Objective To investigate that ox-LDL inhibits endothelial differentiation of bone marrow mesenchymal stem cells (MSCs) in rats and its underlying mechanism .Methods Cultured MSCs were divided into four groups:blank groups , ox-LDL groups ( 5 μg/mL ox-LDL ) , ox-LDL +NAC groups ( 5 μg/mL ox-LDL and pre-treated NAC), and negative LDL groups (5 μg/mL nLDL).Cell morphology, endothelial marker and differentiation effi-ciency as well as signal of oxidative and pathway protein were detected after induction by Western blot , real-time PCR.Results MSCs can differentiate into endothelial cells with the expression of endothelial marker vWF , Flk-1 and CD31 at the mRNA and protein level , vascular morphology , ox-LDL obvious inhibited endothelial differentia-tion of MSCs ( P<0.05 ) , but NAC can reverse the inhibition , the amount of ROS in ox-LDL groups was higher than that in ox-LDL+NAC groups ( P <0.05 ) , The expression of phosphorylated Akt decreased distinctly after treatment with ox-LDL( P<0.05 ) , NAC can stimulated its expression close to normal .Conclusions ox-LDL can inhibit endothelial differentiation of MSCs via ROS , NAC in this procese shows inhibition to effect of ox-LDL and Akt signaling also played a critical role .

Objective To investigate the risk factors of anastomotic leakage after transanal total mesorectal excision.Methods Retrospective analysis of clinical data of 46 patients with rectal cancer who underwent TaTME surgery from May 2015 to May 2018 in Daping Hospital,Army Medical University.There were 22 males and 24 females,the median age was 61.2 (range from 40 to 79)years.To observe the correlation between perioperative factors and anastomotic leakage,including preoperative staging,operation time,bleeding volume,anastomotic approach,anastomotic height,intraoperative adverse events,and concurrent diseases.The software of SPSS 20.0 was adopted to analyze the above indicators.Results Among 46 patients with rectal cancer,38 were treated with TaTME combined with laparoscopic surgery,5 with robotic transanal combined with transabdominal surgery,and 3 with pure transanal total mesorectal excision.There were no deaths in the whole group.The incidence of postoperative anastomotic leakage was 13.0％,1 case of grade B and 1 cases of grade A anastomotic leakage,both accounting for 2.2％ and 4 cases of grade C anastomotic leakage,accounting for 8.7％.Anastomotic leak discovery time average (9.8 ± 4.8) d.No anastomotic leakage occurred in 17 cases of ileostomy.Among them,diabetes mellitus,protective ostomy,blood loss ≥ 100 ml,BMI,height of anastomosis and total operation time were significantly correlated with anastomotic leakage.Conclusions In addition to the influence of the learning curve during TaTME surgery,obesity,diabetes,anastomotic height,intraoperative blood loss ≥ 100 ml,and prolonged total operation time are risk factors for anastomotic leakage.Ileal protective ostomy is valuable for reducing anastomotic leakage.

Objective To evaluate the clinical efficacy of early diagnosis by contrast-enhanced ultrasound (CEUS) combined with mesenchymal stem cell (MSC) therapy in the treatment of biliary ischemia after liver transplantation. Methods Clinical data of 9 recipients presenting with biliary ischemia detected by CEUS within 4 weeks after liver transplantation and diagnosed with non-anastomotic biliary stricture (NAS) within postoperative 1 year were retrospectively analyzed. In the conventional treatment group, 4 recipients were treated with conventional treatment including liver protection, cholagogic therapy and interventional therapy. In MSC treatment group, 5 recipients received intravenous infusion of MSC at 1, 2, 4, 8, 12 and 16 weeks after biliary ischemia detected by CEUS on the basis of conventional therapy. The interventional treatment and clinical prognosis within 1 year after liver transplantation were analyzed between two groups. Results Two recipients in the MSC treatment group required interventional therapy, which was initially given at 7-9 months after liver transplantation for 1-2 times. All recipients in the conventional treatment group required interventional therapy, which was initially delivered at postoperative 1-3 months for 2-6 times, earlier than that in the MSC treatment group. Within 1 year following liver transplantation, diffuse bile duct injury occurred in 2 recipients in MSC treatment group, and no graft dysfunction was observed. In the conventional treatment group, all recipients developed diffuse bile duct injury, and 2 recipients presented with graft dysfunction. Conclusions Early diagnosis of biliary ischemia after liver transplantation by CEUS combined with MSC therapy may delay and reduce the requirement of interventional therapy for NAS, and also improve clinical prognosis of the recipients.

Objective:To investigate the application value of Da Vinci robotic transanal minimally invasive surgery (R-TAMIS) for local resection of rectal neoplasms.Methods:The retros-pective and descriptive study was conducted. The clinicopathological data of 7 rectal neoplasms patients undergoing R-TAMIS in Daping Hospital of Army Medical University from June 2017 to March 2021 were collected. There were 3 males and 4 females, aged (60±7)years. Observation indicators: (1) intraoperative situations; (2) postoperative recovery; (3) postoperative histopatholo-gical examinations; (4) follow-up. Follow-up was conducted using telephone interview or outpatient examination to detect readmission of patients within postoperative 30 days, tumor recurrence and metastasis and survival of patients. Follow-up was performed at postoperative 1, 3, 6 months and once every 6 months thereafter up to April 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Intraoperative situations. All the 7 patients underwent R-TAMIS successfully without conversion to laparotomy or laparoscopic surgery. Of the 7 patients, 2 cases underwent full-thickness rectal resection and 5 cases underwent submucosal dissection of tumor. The rectal wounds were not sutured in 2 cases because of large lesions, and the rectal wounds were sutured with synthetic sutures in 5 cases after resection of lesions. Transanal drainage tube was placed in 2 cases and not in 5 cases. The volume of intra-operative blood loss of the 7 patients was 15(range, 2?50)mL. The total operation time of the 7 patients was (91.4±18.4)minutes, including (19.1±2.3)minutes for transanal platform placement and Da Vinci robotic surgical system installation, and (72.3±16.6)minutes for operation. There was no intraoperative complication such as urethral injury. (2) Postoperative recovery. All the 7 patients started water drinking and out-of-bed activities at postoperative day 1 and liquid food intake at postoperative day 2. The time to postoperative first flatus of the 7 patients was 1(range, 1?3)days. The two cases with transanal drainage underwent removing of transanal drainage at postoperative day 2. There was no postoperative complication and the duration of postoperative hospital stay of the 7 patients was 3(range, 3?9)days. (3) Postoperative histopathological examinations. Of the 7 patients, 3 cases had villous adenoma, 2 cases had villous adenoma combined with high grade intraepithelial neoplasia, local canceration and tumor invasion into submucosa (stage SM1), 1 case had villous adenoma combined with high grade intraepithelial neoplasia, local canceration and tumor localized in the inner mucosa (stage Tis) and 1 case had moderately differentiated adeno-carcinoma with tumor invasion into superficial muscle layer (stage T2). All the 7 patients had negative surgical margins with none of tumor cell remained in the base. (4) Follow-up. All the 7 patients were followed up for 18(range, 1?42)months. One of the 7 patients showed rectal adenocarcinoma with tumor invasion into superficial muscle layer by the postoperative histopathological examina-tion and was recommended for remedial radical surgery. The patient refused further surgery and underwent 3 courses of oral capecitabine chemotherapy. The other 6 patients did not receive postoperative chemotherapy. None of 7 patients underwent readmission within postoperative 30 days, and no patient had tumor local recurrence, distant metastasis or death during the follow-up.Conclusion:R-TAMIS for local resection of rectal neoplasms is safe and feasible for patients with rectal adenoma and early rectal cancer, with reliable short-term efficacy and short-term oncological efficacy.

Objective:To establish selection criteria of community mentors for postgraduates in general medicine.Methods:A subject index system of selection criteria of community tutors for general practice postgraduates was drafted and refined based on literature retrieving and in-depth interviews during January to December 2020. Twenty experts in general practice related fields were invited for two rounds of Delphi consultation. Analytic hierarchy process was used to calculate index weight coefficient and consistency test; and the developed selection criteria were evaluated.Results:Through the in-depth interviews with 11 general practice faculty and 11 general practice postgraduates, the following five first-level thematic frameworks were refined: (1) the professional qualities; (2) the basic qualities; (3) the clinical ability; (4) the teaching ability; (5) the scientific research ability. After two rounds of Delphi expert consultation, the selection criteria of community tutors for postgraduates in general practice were finally constructed, including 5 first-level indicators (professional quality, basic quality, medical practice ability, teaching and guidance ability, academic research ability) and 28 second-level indicators. The positive coefficients of experts were 85% and 100%; the expert authority coefficients were 0.825 and 0.860; and the expert opinion coordination coefficients were 0.486 and 0.515, respectively (all P<0.05). the weight coefficients of the five first-level indicators were 0.345, 0.210, 0.138, 0.210 and 0.097, respectively. Conclusion:The criteria and index system on the selection of community mentors for general practice postgraduates has been successfully developed in the study.

Objective: To analyze the associations between molecular subtypes and overall breast cancer survival among premenopausal and postmenopausal breast cancer in Beijing, and to provide basic information for breast cancer clinical researches and control. Methods: All the resident patients diagnosed with breast cancer in four well-established hospitals were retrieved from Beijing cancer registry, related information, such as TNM stages, receptor status, histological grade, height, weight, were collected by case extraction. Cancer registration information and population-based follow-up information were used to acquire survival outcome. All the patients were followed up until 31 December 2015, 4 531 cases with invasive, primary breast were included in the final analysis. All the cases were classified into Luminal and non-Luminal according to receptor status. Five-year survival rates of the two subtypes were estimated by the life-table method. Multivariable Cox proportional hazards models were employed to evaluate the associations between molecular subtypes and breast cancer survival. Results: Of all the 4 531 patients, premenopausal patients accounted for 44.5% (2 017 cases) and postmenopausal patients accounted for 55.5% (2 514 cases). 643 cases died during the study period. Overall five-year survival was 89.5% (95%CI: 88.6%-90.4%), for premenopausal and postmenopausal patients, they were 92.1% (95%CI: 90.9%-93.3%), and 87.5% (95%CI: 86.2%-88.8%), respectively. Among all the patients, 3 730 patients had molecular subtype, 76.7% (2 861 cases) were Luminal breast cancer, and 23.3% (869 cases) were non-Luminal breast cancer. Five-year survival rates for Luminal and non-Luminal were 91.8% (95%CI: 90.8%-92.8%), and 83.2% (95%CI: 80.7%-85.7%), respectively. No matter in premenopausal or postmenopausal patients, non-Luminal breast cancer had significantly higher risk of death compared to Luminal breast cancer (premenopausal: HR=1.85, 95%CI: 1.26-2.73; premenopausal: HR=1.42, 95%CI: 1.07-1.88). Conclusion For both premenopausal and postmenopausal breast cancer patients, non-Luminal breast cancer had lower five-year survival rates than Luminal breast cancer, which was a risk factor on breast cancer survival.

Objective:To compare the short- and mid-term clinical outcomes of robotic versus laparoscopic radical resection of right- and left-sided colon cancer.Methods:In this retrospective cohort study, clinical data on patients who had undergone robotic or laparoscopic radical resection of right and left sided-colon cancer performed by two senior physicians in the Department of Gastro-Colorectal and Anal Surgery, Daping Hospital, Army Medical University between January 2015 and December 2023 were collected. The patients were allocated to robotic ( n=117) or laparoscopic groups ( n=267). Propensity score matching in a ratio of 1∶1 was implemented to minimize the impact of imbalances in baseline information between the two groups. Propensity score matching left 228 patients in the study cohort, with 114 in each group. The participants were aged (60.8±12.1) and (60.3±13.1) years and the body mass indices were (23.1±3.0) kg/m 2 and (23.1±2.8) kg/m 2 in the robotic and laparoscopic groups respectively. After matching, relevant perioperative indicators, postoperative complications, and 3-year survival outcomes were compared between the two groups. Results:After propensity score matching, the differences in baseline information between the two groups were not statistically significant ( P>0.05). After matching, in the robotic surgery group, radical resection of right- versus left-sided colon cancer had been performed on 80 and 34 patients, respectively; compared with 78 and 36, respectively, in the laparoscopic surgery group. Compared with the laparoscopic group, the robotic group had a longer operative time ( [209.8±48.4] minutes vs. [186.7±46.9] minutes, t=3.665, P<0.001), higher hospitalization cost ( [88657.8±18548.1] yuan vs. [61179.5±13822.7] yuan, t=12.683, P<0.001), and lower rate of postoperative complications (7.9% [9/114] vs. 17.5% [20/114], χ 2=4.780, P=0.029); these differences are statistically significant. The robotic group tended to have a lower conversion rate than the laparoscopic group (0 vs. 4.4% [5/114]); however, this difference between the two groups was not statistically significant (χ 2=3.272, P=0.070). The amount of intraoperative bleeding, time to first passage of flatus, postoperative hospital stay, postoperative complications (Clavien-Dindo grade), number of resected lymph nodes, and number of positive lymph nodes did not differ significantly between the two groups (all P>0.05). Furthermore, the differences between the robotic and laparoscopic groups in 3-year disease-free survival (81.4% vs. 82.8%, P=0.863) and overall survival (83.1% vs. 86.5%, P=0.921) were not statistically significant ( P>0.05). Conclusion:Robotic radical resection of right and left-sided colon cancer is safe and feasible and an effective alternative to laparoscopic surgery. Although robotic surgery has a longer operative time and higher hospitalization costs than laparoscopic surgery, it has a lower rate of postoperative complications, and a 3-year survival outcome comparable to that of laparoscopic surgery.

Objective:To compare the short- and mid-term clinical outcomes of robotic versus laparoscopic radical resection of right- and left-sided colon cancer.Methods:In this retrospective cohort study, clinical data on patients who had undergone robotic or laparoscopic radical resection of right and left sided-colon cancer performed by two senior physicians in the Department of Gastro-Colorectal and Anal Surgery, Daping Hospital, Army Medical University between January 2015 and December 2023 were collected. The patients were allocated to robotic ( n=117) or laparoscopic groups ( n=267). Propensity score matching in a ratio of 1∶1 was implemented to minimize the impact of imbalances in baseline information between the two groups. Propensity score matching left 228 patients in the study cohort, with 114 in each group. The participants were aged (60.8±12.1) and (60.3±13.1) years and the body mass indices were (23.1±3.0) kg/m 2 and (23.1±2.8) kg/m 2 in the robotic and laparoscopic groups respectively. After matching, relevant perioperative indicators, postoperative complications, and 3-year survival outcomes were compared between the two groups. Results:After propensity score matching, the differences in baseline information between the two groups were not statistically significant ( P>0.05). After matching, in the robotic surgery group, radical resection of right- versus left-sided colon cancer had been performed on 80 and 34 patients, respectively; compared with 78 and 36, respectively, in the laparoscopic surgery group. Compared with the laparoscopic group, the robotic group had a longer operative time ( [209.8±48.4] minutes vs. [186.7±46.9] minutes, t=3.665, P<0.001), higher hospitalization cost ( [88657.8±18548.1] yuan vs. [61179.5±13822.7] yuan, t=12.683, P<0.001), and lower rate of postoperative complications (7.9% [9/114] vs. 17.5% [20/114], χ 2=4.780, P=0.029); these differences are statistically significant. The robotic group tended to have a lower conversion rate than the laparoscopic group (0 vs. 4.4% [5/114]); however, this difference between the two groups was not statistically significant (χ 2=3.272, P=0.070). The amount of intraoperative bleeding, time to first passage of flatus, postoperative hospital stay, postoperative complications (Clavien-Dindo grade), number of resected lymph nodes, and number of positive lymph nodes did not differ significantly between the two groups (all P>0.05). Furthermore, the differences between the robotic and laparoscopic groups in 3-year disease-free survival (81.4% vs. 82.8%, P=0.863) and overall survival (83.1% vs. 86.5%, P=0.921) were not statistically significant ( P>0.05). Conclusion:Robotic radical resection of right and left-sided colon cancer is safe and feasible and an effective alternative to laparoscopic surgery. Although robotic surgery has a longer operative time and higher hospitalization costs than laparoscopic surgery, it has a lower rate of postoperative complications, and a 3-year survival outcome comparable to that of laparoscopic surgery.

Objective:To develop the training syllabus of palliative care for general practitioners.Methods:Twenty-nine experts in fields of general practice and hospice care from different teaching hospitals and community health service centers were invited to participate in two rounds of Delphi consultation from April 2022 and August 2022. Based on results of Delphi consultation a preliminary training syllabus was established through data analysis, synthesis and process.Results:Of the 29 experts, 11 (37.9%) were male with age of (52.9±8.9) years and working experience of (17.0±7.2) years. The expert activity coefficient of the two rounds of consultation was 100.0% (29/29) and 96.6% (28/29), authority coefficient was 0.815 and 0.870, and opinion coordination coefficient was 0.359 and 0.515, respectively ( P<0.05). The training syllabus comprised of 4 first-grade indicators, 19 second-grade indicators and 58 third-grade indicators. The weight coefficients of the 4 first-grade indicators, namely objective of training, theory courses and theoretical knowledge, clinical base rotation contents and requirements, community base rotation content and requirements, were 0.251, 0.251, 0.250 and 0.248, respectively. Conclusions:A preliminary training syllabus of palliative care for general practitioner has been developed in this study, which provide a basis for standardized training of community palliative care.