Objective To map the genome-wide distribution profile of histone H3K27me3 modification in diffuse gastric cancer tissues,identify target genes regulated by H3K27me3,and primarily explore the potential mechanism of its modification reprogramming in the occurrence and development of the tumor.Methods Normal gastric mucosal tissues and diffuse gastric cancer tissues were harvested from the patients who underwent examinations or treatments in the departments of gastroenterology and gastrointestinal surgery of our medical center between 2021 and 2023.There were 14 patients in the normal group(6 males and 8 females,average age of 46 years)and 14 patients in the gastric cancer group(8 males and 6 females,average age of 63 years).Cleavage under target and tagmentation(CUT&Tag)technology was employed to capture genomic regions modified by H3K27me3,and analyze the reprogramming characteristics of these modifications.RNA sequencing data,data from high-throughput chromosome conformation capture(Hi-C)technology,and publicly available single-cell data were integrated to investigate the target genes regulated by the reprogramming of H3K27me3 modifications in diffuse gastric cancer cells.Results The quality of the CUT&Tag and RNA sequencing data met the standards required for subsequent analysis.Histone H3K27me3 modifications in normal gastric mucosa and diffuse gastric cancer tissues were primarily distributed in distal intergenic regions and intronic regions.In gastric cancer tissues,compared to normal tissues,there was significant reprogramming of H3K27me3 modifications,characterized by a marked reduction in overall H3K27me3 signal intensity.The loss of 2 912 H3K27me3 signal peaks might lead to the up-regulation of 822 tumor-associated genes.Among them,56 genes displayed the most significant up-regulation(fold change in signal intensity≥2,P<0.05),with notable enrichment in the mammalian target of rapamycin complex 1(mTORC1)signaling pathway.Specifically,the methionine transporter SLC7A5 and the cystine transporter SLC7A11 were found to have the highest expression levels in gastric cancer tissues.Single-cell data revealed that the abnormal overexpression of SLC7A11 in diffuse gastric cancer was primarily observed in tumor epithelial cells.Further validation using public data and immunohistochemical experiments confirmed the elevated expression of SLC7A11 in diffuse gastric cancer,which is associated with poor prognosis in gastric cancer patients.Conclusion The reprogramming of histone H3K27me3 modification is an important epigenetic characteristic in diffuse gastric cancer.Loss of H3K27me3 signal peaks may up-regulate the expression of SLC7A11 in diffuse gastric cancer cells,and thereby promote tumor progression.

Objective To investigate the diagnostic value of endoscopic sign of light blue crest(LBC)capsuling papillary lesion(LCPL)for high-risk intestinal metaplasia(IM).Methods A total of 314 patients(352 biopsy specimens)who underwent endoscopic examination and biopsy in Department of Gastroenterology of Army Medical Center of PLA from January 2021 to June 2023 were recruited,and HE and HID-AB staining(the golden standard of high-risk IM)were apllied to detect the histological types and IM types.The samples were subsequently divided into chronic inflammation group,low-risk IM group,high-risk IM group,well-differentiated intestinal-type gastric cancer group,and poorly-differentiated intestinal-type gastric cancer group.The positive rate of LCPL in each group and its diagnostic efficacy were analyzed based on endoscopic images of the biopsy sites.Logistic regression analysis was used to investigate the relationship between LCPL sign and high-risk IM,as well as the clinical and pathological features associated with LCPL sign.Receiver operating characteristic(ROC)curve was plotted to evaluate the diagnostic efficacy of LCPL for high-risk IM,using indicators such as sensitivity,specificity,Youden index and area under the curve(AUC).Results The positive rate of the LCPL sign in high-risk IM group was 75.70%,significantly higher than that of the other groups(all P<0.001).Logistic regression analysis showed that LCPL sign was significantly correlated with high-risk IM(OR=30.286,95%CI:13.528～67.804,P<0.001).When the sign was employed in diagnosing high-risk IM,the sensitivity was 69.84%,the specificity was 93.75%,the Youden's index was 0.636,and the AUC value was 0.818(95%CI:0.773～0.857).Besides sensitivity,all above parameters of LCPL sign showed significantly better diagnostic efficacy than those of traditional LBC sign,which is used as a sign for diagnosing IM(P<0.001).Moreover,recognition of LCPL sign was not easily affected by age(OR=1.130,95%CI:0.709～1.800,P=0.607),lesion site(Angular incisure:OR=2.360,95%CI:0.732～7.613,P=0.151;Autrum:OR=2.257,95%CI:0.756～6.744,P=0.145),and presence of peptic ulcers(OR=1.085,95%CI:0.208～5.652,P=0.923).Significantly,94.12%of positive and 66.94%of negative LCPL signs could be rapidly recognized within 3 s(OR=4.536,95%CI:1.372～14.997,P=0.013).Conclusion LCPL sign shows high efficacy and potential clinical application value for high-risk IM in gastric mucosa of endoscopic diagnosis.

Objective To systematically evaluate the qualitative studies on the care experience of caregivers for primary malignant bone tumors patients,in order to provide references for the construction of bone tumor support care system.Methods The Cochrane Library,PubMed,Embase,CNKI,Wanfang Database,VIP database,and China Biomedical Literature Database were searched by computer to collect qualitative studies on the care experience of caregivers of malignant bone tumors patients from the establishment of the databases to November 2022.The quality of the literature was evaluated using the Joanna Briggs Institute(JBI)Quality Evaluation Criteria for Quality Research in Evidence-Based Health Care Centers(2016),and the results were integrated by a pooled integration approach.Results A total of 12 studies were included;48 themes were extracted and summarized into 9 categories,which were combined into 3 integrated results.Integration result 1 is obvious physical and mental disturbance.Integration result 2 is multiple role maladaptation.Integration result 3 is positive growth after adjustment.Conclusion Caregivers of patients with malignant bone tumors have serious physical and mental burden and are eager for multiple support.It is suggested that medical staff pay attention to the multi-dimensional needs of patients,formulate personalized support strategies,help caregivers adapt and transform their roles,and promote the post-traumatic growth of caregivers.

Objective:To evaluate the incidence, clinical significance and influencing factors on in-stent stenosis(ISS) after treatment of intracranial aneurysms by Pipeline embolization device(PED).Methods:A retrospective analysis was conducted on the clinical data of 161 patients with intracranial aneurysms treated with PED at the Department of Interventional Radiology of the First Affiliated Hospital of Zhengzhou University from April 2015 to July 2021. PED was implanted into the parent artery through the femoral artery approach after general anesthesia. The first DSA follow-up duration time and imaging data were collected, and the patients were divided into ISS group and non-ISS group accordingly. The degree of aneurysm occlusion was evaluated by O′Kelly-Marotta(OKM) grading scale. Univariate and multivariate logistic regression analysis were applied to identify the factors related to ISS.Results:A total of 179 PED were employed in 161 patients with 168 aneurysms. Eighty-eight (52.38%) aneurysms were treated by PED only, and 80 (47.62%) aneurysms by PED combined with coiling. After a median follow-up of 6 (5, 7) months, 31(18.45%) aneurysms had ISS within the PED, of which 16(9.52%) cases were with mild stenosis (<50%), 13 (7.74%) were with moderate stenosis (50%-75%), and 2(1.19%) were with severe stenosis (>75%). All patients with ISS showed no relevant clinical symptoms. One (0.60%) patient with ISS underwent balloon angioplasty. Univariate analysis showed that the stent diameter, aneurysm location, triglyceride level, the diameter of distal parent artery, and the diameter of proximal parent artery were associated to ISS. Further multivariate logistic regression analysis showed the stent diameter (OR=0.332, 95%CI 0.191-0.578, P<0.001) and triglyceride level (OR=1.641, 95%CI 1.034-2.605, P=0.036) were independent factors of ISS. Conclusions:ISS is a common benign complication after PED treatment. The current results suggest that small stent diameter and high triglyceride level are independent factors of ISS.

Objective? To investigate the changes of body temperature and the effect of nursing intervention in patients with low body mass index (BMI＜18.5 kg/m2) during thoracic surgery. Methods? Sixty patients with low BMI who underwent thoracic surgery in the Operating Department of the 4th Hospital of Hebei Medical University from June 2016 to December 2018 were randomly divided into observation group and control group, with 30 cases in each group. In addition, 30 patients with normal BMI (18.5-23.0 kg/m2) who underwent thoracic surgery in the same period were selected as the normal group. The observation group adopted comprehensive thermal insulation measures during the operation, and the control group and the normal group adopted routine insulation measures. The patient's body temperature of three groups was compared at each time point: entering operation room, disinfection, body cavity exploration , cutting specimens, closing the chest, suture skin and exiting operation time. the occurrence of adverse reactions during surgery, the blood coagulation index and lactic acid in the peripheral blood before and at the end of surgery, and the peripheral blood inflammatory factor levels were also compared. Results? There were no significant differences in body temperature between the three groups (P＞ 0.05). During the operation, the body temperature of the three groups decreased, and the recovery from the chest was restored. There were significant differences in body temperature between the three groups (P＜ 0.05) at the time point: closing the chest, suture skin and exiting operation room. The incidence of adverse reactions in the observation group was lower than that in the control group and the normal group, and the difference was statistically significant (P＜ 0.05). There was no significant difference in the incidence of adverse reactions between the control group and the normal group (P＞ 0.05). The coagulation and stress indexes of the observation group and the control group were significantly different from those of the normal group (P＜ 0.05). There was no significant difference in the coagulation,lactic acid and stress indexes between the observation group and the control group (P＞ 0.05). The coagulation, lactic acid and stress indexes of the three groups were significantly different before and after surgery (P＜ 0.05). There was a statistically significant difference in interleukin-6(IL-6) levels before and after surgery (F=134.241, P＜ 0.001); there was an interaction between the intervention and the time, and the difference was statistically significant (Finteraction =12.202, P＜0.001). There were significant differences between the three groups in the interleukin-10(IL-10) level group (between group F=7.792, P ＜ 0.001); the difference of IL-10 levels before and after surgery was statistically significant (Ftime=112.121, P＜ 0.001); There was an interaction between the intervention and the time, and the difference was not statistically significant (Finteraction=2.990,P=0.055). Conclusions? Compared with patients with normal BMI thoracic surgery, patients with low BMI have abnormal blood coagulation and stress indicators before surgery, and are more likely to have intraoperative blood pressure drop and adverse reactions. Comprehensive intraoperative warming measures can effectively prevent hypothermia in patients with low BMI.

ObjectiveThe aim of this study was to evaluate and compare the surgical outcomes of endoscop ic and conventional open thyroidectomies in patients with thyroid disease.Methods116 patients with tyroid tumor were enrolled.56 patients underwent endoscopic thyroidectomy ( endoscopic group ),and 60 patients underwent conventional open thyroidectomy( conventional group).We analyzed the patients' clinic characteristics,surgical outcomes and complications between the two groups.ResultsThe blood loss was less in the endoscopic group than the open group[( 16.8 ± 9.6) ml vs ( 24.9 ± 14.2 ) ml,t =- 2.427,P ＜ 0.05].The degree of satisfaction for cosmetic outcome in endoscopy group( 96.4％ ) was higher than that in conventional group ( 16.7％ ) ( x2 =74.508,P ＜ 0.01 ).There was no significant difference in the operating time,volume of drainage and postoperative hospital stay between two groups,and there was no significant difference in the skin ecchymosis,redness and swelling and postoperative pain between two groups( all P ＞ 0.05).No severe postoperative complication was encountered,such as injuries of the re current or superior laryngeal nerve,parathyroid gland injury or massive hemorrhage.ConclusionEndoscopic thyroidectomy has less blood loss,mini-open and excellent cosmetic benefits compared with conventional open thyroidectomy.

Objective To look for a better way to assay vascular endothelial growth factor(VEGF) and explore the correlation of serum VEGF levels with platelet and leucocyte count in breast cancer by comparison of peripheral blood plasma, serum and P-APR. Methods Blood samples were obtained from 42 patients with breast cancer and 20 healthy volunteers. Serum, plasma and P-APR samples were analyzed for VEGF using a commercially available sandwich ELISA, and assayed for semiquantitative measurement using microplatereader. At the same time, samples were analyzed by hematology analyzer. Results The level of VEGF in peripheral blood positively correlated to platelet (health control group: r=0.424, P=0.063) and leucocyte (health control group: r=0.443, P=0.050). The difference in VEGF values of P-APR between the localized breast cancer group and the health control group was statistically significant. Conclusion The level of VEGF in peripheral blood positively correlates to platelet and leucocyte. Platelet and leucocyte possibly secrete VEGF in vitro. Compared with serum and plasma, P-APR is the best section assaying VEGF in peripheral blood.

Objective To compare the efficacy of retroperitoneal laparoscopy with open pyeloplasty for ureteropelvic junction obstruction(UPJO).Methods Retroperitoneal laparoscopy was performed under general anesthesia with the patients placed in lateral position.Three trocars were inserted at the midaxillary line above the iliac crest,and the pre- and post-axillary lines beneath the 12th rib.A fourth port was placed at the preaxillary line above the iliac crest.Over the medial margin of the psoas major,Gerota’s fascia was opened to expose the ureter.And then,the tissues around the ureter were cut to show the lower pole of the kidney.Afterwards,the redundant renal pelvis and the strictured segment of the ureter were resected,pelvi-ureteric anastomosis was completed with absorbable sutures,and a double-J stent was inserted.Open pyeloplasty was also carried out under general anesthesia with the patients in lateral position.An incision was made beneath the 12th rib to expose the ureteropelvic junction,and then the renal pelvis was cut at 2 cm away from the renal parenchyma,and the strictured segment of the ureter was resected.Double-J stent was indwelled after pelvi-ureteric anastomosis.The patient was placed in a lateral position under general anesthesia or epidural anesthesia.Subcostal incision was made.The lower pole of the kidney,the dilated renal pelvis and the upper ureter were mobilized in front of the psoas major.Cut the pelvis 2 cm away from the parenchyma and the PUJ was dismembered.The pelvi-ureteric anastomosis was completed with absorbable sutures and then a D-J stent was inserted.Results Compared with the open surgery group,the laparoscopy group experienced significantly longer operation time [(156.9?69.2) min vs(111.9?78.1) min,t=2.514,P=0.014],but less blood loss [mean:35(20-70)ml vs 110(60-175)ml,t=7.502,P=0.000],and shorter analgesic treatment and postoperative hospital stay [(0.7?0.3) d and(8.5?6.1) d vs(1.3?0.5) d and(15.5?10.8) d;t=-5.842,and -3.193;P=0.000 was found and 0.002].No significant difference in the occurrence of postoperative complications and hydronephrosis between the 2 groups was found [laparoscopy vs open surgery:urinary leakage:3 cases vs 3 cases,?2=0.000,P=1.000;incisional infection:0 vs 1,?2=0.000,P=1.000;and recurrence of UPJO:1 vs 0,?2=0.000,P=1.000;hydronephrosis:?2=5.192,P=0.182].Conclusions The efficacy of retroperitoneal laparoscopic pyeloplasty is comparable to open surgery.The procedure results in less blood loss and quicker recovery.