[This corrects the article DOI: 10.1016/j.apsb.2022.05.019.].

Objective To compare the safety and efficacy of flexible terminal suction ureteral access sheath(FTS-UAS)and negative pressure ureteral access sheath(NPUAS)in flexible ureteroscopic lithotripsy with holmium laser in treatment of renal calculi less than 2 cm in diameter.Methods A total of 68 patients(largest diameter of stone＜2 cm)with renal calculi treated in Yangjiang Hospital Affiliated to Guangdong Medical University during Nov.2022 and Aug.2023 were divided into FTS-UAS group(n=34)and NPUAS group(n=34)according to different surgical methods.The perioperative parameters and stone-free rate(SFR)were compared between the two groups.Results The average SFR on the first day after operation was significantly higher in the FTS-UAS group than in the NPUAS group[85.3％(29/34)vs.61.8％(21/34),P=0.028].The operation time was significantly lower in the FTS-UAS group than in the NPUAS group[(65.85±13.16)min vs.(75.59±20.21)min,P=0.022].For lower calyceal renal calculi,the SFR was significantly higher in the FTS-UAS group than in the NPUAS group[82.4％(14/17)vs.43.8％(7/16),P=0.032].One month after operation,the SFR was higher in the FTS-UAS group than in the NPUAS group[94.1％(32/34)vs.85.3％(29/34),P=0.452].There were no significant differences in hemoglobin reduction,serum creatinine level,postoperative complications,hospital stay and hospitalization costs between the two groups(P＞0.05).Conclusion FTS-UAS in flexible ureteroscopic lithotripsy can shorten the operation time and improve stone-clearance rate,which is safe,effective,and worthy of clinical promotion.

Objective:To investigate the value of an MRI and digital pathology images based omics nomogram for the prediction of recurrence risk in soft tissue sarcoma (STS).Methods:This was a retrospective cohort study. From January 2016 to March 2021, 192 patients with STS confirmed by pathology in the Affiliated Hospital of Qingdao University were enrolled, among which 112 patients in the Laoshan campus were enrolled as training set, and 80 patients in the Shinan campus were enrolled as validation set. The patients were divided into recurrence group ( n=87) and no recurrence group ( n=105) during follow-up. The clinical and MRI features of patients were collected. The radiomics features based on fat saturated T 2WI images and pathomics features based on digital pathology images of the lesions were extracted respectively. The clinical model, radiomics model, pathomics model, radiomics-pathomics combined model, and omics nomogram which combined the optimal prediction model and the clinical model were established by multivariate Cox regression analysis. The concordance index (C index) and time-dependent area under the receiver operating characteristic curve (t-AUC) were used to evaluate the performance of each model in predicting STS postoperative recurrence. The DeLong test was used for comparison of t-AUC between every two models. The X-tile software was used to determine the cut-off value of the omics nomogram, then the patients were divided into low risk ( n=106), medium risk ( n=64), and high risk ( n=22) groups. Three groups′ cumulative recurrence-free survival (RFS) rates were calculated and compared by the Kaplan-Meier survival curve and log-rank test. Results:The performance of the radiomics-pathomics combined model was superior to the radiomics model and pathomics model, with C index of 0.727 (95% CI 0.632-0.823) and medium t-AUC value of 0.737 (95% CI0.584-0.891) in the validation set. The omics nomogram was established by combining the clinical model and the radiomics-pathomics combined model, with C index of 0.763 (95% CI 0.685-0.842) and medium t-AUC value of 0.783 (95% CI0.639-0.927) in the validation set. The t-AUC value of omics nomogram was significantly higher than that of clinical model, TNM model, radiomics model, and pathomics model in the validation set ( Z=3.33, 2.18, 2.08, 2.72, P=0.001, 0.029, 0.037, 0.007). There was no statistical difference in t-AUC between the omics nomogram and radiomics-pathomics combined model ( Z=0.70, P=0.487). In the validation set, the 1-year RFS rates of STS patients in the low, medium, and high recurrence risk groups were 92.0% (95% CI 81.5%-100%), 55.9% (95% CI 40.8%-76.6%), and 37.5% (95% CI 15.3%-91.7%). In the training and validation sets, there were statistically significant in cumulative RFS rates among the low, medium, and high groups of STS patients (training set χ2=73.90, P<0.001; validation set χ2=18.70, P<0.001). Conclusion:The omics nomogram based on MRI and digital pathology images has favorable performance for the prediction of STS recurrence risk.

Objective:To explore the effect of low-molecular-weight heparin calcium in preventing lower limb deep vein thrombosis after rectal cancer surgery.Methods:A retrospective case-control study was conducted. The clinical data of 30 rectal cancer patients with postoperative subcutaneous injection of low-molecular-weight heparin calcium in Beijing Hepingli Hospital from February 2018 to February 2022 were retrospectively analyzed, and 30 patients wearing antithrombotic elastic socks during the same period were selected as controls. In the antithrombotic elastic socks group, the appropriate thrombotic elastic socks were selected according to the actual situation of the patients after operation. Low-molecular-weight heparin calcium group was given subcutaneous injection of low-molecular-weight heparin calcium on the 2nd day after operation. The indexes of coagulation function, situation of postoperative lower limb deep vein thrombosis and perioperative indexes were analyzed.Results:The age of patients in the low-molecular-weight heparin calcium group was (62±12) years old, with 17 women and 13 men. The age of patients in the antithrombotic elastic socks group was (63±1) years old, with 18 women and 12 men. Before prevention, there were no significant differences in platelet count (Plt), activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin time (PT), fibrinogen (FIB), D-dimer (D-D) levels between the two groups (all P > 0.05). After prevention, the FIB and D-D levels of patients in the low-molecular-weight heparin calcium group [(3.3±0.7) g/L and (341±30) μg/L] were lower than those in the antithrombotic elastic socks group [(4.9±0.6) g/L and (428±40) μg/L] ( t values were 9.51 and 9.61, both P < 0.05), but there were no significant differences in Plt, APTT, TT and PT between the two groups (all P > 0.05). The rate of lower limb deep vein thrombosis in the low-molecular-weight heparin calcium group was lower than that in the antithrombotic elastic socks group [6.67% (2/30) vs. 26.67% (8/30), χ2 = 4.32, P < 0.05]. The drainage flow of anterior sacral drainage tube in the two groups decreased gradually on the 1st, 2nd, 3rd and 4th day after surgery, but there were no significant differences between the two groups (all P > 0.05). The thrombosis time of patients in the low-molecular-weight heparin calcium group was longer than that in the antithrombotic elastic socks group [(84±9) h vs. (73±10) h, t = 4.81, P < 0.05], but there were no significant differences between the two groups in the intraoperative bleeding amount, operation time and postoperative hospital stay (all P > 0.05). Conclusions:Compared with antithrombotic elastic socks, low-molecular-weight heparin calcium is more effective and safer in the prevention of lower limb deep vein thrombosis after rectal cancer surgery.

Metabolic reprogramming is a hallmark of cancer, including lung cancer. However, the exact underlying mechanism and therapeutic potential are largely unknown. Here we report that protein arginine methyltransferase 6 (PRMT6) is highly expressed in lung cancer and is required for cell metabolism, tumorigenicity, and cisplatin response of lung cancer. PRMT6 regulated the oxidative pentose phosphate pathway (PPP) flux and glycolysis pathway in human lung cancer by increasing the activity of 6-phospho-gluconate dehydrogenase (6PGD) and α-enolase (ENO1). Furthermore, PRMT6 methylated R324 of 6PGD to enhancing its activity; while methylation at R9 and R372 of ENO1 promotes formation of active ENO1 dimers and 2-phosphoglycerate (2-PG) binding to ENO1, respectively. Lastly, targeting PRMT6 blocked the oxidative PPP flux, glycolysis pathway, and tumor growth, as well as enhanced the anti-tumor effects of cisplatin in lung cancer. Together, this study demonstrates that PRMT6 acts as a post-translational modification (PTM) regulator of glucose metabolism, which leads to the pathogenesis of lung cancer. It was proven that the PRMT6-6PGD/ENO1 regulatory axis is an important determinant of carcinogenesis and may become a promising cancer therapeutic strategy.

ObjectiveTo investigate the effects of Huashi Runzao prescription （HRP） on the histopathological injury and function of submandibular gland in naive non-obese diabetic （NOD/Ltj） mouse model of Sjögren's syndrome （SS） and its regulatory effect on aquaporin 5 （AQP5） expression in submandibular gland cells. MethodThe SS model was induced in NOD/Ltj mice. The NOD/Ltj female mice aged nine weeks were selected and randomly assigned into model group，HRP group （7.15 g·kg^-1·d^-1），and hydroxychloroquine （HCQ） group （1.30 g·kg^-1·d^-1）， and female BALB/c mice in the same age were selected and assigned into the normal group， with six mice in each group. Drug intervention lasted eight weeks. The water consumption and salivary flow rate （SFR） of each group were recorded. The pathological staining results of the submandibular gland of mice in each group were observed and scored. AQP5 expression was determined by immunohistochemistry （IHC） and Western blot. ResultCompared with the normal group， the model group showed increased water consumption （P<0.05） and reduced SFR （P<0.05）. Compared with the model group， the HRP group showed decreased water consumption （P<0.05） and increased SFR （P<0.05）， and the HCQ group showed increased SFR （P<0.05）. In terms of histopathological results of the submandibular gland，compared with the normal group，the model group showed increased pathological score， number of lymphocyte infiltration foci，and percentage of lymphatic infiltration area （P<0.05）. Compared with the model group， the HRP group showed reduced pathological scores and number of lymphocyte infiltration foci （P<0.05）， and the HRP group and the HCQ group showed reduced percentage of lymphatic infiltration area（P<0.05）. The results of IHC and Western blot showed that compared with the normal group，the model group showed down-regulated expression level of AQP5 protein （P<0.05）， and compared with the model group and the HCQ group，the HRP group showed up-regulated expression level of AQP5 protein （P<0.05）. ConclusionHRP can improve the secretion function of submandibular gland acinous cells and glandular structure injury in SS model mice， and its mechanism may be related to the up-regulation of AQP5 protein expression level in submandibular gland cells.

Objective:To analyze the cardio-pulmonary ultrasound features of cardiogenic pulmonary edema (CPE) and pneumonia in adults with acute dyspnea, and to construct a differential diagnosis model.Methods:Seven hundred and forty-three patients with sudden acute dyspnea admitted to Hebei General Hospital from November 2018 to May 2022 were retropectively included. Ultrasonographer A performed lung ultrasound with 12 zone method, and interpreted and recorded the ultrasonic signs (including A-lines area, B-lines area, consolidation area and pleural effusion area) together with ultrasonographer B. According to the ultrasonic characteristics of the whole lung, it was divided into A-profile and B-profile. According to the continuity and symmetry of the distribution of B-lines in bilateral lung fields, it could be divided into bilateral lung continuous and discontinuous B-profile, bilateral lung symmetric and asymmetric B-profile. Left ventricular ejection fraction (LVEF), left ventricular filling pressure (E/e′), right ventricular dilatation, tricuspid annular systolic displacement (TAPSE) and inferior vena cava diameter (IVCD) were evaluated by echocardiography, and all the indexes were transformed into binary variables. According to the final clinical diagnosis and treatment results, the disease was divided into CPE group and pneumonia group. Binary Logistic regression model was used to screen independent influencing factors, and partial regression coefficient β value was used as a weight to assign a score, and a differential diagnosis model was established based on the total score. The predictive value of the model was evaluated by the receiver operating characteristic curve (ROC) and area under curve (AUC). After the model was built, 30 patients with CPE or pneumonia were independently collected by ultrasonographer C as external validation data, which were included in the model to draw ROC curve and evaluate the differential diagnosis efficiency of the model. The consistencies between ultrasonographer A and B, A and C in observing lung ultrasound were explored.Results:A total of 743 patients from 43 clinical departments were included, including 246 cases in CPE group and 497 cases in pneumonia group. Multivariate logistic regression analysis showed that bilateral lung continuous B-profile, bilateral lung symmetric B-profile, ≥1 pleural effusion area, LVEF<50%, E/e′>14 were the risk factors for CPE (all OR>1, P<0.05), and ≥1 consolidation area and ≥1 pleural sliding disappearance area were the protective factors for CPE (all OR>1, P<0.05). The sensitivity, specificity and AUC of combined cardio-pulmonary ultrasound index β value weight score in the differential diagnosis of CPE and pneumonia were 0.939, 0.956 and 0.986, respectively. The AUC of external validation data was 0.904. Ultrasonographer A and B, A and C had good consistency in the interpretation of lung ultrasound signs ( P<0.05). Conclusions:The differential diagnosis model based on combined cardio-pulmonary ultrasound indexes has high differential diagnosis efficiency for CPE and pneumonia, and can be used in bedside cardio-pulmonary ultrasound practice.

Objective:To explore the role of video-assisted feedback in clinical skill teaching in undergraduate classes and its application effect.Methods:The experimental control method was adopted in the study. A total of 185 students from Eight-year program of clinical medicine of Batch 2014 and Five-year program of clinical medicine of Batch 2016 in Tongji Medical College of Huazhong University of Science and Technology were collected as the experimental group, and another 166 students from Eight-year program of clinical medicine of Batch 2013 and Five-year program of clinical medicine of Batch 2015 as the control group. The experimental group adopted the teaching mode of video-assisted feedback and the control group received the traditional teaching mode. By the end of training sessions, the differences between the two groups in both the skill assessments and the theories were compared. A satisfaction survey about the video-assisted feedback was made in the experimental group. GraphPad Prism 5 was used for t test. Results:In the students from Five-year program of clinical medicine, the scores of theoretical assessment in the experimental group were (87.64±0.94) points and the scores of skill assessments were (84.78±0.54) points; the scores of theoretical assessment in the control group were (85.14±0.80) points and the scores of skill assessments were (83.10±0.53) points. In the students from Five-year program of clinical medicine, the difference of both the theoretical and the skill assessment scores between the experimental group and the control group was statistically significant ( P<0.05). In the students from Eight-year program of clinical medicine, the scores of theoretical assessment in the experimental group were (86.46±0.66) points and the scores of skill assessments were (86.38±0.73) points; the scores of theoretical assessment in the control group were (84.90±1.21) points and the scores of skill assessments were (83.79±0.64) points. The difference of the skill assessment scores between the experimental group and the control group was statistically significant ( P<0.05), and no significant difference was found in the theoretical assessment. The questionnaire survey in the experimental group based on video-assisted feedback teaching method showed that 93.3% (168/180) of students said that they would not take the initiative to practice after class if there was no video shooting session; 87.8% (158/180) of the students thought the video-assisted feedback teaching method improved their ability of independent learning; 82.8% (149/180) of students thought this method significantly increased their learning efficiency and confidence in clinic; 71.1% (128/180) of the students felt that after-class video shooting, their self-confidence was improved when they faced the corresponding operation clinically. Conclusion:The application of video-assisted feedback has significantly improved the outcome of clinical skill training for students, as compared to the traditional teaching mode.

Objective:To investigate the clinical value of totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization for portal hypertension com-plicated with splenic aneurysm.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 17 patients with portal hypertension complicated with splenic aneurysm who were admitted to 2 medical centers (15 cases in Shenzhen University General Hospital and 2 cases in Wuhan First Hospital) from January 2013 to May 2020 were collected. There were 7 males and 10 females, aged (59±14)years. All patients underwent totally laparoscopic exoclusion of splenic artery aneurysm combined with pericardial devascularization. Observation indicators : (1) surgical and postoperative conditions; (2) complications; (3) follow-up. Follow-up was conducted by out-patient examiantion and telephone interview to detect the effect of exclusion of arterial tumor, and blood re-flow, portal vein thrombosis and survival of patients 3 months after operation. The follow-up was up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Results:(1) Surgical and postoperative conditions. All 17 patients successfully completed the operation, without perioperative death. The operation time, volume of intraoperative blood loss of 17 patients were (181±30)minutes, 187(range, 90?420)mL. The white blood cell count, red blood cell count, hemoglobin, serum albumin were (9±4)×10 9/L, (3.5±0.9)×10 12/L, (86±17)g/L, (36±7)g/L on the postoperative day 3. Time to postoperative abdominal drainage tube removal and duration of post-operative hospital stay were (7±4)days and (11±4)days. (2) Complications. All 17 patients had ascites after surgery, which were improved after oral treatment with diuretics. There was no complication such as intra-abdominal hemorrhage, gastrointestinal fistula, pleural effusion, infection, abscess formation, fever and vascular embolism. (3) Follow-up. All the 17 patients were followed up for 28.6(range, 7.0?84.0)months. During the follow-up, the splenic aneurysm cavity of all patients was completely isolated, no blood re-flow and no portal vein thrombosis was observed, and no patient died. Conclusion:Totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization is safe and feasible in the treatment of portal hypertension complicated with splenic aneurysm.

In this study, 15 second-year resident doctors who had standardized training of OBGYN were taken as research subjects to discuss the effect of training resident doctors with obstetrics forceps by using simulation teaching method. The simulation teaching process includes theoretical study, theoretical examination, simulation teaching of forceps skills and Assessment of forceps skills. In theoretical study section: before learning to use forceps, the students acquired the theoretical knowledge by flipped teaching micro-video mode. In theoretical examination section: the mastery of basic clinical knowledge of using forceps was evaluated through online assessment. In simulation teaching of forceps skills: students who scored 8/10 points were admitted to enter the simulation teaching process, and they had practical training of scenario simulation skills in Clinical Skills Center. In assessment of forceps skills: the mastery of forceps skills was evaluated by standardized forceps delivery procedure items. The results showed that the students in the simulation teaching group had excellent teaching assessment results, and the resident doctors had more confidence in operating forceps independently, and the teaching effect was ideal, which could further promote the simulation teaching of obstetric clinical skills.