Objective To evaluate the effectiveness and safety of a transanal drainage tube(TDT) for decompression of acute left-sided obstruction of colorectum.Methods Fifty-seven patients with acute left-sided colorectal obstruction were enrolled in this study from January 2010 to December 2014.The obstruction location, property, success rate of insertion, one-procedure rate and complication rate were analyzed.Results There were 53 cases of primary colorectal cancer,among which lesions were located in the transverse colon in 1 case, in descending colon in 10, in sigmoid colon in 24,and in rectum in 18.There were 4other cases, one sigmoid colonic metastases of pulmonary cancer, 1 adhesive colonic obstruction after ovary surgery, 1 cervical cancer involved with rectum with stricture and obstruction, and 1 descending colonic obstruction caused by Crohn's Disease.TDT was successfully inserted in 55 cases(96.5％) without complications,in which 43 cases of primary colorectal cancer finally underwent surgery.TDT indwelled from 0 to 22days, for an average of (8.7± 4.4)d.Hartmann operation was performed in 9 patients,6 of which underwent sufficient lymphnode dissection.Among the 43 patients, one-stage operation was performed in 34 (79.1％),of which 30 cases underwent sufficient lymph node dissection, without stoma leakage.And the rest of 13 cases refused surgery because of poor prognosis and financial problems.One patient with Crohn's Disease refused surgery after TDT insertion and was discharged after palliation of distention.Conclusion TDT is safe and effective in decompressing acute left-sided benign obstruction with high success rate and low expenditure, and can achieve preoperative colonic lavage in one-stage operation for acute left-sided colorectal malignant obstruction.

Objective To systematically review the diagnostic value of microRNA(miRNA) quantitation in breast cancer .Meth-ods Literatures about miRNA and breast cancer diagnosis were selected by retrieving Medline ,Embase and Cochrane Library .Ac-cording to the inclusion and exclusion criteria ,the literatures were independently screened ,and a 2 × 2 contingency table was con-structed .Quality of literatures was assessed by quality assessment of diagnostic accuracy studies(QUADAS) .Statistical analysis was performed by employing Meta-Disc 1 .4 software and STATA 11 .0 .Results 16 studies were included ,which contained 1 303 patients and 711 control samples .There were threshold effects among these studies (the spearman′s correlation coefficient was-0 .758 ,P=0 .001) .A random effects model was used for meta-analysis .The summary sensitivity ,specificity ,positive likelihood ratio ,negative likelihood ratio ,and diagnostic odds ratio for miRNA in breast cancer diagnosis were 0 .77(95% CI:0 .75 -0 .79) , 0 .77(95% CI:0 .74-0 .80) ,4 .19(95% CI:2 .79-6 .30) ,0 .25(95% CI:0 .19-0 .35) ,19 .91(95% CI:9 .68-40 .95) .The area un-der curve of SROC was 0 .895 0 .Conclusion These results suggest that miRNAs have potential value to diagnose breast cancer . However ,effective diagnosis of breast cancer still needs to be conducted with assistance of clinical findings and traditional lab inves-tigations .

Objective To explore the relative expression of plasma miR-199a-5p and miR-200c-3p in gastric adenocarcinoma cancer(GAC) patients and its clinical value.Methods Case-control study was used in this research.The relative expression of plasma miR-199a-5p and miR-200c-3p from 47 GAC patients and 50 healthy controls were determined by RT-PCR ( TaqMan Probe method).Meanwhile, the association with age, gender, tumor location, size, degree of differentiation, TNM stage, lymph node metastasis and other clinical pathological parameters were analyzed.The expression of these two miRNAs in plasma of 30 GAC patients during preoperation was compared with their expression 6-8 days after radical surgery.The sensitivity and specificity of plasma miRNAs expression for the diagnosis of GAC were analyzed using the receiver operating characteristic ( ROC ) curve.SPSS20.0 statistical software was used for statistical analysis.T-test, paired t-test and one-factor ANOVA were used for normal distribution of quantitative data.Results The plasma level of miR-199a-5p in GAC patients was significantly lower(1.05 ±0.22) (t =3.058,P =0.003), while miR-200c-3p was significantly higher(15.15 ±3.02) (t =-2.854,P=0.006), when they were compared with those in controls(26.80 ±8.38, 3.39 ±0.87).Low miR-199a-5p expression in GAC patients were associated with lymph node metastasis ( F =4.725, P =0.029) and the differentiation degree of gastric cancer(F=3.854,P=0.032).The relative expression of miR-199a-5p in postoperative plasma was significantly increased(t=-3.814,P=0.001), but the relative expression of miR-200c-3p was significantly reduced when compared to the preoperative samples(t=2.978, P=0.006).Area under the ROC curve of miR-199a-5p, miR-200c-3p and combined miR-199a-5p and miR-200c-3p were 0.692, 0.792 and 0.798, the sensitivity and specificity were 87%,97%,92.5% and 43%,54%, 65%, respectively.Conclusion Combined detection of miR-199a-5p and miR-200c-3p in plasma has a higher sensitivity and specificity than the conventional tumor marker CEA and CA19-9, and may be a useful combination for gastric cancer diagnosis.

Objective To evaluate narrow?band imaging(NBI)for early esophageal cancer and pre?cancerous lesions. Methods A total of 170 patients ( 192 lesions) diagnosed as having superficial esophageal carcinoma and precancerous lesions by endoscopy were retrospectively analyzed. Clinical data of endoscopy, narrow?band imaging (NBI) and iodine chromoscopy were analyzed.Results The detection rates of early esophageal cancer were both 100?? 0% in NBI(13/ 13) and iodine staining (13/ 13), with no statisti?cally significant difference (P>0?? 05).The detection rate of high grade intraepithelial neoplasia in NBI and i?odine staining was 94?? 9% (94/ 99) and 100?? 0% (99/ 99) respectively with no statistically significant differ?ence (P>0?? 05); The detection rate of low grade intraepithelial neoplasia in iodine staining was 100?? 0%(80/ 80), significantly higher than that of NBI 78?? 8% (63/ 80) (P<0?? 01).Conclusion NBI and iodine staining endoscopy show better diagnostic value for early esophageal cancer and similar diagnostic value for high grade intraepithelial neoplasia in precancerous lesions. But for the low grade intraepithelial neoplasia, the diagnostic value of iodine staining endoscopy is better than that of NBI.

Objective To construct Raji-Luc lymphoma cells with CD19 knockout using CRISPR/Cas9 technology and preliminarily validate their immune escape ability.Methods PB-CRISPR-CD19 small guide RNA(sgRNA)plasmids was constructed,the optimal sgRNA sequence was screened,and Raji-Luc cells with pCAG-PBase,PB-CD19 sgRNA,and PB-CRISPR-Cas9 were co-transfected.Stable knockout monoclonal cell lines were screened by flow sorting and limit dilution method and the knockout effect was verified through gene sequence testing.The expression of luciferase on the surface of the cell line was detected by microplate reader,CD19 CAR-T and CD38 CAR-T previously constructed in the laboratory were used as effector cells,and the immune escape ability of Raji-Luc CD19 KO cell line was verified by universal luciferase chemiluminescence method.Results The transfection efficiency of Raji-Luc CD19 KO cells prepared by electro transfection was high,and the knockout efficiency of the two monoclonal cells was more than 99%.There was no significant difference in luciferase expression compared to the original Raji-Luc cells,and CD19 CAR-T cells could not be activated to the kill them.Conclusion Successfully constructed Raji-Luc CD19 KO lymphoma cell line.

Objective To investigate the expression of lncRNA HOTAIR, HOTAIR, CRNDE and AFAP1-AS1 in lung cancer patients with bone metastasis (LCWBM), and to elucidate the diagnostic value of lncRNAs for LCWBM. Methods Serum was collected from 38 LCWBM patients and 38 lung cancer without bone metastasis (LCWOBM) patients. Questionnaires were used to collect basic information of patients. Fasting peripheral venous blood of patients was collected to separate serum. qRT-PCR was used to measure the expression levels of four serum lncRNAs, and their diagnostic value for LCWBM was analyzed. Results The expression of serum HOTAIR was decreased in LCWBM patients, compared with LCWOBM patients (P < 0.05); the AUC of serum HOTAIR diagnosing LCWBM was 0.722 (sensitivity was 70.0%, specificity was 81.3%). And the level of serum HOTTIP was significantly increased in LCWBM patients, compared with LCWOBM patients (P < 0.05); AUC of serum HOTTIP diagnosing LCWBM was 0.784 (sensitivity was 100.0%, specificity was 45.5%). The AUC of serum HOTAIR combined with HOTTIP diagnosing LCWBM was 0.818 (sensitivity, specificity, positive predictive value and negative predictive value were 87.5%, 72.7%, 70.0% and 88.9%, respectively). Conclusion Serum lncRNA HOTAIR and HOTTIP might be potential diagnostic biomarkers for bone metastases in lung cancer patients.

The aim of the study was to develop a simple, rapid and accurate LC-MS/MS method for the determination of digoxin.Digoxin-d3 was taken as the internal standard (IS), and sample preparation was achieved by liquid-liquid extraction.Chromatographic separation was performed on a Kinetex C18 column (2.1 mm × 50 mm, 2.6 μm; Phenomenex) using an isocratic elution with merely 2 min for each sample.The mobile phase consisted of water and acetonitrile solutions, both containing 1 mmol/L ammonium acetate and 1 mmol/L formic acid (55∶45).The detection was conducted on a TripleQuadTM 4500MD mass spectrometer coupled with electrospray ionization interface under positive-ion multiple reaction monitoring mode.The transitions were m/z 798.5 → 651.3 and m/z 801.6 → 654.4 for digoxin and digoxin-d3, respectively.Results showed that the method was linear over the range of 0.100-20.0 ng/mL.The selectivity, accuracy and precision, recovery and stability of the method were all within the acceptable limits with no matrix effect.This method was successfully applied to a girl treated with digoxin with substantial improvement of therapeutic effect and elimination of toxic reaction, so it can provide valuable fuidance and reference for individualized medication in clinical practice.

Objective To explore the feasibility of quantitative EEG parameters for prognostic prediction of patients with severe aneurysmal subarachnoid hemorrhage(SaSAH)90 d after the onset of the disease.Methods Patients with SaSAH admitted to the Neurosurgical Intensive Care Unit(NSICU)of Henan Provincial People's Hospital from September 2022 to September 2023 were prospectively consecutively enrolled,and baseline data were collected,including age,gender,medical history(hypertension,diabetes mellitus,coronary artery disease,and stroke),history of smoking,history of drinking,location of aneurysm(anterior circulation,posterior circulation),surgical modality(craniotomy,interventional surgery,hybrid surgery),Hunt-Hess classification,Glasgow coma scale(GCS)score,acute physiology and chronic health status scoring system Ⅱ(APACHE Ⅱ)score,subarachnoid hemorrhage early brain edema score(SEBES),first randomized blood glucose level after admission to NSICU,lactate level,and duration of NSICU stay.Quantitative EEG monitoring was performed in all patients within 48 h after admission to the NSICU,and amplitude-integrated electroencephalogram(aEEG)upper and lower boundaries,95％spectral edge frequency(SEF95),α change,(δ+θ)to(α+β)power ratio(DTABR),brain symmetry index(BSI),and spectral entropy were collected.Based on modified Rankin scale(mRS)scores 90 d after onset,patients were categorized into good prognosis(mRS score 2 points)and poor prognosis(mRS score 3-6 points)groups.Spearman rank correlation was used to analyze the correlation between quantitative EEG parameters and mRS scores in SaSAH patients.Multifactorial Logistic regression analysis was used to screen for correlates of poor prognosis,and receiver operating characteristic(ROC)curves were plotted to evaluate the efficacy of each index in predicting patients'poor prognosis.Results(1)A total of 72 patients with SaSAH were included,with 47 in the poor prognosis group and 25 in the good prognosis group,and the poor prognosis rate at 90 d after the onset was 65.3％.There was no statistically significant difference between the two groups in terms of gender,age,hypertension,diabetes mellitus,coronary artery disease,history of stroke,history of smoking,history of drinking,location of aneurysm,surgical modality,lactate level,and length of hospitalization in the NSICU(all P＞0.05);the differences between the Hunt-Hess grading,SEBES,and random blood glucose were statistically significant upon comparison(all P＜0.05).Compared with the good prognosis group,the changes of aEEG upper and lower boundary,SEF95,α change and spectral entropy were lower in the poor prognosis group,but DTABR and BSI were higher(all P＜0.05).(2)Spearman rank correlation analysis showed that the upper border of aEEG(r=-0.41,P＜0.01),lower border of aEEG(r=-0.54,P＜0.01),SEF95(r=-0.46,P＜0.01),α change(r=-0.53,P＜0.01)and spectral entropy(r=-0.39,P＜0.01)were negatively correlated with the mRS scores of SaSAH patients,and DTABR(r=0.52,P＜0.01)and BSI(r=0.33,P＜0.01)were positively correlated with poor prognosis of SaSAH patients.(3)The results of multifactorial Logistic regression analysis showed that Hunt-Hess grading(level Ⅳ vs.Ⅲ:OR,1.203,95％CI 1.005-1.441,P=0.044;level V vs.Ⅲ:OR,1.661,95％CI 1.109-2.487,P=0.014),SEBES(OR,1.647,95％CI 1.050-2.586;P=0.030),aEEG lower border(OR,0.687,95％CI 0.496-0.953l;P=0.024),SEF95(OR,0.436,95％CI0.202-0.937;P=0.034),α change(OR,0.368,95％CI0.189-0.717;P=0.003),DTABR(OR,1.324,95％CI 1.064-1.649;P=0.012),and BSI(OR,1.513,95％CI 1.026-2.231;P=0.036)were influencing factors of poor prognosis in SaSAH patients.ROC curve analysis showed that all of the above seven indicators had a certain predictive value for poor prognosis in SaSAH patients,among which the area under the curve of DTABR was the highest as 0.862(95％CI 0.761-0.932),with sensitivity 85.11％and specificity 80.00％.Conclusion Quantitative EEG parameters aEEG lower border,SEF95,α change,DTABR,and BSI may have certain predictive value for the short-term prognosis of SaSAH patients,which needs to be further confirmed in future multi-center large-sample studies.

OBJECTIVE： To study the effects of curcumin on gemcitabine （GEM）-resistant pancreatic cancer SW1990 cells and its mechanism. METHODS： CCK8 assay was used to detect the effects of different concentrations of GEM （50， 100， 150， 200， 250 μmol/L） on the survival rate of SW1990 cells and GEM-resistant SW1990 cells （SW1991/GEM resistant cells）； half inhibitory concentration （IC50） and drug resistance multiple were calculated. CCK8 assay was performed to detect the effects of different concentrations of curcumin （1， 5， 10， 20， 40 μmol/L） on survival rate of SW1990/GEM resistant cells， and IC50 was calculated. CCK8 assay was used to detect the effects of curcumin 2.41 μmol/L combined with different concentrations of GEM （25， 50， 75， 100， 125 μmol/L） on the survival rate of SW1990 cells and SW1990/GEM resistant cells， and IC50 and drug resistance reversal fold of GEM were calculated. Flow cytometry was carried out to detect the cell cycle distribution and apoptosis rate of SW1990 after treated with GEM alone or curcumin （2.41 μmol/L） combined with GEM using IC50 of GEM as drug concentration. Western blot assay was used to the protein expression of FAS， AKT， p-AKT， PI3K， p-PI3K， Caspase-3， Bcl-2 and related X protein （Bax）. RT-PCR was used to detect mRNA expression. RESULTS： IC50 of GEM to SW1990 cells was 92 μmol/L. IC50 of GEM to SW1990/GEM resistant cells was 216 μmol/L， and drug resistance multiple SW1990 cells to GEM was 2.35. IC50 of curcumin to SW1990/GEM resistant cells was 9.2 μmol/L. Under 2.41 μmol/L curcumin， IC50 of GEM to SW1990 cells was 75  μmol/L， and IC50 of GEM to SW1990/GEM resistant cells was 98 μmol/L； drug resistance reversal multiple of SW1990/GEM resistant cells to GEM was 2.2. Compared with GEM alone， the apoptosis rate of SW1990 cells and SW1990/GEM resistant cells were increased significantly after curcumin combined with GEM （P＜0.05）， blocking at G0/G1 phase； the protein expression of FAS， p-AKT， p-PI3K and Bcl-2 and mRNA expression of FAS and Bcl-2 were decreased significantly  （P＜0.05）； the protein and mRNA expression of Bax      and Caspase-3 were increased significantly （P＜0.05）. CONCLUSIONS： Curcumin can reverse drug resistance of SW1990 cells to GEM， the mechanism of which may be associated with PI3K/AKT pathway.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.