Objective To research the changes of calcium regulation hormone and bone mineral density (BMD) in type 2 diabetes mellitus (T2DM ) patients and analyze the main impact factors. Methods 117 T2DM patients (T2DM group ,M/F=52/65 ,age 40~79 years) and 63 age‐ and gender‐matched healthy people (NC group) were selected in this study. According to the course of diabetes ,blood glucose control and the value of BMD ,T2DM patients were divided into subgroups :course≤10 years ,and>10 years ;HbA1 c≤8% ,and>8% ;normal BMD ,osteopenia ,and osteoporosis (OP). Serum 25‐hydroxy vitamin D3 [25(OH)D3 ]and Parathormone (PTH) were measured and BMDs of lumbar spine (L1 ~L4 ) , femoral neck ,total hip ,and whole body were evaluated for all the subjects. Result (1)Compared with NC group ,the level of serum 25(OH)D3 and BMDs of femoral neck and total hip decreased significantly in T2DM group[ (35.57 ± 12.30)nmol/L ,(0.848 ± 0.136)g/cm2 ,(0.873 ± 0.150)g/cm2 vs(44.94 ± 17.40) nmol/L ,(0.927 ± 0.173)g/cm2 ,(0.934 ± 0.140)g/cm2 ,respectively ,P<0.01 or P<0.05)]. The level of PTH increased in T2DM group[ (8.50 ± 4.15) vs(5.62 ± 3.93)pmol/L ,P<0.01]. (2)Compared with the group duration of diabetes≤10 years ,BMD of femoral neck and total hip decreased in patients with duration of diabetes>10 years[ (0.814 ± 0.148) ,(0.840 ± 0.157) vs (0.882 ± 0.111) ,(0.908 ± 0.139) g/cm2 ,respectively ,P<0.05]. The level of PTH increased [(10.55 ± 9.09) vs (7.06 ± 3.74)pmol/L , P<0.05)]. 25(OH)D3 and total body BMD have no significant difference(P>0.05). (3)Compared with HbA1c≤8% group ,BMD of femoral neck and total hip in HbA1c> 8% group decreased [(0.830 ± 0.131) ,(0.832 ± 0.161) vs (0.891 ± 0.130) ,(0.949 ± 0.130)g/cm2 ,respectively ,P<0.05]. The level of PTH increased [(9.96±8.80) vs (7.21±3.98)pmol/L ,P<0.05]. 25(OH)D3and total body BMD have no significant difference(P> 0.05). (4)The rates of OP and osteopenia (41.03% ,47.86% ) in T2DM were higher than those in NC group (26.98% ,33.33% ) (χ2 =4.367 ,4.669 ,P<0.05). The duration of diabetes and the levels of HbA1c and PTH were longer or higher in OP group than those with normal BMD or osteopenia (P<0.05). (5)Logistic regression analysis showed that BMD negatively correlated with the duration of diabetes ,HbA1c ,and PTH (β= 0.076 ,0.213 ,0.112 ,respectively ,P< 0.05) ,and positively correlated with 25(OH)D3 (β= -0.043 ,P<0.05). Conclusion The values of BMD decreased and the incidence of OP is higher in T2DM patients ,particularly in patients with longer diabetic duration and poor glycemic control.

Objective To evaluate the effect of ginsenoside-Rg3 on cellular immune function of nasopharyngeal carcinoma patients with radiotherapy. Methods 50 nasopharyngeal carcinoma patients with radiotherapy were ran-domly divided into Rg3 group ( n=25 ) and control group ( n=25 ) . After the radiotherapy, the peripheral blood lymphocy of each group were collected. MTT method was used to detect lymphocyte proliferation. Lymphocyte sub-group was detected by Flow Cytometry/financal capacity model. IgG,IgM and Th1/Th2 cytokines was detected by ELISA. Results Ginsenoside Rg3 could promote the proliferation of lymphocytes in patients with nasopharyngeal carcinoma radiotherapy,upregulation of CD4 +,CD4 +/CD8 +,IgG,IgM,IL-2,downregulation of CD8 +,IL-6,and showed dose dependent. Conclusion Rg3 ginsenosides can significantly enhance the peripheral blood lymphocyte immune function of nasopharyngeal carcinoma patients with radiotherapy. Rg3 ginsenosides may be a potential im-mune immunosuppression caused by nasopharyngeal carcinoma radiotherapy enhancer antagonism.

Objective To assess the relationship between endometrium damage and focal distance of high intensity focused ultrasound ablation(HIFU).Methods 150 patients with requirement of atoke from Ⅱ type uterine fibroids under HIFU were collected and divided into two groups by the location of fibroids,one was antetheca group, and the other was posterior group,which were further divided into three groups,A group(25 cases),B group(25 cases), and C group(25 cases),in which their distance were 15mm,18mm,and 20mm from endometrium respectively.Those patients were treated with HIFU,and improvement of symptoms was assessed by uterine fibroids symptom (UFS) score,energy efficiency factor(EEF)was served as total energy required by treatment,the closest distance from mar-gin of necrosis of fibroids to endometrium and the rate of ablation were detected by MRI,as well as integrity of endo-metrium and vaginal bleeding were observed on postoperative 2 days and 3 months.Results After treatment by HIFU,significant improvement of symptoms was found,especially for the fibroids in antetheca(t =3.868,P =0.01), moreover,as for the fibroids in antetheca,the obvious efficacy was found in B group and C group(F =4.711,P <0.05),while for posterior fibroids,the efficacy was not associated with the location of HIFU(F =3.898,P >0.05).In addition,high rate of ablation and low EEF for the fibroids in antetheca was found(t =9.818,11.224,respectively,all P <0.01),and the highest rate of ablation in A group was revealed(F =105.673,P <0.01),followed by that of B group,the worse was C group.While in posterior fibroids,the distance was not associated with the rate of ablation(F =0.485,P >0.05).There was significant difference of integrity rate for endometrium between antetheca and posterior fibroids on postoperative 2 days(93.33% vs.77.33%,χ2 =7.67,P <0.05),and the rate in antetheca fibroids was higher than that of posterior fibroids(94.67% vs.82.67%)on postoperative 3 months.After postoperative 2 days,as for the fibroids in antetheca,the rate of integrity in B group(100.00%)and C group(100.00%)was higher than that in A group(80.00%),while in posterior fibroids,the highest rate was in C group(100.00%),followed by B group, which of A group was the worst(60.00%);After postoperative 3 months,in the fibroids of antetheca,there was no sig-nificant difference of rate between B group and C group,which were higher than that in A group(84.00%),while in posterior fibroids,the highest rate was in C group(100.00%),followed by B group(84.00%).In addition,significant difference between varied focal distance and improvement of vaginal bleeding existed in antetheca and posterior fibroids(P <0.05),for example the score of vaginal bleeding in B group and C group at postoperative 3 months was lower than that in A group(F =7.292,P <0.01),while for posterior fibroids,the efficacy of C group was higher than that of B group(F =14.559,P <0.05 ).Conclusion Although improved efficacy of Ⅱ type uterine fibroids is offered by HIFU,for the minimum damage of endometrium,its focal distance is varied with the locations of fibroids, namely,the safe distance in antetheca is more than 18mm,while that in posterior fibroids is more than 20mm.

Objective To explore the correlation between the fluctuation of blood glucose levels and brain damage in neonates with hypoglycemia. Methods The clinical data of 58 cases of neonatal hypoglycemia diagnosed from September 2013 to August 2016 were analyzed retrospectively. According to the results of neonatal cranial MRI and/or amplitude integrated electroencephalogram (aEEG), the neonates were divided into brain injury group and non-brain injury group. The fluctuation index of blood glucose was compared between two groups, and the correlation between the fluctuation of blood glucose level and brain injury was analyzed. Results In these 58 cases, 13 cases were in brain injury group (8 males and 5 females) and 45 cases were in non-brain injury group (27 males and 18 females). The lowest blood glucose (LBG) value in brain injury group was lower than that in non-brain injury group, while the duration of hypoglycemia, maximum blood glucose fluctuations (LAGE), standard deviation of blood glucose (SDBG), and average blood glucose fluctuations (MAGE) were higher than those in non-brain injury group, and they were all significantly different (P all<0.001). Conclusions Whether the hypoglycemia in newborn could lead to the brain injury or not depends not only on the minimum hypoglycaemia level and duration of hypoglycemia, but also on the indicators of glucose variation, such as LAGE, SDBG and MAGE.

Objective To analyze the compliance and the influencing factors of the children with congenital hypothyroidism (CH).Methods 231 children with CH were collected for this study.The questionnaire survey and referring the case were used to collect relative factors.According to regular follow -up treatment,the children were divided into two groups,one group was good compliance and the other one was bad compliance.The results were ana-lyzed by two -independent sample t -test,2 -test and unconditioned logistic regression analysis.Results (1)Blood TSH(χ2 =59.870,P =0.00) and blood FT4 (χ2 =6.468,P =0.01) were normal,short distance from the hospital (χ2 =16.375,P =0.00),level of education of their mothers was high(χ2 =7.483,P =0.02),and regular compli-ance treatment of children with CH(χ2 =7.483,P =0.024) was good.(2) Logistic stepwise regression analysis showed that serum TSH value(OR =17.135),the short distance(OR =1.692) and diagnosis of CH(OR =4.028) were introduced into the logistic regression model (all P <0.05).Conclusion It is essential to take measures actively and reinforce the management of children with long distance,low -educated,and the diagnosis of TSH.More-over,enhancing the regular treatment compliance of children with CH is the key to improve the growth and develop-ment status of children with CH.

Objective Inflammatory bowel disease(IBD)is an unexplained chronic and recurrent inflammatory disease of the intestine,including ulcerative colitis(UC)and Crohn′s disease(CD).At present, the etiology and pathogenesis of IBD are still not clear,and it is believed to be related to the environment, inheritance,infection,immunity and other factors.With the increase of people′s living standard and the economic and social development,the incidence of IBD in China is a rising trend year by year,the impact of diet on the incidence of IBD and the influence of nutritional support on the prognosis of IBD have attracted more and more attention.Vitamin is one of the seven nutrients and is an indispensable part of the health of the body.In recent years,some vitamins have been proved to be related with the occurrence and development of IBD.

Objective:To explore the efficacy of digital and 3D printing technologies on design of superficial iliac circumflex artery flap for coverage the donor site of anterolateral thigh flap(ALTF).Methods:Clinical data of 8 patients were studied retrospectively for treatment of soft tissue defects of hand in the Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, from April 2017 to October 2021. The patients were 6 males and 2 females, aged from 29 to 59 years(mean, 45.8 years). Cause of injury: 3 patients were crushed, 2 by hot pressing, and 3 by machine strangulation. Site of injury included: 5 cases were dorsal hand defects and 3 cases were palm defects. All the wounds were contaminated to varying degrees with soft tissue defects. The areas of soft tissue defect ranged from 11 cm×10 cm to 22 cm×14 cm. Four patients had combined injuries of open fracture of metacarpals and phalanges and 3 with tendon defects. All wounds were repaired by free ALTF transplantation. And the donor sites in the thigh were repaired by superficial iliac circumflex artery flaps. The secondary wounds caused by flap harvesting on abdominal wall were closed directly. The targeted perforator vessels were detected preoperatively by CTA combined with CDU. 3D printed models of the affected hand were obtained before operation for individualised repairs according to the shape and area of the wounds. After the operation, all patients entered scheduled follow-ups at the outpatient clinic and via internet by observing the flap shape and testing the recovery of sensory and movement of adjacent joint.Results:The shapes and sizes of the wounds and the flaps were found basically in accordance with those in the preoperative simulative designs. All flaps in 8 patients survived and the wounds healed completely. All patients entered follow-ups for 8 to 24(average, 17.5) months. The donor thighs presented good appearance and colour, pliability without bloating. The range of motion of the hips and knees was not affected. Only linear scars remained in the abdominal donor sites, with natural colour and appearance.Conclusion:Digital and 3D printing technologies in preoperative design of flaps can help to locate the perforator vessels intraoperatively and guide the individualised design of the flaps with improved operation efficiency and satisfactory appearance of the flaps.

Objective:To explore the key genes and its biological functions of aldosterone producing adenoma (APA) using bioinformatics analysis.Methods:Differentially expressed genes of APA were identified from two training datasets GSE60042 and GSE64957 in GEO database. Function and pathway enrichment analyses for differentially expressed genes were performed and transcriptional regulation network among these genes were determined. Hub genes were extracted by node analysis from the protein-protein interaction (PPI) network. The expression of key genes was verified by a testing dataset GSE8514. Receiver operating characteristic(ROC) curve analysis was applied to assess the diagnostic efficiency of key genes in APA. The biofunction of each key gene were determined by gene set enrichment analysis (GSEA).Results:A total of 68 differentially expressed genes, including 33 up-regulated genes and 35 down-regulated genes, were detected from the training datasets. These genes were mainly enriched in aldosterone biosynthetic process, calcium signaling pathway, serotonin receptor signaling pathway, transcriptional activator activity, and regulation of transcription. JUN and VDR were at the center of the transcriptional factor-gene network. Furthermore, we identified nine Hub genes from the PPI network. In testing dataset, CYP11B2 and VDR showed the higher expression, while JUN, NFKBIZ, EGR3, and KLF6 showed lower expression in APA (all P<0.05), and the value of area under ROC curve analysis was 0.936, 0.833, 0.953, 0.854, 0.868, and 0.929, respectively. GSEA indicated the alter of key genes in APA led to up-regulation of the steroid biosynthesis, cell adhesion molecules, immune cells signaling pathway, and complement and coagulation cascades [all normalized enrichment score (NES)>1.5, P<0.05], but down-regulation of the DNA replication, ribosome, and autophagy (all NES<-1.5, P<0.05). Conclusion:Results of bioinformatics indicate that JUN and VDR are key transcriptional factors, and CYP11B2, NFKBIZ, EGR3, and KLF6 are the key genes for APA, which are involved in the steroid biosynthesis, cell adhesion molecules, immune cells signaling pathway in APA.

Objective: To evaluate the efficacy and safety of generic imatinib (Genike, Chiatai Tianqing Pharmaceutical Group Co., Ltd.) and imatinib (Glevic, Novartis, Switzerland) in newly diagnosed patients with chronic myeloid leukemia in chronic phase (CML-CP) . Methods: A retrospective study of 323 CML-CP patients (205 in Glivec treatment group and 118 in Genike group) who were ≥ 18 years old receiving imatinib monotherapy over the period of June 2013 to March 2016 was done to compare the differences of cytogenetics, molecular curative effect, survival, and adverse reactions between the two groups. The beginning dosage of imatinib was 400mg per day. There was no statistically difference between the two groups of patients on baseline. Results: ①The median duration of imatinib treatment was 13 (0.5-36) months in Glevic group and 11 (1-31) months in Genike group. ②The rate of complete hematological remission (CHR) had no statistically difference between Glivec and Genike treatment groups[98% (201/205) vs 97.5% (115/118) , χ²=0.123, P=0.725]. ③Cumulative rates of major cytogenetic responses (MCyR) at 3, 6 and 12 months after imatinib treatment in Gleevec and Genike groups were (59.7±3.5) % vs (79.8±3.1) %, (89.2±2.6) % vs (59.1±4.7) %, (80.3±4.1) % vs (87.1±4.3) %, respectively, the difference was not statistically significant (χ²=0.084, P=0.772) . Cumulative rates of complete cytogenetic response (CCyR) at 3, 6 and 12 months after imatinib treatment in Gleevec and Genike groups were (32.9±3.4) % vs (58.3±3.7) %, (87.4±3.0) % vs (35.2±4.5) %, (64.8±4.8) % vs (87.3±4.7) %, respectively, the difference was not statistically significant (χ²=0.660, P=0.417) . ④Cumulative rates of major molecular responses at 6, 12 months after imatinib treatment in Glevic and Genike groups were (24.9±3.3) % vs (57.0±4.1) %, (16.3±4.0) % vs (55.3±7.7) %, respectively, there was no statistical significance (χ²=1.617, P=0.204) . Cumulative rates of molecular response 4.5 (MR4.5) at 12 months after imatinib treatment in Glevic and Genike groups were (14.9±3.2) % vs (8.1±2.1) % (χ²=3.628, P=0.057) , respectively. ⑤At a median follow-up of 12 months, the difference of progression-free survival (PFS) in Glevic and Genike groups had no statistical significance[ (96.6±1.4) % vs (93.3±2.5) %, χ²=2.293, P=0.130]. The difference of event-free survival (EFS) had no statistical significance, either[ (95.6±1.5) % vs (93.3±2.4) %, χ²=2.124, P=0.145]. ⑥Genike was well tolerated in patients with CML-CP and had no statistically significant difference in adverse events compared with Glevic group. Conclusion There were no statistically significant differences in efficacy and safety between Glevic and Genike treatment in newly diagnosed patients with CML-CP.

Objective:To investigate the value of transanal multipoint full-layer puncture biopsy (TMFP) in predicting pathological complete response (pCR) after neoadjuvant radiotherapy and chemotherapy (nCRT) in patients with locally advanced rectal cancer (LARC) and to establish a predictive model for providing clinical guidance regarding the treatment of LARC.Methods:In this multicenter, prospective, cohort study, we collected data on 110 LARC patients from four hospitals between April 2020 and March 2023: Beijing Chaoyang Hospital of Capital Medical University (50 patients), Beijing Friendship Hospital of Capital Medical University (41 patients), Qilu Hospital of Shandong University (16 patients), and Zhongnan Hospital of Wuhan University (three patients). The patients had all received TMFP after completing standard nCRT. The variables studied included (1) clinicopathological characteristics; (2) clinical complete remission (cCR) and efficacy of TMFP in determining pCR after NCRT in LARC patients; and (3) hospital attended, sex, age, clinical T- and N-stages, distance between the lower margin of the tumor and the anal verge, baseline and post-radiotherapy serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 concentrations, chemotherapy regimen, use of immunosuppressants with or without radiotherapy, radiation therapy dosage, interval between surgery and radiotherapy, surgical procedure, clinical T/N stage after radiotherapy, cCR, pathological results of TMFP, puncture method (endoscopic or percutaneous), and number and timing of punctures. Single-factor and multifactorial logistic regression analysis were used to determine the factors affecting pCR after NCRT in LARC patients. A prediction model was constructed based on the results of multivariat analysis and the performance of this model evaluated by analyzing subject work characteristics (ROC), calibration, and clinical decision-making (DCA) curves. pCR was defined as complete absence of tumor cells on microscopic examination of the surgical specimens of rectal cancer (including lymph node dissection) after NCRT, that is, ypT0+N0. cCR was defined according to the Chinese Neoadjuvant Rectal Cancer Waiting Watch Database Study Collaborative Group criteria after treatment, which specify an absence of ulceration and nodules on endoscopy; negative rectal palpation; no tumor signals on rectal MRI T2 and DWI sequences; normal serum CEA concentrations, and no evidence of recurrence on pelvic computed tomography/magnetic resonance imaging.Results:Of the 110 patients, 45 (40.9%) achieved pCR after nCRT, which was combined with immune checkpoint inhibitors in 34 (30.9%). cCR was diagnosed before puncture in 38 (34.5%) patients, 43 (39.1%) of the punctures being endoscopic. There were no complications of puncture such as enterocutaneous fistulae, vaginal injury, prostatic injury, or presacral bleeding . Only one (2.3%) patient had a small amount of blood in the stools, which was relieved by anal pressure. cCR had a sensitivity of 57.8% (26/45) for determining pCR, specificity of 81.5% (53/65), accuracy of 71.8% (79/110), positive predictive value 68.4% (26/38), and negative predictive value of 73.6% (53/72). In contrast, the sensitivity of TMFP pathology in determining pCR was 100% (45/45), specificity 66.2% (43/65), accuracy 80.0% (88/110), positive predictive value 67.2% (45/67), and negative predictive value 100.0% (43/43). In this study, the sensitivity of TMFP for pCR (100.0% vs. 57.8%, χ 2=24.09, P<0.001) was significantly higher than that for cCR. However, the accuracy of pCR did not differ significantly (80.0% vs. 71.8%, χ 2=2.01, P=0.156). Univariate and multivariate logistic regression analyses showed that a ≥4 cm distance between the lower edge of the tumor and the anal verge (OR=7.84, 95%CI: 1.48-41.45, P=0.015), non-cCR (OR=4.81, 95%CI: 1.39-16.69, P=0.013), and pathological diagnosis by TMFP (OR=114.29, the 95%CI: 11.07-1180.28, P<0.001) were risk factors for pCR after NCRT in LARC patients. Additionally, endoscopic puncture (OR=0.02, 95%CI: 0.05-0.77, P=0.020) was a protective factor for pCR after NCRT in LARC patients. The area under the ROC curve of the established prediction model was 0.934 (95%CI: 0.892-0.977), suggesting that the model has good discrimination. The calibration curve was relatively close to the ideal 45° reference line, indicating that the predicted values of the model were in good agreement with the actual values. A decision-making curve showed that the model had a good net clinical benefit. Conclusion:Our predictive model, which incorporates TMFP, has considerable accuracy in predicting pCR after nCRT in patients with locally advanced rectal cancer. This may provide a basis for more precisely selecting individualized therapy.