Objective:To establish the ultra high performance liquid chromatography (UPLC) fingerprints of Mume flos at different flowering stages; To provide reference for the quality research of Mume flos.Methods:The fingerprints of Mume flos were established by UPLC method, and the common peaks were identified by high performance liquid chromatography high resolution mass spectrometry (LC-MS). Chemometrics analysis was carried out with the fingerprints' common peak area of plum blossom at different flowering stages as a variable. Semiquantitative analysis of changes in flavonoids and phenolic acids in Mume flos at different flowering stages was conduct using peak area calculation method.Results:Totally 31 common peaks were identified in the fingerprints of plum blossom medicinal materials at different flowering stages and 9 components were identified. Clustering analysis (HCA) and principal component analysis (PCA) both classified plum blossom medicinal herbs at different flowering stages into three categories. Among them, there were significant differences between the groups at the bud stage, blooming period, and final flowering period, while the differences between the groups at blooming period and final flowering period were relatively small. The orthogonal partial least squares discriminant analysis (OPLS-DA) screened 16 different components with VIP>1.0. The contents of phenolic acids in different flowering stages were as follows: bud stage>blooming period>final flowering period, while the contents of flavonoids were as follows: blooming period>final flowering period>bud stage.Conclusions:This method is simple and reliable, and can provide reference for the quality evaluation of plum blossom medicinal materials at different flowering stages.

Objective To construct a support vector machine (SVM) model based on magnetic resonance imaging (MRI) T₂WI turbo inversion recovery magnitude (TIRM) and diffusion-weighted imaging (DWI) sequences, and evaluate its predictive performance for expression levels of human epidermal growth factor receptor-2 (HER-2) and hormone receptor (HR) in breast cancer. Methods A total of 128 breast cancer lesions underwent breast MRI before surgery or treatment were collected, and were grouped according to immunohistochemical (IHC) method or in situ fluorescence hybridization (FISH) results. ITK-SNAP software was used to outline the three-dimensional volume region of interest (VOI) on magnetic resonance TIRM and DWI sequence images, and Pyradiomics program was introduced to extract the image omics features. After normalization of the data, a recursive feature elimination method based on support vector machine-recursive feature elimination (SVM-RFE) was used to filter the features. A total of 108 cases were divided into training group and verification group according to 8∶2 ratio by random stratified sampling method, and the other 20 cases were used as external test group. SVM machine learning classifier was used to construct the image omics model. Receiver operating characteristic (ROC) curve was used to evaluate the prediction efficiency of the model. DeLong test was used to evaluate the area under the curve (AUC) of each image omics model. SHAP algorithm was used for visual analysis, and the most contributing prediction features were screened. Results The prediction efficiency of the combined model (training group AUC=0.94, verification group AUC=0.90) for HER-2 was higher than that of TIRM model(training group AUC=0.85, verification group AUC=0.80) and single DWI model(training group AUC=0.88, verification group AUC=0.66). The AUC of combined model in the external test group was 0.89. The feature contribution of DWI sequence obtained by SHAP algorithm was great. The image omics model based on the combination of TIRM and DWI sequence features (training group AUC=0.96, verification group AUC=0.88) and the single DWI sequence features (training group AUC=0.92, verification group AUC=0.86) was better than the model based on the single TIRM sequence features (training group AUC=0.84, verification group AUC=0.68) in HR prediction. The external test group proved that the combined model had good predictive efficiency, with an AUC of 0.90. The feature contribution of TIRM sequence obtained by SHAP algorithm was great. Conclusion The imaging omics model constructed based on the combined features of TIRM and DWI sequences in magnetic resonance imaging has good predictive efficacy for HER-2 level, and has great potential in predicting HR expression, which can provide a basis for the formulation of personalized treatment for breast cancer patients.

Objective:To evaluate the feasibility and perioperative safety of retroperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease (ADPKD) before kidney transplantation.Methods:A total of 22 patients with ADPKD who underwent laparoscopic polycystic nephrectomy before kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2013 to December 2020 were enrolled in this retrospective study. Preoperative epidemiological data, operation time, intraoperative blood loss, perioperative blood transfusion, conversion rate, postoperative gastrointestinal function recovery time, drainage tube placement time, postoperative hospital stay, incidence and severity of complications were collected.Results:The mean age of all patients in this study was (50.95±9.28) years old, and the mean preoperative polycystic kidney diameter was (18.83±2.38) cm. In all patients, 20 patients were scheduled for polycystic nephrectomy due to transplantation and 2 patients were done for polycystic renal cyst rupture and hemorrhage. The mean operation time of all patients was (191.14±70.46) min, and the median intraoperative blood loss was 100 mL. Among them, 5 patients had large intraoperative blood loss, and were given intraoperative blood transfusion. Two of all patients were converted to open due to severe intraoperative adhesions. In terms of postoperative recovery, the mean recovery time of gastrointestinal function was (2.09±0.61) d, the mean time of abdominal drainage tube placement was (5.32±2.08) d, the mean postoperative hospital stay was (7.55±2.34) d. In terms of postoperative complications, 4 patients developed postoperative incision pain, bleeding or other complications, but all improved after symptomatic treatment.Conclusions:For patients with ADPKD, original polycystic kidney can be effectively resected by retroperitoneoscopy before transplantation. At the same time, the operation time is short, and patients have quick postoperative recovery, even the incidence and severity of postoperative complications are low. Therefore, retroperitoneal laparoscopic nephrectomy can be used as the first choice for the removal of original polycystic kidney before renal transplantation in ADPKD patients.

The oral cavity of each person is home to hundreds of bacterial species.While taxa for oral diseases have been studied using culture-based characterization as well as amplicon sequencing,metagenomic and genomic information remains scarce compared to the fecal microbiome.Here,using metagenomic shotgun data for 3346 oral metagenomic samples together with 808 published samples,we obtain 56,213 metagenome-assembled genomes(MAGs),and more than 64％of the 3589 species-level genome bins(SGBs)contain no publicly available genomes.The resulting genome collection is representative of samples around the world and contains many genomes from candi-date phyla radiation(CPR)that lack monoculture.Also,it enables the discovery of new taxa such as a genus Candidatus Bgiplasma within the family Acholeplasmataceae.Large-scale metagenomic data from massive samples also allow the assembly of strains from important oral taxa such as Por-phyromonas and Neisseria.The oral microbes encode genes that could potentially metabolize drugs.Apart from these findings,a strongly male-enriched Campylobacter species was identified.Oral sam-ples would be more user-friendly collected than fecal samples and have the potential for disease diagnosis.Thus,these data lay down a genomic framework for future inquiries of the human oral microbiome.

Objective:To evaluate the effect of intraoperative incision combined with local anesthesia in improving postoperative pain after retroperitoneal laparoscopic living donor nephrectomy.Methods:Using retrospective research methods, 28 donors who underwent hand-assisted retroperitoneal laparoscopic living donor nephrectomy at the Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2020 were selected as the research group. Before the wound was sutured during the operation use 0.2% ropivacaine 20 mL+ 5 mg dexamethasone to block the transverse abdominis fascia and subcutaneously for infiltration anesthesia. The other 1∶1 matched 28 donors who had the same operation method but used on-demand systemic opioid analgesia after the operation as the control group. The demographic indicators (age, gender, body mass index, length of donor kidney), intraoperative conditions (intraoperative blood loss, operation time, warm ischemia time), 2, 12, 24, and 48 hours pain visual analogue scales(VAS) after operation were compared between the two groups of patients, postoperative systemic opioid demand rate, postoperative exhaust time, time to return to the ground, complication rate (postoperative bleeding, lung infection, lymphatic fistula, wound infection, intestinal obstruction), postoperative length of hospitalization and other information. Measurement data were expressed as mean±standard deviation ( Mean± SD), and independent sample t-test was used for comparison between groups; Chi-square test or Fisher exact probability method was used for comparison of count data between groups. Results:The pain VAS of the donors in the research group were significantly lower than those in the control group at 2 h, 12 h, 24 h, and 48 h after surgery (2 h: 1.6±1.0 vs 3.9±1.1; 12 h: 1.9±0.7 vs 3.1±1.0; 24 h: 1.6±0.5 vs 2.9±0.8; 48 h: 1.2±0.5 vs 2.3±0.8; P<0.05). The donors in the research group postoperative morphine requirement rate was also significantly lower than that of the control group (0 vs 21.4%), and the postoperative recovery time was significantly earlier than that of the control group [(25.7±4.5) h vs (30.6±6.6) h], the difference was statistically significant ( P<0.05). Lymphatic fistula was the main postoperative complication. There was no statistically significant difference between the research group and the control group (14.3% vs 25.0%) ( P>0.05). Conclusion:Intraoperative incision transversus abdominis fascia and subcutaneous combined local block anesthesia can effectively reduce the pain after laparoscopic donor nephrectomy, reduce the use of opioids, promote early postoperative activities of the donor, and will not increase postoperative complications incidence rate.

Objective:To evaluate the feasibility and accuracy of a multi-dimensional peripheral quick contrast sensitivity function (pqCSF) measurement established based on Bayesian probability estimation algorithm.Methods:A cross-sectional study was conducted.Nineteen eyes of 12 healthy emmetropic subjects in Zhongshan Ophthalmic Center of Sun Yat-sen University from September 2017 to March 2018 were included, with an average age of (22.92±2.91) years.The average spherical power and cylindrical power were (-0.34±0.52)D and (-0.30±0.42)D, respectively, and the average uncorrected vision acuity was≥1.0.Based on the Bayesian probability algorithm, the peak contrast sensitivity γ max, the peak spatial frequency ? max, the bandwidth β and the low contrast intercept δ were used to quickly describe the contrast sensitivity function (CSF) curve of the full spatial frequency through multi-dimensional pqCSF method.The 16 peripheral visual field positions of all subjects were tested at 6°, 12°, 18° and 24° eccentricity of the superior, inferior, the temporal and nasal visual field by the pqCSF method, but the 18° eccentricity of temporal field, which was near the physiological blind spot, was excluded.The area under Log CSF (AULCSF) of different peripheral visual fields and the Log CSF of 19 spatial frequencies (distributed at equal intervals in logarithmic units) were compared.This study followed the Declaration of Helsinki, and the study protocol was approved by an Ethics Committee of Zhongshan Ophthalmic Center of Sun Yat-sen University (No.2018KYPJ017). Written informed consent was obtained from each subject prior to any examination. Results:With the increase of eccentricity in different visual fields, the AULCSF decreased gradually, and there were significant differences in AULCSF between different eccentricities (all at P<0.05). The AULCSF of the nasal and temporal visual field at 6°, 12° and 24° eccentricity was significantly larger than that of the superior and inferior visual field (all at P<0.05). As the distance from the fovea was increased, the pqCSF, the AULCSF, and the high-frequency cutoff were all decreased, and the standard deviation of AULCSF was increased gradually. Conclusions:The pqCSF method can depict a relatively complete peripheral CSF curve of a wide peripheral visual field, and reflect the function quality of the peripheral vision comprehensively and accurately.

Objective    To analyze the correlation between the gray value of epicardial fat and the prognosis of patients with atrial fibrillation (AF) treated by thoracoscopic radiofrequency ablation. Methods    The clinical data of 97 patients, including 75 males and 22 females with an average age of 57.8±9.4 years, who underwent thoracoscopic radiofrequency ablation in Fuwai Hospital from 2017 to 2018 were analyzed retrospectively. The left atrial fat volume and average gray scale were calculated by left atrial enhanced CT. According to the average gray scale of left atrial fat tissue, the patients were divided into three groups: a high gray scale group, a medium gray scale group and a low gray scale group. The patients were followed up at 3, 6 and 12 months after operation. The end point of follow-up was the recovery rate of sinus rhythm. Survival analysis was used to analyze the correlation between CT features of epicardial fat enhancement and prognosis. Results    After adjustment of body mass index, body surface area, gender and left atrial end diastolic diameter, regression analysis showed that the fat gray of left atrial enhanced CT was correlated with the type of AF (OR=0.30, 95%CI 0.12-0.79, P=0.014). Cox regression analysis showed that the fat gray value of left atrial CT predicted the recurrence of AF after thoracoscopic radiofrequency ablation (OR=0.92, 95%CI 0.85-0.99). The Kaplan-Meier curve showed significant difference in the long-term recurrence rate of AF among the three groups (P=0.011). The lower left atrial fat enhanced CT gray scale was, the higher long-term recurrence rate of AF was. Conclusion    The gray value of left atrial fat enhanced CT can effectively predict the recurrence of AF after radiofrequency ablation in thoracoscopic surgery.

Objective:To explore the clinical value by analyzing the application of abdominal aortic balloon occlusion in the uterine curettage treatment for patients with cesarean scar pregnancy (CSP).Methods:Totally 42 CSP patients in the first Affiliated Hospital of Zhengzhou University were analyzed retrospectively, 21 cases in the observation group, placing the balloon catheter to the abdominal aorta under the renal artery under the digital substraction angiography(DSA), conducting curettage under hysteroscopy or uterine laparoscopy immediately, and making intermittent blockage in abdominal aorta blood flow during the surgery;21 patients in the control group, conducting uterine artery embolization (UAE) before operation, conducting curettage under hysteroscopy or uterine laparoscopy after 1-3 days. The fluoroscopy time under DSA, body surface radiation dose, intraoperative blood loss, operation time, incidence of postoperative adverse reactions, hospitalization time and follow-up menstruation were comparatively analyzed.Results:All patients operated and retained the uterus successfully. In the control group, all 21 patients had different degrees of fever, pain and other symptoms after UAE. In the observation group and control group, the fluoroscopy time and body surface radiation dose under DSA respectively were (7.4±1.4) s, (5.4±1.1) mGy and (1 142.8±315.5) s, (1 442.0±300.0) mGy (both P<0.01);the average amount of intraoperative blood loss were (22±15), (19±14) ml ( P>0.05), the time of uterine curettage were (37±20), (42±19) minutes ( P>0.05);hospitalization time were (5.0±0.9), (7.7±1.3) days ( P<0.01). The follow-up period was more than 3 months, no adverse reactions were observed in the observation group; 4 cases of menstrual reduction and 1 case of intrauterine adhesions were found in the control group. Conclusion:Abdominal aortic balloon occlusion and UAE could effectively reduce intraoperative bleeding in uterine curettage for patients with CSP; abdominal aortic balloon occlusion has significant reduction of the X-ray dose, shorter hospitalization time, and fewer adverse events comparing to UAE.

OBJECTIVETo investigate the efficacy of single-hand four-needle suture with sled-shaped needle three-tail fixed stitch in closure of pesudohernia sac of direct hernia under transabdominal preperitoneal (TAPP) inguinal hernia repair.

METHODSA randomized controlled trail was conducted on adult patients with unilateral direct inguinal hernia undergoing laparoscopic TAPP repair from January 2014 to January 2018 at the Sixth Affiliated Hospital of Sun Yat-sen University. A total of 156 patients were enrolled prospectively in the study and were randomly divided into single-hand four-needle suture group (trial group, 76 cases) and traditional tacking group (control group, 80 cases). In trial group, sled-shaped needle three-tail knot-free stitch was applied to the continuous four-needle suture. The sled-shaped needle three-tail fixed stitch was made as follows: straighten the tail of a 3-0, 1/2-circle looper VICRYL Rapide into a sled shape; use suture overlap method to make and tighten a single knot; thread the end of the needle into the single knot loop;knot two ends of the thread next to the first knot; tighten the second knot, leaving about 12 cm to the end of the needle;cut the end of the loop (leaving about 0.6 cm) and the other end of the thread(leaving about 1.5 cm). In the control group, a hernia repair tack was used to fix the pseudohernia sac on pectineal ligament. This study was approved by the Hospital Ethics Committee(approval number: L2014ZSLYEC-016). Operation time, pseudoherina sac closure time, hospitalization cost, morbidity of postoperative complication, VAS score and postoperative recurrence were compared between two groups.

RESULTSAll the patients completed operations successfully. There were no significant differences between trial group and control group in age [(60.2±0.4) years vs. (61.1±0.7) years)], gender (male ratio 93.4% vs. 92.5%), BMI [(25.1±0.2) kg/m vs. (24.9±0.2) kg/m ], defection area [(16.1±0.4) cm vs. (15.7±0.7) cm ] (all P > 0.05). As compared to control group, trial group had longer operative time[(34.2±1.9) minutes vs. (30.3±1.1) minutes, t=5.484, P=0.045], longer closure time of psudohernia sac [(4.2±0.5) minutes vs. (1.8±0.7) minutes, t=7.423, P=0.031], but lower VAS score (3.2±0.1 vs. 5.3±0.6, t=-3.186, P=0.015) and lower total cost [(9 897.3±104.4) yuan vs. (12 325.6±169.7) yuan, t=-3.972, P=0.023]. No severe complication and death were found in either groups intra-operatively and postoperatively. No mesh infection and relapse occurred during postoperative follow-up of 1-24 (12.0±1.2) months. During follow-up, seroma occurred in 2 cases (2.6%) of trial group and 3 cases (3.8%) of control group without significant difference (χ =1.284, P=0.799), and all were absorbed and disappeared within 30 days after local application of mirabilite.

CONCLUSIONCompared to tack fix method, single-hand four-needle suture with sled-shaped needle three-tail fixed stitch can effectively close pseudohernia sac, reduce hospitalization cost and ameliorate postoperative pain in TAPP repair, which is worth promotion.

Hernia, Inguinal ; surgery ; Herniorrhaphy ; methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Surgical Mesh ; Suture Techniques ; Sutures ; Treatment Outcome

Objective To investigate the application value of the preoperative progressive pneumoperitoneum (PPP) in parastomal hernia repair.Methods The retrospective cross-sectional study was conducted.The clinical data of 28 patients who underwent parastomal hernia repair using PPP in the Sixth Affiliated Hospital of Sun Yat-sen University from December 2014 to February 2017 were collected.Patients received abdominal computed tomography (CT) scan after admission,and volumes of the hernia sac and abdominal cavity and (volume of the hernia sac / total volume of the abdominal cavity)× 100.0％ were respectively calculated.Open or laparoscopic parastomal hernia repair was selected based on the effects of artificial pneumoperitoneum.Observation indicators:(1) PPP situations:① completion;② changes of volumes of the hernia sac and abdominal cavity before and after PPP;③ adhesion and retraction of parastomal hernia contents after PPP;(2) surgical and postoperative recovery situations;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative long-term complications and recurrence of parastomal hernia up to May 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Repeated measurement data were evaluated with the repeated measures ANOVA.Results (1) PPP situations:① completion:28 patients received successful ultrasound-guided indwelling catcher.Twenty-four patients completed PPP,with a completion rate of 85.7％ (24/28) and an air injection volume of (3 995±531) mL,and 4 stopped PPP.Eighteen patients had varying degrees of abdominal pain,abdominal distension and scapular pain,including 17 with tolerance and 1 with disappearing of symptoms at day 6.Of 5 patients with shortness of breath,3 were improved or well tolerated through breathing exercises,and symptoms of 2 disappeared at day 7 and 9.Three patients had mild subcutaneous emphysema.The arterial CO2 tension of 1 patient was high and then returned to normal at day 7.Some patients had simultaneously multiple adverse reactions.② Changes of volumes of the hernia sac and abdominal cavity before and after PPP:volumes of the hernia sac before and after PPP were (699± 231) mL and (993 ± 332) mL,with a statistically significant difference (F=129.29,P＜0.05),and increasing volume of the hernia sac was (294± 167) mL,with an increasing rate of 43％±15％.Volumes of the abdominal cavity before and after PPP were (6 520±745)mL and (9 196± 909) mL,with a statistically significant difference (F=429.42,P＜0.05),and increasing volume of the abdominal cavity was (2 715±709)mL,with an increasing rate of 42％± 12％.(Volume of the hernia sac / total volume of the abdominal cavity) × 100.0％ before and after PPP were 9.6％ ± 2.7％ (less than or equal to 10.0％ in 20 patients,more than 10.0％ and less than or equal to 15.0％ in 6 patients,and more than 15.0％ in 2 patients) and 9.7％± 2.8％,with no statistically significant difference (F =0.44,P＞0.05).③ Adhesion and retraction of parastomal hernia contents after PPP:results of abdominal CT showed anterior abdominal bulging,abdominal contents prostrated at the base of the abdominal cavity due to gravity,and gas was full of gaps.Abdominal adhesion signs:adhesions of banded fibrous connective tissue established a connection between the base of the abdominal cavity and anterior abdominal wall,and intestinal canals were found inside the adhesions.Parastomal hernia contents of 28 patients had varying degrees of retraction to abdominal cavity,including 9 with complete retraction,13 with a great amount of retraction (retraction volume ＞50％) and 6 with a small amount of retraction (retraction volume ＜50％).Four patients were accompanied by incomplete stoma obstruction,and then obstruction disappeared or relieved after PPP.(2) Surgical and postoperative recovery situations:all the 28 patients underwent successful operations,without intestinal canal injury.Three patients received open parastomal hernia repair,including 2 receiving preperitoneal mesh repair using 8 layers Biodesign meshes (deep venous catheter for local drainage was placed and then removed at postoperative day 2 and 3) and 1 receiving Sugarbaker surgery using PCOPM mesh (peritoneal drainage-tube was placed and then removed at postoperative day 2).Other 25 patients received laparoscopic parastomal hernia repair and Sugarbaker surgery using PCOPM and Sepramesh meshes (no drainage-tube was placed).Bladder pressure of 28 patients at postoperative day 3 was (13±6)cmH2O (1 cmH2O =0.098 kPa),without an abnormal high pressure.Nine patients with postoperative complications were improved by conservative treatment,including 3 with seroma,3 with delayed stoma defecation or incomplete intestinal obstruction,2 with pulmonary infection and 1 with urinary tract infection.There were no occurrences of abdominal compartment syndrome,cardiac failure,lung failure,renal failure,other severe complications and perioperative death.Duration of postoperative hospital stay was (7.2± 1.5) days.(3) Follow-up situations:25 of 28 patients were followed up for 3-25 months,with a median time of 11 months.During follow-up,2 patients had chronic pain around the operation and a sense of discomfort and then were improved by symptomatic treatment,and 1 with parastomal hernia recurrence at postoperative month 6 after open preperitoneal mesh repair underwent again open preperitoneal mesh repair,without recurrence.There were no occurrence of tardive mesh infection and other longterm complications.Conclusion PPP in the treatment of parastomal hernia repair is safe and feasible.