteristics, and inflammatory lymphadenopathy will also lead to a high false positive rate. The clinicopathological characteristics obtained by analyzing the clinical data of patients with NSCLC can improve the accuracy of lymph node metastasis prediction to a certain extent. The clinical prediction model based on medical images combined with the clinical characteristics of patients can provide more intuitive and rational information for doctors and patients, but the performance and applicability of the model will inevitably decrease due to changes in disease risk factors and treatment measures. In recent years, with the significant improvement of image analysis technology and computing ability, radiomics models based on medical images can deeply dig into the data in radiological images for quantitative analysis, providing new ideas for predicting mediastinal lymph node metastasis in NSCLC patients, which has attracted extensive attention at home and abroad. This article reviews the progress and makes prospects of the above methods in the prediction of mediastinal lymph node metastasis in NSCLC.

Prostate cancer is one of the most common malignant tumors in the world.Without typical early manifestations in the early stage, it is often too late when found. Therefore, early diagnosis, treatment, and prognosis are critical to improving the survival rate of patients with prostate cancer. Over the past few years, artificial intelligence(AI) has developed rapidly in the field of prostate cancer. In terms of diagnosis, AI is used as a tool to screen the images to reduce the error caused by the professionalism and subjectivity of the technician and to improve the repeatability of the results; In the prediction of prognosis, the algorithm calculates and evaluates disease-related parameters such as recurrence rate, lymph node metastasis rate and mortality rate, so as to assistant clinicians in decision-making and treatment improvements. This reviews aims to introduce the application of artificial intelligence in the diagnosis, treatment and prognosis of prostate cancer in recent years, as well as the prospect and challenges faced by artificial intelligence in the medical field.