Objective:To analyze the role of preoperative circulating tumor cell(CTC) and circulating tumor vascular endothelial cells (CTEC) in the diagnosis of gastric cancer and its correlation with the clinicopathological characteristics of gastric cancer.Methods:Sixty-two gastric cancer patients and 11 patients of benign gastric diseases were enrolled. Subtraction enrichment (SE) and immunofluorescence staining-chromosome fluorescence in situ hybridization (i·FISH) were used to integrate the unique SE-i ·FISH technology platform detecting patients′ CTC and CTEC.Results:The number of CTC in the gastric cancer group was significantly higher than that in the control group ( t=2.693, P=0.009); the number of CTEC in the gastric cancer group was higher than the control group ( t=2.015, P=0.048). With the cut-off value being set at 9 cells/6 ml in blood, the sensitivity of CTC in the diagnosis of gastric cancer is 84%, and the specificity is 82% (AUC=0.876, 95% CI, 0.792-0.963, P<0.01); When set at 6 cells/6 ml, the sensitivity of CTEC in the diagnosis of gastric cancer is 50%, and the specificity is 100%(AUC=0.727, 95% CI, 0.603-0.851, P=0.02). CTC positive is closely related to tumor location(χ 2=4.292, P=0.038 ) and TNM stage(CTC≥10, χ 2=4.848, P=0.028; CTC≥11, χ 2=6.234, P=0.013). CTEC positive is closely related to serum CA19-9(χ 2=4.858, P=0.028) and serum CA724 (χ 2=4.108, P=0.043 ) . Conclusion:SE-i·FISH technology has high sensitivity and specificity in the detection of CTC and CTEC of gastric cancer.

Objective To investigate the curative effect of cocktail combined with tranexamic acid(TXA)on total knee arthroplasty(TKA)under the concept of enhanced recovery after surgery(ERAS).Methods Seventy patients with knee osteoarthritis who received unilateral TKA treatment admitted to the Second Affiliated Hospital of Bengbu Medical College from September 2020 to July 2022 were ret-rospectively analyzed.According to different treatment methods,they were divided into experimental group and control group,with 35 ca-ses in each group.Under the guidance of ERAS concept,the experimental group received injected intraarticular mixture of cocktail and TXA during the operation,while the control group received injected intraarticular mixture of cocktail and normal saline.Postoperative drainage volume,hemoglobin(Hb)decline and total blood loss at 3 days after operation,blood transfusion rate,first ambulation time,length of hospital stay,postoperative pain visual analogue scale(VAS)、knee range of motion(ROM)and HSS score at different time points after operation,delayed wound healing,wound infection and incidence of deep vein thrombosis were compared between the two groups.Results The postoperative drainage volume,decline of Hb and total blood loss at 3 days after operation,blood transfusion rate in the experimental group were less than those of the control group,the differences were statistically significant(P＜0.05).The first ambu-lation time and length of hospital stay in the experimental group were significantly lower than those of the control group,the difference were statistically significant(P＜0.05).There were no significant differences in pain VAS score at 1 day,2 days,3 days,7 days,14 days af-ter operation between two groups(P＞0.05).There were no significant differences in ROM at 7 days,14 days after operation and HSS score at 4 weeks,12 weeks after operation between two groups(P＞0.05).Conclusion Under the concept of ERAS,intraarticular in-jection of cocktail combined with TXA in TKA can effectively reduce postoperative blood loss,improve postoperative pain,reduce periop-erative risks,and promote better early postoperative rehabilitation,the clinical effect is significant.

Objective A highly feasible and reliable ultra-high performance liquid chromatography tandem mass spectrometry(UPLC-MS/MS)method was presented for therapeutic drug monitoring of five anti-schizophrenic drugs (aripiprazole, amisulpride, olanzapine, paliperidone and ziprasidone) simultaneously and the reference range of plasma concentration was investigated.Methods establishment and evaluation.The selectivity,accuracy,precision,stability and linear range of established UPLC-MS/MS method were evaluated according to FDA and CLSI.After a ten-month clinical application, a retrospective analysis of 253 positive samples was carried out to investigate conformance of the AGNP therapeutic reference range for Chinese patients.Results The five anti-schizophrenic drugs could be simultaneously measured by the established UPLC-MS/MS within 6 minutes.The LOQs were 0.1 to 9.0 ng/ml.The correlation coefficients were all higher than 0.997 7.The intra-day and inter-day precisions were less than 11.1%,and the recoveries ranged from 86.2% to 104.8%.The clinical results suggested the good consistency in reference range with AGNP for olanzapine, aripiprazole, paliperidone and ziprasidone.While for amisulpride, the plasma concentration level(445.2 ±231.5)ng/ml was significantly higher than the AGNP-recommended range(100 -320)ng/ml.Conclusion The established UPLC-MS/MS method was very suitable for monitoring anti-schizophrenic drugs.

Objective:To explore the safety of inactivated novel coronavirus vaccine inoculation and the fluctuating neutralizing antibody in patients with chronic hepatitis B (CHB).Methods:Retrospective and prospective epidemiological research methods were employed. 153 CHB patients who visited the Department of Infectious Diseases at the First Hospital of Shanxi Medical University from September 2021 to February 2022 were selected as the research subjects. Information on vaccination-related adverse reactions was collected. Colloidal gold immunochromatography was used to identify neutralizing antibodies in the body after 3-6 months of vaccination. Statistical analysis was performed using the χ2-test or Fisher's exact test. Results:The positive rates of neutralizing antibodies after inactivated novel coronavirus vaccine inoculation in 153 patients with CHB were 45.50%, 44.70%, 40.00% and 16.20%, respectively, at 3, 4, 5, and 6 months. The neutralizing antibody concentrations were 10.00 (2.95, 30.01) U/ml, 6.08 (3.41, 24.50) U/ml, 5.90 (3.93, 14.68) U/ml, and 1.25 (0.92, 3.75) U/ml, respectively. The difference was not statistically significant ( P>0.05) when the neutralizing antibody positivity rates in hepatitis B virus (HBV) DNA-negative and positive patients and HBeAg-negative and positive patients at different time points were compared. The overall incidence of adverse reactions following vaccination was 18.30%. Pain at the site of inoculation and fatigue were the main presentations, and no serious adverse reactions occurred. Conclusion:CHB patients, when inoculated with an inactivated novel coronavirus vaccine, can produce neutralizing antibodies, which can stay at certain levels for 3, 4, and 5 months. However, the neutralizing antibody level gradually decreases over time, and the decrease is remarkable at 6 months. So, it is recommended to boost vaccinations at an appropriate time. Additionally, the results of the study suggest that HBV replication status has little effect on the production of neutralizing antibodies in CHB patients with relatively stable liver function, which means the inactivated novel coronavirus vaccine has a good safety profile.

Objective To investigate the accuracy and application value of optical surface monitoring system in intensity modulated radiotherapy for thoracic tumors patients.Methods Twenty-eight patients with thoracic tumors were included.During each treatment fraction,the patients were immobilized with body surface markers and laser lamps.The surface images obtained by the optical surface monitoring system were registered with the reference images and recorded during the CBCT scan.The translation and rotation errors of x (left-right),y (craniocaudal) and z (anterior-posterior) axes were recorded.After scanning,the CBCT images were registered with the planned CT images and the translation and rotation errors of x,y and z axes were recorded.The setup errors of these two image systems were analyzed and corrected before each treatment.The correlation between the two sets of setup errors were analyzed with Pearson test,and systematic error (∑) and random error (σy) were also calculated.The consistency of the two image systems was evaluated with the Bland-Altman method and the 95％ limits of agreement were calculated.Results There was a good correlation between these two groups,and the correlation coefficients were 0.79,0.62,and 0.53 in x,y and z axes,respectively.The ∑/σr of the optical surface monitoring system were 0.7 mm/1.5 mm,0.9 mm/1.8 mm and 0.9 mm/1.5 mm in x,y and z axes,respectively.The ∑/σ of CBCT were 0.8 mm/1.6 mm,1.3 mm/1.9 mm and 0.7 mm/1.5 mm in x,y and z axes,respectively.The 95％ limits of agreement of translations direction were (-2.0-2.3),(-3.4-3.6) and (-3.3-2.4) mm,and the 95％ limits of agreement of rotation direction were (-2.0 to 1.6)°,(-2.0 to 1.4)° and (-1.6 to 1.6)° inx,y and z axes,respectively.Conclusions The optical surface monitoring system is an effective image guide tool,which can quickly and accurately verify the patient's position and improve the position accuracy.It can be applied for positioning in the intensity modulated radiation treatments for the thoracic tumor patients.

BACKGROUND: Acute cerebral infarction is a form of Trousseau syndrome (TS), but is relatively rare and often overlooked by clinicians. The aim of this study was to investigate the clinical, laboratory and imaging features of acute cerebral infarction in non-small cell lung cancer (NSCLC) patients with TS. METHODS: Clinical data, laboratory examination and imaging data of 25 NSCLC patients with TS presented with acute cerebral infarction were collected retrospectively for analysis. RESULTS: Of the 25 patients, 18 males and 7 females, aged 39-78 years old, including 22 cases of adenocarcinoma, 2 cases of squamous cell carcinoma, and 1 case of large cell carcinoma; all patients had clinical symptoms and signs of acute cerebral infarction; plasma D-dimer was significantly increased, and prothrombin time and activated partial thromboplastin time were shortened to varying degrees; all patients showed acute multiple cerebral infarction foci involving multiple intracranial arterial blood supply areas on plain head magnetic resonance imaging (MRI) [diffusion-weighted imaging (DWI) sequence], the blood supply vessel lumen corresponding to the infarction foci did not show moderate to severe stenosis on the head MR angiography (MRA). CONCLUSIONS NSCLC with multiple acute cerebral infarctions is a rare manifestation of TS, which is characterized by multiple acute cerebral infarctions involving multiple arterial blood supply areas with significant hypercoagulability. Improving the early understanding of this disease can provide some help for clinical diagnosis and treatment.

Objective:To examine the influence of acute hypoxemia on central venous pressure (CVP) and diastolic blood pressure (DBP) in critical patients assisted by mechanical ventilation.Methods:We retrospectively analyzed the clinical data of critical patients assisted by mechanical ventilation in Medical Information Mart for Intensive Care Ⅲ (MIMIC-Ⅲ) database. Influence of acute hypoxemia on CVP and diastolic blood pressure (DBP) were evaluated. Hypoxemia was defined according to oxygenation index (OI) (OI≤100 as severe, 100

Objective:To compare the preliminary clinical effect of mitral valve replacement and mitral valvuloplasty on hypertrophic obstructive cardiomyopathy with mitral regurgitation.Methods:From January 2010 to December 2013, the patients undergoing cardiac surgery at Bakulev Cardiovascular Surgery Research Center in Russia were randomly divided into two groups: Forty-one patients received left ventricular outflow tract hypertrophy myocardial resection (Morrow operation) combined with mitral valve replacement (MVR) as MVR group; Forty-seven patients received Morrow surgery combined with mitral valve repair (MVr) as MVr group.The primary end point: death, secondary end point: thrombosis complications (cerebral infarction, peripheral arterial embolism), recurrence of mitral regurgitation and left ventricular outflow tract pressure difference were compared between the two groups.Results:In the MVr group, 6 cases were converted to MVR and were excluded from the study.The survival rates of MVR group and MVR group were 78.9% and 96.6%, respectively , and the thromboembolic free survival rates of MVR group and MVr group were 83.2% and 100%, respectively. The differences were statistically significant( P=0.034, 0.026, respectively). There was no significant difference in mitral regurgitation and left ventricular outflow tract pressure difference between MVR group and MVR group 24 months after operation( P=1.000, 0.934, respectively). Conclusion:Operation combined with MVR or MVr is an effective method to relieve left ventricular outflow tract obstruction and mitral regurgitation. Morrow operation combined with MVr can improve survival rate and reduce thrombosis complications.

Background::Although some well-established oncogenes are involved in cancer initiation and progression such as prostate cancer (PCa), the long tail of cancer genes remains to be defined. Goosecoid ( GSC) has been implicated in cancer development. However, the comprehensive biological role of GSC in pan-cancer, specifically in PCa, remains unexplored. The aim of this study was to investigate the role of GSC in PCa development. Methods::We performed a systematic bioinformatics exploration of GSC using datasets from The Cancer Genome Atlas, Genotype-Tissue Expression, Gene Expression Omnibus, German Cancer Research Center, and our in-house cohorts. First, we evaluated the expression of GSC and its association with patient prognosis, and identified GSC-relevant genetic alterations in cancers. Further, we focused on the clinical characterization and prognostic analysis of GSC in PCa. To understand the transcriptional regulation of GSC by E2F transcription factor 1 ( E2F1), we performed chromatin immunoprecipitation quantitative polymerase chain reaction (qPCR). Functional experiments were conducted to validate the effect of GSC on the tumor cellular phenotype and sensitivity to trametinib. Results::GSC expression was elevated in various tumors and significantly correlated with patient prognosis. The alterations of GSC contribute to the progression of various tumors especially in PCa. Patients with PCa and high GSC expression exhibited worse progression-free survival and biochemical recurrence outcomes. Further, GSC upregulation in patients with PCa was mostly accompanied with higher Gleason score, advanced tumor stage, lymph node metastasis, and elevated prostate-specific antigen (PSA) levels. Mechanistically, the transcription factor, E2F1, stimulates GSC by binding to its promoter region. Detailed experiments further demonstrated that GSC acted as an oncogene and influenced the response of PCa cells to trametinib treatment. Conclusions::GSC was highly overexpressed and strongly correlated with patient prognosis in PCa. We found that GSC, regulated by E2F1, acted as an oncogene and impeded the therapeutic efficacy of trametinib in PCa.

ObjectiveTo evaluate the clinical efficacy and safety of Qidan Tangshen Granules （芪丹糖肾颗粒， QTG） in the treatment of early diabetic kidney disease （DKD） with qi deficiency， blood stasis， and kidney deficiency syndrome， and to explore its mechanism. MethodsA double-blind， double-simulated method was used to enroll 200 patients with early DKD and qi deficiency， blood stasis， and kidney deficiency syndrome. Patients were randomly assigned in a 1∶1 ratio to the treatment group （100 cases） and the control group （100 cases）. The treatment group received QTG plus a valsartan capsule simulant， while the control group received valsartan capsules plus a QTG simulant， both for 12 weeks. The primary outcome was the urinary albumin-to-creatinine ratio （UACR）. Secondary outcomes included estimated glomerular filtration rate （eGFR）， fasting blood glucose （FBG）， 2-hour postprandial blood glucose （PBG）， glycated hemoglobin （HbA1c）， and traditional Chinese medicine （TCM） syndrome scores （including individual symptom scores for fatigue， dull complexion， soreness and weakness of the waist and knees， headache and chest pain， irritability， spontaneous sweating， thirst and polydipsia， polyphagia， polyuria， numbness of the limbs， and the total TCM syndrome score）. Oxidative stress markers including serum 8-hydroxy-2'-deoxyguanosine （8-OHDG）， 3-nitrotyrosine （3-NT）， and superoxide dismutase （SOD） were also assessed. Clinical efficacy and TCM syndrome efficacy were evaluated after treatment， and routine blood tests， urinalysis， and liver function tests were conducted and adverse reaction during the tria was recorded to assess safety. ResultsA total of 191 patients completed the study （95 in the treatment group and 96 in the control group）. The treatment group showed significant reductions in UACR， FBG， PBG， and HbA1c levels after treatment （P＜0.05 or P＜0.01）. The single TCM symptom scores except for polyphagia and total TCM syndrome scores significantly decreased （P＜0.05 or P＜0.01）. Compared to the control group， the treatment group had signi-ficantly lower UACR， FBG， PBG levels， and total TCM syndrome scores， sinlge symptoms scores except for polyphagia and limb numbness （P＜0.05 or P＜0.01）. Among 40 randomly selected patients （21 cases in the treatment group and 19 cases in the control group） for oxidative stress analysis， there were no significant differences in SOD， 3-NT， and 8-OHDG levels before and after treatment within or between groups （P＞0.05）. The overall effective rate in the treatment group was 64.2% （61/95） and 39.6% （38/96） in the control group， while the TCM syndrome efficacy rates were 80.0% （76/95） and 24.0% （23/96）， respectively， with the treatment group showing superior efficacy （P＜0.01）. No significant differences were observed in routine blood tests， urinalysis， or liver function indices before and after treatment in either group （P＞0.05）. The incidence of adverse reactions was 8.4% （8/95） in the treatment group and 9.4% （9/96） in the control group， with no statistically significant difference （P＞0.05）. ConclusionQTG can effectively reduce UACR and blood glucose levels， alleviate clinical symptoms， and improve clinical efficacy in patients with early DKD with qi deficiency， blood stasis， and kidney deficiency syndrome. The treatment is well-tolerated and safe， with no significant impact on oxidative stress markers.