Objective To compare the safety and efficacy of minimally-access percutaneous nephrolithotomy (Mini-PCNL) in modified lateral position and prone position in high-risk patients with upper urinary tract stones and explore the clinical value of the modified lateral position. Methods We retrospectively analyzed 82 cases of high-risk patients underwent ultrasound-guided percutaneous nephrolithotomy from June 2010 to December 2015. 43 cases in group of modified lateral position and 39 case in group of prone position. The mean operating time, the success rate of stone fragmentation, hospitalization days, the value of postoperative hemoglobin decline and complication rate of patients were record and compared between the two groups. Results There was no statistical significance between the modified lateral position group and prone position group (P > 0.05) in gender, age, stone type, BMI, the score of ASA and preoperative complication. There was statistical significance in found access time, (7.88 ± 0.82) min in the modified lateral position group and (8.50 ± 0.80) min in the prone position group (P < 0.01). The stone free rate in the modified lateral position group (95.35 %) was higher than that in prone position group (74.36 %), the value of postoperative hemoglobin decline were (9.33 ± 2.49) g/L and (10.90 ± 3.54) g/L, respectively (P < 0.05); Two groups of the pleural damage rate had significant difference (P < 0.05); the hospitalization days and operating time were no statistical difference between the two groups (P > 0.05). Conclusions The Mini-PCNL in modified lateral position for high-risk patients had advantages of found access time, stone clearance rate, pleural injury, blood loss, comfort degree and security and worthy of clinical promoting.

Objective To explore the clinical features,electroneurophysiology,neuroimaging and gene characteristics of one juvenile dentatorubral-pallidoluysian atrophy (DRPLA) pedigree with an onset of epilepsy.Methods The clinical data of the elder sister and younger brother in a family with juvenile DRPLA were collected.Furthermore,their clinical manifestations,electroneurophysiology results,neuroimaging characteristics and atrophin-1 gene CAG repeat numbers were detected and analyzed in detail.Results There were four patients in this family in total.The probands were two siblings,and they both had the onset manifestation of epilepsy.The younger brother had frequently epileptic seizure,marked cerebellar ataxia,involuntary movement and mental retardation.Compared with her younger brother,the sister had light symptoms such as mild memory deterioration without ataxia and involuntary movement,and she could undertake some simple work.The spike wave and sharp wave complex can be detected in electroencephalogram (EEG) examination,the cortical center segment lesions pathological changes were revealed in somatosensory evoked potentials (EP),and the latency period of P300 was prolonged in the both siblings.Magnetic resonance imaging (MRI) showed that the younger brother had marked atrophies in the cerebral cortex,brainstem and cerebellum.Furthermore,MRI showed that the elder sister had only mild atrophies in the cerebral cortex,brainstem and cerebellum,and that on the contrary some abnormally high signals were observed in cerebral cortex but not white matter.DRPLA gene detection revealed that the numbers of CAG repeats were 15/68 (the younger brother) and 15/64 (the elder sister),respectively.Conclusions Epilepsy,especially the myoclonus,is a common clinical manifestation for juvenile DRPLA,and many other types of epileptic seizures may arise with the development of DRPLA.DRPLA has diverse clinical heterogeneity.EEG,EP and brain MRI examination are great for DRPLA diagnosis and differential diagnosis,and the specific gene detection can be helpful for a definitive diagnosis.

Objective: To investigate the urban and rural differences in adverse outcomes of pulmonary tuberculosis (PTB) in patients with pulmonary tuberculosis-diabetes mellitus comorbidity (PTB-DM), so as to provide insights into improving the prevention and treatment measures for PTB-DM. Methods: Patients with PTB-DM who were admitted and discharged from 14 designated tuberculosis hospitals in Hangzhou City from 2018 to 2022 were selected. Basic information, and history of diagnosis and treatment were collected through hospital information systems. The adverse outcomes of PTB were defined as endpoints, and the proportions of adverse outcomes of PTB in urban and rural patients with PTB-DM were analyzed. Factors affecting the adverse outcomes of PTB were identified using a multivariable Cox proportional hazards regression model. Results: A total of 823 patients with PTB-DM were enrolled, including 354 (43.01%) urban and 469 (56.99%) rural patients. There were 112 (13.61%) patients with adverse outcomes of PTB. The proportions of adverse outcomes of PTB in urban and rural patients were 14.41% and 13.01%, respectively, with no statistically significant difference (P>0.05). Multivariable Cox proportional hazards regression analysis identified first diagnosed in county-level hospitals or above (HR=2.107, 95%CI: 1.181-3.758) and drug resistance (HR=3.303, 95%CI: 1.653-6.600) as the risk factors for adverse outcomes of PTB in urban patients with PTB-DM, while the treatment/observed management throughout the process (HR=0.470, 95%CI: 0.274-0.803) and fixed-dose combinations throughout the process (HR=0.331, 95%CI: 0.151-0.729) as the protective factors for adverse outcomes in rural patients with PTB-DM. Conclusions There are differences in influencing factors for adverse outcomes of PTB in urban and rural patients with PTB-DM. The adverse outcomes of PTB are associated with first diagnosed hospitals and drug resistance in urban patients, and are associated with the treatment/observed management and fixed-dose combinations throughout the process in rural patients.

Objective: To observe the clinical therapeutic effect of Tang Shen Ning(TSN,a prescription of traditional Chinese medicine)for curing the early stage of diabetic nephropathy(DN).Methods: Adopting random and double-blind controlled trial methods,several indexes were observed in terms of uric micro-amount albumin excretion rate,creatinine clearance,hemorheology and platelet function et al.Results: TSN could significantly reduce urinary albumin,glomerulus's hyper-filtration,improve blood stream transform and inhibit platelet aggregation.Conclusion: TSN could protect renal functions during the early stage of DN.

PURPOSE: Evidence on the contribution of genes to the hereditary predisposition to pulmonary arterial hypertension (PAH) is limited. MATERIALS AND METHODS: In this study, we hypothesized that single nucleotide variants in vascular endothelial growth factor (VEGF) gene may alter gene function and expression and may be associated with PAH risk. Five putatively functional loci (rs699947C>A and rs833061T>C in the promoter, rs3025040C>T, rs10434G>A and rs3025053G>A in the 3'-UTR) in the VEGF gene were genotyped and analyzed in a retrospective study of 587 patients with PAH and 736 healthy subjects from southern China. RESULTS: We found that the rs833061T>C polymorphism was significantly associated with PAH risk, while the other single nucleotide polymorphisms were not. Compared to carriers with TT genotype, those with rs833061C variant genotype (CT/CC) had an increased risk of PAH (odds ratio=1.47, 95% confidence interval=1.18–1.83, p=0.001). Functional assays indicated that CT/CC variant genotype had significantly higher mRNA levels of VEGF in peripheral blood mononuclear cells than TT genotype (p=0.021). Luciferase reporter assay indicated that having a C allele conferred a significantly higher transcription activity than that with a T allele. CONCLUSION: Our findings suggest that the functional polymorphism rs833061T>C in VEGF gene promoter modulates VEGF expression and may be a valuable biomarker for predicting PAH susceptibility.
Alleles ; Asian Continental Ancestry Group* ; China ; Genotype ; Healthy Volunteers ; Humans ; Hypertension* ; Luciferases ; Polymorphism, Single Nucleotide ; Retrospective Studies ; RNA, Messenger ; Vascular Endothelial Growth Factor A*

Objective:To investigate the prognostic value of serum levels of miR-134 and miR-146b in elderly patients with acute ischemic stroke(AIS).Methods:A total of 162 elderly patients with AIS admitted to the Third People's Hospital of Haikou from January 2017 to October 2019 were enrolled.According to modified Rankin Scale(mRS)scores, they were divided into the good prognosis group(n=98, mRS score≤2)and the poor prognosis group(n=64, mRS score>2). Based on the National Institutes of Health Stroke Scale(NIHSS), patients were divide into the mild group(n=46, NIHSS score<5), moderate group(n=75, 5≤NIHSS score≤20), and severe group(n=41, NIHSS score>20). Real-time fluorescence quantitative PCR was used to detect serum levels of miR-134 and miR-146b in each group.Multivariate logistic regression was used to analyze risk factors for poor prognosis in elderly patients with AIS.The receiver operating characteristic(ROC)curve was used to analyze the value of serum miR-134 and miR-146b levels in predicting poor prognosis of elderly patients with AIS.Pearson correlation was used to analyze the correlations of serum levels of miR-134 and miR-146b with NIHSS and mRS scores in elderly patients with AIS.Results:Serum levels of miR-134(3.26±1.13 vs.0.85±0.38)and miR-146b(2.27±0.93 vs.0.56±0.21)were higher in the AIS group than in the control group( t=14.360 and 12.527, P<0.01). Serum levels of miR-134(4.35±1.46 vs.2.28±0.85)and miR-146b(3.07±1.04 vs.1.51±0.66)were higher in the poor prognosis group than in the good prognosis group( t=13.520 and 11.242, P<0.01). Serum levels of miR-134 and miR-146b in the severe group were higher than in the moderate and mild groups( t=10.815 and 9.462, P<0.01), and they were also higher in the moderate group than in the mild group( t=13.627, 11.611, P<0.01). Multivariate Logistic regression analysis showed that serum miR-134( OR=2.470, 95% CI: 1.603-4.927)and miR-146b( OR=1.914, 95% CI: 1.350-3.406)were risk factors for poor prognosis in elderly AIS patients( P<0.05). The ROC curve analysis showed that the optimal cut-off values of serum miR-134 and miR-146b to predict poor prognosis in elderly AIS patients were 3.84 and 2.68, respectively.The area under the ROC curve(AUC)of combined serum miR-134 and miR-146b(0.926, 95% CI: 0.865-0.987)for the prediction of poor prognosis was higher than that of either marker alone, with a sensitivity and specificity of 92.4% and 86.2%, respectively.The correlation analysis showed that serum levels of miR-134 and miR-146b were positively correlated with NIHSS and mRS scores in elderly AIS patients( r=0.806, 0.871, 0.785 and 0.842, all P<0.01). Conclusions:Increased serum miR-134 and miR-146b levels are correlated with the severity of neurological impairment and prognosis in elderly patients with AIS.Serum miR-134 and miR-146b levels together have a high value in predicting poor prognosis in elderly AIS patients.

Objective:To investigate the clinical characteristics and possible mechanisms of remote intracranial hematoma (RIH) in patients with intracranial aneurysm after interventional embolization.Methods:Six patients with RIH from a series of 58 consecutive patients with intracranial aneurysm, admitted to and performed interventional embolization in our hospital from January 2016 and December 2018, were chosen in our study. Their clinical data were analyzed retrospectively and compared with those without RIH at the same period.Results:In these 6 patients, 4 had history of hypertension, 5 had aneurysm located in the internal carotid artery, 5 were treated with stents combined with postoperative routine anticoagulation treatment. The remote intracranial hematoma occurred within 7 d of interventional embolization, and the hematoma was located in the cerebral hemisphere on the same side of the aneurysm; 4 patients underwent intracranial hematoma puncture catheter drainage; 1 patient was treated conservatively, and one was treated by craniotomy. After treatment, 1 patient recovered (modified Rankin scale [mRS] score of 1), 1 patient had poor prognosis (mRS scores of 5) and discharged automatically, and the rest 4 patients (mRS scores of 3-5) left some degrees of neurological dysfunction. As compared with 52 patients without RIH, 6 patients with RIH had significantly higher percentages of patients used stents and postoperatively used anticoagulation, and higher percentages of patients with poor clinical outcomes at discharge ( P<0.05). Conclusion:Stent-assisted coil embolization in patients with internal carotid artery aneurysm combined with hypertension should be highly vigilant about the possibility of RIH.

Objective To compare the efficacy and safety among individualized regimens ( IR ) containing clofazimine ( Cfz ) , linezolid ( Lzd ) or meropenem-clavulanic acid ( MC ) in treatment of multidrug/extensively resistant tuberculosis (MDR/XDR-TB) by using network meta-analysis.Methods Randomized controlled trials ( RCTs) and observational studies of Cfz-IR, Lzd-IR and MC-IR regimens in the treatment of MDR/XDR-TB published from January 2000 to August 2017 at home and abroad were retrieved.The literature was screened according to inclusion and exclusion criteria.The quality of the literature was evaluated and valid data were extracted.The efficacy and safety of Cfz-IR, Lzd-IR and MC-IR in the treatment of MDR/XDR-TB were directly and indirectly compared by network meta-analysis.Relative risk ( RR) or relative comparative effect ( Mean) or adverse reaction rate and 95％confidence interval ( CI) were used as indicators of systematic evaluation , and Berg' s funnel plot was used for the existing publication bias.Results A total of 20 papers and 21 studies were included.There were 2490 cases in the study group and 2303 cases in the control group included.According to the direct comparison of the network meta-analysis, the efficacy for treatment of MDR/XDR-TB of Lzd-IR ( RR=1.18, 95％ CI 1.02-1.36, Z=2.28, P <0.05) and MC-IR(RR=1.23,95％CI 1.01-1.50,Z=2.10,P<0.05)was better than that of IR in control group.The rates of adverse reactions of Lzd-IR, Cfz-IR and MC-IR were 29％(95％CI 0.24-0.35), 21％(95％CI 0.13-0.28) and 7％ (95％ CI 0.03-0.10), respectively.The top-down efficacy outcomes of the 4 individualized chemotherapy regimens were MC-IR (66.4％), Lzd-IR(22.6％), Cfz-IR (10.0％) and IR without Cfz, Lzd or MC (1.0％).The fitting model showed that MC-IR (Z=3.04, P<0.05) and Lzd-IR (Z=2.31, P<0.05) significantly shortened the "off"time compared with IR without Cfz, Lzd or MC.Conclusion The network meta-analysis shows that the efficacy and safety of regimen MC-IR are significantly higher than those of Lzd-IR and Cfz-IR in treatment of MDR/XDR-TB.

Objective:To construct a simple, precise and personalized comprehensive nomogram for prediction the risk of multidrug-resistant tuberculosis (MDR-TB) and to evaluate its prediction value among individuals with previous tuberculosis history (PTBH).Methods:A matched case-control study (1∶2 ratios) was performed in 1 881 patients with PTBH treated in 12 designated tuberculosis hospitals in Hangzhou City between January 1, 2005 and December 31, 2019, and there were 1 719 patients in training set, and 162 in validation set. A multivariable Cox regression analysis was used to evaluate independent predictors for the incident of MDR-TB in individuals with PTBH. A comprehensive nomogram was developed based on the multivariable Cox model. The accuracy of the prediction was assessed using concordance index (C-index), calibration curve and area under the receiver operator characteristic (ROC) curve.Results:The nomogram constructed based on the multivariable Cox regression model incorporated 10 independent predictors of the risk of MDR-TB. A history of direct contact (grade 1, 0-100.0 points) ranked on the top of all risk factors, followed by duration of positive sputum culture (grade 2, 0-84.5 points), unfavorable treatment outcome (grade 3, 0-52.0 points), human immunodeficiency virus infection (grade 4, 0-48.5 points), retreated tuberculosis history (grade 5, 0-40.0 points), non-standardized treatment regimens of retreated tuberculosis (grade 6, 0-32.5 points), duration of pulmonary cavities (grade 7, 0-31.0 points), passive mode of tuberculosis case finding (grade 8, 0-25.0 points), age<60 years (grade 9, 0-17.5 points), and standard frequencies of chest X-ray examination (grade 10, 0-14.0 points). The C-indexes of this nomogram for the training and validation sets were 0.833 (95% confidence interval ( CI) 0.807-0.859) and 0.871 (95% CI 0.773-0.969), respectively, indicating that the nomogram had good fitting effect. The calibration curves for the risk of incident MDR-TB showed an optimal agreement between nomogram prediction and actual observation in the training and validation sets, respectively.The areas under ROC curve of the 1-year, 5-year, and 10-year MDR-TB risk probability of the training set were 0.904, 0.921, and 0.908, respectively, and those of the validation set were 0.954, 0.970, and 0.919, respectively. Conclusion:Through this nomogram model, clinicians could precisely predict the risk of incident MDR-TB among individuals with PTBH in the clinical practice.

Objective:To investigate the expression, methylation and prognosis of DKK2 in non-small cell lung cancer, and also its effect and correlation with the sensitivity of hypofractionated radiotherapy sensitivity in non-small cell lung cancer.Methods:qPCR, online database and Kaplan-Meier survival curve were used to detect the expression, methylation and prognosis of DKK2 in NSCLC samples. A549 cells was set as the research objects, and cloning formation experiment and Western blot were used to evaluated the effects of DKK2 on hypofractionated radiotherapy in NSCLC.Results:Compared with the normal tissues, the expression of DKK2 mRNA in NSCLC samples was down-regulaged [ (0.00042±0.0001) vs (0.00065±0.0002), P<0.001]. Data taken from an online methylation database showed that compared with normal tissue, DKK2 hypermethylated in NSCLC, and its methylation was significantly negatively correlated with the mRNA expression. Downregulated DKK2 expression was inversely correlated with its methylation status ( P=0.034). The hypofractionated radiotherapy sensitivity of NSCLC patients was 53.3%. Compared with radiosensitivity group, DKK2 mRNA expression was significantly down-regulated in radioresistance group[ (0.00064±0.0002) vs (0.00043±0.0002), P<0.001]. The progression free survival of radiotherapy sensitive group was better than that of radiotherapy resistant group (median PFS: 21.4 months vs 4.6 months). Ectopic expression of DKK2 in A549 lines inhibited colony formation after irradiation with 4 Gy X-ray radiotherapy. Western blot further showed that restoration of DKK2 expression resulted in upregulation of DNA damage markers γ-H2AX[ (1.00±0.24) vs (3.22±0.41), P<0.001], and the difference was statistically significant. Conclusion:DKK2 expression is downregulated in NSCLC due to methylation, which may be acted as an important target to predict the hypofractionated radiotherapy sensitivity of NSCLC.