Objective To evaluate the prognostic value of lateral lymphadenectomy for advanced lower rectal cancer. Methods A total of 96 consecutive patients who underwent total mesorectal excision and lateral lymphadenectomy for advanced lower rectal cancer were retrospectively evaluated by using therapeutic index. A product of the frequency of lymph node metastasis and the cancer-related 5-year survival rate. Results The incidences of lymph node metastasis in mesorectal area, superior rectal artery area, inferior mesenteric artery area and lateral area was 21%,13%.10%and 15%respectively.The 5-year survival rate of patients with metastasis to the mesorectal area, superior rectal artery area, inferior mesenteric artery area and lateral area was 35%,25%,20%and 36%respectively.The therapeutic indexes for total mesorectal excision and lateral lymphadenectomy were 7.4 and 5.4,which were much higher than that of lymphadenectomy of the superior rectal artery area(3.3)and inferior mesenteric artery area(2.0).Local recurrence occurred in 19%(18 out of 96 cases)patients with advanced lower rectal cancer. Local recurrence rate of patients with positive lateral lymph node metastasis was 64%(9 of 14 cases),whereas it was 11%(9 of 82 cases)in those without lateral lymph node metastasis. The difference between these two groups was statistically significant(x2=22.308,P=0.000).Kaplan-Meier survival analysis showed significant improvements in median survival(80.9±2.1)m,95%CI:76.7～85.1 m vs(38±6.7)m,(95%CI:24.8～51.2 m)for patients with negative lateral lymph node metastasis over patients with lateral lymph node metastasis(log-rank,P=0.000). Conclusion The current results indicate that lateral pelvic lymphadenectomy could significantly reduce loeal recurrence and effectively improve the survival of patients with advanced lower rectal cancer. Except for total mesorectal excision, lateral pelvic lymphadenectomy should be followed in the surgery of pailents with advanced low rectal cancer.

Objective To establish a scientific and practical principle , grading standard and reasonable statistical method for evaluating the protective effect of health food to gastric mucosal injury , based on general pathology and histopathological diagnosis .Methods A methodological study was conducted on rat model of acute gastric mucosa injury induced by alcoholic through comprehensive analysis and comparing shortcomings of the current standard evaluation method, and methods of semi-quantitative analysis and corresponding information statistic processing were based on characteristics of the lesion and principles of pathology .Results Gross pathological evaluation of gastric mucosa lesion was based on the area occupied and proportion in the whole gastric mucosa .Histopathological diagnosis was based on the mucous layer depth of lesion as main determination point and other lesions as reference factors .Grades of lesion were divided into no abnormality (0), mild lesions (1 point), moderate lesions (2 points), and severe lesions (3 points). Ridit statistical method was used for pathological analysis of semi-quantitative results .Conclusion A scientific and feasible evaluation method for the protective effect of health food to gastric mucosal injury was provided from the aspects of gross pathology , histopathological evaluation method , data processing method and result determination .

Objective:To explore management experience for post-adolescent postoperative urethral stricture of hypospadias in a single center.Methods:The clinical data of 71 cases of postoperative urethral stricture of post-adolescent hypospadias from January 2015 to December 2019 were retrospectively analyzed. The average age was 27.7(12-65) years. The mean duration of urethral stricture was 33.4(1-240) months. The number of prior surgeries was 2.5(1-9). There were 32 cases of ectopic urethral orifice, including 22 on penile, 8 on scrotum and 2 on perineum. There were 17 cases of urethral stricture with penile curvature, 11 with urethra-cutaneous fistula, 9 with urethral diverticulum, 11 with urethral calculus and 25 with urethral infection. Ten patients kept suprapubic tubes; 61 patients were able to urinate on their own, but suffered from dysuria and weak steam. The average maximum uroflow rate of 71 cases was 4.7(0-11.2) ml/s. The primary urethral reconstruction procedures were performed on 33 cases, included 11 penile or scrotal septum flap urethroplasty, 2 urethral diverticulum wall flap urethroplasty, 12 oral mucosal urethroplasty and 8 urethrotomy. Thirty-three cases underwent two-staged surgery. For patients with penile curvature greater than 30 degrees, the penis was straightened with a urethrotomy in first stage. Besides, the dorsal skin of penis or oral mucosal graft were transferred to the ventral side of the penis to the preset urethral plate. In second-stage, Denis Brown urethroplasty was performed on 23 patients, tubularized incised plate (Snodgrass) urethroplasty on 6, and oral mucosa inlay urethral plate (Snodgraft) urethroplasty on 4. In 5 cases, preplacing of oral mucosa was done in the second stage with a third-staged urethroplasty. Penile curvature was relieved by ventral scar resection with the folding the dorsal tunica albuginea of corpus cavernosum when necessary.Results:The mean follow-up time was 30.5(4-59) months. Sixty-one patients got satisfying postoperative urination, with an average maximum uroflow rate of 22.7 ml/s (15.8-37.2 ml/s). Restenosis occurred in 10 cases, and urethral fistula in 7 cases. Re-stricture patients underwent urethrotomy in 5 cases, augmented urethroplasty with flap in 4 cases, and urethroplasty with oral mucosal graft in 1 case. Among the 7 patients with urethral fistula, 5 were cured by one fistula repair, and 1 cured by second repair; the rest one was left untreated. 2 patients still had penile curvature after operation.Conclusions:It is difficult to manage post-adolescent postoperative urethral stricture of hypospadias, especially for patients with residual penile curvature greater than 30 degrees and lack of penile skin. Performing correction of the curvature and reconstruction of the urethral plate in first stage and Denis Brown urethroplasty or Snodgrass urethroplasty in second or third stage could achieve good results.

Objective: To explore the longitudinal relationship between upward social comparison and online aggressive behavior among college students, in order to provide an empirical evidence for educators to carry out mental health promotion for college students. Methods: From December 2021 to March 2022, 539 college students from one university in Inner Mongolia were recruited to complete the Upward Social Comparison Questionnaire (USCQ) and Online Aggressive Behavior Scale (OABS) in a 4 month follow-up study. The structural equation model was used to conduct cross-lagged analysis. Results: The mean scores of upward social comparison for college students tracked at baseline (T1) and 4 months follow-up (T2) were (2.77±0.93, 2.70±1.00) points, and the mean scores of online aggressive behavior were (1.06±0.13, 1.05±0.11) points. There were positive relations between upward social comparison and online aggressive behavior of college students at both cross-sectional levels ( r=0.14-0.19, P <0.05). In the autoregression, T1 upward social comparison could positively predict T2 upward social comparison ( β =0.66), and T1 online aggressive behavior could positively predict T2 online aggressive behavior ( β =0.47)( P <0.01); In the cross-lagged regression, T1 upward social comparison could positively predict T2 online aggressive behavior ( β=0.10, P <0.01), whereas T1 online aggressive behavior could not predict T2 upward social comparison ( β=0.04, P >0.05). Conclusion Upward social comparison is the cause of online aggressive behavior among college students. The probability of online aggressive behavior among college students should be reduced by guiding students to correctly view the gap between themselves and others.

Objective To appraise the safety and validity of early enteral nutrition on the course on treating severe acute pancreatitis(SAP).Methods The clinical data of 71 patients with SAP were analyzed retrospectively. The album, prealbumin, TNF-β,CD4/CD8,IgG were observed. All the patients were randomly divided into two groups: enteral nutrition(EN)group for 36 patients and total parenteral nutrition(TPN)group for 35 patients. Results Fourteen days after treatment,CD4/CD8 and IgG in EN group were significantly increased than those in TPN group(P＜0.05),and prealbumin level in EN group significantly elevated(P＜0.05)and was higher than that in TPN group(P＜0.05).After treatment,TNF-α level in EN group significantly depressed(P＜0.05)and was lower than that in TPN group(P＜0.05).Conclusion Early enteral nutrition is safe and valid, and can promote albumin synthesis and prealbumin levels to improve their nutrition in patients with SAP, and may build-up the barrier of enteric mucosa to prevent bacterial shift, reduce systemic inflammatory reaction and improve its prognosis.

Objective:To investigate the impact of obstructive sleep apnea(OSA)on cardiac structure and function in elderly patients with type 2 diabetes mellitus(T2DM).Methods:This was a case-control study.Elderly patients with T2DM aged 65 years and above at the Department of Geriatrics of Tianjin Medical University General Hospital were consecutively enrolled in this study, and eventually 61 patients with complete general information were included.All patients were examined with polysomnography(PSG). They were divided into the T2DM group and the T2DM+ OSA group based on whether there was concurrent OSA.Differences in cardiac structure and function were compared between the two groups and between patients with mild OSA and those with moderate-severe OSA.The correlation of OSA with cardiac structure and function in T2DM patients was analyzed by using Pearson correlation and multiple linear regression analysis.Results:The left ventricular ejection fraction(LVEF)was lower in the T2DM+ OSA group than in the T2DM group(52.38±4.70 % vs.56.34±5.92%, t=2.892, P=0.005). The anteroposterior diameter of the right ventricle, inter-ventricular septum thickness and left ventricular posterior wall thickness increased in the T2DM+ OSA group compared with the T2DM group(21.50±1.49 mm vs.20.55±1.05 mm, 10.21±0.88 mm vs.9.52±1.04 mm, 10.42±0.83 mm vs.9.83±0.83 mm, t=-2.670, -2.770 and -2.716, P=0.010, 0.007 and 0.009). LVEF was lower in patients with moderate-severe OSA than in those with mild OSA group(50.58±3.55% vs.55.83±4.83%, t=3.813, P=0.001). The anteroposterior diameter of the right ventricle, inter-ventricular septum thickness and left ventricular posterior wall thickness were greater in patients with moderate-severe OSA than in those with mild OSA(21.86±1.39 mm vs.20.79±1.46 mm, 10.48±0.82 mm vs.9.69±0.75 mm, 10.68±0.80 mm vs.9.92±0.64 mm, t=-2.231, -2.871 and -2.943, P=0.032, 0.007 and 0.006). Pearson correlation analysis showed that the Apnea Hypopnea Index(AHI)was correlated with LVEF, the anteroposterior diameter of the right ventricle, inter-ventricular septum thickness and left ventricular posterior wall thickness( r=-0.425, 0.340, 0.458 and 0.473, P=0.001, 0.007, <0.001 and <0.001). After adjusting for age, body mass index, systolic blood pressure and triglycerides, multiple linear regression analysis showed that AHI was also correlated with LVEF, the anteroposterior diameter of the right ventricle, inter-ventricular septum thickness and left ventricular posterior wall thickness( β=-0.385, 0.520, 0.604 and 0.388, P=0.036, 0.011, 0.001 and 0.039). Conclusions:OSA aggravates cardiac remodeling and systolic insufficiency in T2DM patients and may be related to the severity of intermittent hypoxia.

Objective To verify the efficacy and safety of intravesical instillation of Cystistat in reducing complications caused by intravesical chemotherapy after TUR-BT in non-muscle invasive bladder cancer patients. Methods One hundred and twenty patients who met the inclusion/exclusion criteria were enrolled into this multi-centered, randomized and blank controlled clinical study. Selected patients were randomized into the observation group and control group. TUR-BT was carried out in both groups followed by pirarubicin (THP) and Cystistat intravesical instillation in the observation group, and THP intravesical instillation alone in control group. Visual analog scale (VAS) was used as the primary efficacy variable. The secondary efficacy variables were assessments of hematuria and bladder irritation symptoms. Adverse events, laboratory tests and changes of vital signs before and after treatment were strictly observed during observation to evaluate the efficacy and safety of Cystistat.Results Demographics and baseline characteristics were comparable in both groups. The differences and the improvement rate of VAS score in the 2 groups were significant, both P＜0.01. The changes of VAS score and the improvement rate before and after treatment were (2. 24±1.70) and (92. 92±14.76) % in observation group and (0. 70±1.82) and (20. 59±87.34)% in control group respectively. According to the covariance analysis, there were significant differences in changes of VAS score between the observation group and the control group. Also, the improvement rate of VAS score was significant from visit 2. The urine frequency decreased from 9.06±4.09 to 6. 69±2.89 in observation group and increased from 8. 85±3. 32 to 10. 15±4.40 in control group, P＜0.01. There were also significant differences in changes of nocturia before and after treatment between these two groups (P＜0.01), the nocturia decreased from 2. 88±1.74 to 1. 47±1.62 in observation group and 3. 22±2.30 to 2.91±1.73 in control group, respectively. The changes of WHO assessment for hematuria,urgency and dysuria were not significantly different between the 2 groups. No Cystistat related adverse event was observed. Conclusions Cystistat combined instillation can significantly improve the VAS score of patients with chemotherapeutic agent instillation. Relief of bladder pain, frequency and nocturia are more rapidly and more durable in Cystistat combined instillation group. The improvement is more effective in patients with a high VAS score. Cystistat instillation with chemotherapeutics agents is both well tolerated and safe.

Objective:To screen and analyze ferroptosis-related genes (FRG) impacting the prognosis of colorectal adenocarcinoma patients based on bioinformatics.Methods:RNA sequencing data including the clinical information of 545 colorectal adenocarcinoma patients and 602 data sets were downloaded from the Cancer Genome Atlas (TCGA) database. FRG gene sets were downloaded from FerrDb database. FRG expression dataset could be obtained after taking the intersection between FRG gene sets and TCGA database gene sets. Differentially expressed FRG and prognosis-related genes between colorectal adenocarcinoma tissues and the adjacent tissues were screened by using R software, and finally FRG influencing the prognosis of colorectal adenocarcinoma were obtained. According to protein-protein interaction networks, the interaction and the expression association of proteins were analyzed. LASSO regression analysis was used to build a risk model for patients' 5-year overall survival rate. The risk value was calculated for 509 colorectal adenocarcinoma samples in the TCGA database, and then the median risk value was taken as the cut-off value. All patients were divided into the high-risk group (≥ median risk value) and the low-risk group (< median risk value), and the survival curves of the two groups were drawn. The receiver operating characteristic (ROC) curve was drawn for predicting the 5-year overall survival rate of colorectal adenocarcinoma patients in a time-dependent way in TCGA database according to the risk value of FRG prognosis model. Cox proportional risk model was used to make univariate and multivariate survival analysis in order to screen factors affecting the prognosis. The pathway enrichment analysis of prognosis-related FRG of colorectal adenocarcinoma was performed based on gene ontology (GO) database and Kyoto Encyclopedia of Genes and Genomes (KEGG) database.Results:The clinical information of 545 patients and 602 datasets were extracted from the database. A total of differential expressed 199 FRG in colorectal adenocarcinoma and 28 prognosis-related FRG were identified. After taking the intersection, 21 FRG affecting the prognosis of colorectal adenocarcinoma patients were identified. DUOX2, NOX4, NOX1, DDIT3, JDP2, ATP6V1G2, ULK1, ATG3 were probably associated with WIPI1; expressions of NOX4, NOX5, PLIN4 were positively correlated with ATP6V1G2, while the expression of ULK1 was negatively correlated with MAPK1, MYB, FANCD2, ATG3 and ATP5MC3. LASSO regression analysis showed that 15 FRG were finally screened out (ATP5MC3, NOX4, NOX5, ALOX12B, ATG3, WIPI1, MAPK1, MYB, AKR1C1, DDIT3, JDP2, ATP6V1G2, DRD4, SLC2A3, PLIN4), and the risk model was constructed by calculating the risk value, and the risk value = NOX4×0.139-ATP5M3×0.108+NOX5×1.486+ALOX12B×0.475-ATG3×0.030-WIPI1×0.170-MAPK1×0.271-MYB×0.063+AKR1C1×0.021+DDIT3×0.186+JDP2×0.292+ATP6V1G2×0.777+DRD4×0.294+SLC2A3×0.059+PLIN4×0.113. The overall survival of patients in the high-risk group was worse than that in the low-risk group ( P < 0.001). The 5-year overall survival rate was 48.2% in the high-risk group and 76.8% in the low-risk group. Multivariate survival showed that the age and risk value were independent affecting factors of the prognosis. ROC curves revealed that the risk model constructed by using prognosis-related FRG could well predict the 5-year overall survival rate of patients (the area under the curve was 0.728). The differential expressed genes of both groups may be associated with genetic pathways such as extracellular matrix composition, extracellular structure composition and focal adhesion. Conclusions:The prognostic risk model constructed by the screened FRG can better evaluate the prognosis of colorectal adenocarcinoma patients. These FRG are expected to become new candidate biomarkers related to the prognosis of colorectal adenocarcinoma.

Objective: To analyze the association between clinicopathological factors and clinical diagnosis, treatment and surgery of local regional recurrence (LRR) in breast cancer. Methods: A retrospective study was done to evaluate consecutive 7 823 breast cancer LRR cases between January 2009 and August 2018 at Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine. A total of 108 LRR patients were enrolled: 35 cases (32.4%) with ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery, 40 cases (37.0%) of chest wall recurrence (CR), and 33 cases (30.6%) with regional lymph node recurrence (LNR). All patients were female, aged from 26 to 83 years with a mean of 49 years. Clinicopathological factor and its relationship with different sites of LRR and following surgical choice were analyzed by χ² test, rank-sum test and Logistic regression. Survival analysis were performed between different LRR patterns and whether undergoing second surgery. Kaplan-Meier survival curves and Log-rank tests demonstrated the distribution of overall survival. Results: Both univariate analysis and multivariate analysis found that axillary lymph nodes (ALN) status (OR=7.27, 95% CI: 1.30 to 40.53, P=0.042) and disease-free interval (OR=0.18, 95% CI: 0.06 to 0.60, P=0.013) were related to different site of LRR. Compared with patients with IBTR, LNR and CR patients had a higher rate of ALN metastasis and a shorter disease-free interval. A total of 36 LRR patients underwent following surgery. In univariate analysis, initial ALN surgery (χ²=16.705, P=0.001), pathological type (χ²=7.047, P=0.03), ALN status (χ²=10.812, P=0.002), disease-free interval (χ²=6.118, P=0.023) and LRR site(χ²=19.328, P=0.000) were associated with surgical treatment for LRR patients. Multivariate analysis demonstrated that only site of LRR was independently associated with surgery (OR=0.17, 95% CI: 0.05 to 0.65, P=0.024). The 5-year overall survival was 100% and 60.1% (P=0.018) for LRR patients treated with surgery or not. Furthermore, CR patients had significantly worse overall survival than LNR and IBTR patients, with 5-year overall survival 53.1%, 73.5%, and 100% respectively (P=0.021). Conclusions Initial lymph nodes metastasis and disease-free interval are associated with different site of LRR. LRR site significantly influenced following surgery choice after LRR, which are both related with overall survival after LRR.

Objective:To investigate the relationship between childhood abuse experience and suicide attitude among male prisoners, and the mediating effect of impact of event and thought suppression.Methods:Totally 370 male prisoners were tested by personal report of childhood abuse(PRCA), impact of event scale(IES), white bear suppression inventory(WBSI) and suicide attitude inventory(SAI). SPSS 22.0 was used for correlation analysis, regression analysis and other statistical analysis.Results:The scores of PRCA, IES, WBSI and SAI were (2.60±0.62), (2.69±0.62), (2.83±0.79), (3.06±0.61), respectively.There were significant differences in the scores of PRCA, IES and WBSI among different suicide attitude groups( F=42.69, 51.06, 78.76, all P<0.01). After controlling age variables, positive correlation was observed between PRCA, IES, WBSI and SAI ( r=0.38-0.76, all P<0.01). Impact of event and thought suppression played a mediating role in the relationship between childhood abuse experience and suicide attitude among male prisoners.The mediating effect included three paths: one was the single mediating effect of impact of event, the other was the single mediating effect of thought suppression and the third was the chain mediating effect of impact of event and thought suppression, and the effect values were 0.29, 0.23 and 0.05, respectively. Conclusion:Childhood abuse experience not only directly influences male prisoners' suicide attitude, but also indirectly influences their suicide attitude through the mediating effects of impact of event and thought suppression.