Objective To compare complications incidence rates of 8-core and 12-core prostate biopsies guided with transrectal ultrasound retrospectively,and to study intervention ways to decrease complications.Methods The data of 260 consecutive patients undergoing first-time transrectal ultrasound-guided biopsy were analyzed.132 patients underwent 8-core biopsy and 128 patients underwent 12-core biopsy.Results In 8-core group,there were 7 cases of infections,15 cases of gross hematuria,7 cases of rectal bleeding and 6 cases of acute urinary retention,and in 12-core group,5 cases of infections,19 cases of gross hematuria,9 cases of rectal bleeding and 7 cases of acute urinary retention in 12-core group.There are no statistical differences of complications incidence rate between two groups (P ＞ 0.05).when prostate volume ＞ 45 ml,detection rate of prostate cancer in 12-core group was significantly higher than that in 8-core group.Conclusions There are no statistical differences of complications incidence rate between 8-and 12-core prostate biopsy.Homologous measure must be taken to reduce complications.12-core prostate biopsy is recommended as prostate volume ＞ 45 ml.

Sox9 gene was cloned from immortalized precartilaginous stem cells and its eukaryotic expression vector constructed in order to explore the possibility of bone marrow-derived stromal cells differentiation into precartilaginous stem cells induced by Sox9. A full-length fragment of Sox9 was obtained by RT-PCR, inserted into pGEM-T Easy clone vector, and ligated with pEGFP-IRES2 expression vector by double digestion after sequencing. The compound plasmid was transfected into born marrow-derived stromal cells by Lipofectamine 2000, and the transfection efficacy and the expression of Sox9 and FGFR-3 were observed. Flow cytometry was used to identify the cell phenotype, and MTT was employed to assay proliferative viability of cells. Sequencing, restrictive endonuclease identification and RT-PCR confirmed that the expansion of Sox9 and construction of Sox9 expression vector were successful. After transfection of the recombinant vector into bone marrow-derived stromal cells, the expression of Sox9 and FGFR-3 was detected, and proliferative viability was not different from that of precartilaginous stem cells. It was concluded that Sox9 gene eukaryotic expression vector was successfully constructed, and the transfected bone marrow-derived stromal cells differentiated into the precartilaginous stem cells.
Base Sequence ; Bone Marrow Cells/*cytology ; Cartilage/*cytology ; Cell Differentiation/genetics ; Cells, Cultured ; Cloning, Molecular ; Genetic Vectors/genetics ; Molecular Sequence Data ; Receptor, Fibroblast Growth Factor, Type 3/metabolism ; Recombinant Proteins/biosynthesis ; Recombinant Proteins/genetics ; SOX9 Transcription Factor/biosynthesis ; SOX9 Transcription Factor/*genetics ; Stem Cells/*cytology ; Stromal Cells/*cytology ; Transfection

This study was aimed to observe the effect ofJian-Zhong-Li-Lao(JZLL) decoction-mediated serum on the TGF-β1-induced proliferation of HBZY-1 cells, the expression of matrix metalloproteinases and its inhibitory enzyme, in order to investigate the mechanisms of JZLL decoction in treatment of the renal fibrosis of chronic renal failure. HBZY-1 cells were culturedin vitro. JZLL decoction-mediated serum was prepared. The experiment contained the blank control group, TGF-β1-induced group, control serum group, low-dose JZLL decoction group, high-dose JZLL decoction group, and theNiao-Du-Qinggroup. The cytotoxic effects of JZLL decoction-mediated serum on HBZY-1 cells were assessed by LDH assay. The morphology and proliferation of HBZY-1 cells were examined by CCK8 assay. The expression of matrix metalloproteinases (MMP-2, MMP-9) and its inhibitory enzymes (TIMP-1, TIMP-2) were examined by ELISA assay. The results showed that there was no cytotoxic effect of JZLL decoction-mediated serum on HBZY-1 cells (P > 0.05). Compared with the model group, JZLL decoction can obviously inhibit TGF-β1-induced proliferation of HBZY-1 cells (P < 0.05). JZLL decoction can obviously increase the expressions of MMP-2 and MMP-9 (P < 0.05), and inhibit the expressions of TIMP-1 and TIMP-2 (P < 0.05). It was concluded that JZLL decoction-mediated serum significantly inhibited TGF-β1-induced proliferation of HBZY-1 cells, relieved the renal fibrosis of chronic renal failure through affecting the expression of matrix metalloproteinases and its inhibitory enzymes.

-tiated into the precartilaginons stem cells.

Objective To explore the safety and feasibility of robot splenectomy.Methods 65 patients undergoing robotic or laparoscopic splenectomy at No.940 Hospital of Chinese people's Liberation Army Joint Service Support Force from Jan 2015 to Sep 2019 were analyzed retrospectively.Results The operation time and total hospitalization cost of robot spleen resection group and laparoscopic splenectomy group were [(167 ± 34) min vs.(123 ± 24) min,t =8.554,P =0.00] and (73 002 ± 21 009) yuan vs.(42 095 ± 9 999) yuan,(t =6.484,P =0.00),respectively.In laparoscopy group,3 cases were converted to laparotomy.In the subgroup of splenic hilum thickness ≥ 5 cm,the intraoperative bleeding volume of robot group and laparoscopic group was (145 ± 67) ml vs.(263 ± 180) ml,(t =-2.195,P =0.04).There were significant differences in VAS score (3 ±1) vs.(4 ±1),(t=2.175,P=0.04).Conclusion Robotic splenectomy is safe and feasible.For patients with splenomegaly,robot surgery has more minimally invasive advantages than laparoscopy,but it is expensive and time-consuming.

OBJECTIVE: To analyze the clinical phenotype and genetic basis for a child with acute form of tyrosinemia type I (TYRSN1). METHODS: A child with TYRSN1 who presented at the Gansu Provincial Maternal and Child Health Care Hospital in October 2020 was selected as the subject. The child was subjected to tandem mass spectrometry (MS-MS) and urine gas chromatography-mass spectrometry (GC-MS) for the detection of inherited metabolic disorders, in addition with whole exome sequencing (WES). Candidate variants were validated by Sanger sequencing. RESULTS: The child's clinical features included abdominal distension, hepatomegaly, anemia and tendency of bleeding. By mass spectrometry analysis, her serum and urine tyrosine and succinylacetone levels have both exceeded the normal ranges. WES and Sanger sequencing revealed that she has harbored c.1062+5G>A and c.943T>C (p.Cys315Arg) compound heterozygous variants of the FAH gene, which were inherited from her father and mother, respectively. Among these, the c.943T>C was unreported previously. CONCLUSION Considering her clinical phenotype and result of genetic testing, the child was diagnosed with TYRSN1 (acute type). The compound heterozygous variants of the FAH gene probably underlay the disease in this child. Above finding has further expanded the spectrum of FAH gene variants, and provided a basis for accurate treatment, genetic counseling and prenatal diagnosis for her family.
Female ; Humans ; Gas Chromatography-Mass Spectrometry ; Genetic Testing ; Mutation ; Phenotype ; Prenatal Diagnosis ; Tyrosinemias/genetics* ; Child

With the rapid development of information technology, artificial intelligence technology (AI) and how to use it have become the focus of current researches. The application of AI in the field of TCM has shown its uniqueness. The combination of artificial intelligence technology and traditional Chinese medicine provides a new direction and idea for the development of TCM. This paper analyzes the strengths, weaknesses, opportunities and threats (SWOT) of TCM development against the background of AI technology in China by SWOT analysis method. Based on these analyses, this paper puts forward some counter measures such as protecting personal information, avoiding negative effects and medical regulations etc. In order to facilitate and guarantee the development of TCM, we should take advantage of the AI, and avoid its disadvantages.

Objective:To investigate the application value of Clavien-Dindo classification in evaluation of postoperative short-term complications of Da Vinci robotic-assisted or laparoscopic-assisted total gastrectomy with D 2 lymphadenectomy. Methods:The retrospective cohort study was conducted. The clinicopathological data of 262 patients with gastric cancer who were admitted to the 940th Hospital of Joint Logistic Support Force of Chinese People′s Liberation Army from January 2016 to January 2019 were collected. There were 214 males and 48 females, aged (58±11) years, with a range from 17 to 81 years. Of 262 patients, 120 cases undergoing Da Vinci robotic-assisted total gastrectomy + D 2 lymphadenectomy + Roux-en-Y anastomosis were divided into robotic group, and 142 cases undergoing laparoscopic-assisted total gastrectomy + D 2 lymphadenectomy + Roux-en-Y anastomosis were divided into laparoscopic group. Observation indicators: (1) intraoperative and postoperative situations; (2) postoperative pathological examination; (3)complications; (4) stratified analysis; (5) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect complications, tumor recurrence and survival of patients within postoperative 2 months. The follow-up was up to May 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ranked data between groups was analyzed using the rank sum test. Results:(1) Intraoperative and postoperative situations: cases undergoing conversion to open surgery, the operation time, volume of intraoperative blood loss, the number of lymph node dissected, time to first flatus, time to initial fluid diet intake, duration of postoperative hospital stay of the robotic group were 1, (243±42)minutes, 100 mL(range, 100-150 mL), 38±15, (2.8±1.0)days, 3 days(range, 3-4 days), 11 days(range, 9-13 days), respectively. The above indicators of the laparoscopic group were 2, (244±38)minutes, 100 mL(range, 100-150 mL), 34±14, (3.2±1.0)days, 4 days(range, 3-5 days), 10 days(range, 9-13 days), respectively. There were significant differences in the number of lymph node dissected, time to first flatus, time to initial fluid diet intake between the two groups ( t=2.068, -3.030, Z=-3.370, P<0.05), and there was no significant difference in cases undergoing conversion to open surgery, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay between the two groups ( χ2=0.000, t=-0.158, Z=-1.824, -0.088, P>0.05). (2) Postoperative pathological examination: cases with well differentiated tumor, moderately differentiated tumor, poorly differentiated tumor, signet ring cell carcinoma or other types of tumor, cases in stage T1b, T2, T3 or T4a (pT staging), cases in stage N0, N1, N2, N3a or N3b (pN staging), cases in stage ⅠB, ⅡA, ⅡB, ⅢA, ⅢB or ⅢC (pTNM staging) of the robotic group were 6, 50, 55, 9, 10, 22, 63, 25, 42, 19, 19, 24, 16, 17, 22, 23, 20, 23, 15, respectively. The above indicators of the laparoscopic group were 4, 42, 84, 12, 6, 18, 81, 37, 39, 27, 32, 19, 25, 13, 19, 28, 39, 16, 27, respectively. There was no significant difference in the above indicators between the two groups ( Z=-1.880, -1.827, -0.140, -1.460, P>0.05). (3) Complications: cases with complication classified as grade Ⅰ, grade Ⅱ, grade Ⅲa, grade Ⅲb, grade Ⅳa, grade Ⅳb of Clavien-Dindo classification, cases with death, cases with overall complications, cases with severe complications of the robotic group were 9, 6, 3, 2, 2, 0, 0, 22, 7, respectively. The above indicators of the laparoscopic group were 12, 15, 9, 6, 3, 1, 1, 47, 20, respectively. There were significant differences in cases with overall complications, cases with severe complications between the two groups ( χ2=7.309, 4.790, P<0.05), and there was no significant difference in cases with complication classified as grade Ⅰ, grade Ⅱ, grade Ⅲa, grade Ⅲb, grade Ⅳa, grade Ⅳb of Clavien-Dindo classification, cases with death between the two groups ( χ2=0.080, 2.730, 1.042, 0.704, 0.000, 0.000, 0.000, P>0.05). (4) Stratified analysis: of the patients with overall complications in robotic group, cases of male or female, cases aged ≥65 years or <65 years, cases with body mass index (BMI) ≥24 kg/m 2 or <24 kg/m 2, cases with tumor diameter ≥5 cm or <5 cm, cases with or without abdominal surgery, cases with tumor located at upper stomach or middle stomach, cases in Ⅰ-Ⅱ grade or Ⅲ grade of American Society of Anesthesiologists (ASA) classification, cases with well differentiated tumor or undifferentiated tumor, cases in stage Ⅰ-Ⅱ or stage Ⅲ (pTNM staging), cases with operation time ≥250 minutes or <250 minutes, cases with volume of intraoperative blood loss ≥150 mL or <150 mL, cases with the number of lymph node dissected ≥25 or <25 were 15, 7, 14, 8, 11, 11, 16, 6, 4, 18, 19, 3, 15, 7, 7, 15, 8, 14, 12, 10, 12, 10, 14, 8, respectively. The above indicators of patients with overall complications in the laparoscopic group were 33, 14, 17, 30, 16, 31, 36, 11, 11, 36, 27, 20, 31, 16, 13, 34, 14, 33, 24, 23, respectively. Of the patients with overall complication, there were significant differences in cases of male, cases aged ≥65 years or <65 years, cases with BMI<24 kg/m 2, cases with tumor diameter≥5 cm, cases without abdominal surgery, cases with tumor located at middle stomach, cases in Ⅰ-Ⅱ grade or Ⅲ grade of ASA classification, cases with well differentiated tumor, cases in stage Ⅲ (pTNM staging), cases with operation time ≥250 minutes, cases with volume of intraoperative blood loss <150 mL, cases with the number of lymph node dissected ≥25 between the two groups ( χ2=6.683, 4.207, 6.761, 7.438, 4.297, 6.325, 9.433, 3.970, 4.850, 4.911, 3.952, 3.915, 6.865, 4.128, P<0.05) and there was no significant difference in cases of female, cases with BMI≥24 kg/m 2, cases with tumor diameter <5 cm, cases with abdominal surgery, cases with tumor located at upper stomach, cases with undifferentiated tumor, cases in stage Ⅰ-Ⅱ (pTNM staging), cases with operation time < 250 minutes, cases with volume of intraoperative blood loss ≥150 mL, cases with the number of lymph node dissected <25 between the two groups ( χ2=0.277, 1.052, 1.996, 1.552, 2.172, 2.594, 2.244, 3.771, 1.627, 3.223, P>0.05). (5) Follow-up: 262 patients were followed up postoperatively for 2 months. During the follow-up, no patient was diagnosed with tumor recurrence, and one patient in the laparoscopic group died of severe infection. Conclusions:The Clavien-Dindo classification can be used in evaluating postoperative short-term complications of Da Vinci robotic-assisted or laparoscopic-assisted total gastrectomy with D 2 lymphadenectomy. Compared with laparoscopic-assisted total gastrectomy with D 2 lymphadenectomy, Da Vinci robotic-assisted total gastrectomy with D 2 lymphadenectomy has the advantages of minimally invasiveness, low incidence of overall and severe complication.

BACKGROUNDThe prevalence of thyroid nodules (TN) is increasing rapidly. This study analyzed the epidemiological and clinical characteristics of TN in surgically treated patients and identified the risk factors for malignant nodules (MN) to provide more understanding of the differential diagnosis of TN.

METHODSA total of 6 304 TN cases who underwent thyroid surgery were included in this retrospective study. The clinical data were collected to evaluate the clinical and epidemiological characteristics and related risk factors for MN. The nature of TN (benign nodules (BN) or MN), medical records, laboratory data, and imaging data were analyzed. The risk factors for MN were screened using Spearman's rank correlation analysis and nonconditional binary Logistic regression analysis.

RESULTSThe number of surgically treated TN cases increased yearly. A total of 34.33% of cases were MN and 65.67% were BN. Up to 56.74% of these cases underwent unnecessary surgery. Among the MN cases, papillary thyroid carcinoma accounted for 94%, in which 46.71% coexisted with benign thyroid disease and 32.28% with multiple foci. Single-related factor analysis showed that age, employment, disease duration, history of breast nodules and/or hypertension, the levels of serum thyroid-stimulating hormone (TSH), thyroglobulin antibody (TgAb), and thyroid peroxidase antibody (TPoAb), and ultrasound features of TN were related to MN. Stepwise nonconditional binary Logistic regression analysis showed that 13 factors may be the independent risk factors for MN, including <40 years old, previous history of breast nodules and/or hypertension, disease duration <1 month, employment, hypoechoic nodule, irregular nodules, nodule calcification, solid echo nodule, fuzzy boundary, rich blood flow within nodules, abnormal lymph nodes around the neck, nodule diameter <1 cm, and abnormally high TgAb.

CONCLUSIONSOur results demonstrate a rapid increase in surgically treated TN cases and ratio of MN and indicate unnecessary surgeries in some cases. This study also suggest that age, duration of thyroid disease, history of breast disease and/or hypertension, the levels of serum TSH, TgAb, and TPoAb, and ultrasound features of TN are related to MN, and some of these factors may be the risk factors for MN.

Adult ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms ; epidemiology ; Thyroid Nodule ; epidemiology