Objective: To evaluate the feasibility and effectiveness of dual fluorescence laparoscopy in the localization of ureteral stricture and its blood supply，and to provide a new idea for the treatment of complex ureteral stenosis，thus helping doctors to improve the efficiency of ureteral reconstruction surgery. Methods: Our team developed a dual fluorescence laparoscopic system，which could simultaneously identify the ureter stricture by intra-ureteral injection of methylene blue (MB) and assess the blood supply of the ureteral stumps by intravenous injection of indocyanine green (ICG). Results: The clinical data of 3 patients who underwent lingual mucosa ureteroplasty using dual fluorescence laparoscopy in Zhongnan Hospital of Wuhan University were retrospectively analyzed.All operations were successful，without conversion to open surgery.The operation time was 144，132 and 163 minutes，respectively.The length of harvested lingual mucosa graft was 2.0，2.8 and 3.5 cm，respectively.No intraoperative or postoperative complications occurred.Eight weeks after operation，ureterography showed that the ureter was unobstructed. Conclusion: Dual fluorescence laparoscopy is safe and feasible in the repair of complex ureteral stricture with lingual mucosa graft，which provides a new idea for complex ureteral reconstruction.

Expert consensus, as an important supplement to clinical practice guidelines, supports clinical decision-making when evidence is lacking or controversial. Compared to clinical practice guidelines, the presentation of expert consensus is more diverse. Currently, there are no reporting guidelines for expert consensus in clinical and public health decision-making. The RIGHT (Reporting Items for Practice Guidelines in Healthcare) checklist is the most commonly used international guideline reporting standard, and is often referred to when writing expert consensus. However, the RIGHT checklist does not include a section on consensus formation methods; while the ACCORD (ACcurate COnsensus Reporting Document) checklist includes reporting requirements for consensus formation methods, but not for reporting recommendations. Therefore, this article integrates the RIGHT and ACCORD reporting checklists and proposes an integrated reporting framework (TIMER-DO) to help authors combine these two commonly used international reporting standards and complete the standardized reporting of expert consensus.

The rules of acupoint selection and treatment were identified and discovered from the collected ancient acupuncture-moxibustion prescriptions recorded the earliest for epigastric pain. The database of ancient acupuncture-moxibustion prescriptions for epigastric pain was set up using Excel2016 software. After the disease term, etiology, pathogenesis, symptoms and acupoints were normalized, the underlying multi-dimensional correlation among the elements of acupuncture-moxibustion was explored, using the frequency statistics and the association rule of Apriori algorithm. In the ancient time, in treatment with acupuncture-moxibustion therapy for epigastric pain, the acupoints of the high use frequency were sequenced as Zhongwan (CV12), Shangwan (CV13), Zusanli (ST36), Neiguan (PC6), Gongsun (SP4), Pishu (BL20) and Weishu (BL21). The common combinations of acupoints included the pairs of back-shu points, the combination of back-shu points and front-mu points, the combination of front-mu points and yuan-source points and the combination of back-shu points and the lower he-sea points. The highly involved acupoints were those from the conception vessel, pericardium meridian, spleen meridian, stomach meridian and bladder meridian; and they were commonly distributed on the abdomen, the yin parts of the foot and the arm, the yang part of the leg and on the back. Regarding the etiologies such as parasites, food retention, masses, qi stagnation and stomach cold, Zhongwan (CV12) and Shangwan (CV13) were coordinated; and Sanyinjiao (SP6) and Daling (PC7) were highly associated with masses. Besides cold injury, parasites and masses, for the epigastric pain caused by other factors of etiology (qi stagnation, stomach cold and food retention), moxibustion therapy was greatly applicable. For epigastric pain combined with qi reversion in the lower abdominal region, Qichong (ST30), Sanyinjiao (SP6), Tianshu (ST25) and Zusanli (ST36) must be selected. Dadu (SP2) and Taibai (SP3) must be used if the distention in the chest and abdomen accompanied; and Zhongzhu (TE3) be used if back pain involved. Zusanli (ST36) was commonly selected for hiccups. For the other accompanied symptoms, Zhongwan (CV12) was used, which is consistent with the acupoint selection of main symptoms. On the trunk, moxibustion was generally used at Weishu (BL21), Pishu (BL20), Geshu (BL17), Zhongwan (CV12), Juque (CV14) and Qihai (CV6), except Shangwan (CV13). Among the acupoints below the elbows and knees, moxibustion was commonly applicable at Zusanli (ST36), and acupuncture was often used at Gongsun (SP4) and Daling (PC7).
Acupuncture Points ; Humans ; Moxibustion/history* ; History, Ancient ; Acupuncture Therapy/history* ; Data Mining ; Abdominal Pain/history*

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

PURPOSE: To screen laboratory markers with predictive value in early spinal surgical site infections (SSI) that are diagnosed within 30 days postoperatively. METHODS: Patients who underwent surgical treatment for internal spinal fixation between March 2022 and March 2023 in our hospital were retrospectively studied. The inclusion criteria were aged >18 years, undergoing internal fixation surgery, complete medical records with >30 days of postoperative follow-up, diagnosis was made within 30 days postoperatively, and an informed consent form was obtained. The exclusion criteria were abnormal white blood cell count or neutrophil percentage in the preoperative blood routine and combined diseases that may affect the C-reactive protein (CRP) or procalcitonin (PCT) values, including lower respiratory tract infection, renal insufficiency, and liver disease. We collected patients' personal information, surgical information, and blood laboratory data, including CRP, PCT, lymphocyte-neutrophil ratio, platelet-neutrophil ratio, and routine blood tests on preoperative and postoperative days 3, 5, and 7, from these patients. These data were statistically analyzed to determine which laboratory markers were statistically significant. The diagnostic value and optimal diagnostic threshold of these laboratory markers were further determined by receiver operating characteristic curve analysis. RESULTS: A total of 106 patients were enrolled in this study, of whom 8 patients were diagnosed with early SSI. A total of 4 laboratory markers were screened, namely, CRP on postoperative day 7 (optimal diagnostic threshold of ≥64.1 mg/L, sensitivity of 100%, specificity of 76.5%, area under the curve (AUC) of 0.908), PCT on postoperative day 7 (optimal diagnostic threshold of ≥0.2 ng/mL, sensitivity of 87.5%, specificity of 94.1%, AUC of 0.967), lymphocyte count on postoperative day 5 (optimal diagnostic threshold of ≤0.67 × 10⁹/L, sensitivity of 50%, specificity of 95.9%, AUC of 0.760), and lymphocyte count on postoperative day 7 (optimal diagnostic threshold of ≤1.32 × 10⁹/L, sensitivity of 87.5%, specificity of 55.1%, AUC of 0.721). CONCLUSION We concluded that CRP and PCT levels on postoperative day 7 and lymphocyte counts on postoperative days 5 and 7 are useful markers in screening for early spinal SSI.
Humans ; Retrospective Studies ; Male ; Female ; Biomarkers/blood* ; Middle Aged ; C-Reactive Protein/analysis* ; Surgical Wound Infection/blood* ; Procalcitonin/blood* ; Adult ; Aged ; Postoperative Period ; ROC Curve ; Predictive Value of Tests ; Spine/surgery*

OBJECTIVE: To evaluate the feasibility and accuracy of cone-beam CT (CBCT) images for radiotherapy dose calculation in pelvic tumors. METHODS: An improved volumetric density coverage method was used to establish CT value-relative electron density (RED) curves for CBCT images. The planning CT plans were transferred to the CBCT images, and the constructed density curves were applied to calculate doses for CBCT plans while maintaining the optimization parameters unchanged. Dose calculation deviations between the two plans were analyzed. RESULTS: The mean differences in dosimetric parameters for the target volume and organs at risk (OAR) between the two plans were less than 1% and 1.5%, respectively. The target conformity index (CI), homogeneity index (HI), and gamma passing rates were highly consistent, with no statistically significant differences. CONCLUSION CBCT images corrected by this method can be used for dose calculation in pelvic tumor radiotherapy planning.
Cone-Beam Computed Tomography/methods* ; Humans ; Radiotherapy Planning, Computer-Assisted/methods* ; Radiotherapy Dosage ; Pelvic Neoplasms/diagnostic imaging*

Psoriasis is a chronic inflammatory skin disease, and its pathogenesis is largely modulated by abnormal angiogenesis. Previous research has indicated that AlkB homolog 5 (ALKBH5), an important demethylase affecting N⁶-methyladenosine (m⁶A) modification, plays a role in regulating angiogenesis in cardiovascular and eye diseases. Our present study found that ALKBH5 was upregulated and co-localized with cluster of differentiation 31 (CD31) in the skin of IMQ group compared with control group. ALKBH5-deficient mice decreased IMQ-induced psoriatic dermatitis and exhibited histological improvements, including decreased epidermal thickness, hyperkeratosis, numbers of dermal capillary vessels and inflammatory cell infiltration. ALKBH5-KO mice alleviated angiogenesis in psoriatic lesions by downregulating the protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway. Additionally, the expression of ALKBH5 was significantly upregulated in IL-17A-induced human umbilical vein endothelial cells (HUVECs), which further promoted the expression of angiogenesis-related cytokines and endothelial cell proliferation. Cell proliferation and angiogenesis were suppressed in ALKBH5 knockdown group, whereas ALKBH5 overexpression promoted these processes. The regulation of angiogenesis in HUVECs by ALKBH5 was facilitated through the AKT-mTOR pathway. Collectively, ALKBH5 plays a pivotal role in psoriatic dermatitis and angiogenesis, which may offer a new potential targets for treating psoriasis.
Animals ; Psoriasis/chemically induced* ; Mice ; Humans ; Neovascularization, Pathologic/genetics* ; Human Umbilical Vein Endothelial Cells/metabolism* ; AlkB Homolog 5, RNA Demethylase/genetics* ; Proto-Oncogene Proteins c-akt/metabolism* ; TOR Serine-Threonine Kinases/metabolism* ; Cell Proliferation ; Mice, Knockout ; Disease Models, Animal ; Signal Transduction ; Male ; Skin/blood supply* ; Mice, Inbred C57BL ; Angiogenesis

Peganum harmala L. (P. harmala) is a significant economic and medicinal plant. The seeds of P. harmala have been extensively utilized in traditional Chinese medicine, Uighur medicine, and Mongolian medicine, as documented in the Drug Standard of the Ministry of Health of China. Twelve novel tryptamine-derived alkaloids (1-12) and eight known compounds (13-20) were isolated from P. harmala seeds. Compounds 1 and 2 represent the first reported instances of tryptamine-derived heteromers, comprising tryptamine and aniline fragments with previously undocumented C-3-N-1' linkage and C-3-C-4' connection, respectively. Compounds 3-5 were identified as indole-quinazoline heteromers, exhibiting a novel C-3 and NH-1' linkage between indole and quinazoline-derived fragments. Compound 6 demonstrates the dimerization pattern of C-C linked tryptamine-quinazoline dimer. Compound 8 represents a tryptamine-derived heterodimer with a distinctive carbon skeleton, featuring an unusual spiro-tricyclic ring (7) and conventional bicyclic tryptamine. Compounds 9-11 constitute novel 6/5/5/5 spiro-tetracyclic tryptamine-derived alkaloids presenting a unique ring system of tryptamine-spiro-pyrrolizine. Compounds 1-3 and 6-11 were identified as racemates. Compounds 2, 7, 9, 10, and 12 were confirmed via X-ray crystallographic analysis. All isolated compounds (1-20) exhibited varying degrees of antiviral efficacy against respiratory syncytial virus (RSV). Notably, the anti-RSV activity of compound 12 (IC₅₀ 5.01 ± 0.14 μmol·L^-1) surpassed that of the positive control (ribavirin, IC₅₀ 6.23 ± 0.95 μmol·L^-1), as validated through plaque reduction and immunofluorescence assays. The identification of anti-RSV compounds from P. harmala seeds may enhance the development and application of this plant in antiviral therapeutic products.
Antiviral Agents/isolation & purification* ; Tryptamines/isolation & purification* ; Peganum/chemistry* ; Seeds/chemistry* ; Alkaloids/isolation & purification* ; Molecular Structure ; Humans ; Respiratory Syncytial Viruses/drug effects* ; Plant Extracts/pharmacology* ; Drugs, Chinese Herbal/pharmacology*

ObjectiveTo investigate the impact of metabolic associated fatty liver disease （MAFLD） on metabolic markers in patients with HIV infection， and to assess the risk of new-onset MAFLD in previously untreated HIV patients. MethodsA total of 161 HIV patients who attended the outpatient service of Zhongnan Hospital of Wuhan University from April 2020 to December 2021 were enrolled， and they were treated with the lamivudine/efavirenz/tenofovir disoproxil fumarate （3TC/EFV/TDF） regimen and were followed up for more than 36 months. According to the presence or absence of MAFLD， they were divided into MAFLD group with 42 patients and non-MAFLD group with 119 patients， and metabolic markers were compared between the two groups before and after treatment. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the paired t-test was used for comparison within each group before and after treatment； the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， and the Wilcoxon signed-rank test was used for comparison within each group before and after treatment； the chi-square test was used for comparison of categorical data between groups. Hepatic steatosis index （HIS） and Zhejiang University （ZJU） index were used to assess the risk of new-onset MAFLD after antiretroviral therapy. ResultsAfter 36 months of 3TC/EFV/TDF treatment， the MAFLD group had significant increases in body mass index （BMI） ［24.8 （23.2 — 25.9） kg/m² vs 25.3 （22.8 — 27.7） kg/m²， Z=-2.540， P=0.011］， total cholesterol （TC） （4.0±0.6 mmol/L vs 4.3±0.6 mmol/L， t=-2.388， P=0.022）， and high-density lipoprotein cholesterol （HDL-C） ［0.9 （0.8 — 1.1） mmol/L vs 1.1 （0.9 — 1.2） mmol/L， Z=-2.858， P=0.004］ and a significant reduction in serum uric acid （462.1±101.6 μmol/L vs 383.3±85.2 μmol/L， t=4.361， P<0.001）. There was a significant difference in BMI between the MAFLD group and the non-MAFLD group after 3TC/EFV/TDF treatment ［25.3 （22.8 — 27.7） kg/m² vs 21.6 （19.9 — 23.4） kg/m²， Z=-5.462， P<0.001］， while there were no significant differences between the two groups in serum uric acid， TC， triglyceride， HDL-C， low-density lipoprotein cholesterol， lipoprotein a， and CD4⁺ T cell count （all P >0.05）. Furthermore， for the patients in the non-MAFLD group after treatment， there was a significant increase in the proportion of patients at a high risk of MAFLD based on HSI and ZJU indices （χ²=10.829 and 5.658， P=0.001 and 0.017）. ConclusionAfter 36 months of 3TC/EFV/TDF treatment， there are increases in blood lipid levels in HIV patients with MAFLD， and there is an increase in the risk of new-onset MAFLD in HIV patients without MAFLD.

Objective : To predict and validate key targets for cisplatin(DDP) resistance in colorectal cancer(CRC) to provide more options for precision medicine in clinical treatment. Methods: Differentially expressed genes(DEGs) between normal colonic mucosa and CRC were screened from the gene expression omnibus(GEO) database. Key genes were identified using the STRING database and Cytoscape software. DEGs were subjected to enrichment analysis using the gene ontology(GO) and kyoto encyclopedia of genes and genomes(KEGG) databases. Key targets were validated through RNA-seq, qRT-PCR, and Western blot. The versican(VCAN) gene overexpression vector was transfected into human ileocecal colorectal adenocarcinoma cell line HCT8, and cell viability was assessed using the CCK-8 assay. Flow cytometry was used to assess apoptosis and cell cycle distribution. qRT-PCR and Western blot were performed to detect mRNA and protein levels of the target genes. Results : In this study, 118 upregulated DEGs and 146 downregulated DEGs were identified from the GEO database. DEGs were mainly enriched in extracellular matrix degradation, extracellular matrix organization, and the phosphoinositide 3-kinase(PI3K)-protein kinase B(AKT) signaling pathway. Based on protein-protein interaction network analysis, 20 hub genes were identified. By comparing the transcriptome sequencing results of the HCT8 parental strain and DDP-resistant strain, the VCAN gene was further selected. In CRC tissues, the expression level of VCAN was higher than that in normal colonic mucosa, and patients with high VCAN expression had shorter overall survival(OS) and recurrence free survival(RFS) times. Overexpression of VCAN in CRC cells promoted cell proliferation(P<0.05), increased resistance to DDP, reduced DDP-induced apoptosis(P<0.05), and G0/G1phase arrest(P<0.05); upregulation of VCAN activated the protein kinase B(AKT)-mammalian target of rapamycin(mTOR) signaling pathway. Conclusion Bioinformatics and transcriptome sequencing identified VCAN as a key target gene for DDP resistance in CRC, potentially promoting CRC progression and DDP resistance by regulating the AKT-mTOR pathway.