Objective To analyze the risk factors associated with the occurrence of rectal neuroendocrine tumors (RNETs) and construct a risk prediction model. Methods Clinical data of patients who underwent electronic colonoscopy were collected. The clinical information on patients with and without RNETs were compared, and potential risk factors for RNETs were identified. Binary logistic regression was performed to analyze the relevant risk factors and construct a risk prediction model. Results Among 164 patients, 66 were diagnosed with RNETs, and 98 who did not have such a condition were randomly selected. Univariate logistic regression analysis revealed that age, fatty liver, anxiety and depression, total cholesterol, triglyceride levels, and carcinoembryonic antigen (CEA) were significant factors influencing the occurrence of RNETs (P<0.05). Multivariate logistic regression analysis identified age (P=0.015), anxiety and depression (P=0.031), cholesterol level (P=0.009), fatty liver (P=0.001), and CEA (P<0.001) as independent risk factors for RNETs. The participants were randomly divided into training and test sets at a 7:3 ratio. The training set was used to construct a nomogram-based risk prediction model, and the testing set was used for internal validation. The area under the curve values for the training and testing sets were 0.843 and 0.772, respectively (P>0.05). These findings indicate a good discriminative performance. The calibration curves for the training and testing sets were in good agreement with the 45° standard line, which suggests that the predicted probabilities were consistent with the actual outcomes. Decision curve analysis showed that the model provided a high net benefit within a threshold range of 0.2 to 0.7 for clinical decision making. Conclusion Young age, fatty liver, high CEA levels, high cholesterol levels, and anxiety and depression are independent risk factors for RNETs. The nomogram model constructed based on these risk factors exhibits a strong capability to predict the occurrence of RNETs, and clinical intervention can be considered based on the predicted probability values.

Objective To evaluate the effectiveness and safety of different Chinese patent medicine in improving blood lipid and microcirculation in coronary heart disease patients with phlegm-blood stasis syndrome based on network meta-analysis.Methods The randomized controlled trials(RCTs)of different Chinese patent medicine in the treatment of blood lipid and microcirculation in coronary heart disease patients with phlegm-blood stasis syndrome were collected by searching CNKI,Wanfang,VIP,SinoMed,PubMed,EMbase,Cochrane Library,and Web of science databases from the establishment of the database to April 3,2023.Literature quality evaluation and network meta-analysis were conducted using Review Manager 5.4 and Stata15.1 software.Results Thirty-seven RCTs were included,with a total sample size of 4 064 cases,involving 15 different Chinese patent medicines.The network meta-analysis showed that the efficacy of Chinese patent medicine combined with conventional Western medicine is often better than that of conventional Western medicine alone.There are no serious adverse reactions.The top three Chinese patent medicines with cumulative probability of total clinical efficacy were Guanmai Zaitong soft extract,Gualoupi Injection and Quyu Xiaoban Capsule.In terms of improving triglyceride(TG)and low-density lipoprotein(LDL-C),the top three Chinese patent medicines were Gualoupi Injection,Huxinkang Tablet and Guanxin Shutong Capsule.In terms of improving plasma viscosity and fibrinogen,the top three Chinese patent medicines were Ginkgo Damo Injection,Gualoupi Injection and Guanxin Shutong Capsule.In terms of improving endothelial function[nitric oxide(NO)and endothelin-1(ET-1)],the top three Chinese patent medicines were Ginkgo Damo Injection,Danlou Tablet and Tongmai Yuxin Pill.In terms of reducing inflammation hypersensitivity C-reactive protein(hs-CRP),the top three Chinese patent medicines were Ginkgo Damo Injection,Huxinkang Tablet and Guanxin Shutong Capsule.Conclusion The current evidence shows that the combination of TCM,which is used for the treatment of phlegm-blood stasis syndrome,with conventional Western medicine in the treatment of coronary heart disease has advantages in improving clinical efficacy,blood lipids and microcirculation.TCM especially for the treatment of phlegm-blood stasis syndrome shows more obvious advantage,such as Guanmai Zaitong soft extract and Gualoupi injection,which can be taken into consideration as part of the clinical guidelines.However,due to the limited number and quality of the included literatures,the research results still need to be verified by more high-quality,multi-center,double-blind randomized trials.The purpose is to provide more reliable evidence-based medical reference.

Objective:To explore the characteristics of nail fold microcirculation in hemodialysis patients and its correlation with cardiovascular events.Methods:The clinical data of 185 patients undergoing regular hemodialysis in Dongguan Donghua Hospital from January 2017 to December 2021 were retrospectively analyzed. Among them, there were 76 cases of cardiovascular events (cardiovascular events group) and 109 cases of no cardiovascular events (non-cardiovascular events group). The nail fold microcirculation detector was used to detect the nail fold microcirculation of the first row of capillaries in the nail fold dermal papilla of the left ring finger. The nail fold microcirculation indexes and morphology integral, flow integral, loop integral, total integral were recorded. The general information and laboratory indexes (peripheral venous blood) were recorded. The value of total integral of nail fold microcirculation in predicting the cardiovascular events in hemodialysis patients was evaluated using the receiver operating characteristics (ROC) curve.Results:The age, proportion of hypertension, proportion of diabetes, C-reactive protein (CRP), alkaline phosphatase and N-terminal pro-brain natriuretic peptide (NT-ProBNP) in cardiovascular events group were significantly higher than those in non-cardiovascular events group: 58 (44, 69) years vs. 49 (40, 63) years, 97.4% (74/76) vs. 83.5% (91/109), 43.4% (33/76) vs. 24.8% (27/109), 9.02 (2.73, 11.70) mg/L vs. 3.76 (1.28, 11.70) mg/L, 82 (75, 97) U/L vs. 72 (59, 82) U/L and 2 652 (1 020, 5 359) ng/L vs. 1 894 (780, 4 601) ng/L, the creatinine and triglyceride (TG) were significantly lower than those in non-cardiovascular events group: (961.95 ± 277.11) μmol/L vs. (1 058.93 ± 284.66) μmol/L and (1.73 ± 1.02) mmol/L vs. (2.27 ± 2.02) mmol/L, and there were statistical differences ( P<0.01 or <0.05). There were no statistical differences in gender composition, dialysis age, dialysis time, dialysis pathway, blood routine, serum iron, serum ferritin, total iron binding capacity, serum potassium, serum calcium, serum phosphorus, parathyroid hormone, urea nitrogen, albumin, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol between two groups ( P>0.05). There was statistical difference in erythrocyte aggregation between two groups ( P<0.05); there were no statistical differences in the number of vascular loops, diameter of input branch, diameter of output branch, length of loop, diameter of loop top, blood flow rate, clarity, condition of cross loop, condition of malformed loop, shape of nipple and subpapillary venous plexus between two groups ( P>0.05). The morphology integral and total integral in cardiovascular events group were significantly higher than those in non-cardiovascular events group: 1.8 (1.1, 3.1) scores vs. 1.4 (0.8, 2.5) scores and 4.2 (2.4, 6.1) scores vs. 3.1 (1.8, 5.2) scores, and there were statistical differences ( P<0.05); there were no statistical differences in flow integral and loop integral between two groups ( P>0.05). ROC curve analysis result showed that the area under the curve of the total integral of nail fold microcirculation for predicting cardiovascular events in hemodialysis patients was 0.590 (95% CI 0.506 to 0.673), the best cut-off value was 2.85 scores, the sensitivity was 69.7% and the specificity was 45.9%. Conclusions:The nail fold microcirculation disorder is more serious in hemodialysis patients with cardiovascular events. The nail fold microcirculation detection may help to predict cardiovascular disease.

The oncolytic virus(OV)therapy utilizes natural or genetically modified viruses to specifically target and infect tumor cells,leading to the destruction of cancer cells by the replication of the virus itself.This process also alters the immune microenvironment of the tumor transforming"cold"into"hot",and mobilizes the body's immune system.The effectiveness of oncolytic viruses in anti-tumor therapy depends on factors such as the type of virus,host immunity and route of administration.Immunotherapy aims to activate the immune system and exert anti-tumor effect by relying on autoimmune function.With the development of genetic engineering technology,oncolytic viruses can enhance the anti-tumor effect through gene editing reconstruction,and can be used to treat tumors alone or in combination with other therapies.In view of the limited efficacy of single application of oncolytic virus therapy in clinic,the combination of oncolytic virus therapy and immunotherapy provides a new strategy for tumor treatment.This review started from the types of oncolytic viruses approved in the clinic,characteristics and its anti-tumor mechanisms.At the same time,it combed through the treatment of oncolytic viruses in the clinical trial stage,summarized the combined treatment strategies of oncolytic viruses,especially the combination of tumor immunotherapy represented by immune checkpoint inhibitor(ICI)and adoptive cell therapy(ACT),and put forward some thoughts and prospects of oncolytic viruses in the anti-tumor treatment in combination with the experience accumulated by the project team in the research of oncolytic viruses.

Objective:To analyze and summarize the clinical, genotypic and pathological characteristics of children with PAX2 gene mutation in China, and to provide information for the monitoring, treatment and prognosis of the disease. Methods:It was a case series analysis study. The clinical data of children with PAX2 gene mutation in Pediatric Nephrology Department, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from January 2014 to December 2022 were collected, and peripheral blood gene DNA was extracted and sequenced for whole exome sequencing. The clinical, pathological and genotypic characteristics of PAX2 gene variation of children in China were summarized by searching PubMed, Medline, China National Knowledge Infrastructure and Wanfang database and compared with the cases in this single center. Results:Among the 13 children with PAX2 gene mutation, there were 9 males and 4 females, 12 patients with abnormal urine tests, 7 patients with small kidney volume by imaging examination, and 5 patients with renal cysts. The clinical phenotypes were congenital renal and urinary tract malformations in 8 cases, renal coloboma syndrome in 1 case, and hematuria or proteinuria in 3 cases. Five patients underwent renal biopsies, showing focal segmental glomerulosclerosis and C3 glomerulopathy in 1 case, focal segmental glomerulosclerosis in 1 case, thin basement membrane lesion in 1 case, and IgA nephropathy in 2 cases. The genetic testing in 13 children showed 9 de novo mutations and 4 new mutations of c.321G>A, c.213-8C>G, c.63C>A and c.449C>T. There were 2 cases of 76dupG (p.V26Gfs*28) mutant. A total of 51 Chinese children with PAX2 gene mutation were found in the literature search. There were 32 males and 19 females, 8 cases with small kidney volume and 12 cases with renal cysts. The clinical phenotypes were congenital anomalies of kidney and urinary tract in 28 cases, renal coloboma syndrome in 17 cases, and hematuria or proteinuria in 6 cases. Seven patients underwent renal biopsies, including 2 cases with focal segmental glomerulosclerosis, 1 case with minimal lesion, 1 case with mesangial proliferative glomerulonephritis, 1 case with IgA nephropathy, 1 case with membranous nephropathy and a case with focal proliferative sclerosing purpura nephritis combined with glomerular hypertrophy. Thirty-four cases were de novo mutations, and 12 mutations were from the father or mother. The father or mother of 5 children had no clinical manifestations, with normal renal function. There were 11 cases of 76dupG (p.V26Gfs*28) mutant. Conclusions:The clinical phenotypes and genotypes of PAX2 gene variation in Chinese children are diverse. The most common clinical phenotype of PAX2 gene variation is congenital anomalies of kidney and urinary tract. c.76dupG (p.V26Gfs*28) is the most common of PAX2 gene variant.

Objective:To investigate the prognosis and risk factors of IgA vasculitis nephritis (IgAVN) in children.Methods:A retrospective cohort study was conducted. Clinical data were collected from 264 children who were pathologically diagnosed with IgAVN at Department of Pediatric Nephrology, Tongji Hospital, affiliated with Tongji Medical College, Huazhong University of Science and Technology, between January 2011 and December 2017. All patients had a follow-up period of more than 3 years. Clinical characteristics, renal pathology, 3-year and 5-year prognosis were analyzed. The patients were grouped based on gender, age of onset (≤6 years, >6-9 years, and >9 years), pathological classification (≤Ⅲ and>Ⅲ),whether the prognosis was complete remission at 3 and 5 years. Independent sample t-tests, ANOVA or chi-squared test were used for intergroup comparisons. Spearman correlation analysis was applied for ordinal data, and multivariate Logistic regression was used to analyze factors affecting the prognosis. Receiver operating characteristic (ROC) curve was utilized to evaluate the predictive value of these factors. Results:Of the 264 children with IgAVN, 153 were male and 111 were female, the age of onset was 8.3 (6.7, 10.3) years, 118 patients (45%) with onset age >6-9 years accounted for the highest proportion. All patients presented with skin purpura and renal involvement, primarily manifesting as hematuria and/or proteinuria. Microscopic hematuria was observed in 253 patients (95.8%), while 246 patients (93.2%) showed proteinuria. In 256 patients (97.0%), hematuria or proteinuria urinalysis was detected within 6 months of skin purpura onset, and 243 patients (92.0%) underwent renal biopsy within 6 months of renal involvement. The most common clinical subtype in 264 IgAVN children was hematuria and proteinuria (204 cases, 77.3%), with grade Ⅲ being the predominant pathological classification (181 cases, 68.6%). Among children ≤6 years old, the 3-year complete remission rate was higher in males than in females (83.9% (26/31) vs. 7/16, χ2=8.12, P=0.012). Factors independently associated with poor 5-year prognosis included time from hematuria or proteinuria urinalysis to renal biopsy >6 months, elevated serum cholesterol levels, and incomplete remission 3 years post-biopsy ( OR=5.41, 1.39, 6.02, 95% CI 1.40-20.86, 1.04-1.84, 2.61-13.88, all P<0.05). The serum cholesterol has a predictive value for 5-year prognosis ( P=0.020, AUC=0.62, 95% CI 0.52-0.71, Youden index=0.27, cutoff=4.37). Conclusions:For children with IgAVN aged≤6 years, the 3-year prognosis is better in males than in females. Time from hematuria or proteinuria urinalysis to renal biopsy >6 months, elevated serum cholesterol levels, and incomplete remission at 3 years post-biopsy may be independent risk factors for poor 5-year prognosis in children with IgAVN.

OBJECTIVE Investigating the clinical characteristics,risk factors,treatment strategies and prognosis of head and neck extramedullary plasmacytoma(HNEMP).METHODS To analyze indicators affecting survival and prognosis,retrospective study was conducted on the clinical data of 38 newly diagnosed and untreated patients with HNEMP who were admitted to Beijing Tongren Hospital from September 2008 to January 2022.RESULTS Among 38 patients,5 cases(13.2%)displayed a manifestation as cranial-nasal-orbital communication,and 8 cases(21.1%)involved a tumor with diameter≥5 cm.There were 17 patients(44.7%)who underwent surgical resection along,13 patients(34.2%)who received postoperative radiotherapy,8 cases(21.1%)who accepted chemotherapy,and 5 cases(13.2%)who experienced combined radiochemotherapy.Following treatment evaluation,32 cases achieved CR,3 cases showed PR,1 case demonstrated SD and 2 cases experienced PD.The median follow-up time was 86 months,with 5-year PFS and OS rates of 92.1%and 94.7%,respectively.Of note,the patients with cranial-nasal-orbital communication exhibited significantly unfavorable 5-year PFS and OS rates of 40%and 60%,respectively,with median PFS of 13 months,whereas the patients in other groups achieved 100%of 5-year PFS and OS rates.Additionally,tumor diameter≥5 cm and the involvement of cranial-nasal-orbital communication were adverse prognostic factors for both PFS and OS.CONCLUSION HNEMP is a rare disease and the primary treatment approach is surgery combined with radiotherapy.The prognosis for HNEMP tends to be relatively favorable,with the involvement of cranial-nasal-orbital communication and high tumor burden as the adverse prognostic indicators.

This study details a rare instance of a high fibula fracture, classified as a Bosworth fracture. A 54-year-old male presented with pain and restricted movement in his right ankle after a sprain that occurred 10 hours ago. After initial assessments he was diagnosed as a right ankle fracture with posterior dislocation, a proximal right fibula fracture, and an injury to the right lower tibiofibular joint. According to Lauge-Hansen classification this was a type IV injury charactered by pronation-external rotation. Attempts at manual reduction were unsuccessful. Further evaluation using CT scans with three-dimensional reconstruction showed a separation and dislocation at the lower tibiofibular joint, with the distal fibula interlocked with the posterolateral tibia. Additionally, comminuted fractures of the medial and posterior malleoli showed significant displacement and misalignment, leading to persistent ankle dislocation. Immediate calcaneal traction and symptomatic treatment were applied. On the third day of admission a reevaluation indicated successful reduction of the dislocated ankle and tibiofibular joint. Surgery was then performed with favorable outcome. Follow-up X-rays at one and a half years after surgery demonstrated bony heal of the fractures with normal ankle joint space and functionality. Bosworth fractures involving pronation-external rotation are notably less common than those with posterior-external rotation. When manual reduction proves ineffective, applying continuous calcaneal traction with gradual tension can help unlock fibular dislocation, thereby expediting surgical intervention.

Objective To analyze the epidemiological characteristics of syphilis in Yichang City from 2011 to 2020, and provide a scientific basis for developing effective control measures. Methods The data of syphilis cases reported in Yichang City from 2011 to 2020 were collected and analyzed by descriptive epidemiological methods. Results A total of 8 107 cases of syphilis were reported in Yichang City from 2011 to 2020, with an average annual reported incidence rate of 19.76 per 100 000.The reported incidence of syphilis increased from 17.39/100 000 in 2011 to 24.49/100 000 in 2018 （APC=6.82%，95%CI：2.34%~11.49%， P＜0.05）, from 24.49/100 000 in 2018 Decline to 17.55/100 000 in 2020（P＞0.05）. Recessive syphilis is the main type, with 5 837 cases (72.00%), and the annual reported incidence rate is 14.23 per 100 000. The number of cases peaked in July, at 836 (10.31%), and 433 (5.34%) of the lowest in February . The top 3 counties with annual average reported incidence rates were Zigui County (28.51/100 000) , Xiling District (25.01/100 000), and Dangyang City (23.73/100 000). There were a statistically significant differences in reported incidence between counties (2 =933.92, P＜0.01). Gender ratio was 0.72. Cases mainly concentrated in people over 20 years old, 7901 cases (97.46%). The occupation distribution is mainly farmers, housework, unemployed, and retired people. Conclusion The incidence of syphilis in Yichang City has been on the rise in recent ten years, and there is still a long way to go to prevent and control syphilis. We suggested to continue to strengthen the prevention and control of syphilis and comprehensively prevent and control the spread of syphilis.

Objective:To investigate the clinical effect of free anterolateral thigh perforator flap(ALTPF) in reconstruction of temporal scalp defect after blood circulation reconstruction surgery for moyamoya disease.Methods:From May 2020 to July 2022, 7 patients with scalp defect after revascularisation of moyamoya disease were treated in Department of Hand and Foot Microsurgery, Henan Provincial People’s Hospital (People’s Hospital of Zhengzhou University). The patients were 4 males and 3 females, aged 33-59 years old, at 43 years old in average. There were 5 defects in left tempus and 2 in right tempus. The sizes of scalp defect were 4.5 cm × 5.5 cm-7.5 cm × 9.5 cm. Debridement and VSD management were primarily performed. After wounds were stabilised, ultrasound location of perforator vessels of ALTPFs was performed. Having confirmed that the perforator vessels were suitable for the surgical requirements, flap transfers were then performed. The descending branch of the lateral femoral circumflex artery was end-to-side anastomosed with the superficial temporal artery, and the descending branch of the lateral femoral circumflex vein was end-to-end anastomosed with the superficial temporal vein. Postoperative follow-up was conducted through outpatient clinic visits, telephone and WeChat reviews. Appearance, texture of ALTPFs and the flap donor sites were observed in follow-ups. Comparisons of the changes of nervous system before and after surgery were made. Cognitive function of the patients was assessed with the Mini Mental State Examination (MMSE), together with the Activities of Daily Living (ADL) .Results:All 7 flaps survived. One flap had vascular compromise 6 hours after surgery, and was rectified after surgical intervention. All the patients were included in the postoperative follow-up for 7-33 (average 19) months. All flaps had good appearance with soft texture. There was no obvious difference in colour comparing with the skin around the recipient region. The donor sites healed well without hypertrophic scar. Examinations of nervous system of the patients were found the same as that before surgery. Using Manual Muscle Testing (MMT), the average limb muscle strength of the patients was 4 before surgery and 4 after surgery, without change; Using the Ashworth assessment scale, the average preoperative and postoperative limb muscle tension in this group of patients was 1, without change; The Berg balance scale was used to evaluate the patient's balance function, with an average score of 42 before surgery and 42 after surgery, without any changes; There was no change in limb sensation before and after surgery; Using the MMSE, the average preoperative score and postoperative score of this group of patients were 25 points, without any change. Using the modified Barthel index scoring standard, the average preoperative score for this group of patients was 75 points, and the average postoperative score was 79 points, and the ADL of the patient had improved to various levels.Conclusion:Reconstruction of scalp defect with free ALTPF after revascularisation of moyamoya disease has obvious advantages, such as it closes the wound quickly, prevents infection and achieves a good appearance. This surgical procedure can produce a good clinical effect.