Objective To investigate the molecular mechanism of the glucocorticoid?induced osteoblasts apoptosis,and to develop the effective intervention measures. Methods The MC3T3?E1 cells were treated with different concentrations of dexamethasone for 24 hours,then the apoptosis rate was detected with TUNEL analysis,the intracellular expression of Bim and Bax were determined by Westen blot. In addition,MC3T3?E1 cells were randomly divided into Bim?siRNA group,negative control siRNA group and control group. Twenty?four hours after transfection,10-4mmol/L dexamethasone was added to each group of cells for another 24 hours administration. The apoptosis rate was analyzed using the TUNEL,the mito?chondrial transmembrane electric potential was detected by flow cytometry after JC?1 staining,the expression of Bax,Bcl?2 in mitochondrial and Cyt?C,AIF in cytosolic were determined by Western blot. Results The rate of osteoblast apoptosis and Bim expression in cells were both significantly in?creased with the dosage of dexamethasone,there was no significant difference between the groups in the expression of Bax;the rate of osteoblast apop?tosis after the expression of silence Bim was significantly lower than the negative control siRNA group and control group,the expression of Bax and Cyt?C,AIF in cytosolic were significantly reduced,and the mitochondrial transmembrane electric potential was increased. Conclusion Bim is the key molecules in hormone?induced apoptosis of osteoblasts ,the expression of silence Bim can inhibit dexamethasone induced osteoblasts apoptosis through the mitochondrial pathway.

Objective To assess the therapeutic efficiency of short anterior urethral stricture treated with endourethral surgery combined with iridium 192 radiation therapy in order to decrease the recurrence rate after endourethral surgery. Methods A total of 286 patients with anterior urethral stricture (stricture length ranging from 0.5 to 2.5cm, averaging at 1.6cm) were divided randomly into two groups after internal urethrotomy and cicatrix electrotomy. The radiation group of 173 patients was treated as soon as possible with iridium 192 radiation therapy on the stricture sections while the control group of 113 patients was not. The recurrence rate was compared between the two groups during one year's follow-up. Results Among all the 286 successful operations, stricture recurred in 19 patients of the radiation group (recurrence rate of 10.98%) and in 62 ones of the control group (recurrence rate of 54.86%), with a significant difference (P=0.003). Conclusion It is an effective way to prevent recurrence by treating patients as early as possible with iridium 192 radiation on the stricture sections after endourethral operation on anterior urethral stricture.

Objective: To observe the effects of recombinant adenovirus TRAIL (AdS-TRAIL & Ad5F35-TRAIL) on apoptosis of non-small cell lung (NSCLC) cells, so as to assess the value of Ad-TRAIL in gene therapy of NSCLC. Meth-ods: CAR and CD46 expression levels in lung cancer cell lines (A549, Z793, QG56 and NCI-H520) and the primary lung cancer cells from samples of 10 NSCLC patients were assayed by flow cytometry analysis. The lung cancer cell lines and primary lung cancer cells were infected with Ad5-TRAIL & Ad5F35-TRAIL adenoviral vectors at MOI 10 or 50, re-spectively; the percentage of apoptosis cells labeled by Annexin V-FITC in different cells were measured by flow cytometry 48 h after transfection. Results: The expression of CD46 were higher than that of CAR in all the lung cancer lines (A549, Z793, QG56 and NCI-H520) and the primary lung cancer cells. Significant apoptosis was observed in Z793 and QG56 cells transfected with Ad5-TRAIL or Ad5F35-TRAIL at MOI 10, with the apoptosis rate being (1.76±2.10)% (Ad5-TRAIL), (15.96±2.89) % (Ad5F35-THAIL) and (6.05±1.58) % (Ad5-TRAIL), (10.11±1.26) % (Ad5F35-TRAIL), respectively, compared to no adenovirus-transfected cells ([2.33±0.37] % and [5.95±1.89]%, respectively, P < 0.05). Less than 10% of apoptosis cells were detected in NCI-H520 cells transfected with Ad5- or Ad5F35-TRAIL at MOI 50 ([12.89±3.2] % for AdS-TRAIL and [9.08±1.35]% for Ad5F35-TRAIL, respectively) compared to no adenovirus-transfected cells ([7.04±2.17] %, P > 0.05). Moreover, apoptosis induced by Ad5- or Ad5F35-TRAIL transfection in A549 cells was not detected both at MOI 10 and 50. About half of the primary lung cancer cells from 10 patients induced apoptosis after transfected with Ad5-TRAIL or Ad5F35-TRAIL vector. A higher percentage of apoptotic cells were found in Ad5F35-TRAIL group than those in Ad5-TRAIL and control groups. Conclusion: Ad5-TRAIL can induce apoptosis of NSCLC cells in vitro, and Ad5F35-TRAIL is more potent than Ad5-TRAIL, so Ad5F35-TRAIL is more suitable for gene therapy of NSCLC.

Objective To establish the benign prostatic hyperplasia evaluation index system for nursing quality. Methods Indicators framework for perioperative nursing quality evaluation index system was built up by the theoretical research, clinical research, expert meetings approach firstly, then the Delphi method was used to screen and verify the indicators. Results Two rounds of consultation questionnaires were collected with rate of 86.0%, 95.3% respectively, the first round of consultation had the retention of 13 indicators, removed 4 indicators of those. After the second round, the average score of important target was no less than 8.0, and more than half of indicators had a full mark, coefficient of variation targets no higher than 0.20 were up to 100%. Coefficient of concordance of two rounds were 0.241 and 0.433 respectively. ConclusionsAfter two rounds of consultation, there were 13 quality indicators left and experts had well authoritativeness and representative.

Objective To investigate the clinical value of transrectal ultrasound-guided improved 13-core prostate biopsy in the detection of prostate cancer.Methods Retrospective analysis was conducted in the clinical data of 82 clinically suspected prostate cancer patients in Shaanxi Provincial People's Hospital from October 2015 to October 2016.All patients were undergone transrectal uhrasound-guided improved 13-core prostate biopsy and surgical treatment,and the prostate biopsy results were compared with the postoperative pathological results.The accuracy of the improved 13-core prostate biopsy and the standard 6-core prostate biopsy was compared.The complications of improved 13-core prostate biopsy were also discussed.Results The diagnostic results of prostate biopsy included prostate cancer in 26 patients and benign prostatic hyperplasia (BPH) in 54 patients.The diagnostic results of 80 patients are consistent with postoperative pathological examination.Two patients were diagnosed as BPH by biopsy,but confirmed to be prostate cancer by postoperative pathological examination.The accuracy of the improved 13-core prostate biopsy and the standard 6-core prostate biopsy were 97.6％ (80/82) and 84.1％ (69/82) respectively,and the difference showed statistical significance (P =0.023).No severe complications were found in patients who underwent transrectal ultrasound improved 13-core prostate biopsy.Conclusion Transrectal ultrasound guided improved 13-core prostate biopsy can increase the detection rate significantly.It is safe and efficacious,and can be widely used in clinic.

Retrovenal ureter is a type of inferior vena cava mutation. Retrovenal ureter with right double inferior vena cava mutation is rare. We reported a case of retrocaval ureteral with right double inferior vena cava variation, right ureteral calculi and hydronephrosis of the right kidney. Peritoneal laparoscopic ureterolithotomy and right posterior vena cava dissection ureteroplasty were performed. Fourteen months after surgery, B-ultrasound of the urinary system was reexamined, and no hydronephrosis was found in the right renal pelvis and ureter.

Objective To investigate the clinical efficacies of free endoscopic nasobiliary drainage (ENBD) in primary duct closure (PDC) following laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis.Methods The retrospective cohort study was conducted.The clinical data of 312 patients with extrahepatic bile duct stones accompanied with or without cholecystolithiasis who were admitted to the 11 medical centers [86 in the Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,62 in the Second Affiliated Hospital of Zhejiang University School of Medicine,44 in the West China Hospital of Sichuan University,29 in the First Affiliated Hospital of Xi'an Jiaotong University,27 in the First Hospital Affiliated to Army Medical University (Third Military Medical University),25 in the Hunan Provincial People's Hospital,17 in the Beijing Friendship Hospital of Capital Medical University,10 in the First Affiliated Hospital of Hainan Medical University,5 in the Henan Provincial People's Hospital,4 in the Beijing Tian Tan Hospital of Capital Medical University,3 in the First Affiliated Hospital of Fujian Medical University] from January 2011 to June 2017 were collected.All patients underwent LCBDE+PDC,and 81 and 231 patients with and without ENBD were respectively allocated into the ENBD group and PDC group.Observation indicators:(1) comparisons of operation situations;(2) comparisons of postoperative recovery;(3) comparisons of postoperative complications;(4) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative complications up to June 2017.Measurement data with normal distribution were represented as x±s.Comparison between groups was analyzed by the t test.Measurement data with skewed distribution were represented M [interquartile range (IQR)],and comparison between groups was analyzed by the nonparametic test.Comparisons of count data were analyzed using the chi-square test and Fisher exact probability.Results (1) Comparisons of operation situations:all the 312 patients underwent successful laparoscopic LCBDE + PDC,without conversion to open surgery,including postoperative death of 1 patient in the PDC group.The common bile duct diameter,cases using interrupted sutures,continuous sutures,absorbable threads and nonabsorbable threads were respectively (1.2±0.4)cm,106,125,195,36 in the PDC group and (1.1±0.5)cm,76,5,79,2 in the ENBD group,with statistically significant differences between groups (t =2.497,x2 =56.706,8.457,P＜0.05).The numbers of stones,stone diameter,cases with common bile duct wall (≤ 3 mm and ＞3 mm),normal and abnormal Oddi sphincter contraction function,volume of intraoperative blood loss and operation time were respectively 2.1±1.7,(1.1-±0.6)cm,148,83,226,5,20 mL (10-45 mL),(116± 49)minutes in the PDC group and 1.9±1.6,(1.0±0.6)cm,49,32,75,6,20 mL (15-30 mL),(113± 23)minutes in the ENBD group,with no statistically significant difference between groups (t =1.021,0.329,x2 =0.329,3.428,Z=1.147,t=0.521,P＞0.05).The further analysis:of 312 patients,cases and time using interrupted sutures and continuous sutures were respectively 182,130 and (133±.49) minutes,(103±34) minutes,with a statistically significant difference between groups (t =-6.605,P＜0.05).The volume of intraoperative blood loss and cases with postoperative complications using interrupted sutures and continuous sutures were respectively 20 mL (15-31 mL),21 and 20 mL (10-45 mL),18,with no statistically significant difference between groups (Z =-0.285,x2 =0.369,P＞ 0.05).Of 312 patients,cases,operation time,volume of intraoperative blood loss and postoperative complications using absorbable threads and non-absorbable threads were respectively 274,(116±44)minutes,20 mL (15-40 mL),33 and 38,(115±35) minutes,18 mL (10-26 mL),6,with no statistically significant difference between groups (Z =0.971,t =0.023,x2 =0.154,P＞ 0.05).(2) Comparisons of postoperative recovery:recovery time of gastrointestinal function,time of abdominal drainage-tube removal,using time of antibiotics and duration of hospital stay were respectively (2.0± 1.5) days,(4.0 ± 2.4) days,(4.0±2.8) days,(5.5±3.0) days in the PDC group and (4.0±1.9) days,(6.9±3.5) days,(10.0± 3.9) days,(11.1±3.7)days in the ENBD group,with statistically significant differences between groups (t =-9.507,-8.258,-15.103,-13.575,P＜0.05).The total expenses of hospital stay in the Affiliated Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology were respectively (5.1 ±0.6)× 104 yuan in the PDC group and (6.5-±0.5)× 104 yuan in the ENBD group,with a statistically significant difference between groups (t =-9.516,P＜0.05).(3) Comparisons of postoperative complications:incidence of complications in the PDC group was 14.29％ (33/231),including 16 with biliary fistula,11 with biliary tract infection,3 with wound infection,1 with biliary tract bleeding,1 with residual stones of common bile duct and 1 with death;incidence of complications in the ENBD group was 6.17％ (5/81),including 2 with biliary fistula,2 with biliary tract infection and 1 with biliary tract bleeding,showing no statistically significant difference between groups (x2 =3.151,P＞0.05).(4) Follow-up situations:of 312 patients,252 were followed up for 2-67 month,with a median time of 15 months,including 175 in the PDC group and 77 in the ENBD group.During the follow up,there was no occurrence of jaundice,cholangitis and pancreatitis,and stone recurrence and postoperative cholangiostenosis were not detected by abdominal color Doppler ultrasound or CT or magnetic resonanced cholangio-pancreatography.Conclusion On the basis of grasping operative indication strictly,ENBD in PDC following LCBDE for choledocholithiasis is safe and effective.

Objective:To summarize the best evidence of intracranial hypertension nursing for adult patients with severe brain injury, and to provide reference for clinical nursing practice.Methods:According to the evidence-based methodology, a systematic search of Chinese and English literature on intracranial hypertension nursing of adult patients with severe brain injury was conducted in domestic and foreign databases such as CNKI, Wanfang, PubMed, Cochrane Library and Cinahl Plus and so on, as well as related guide websites and professional association websites from the establishment of database to August 2022. Two researchers independently evaluated literature quality and screened evidence, and then the project team summarized and concluded the evidence.Results:A total of 6 009 articles were obtained through preliminary search, and 33 articles were included after screening, including 13 guidelines, 1 systematic review, 17 expert consensus, 1 evidence summary, and 1 meta-analysis. In total, 33 pieces of best evidence were obtained from 8 dimensions, including intracranial pressure related threshold, assessment and monitoring, respiratory care, circulation care, analgesic and sedative care, temperature care, nutrition care and cerebrospinal fluid care.Conclusions:This study summarizes the evidence-based basis of intracranial hypertension nursing in adult patients with severe brain injury, which provides a basis for the standardized construction of clinical nursing strategies and empirical research.

Objective:To investigate the evaluation efficacy and predictive prognostic value of alpha-fetoprotein (AFP) response in tyrosine kinase inhibitors (TKIs) in combination with PD-1 inhibitors (α-PD-1) for intermediate-to-advanced hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 205 patients with intermediate-to-advanced HCC who were admitted to 9 medical centers, including Mengchao Hepatobiliary Hospital of Fujian Medical University et al, from March 2020 to July 2022 were collected. There were 178 males and 27 females, aged (52±12)years. Based on AFP response at 6-8 weeks after treatment, patients were divided into the AFP response group (AFP level decreased by ≥50% compared to baseline) and the AFP no response group (AFP level decreased by <50% compared to baseline). Observation indicators: (1) AFP response evaluation of anti-tumor efficacy; (2) comparison of patient prognosis; (3) analysis of factors affecting patient prognosis. Measurement data with normal distrubution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range) and M( Q1, Q3). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to draw survival curve and calculate survival rate, and the Log-Rank test was used for survival analysis. The COX proportional risk model was used for univariate analysis and the COX stepwise regression model was used for multivariate analysis. Results:(1) AFP response evaluation of anti-tumor efficacy. Before treatment, all 205 patients were positive of AFP, with a baseline AFP level of 1 560(219,3 400)μg/L. All 205 patients were treated with TKIs in combination with α-PD-1, and the AFP level was 776(66,2 000)μg/L after 6 to 8 weeks of treatment. Of the 205 patients, 88 cases were classified as AFP response and 117 cases were classified as AFP no response. According to the response evaluation criteria in solid tumors version 1.1, the objective response rate (ORR) and disease control rate (DCR) were 42.05%(37/88) and 94.32%(83/88) in patients of the AFP response group and 16.24% (19/117) and 64.10% (75/117) in patients of the AFP no response group, showing significant differences between them ( χ2=16.846, 25.950, P<0.05). According to the modified response evaluation criteria in solid tumors, the ORR and DCR were 69.32% (61/88) and 94.32% (83/88) in patients of the AFP response group and 33.33% (39/117) and 64.10% (75/117) in patients of the AFP no response group, showing significant differences between them ( χ2=26.030, 25.950, P<0.05). (2) Comparison of patient prognosis. All 205 patients were followed up for 12.4(range, 2.4-34.0)months after treatment. The median progression free survival time and total survival time were 5.5 months and 17.8 months, respectively. The 1-year, 2-year progression free survival rates were 20.8% and 7.2%, and the 1-year, 2-year overall survival rates were 68.7% and 31.5%, respectively. The median progression free survival time, 1-year and 2-year progression free survival rates were 9.7 months, 39.6% and 14.2% in patients of the AFP response group and 3.7 months, 7.8% and 2.0% in patients of the AFP no response group, showing a significant difference in progression free survival between them ( χ2=43.154, P<0.05). The median overall survival time, 1-year and 2-year overall survival rates were not reached, 85.2% and 56.3% in patients of the AFP response group and 14.6 months, 56.3% and 14.5% in patients of the AFP no response group, showing a significant difference in overall survival between them ( χ2=33.899, P<0.05). (3) Analysis of factors affecting patient prognosis. Results of multivariate analysis showed that invasion of large blood vessels, extrahepatic metastasis, combined hepatic artery intervention therapy, and AFP response were independent factors influencing progression free survival in patients with intermediate-to-advanced HCC who were treated with TKIs in combination with α-PD-1 ( hazard ratio=1.474, 1.584, 0.631, 0.367, 95% confidence interval as 1.069-2.033, 1.159-2.167, 0.446-0.893, 0.261-0.516, P<0.05), and Eastern Cooperative Oncology Group score, invasion of large blood vessels, extrahepatic metastasis, and AFP response were independent factors influencing overall survival in patients with intermediate-to-advanced HCC who were treated with TKIs in combination with α-PD-1 ( hazard ratio= 1.347, 1.914, 1.673, 0.312, 95% confidence interval as 1.041-1.742, 1.293-2.833, 1.141-2.454, 0.197-0.492, P<0.05). Conclusions:AFP response at 6-8 weeks after treatment can effectively evaluate anti-tumor efficacy of TKIs in combination with α-PD-1 for intermediate-to-advanced HCC. AFP response is the independent factor influencing progression free survival and overall survival in patients with intermediate-to-advanced HCC who were treated with TKIs in combination with α-PD-1.

【Objective】 To establish a prognostic model of fatty acid metabolism related genes for predicting the prognosis of renal clear cell carcinoma. 【Methods】 The differentially expressed fatty acid metabolism-related genes in renal clear cell carcinoma samples and normal samples in TCGA database were screened by R language software. The Cox proportional hazard regression model was used to select and establish a multigene prognostic model and the prognostic score was calculated. Patients were divided into high-risk group and low-risk group according to the median prognostic score. Kaplan-Meier survival curve was used to analyze the difference in two groups. The clinical pathological factors and prognostic score factors were included in the Cox regression model to analyze the factors affecting the survival of patients with renal clear cell carcinoma. ROC receiver operating curve analysis was used to evaluate the accuracy of the prognostic prediction model. The prognostic model of fatty acid metabolism-related genes and their correlation with clinical factors were analyzed. GSEA enrichment analysis analyzed the differences of gene sets in risk groups. 【Results】 A total of 4 differential genes (CPT1B, HADH, CYP4A11, and ACADSB) were selected to establish a prognostic model for genes related to fatty acid metabolism in renal cell carcinoma. The prognostic risk score (RS) formula is as follows: RS=0.490×CPT1B-0.428×HADH-0.11 × CYP4A11-0.372 × ACADSB. Kaplan-Meier survival analysis confirmed that the overall survival rate of patients with low-risk prognostic score was significantly higher in patients with overall renal clear cell carcinoma, and the difference was statistically significant (P<0.001). Cox regression analysis showed that the prognostic model of genes related to age and fatty acid metabolism is an independent influencing factor for the prognosis of patients with renal clear cell carcinoma (P<0.01). The 5 years’ AUC of the renal clear cell carcinoma ROC curve of the renal cancer fatty acid metabolism related gene model was 0.802. GSEA analysis showed that the difference of 81 gene sets in the low-risk group was statistically significant (P<0.05). 【Conclusion】 The prognostic model of renal cancer fatty acid metabolism-related genes can be used to predict the prognosis of patients with renal clear cell carcinoma, which is conducive to further guide clinical treatment.