Objective:To study the effect of androgen on osteoporosis(Op) in male rats.Methods: Thirty-two 15-week-old male Spague-Dawley rats underwent orchidectomy and then were randomly divided into 3 groups: a normal controls,a model and a andriol treated group.Biochemical markers,bone density(BMD) and bone histomorphometry were investigated after 28 weeks.Results: Orchidectomy caused a significantly decreased in the level of testosterone(P

Liver metastases (LMs) are common in lung cancer. Despite substantial advances in diagnosis and treatment, the survival rate of patients with LM remains low as the immune-suppressive microenvironment of the liver allows tumor cells to evade the immune system. The impact of LMs on the outcomes of immune checkpoint inhibitors in patients with solid tumors has been the main focus of recent translational and clinical research. Growing evidence indicates that the hepatic microenvironment delivers paracrine and autocrine signals from non-parenchymal and parenchymal cells. Overall, these microenvironments create pre- and post-metastatic conditions for the progression of LMs. Herein, we reviewed the epidemiology, physiology, pathology and immunology, of LMs associated with non-small cell lung cancer and the role and potential targets of the liver microenvironment in LM in each phase of metastasis. Additionally, we reviewed the current treatment strategies and challenges that should be overcome in preclinical and clinical investigations. These approaches target liver elements as the basis for future clinical trials, including combinatorial interventions reported to resolve hepatic immune suppression, such as immunotherapy plus chemotherapy, immunotherapy plus radiotherapy, immunotherapy plus anti-angiogenesis therapy, and surgical resection.

To evaluate the effectiveness and safety of 8-ring assisted traction in endoscopic submucosal dissection (ESD), a total of 13 patients with 15 gastric lesions who underwent 8-ring traction-assisted ESD in Nanjing Drum Tower Hospital from July 2021 to January 2022 were included in the retrospective cohort study. All patients successfully completed the operation. The median procedure time was 56 min, and the dissected area per unit time was 0.20±0.02 cm 2/min. The en bloc resection rate, the complete resection rate and the curative resection rate were 93.3% (14/15), 80.0% (12/15) and 80.0% (12/15), respectively. There were no ESD-related complications, such as delayed bleeding or intraperative and postoperative perforation. No deaths occurred. As a novel internal traction technology, 8-ring traction method is simple to operate, providing a good field of vision during ESD to improve the dissection efficiency and reduce complications, which is worthy of further clinical research and promotion.

Objective:To evaluate the efficacy and outcomes of early removal of lumen-apposing metal stent (LAMS) in the treatment of pancreatic wall-off necrosis (WON).Methods:A retrospective analysis was performed on 51 patients with WON who underwent endoscopic ultrasound (EUS)-guided transluminal drainage (ETD) and direct endoscopic necrosectomy (DEN) using LAMS at Nanjing Drum Tower Hospital from January 2018 to December 2022. Patients were divided into the early removal group (within two weeks, n=24) and the traditional removal group (after two weeks, n=27) based on the timing of LAMS removal. The short-term effects, safety and long-term outcomes of WON were compared between the two groups. Results:The technical success rate of LAMS placement in 51 patients reached 100%, and all patients underwent ETD and DEN. The median number of necrosectomy sessions in the early removal group was significantly lower than in the traditional removal group, 2.0 sessions vs 3.0 sessions and the difference was statistically significant ( P<0.05). Postoperatively, 15.7% of patients required percutaneous catheter drainage (PCD) and 5.9% required surgery, with no significant difference between the two groups. The clinical success rate and mortality rate in the early removal group were 79.2% and 8.3%, respectively, compared to 81.5% and 3.7% in the traditional removal group, with no statistically significant difference. In terms of safety, the early removal group exhibited a significantly lower rate of adverse events during stent retention with statistically significant difference (12.5% vs 37.0%, P<0.05) compared to the traditional removal group. A total of 46 patients were followed up for six months. In the early removal group, the rates of disease recurrence, need for endoscopic reintervention and occurrence of long-term complications were 20.0%, 10.0% and 20.0%, respectively. These rates did not show a significant increase compared to the traditional removal group, which were 7.7%, 3.8% and 38.5%, respectively, without significant differences between the groups. Conclusions:In the treatment of WON, early removal of LAMS is safe and effective to a certain extent. In comparison to the traditional practice of removing LAMS after two weeks, early removal does not reduce clinical success rates, nor does it increase the rates of disease-related mortality, recurrence, or long-term complications. On the contrary, it may reduce the occurrence of adverse events during stent retention and decrease the number of necrosectomy procedures subsequently.

Objective:To assess the safety and efficacy of single metal clip traction-assisted endoscopic submucosal dissection (ESD) for the treatment of duodenal lesions.Methods:Data of 45 patients with duodenal lesions who underwent ESD in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between April 2021 and October 2022 were retrospectively recruited. Among them, 19 patients received single metal clip traction- assisted ESD while 26 patients received traditional ESD. The incidence of complications, dissection speed, en bloc resection rate and R0 resection rate of the two groups were mainly observed. Secondary observation indexes included specimen longer diameter, shorter diameter and area.Results:All 45 procedures were successfully completed, with the procedure time of 44.0 (27.0, 67.0) min for the single metal clip traction- assisted ESD group and 34.0 (24.0, 43.5) min for the traditional ESD group ( Z=-1.678, P=0.093). In the single metal clip traction-assisted ESD group, 2 cases (10.5%) had complications, including 1 intraoperative perforation and 1 postoperative bleeding (approximately 20 mL). There were three cases (11.5%) of complications in the traditional ESD group, including 1 case of postoperative bleeding (approximately 50 mL) and 2 cases of postoperative perforation, with no significant intergroup variation ( P=1.000). The dissection speed of the single metal clip traction-assisted ESD group was 16.0 (11.0, 25.8) mm 2/min, significantly larger than that of the traditional ESD group [5.3 (2.2, 21.1) mm 2/min, Z=-2.287, P=0.022]. The en block resection rate and R0 resection rate of the single metal clip traction-assisted ESD group were both 100.0% (19/19). Additionally, the specimen longer diameter, shorter diameter and area of the single metal clip traction-assisted ESD group were 34.0 (22.0, 45.0) mm, 25.0 (20.0, 34.0) mm, and 745.8 (380.0, 1 342.4) mm 2, respectively, significantly larger than those of the traditional ESD group of 20.0 (12.8, 30.3) mm ( Z=-3.119, P=0.002), 14.0 (8.8, 21.3) mm ( Z=-3.417, P=0.001), 190.4 (84.0, 498.7) mm 2 ( Z=-3.275, P=0.001). Conclusion:Single metal clip traction is safe and effective for duodenal ESD, demonstrating a notable improvement in the dissection speed, especially suitable for large duodenal lesions.

Objective To explore the clinical significance of centralized surveillance of hydatidiform mole.Methods From Feb.2013 to Feb.2017 all patients with hydatidiform mole,who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and Child Health Care Hospital,were registered centrally for serum hCG monitoring and treatment if necessary.Prophylactic chemotherapy was not administered regardless of risk factors for malignant transformation of hydatidiform mole.The risk factors included age of over 40 years,excessive uterine enlargement for presumed gestational age,a serum hCG level greater than 5 00 000 U/L,large theca lutein ovarian cysts (＞6 cm),and a history of previous hydatidiform mole.The centralized surveillance of hydatidiform mole was based on the central pathology review,team cooperation and service improvement.Their treatments and outcomes were analyzed retrospectively.Results A total of 407 women of hydatidiform mole were registered with histopathology confirmation,including 70 high-risk hydatidiform moles.The follow-up rate was 97.5％ (397/407).The incidence of post-mole neoplasia was 8.1％ (32/397),which was diagnosed in 22.9％ (16/70) of high-risk and in 4.9％ (16/327) of low-risk hydatidiform moles,showed statistically significant difference between high-risk and low-risk groups (x2=25.108,P＜0.01).Thirty-two patients with post-mole neoplasia were all at low risk of International Federation of Gynecology and Obstetrics (FIGO) score (range,0-6) and received complete remission with chemotherapy alone in 31 of them except one treated by hysterectomy.The primary cure rate of single-agent chemotherapy was 60.0％ (18/30).Patients with low-risk or high-risk post-mole neoplasia were both 16.There were no significant differences between the two groups in interval that was end of antecedent pregnancy to start of treatment,the serum level of hCG before treatment,clinical stage or risk factor score (all P＞0.05).Conclusions The risk of malignant transformation is increased in high-risk hydatidiform mole,however,the high risk factor itself does not affect the prognosis in patients with timely diagnosis and treatment of post-mole neoplasia.Therefore,prophylactic chemotherapy is not recommended to high-risk hydatidiform mole patients.Centralized surveillance of hydatidiform mole is practical in a local hospital of China and could greatly improve the prognosis of post-mole neoplasia.

The pre-S/S gene of hepatitis B virus (HBV) can encode for the production of large, medium and small surface protein. Different protein expression levels and their composition ratios have certain influences on the diagnosis, treatment and outcome of HBV infection. It is of great significance to clarify the functions of large, medium and small surface protein as serum markers and to explore their value in the diagnosis and treatment of HBV infection. In this paper, the expression status, detection methods and clinical significance of the three HBV proteins were reviewed.

Purpose: The risk stratification of pediatric anaplastic large cell lymphoma (ALCL) has not been standardized. In this study, new risk factors were included to establish a new risk stratification system for ALCL, and its feasibility in clinical practice was explored. Materials and Methods: On the basis of the non-Hodgkin’s lymphoma Berlin–Frankfurt–Munster 95 (NHL-BFM-95) protocol, patients with minimal disseminated disease (MDD), high-risk tumor site (multiple bone, skin, liver, and lung involvement), and small cell/lymphohistiocytic (SC/LH) pathological subtype were enrolled in risk stratification. Patients were treated with a modified NHL-BFM-95 protocol combined with an anaplastic lymphoma kinase inhibitor or vinblastine (VBL). Results: A total of 136 patients were enrolled in this study. The median age was 8.8 years. The 3-year event-free survival (EFS) and overall survival of the entire cohort were 77.7% (95% confidence interval [CI], 69.0% to 83.9%) and 92.3% (95% CI, 86.1% to 95.8%), respectively. The 3-year EFS rates of low-risk group (R1), intermediate-risk group (R2), and high-risk group (R3) patients were 100%, 89.5% (95% CI, 76.5% to 95.5%), and 67.9% (95% CI, 55.4% to 77.6%), respectively. The prognosis of patients with MDD (+), stage IV cancer, SC/LH lymphoma, and high-risk sites was poor, and the 3-year EFS rates were 45.3% (95% CI, 68.6% to 19.0%), 65.7% (95% CI, 47.6% to 78.9%), 55.7% (95% CI, 26.2% to 77.5%), and 70.7% (95% CI, 48.6% to 84.6%), respectively. At the end of follow-up, one of the five patients who received maintenance therapy with VBL relapsed, and seven patients receiving anaplastic lymphoma kinase inhibitor maintenance therapy did not experience relapse. Conclusion This study has confirmed the poor prognostic of MDD (+), high-risk site and SC/LH, but patients with SC/LH lymphoma and MDD (+) at diagnosis still need to receive better treatment (ClinicalTrials.gov number, NCT03971305).

Purpose: The risk stratification of pediatric anaplastic large cell lymphoma (ALCL) has not been standardized. In this study, new risk factors were included to establish a new risk stratification system for ALCL, and its feasibility in clinical practice was explored. Materials and Methods: On the basis of the non-Hodgkin’s lymphoma Berlin–Frankfurt–Munster 95 (NHL-BFM-95) protocol, patients with minimal disseminated disease (MDD), high-risk tumor site (multiple bone, skin, liver, and lung involvement), and small cell/lymphohistiocytic (SC/LH) pathological subtype were enrolled in risk stratification. Patients were treated with a modified NHL-BFM-95 protocol combined with an anaplastic lymphoma kinase inhibitor or vinblastine (VBL). Results: A total of 136 patients were enrolled in this study. The median age was 8.8 years. The 3-year event-free survival (EFS) and overall survival of the entire cohort were 77.7% (95% confidence interval [CI], 69.0% to 83.9%) and 92.3% (95% CI, 86.1% to 95.8%), respectively. The 3-year EFS rates of low-risk group (R1), intermediate-risk group (R2), and high-risk group (R3) patients were 100%, 89.5% (95% CI, 76.5% to 95.5%), and 67.9% (95% CI, 55.4% to 77.6%), respectively. The prognosis of patients with MDD (+), stage IV cancer, SC/LH lymphoma, and high-risk sites was poor, and the 3-year EFS rates were 45.3% (95% CI, 68.6% to 19.0%), 65.7% (95% CI, 47.6% to 78.9%), 55.7% (95% CI, 26.2% to 77.5%), and 70.7% (95% CI, 48.6% to 84.6%), respectively. At the end of follow-up, one of the five patients who received maintenance therapy with VBL relapsed, and seven patients receiving anaplastic lymphoma kinase inhibitor maintenance therapy did not experience relapse. Conclusion This study has confirmed the poor prognostic of MDD (+), high-risk site and SC/LH, but patients with SC/LH lymphoma and MDD (+) at diagnosis still need to receive better treatment (ClinicalTrials.gov number, NCT03971305).

Purpose: The risk stratification of pediatric anaplastic large cell lymphoma (ALCL) has not been standardized. In this study, new risk factors were included to establish a new risk stratification system for ALCL, and its feasibility in clinical practice was explored. Materials and Methods: On the basis of the non-Hodgkin’s lymphoma Berlin–Frankfurt–Munster 95 (NHL-BFM-95) protocol, patients with minimal disseminated disease (MDD), high-risk tumor site (multiple bone, skin, liver, and lung involvement), and small cell/lymphohistiocytic (SC/LH) pathological subtype were enrolled in risk stratification. Patients were treated with a modified NHL-BFM-95 protocol combined with an anaplastic lymphoma kinase inhibitor or vinblastine (VBL). Results: A total of 136 patients were enrolled in this study. The median age was 8.8 years. The 3-year event-free survival (EFS) and overall survival of the entire cohort were 77.7% (95% confidence interval [CI], 69.0% to 83.9%) and 92.3% (95% CI, 86.1% to 95.8%), respectively. The 3-year EFS rates of low-risk group (R1), intermediate-risk group (R2), and high-risk group (R3) patients were 100%, 89.5% (95% CI, 76.5% to 95.5%), and 67.9% (95% CI, 55.4% to 77.6%), respectively. The prognosis of patients with MDD (+), stage IV cancer, SC/LH lymphoma, and high-risk sites was poor, and the 3-year EFS rates were 45.3% (95% CI, 68.6% to 19.0%), 65.7% (95% CI, 47.6% to 78.9%), 55.7% (95% CI, 26.2% to 77.5%), and 70.7% (95% CI, 48.6% to 84.6%), respectively. At the end of follow-up, one of the five patients who received maintenance therapy with VBL relapsed, and seven patients receiving anaplastic lymphoma kinase inhibitor maintenance therapy did not experience relapse. Conclusion This study has confirmed the poor prognostic of MDD (+), high-risk site and SC/LH, but patients with SC/LH lymphoma and MDD (+) at diagnosis still need to receive better treatment (ClinicalTrials.gov number, NCT03971305).