Objective To investigate the association of metabolic syndrome and calculous chole-cystitis.Methods The retrospective cross-sectional study was conducted between July 2012 to February 2013.Seventy-two consecutive patients with calculous cholecystitis were included as study participants and 58 patients with asymptomatic gallstone were recruited as controls.Basic demographic data,waistline,blood sugar,blood fat,blood pressure,abdominal ultrasonography and other laboratory tests were collected.Re-sults The prevalence of metabolic syndrome in patients with symptomatic gallstone was significant higher than the controls(47.2% vs 22.4%,P<0.05).The presence of the metabolic syndrome(OR 1.452, 95%CI 1.210~1.694,P=0.018)and large gallstones(diameter≥2.5 cm,OR 1.138,95%CI 1.028 ~1.248)were significantly correlated with symptomatic gallstone.Conclusion The presence of metabolic syndrome may increase asymptomatic gallstone patients'risk of developing symptomatic calculous cholecys-titis.

Chemotherapy- induced peripheral neuropathy (CIPN) can be caused by many commonly used chemotherapeutic agents, such as taxanes, vinca alkaloids, platinum drugs, thalidomide,and also by newer agents such as bortezomib. Both animal experiments and clinical studies are being conducted to investigate strategies for preventing CIPN or ameliorating established CIPN without affecting the antitumor efficacy of chemotherapy. Treatments using calcium and magnesium infusions,glutathione,lipoid acid are being evaluated for their clinical application.

Objective To discuss the clinical efficacy of advanced primary liver cancer under the chemother-apy of hyperthermia combined with EOF approach.Methods 75 patient samples who had advanced primary liver cancer in total were chosen and were divided into the two groups randomly.The control group containing 37 patient samples had advanced primary liver cancer which would be applied with EOF approach.The treatment group contai-ning 38 samples had advanced primary liver cancer.The treatment strategy was to apply EOF approach combined with high -frequency hyperthermia in vitro.Results The total rate of efficiency on the treatment group and control group was 73.68% vs 48.6%.The DCR rate was 92.1% versus 56.8%,1 year survival rate was 57.8% versus 45.9%and 2 years survival rate was 10.5% versus 5.4% which showed that the results of the treatment group was obviously better than that of the control group.Conclusion The method that combining the chemotherapy of hyperthermia with EOF to treat advanced primary liver cancer can obviously improve clinical efficacy and survival period.What′s better is that this approach will not increase the toxicity of chemotherapy.

Objective To measure the value of orthopedic physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth modified POSSUM (P-POSSUM) scoring systems in predicting operative risks in aged hip fracture patients.Methods Orthopedic POSSUM and P-POSSUM were performed to predict complication incidence and mortality for 164 aged patients operated for hip fracture.Validation of the scoring systems was tested by assessing observed to expected ratio,discrimination,and calibration.Discriminative ability and calibration of both scores were estimated using receiver operation characteristic curve (ROC) and Hosmer-Lemeshow test respectively.Results Orthopedic POSSUM score performed in predicting incidence of postoperative complications showed overall observed to expected ratio of 0.86,area under the curve of 0.82,and good calibration (H2 =3.66,df=8,P ＞ 0.05).P-POSSUM performed in predicting mortality showed overall observed to expected ratio of 0.80,area under the curve of 0.93 and good calibration (H2 =3.21,df =4,P ＞ 0.05).While orthopedic POSSUM overestimated postoperative mortality (overall observed to expected ratio =0.27).Conclusion Orthopedic POSSUM and P-POSSUM scores are respectively accurate in predicting postoperative complication incidence and mortality in aged hip fracture patients,but orthopedic POSSUM score overestimates the mortality.

Objective To investigate the changing characteristics of the fractional anisotropy (FA) in cerebral peduncles and its relation with motor evoked potential (MEP) after acute cerebral infarction and to clear the clinical sigiificance of the low limit value of the FA in cerebral peduncles. Methods The low limit value of the FA in normal cerebral peduncles was determined based on mean - 1. 64 standard deviation. The patients with acute cerebral infarction (n = 58) were divided into MEP positive group and MEP negative group according to the absence and presence of MEP, in which the patients in the MEP positive group were redivided into the FA in cerebral peduncles ＜ the low limit value and≥ the low limit value groups according to the FA in cerebral peduncles on the affected sides. Results The low limit value of the FA in normal cerebral peduncles was 0. 36. There was significant difference in the FA in cerebral peduncles on the affected sides between the MEP negtive and MEP positive groups. The MEP negative group was the lowest (P=0. 000). The FA in cerebral peduncles on the affected sides in the positive group was significantly lower than that on the unaffected sides (P=0. 000), and the latency on the affected sides was longer than that on the normal sides (P=0. 000). The FA in cerebral peduncles on the affected sides was negatively correlated with the MEP latency (r=-0.332,P=0. 042). The MEP latency in the FA＜the low limit value group was significantly longer than that in the FA ≥ low limit value group (P=0. 002). There were no significant differences in the FA in cerebral peduncles on the normal sides and the MEP latency among an groups. The detection rate of the FA in cerebral peduncle＜0. 36 on the affected sides was the highest (50%). Conclusions In the evaluation of the prognosis of the patients, the changes of the FA in cerebral peduncles on the affected sides in patients with acute cerebral infarction had correlation,consistency, and complementarity with MEP.The detection rate of the low limit value of the FA in normal cerebral peduncles was the highest in the MEP negative patients. When the FA in cerebral peduncles was＜0.36 on the affected sides, particularly when MET was negative, it might predict that the prognosis was poor.

Objeetive To evaluate the performance characteristics of the second trimester double test for the detection of fetal Down's syndrome(DS)in women of advanced maternal age(AMA).Methods We undertook a prospective nation-wide multi-centered study and chose alpha-fetoprotein(AFP))and free β-subunit of human chorionic gonadotrophin(free β-hCG)as the serum markers.Between May 2004 and September 2006,12 centers participated in the collection and analysis of maternal serum AFP and free β-hCG.Patients with an iuereaged risk of DS(≥1/270)wero offered generic sunniocentesis.Follow up of the outcome of all pregnancies was obtained.Patients were divided into two groups,the AMA group and the non-AMA group and the screening efficiency Was evaluated in beth groups.Results A total of 66 132 singleton pregnancies were included in the study.and there were 36 10(5.46%)AMA women.The median maternal age of AMA women was 36.8years(35-47 years).At a cut-off of 1/270,in the AMA group,the number of positive cases screened was 727 and 22 cases of fetal DS were detected:the number of negative cases screened was 2883,and no fetal DS was found.In the non-AMA group,the number of positive cases screened was 4743 and 69 cases of fetal DS were detected:the number of negative cases screened was 57 779,and 6 cases of fetal DS were diagnosed postnatally.In AMA group,the detection rate(DR),false positive rate(FPR)and odds of being affected given a positive result(OAPR)were 100%,19.7%and 3.0%respectively.In the non-AMA group,the DR,FPR and OAPR were 92.0%.7.5%and 1.5%respectively.Conclusion The double-marker test using AFP and free β-hCG is an effective screen strategy for second-trimester detection of Down syndrome in AMA women.

Objective To evaluate the performance characteristics of the second trimester double-marker test for the detection of fetal Down's syndrome in mainland China. Methods This prospective national multi-centered study used alpha-fetoprotein (AFP) and free β-subunit of human chorionic gonadotrophin( free β-hCG)as the serum markers. From May 2004 to September 2006, 11 centers participated in the collection and analysis of maternal serum AFP and free β-hCG between 14 and 20+6 weeks of pregnancy. The screening results were calculated using the standard algorithm based on the standard database provided with the analytic software. Patients with an increased risk of Down's syndrome pregnancy (≥1/270) were offered genetic anmiocentesis. Outcomes of all pregnancies were obtained.Results A total of 66 132 singleton pregnancies were included in the study. The median maternal age was 27 years. At a cut-eft of 1 in 270, the detection rate (DR) based on a Caucasian database was 72% corresponding to a false positive rate (FPR) of 5%, and the DR based on the Chinese database was raised to 76% corresponding to an FPR of 5%. Conclusion The double-marker test using AFP and free β-hCG is an effective screen strategy for second-trimester detection of fetal Down's syndrome in mainland China. Ethnic variance exists between the Caucasian and Chinese populations. The accuracy of screening is increased by the use of race-specific medians.

The research of triterpenoids on hypoglycemic and anti-diabetic activities have made great progress. Findings indicated that triterpenoids could reduce blood glucose via different mechanisms, including increasing insulin secretion, enhancing insulin sensitivity, promoting glucose uptake by activation of AMP-activated protein kinase(AMPK), decreasing glycogenolysis and gluconeogenesis, and inhibiting protein tyrosine phosphates 1B(PTP1B), α-glycosidase, aldose reductase(AR)and dipeptidyl peptidase-4(DPP-4). This article reviews the hypoglycemic effects and mechanisms of triterpenoids, providing the reference for further research and development of triterpenoids.

Objective:To investigate the short-term efficacy and safety of Donafenib as postoperative adjuvant therapy for patients with high risk of recurrence after radical resection of hepatocellular carcinoma (HCC).Methods:The propensity score matching (PSM) and retrospective cohort study was conducted. The clinicopathological data of 157 HCC patients with high risk of recurrence after radical resection who were admitted to 6 medical centers, including The First Affiliated Hospital of Nanjing Medical University et al, from June 2021 to February 2023 were collected. There were 128 males and 29 females, aged (59±10)years. Of 157 patients, 101 cases undergoing Donafenib as postoperative adjuvant therapy were divided into the the Donafenib group, and 56 cases under-going no systemic postoperative adjuvant therapy were divided into the control group. Observation indicators: (1) PSM and comparison of general data of patients between the two groups after matching; (2) postoperative treatment; (3) follow-up and survival of patients; (4) analysis of risk factors affecting recurrence-free survival of patients. PSM was done based on the principle of optimal perfect matching, with the clamp value of 0.5, and the Donafenib group and the control group were matched at a ratio of 1.25∶1. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and/or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the Kruskal-Wallis H test. The Kaplan-Meier method was used to calculate survival rates and draw survival curves, and the Log-Rank test was used for survival analysis. The COX proportional hazard model was used for univariate and multivariate analyses. Results:(1) PSM and comparison of general data of patients between the two groups after matching. Of 157 patients, 126 cases were successfully matched, including 70 cases in the Donafenib group and 56 cases in the control group, respectively. The elimination of tumor number confounding bias ensured comparability between the two groups after PSM. (2) Postoperative treatment. After PSM, of 70 patients in the Donafenib group, there were 23 cases receiving Donafenib monotherapy, 26 cases combined with transcatheter arterial chemoembolization (TACE), 14 cases combined with immunotherapy, and 7 cases combined with TACE+immunotherapy. Of 56 patients in the control group, there were 37 cases receiving postoperative follow-up alone and 19 cases combined with TACE. (3) Follow-up and survival of patients. All 157 patients were followed up, and the follow-up time of the 101 patients in Donafenib group and the 56 patients in control group were 10.1(range, 6.3-14.6)months and 22.2(range, 15.1-25.5)months, respectively. During the follow-up period, 70 patients in the Donafenib group experienced treatment-related adverse reactions, inclu-ding 8 cases of grade 3 adverse reactions, 23 cases of grade 2 and 39 cases of grade 1 adverse reactions, respectively. After PSM, the postoperative 12-, 18-month recurrence-free survival rates were 83.7%, 83.7% in the 70 patients of Donafenib group and 67.8%, 58.9% in the 56 patients of control group, respectively, showing a significant difference in the postoperative recurrence-free survival time between the two groups ( hazard ratio=0.395, 95% confidence interval as 0.176-0.888, P<0.05). (4) Analysis of risk factors affecting recurrence free survival of patients. Results of multivariate ana-lysis showed that microvascular invasion, vascular thrombus, clinical stage as ⅢA were independent risk factors affecting recurrence-free survival in patients with high risk of recurrence after radical resection of HCC ( hazard ratio=2.181, 2.612, 2.612, 95% confidence interval as 1.028-4.629, 1.128-6.047, 1.128-6.047, P<0.05), Donafenib as postoperative adjuvant therapy was an independent protective factor affecting recurrence-free survival in patients with high risk of recurrence after radical resection of HCC ( hazard ratio=0.457, 95% confidence interval as 0.227-0.920, P<0.05). Results of further analysis showed that after PSM, there were significant differences in the postoperative recurrence-free survival time in patients with different clinical factors, including male, age ≥60 years, tumor diameter >5 cm, positive microvascular invasion, positive hepatitis B virus infection, alpha fetoprotein <200 μg/L, between the Donafenib group and the control group ( hazard ratio=0.283, 0.202, 0.174, 0.345, 0.273, 0.180, 95% confidence interval as 0.114-0.707, 0.044-0.937, 0.038-0.794, 0.128-0.929, 0.091-0.819, 0.052-0.620, P<0.05). Conclusion:Donafenib as postoperative adjuvant therapy can effectively reduce the short-term recurrence rate in patients with high risk of recurrence after radical resection of HCC, with good safety and tolerance.

Objective:To compare the safety and clinical efficacy of endoscopic and surgical treatment of patients with delayed iatrogenic bile duct injury (DBDI) with severity (SG) grade 1 to 2.Methods:The clinical data of 129 patients with SG grade 1 to 2 DBDI who received endoscopic or surgical treatment in the First Hospital of Lanzhou University from November 2007 to November 2021 were retrospectively collected. There were 46 males and 83 females,aged ( M(IQR)) 54(22)years(range: 21 to 82 years). The baseline data of the two groups were matched 1∶1 by propensity score matching(caliper value was 0.2). Independent sample t test,rank sum test, χ2 test or Fisher exact probability test were used to analyze the data of the two matched groups. Results:There were 48 patients in each of the endoscopic treatment and surgical groups after matching,and there was no difference in general information between the two groups(both P>0.05). The bile duct injury-repair interval and intraoperative anesthesia complications were not statistically significant between the two groups after matching(all P>0.05). Compared with the surgical group, patients in the endoscopic treatment group had significantly shorter operative time(50 (30) minutes vs. 185 (100) minutes, Z=7.675, P<0.01) and postoperative hospital stay(5 (5) days vs. 12 (7) days, Z=5.848, P<0.01).For safety,there was no statistical difference in the incidence of immediate postoperative complications between the two groups with Clavien-Dindo classification of surgical complications<Ⅲ;the incidence of serious postoperative complications (Clavien-Dindo classification of surgical complications≥Ⅲ) was significantly higher in the surgical group than in the endoscopic treatment group( P=0.012). The incidence of long-term postoperative complications was not statistically different between the two groups(28.1% vs. 20.7%, P=0.562). In terms of efficacy,the postoperative liver function indexes of patients in both groups improved significantly compared with the preoperative period and returned to normal or near normal levels; the postoperative infection indexes of both groups showed an increasing trend,but were within the normal range. Of the 96 patients in both groups,61 obtained follow-up,and the follow-up time was (89.4±48.0)months(range: 3 to 165 months),and there was no statistical difference between the two groups( P=0.079). The probability of excellent long-term follow-up (78.1% vs. 86.2%) was not statistically different between the two groups( P=0.412).In patients with Strasberg-Bismuth type E1,the probability of excellent long-term follow-up was higher in the endoscopic treatment group compared with the surgical group(13/14 vs. 2/5, P=0.037). Conclusions:For DBDI patients with SG grade 1 to 2 and bile duct continuity,endoscopy can be used as the first deterministic treatment. The advantages of endoscopic therapy compared to surgery are the lower incidence of postoperative serious complications,and the shorter duration of surgery and postoperative hospital stay.