Objective:To review the literature and summarize the clinical characteristics and treatment methods of rectal buttonhole tears associated with vaginal delivery.Methods:Using the keywords "rectal tear and delivery" "rectal laceration and delivery" "rectal lesion and delivery", and "rectal buttonhole tear", we conducted a search for Chinese-language papers published on the Yiigle, CNKI (China National Knowledge Infrastructure), Wanfang Data Knowledge Service Platform, and VIP Chinese Journal Service Platform. Additionally, using the same keywords in English, we searched for papers published on PubMed and Embase. The search period covers from the establishment of the databases up to November 15, 2023. Cases with a clear diagnosis of rectal buttonhole tears associated with vaginal delivery were included. Data on maternal age, parity, gestational weeks, neonatal birth weight, time of rectal tear discovery, whether episiotomy was performed, whether instrumental delivery was used, details of the rectal tear, management after discovering the tear, and prognosis were analyzed. Descriptive statistical analysis was used.Results:A total of 30 papers were included, published from 1952 to 2023, encompassing 48 cases of vaginal delivery with rectal buttonhole tears. (1) Age and parity: The median age of patients was 28.0 years (range 21-44 years), with primiparas and multiparas accounting for 72.5% (29/40) and 27.5% (11/40), respectively. (2) Gestational weeks: The median gestational age at delivery was 39.0 weeks (range 36.0-41.0 weeks). (3) Neonatal birth weight: The median birth weight of the neonates was 3 595 g (range 2 320-4 250 g), with four cases of macrosomia (birth weight≥4 000 g), accounting for 9.5% (4/42) of singleton births. (4) Time at identification of rectal buttonhole tear: Rectal tears were discovered before fetal delivery in 26.7% (12/45) of cases and after delivery in 73.3% (33/45) of cases. (5) Location: Rectal buttonhole tears most commonly occurred at the midline of the posterior vaginal wall (65.6%, 21/32), followed by the right side of the episiotomy wound (12.5%, 4/32). (6) Relationship between rectal buttonhole tears and delivery mode: Rectal buttonhole tears can occur in spontaneous vaginal delivery, episiotomy, and instrumental vaginal delivery. They may occur during the first or second stage of labor. (7) Timing of rectal tear suturing and prognosis: 93.4% (45/48) of patients underwent primary rectal suturing, among whom, 93.3% (42/45) had good healing, while 6.7% (3/45) developed rectovaginal fistula postoperatively.Conclusions:Rectal buttonhole tear is a rare complication of vaginal delivery and should be recognized. If identified promptly and repaired with primary suturing, the prognosis is generally favorable.

Objective:To analyze the etiological distribution and phylogenetic characteristics of hand, foot and mouth disease (HFMD) in Qujing city of Yunnan Province in 2020.Methods:Stool samples were collected from HFMD cases in Qujing city in 2020 and virus RNA was extracted directly from treated stool suspensions. Virus VP4 gene sequences were firstly amplified using MD91/OL68-1 primer pairs and sequenced, then the virus serotypes were determined by BLAST search on the GenBank. Virus entire VP1 gene sequences were amplified and sequenced. Virus serotypes were identified online using Enterovirus Genotyping Tool Version 0.1. Sequences of reference virus genotypes/sub-genotypes were downloaded according to references. Phylogenetic trees were constructed by MEGA5.2 software and the genetic characteristics were analyzed.Results:A total of 47 strains of enteroviruses (EVs) were detected with a detection rate of 10.22% (47/460). The detected viruses were coxsackievirus A4 (CVA4, 0.65%, 3/460), CVA6 (7.83%, 36/460), CVA10 (0.87%, 4/460) and CVA16 (0.87%, 4/460). All were enterovirus species A (EVA), while other group viruses were not detected. The predominant virus was CVA6, accounting for 7.83% (36/460). EVA71 was not detected. CVA4 strains of C2 and C4 subgenotypes were co-circulating strains in Qujing city. CVA6 subgenotype D3a and CVA16 subgenotype B1a were also circulated in Qujing city. All CVA10 strains were in a separate lineage.Conclusions:Similar to the previous situation in China, the detection rates of EVA71 and CVA16 were very low, even zero. This study showed that CVA6 was the predominant virus, indicating a HFMD outbreak caused by CVA6 in Qujing city in 2020. The phylogenetic analysis showed CVA10 isolates belonged to a separate lineage, which might be unique to Qujing city. Laboratory and molecular epidemiological surveillance of non-EVA71 and non-CVA16 viruses, especially CVA6 and CVA10 should be strengthened in the future.

Objective:To investigate the epidemiological and clinicopathological characteristics of thyroid cancer.Methods:Data of 13 673 thyroid cancer patients admitted to the First Medical Center of PLA General Hospital from Jan. 2014 to Dec. 2019 were retrospectively analyzed. According to the admission criteria, 9 662 patients were screened out, including 2 768 males and 6 894 females, with an average age of 43.98±11.28 years. According to the year of diagnosis and treatment, the incidence of thyroid cancer, the changing trend of age of new cases, the average length of hospitalization, the pathological classification of the tumor, the size of the primary tumor, multifocal tumor, and the rate of lymph node metastasis were statistically analyzed. The surgical methods were summarized and discussed.Results:① Characteristics of population economics: the ratio of males to females were 1.00:2.49, the number of cases increased year by year, and the rate of increase of female was higher than that of male. The average age of onset of the patients was (43.98±11.28) years old, and the incidence rate of the young population increased by 6.0%, showing a younger trend. The mean length of hospital stay was (7.21±2.85) d, and the length of hospital stay decreased. ② Clinicopathological features: There were 9 513 cases of papillary thyroid carcinoma (PTC) (98.46%) , 45 cases of follicular thyroid carcinoma (FTC) (0.47%) , 58 cases of medullary carcinoma (MTC) (0.60%) and 18 cases of poorly differentiated thyroid carcinoma (PDTC) (0.19%) . There were 2 cases (0.02%) of undifferentiated thyroid carcinoma (ATC) and 26 cases (0.26%) of a particular type. The tumor size was (1.10±0.85) cm, among which the microcarcinoma (D ≤1 cm) accounted for 64.5% and showed an increasing trend year by year, with the fastest growth rate. There were 3 809 cases of multifocal carcinoma (39.4%) , and the proportion of multifocal carcinoma increased year by year in recent 3 years. The central region and lateral region lymph node metastasis rates were 33.0% and 13.0%, respectively. Correlation analysis showed that the differences were statistically significant except for pathological types ( P<0.05) . ③ Surgical methods: in the first 3 years, 2 224 patients (84.2%) underwent normative primary resection, which increased to 94.9% in the last 3 years. In the first 3 years, 2 033 patients (77.0%) underwent central lymph node dissection, which increased to 91.8% in the last 3 years. In the first 3 years, 188 cases (50.5%) underwent normative lateral cervical dissection, which increased to 71.6% in the last 3 years. Conclusions:The incidence of thyroid cancer is increasing year by year, showing a younger trend; Papillary carcinoma accounts for 98.5% of thyroid cancer. The proportion of microcarcinoma and multifocal carcinoma is increasing. The rate of lymph node metastasis in the central region and lateral region is increasing; surgery is gradually standardized, and it is necessary to standardize the diagnosis and treatment of thyroid cancer and postoperative follow-up.

Objective:To evaluate the effect of WeChat platform in the diagnosis and treatment of menopausal-related diseases for gynecologists.Methods:In March 2017, 47 gynecologists who voluntarily participated in the offline continuing medical education project "Diagnosis and Treatment training of menopause-related diseases" in Beijing Shijitan Hospital Affiliated to Capital Medical University were selected as the control group (traditional teaching mode), and 52 gynecologists who volunteered to participate in WeChat platform training were selected as the experimental group (WeChat teaching mode). The main outcome measure was the knowledge level of menopause-related diseases and curriculum satisfaction before and after training. SPSS was used to perform t-test or chi-square test for inter-group data. Results:All gynecologists completed the study, the recovery rate of the evaluation questionnaire before and after training was 100%. Before training, the average score of menopause-related disease knowledge and the test passing rate of knowledge examination in experimental group were (63.65±21.42) and 65.4%, while those in the control group were (60.85±24.83) and 63.8%, respectively. No significant difference was found ( P>0.05). After training, the knowledge level of menopause-related diseases and the test passing rate significantly improved in both groups ( P<0.05). The average score of students and the passing rate in the experimental group were (77.50±16.19) and 90.1%, which were better than those in the control group [(78.72±16.89), 87.2%]. However, there was no significant difference between the two groups ( P>0.05). Besides, the experimental group was more satisfied, but the difference was not statistically significant compared with control group ( P>0.05). Conclusion:WeChat platform training for gynecologists not only has the same effects as the traditional teaching model on menopausal disease diagnosis and treatment training, but also gains higher training satisfaction, suggesting WeChat platform training can be further applied to other subdisciplines.

Objective:To investigate the risk factors of cervical lymph node metastasis (LNM) and survival analysis in patients with medullary thyroid carcinoma (MTC) .Methods:93 patients with MTC admitted to the Department of General Surgery and Department of Otorhinolaryngology, First Medical Center of PLA General Hospital from Sep. 2008 to Aug. 2020 were analyzed retrospectively, including 45 males and 48 females, with an average age of 47 years old. SPSS 26.0 statistical software was used for data processing of the initial surgical year and procedures, tumor pathological stages, preoperative calcitonin (Ctn) level, preoperative carcinoembryonic antigen (CEA) level, LNM status, recurrence free survival (RFS) , etc. The risk factors of LNM and prognosis of MTC patients were analyzed by COX univariate and multivariate regression. Kaplan Meier method was used to estimate the survival rates of independent risk factors affecting prognosis and draw their survival curves.Results:The median follow-up time of 93 patients was 53 months, ranging from 2 to 192 months. The 1-year, 3-year, 5-year and 10-year survival rates were 97.8%, 96.6%, 94.6% and 88.9% respectively. Multivariate COX regression analysis showed that Initial surgical procedures ( P=0.018) and preoperative Ctn level ( P=0.012) were independent risk factors of central cervical LNM. Preoperative Ctn level ( P=0.028) and Capsule invasion ( P=0.024) were the independent risk factors of lateral cervical LNM. Preoperative Ctn level≥180.30 pg/ml and ≥234.15pg/ml indicated central and lateral cervical LNM respectively (all P<0.001) . Distant metastasis was an independent risk factor of RFS ( P=0.037) of MTC. Conclusions:Standardized surgical procedures are recommended for initial treatment of MTC, which can reduce the possibility of residual occult metastasis and the risk of reoperation. Distant metastasis affects prognosis of MTC.

Background::Gut-resident macrophages (gMacs) supplemented by monocytes-to-gMacs differentiation play a critical role in maintaining intestinal homeostasis. Activating transcription factor 4 (ATF4) is involved in immune cell differentiation. We therefore set out to investigate the role of ATF4-regulated monocytes-to-gMacs differentiation in sepsis-induced intestinal injury.Methods::Sepsis was induced in C57BL/6 wild type (WT) mice and Atf4-knockdown ( Atf4+/-) mice by cecal ligation and puncture or administration of lipopolysaccharide (LPS). Colon, peripheral blood mononuclear cells, sera, lung, liver, and mesenteric lymph nodes were collected for flow cytometry, hematoxylin and eosin staining, immunohistochemistry, quantitative reverse transcription polymerase chain reaction, and enzyme-linked immunosorbent assay, respectively. Results::CD64, CD11b, Ly6C, major histocompatibility complex-II (MHC-II), CX3CR1, Ly6G, and SSC were identified as optimal primary markers for detecting the process of monocytes-to-gMacs differentiation in the colon of WT mice. Monocytes-to-gMacs differentiation was impaired in the colon during sepsis and was associated with decreased expression of ATF4 in P1 (Ly6C hi monocytes), the precursor cells of gMacs. Atf4 knockdown exacerbated the impairment of monocytes-to-gMacs differentiation in response to LPS, resulting in a significant reduction of gMacs in the colon. Furthermore, compared with WT mice, Atf4+/- mice exhibited higher pathology scores, increased expression of inflammatory factor genes ( TNF-α, IL-1β), suppressed expression of CD31 and vascular endothelial-cadherin in the colon, and increased translocation of intestinal bacteria to lymph nodes and lungs following exposure to LPS. However, the aggravation of sepsis-induced intestinal injury resulting from Atf4 knockdown was not caused by the enhanced inflammatory effect of Ly6C hi monocytes and gMacs. Conclusion::ATF4, as a novel regulator of monocytes-to-gMacs differentiation, plays a critical role in protecting mice against sepsis-induced intestinal injury, suggesting that ATF4 might be a potential therapeutic target for sepsis treatment.

[摘 要] 目的：体内外实验探讨木鳖子单体化合物对羟基桂皮醛[Momordica cochinchinensis(Lour.)Spreng.p-hydroxycinnamaldehyde，CMSP]对小鼠黑色素瘤移植瘤生长和转移的影响及其作用机制。方法：建立荷瘤小鼠动物模型，并将18只C57BL/6小鼠随机分成3组（每组6只）：对照组（腹腔注射0.1 ml生理盐水）、CMSP治疗组（分别腹腔注射0.1 ml 1、2 mg/ml CMSP），给药的第5天开始，每次给药前用卡尺分别测量和计算小鼠移植瘤的体积，实验结束后称量移植瘤的质量；H-E染色后光镜观察肝组织的病理学变化；免疫组织化学SP法观察移植瘤组织E-cadherin和vimentin蛋白的表达。采用细胞划痕和Transwell实验分别检测CMSP实验组（10、20 µg/ml）黑色素瘤B16细胞24、48 h的迁移能力，qPCR法检测CMSP处理24 h后B16细胞EMT相关mRNA表达，WB法检测CMSP处理B16细胞48 h后β-catenin、p-β-catenin（Ser675）、vimentin和E-cadherin蛋白的表达水平。结果：CMSP治疗组小鼠移植瘤平均体积和肿瘤质量明显降低（均P<0.05）；对照组小鼠肝脏中转移灶的数量明显多于CMSP（1、2 mg/kg）治疗组（均P<0.05），CMSP（2 mg/kg）处理组小鼠的肝组织内未发现明显转移灶。CMSP治疗组（1、2 mg/kg）移植瘤组织中E-cadherin蛋白表达水平明显高于对照组（均P<0.05），而vimentin蛋白表达显著低于对照组（均P<0.01）。体外实验中，CMSP实验组（10、20 μg/ml）B16细胞24、48 h后划痕愈合率较对照组均明显降低（均P<0.05）。20 μg/ml CMSP处理B16细胞24、48 h后穿过Transwell小室的细胞数较对照组则显著下降（均P<0.01）。CMSP（10、20 μg/ml）处理B16细胞后β-catenin mRNA表达水平较对照组明显降低（均P<0.01），E-cadherin mRNA表达水平则明显升高（均P<0.05），而vimentin mRNA表达水平在10 μg/ml处理组与对照组相比差异无统计学意义（P>0.05），20 μg/ml处理组则明显降低（P<0.01）。与对照组相比，CMSP实验组（10、20 μg/ml）处理B16细胞后β-catenin、p-β-catenin和vimentin蛋白表达均显著降低（均P<0.01），而E-cadherin蛋白表达则明显升高（均P<0.01）。结论：CMSP能够抑制小鼠黑色素瘤移植瘤的生长和转移，其作用机制可能与抑制wnt/β-catenin通路的活性相关。

OBJECTIVE: To investigate the effect of the chemoprotectant tempol on the anti-tumor activity of cisplatin (DDP). METHODS: The cellular toxicity of tempol in human colon cancer SW480 cells and mouse colon cancer CT26 cells were evaluated using MTT and cell counting kit-8 assays. CalcuSyn software analysis was used to determine the interaction between tempol and DDP in inhibition of the cell viability. A subcutaneous homograft mouse model of colon cancer was established. The mice were randomly divided into control group, tempol group, cisplatin group and tempol + DDP treatment group with intraperitoneal injections of the indicated agents. The tumor size, body weight and lifespan of the mice were measured, and HE staining was used to analyze the cytotoxic effect of the agents on the kidney and liver. Immunohistochemistry and Western blotting were performed to detect the expression of Bax and Bcl2 in the tumor tissue, and TUNEL staining was used to analyze the tumor cell apoptosis. The level of reactive oxygen species (ROS) in the tumor tissue was determined using flow cytometry. RESULTS: Tempol showed inhibitory effects on the viability of SW480 and CT26 cells. CalcuSyn software analysis showed that tempol had a synergistic anti-tumor effect with DDP (CI < 1). In the homograft mouse model, tempol treatment alone did not produce obvious anti-tumor effect. HE staining showed that the combined use of tempol and DDP alleviated DDP-induced fibrogenesis in the kidneys, but tempol also reduced the anti-tumor activity of DDP. Compared with the mice treated with DDP alone, the mice treated with both tempol and DDP had a significantly larger tumor size ( < 0.01) and a shorter lifespan ( < 0.05). Tempol significantly reversed DDP-induced expression of Bax and Bcl2 in the tumor tissue and tumor cell apoptosis ( < 0.001), and obviously reduced the elevation of ROS level in the tumor tissue induced by DDP treatment ( < 0.05). CONCLUSIONS Tempol can attenuate the anti-tumor effect of DDP while reducing the side effects of DDP. Caution must be taken and the risks and benefits should be carefully weighed when considering the use of tempol as an anti-oxidant to reduce the toxicities of DDP.
Animals ; Antineoplastic Agents ; Antioxidants ; Apoptosis ; Cell Line, Tumor ; Cell Proliferation ; Cisplatin ; Cyclic N-Oxides ; pharmacology ; Drug Resistance, Neoplasm ; Humans ; Mice ; Spin Labels