Objective To detect the expression of N-acetyltransferase 10(NAT10)and polyadenylate bind-ing protein cytoplasmic 1(PABPC1)in non muscle invasive bladder cancer(NMIBC),and analyze the correla-tion between them and epithelial mesenchymal transition(EMT)and prognosis.Methods A total of 122 pa-tients with NMIBC treated in the hospital from May 2019 to May 2021 were selected.Immunohistochemistry was used to detect the expression of NAT10 and PABPC1 proteins in NMIBC tissues.Real time fluorescence quantitative polymerase chain reaction(qPCR)was used to detect the expression of NAT10,PABPC1 mRNA,and EMT markers in NMIBC tissues.Pearson correlation analysis was conducted on the correlation between EMT indicators[Snail,N-cadherin(N-cad),vimentin(Vim)mRNA].Cox regression analysis was conducted on the relationship between NAT10,PABPC1 and prognosis of NMIBC.Results Compared with adjacent tis-sues,the expression of NAT10 mRNA,PABPC1 mRNA,Snail mRNA,N-cad mRNA,and Vim mRNA in NMIBC cancer tissues was higher,and the difference was statistically significant(P＜0.001).The expression of NAT10 mRNA,PABPC1 mRNA in NMIBC cancer tissues was positively correlated with Snail mRNA,N-cad mRNA,and Vim mRNA(r=0.678,0.702,0.711,0.754,0.788,0.663,P＜0.001).The positive rates of NAT10 and PABPC1 in NMIBC cancer tissues were 59.02％(72/122)and 60.66％(74/122),respectively,while those in adjacent tissues were 6.56％(8/122)and 4.92％(6/122),respectively(x2=76.176,85.995,P＜0.001).The positive rates of NAT10 and PABPC1 in NMIBC cancer tissues were higher than those in ad-jacent tissues,and the difference was statistically significant(x2=76.176,85.995,P＜0.001).The positivity rates of NAT10 and PABPC1 in cancer tissues of stage T1,high-grade NMIBC patients were higher than those in cancer tissues of Ta/Ti,low-grade patients,and the differences were statistically significant(P＜0.05).The 3-year overall progression free survival rates of NMIBC patients in the NAT10 positive and negative groups were 48.61％(35/72)and 80.00％(40/50),respectively,with a statistically significant difference(Log rank x2=13.780,P=0.000).The 3-year overall progression free survival rates of PABPC1 positive and negative patients were 47.30％(35/74)and 83.33％(40/48),respectively,with a statistically significant difference(Log rank x2=11.830,P=0.001).T1 stage,high-grade,NAT10 positive,and PABPC1 positive were risk fac-tors affecting the prognosis of NMIBC.Conclusion The expression of NAT10 and PABPC1 in NMIBC cancer tissue is significantly upregulated and positively correlated with EMT markers,which is correlated with poor prognosis of NMIBC.

Objective To observe the clinical efficacy of Ginkgo Diterpene Lactone Meglumine Injection combined with alteplase(rt-PA)in the treatment of acute ischemic stroke with large vessel occlusion.Methods A total of 170 patients with acute ischemic stroke with large vessel occlusion were selected as the study subjects and randomly divided into control group(receiving intravenous rt-PA thrombolytic therapy)and observation group(receiving Ginkgo Diterpene Lactone Meglumine In-jection in addition to the treatment in the control group),with 85 cases in each group.Serological in-dicators[neuron-specific enolase(NSE),vascular endothelial growth factor(VEGF),homocysteine(Hcy),high-sensitivity C-reactive protein(hs-CRP),matrix metalloproteinase-9(MMP-9)],cere-bral blood flow velocity in the middle cerebral artery[end-diastolic velocity(EDV),peak systolic ve-locity(PSV),mean velocity(Vm)],neurological function[National Institutes of Health Stroke Scale(NIHSS)score],cognitive function[Mini-mental State Examination(MMSE)score],modi-fied Rankin Scale(mRS)score,and the incidence of complications were compared between the two groups.Results After treatment,the serum levels of NSE,Hcy,hs-CRP,MMP-9,and the NIHSS and mRS scores in both groups were lower than those before treatment,while the serum level of VEGF and the MMSE score were higher than those before treatment(P＜0.05).Moreover,the serum lev-els of NSE,Hcy,hs-CRP,MMP-9,and the NIHSS and mRS scores in the observation group were lower than those in the control group,and the serum level of VEGF and the MMSE score were higher than those in the control group,with statistically significant differences(P＜0.05).After treat-ment,the EDV,PSV and Vm in both groups were higher than those before treatment,and those in the observation group were higher than those in the control group,with statistically significant differ-ences(P＜0.05).There was no statistically significant difference in the overall incidence of com-plications between the two groups(P＞0.05).Conclusion Ginkgo Diterpene Lactone Meglumine Injection combined with rt-PA can effectively improve the neurological and cognitive functions of a-cute ischemic stroke patients with large vessel occlusion.

【Objective】 To investigate the efficacy and safety of 450 nm blue laser with 6 o’clock positioning in the treatment of middle lobe hyperplasia of prostate, in order to promote the clinical application of this surgery. 【Methods】 Clinical data of 20 patients with middle lobe hyperplasia of prostate treated with 450 nm blue laser with 6 o’clock positioning during Mar.and Aug.2023 were retrospectively analyzed.The operation time, postoperative bladder irrigation time, catheter indwelling time, hospital stay, and complications were recorded.The maximum urinary flow rate (Qmax), post-void residual volume (PVR), quality of life scale (QoL), international prostate symptom score (IPSS) before surgery and 1 month after surgery were compared. 【Results】 The operation time was (26.80±7.22) min, and bladder irrigation time was (20.50±1.79) h.The catheter was removed on the next day after surgery and all patients were discharged 2 days after operation.Compared to preoperative, one month after surgery, the Qmax [(7.40±1.05) mL/s vs.(19.60±1.76) mL/s] was significantly higher, PVR [(73.50±12.26) mL vs.(9.25±4.94) mL], QoL [(4.55±1.19) vs.(1.95±0.95)], and IPSS [(26.55±1.88) vs.(10.05±1.36)] were significantly lower, the differences being statistically significant (P<0.05).No complications occurred during operation and 1-month follow-up. 【Conclusion】 The 450 nm blue laser with 6 o’clock positioning is a new, safe and effective surgical treatment of middle lobe hyperplasia of prostate, which is worthy of clinical promotion and application.

[Objective] To explore the correlation between the 5-factor modified frailty index (mFI-5) and acute kidney injury (AKI) after laparoscopic radical nephrectomy in elderly patients with renal cancer, so as to provide reference for the prevention and treatment of postoperative AKI. [Methods] A retrospective analysis was conducted on the clinical data of 214 elderly patients (≥60 years) who underwent laparoscopic radical nephrectomy at our hospital during Dec.2018 and Dec.2021.Patients were divided into frail group (n=75, mFI-5≥2) and non-frail group (n=139, mFI-5<2). The incidence of AKI and sub items of mFI-5 were compared between the two groups.According to the occurrence of AKI, patients were divided into AKI group (n=77) and non-AKI group (n=137). Univariate and multivariate logistic analyses were conducted to identify risk factors of AKI.Receiver operating characteristic (ROC) curves were plotted to test the effectiveness of mFI-5 in predicting AKI. [Results] The incidence of AKI was significantly higher in the frail group than in the non-frail group (64.00% vs. 20.86%, P<0.05). Univariate analysis showed that the incidence of AKI was related to gender, diabetes, hypertension, nonfunctional independent status, weakness and split kidney glomerular filtration rate (GFR). Multivariate logistic regression analysis showed that male (OR=2.454, 95%CI: 1.193—5.047), complicated weakness (OR=6.580, 95%CI: 3.380—12.811), and low split kidney GFR (OR=0.945, 95%CI: 0.911—0.980) were independent risk factors of AKI (P<0.05). The area under the ROC curve of AKI predicted by mFI-5 was 0.711. [Conclusion] Preoperative mFI-5 score is an effective predictor of AKI in elderly patients undergoing laparoscopic radical nephrectomy.As patients with frailty have a higher risk of AKI, preoperative evaluation and monitoring should be strengthened and timely intervention should be taken to improve the prognosis.

Objective To study the value of postmortem imaging on the diagnosis of intestinal perforation.Method Postmortem imaging(PMCT and PMCTA)data of 2 intestinal perforation deaths(and 4 controlled cases)were reviewed retrospectively.Diagnosing capacities of intestinal perforation by postmortem imaging method were further investigated.Results PMCT is sensitive in detecting the free air and liquid induced by intestinal perforation.PMCT can sometimes detect the gravity-dependent purulent secretions in the abdominopelvic cavity.PMCTA can visualize the extravasation of contrast agent from the perforation,which can be used to locate the accurate perforation region.Conclusion Postmortem imaging method(PMCT and PMCTA)is an important tool for the diagnosis of intestinal perforation,which can not only be used as a forensic diagnosis method,but is also useful to locate the perforation site before an forensic autopsy.

Objective:To investigate the clinical value of improved perforator area CTA three-dimensional reconstruction in design and harvest of anterolateral thigh perforator flap(ALTPF) and deep inferior epigastric artery perforator flap(DIEPF).Methods:Repairs of defects of oral and maxillofacial tumour resection with ALTPF for 8 patients and defects of breast tumour resection with DIEPF for 2 patients were performed from September 2021 to January 2022 in the Department of Hand and Microsurgery of Affiliated Hospital of Binzhou Medical College. According to the improved scanning parameters and drug administration protocol, patients underwent CTA scans of both thighs or abbomen before operation. The data of CTA were sent to GE AW 4.7 work station to produce three-dimensional reconstruction of perforator area and angiosome. The source artery and perforator were observed dynamically from the angiosome in the perforator area, and the specific data were measured. The perforator location was marked by HHD, and then according to the measurement data of CTA three-dimensional reconstruction marked the location, course of perforator and the course of source artery on the body surface. The data of source arteries and perforators explored during the operation were compared with preoperative three-dimensional reconstruction. The perforator locations of CTA were compared with the HHD. The harvest time and survival condition of flap were compared with the previous patients who only had the perforator location markers from HHD. The sizes of ALTPFs and DIEPFs were 4.0 cm×4.0 cm-15.0 cm×6.0 cm and 19.0 cm×7.5 cm-25.0 cm×10.0 cm, respectively. The survival of flaps and the healing of wound were observed in the postoperative follow-up in terms of appearance, texture, function of recipient site and the shape and function of the donor site.Results:Eight ALTPFs and 2 DIEPFs all survived without any adverse event. Both recipient and donor sites healed well without any complication. Seven femoral septocutaneous perforators, 2 musculocutaneous perforators and abdominal 3 perforators coursed directly, 2 tortuously perforators were seen from three-dimensional reconstruction. The types and origins of perforators explored during operation were basically consistent with three-dimensional reconstruction. The accuracy of CTA[(0.36±0.11) cm] was higher than HHD[(0.54±0.19) cm] for perforators location( t=-3.160, P<0.05). Compared with the previous group[(74.60±30.53) min], this group[(52.80±24.57) min] had a shorter time to cut out the flap of similar area( t=-9.179, P<0.05). In the previous group, one flap transfer was failed due to the thinner caliber of perforator and source artery. All the flaps survived with satisfactory outline and softness with good blood supply after 2-6 months of follow-up. The oral and maxillofacial functions were normal. The reconstructed breasts were symmetrical with the healthy side, and the shape was satisfactory. Only linear scars remained in the donor sites without dysfunction. Conclusion:The improved CTA three-dimensional reconstruction of perforator area can help to determine the detailed location, course and distribution of the perforators at the superficial fascia layer. It provides a reliable bases in the design and harvest of perforator flaps during operation, reduces the perioperative risks and has certain clinical values.

【Objective】 To identify and propose blood transfusion suggestions for 3 children suspected to have red blood cell T polyagglutination. 【Methods】 According to the RBC reactions with phytohemagglutinin, adult serum and cord blood serum, aggregation test with polybrene reagent and MN antigen phenotype test were carried out on 3 children to confirm the presence of T polyagglutination. The donor serum with negative or weak reactions was selected by minor cross matching for the 3 children who needed therapeutic plasma exchange(TPE). 【Results】 Three cases of RBC T polyagglutination were caused by bacterial infection, with transient appearance of MN antigen; the samples were reactive to peanut agglutinin, soybean agglutinin, adult serum but nonreactive to cord blood serum, and didn′t aggregate after adding polybrene reagent. After receiving timely TPE, the T polyagglutination gradually disappeared. 【Conclusion】 Some bacteria, such as Streptococcus pneumoniae, may cause polyagglutination of red blood cells. The patients with suspected T polyagglutination should be diagnosed in time. For T polyagglutination patients, the minor matched plasma should be used for avoiding the random plasma with anti-T antibody transfusion.

Objective:To explore the relationship between microRNA-4429 (miR-4429) derived from serum exosomes and prognosis of radical radiation and chemotherapy for non-small cell lung cancer (NSCLC).Methods:309 blood samples of NSCLC patients were collected [before chemotherapy (T0), after 1 cycle of chemotherapy (T1) and after 2 cycles of chemotherapy (T2), 103 cases at each time point], and the expression level of miR-4429 was detected by real-time fluorescent quantitative PCR method, and the relationship between it and the prognosis of radical radiation and chemotherapy in NSCLC was analyzed.Results:The 1-year, 2-year and 3-year survival rates of 103 NSCLC patients were 69.90%, 45.63% and 34.95%, respectively. The expression levels of T1-miR-4429 and T2-miR-4429 in the survival group were 0.66±0.14 and 0.77±0.11, respectively, which were higher than T1-miR-4429 (0.60±0.06) and T2-miR-4429 (0.62±0.11) in the death group, and the differences were statistically significant ( t=2.269, 6.997, P<0.05). Restricted cubic spline fitting COX regression analysis showed that T2-miR-4429 had a linear relationship with survival in NSCLC. COX regression analysis showed that TNM staging was an independent risk factor for the survival and prognosis in NSCLC ( P<0.05), and the degree of differentiation, targeted therapy and T2-miR-4429 were all independent protective factors for the survival and prognosis in NSCLC ( P<0.05). The calibration curve of the nomogram regression model constructed by TNM stage, degree of differentiation, targeted therapy and T2-miR-4429 coincided well with the ideal curve, and the C-index was 0.713. Conclusions:The high expression level of T2-miR-4429 indicates that NSCLC patients have a low risk of poor survival prognosis. The nomogram regression model constructed by TNM staging, degree of differentiation, targeted therapy and T2-miR-4429 has a certain degree of discrimination and accuracy, which can assist in evaluating the prognosis of NSCLC.

Objective:To analyze the expression of mismatch repair genes MLH1 and PMS2 in elderly colorectal cancer patients and its association with the clinicopathological features.Methods:This study was a single-center retrospective cohort study.According to the loss of MLH1 and PMS2 gene expression, elderly patients with colorectal cancer admitted to Beijing Hospital from January 2014 to December 2018 were consecutively enrolled and divided into the MLH1 group(n=65)and the PMS2 group(n=80). Pathological features were compared between the MLH1 group, the PMS2 group and patients with normal MLH1 and PMS2 gene expression.Results:Among patients with the loss of MHL1 protein expression, pathological features were similar in males and females.A minority of patients(16.9%)had a family history of tumors.Most lesions were either moderately differentiated(63.1%)or poorly differentiated(24.6%). Regarding staging, 44.6% were in stage T4, 27.7% were in stage T3, 61.5% were in N0, 89.2% were in M0, and most patients were in TNM stage Ⅲ.Lesions were mostly located in the ascending colon(61.5%). Compared with patients with normal expression of MHL1, patients with the loss of MHL1 protein expression were younger[(74.6±8.8) years old vs.(77.3±6.2) years old, t=-2.072, P=0.040]and had greater maximal tumor length[(5.7±2.3) cm vs.(4.4±1.3) cm, t=3.753, P<0.001], and there were significant differences in lesion differentiation, T staging and tumor location between the two groups( P<0.05). Conclusions:Loss of MLH1 or PMS2 gene expression in elderly colorectal cancer patients is associated with an early age of onset, rapid tumor progression, poor differentiation, and pathological staging.

Objective: To evaluate the effect of preservation of left colic artery (LCA) on postoperative anastomotic leakage in patients with rectal cancer after neoadjuvant therapy. Methods: A retrospective cohort study was conducted to collect data of rectal cancer patients at Department of Gastrointestinal Surgery of Fujian Cancer Hospital from September 2014 to August 2017. Inclusion criteria: (1) age of 18 to 79 years; (2) rectal adenocarcinoma confirmed by postoperative pathology; (3) patients without preoperative serious cardiovascular and cerebrovascular disease receiving preoperative neoadjuvant radiotherapy or chemoradiotherapy; (4) laparoscopic-assisted anterior rectal resection and distal ileostomy were performed simultaneously; (5) complete clinical data. Exclusion criteria: patients with extensive abdominal metastasis, or distant organ metastasis during operation, and combined organ resection. According to whether LCA was retained during operation, the patients were divided into two groups, then the intraoperative and postoperative clinical outcomes were compared. Moreover, univariate analysis and multivariate logistic regression were used to analyze risk factors of postoperative anastomotic leakage. Results: A total of 125 patients were included in this study, including 56 patients in the retained LCA group and 69 patients in the non-retained LCA group. Differences in baseline data, such as gender, age, diabetes mellitus, body mass index, hemoglobin, distance between tumor and anal margin, maximum diameter of tumor, preoperative neoadjuvant therapy, and ypTNM stage, between retained LCA group and non-retained LCA group were not statistically significant (all P>0.05), indicating that two groups were comparable. Meanwhile there were no significant differences in operation time, intraoperative blood loss, total number of lymph node harvested, number of harvested lymph node at the root of inferior mesenteric artery, circumferential margin, anastomotic bleeding, or postoperative hospital stay between two groups (all P>0.05). Thirteen patients in the non-retained LCA group (18.8%) developed postoperative anastomotic leakage, including 7 cases of grade A, 5 cases of grade B and 1 case of grade C, while in the retained LCA group, only 5.4% (3/56) of patients developed postoperative anastomotic leakage, including 1 case of grade A and 2 cases of grade B without case of grade C, whose difference was statistically significant (U=1674.500, P=0.028). Univariate analysis showed that preoperative hemoglobin <120 g/L and non-retained LCA were associated with postoperative anastomotic leakage (both P<0.05). Multivariate analysis cofirmed that preoperative hemoglobin < 120 g/L (OR=3.508, 95% CI: 1.158 to 10.628, P=0.017) and non-retained LCA (OR=4.065, 95%CI: 1.074 to 15.388, P=0.031) were independent risk factors for postoperative anastomotic leakage. Median follow-up time was 31 months (16 to 51 months), and no long-term complication was found. Local recurrence and distant metastasis were found in 1 case (1.8%) and 7 case (12.5%) in the retained LCA group, while those were found in 2 cases (2.9%) and 5 cases (7.2%) respectively, in the non-retained LCA group, whose differences were not statistically significant (P=1.000, P=0.321 respectively). Conclusion Preservation of left colic artery not only can ensure radical lymph node dissection efficacy under the condition of similar operation time and blood loss, but also can effectively reduce the incidence of postoperative anastomotic leakage for rectal cancer patients after neoadjuvant therapy.