Objective Based on the theory of"stomach disharmony leads to restlessness",the causal relationship between gastroesophageal reflux disease and insomnia was discussed by Mendel randomization method with two samples.Methods The data were collected from genome-wide association studies,the exposure factor was gastroesophageal reflux disease,and the outcome variable was insomnia.Mendel randomization analysis is realized by inverse variance weighted method,MR-Egger method,simple model method,weighted model method and weighted median method.Sensitivity analysis includes pleiotropic test,heterogeneity test and one-by-one elimination test,and is calculated by MR-Egger method,Cochran Q test and one-out-of-one method in turn.Results A total of 75 single nucleotide polymorphisms(SNPs)were screened.The inverse variance weighted method showed that gastroesophageal reflux disease increased the risk of insomnia(OR=1.255,95%CI:1.071-1.470,P<0.05).The weighted median method also confirmed that there was a positive causal relationship between gastroesophageal reflux disease and insomnia(OR=1.403,95%CI:1.117-1.762,P<0.05).Multiple sensitivity analysis indicated that there was no pleiotropy and heterogeneity in the results of Mendelian randomized analysis,which verified the stability of the research results.Conclusion There is a positive causal relationship between gastroesophageal reflux disease and insomnia,which enriches the theoretical connotation of"stomach disharmony leads to restlessness"from the genetic point of view and lays a foundation for further study.

Objective Based on the theory of"stomach disharmony leads to restlessness",the causal relationship between gastroesophageal reflux disease and insomnia was discussed by Mendel randomization method with two samples.Methods The data were collected from genome-wide association studies,the exposure factor was gastroesophageal reflux disease,and the outcome variable was insomnia.Mendel randomization analysis is realized by inverse variance weighted method,MR-Egger method,simple model method,weighted model method and weighted median method.Sensitivity analysis includes pleiotropic test,heterogeneity test and one-by-one elimination test,and is calculated by MR-Egger method,Cochran Q test and one-out-of-one method in turn.Results A total of 75 single nucleotide polymorphisms(SNPs)were screened.The inverse variance weighted method showed that gastroesophageal reflux disease increased the risk of insomnia(OR=1.255,95%CI:1.071-1.470,P<0.05).The weighted median method also confirmed that there was a positive causal relationship between gastroesophageal reflux disease and insomnia(OR=1.403,95%CI:1.117-1.762,P<0.05).Multiple sensitivity analysis indicated that there was no pleiotropy and heterogeneity in the results of Mendelian randomized analysis,which verified the stability of the research results.Conclusion There is a positive causal relationship between gastroesophageal reflux disease and insomnia,which enriches the theoretical connotation of"stomach disharmony leads to restlessness"from the genetic point of view and lays a foundation for further study.

Objective:To evaluate the clinical efficacy of acupuncture combined with extracorporeal shock wave therapy in the treatment of piriformis syndrome.Methods:Eighty patients with piriformis syndrome who received treatment in Huaihe Energy Occupational Disease Prevention Hospital Rehabilitation Medicine Center from February 2021 to December 2022 were included in this study. They were divided into a treatment group ( n = 40) and a control group ( n = 40) according to different treatment methods using a retrospective cohort study design. The treatment group was treated with acupuncture combined with extracorporeal shock wave therapy, once every 7 days for 3 consecutive weeks. The control group was treated with extracorporeal shock wave therapy alone once every 7 days for 3 consecutive weeks.Pre- and post-treatment visual analogue scale scores and clinical efficacy were compared between the two groups. Results:There was no significant difference in baseline data between the two groups (all P > 0.05). After treatment, the visual analogue scale score decreased in each group. After adjusting for covariates, there was no significant difference in visual analogue scale score between the two groups ( F = 112.38, P < 0.001). After adjusting the pre-treatment visual analogue scale score, the post-treatment visual analogue scale score in the treatment group was lower than that in the control group [1.417 (95% CI: 1.151-1.683)]. The total response rate in the treatment group was 97.5% (39/40), which was significantly higher than 82.5% (33/40) in the control group ( Z = -2.03, P = 0.042). Conclusion:Acupuncture combined with extracorporeal shock wave therapy is highly effective on piriformis syndrome.

ObjectiveTo determine whether HBV DNA polymerase is associated with T-cell failure and thus mediates the immune escape of HBV-related hepatocellular carcinoma （HCC） tumor cells， and to investigate the specific molecular mechanisms. MethodsLiver cancer cell lines Huh7 and HepG2 stably transfected with HBV DNA polymerase expression plasmid with Flag （Flag-HBV-P） and intercellular adhesion molecule-1 （ICAM1） were co-cultured with Jurkat cells， and MTT assay， qRT-PCR， and ELISA were used to measure Jurkat cell proliferation， activation （CD69 expression）， and secretion of the cytokine IFN-γ. RNA-seq was used to screen for differentially expressed immune-associated molecules between stably transfected cell lines and control cells， and mRNA half-life and protein half-life assays were used to determine the specific levels of the immune-associated molecules that were affected by HBV DNA polymerase. Related websites were used to predict the transcription factors that may bind to the promoter region of this immune-associated molecule， Western blot was used to verify the effect of transcription factors on the immune-associated molecule， and rescue experiment was used to determine whether HBV DNA polymerase affects the expression level of the immune-associated molecule through this transcription factor. The independent-samples t test was used for comparison between two groups. ResultsThe experimental group had significant reductions in Jurkat cell proliferation， activation， and cytokine secretion compared with the control group （all P<0.01）. Compared with the control group， the experimental group （Huh7 and HepG2 cell lines） had significant reductions in the mRNA and protein expression levels of ICAM1 （all P<0.01）. Website prediction identified the ICAM1 promoter and preliminarily highlighted NFKB1， RELA， and STAT3. Compared with the control group， the experimental group （Huh7 and HepG2 cell lines） had a significant reduction in the protein expression level of p65 （all P<0.01）. After p65 overexpression， there was a significant increase in the protein expression level of ICAM1， and after the expression of p65 was reduced， there was a significant reduction in the protein expression level of ICAM1 （all P<0.01）. In the rescue experiment， there was no significant difference in the protein expression level of ICAM1 between the control group and the experimental group after p65 overexpression （all P>0.05）. After the overexpression of ICAM1， there were no significant differences in the proliferation， activation， and cytokine secretion of Jurkat cells between the control group and the experimental group （Huh7 and HepG2 cell lines） （all P>0.05）. ConclusionHBV DNA polymerase downregulates the level of ICAM1 to mediate HCC immune escape by inhibiting the expression of p65 in NF-κB.

Objective: To investigate the influencing factors of depressive symptoms among rural elderly patients with chronic diseases in China, so as to provide insights into depression prevention and control among the rural elderly patients with chronic diseases. Methods: The basic demographics, health status, and lifestyle of rural residents at ages of 65 years and older who had at least one chronic disease were retrieved from The Chinese Longitudinal Healthy Longevity Survey (CLHLS) database in 2018, and participants' depressive symptoms were assessed with The Center for Epidemiological Studies Depression-10 (CES-D-10) scale. Factors affecting the depressive symptoms were identified with a multivariable logistic regression model. Results: Totally 5 146 rural elderly patients with chronic diseases were enrolled, including 2 373 men (46.11%) and 2 773 women (53.89%). The prevalence of depressive symptoms was 27.13%. Multivariable logistic regression analysis identified having two and more children (OR=0.614, 95%CI: 0.387-0.975), living alone (OR=1.450, 95%CI: 1.192-1.764), life satisfaction (general, OR=1.933, 95%CI: 1.651-2.264; low, OR=5.366, 95%CI: 3.488-8.254), self-assessed health status (general, OR=2.697, 95%CI: 2.284-3.185; poor, OR=5.338, 95%CI: 4.262-6.685), disability in instrumental activities of daily living (OR=1.592, 95%CI: 1.328-1.908), sleep duration (normal, OR=0.502, 95%CI: 0.429-0.586; too long, OR=0.494, 95%CI: 0.405-0.603), exercise (OR=0.721, 95%CI: 0.607-0.856), watching TV (OR=0.787, 95%CI: 0.664-0.933), and gardening activities (OR=0.781, 95%CI: 0.626-0.975) as factors affecting depressive symptoms among rural elderly patients with chronic diseases. Conclusions The prevalence of depressive symptoms was 27.13% among rural elderly patients with chronic diseases. Number of children, living style, life satisfaction, health status, sleep duration, exercise, watching TV, and gardening activities are associated with the development of depressive symptoms among rural elderly patients with chronic diseases.

Objective:To compare the effect of three-dimensional CT angiography (CTA) and color Doppler ultrasound (CDU) in reconstruction of soft tissue defects after oral cancer surgery with anterolateral thigh flap (ALTF).Methods:Patients who underwent reconstruction of postoperative defects with ALTF in Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital of Southwest Medical University from January 2013 to January 2020 were retrospectively reviewed. According to the imaging method used for examining perforating artery, all patients were divided into two groups. In group A, CTA and three-dimensional vascular reconstruction were used to locate the lateral femoral circumflex artery and its perforating vessels, and the individualized ALTF was designed. In group B, the lateral circumflex femoral artery and its perforating vessels were located by CDU. The clinical features, operation time, flap survival rate, postoperative complication rate, image quality of angiography, difference of superficial skin points of perforating vessels before and during operation, and diameter of perforators were compared between the two groups. The measurement data were expressed by Mean±SD, and the differences between the two groups were compared by independent sample t-test; paired sample t-test was used to compare the intra-group differences; patients’ clinical features and other enumeration data were expressed in the number of cases (%), and analyzed by chi-square test; reliability analysis was adopted for the image quality score of two doctors at different times, taking Cronbach’s α value; correlations between body mass index (BMI) and flap survival rate were tested by Pearson correlation, whereas the correlation between flap survival rate and underlying diseases, drug combination, bad smoking and drinking habits, and surgical complications were tested by Spearman correlation, which were all performed using SPSS version 20.0 at significance level P<0.05. Results:A total of 50 patients with oral cancer were collected, 25 patients in each group. There were no significant differences between the two groups in clinical features such as sex distribution, age, TNM stage, BMI, underlying diseases, drug combination, bad smoking and drinking habits, tumor location and so on ( P>0.05). The mean operation time of group A was significantly shorter than that of group B[(67.64±5.94) min vs. (70.88±4.88) min, P<0.05]. All flaps in group A survived; one case in group B had complete flap necrosis. There was no significant difference in flap survival rate between the two groups(100% vs. 96%, P>0.05). One case in group A and two cases in group B had complications such as effusion of donor site wound, and there was no significant difference ( P>0.05). Compared with the image quality of the two groups, the angiographic quality score of group A was significantly higher than that of group B, the difference was statistically significant [(3.08±0.64) scores vs. (2.56±0.65) scores, P<0.05]. In group A, the distance difference between the position of the skin superficial point of perforator vessel positioned before operation and during operation was significantly shorter than that in group B, and the difference was statistically significant [(1.32±0.50) mm vs. (1.75±0.84) mm, P<0.05]. In group A, the diameter of perforating artery measured by imaging before operation was (1.68±0.17) mm, which had no significant difference with the actual value[(1.70±0.18) mm] ( P>0.05); whereas, in group B, the diameter of perforating artery measured by imaging before operation was (1.77±0.14) mm. The actual measured value during operation was (1.66±0.15) mm, the difference was statistically significant ( P<0.05). A significant correlation emerged between surgical complications and flap survival rate ( r=0.57, P<0.001), however, there were no significant correlations between BMI, combined with basic diseases, combined medication, bad smoking and drinking habits and flap survival ( P>0.05). Conclusions:Compared with CDU, CTA combined with three-dimensional vascular reconstruction is a feasible and reliable method for preoperative evaluation, flap design. The flap preparation time is shorter. Therefore, it is a good method of preoperative vascular localization.

Objective:To compare the effect of three-dimensional CT angiography (CTA) and color Doppler ultrasound (CDU) in reconstruction of soft tissue defects after oral cancer surgery with anterolateral thigh flap (ALTF).Methods:Patients who underwent reconstruction of postoperative defects with ALTF in Department of Oral and Maxillofacial Surgery, the Affiliated Stomatological Hospital of Southwest Medical University from January 2013 to January 2020 were retrospectively reviewed. According to the imaging method used for examining perforating artery, all patients were divided into two groups. In group A, CTA and three-dimensional vascular reconstruction were used to locate the lateral femoral circumflex artery and its perforating vessels, and the individualized ALTF was designed. In group B, the lateral circumflex femoral artery and its perforating vessels were located by CDU. The clinical features, operation time, flap survival rate, postoperative complication rate, image quality of angiography, difference of superficial skin points of perforating vessels before and during operation, and diameter of perforators were compared between the two groups. The measurement data were expressed by Mean±SD, and the differences between the two groups were compared by independent sample t-test; paired sample t-test was used to compare the intra-group differences; patients’ clinical features and other enumeration data were expressed in the number of cases (%), and analyzed by chi-square test; reliability analysis was adopted for the image quality score of two doctors at different times, taking Cronbach’s α value; correlations between body mass index (BMI) and flap survival rate were tested by Pearson correlation, whereas the correlation between flap survival rate and underlying diseases, drug combination, bad smoking and drinking habits, and surgical complications were tested by Spearman correlation, which were all performed using SPSS version 20.0 at significance level P<0.05. Results:A total of 50 patients with oral cancer were collected, 25 patients in each group. There were no significant differences between the two groups in clinical features such as sex distribution, age, TNM stage, BMI, underlying diseases, drug combination, bad smoking and drinking habits, tumor location and so on ( P>0.05). The mean operation time of group A was significantly shorter than that of group B[(67.64±5.94) min vs. (70.88±4.88) min, P<0.05]. All flaps in group A survived; one case in group B had complete flap necrosis. There was no significant difference in flap survival rate between the two groups(100% vs. 96%, P>0.05). One case in group A and two cases in group B had complications such as effusion of donor site wound, and there was no significant difference ( P>0.05). Compared with the image quality of the two groups, the angiographic quality score of group A was significantly higher than that of group B, the difference was statistically significant [(3.08±0.64) scores vs. (2.56±0.65) scores, P<0.05]. In group A, the distance difference between the position of the skin superficial point of perforator vessel positioned before operation and during operation was significantly shorter than that in group B, and the difference was statistically significant [(1.32±0.50) mm vs. (1.75±0.84) mm, P<0.05]. In group A, the diameter of perforating artery measured by imaging before operation was (1.68±0.17) mm, which had no significant difference with the actual value[(1.70±0.18) mm] ( P>0.05); whereas, in group B, the diameter of perforating artery measured by imaging before operation was (1.77±0.14) mm. The actual measured value during operation was (1.66±0.15) mm, the difference was statistically significant ( P<0.05). A significant correlation emerged between surgical complications and flap survival rate ( r=0.57, P<0.001), however, there were no significant correlations between BMI, combined with basic diseases, combined medication, bad smoking and drinking habits and flap survival ( P>0.05). Conclusions:Compared with CDU, CTA combined with three-dimensional vascular reconstruction is a feasible and reliable method for preoperative evaluation, flap design. The flap preparation time is shorter. Therefore, it is a good method of preoperative vascular localization.

Objective:To investigate the diagnosis, classification and treatment of pancreatic duct stones (PDS) .Methods:Clinical data and prognosis of 32 patients with PDS treated in our hospital from Jan. 2010 to Dec. 2019 were retrospectively analyzed. The treatment methods were summarized.Results:All 32 cases were diagnosed with PDS by imaging examinations such as B ultrasonography, CT, endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) . The diagnosis accuracy was 81.3% (26/32) for B-ultrasound, 86.2% (25/29) for CT, 90.4% (19/21) for MRCP, and 100% (8/8) for ERCP. According to the location of stones and intraoperative exploration, the 32 patients were divided into 3 groups: Type I, 17 patients, the stones were located in the main pancreatic duct; TypeⅡ, 11 patients, the stones were located in both main and branch pancreatic duct; Type Ⅲ, 4 patients, the stones were located in the branch pancreatic duct. Different treatment methods were employed according to the different types. No patient died in the perioperative period. 11 (34.3%) patients had postoperative complications. 3 (9.3%) patients had postoperative residual stones. 32 cases were followed up for a period of 6 to 60 months. The abdominal pain and steatorrhea disappeared or significantly improved postoperatively. 2 patients complicated with pancreatic cancer died 12 to 35 months after operation.Conclusions:The treatment and diagnosis of the PDS still remains complicated. Imaging examinations are the main methods for diagnosis of PDS. The accurate classification and individual treatment are important. Surgery is the most commonly used method for PDS.

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.

OBJECTIVE: To establish a method of determination of difluorochloromethane in workplace air by direct sampling gas chromatography. METHODS: Difluorochloromethane in workplace air was collected with aluminum plastic composite film airbag and then directly injected. Difluorochloromethane was separated by DB-1 capillary column and detected with hydrogen flame ionization detector. RESULTS: Good linearity was obtained in the range of 1.50-15 042.90 mg/m~3 with the correlation coefficient of 0.999 96. The limit of detection was 1.26 mg/m~3 and the limit of quantitation was 3.78 mg/m~3. The minimum detection concentration was 1.26 mg/m~3 and the minimum quantification concentration was 3.78 mg/m~3. The standard recovery was 98.34%-99.19%. The within-run relative standard deviation(RSD) and the between-run RSD were 1.82%-3.72% and 2.17%-4.17%, respectively. The samples can be stored at room temperature for at least 7 days. CONCLUSION: This method is suitable for difluorochloromethane detection in workplace air.