Debates persist regarding the efficacy and safety of azvudine, particularly its real-world outcomes. This study involved patients aged ≥60 years who were admitted to 25 hospitals in mainland China with confirmed SARS-CoV-2 infection between December 1, 2022, and February 28, 2023. Efficacy outcomes were all-cause mortality during hospitalization, the proportion of patients discharged with recovery, time to nucleic acid-negative conversion (T _NANC), time to symptom improvement (T _SI), and time of hospital stay (T _HS). Safety was also assessed. Among the 5884 participants identified, 1999 received azvudine, and 1999 matched controls were included after exclusion and propensity score matching. Azvudine recipients exhibited lower all-cause mortality compared with controls in the overall population (13.3% vs. 17.1%, RR, 0.78; 95% CI, 0.67-0.90; P = 0.001) and in the severe subgroup (25.7% vs. 33.7%; RR, 0.76; 95% CI, 0.66-0.88; P < 0.001). A higher proportion of patients discharged with recovery, and a shorter T _NANC were associated with azvudine recipients, especially in the severe subgroup. The incidence of adverse events in azvudine recipients was comparable to that in the control group (2.3% vs. 1.7%, P = 0.170). In conclusion, azvudine showed efficacy and safety in older patients hospitalized with COVID-19 during the SARS-CoV-2 omicron wave in China.

Objective:To explore the effect of Wnt/β-catenin signaling pathway on growth plate development of tibial growth plate in young chronic renal failure (CRF) rats.Methods:Four-week-old male SD rats were randomly divided into control group and CRF group ( n=20/per group). Control group was intragastric administration with distilled water, and CRF group was given adenine suspension (150 mg·kg -1·d -1). All the young rats were sacrificed after continuous gavages for 6 weeks. The full length of tibia was compared between the two groups. The width of tibia proximal growth plates was measured by micro-CT scanning, and the width of the growth plate was also measured in histological sections. Chondrocytes isolated from growth plate in two groups were cultured in vitro to P3 generation. Immunohistochemical staining was used to detect the expression of collagen Ⅱ, matrix metalloproteinase 13 (MMP-13) and β-catenin in chondrocytes. Western blotting was used to detect the protein expressions of collagen Ⅱ, MMP-13 and β-catenin. Results:Compared with the control group, the tibial length of rats in the CRF group was shorter [(27.32±5.81) mm vs (35.43±3.61) mm, t=5.226, P<0.001], the width of growth plate in micro-CT picture was more narrow [(0.72±0.22) mm vs (1.13±0.27) mm, t=5.096, P<0.001], and the relative width of the growth plate was also more narrow ( t=6.744, P<0.001) in histological sections. The results of immunohistochemistry and Western blotting showed the expressions of collagen Ⅱ in the CRF group decreased significantly ( t=8.212, P<0.001), MMP-13 ( t=13.091, P<0.001) and β-catenin ( t=7.534, P<0.001) increased significantly compared the control group in chondrocytes. Conclusion:The Wnt/β-catenin signaling pathway is highly expressed in the tibial growth plate of young rats with chronic renal failure, which leads to accelerated degeneration and differentiation of chondrocytes and a closure tendency of growth plate.

Objective:To investigate the value of tumor budding in the clinicopathology and prognosis of pancreatic neuroendocrine tumors.Methods:The Cliniccal data of 105 pancreatic neuroendocrine tumor patients underwent resection in Henan Provincial People's Hospital from Jan 2010 to Dec 2016 were retrospectively analyzed. Tumor budding was calculated through hematoxylin-eosin (HE) and immunohistochemical stained slides. Based on the receiver operating characteristic curve (ROC), the number of tumor budding ≥10 was defined as the high-grade budding group, and <10 as the low-grade budding group. Multiple analysis was performed to determine the relationship between tumor budding and clinicopathology as well as prognosis.Results:High-grade budding group was observed in 35 cases and low-grade group in 70. High-grade budding were more common in tumors with advanced T stage, high risk of lymphatic metastasis, preoperative liver metastasis, vascular invasion and postoperative recurrence (respectively χ 2=9.043, 4.286, 10.130, 12.090, 9.260, all P<0.05). Multivariate COX regression analysis showed that tumor budding ( P=0.018), tumor grade ( P=0.026), preoperative liver metastasis ( P=0.042), vascular invasion( P=0.048) was independent risk factors predicting poor prognosis. Conclusion:Tumor budding is highly correlated with clinicopathological parameters which reflect the aggressiveness of pancreatic neuroendocrine tumor, it is also an important prognostic factor.

Objective To explore the clinical effect of training assisted by a lower limb rehabilitation robot on the bladder and intestinal function of paraplegic spinal cord injury survivors. Methods Thirty-eight paraplegic patients with spinal cord injury were divided according to their admission order into an experimental group ( n=19) and a control group (n=19). Both groups were given conventional rehabilitation training, while the experimental group was additionally provided with robot-assisted lower limb training in three stages:adaptation, training and con-solidation. It lasted 30 minutes daily, 5 days per week for 12 weeks. Before and after the training, an urodynamics examination system was used to evaluate the maximum urine flow, bladder capacity, residual urine volume, bladder pressure and detrusor pressure. Colon transit time, mean rectal pressure and intestinal function were measured using the colon transit test, a mean rectal pressure test, and the Functional Independence Measure ( FIM) scale respective-ly. Results The average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance, average rectal pressure and intestinal FIM score of the robot training group after training were all significantly better than before the training, as were the average residual urine volume and colon transit time. After the training, the average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance and average rectal pressure of the robot training group were all significantly higher than those of the control group, while the average residual urine volume and colon transit time were significantly smaller. Then, 32％ of the patients in the experimental group achieved no less than 6 points for their average FIM score, significantly higher than in the control group. Conclusion Robot-assisted lower limb training combined with comprehensive rehabilitation training can effectively improve the bladder and intestinal function of paraplegic patients after a spinal cord injury.

Objective To evaluate enhanced recovery after surgery (ERAS) in the treatment of cholecystolithiasis complicated with extra hepaticbile duct stones by laparoscopy and choledochoscopy.Methods Patients were divided into ERAS and control groups according to the inclusion and exclusion criteria.Patients in ERAS group received perioperative management according to enhanced recovery rehabilitation program.Clinical and laboratory results were compared between the two groups.Results 46 patients were enrolled into ERAS group and 40 patients into control group.The ERAS group had shorter time of first postoperative exhaust,first postoperative oral intake,getting out of bed,removal of abdominal drainage tube,postoperative hospital stay (respectively t =-3.658,-15.552,-8.864,-6.673,-6.036,all P ＜ 0.05),less pain in 6,12,24 and 48 hours after operation (F =8.284,P =0.000),and lower complication rate (x2 =4.172,P =0.043),lower C-reactive protein (CRP) level from pre-operation to postoperative day 1,3 and 5 (F =6.692,P =0.013),higher level of prealbumin (PA) from preoperation to postoperative day 1,3 and 5 (F =21.191,P =0.000),lower hospitalization costs (t =-0.592,P =0.004).Conclusion The application of ERAS in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones by laparoscopy combined with choledochoscopy is conducive to rapid postoperative recovery of patients.

Objective To explore the application value of nano carbon lymph tracing technique in the radical resection of gallbladder cancer.Methods The prospective study was conducted.The clinical data of 120 patients with gallbladder cancer who were admitted to the Henan Provincial People's Hospital between January 2010 and December 2014 were collected.All the patients were allocated into the experimental group and control group by random number table.For the experimental group,a total of 0.1 mL carbon nanoparticles were injected at 4-6 locations subserously around the cancerous site,radical resection of gallbladder cancer were performed at 15 minutes after injection,and intraoperative stained lymph nodes were used as markers to guide lymphadenectomy.Patients in the control group underwent regular radical resection of gallbladder cancer.Observation indicators:(1) intra-and post-operative situations;(2) number of lymph node sorting;(3) follow-up situations.Follow-up using telephone interview was performed to detect survival of patients up to January 2016.Measurement data with normal distribution were represented as x-±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M(P25,P75),and comparison between groups was analyzed by the Mann-whitney rank-sum test.Comparisons of count data were analyzed using the chi-square test.Comparison of ordinal data were analyzed by the nonparametric test.The survival curve was drawn by the Kaplan-Meier method.Survival analysis was done using the Log-rank test.Results One hundred and twenty patients were screened for eligibility,and were allocated into the experimental group and control group,60 in each group.(1) Intra-and postoperative situations:operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were respectively (164± 51) minutes,(200 ± 98) mL,(13 ± 4) days in the experimental group and (178± 52) minutes,(225±98)mL,(14±5)days in the control group,with no statistically significant difference between groups (t=-l.50,-1.42,-1.03,P＞0.05).(2) Comparison of lymph node sorting:overall number of lymph node sorting,overall number of positive lymph node sorting,number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 13.0 (12.0,15.0),8.0 (5.0,9.0),7.0 (5.0,8.0),3.0 (2.0,4.0) in the experimental group and 10.0 (8.0,12.0),5.0 (4.0,6.0),5.0 (3.0,5.0),1.0 (1.0,2.0) in the control group,with statistically significant differences between groups (Z =-5.51,-4.37,-6.24,-6.18,P＜0.05).Number of N1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 6.0 (5.0,6.0),4.0 (3.0,5.0) in the experimental group and 6.0 (4.0,7.0),4.0 (2,0,5.0) in the control group,with no statistically significant difference between groups (Z =-0.82,-1.34,P＞0.05).Overall number of lymph node sorting,overall number of positive lymph node sorting,number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 5.0 (4.8,6.3),0(0,0.8),2.0 (1.0,3.3),0(0,0.5) in patients with stage Ⅱ of the experimental group and 3.0 (2.0,4.3),0 (0,0),0 (0,1.3),0(0,0) in patients with stage Ⅱ of the control group,with statistically significant differences between groups (Z=-2.96,-2.02,-2.38,-2.01,P＜0.05).Number of N 1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 3.0 (3.0,3.3),0 (0,0.3) in patients with stage [[of the experimental group and 3.0 (2.0,3.0),0 (0,0) in patients with stage Ⅱ of the control group,with no statistically significant difference between groups (Z=-1.18,-1.81,P＞0.05).Overall number of lymph node sorting,overall number of positive lymph node sorting,number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 13.0 (12.0,15.0),7.0 (5.0,8.0),7.0 (5.0,8.0),3.0 (2.0,4.0) in patients with stage Ⅲ of the experimental group and 10.0 (9.0,12.0),5.0 (4.0,6.0),5.0 (4.0,5.0),2.0 (1.0,2.0) in patients with stage Ⅲ of the control group,with statistically significant differences between groups (Z =-4.80,-3.43,-5.25,-4.76,P＜ 0.05).Number of N1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 6.0 (6.0,8.0),4.0 (3.0,5.0) in patients with stage Ⅲ of the experimental group and 6.0 (5.0,7.0),4.0 (3.0,4.5) in patients with stage Ⅲ of the control group,with no statistically significant difference between groups (Z=-1.52,-1.16,P＞0.05).Overall number of lymph node sorting,overall number of positive lymph node sorting,number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 14.0 (13.0,15.0),9.0 (8.0,10.0),8.0 (7.5,8.0),4.0 (4.0,5.0) in patients with stage Ⅳa of the experimental group and 11.0 (10.0,13.0),6.0 (4.0,8.0),5.0 (5.0,6.0),2.0 (1.0,2.0) in patients with stage Ⅳ a of the control group,with statistically significant differences between groups (Z =-3.47,-3.25,-4.02,-3.92,P＜0.05).Number of N1 station lymph node sorting and number of positive N1 station lymph node sorting were respectively 6.0 (5.5,6.0),5.0 (4.0,5.0) in patients with stage Ⅳa of the experimental group and 6.0 (5.0,7.0),4.0 (3.0,6.0) in patients with stage Ⅳa of the control group,with no statistically significant difference between groups (Z=-0.14,-0.45,P＞0.05).(3) Follow-up situations:120 patients were followed up for 12-60 months,with a median time of 28 months.The postoperative overall survival time was (45.7 ± 2.3) months in the experimental group and (36.5 ± 2.4) months in the control group,with a statistically significant difference between groups (x2 =8.32,P＜ 0.05).The postoperative overall survival time was (54.5±3.0) months in patients with stage Ⅱ of the experimental group and (39.6±0.9)months in patients with stage Ⅱ of the control group,with no statistically significant difference between groups (x2 =3.77,P＞0.05).The postoperative overall survival time was (42.2±2.7)months in patients with stage Ⅲ of the experimental group and (35.0±3.0)months in patients with stage]Ⅲ of the control group,with a statistically significant difference between groups (x2=4.12,P＜0.05).The postoperative overall survival time was (37.7±2.5)months in patients with stage Ⅳa of the experimental group and (27.0±3.1)months in patients with stage Ⅳa of the control group,with a statistically significant difference between groups (x2 =4.14,P＜0.05).Conclusion The nano carbon lymph tracing technique in the radical resection of gallbladder cancer can guide precise operation,increase the numbers of overall and positive lymph nodes sorting,and extend postoperative overall survival time.

Objective To investigate the predictive value of the whole nodule size and solid component size of lung adenocarcinoma manifesting as subsolid nodule(SSN) in three different dimensions for pathologic grade.Methods We evaluated retrospectively preoperative chest HRCT data of 125 patients with 127 SSNs surgically resected and pathologically conformed lung adenocarcinomas.All specimens were divided into two groups: a total of 69 SSNs in group A, including 22 AIS and 47 MIA;a total of 58 SSNs in group B, only including IAC.Computer aided diagnosis software were used to measure the one dimension maximum diameter of solid component with lung window setting(1D-SCLW),two dimension maximum diameter of solid component with lung window setting(2D-SCLW),one dimension maximum diameter of solid component with mediastinal window setting(1D-SCMW),two dimension maximum diameter of solid component with mediastinal window setting(2D-SCMW),one dimension maximum diameter of whole nodule with lung window setting (1D-WNLW), two dimension maximum diameter of whole nodule with lung window setting (2D-WNLW), and volume of solid component with threshold of-300 HU (SCT) of all SSNs.Results 1D-SCLW, 2D-SCLW,1D-SCMW,2D-SCMW,1D-WNLW,2D-WNLW and SCT of the group B were significantly larger than those of the group A(P=0.000).ROC analyses indicated that the diagnostic efficiency of SCT for the pathologic grade was the highest among 7 CT features(AUC=0.887, sensitivity:81%,specificity:93%);The cut-off values of 1D-SCLW,2D-SCLW,1D-SCMW,2D-SCMW,1D-WNLW, 2D-WNLW and SCT were 17.50 mm,14.75 mm,9.50 mm,7.75 mm,0.50 mm,1.25 mm and 139.00 mm3.Multiple Logistic regression analysis revealed that SCT was the independent predictor of pathologic grade(OR=4.978,95%CI=1.430-17.331,P=0.012).SCT of 139.00 mm3 or greater was a significant indicator of IAC.Conclusion Among the whole nodule size and solid component size of SSN in three different dimensions on preoperative HRCT, SCT is found to be the independent predictor of pathologic grade, which may provide reference for surgery.

Objective To evaluate carbon lymph tracer (CH40) in pancreatic cancer surgery.Method 61cases of pancreas head carcinoma undergoing whipple procedure from June 2011 to December 2013 were divided into intraoperative nano carbon group (group A,36 cases),in which resection range was adjusted according to lymph node staining including 13 standard resection cases (group A1),and 23 modified extended radical resection cases (group A2).Standard group (group B,n =17),and extended radical operation group (group C,n =8),respectively.Results The average lymph nodes harvested in group A1 were 25.08 ± 2.72,with positive lymph nodes of 7.92 ± 2.22,significantly more than group B (19.47±1.55,2.68 ±5.24),P＜0.05.In group A2,the average lymph node was 29.91 ±2.68,positive lymph node was 11.04 ± 2.38,significantly more than group C (25.13 ± 2.85,8.49 ± 3.32),P ＜0.05.The mean survival time and overall survival time of group A1 were 43.80 ±4.09 months,51.44 ±1.64 months,significantly more than group B (27.11 ±3.36,41.74 ±3.28 months),P ＜0.05.In group A2,the average tumor free survival time,and overall survival time was 31.58 ±2.99 months,45.02 ±2.54 months,not statistically different with group C (29.13±4.76 month,43.67 ±3.33 months),P ＞0.05.Conclusions Intraoperative lymphatic tracer technology significantly increases lymph node harvest,improving the survival time and tumor free prognosis.

Objective To investigate the influence of different pancreaticojejunostomy on the incidence of postoperative pancreatic (PF) fistula in pancreaticoduodenectomy (PD).Methods The clinical data of 343 patients undergoing radical PD from January 2011 to December 2015 were collected.343 patients were divided into 3 groups,including 124 cases of continuous lamellar duct-to-mucosa pancreaticojejunostomy (CL-DMP) (group A),111 cases of invaginated pancreaticojejunostomy (group B) and 108 cases of binding pancreaticojejunostomy (group C).The rates of postoperative PF and related complications,length of postoperative hospital stay,perioperative mortality and hospitalization costs were compared between the 3 groups.Results There was no statistical difference in the size of pancreatic duct between the 3 groups (P ＞ 0.05).The postoperative PF incidence of group A was 4.84％,significantly lower than 13.51％ in group B and 15.74％ in group C,respectively (P ＜0.05).The anastomosis took less time and postoperative hospital stay was shorter in group A than that in the other 2 groups (P ＜0.05).Conclusion CL-DMP is time-saving,safe and effective method of pancreaticojejunostomy during the process of pancreaticoduodenectomy.

Objective To investigate the predictive value of whole nodule size and solid component size of pulmonary subsolid nodules (SSNs)with different window setting on preoperative HRCT for pathologic grade in lung adenocarcinoma.Methods We retrospectively evaluated preoperative chest HRCT and pathological data of 125 patients with 127 surgically resected lung adenocarcinoma manifesting as SSNs.All specimens were divided into two groups:a total of 69 SSNs in group A,including 22 adenocarcinomas in situ (AIS) and 47 minimally invasive adenocarcinoma (MIA);a total of 58 SSNs in group B,including invasive adenocarcinoma (IAC).Observer 1 used computer aided diagnosis software to measure the volume of whole nodule with lung window setting (WNLW),volume of solid component with lung window setting (SCLW),volume of solid component with mediastinal window setting (SCMW) and volume of solid component with threshold of-300 HU(SCT) of all SSNs.Observer 2 randomly selected 50 SSNs and repeated all the measurements.The interobserver agreement regarding quantitative measurements were evaluated by using intraclass correlation coefficient(ICC).The differences of all quantitative features between two groups were evaluated by Mann-Whitney U test.All the quantitative features were evaluated by using univariate logistic regression analysis,significant quantitative features identified by univariate logistic regression analysis were included in the multivariate logistic regression and independent predictors of pathological grade were obtained.Receiver operating characteristic analysis was conducted for the independent predictive factors that exhibited statistically significant differences in the multivariate logistic regression.Results The interobserver agreement regarding quantitative features were excellent (ICC＞ 0.75).The WNLW,SCLW,SCMW and SCT of group B were significantly larger than those of group A (P＜ 0.001).The univariate logistic regression analysis indicated that WNLW,SCLW,SCMW and SCT were significant (P＜0.001),the multivariate logistic regression analysis indicated that SCT was the independent predictive factor (OR=1.013,95％CI:1.006—1.020,P＜0.001).When SCT larger than 139.00 mm3,SSN was significantly associated with IACs (AUC=0.887,sensitivity=81％,specificity=93％).Conclusion SCT of SSNs on preoperative HRCT can be used to distinguish between AIS-MIA and IAC,which may provide information for choice of operation.