Objective To investigate the present state of mineral metabolism and its related factors in elderly patients with maintenance hemodialysis (MHD),in order to improve the quality of life and survival rate in elderly patients with MHD in Xinxiang.Methods Clinical data of 466 patients with treatment of MHD for over 3 months in 4 hospitals in Xinxiang district were enrolled from January 2012 to August 2013 in this study,and the patients were divided into the elderly group (n=159,aged ≥ 60 years) and the non-elderly group (n =307,aged ＜ 60 years).The evaluation indexes for mineral metabolism were determinated,such as serum levels of calcium,phosphorus,intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP).The present state of mineral metabolism and its relationships with anemia,dialysis ages,adequacy of dialysis,malnutrition and inflammatory factors were analyzed in elderly patients with MHD.Results Among 466 patients,the serum levels of calcium,phosphorus and iPTH in MHD patients were (1.95 ± 0.34) mmol/L,(2.54±1.38) mmol/L and (409.5±345.6) ng/L respectively,and their control rates were 34.3％,20.4％ and 25.5％ respectively.And in patients with hemodialysis three times a week,the control rates were 50.8％,31.4％ and 32.2％ respectively.The serum levels of phosphorus,iPTH,ALP,albumin and transferrin saturation were lower in elderly group than in non-elderly group (all P＜0.01),and the serum levels of pre-albumin,hemoglobin and feritin were lower in elderly group than in non-elderly group (all P＜0.05).But the serum levels of calcium and C-reactive protein (CRP)were higher in elderly group than in non-elderly group (all P＜0.05).Conclusions The elderly patients with MHD exhibit unique clinical manifestations of abnormal mineral metabolism,and low bone transformation osteopathy is the main manifestation.The micro-inflammation,malnutrition and anemia are more severe in elderly patients than in non elderly patients.

Objective To study the feasibility,safety,indications and possible advantages of minimally invasive surgery over traditional open surgery in treating pancreatic body or tail lesions.Methods From December 2009 to December 2014,the clinical data of 71 patients with lesions in pancreatic body or tail who underwent minimally invasive distal pancreatectomy (MIDP) or open distal pancreatectomy (ODP) at the General Surgery of Huadong Hospital were retrospectively analyzed.There were 22 patients in the MIDP group and 49 patients in the ODP group.The operations in 15 patients in the MIDP group were performed by the Da Vinci robot-assisted surgical system and 7 patients by laparoscopic distal pancreatectomy.Results The MIDP group had a shorter time to pass first flatus [(MIDP (2.5 ± 1.0) d vs ODP (3.5 ±1.0)d,P ＜ 0.05],and shorter postoperative hospital stay [(MIDP (15.2 ± 7.9) d vs ODP (23.4 ±21.2) d,P ＜ 0.05] than the ODP group.There were no significant differences on total pancreatic fistula rate [MIDP 45.5％ (10/22) vs ODP 55.1％ (27/49),P ＞ 0.05] and symptomatic postoperative pancreatic fistula rate [MIDP 18.2％ (4/22) vs ODP 18.4％ (9/49),P ＞ 0.05] between the two groups.The MIDP group had a significant longer operative time [MIDP (246.3 ±75.3)min vs ODP (168.1 ±33.7)min,P＜0.05] than the ODP group.Conclusions Minimally invasive surgery is safe and feasible in treatment of lesions in pancreatic body or tail with less trauma and faster recovery.The application of robotic surgery has expanded the treatment options for lesions in pancreatic body or tail.

Objective:To investigate the expression of human epidermal growth factor receptor 2 (HER2) in pancreatic ductal adenocarcinoma(PDAC) and its relationship with the prognosis of patients with PDAC.Methods:From January 2001 to December 2012, 109 paraffin embedded PDAC tissue samples and 27 normal pancreatic tissue samples were collected from the Department of Pathology, Huadong Hospital Affiliated to Fudan University. The expression of HER2 protein in pancreatic tissue was detected by immunohistochemical Envision two-step method. HER2 expression was evaluated according to Hercept test, and its relationship with clinicopathological features and survival time was analyzed.Results:The expression of HER2 protein was negative (-) in 29.4% of PDAC tissues, weakly positive (+ ) in 35.8%, positive (+ + ) in 25.7% and strongly positive (+ + + ) in 9.2%, respectively, and the overexpression rate (+ + , + + + ) was 34.9%; the negative (-) and weakly positive (+ ) expression of HER2 protein in normal pancreatic tissues accounted for 88.9% and 11.1% respectively. There was no expression with positive (+ + ) or strongly positive (+ + + ), therefore, the overexpression rate was 0. The overexpression rate of HER2 protein in PDAC and normal pancreatic tissues was significantly different ( P=0.000). The expression of HER2 protein was significantly correlated with age, and the expression of HER2 protein in patients with PDAC over 65 years old was significantly higher than that in patients with PDAC under 65 years old ( P=0.043), but not with gender, tumor location, tumor grade, T stage, N stage and nerve invasion (all P>0.05). Univariate Cox proportional hazards analysis showed that HER2 expression was associated with postoperative survival time of patients with PDAC ( P=0.032). Multivariate Cox proportional hazards analysis showed that HER2 expression was an independent prognostic factor for survival of patients with PDAC ( P=0.040). The median survival period of patients with HER2 expression + + + was significantly longer than that of patients with HER2 expression -~+ + (128.4 months vs 21.5 months), and the difference was statistically significant ( P=0.038). Conclusions:The overexpression of HER2 in PDAC tissue was related to the age of patients. The survival time of patients with HER2 strongly positive PDAC was significantly longer. HER2 can be considered as an index to evaluate the biological behavior and prognosis of PDAC.

Objective: To investigate the relationship of clinicopathological characteristics with neoadjuvant chemotherapeutic efficacy and prognosis of inflammatory breast cancer (IBC) patients. Methods: Medical records of 81 patients who underwent neoadjuvant chemotherapy for IBC in Tianjin Medical University Cancer Institute and Hospital between January 2010 and December 2013, were retrospectively analyzed. Clinicopathological features, response to neoadjuvant chemotherapy, and prognostic factors were studied by univariate and multivariate analyses. Results: The 3-year overall survival rate (OS) and disease-free survival rate (DFS) of patients were 53.1％ and 37.0％, respectively. The pathologic complete response (pCR) rate of patients after accepting neoadjuvant chemotherapy was 13.6％ (11/81). Statistically significant association was observed between pCR and pathological types in IBC (P<0.05). However,pCR had no benefit in improving the clinical outcomes of IBC patients (P>0.05). Preoperative lymph node stage was an independent prognostic factor of overall survival (OS) and disease- free survival (DFS) in IBC patients (P<0.05). Neoadjuvant chemotherapy and lymph vessel tumor emboli were independent factors of DFS (all P<0.05). Conclusion: Clinicopathological characteristics of IBC patients affected chemosensitivity. We could predict the prognosis of these patients by preoperative lymph node stage and lymph vessel tumor emboli and select chemotherapy to achieve the best curative effect.

Background: Despite strengthened efforts on human immunodeficiency virus (HIV) prevention and control, new HIV infections continue to increase among men who have sex with men (MSM) in China. Pre-exposure prophylaxis (PrEP), a highly effective HIV-prevention tool, has recently been included in China's Action Plan of HIV Prevention and Control. To promote future PrEP implementation, this study aims to identify the barriers and facilitators in PrEP use intention among MSM in China.Methods: In 2018, a cross-sectional survey was conducted among 300 MSM in Nanjing, Jiangsu Province. Questions on demographics, sexual behavior (including a seven-item high-risk behavior index), PrEP use intention, PrEP-related awareness and accessibility, and a seven-item public HIV stigma scale were included in the questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with PrEP use intention. Results: Overall, 44.67％ of the participants had more than two male sexual partners and 5.56％ had HIV-positive sexual partners. Only 57.00％ had heard of PrEP and only four (1.33％) participants had used PrEP. However, 75.34％ expressed the willingness to use oral PrEP if its efficacy was assured. The beliefs that "PrEP can prevent HIV if taken as prescribed" (adjusted odds ratio (AOR) = 4.84, P < 0.001) and "PrEP can be scaled up in the community" (AOR = 3.24, P < 0.001) were positively associated with oral PrEP use intention. Concerns of side effects were negatively associated with oral PrEP use intention (AOR = 0.32, P = 0.006). Further, 77.00％ of the participants would choose injectable or implanted PrEP instead of oral PrEP. One of the PrEP stigma items, "Not certain if doctors can prescribe PrEP if I go to the clinic" was positively associated with the intention to use injectable or implanted PrEP (AOR = 3.03). The items "Heard of PrEP" (AOR = 2.74) and "PrEP can prevent HIV if taken as prescribed" (AOR = 2.65) were also positively related to the intention to use injectable or implanted PrEP. The most common concerns regarding PrEP use were efficacy (44.67％) and side effects (38.67％). The most common reasons for using injectable and implanted PrEP were adherence (81.94％ and 77.86％, respectively) and privacy concerns (56.48％ and 55.00％, respectively). Affordable price and coverage by health insurance were the driving factors for PrEP use. Conclusion: Given the low level of awareness of PrEP-related information in China, it's necessary to provide interventions for high-risk individuals and communities, in order to increase their awareness and knowledge of PrEP. Furthermore, additional alternatives to HIV prevention, such as long-acting injectable or implanted PrEP, should be investigated to reduce the risk of HIV infection in at-risk MSM. Even if this programme could be approved by the National Medical Products Administration of China and implemented, a supportive social environment for MSM is essential during its implementing.

Objective:To investigate the risk factors of breast cancer complicated with deep venous thrombosis (DVT) in lower limb and to explore the predictive significance of the thrombus risk assessment model for patients with breast cancer. Methods:A total of 703 patients with breast cancer in Tianjin Medical University Cancer Institute and Hospital who suffered from DVT after operation dur-ing January 2013 to June 2016 were retrospectively selected as the thrombosis group. A total of 706 cases for the control group were selected by systematic sampling. The risk factors of lower limb DVT after surgery were investigated. The predictive values of the Khora-na and Caprini thrombosis risk assessment models for these patients were also presented in this research. Results:Age, BMI≥30 kg/m2, diagnosis by excisional biopsy, neoadjuvant chemotherapy, operation time>2 h, lipoprotein a (Lpa)>475.5 mg/L, protein C (PC)<102.5%, blood coagulation factor-Ⅷ(F-Ⅷ)>129.8%, and D-Dimer (D-D)>289.99 ng/mL had statistical differences between in the two groups (P<0.05). Significant difference between the groups was found in the Caprini scores (P<0.001) but not in the Khorana thrombo-sis risk assessment model (P=0.207). Conclusion:Age, BMI≥30 kg/m2, diagnosis by excisional biopsy, neoadjuvant chemotherapy, op-eration time>2 h, Lpa>475.5 mg/L, PC<102.5%, F-Ⅷ>129.8%, and D-D>289.99 ng/mL are the independent risk factors of thrombo-sis. The Caprini thrombosis risk assessment model may require complicated evaluation. Hence, a new model that is suitable for pa-tients with breast cancer must be developed.

Objective To investigate the expression of resistin and inflammatory cytokines in pancreatic cancer and explore the association with clinicopathological features.Methods The enzyme-linked immunosorbent assay (ELISA) technique was used to examine the serum resistin level in 38 patients with pancreatic cancer and 32 healthy controls.The real-time PCR technique was used to detect the mRNA expression level of resistin and inflammatory cytokines TNF-α,IL-2 and IL-8 in surgically resected specimens of pancreatic cancer patients.Results The serum resistin level in patients with pancreatic cancer was significantly higher than that in healthy controls (P ＜ 0.05).The serum resistin level was positively associated with TNM stage and lymph node metastasis,respectively (P ＜ 0.05).There was no significant correlation between serum resistin level and age,gender,BMI,preoperative blood glucose levels,tumor location,tumor size,nerve invasion and differentiation grade (P ＞ 0.05).The expression level of resistin mRNA in pancreatic cancer tissues was 3.8 times more than that in normal pancreatic tissues (P ＜ 0.05).The mRNA expressiou level of proinflammatory cytokines as TNF-α and IL-8 in pancreatic cancer tissues were 2.1 and 1.9 times higher than those in normal pancreatic tissues (P ＜ 0.05).The mRNA expression level of anti-inflammatory cytokines IL-2 accounted for 20％ of that in normal pancreatic tissues (P ＜ 0.05).Conlusions The serum resistin level in patients with pancreatic cancer was significantly higher than that of healthy controls,and positively associated with TNM stage and lymph node metastasis.The expression level of resistin and proinflammatory cytokines IL-8 and TNF-α of pancreatic cancer tissues were significantly higher than those of normal pancreatic tissues.The expression level of anti-inflammatory cytokine IL-2 was less than that in normal pancreatic tissues.It's suggested that resistin may take part in the development and progression of pancreatic cancer by mediating inflammatory reaction.

Postoperative pancreatic fistula (POPF) is one of the main life-threatening complications after pancreatectomy, with an incidence of 3% to 45%. Despite there were significant advances in pancreatic surgery in recent decades and continued decreasing mortality, the incidence of postoperative pancreatic fistula still remains high. Clinically relevant postoperative pancreatic fistula after pancreatic surgery is often accompanied by abdominal infection. Studies have shown that abdominal infection is not only related to postoperative pancreatic fistula, but also it’s an important factor which may induce and aggravate the development of postoperative pancreatic fistula. The exact correlation between POPF and abdominal infection is not clear. The goal of this review is to discuss the current research progress on the relationship between postoperative pancreatic fistula and abdominal infection.

Yinchenhao Tang has definite clinical efficacy. It has been inherited and documented since the ancestor of Shanghanlun in the Eastern Han dynasty and is a classical formulas for clearing away heat， promoting diuresis， and eliminating jaundice adopted by medical experts of successive generations. It has been included in the Catalogue of Ancient Classical Formulas （the Second Batch of Han Medicine） published by the National Administration of Traditional Chinese Medicine （TCM） in 2023. By means of bibliometrics， 801 pieces of ancient literature data related to Yinchenhao Tang were collected， and 36 pieces of effective data were selected， involving 36 ancient books of TCM. The origin， name， composition， efficacy， formula and meaning analysis， drug origin， dosage， preparation method and usage， indications， and modern clinical application of Yinchenhao Tang were analyzed. It was suggested that the modern dosage and application of Yinchenhao Tang should be as follows： The 82.8 g of Artemisiae Scopariae Herba， 12.6 g of Gardeniae Fructus， and 27.2 g of Rhei Radix et Rhizoma. The formulas was prepared by firstly adding 2 400 mL of water into Artemisiae Scopariae Herba and boiling it to about 1 200 mL， then adding Gardeniae Fructus and Rhei Radix et Rhizoma to boil it for 600 mL， and removing the residue. It could be orally taken for 200 mL each time in warm conditions， three times a day. Yinchenhao Tang has the effect of clearing away heat， promoting diuresis， and eliminating jaundice， and it mainly treats symptoms of hygropyretic jaundice. In the formulas， Yinchenhao Tang is the monarch drug， which is mainly to remove dampness and jaundice. Gardeniae Fructus is the ministerial drug， which is mainly responsible for clearing the triple energizer and facilitating urination. Rhei Radix et Rhizoma is an adjuvant， mainly responsible for clearing away heat and eliminating jaundice. The modern application of this formulas involves the hepatobiliary system， skin system， endocrine system， digestive system， etc.， and it has more advantages in treating jaundice， icteric hepatitis， and hepatitis B. In this study， the ancient literature related to Yinchenhao Tang was sorted out to determine its key information， so as to provide a scientific reference for clinical application of classic formulas and new drug development.