Objective:To discuss the factors related to the prognosis in the alpha fetoprotein(AFP)negative hepatocellular carcinoma(HCC)patients,and to construct the nomogram for predicting the survival time of the patients.Methods:The retrospective analysis on data of 2 064 cases of AFP negative HCC patients extracted from the Surveillance,Epidemiology,and End Results(SEER)Database was conducted,and all the patients were divided into training cohort and internal validation cohort at a ratio of 7∶3,and 101 AFP negative HCC patients from the Integrated Traditional Chinese and Western Medicine Hospital in Hunan Province were regarded as the external validation cohort.The univariate Cox regression analysis results were incorporated into the multivariate analysis,and the independent risk factors for the AFP negative HCC patients were obtained by multivariate Cox analysis to build a cancer specific survival(CSS)prognosis nomogram for the AFP negative HCC patients.The predictive efficacy and clinical utility of the nomogram were evaluated by time-dependent receiver operating characteristic curve(ROC),calibration plots,and decision curve analysis(DCA).The total score obtained from the nomogram was used for the risk stratification to compare the degree of risk discrimination between the nomogram and the American Joint Committee on Cancer(AJCC)staging system.Results:Ten independent risk factors were selected by multivariate Cox regression analysis to construct 3-year,4-year,and 5-year CSS prognostic nomograms for the AFP negative HCC patients,including the patient's age,pathological grade,surgical status,radiotherapy status,chemotherapy status,lung metastasis status,tumor size,tumor T stage,tumor M stage,and marital status.The area under curve(AUC)for the 3-year,4-year,and 5-year time-dependent ROC in the training cohort were 0.807(95%CI:0.786-0.828),0.804(95%CI:0.782-0.826),and 0.813(95%CI:0.790-0.835),respectively.In the internal validation cohort,they were 0.776(95%CI:0.743-0.810),0.772(95%CI:0.737-0.808),and 0.789(95%CI:0.752-0.826),and in the external validation cohort,they were 0.773(95%CI:0.677-0.868),0.746(95%CI:0.620-0.872),and 0.736(95%CI:0.577-0.895).The calibration plots verified that the nomogram fitted well with the perfect line.The DCA curve revealed that the net benefit of the nomogram was significatly higer than that of the AJCC staging system at certain probability thresholds compared with AJCC staging,the nomogram had a better ability to identify high-risk individuals.Conclusion:The serum AFP expression is one of the prognostic markers for the HCC patients.For those patients with AFP negative expression in serum,different considerations should be taken.The nomogram model based on multiple risk factors is a promising clinical tool for assessing the CSS in the AFP negative HCC patients.

ObjectiveTo investigate the effects of epigallocatechin-3-gallate （EGCG） on learning and memory abilities of amygdala electrical kindling-induced epilepsy in rats and its mechanism. MethodMale SD rats were randomly divided into the normal group， model group， intervention group （model+25 mg·kg^-1 EGCG）， and EGCG group （25 mg·kg^-1 EGCG）. Rats in the EGCG group were only given EGCG intraperitoneal injection， those in the normal group were only given electrode implantation， and those in the other experimental groups were given amygdala electrical kindling stimulation to establish a chronic kindling epilepsy model. EGCG was injected intraperitoneally daily before electrical stimulation. Twenty-four hours after the last electrical stimulation， the escape latency and percentage of target quadrant were recorded by the Morris water maze. Twenty-four hours after the behavioral test， rats in each group were sacrificed by decapitation. The number of hippocampal neurons was observed by Nissl staining. The thickness of postsynaptic density in the hippocampus， synaptic cleft， length of active zone and the curvature of synaptic interface were observed by transmission electron microscopy （TEM）. The expressions of synapse-related proteins synaptotagmin （Syt）， postsynaptic density-95 （PSD-95） and Kalirin-7 in the hippocampus were examined by Western blot. ResultCompared with those in the normal group， the escape latency was significantly prolonged （P<0.05， P<0.01） and the target quadrant ratio was significantly decreased in the model group （P<0.05）. The number of hippocampus neurons decreased significantly （P<0.01）. The synaptic cleft of the hippocampus was widened significantly， and the length of active zone and the thickness of postsynaptic density were significantly decreased （P<0.05， P<0.01）. The expressions of synapse-related proteins Syt， PSD-95 and Kalirin-7 in the hippocampus were significantly decreased （P<0.05，P<0.01）. Compared with those in the model group， the escape latency was significantly shortened and the percentage of target quadrant was significantly increased in the intervention group （P<0.05， P<0，01）. The number of hippocampal neurons significantly increased （P<0.01）. The synaptic cleft of the hippocampus was significantly shortened， and the length of active zone and postsynaptic density were significantly increased （P<0.05， P<0.01）. The expressions of synaptic related proteins Syt， PSD-95 and Kalirin-7 were significantly increased （P<0.05， P<0.01）. ConclusionEGCG can effectively improve cognitive dysfunction after epilepsy. Its protective effect may be achieved by protecting the ultrastructure of hippocampal synapses and regulating the expressions of synapse-related proteins Syt， PSD-95 and Kalirin-7.

Objective:Proximal femur tumor resection often leads to hip joint instability and functional loss.Various methods have been clinically applied to repair hip joint soft tissue function,but deficiencies remain.This study aims to evaluate the advantages and disadvantages of the ligament advanced reinforcement system(LARS)tumor tube in assisting soft tissue function reconstruction in patients undergoing tumor type artificial hip replacement surgery. Methods:This study included 85 patients(41 males,44 females)with proximal femoral tumors treated at the Xiangya Bone Tumor Treatment Center from January 2012 to January 2022,aged 10 to 79(38.5±18.2)years.Among them,13 cases had benign aggressive tumors,45 had primary malignant bone tumors,and 27 had bone metastases.Clinical data,imaging data,and intraoperative photos were collected.Patients were followed up and postoperative functional evaluations were conducted using the Musculoskeletal Tumor Society(MSTS)scoring system and Harris hip joint scoring system to assess limb function and hip joint function. Results:Preoperative pathological fractures were present in 37 cases(43.5％),with a lesion length of(9.4±2.9)cm.Among non-metastatic tumor patients,7 experienced postoperative recurrence,including 6 cases of osteosarcoma and 1 case of fibrosarcoma.Pulmonary metastases occurred in 9 osteosarcoma patients.Five patients required reoperation due to postoperative complications,including 3 cases of deep vein thrombosis,1 case of giant cell granuloma,and 1 case of prosthesis infection.Postoperatively,5 patients exhibited Trendelenburg gait,and 6 had leg length discrepancies.The postoperative MSTS score was 26.7±1.4,and the Harris score was 89.6±5.3. Conclusion:The LARS tumor tube can effectively assist in reconstructing the soft tissue function of the hip joint and greatly reduce postoperative complications,making it an effective technical improvement in joint function reconstruction in tumor type artificial hip replacement surgery.

OBJECTIVE To establish the quality standard of Triadica cochinchinensis and to perform the acute toxicity study. METHODS Appearance properties, powder microscopic identification, and thin-layer chromatography(TLC) identification were researched. The specific chromatogram was established by HPLC. The content of cadmium(Cd), lead(Pb), arsenic(As), copper(Cu), and mercury(Hg) was determined by inductively coupled plasma-mass spectrometry(ICP-MS). Acute toxicity was studied by maximum dose. RESULTS The outer skin of herbs was dark brown, and the inner surface was light yellow brown and fibrous. Besides, crystal sheath fiber was common, and calcium oxalate clusters arranges in rows. In the TLC diagram of the test product, the fluorescent spots of the same color were displayed at the corresponding position of the control product(scopoletin, isofraxidin). Five common peaks were calibrated in the characteristic map and the three characteristic peaks(scopoletin, isofraxidin, dimethylfraxetin) were recognized. The content of the measured heavy metal elements was lower than the national limit standard. The linear correlation coefficient was R2 > 0.999. The precision, stability, repetitive RSD were < 10%. The average recovery rate of the added sample was 80%−120%, and the RSD was < 10%. The maximum dose of the acute toxicity test was 184.09 g·kg−1. The 14 d internal body mass, food intake, organ-body ratios, the serum glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, blood urea nitrogen, and creatinine were not significantly different by comparing with the normal controls. Therefore, no significant toxicity was observed. CONCLUSION The established standard can provide a reference for evaluating the quality of Triadica cochinchinensis. The heavy metal content of ten batches of medicinal materials is within the safe range. Acute toxicity test show that there is no obvious significant adverse teactions after oral administration, and the safe dose range is large, which can provide a reference for the subsequent development and utilization.

China has become the world's second largest consumer market for cosmetics. The rapid development of the cosmetics industry requires that its regulatory management and standard and regulation also need to keep pace with the times and constantly improve. This paper compares domestic and foreign standards for skin sensitisation test, skin phototoxicity test and skin photoallergy test, and analysis the specific problems of the current standards and make recommendations.

Objective:To investigate the clinical significances of evaluation indexes of right heart function injury in patients with BCR-ABL-negative myroproliferative neoplasms (MPN).Methods:The clinical data of 208 patients with BCR-ABL-negative MPN diagnosed in the Second People's Hospital of Lianyungang and Jiangsu Province Hospital from January 2015 to August 2021 were retrospectively analyzed, including 63 cases of primary myelopathic fibrosis (PMF), 39 cases of polycytosis vera (PV) and 106 cases of essential thrombocythemia (ET). The clinical characteristics of patients and the examination results of hematological related indicators were compared among the three groups. The examination results of indexes of right heart function injury were analyzed, including echocardiography, brain natriuretic peptide, soluble growth stimulation expression gene-2 (sST-2), lactate dehydrogenase (LDH), D-dimer, ferritin, β 2-microglobulin, peripheral blood WT1 gene, CD34 + cell count, etc. Results:Of the 208 patients, 109 were male and 99 were female; the median age was 62 years old (23 years old, 89 years old). The differences in levels of hemoglobin, platelet count, D-dimer, LDH and ferritin among PMF, PV and ET patients were statistically significant (all P < 0.05). Color echocardiography was performed in 87 patients, including 26 cases of PMF, 19 cases of PV and 42 cases of ET. Pulmonary artery pressure increased in 69 cases (79.3%), left atrial diameter increased in 76 cases (87.3%), and diameter increased during right ventricular diastolic period in 59 cases (67.8%). There were significant differences in pulmonary artery pressure, left atrial diameter and diameter during right ventricular diastolic period among PMF, PV and ET patients (all P < 0.05). Pearson correlation analysis showed that pulmonary artery pressure was positively correlated with ferritin, LDH, sST-2 and age ( r values were 0.796, 0.768, 0.915 and 0.734, all P<0.05), while it was negatively correlated with platelet count ( r = -2.330, P = 0.034). Conclusions:For BCR-ABL-negative MPN patients, the increase of pulmonary artery pressure, ferritin and LDH and the decreased platelet count and hemoglobin may increase the probability of right heart function impairment. For BCR-ABL-negative MPN patients with the higher levels of ferritin, LDH, sST-2, age, and the lower level of platelet count, the pulmonary artery pressure may be higher.

Objective     To investigate the safety and feasibility of day surgery for patients with palmar hyperhidrosis based on the principles of enhanced recovery after surgery (ERAS). Methods     We retrospectively reviewed the medical records of consecutive patients who underwent endoscopic thoracic sympathicotomy (ETS) in the First Affiliated Hospital of Xi'an Jiaotong University from March 2020 to December 2021. Patients were divided into a day surgery group and a conventional group according to their perioperative management methods. The patients in the day surgery group underwent an optimized perioperative procedure under the guidance of ERAS, and were ventilated with a laryngeal or face mask during the operation. The patients in the conventional group completed the preoperative examination, operation and postoperative observation according to the conventional procedures, and were intubated with a single-lumen endotracheal tube. The demographic characteristics, operation time, hospital stay, postoperative complications, and hospitalization cost were compared between the two groups. Results     Finally 172 patients were collected, including 90 males and 82 females, with an average age of 25.97±7.43 years. There were 86 patients in each group. All patients ceased suffering from palmar sweating after surgery. No patient experienced massive bleeding or conversion to thoracotomy. There was no statistical difference in operation time between the two groups (P=0.534). Patients in the day surgery group were discharged within 24 hours. The average hospital stay in the conventional group was 2.09±0.41 days. Incidence of postoperative respiratory complications, and the hospitalization cost of the day surgery group were significantly lower than those of the conventional group (P<0.001). The satisfaction rate in both groups was greater than 95%. Conclusion     Day surgery for patients with palmar hyperhidrosis based on the principles of ERAS is safe and feasible, which can reduce postoperative complications, shorten the length of hospital stay and save the cost of hospitalization.

【Objective】 To investigate the feasibility and safety of semiconductor blue laser in the treatment of non-muscle invasive bladder cancer (NMIBC) in the day surgery model. 【Methods】 The clinical data of 22 NMIBC patients (average age 55.8 years and tumor size 1.4 cm) who underwent outpatient screening and accepted blue laser ambulatory surgery in our hospital during Jun.2022 and Sep.2022 were retrospectively analyzed. On the day of admission, transurethral resection of cancer was performed using blue laser en bloc enucleation. On the day of surgery or in the morning of next day, bladder irrigation was stopped, the catheter was removed, and patients were discharged. The baseline data, pre-hospital waiting time, operation time, length of hospital stay, hemoglobin decrease, complications and management, follow-up, medical costs, and patients’ satisfaction rate were recorded. 【Results】 The pre-hospital waiting time was 2 to 7 days, average (4.1±1.3)days. The operation time was 29 to 50 minutes, average (40.8±5.5)minutes. The length of hospital stay was 0.6 to 1.2 days, average (0.9±0.2)days. Hemoglobin decrease was 1 g/L to 8 g/L, average (3.8±1.8)g/L. The catheter was indwelt for 0.5 to 1 day, average (0.7±0.1)day. The medical costs were 13 790 to 16 811 Yuan, average (14 941.5±690.2) Yuan. Patients’ satisfaction rate was 100.0%. Mild intraoperative and postoperative complications occurred in 2 cases. One patient developed symptoms of cystitis which disappeared after 2 days of oral antibiotic cefixime, and another patient developed bladder spasm which was relieved after oral solifenacin succinate tablets. No adverse events such as obturator nerve reflex or bladder perforation occurred. After removal of the catheter, no urinary retention was observed. 【Conclusion】 This study was the first to apply blue laser ambulatory surgery in the treatment of bladder cancer, confirming that it is a safe, feasible, economical and efficient model for selected patients, which can be promoted in suitable hospitals.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Objective:To evaluate the effect of continuous positive airway pressure (CPAP) ventilation during induction of anesthesia on perioperative atelectasis and oxygenation in elderly patients.Methods:Forty-six elderly patients of either sex, aged 65-80 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective cerebrovascular intervention surgery under general anesthesia, were divided into 2 groups ( n=23 each) according to the random number table method: control group (group C) and CPAP ventilation group (group CPAP). During induction of anesthesia, CPAP was set at 5 cmH 2O during spontaneous breathing, and PEEP was set at 5 cmH 2O when spontaneous breathing disappeared, and the ventilation mode was changed to pressure-controlled ventilation (PCV) mode in group CPAP. CPAP was not set, and PEEP was set at 0 cmH 2O for PCV when spontaneous breathing disappeared in group C. During anesthesia maintenance, PCV-volume guaranteed mode was used in both groups, and PEEP was set at 5 cmH 2O. Whole lung CT scanning was performed immediately after radial artery catheterization (T 0), at 1 min after endotracheal intubation (T 1), and before tracheal extubation (T 2) at the end of operation to calculate the percentage of atelectasis area at 1 cm above the right diaphragm. At T 0, T 1, T 2 and 30 min after entering postanesthesia care unit (T 3), blood samples from the radial artery were taken to record PaO 2 and PaCO 2 and calculate the oxygenation index (OI). Results:Compared with the baseline at T 0, the percentage of atelectasis area was significantly increased at T 1 and T 2 in two groups ( P<0.05); PaO 2 was significantly increased at T 1 and T 2 and decreased to T 0 level at T 3, OI was decreased at T 1 and T 2 and increased to T 0 level at T 3 in two groups ( P<0.05). Compared with group C, the percentage of atelectasis area was significantly decreased and PaO 2 and OI were increased at T 1 and T 2 in group CPAP ( P<0.05). There was no significant difference in PaCO 2 at each time point between the two groups ( P>0.05). Conclusions:CPAP ventilation during induction of anesthesia can reduce the development of perioperative atelectasis and improve the oxygenation in elderly patients.