Purpose/Significance The data security management system is built based on the big data of medical alliance to achieve the purpose of enhancing data protection,reducing security risks and improving data security.Method/Process By analyzing the busi-ness scenario of medical alliance,data security policies and application security technologies are established in the full life cycle of collec-tion,transmission,storage,processing,sharing and destruction,and the construction of data security system is improved.Result/Con-clusion The data security management system is a"safety belt"for the business of medical alliance.With a clear security system and standards as the outline,it provides an effective path for the legal and compliant development of hospital business and establishes a feed-back mechanism.

The p21 activated kinase 4 (PAK4) is serine/threonine protein kinase that is critical for cancer progression. Guided by X-ray crystallography and structure-based optimization, we report a novel subseries of C-3-substituted 6-ethynyl-1H-indole derivatives that display high potential and specificity towards group II PAKs. Among these inhibitors, compound 55 exhibited excellent inhibitory activity and kinase selectivity, displayed superior anti-migratory and anti-invasive properties against the lung cancer cell line A549 and the melanoma cell line B16. Compound 55 exhibited potent in vivo antitumor metastatic efficacy, with over 80% and 90% inhibition of lung metastasis in A549 or B16-BL6 lung metastasis models, respectively. Further mechanistic studies demonstrated that compound 55 mitigated TGF-β1-induced epithelial-mesenchymal transition (EMT).

Objective:To evaluate the clinical efficacy and safety of ultrasound negative pressure suction with percutaneous nephroscope in the treatment of perirenal abscess.Methods:The clinical data of 11 patients with perirenal abscess admitted to Zhejiang Provincial People's Hospital from January 2013 to February 2021 were retrospectively analyzed. There were 4 males and 7 females. The average age was 59(51-76) years. The abscess was located on the left side in 4 cases and on the right side in 7 cases. The average diameter of abscess was 11.2(8.1-19.2) cm. All patients had fever, low back pain and abdominal mass, accompanied by bladder irritation in 6 cases, gross hematuria in 5 cases, abdominal distension, nausea and anorexia in 3 cases. There were 7 cases with type 2 diabetes, 2 cases with rheumatoid arthritis and 6 cases with ipsilateral kidney and ureter stone. Among the 11 patients, 6 had a history of urinary tract infection, 1 had a history of upper respiratory tract infection, 1 had secondary infection of perirenal hematoma after traumatic renal rupture, and 3 had secondary infection of perirenal hematoma after percutaneous nephroscopy. All patients were treated with ultrasound negative pressure suction with percutaneous nephroscope under local anesthesia by single operator. The operation time, intraoperative blood loss, drainage volume, drainage tube indwelling time, postoperative body temperature returned to normal time, postoperative hospital stay, therapeutic effect and complications were analyzed.Results:All operation procedures of 11 patients were successfully completed, including 8 cases of single channel, 2 cases of double channels and 1 case of three channels. The average operation time was 44(20-74)min, the average amount of blood loss was 15(10-20)ml, the average amount of pus was 325(200-500)ml, the average indwelling time of drainage tube was 8(6-12)d, the average time of body temperature returned to normal was 0.9(0.5-2.0)d, and the average hospitalization time was 9.6(7.0-14.0)d. Before discharge, CT reexamination showed that the perirenal abscess disappeared. There were no serious complications during and after operation. The average follow-up time was 4.4(3-8) months. There was no recurrence in all patients.Conclusions:Ultrasound negative pressure suction with percutaneous nephroscope is one of the safe and effective surgical methods for the treatment of perirenal abscess. It has the advantages of small trauma, quick recovery, complete drainage, exact effect and fewer complications.

Objective:To evaluate the effect of transfusion-free techniques on the prognosis of liver transplant patients.Methods:The recipients of adult liver transplantation at Tianjin First Central Hospital from August to December 2019 were included in the clinical observation. Liver transplantation without allogeneic blood transfusion was performed through anesthesia management techniques such as acute hemodilution or phlebotomy without volume replacement,maintaining decreased baseline central venous pressure and cell saver. According to the actual results,the patients were divided into two groups: transfusion-free group( n=21) and allogeneic transfusion group( n=28). There were 13 males and 8 females aged of (56.3±11.6) years in the transfusion-free group;and there were 16 males and 12 females aged (54.3±14.2)years in the allogeneic transfusion group. The transplant recipients who had not adopted transfusion management strategy from January to July 2019 were included as control group(27 males and 13 females,aged of (58.9±14.1)years). The clinical data of patients in perioperative period were collected to compare whether there were differences in the recovery of liver function and early complications among the three groups, one-way ANOVA test, rank-sum test, and χ 2 test were used for data analysis. Results:The amount of intraoperative blood loss in both the transfusion-free group and the transfusion group was less than that in the control group((454.2±271.3)ml vs.(673.6±333.4)ml vs.(890.3±346.7)ml; q=-6.342,-5.286,both P<0.05).The duration of stay in ICU of the transfusion-free group was less than that of the transfusion group and control group((36.4±9.1)hours vs.(44.3±14.9)hours vs.(58.2±21.1)hours; q=-4.432,-3.824,both P<0.05).The mean ALT level at 7 days after operation was significantly lower in the transfusion-free group than in the control group((56.8±32.1)U/L vs.(89.6±45.6)U/L; q=-3.358, P<0.05). Conclusions:The improvement of multi-disciplinary transfusion management technology aimed at transfusion-free liver transplantation can effectively reduce intraoperative hemorrhage and help to avoid surgical transfusion. Transfusion-free liver transplantation is beneficial to the early postoperative recovery,and its long-term clinical significance is worthy of further clinical research.

Objective:To evaluate the effect of transfusion-free techniques on the prognosis of liver transplant patients.Methods:The recipients of adult liver transplantation at Tianjin First Central Hospital from August to December 2019 were included in the clinical observation. Liver transplantation without allogeneic blood transfusion was performed through anesthesia management techniques such as acute hemodilution or phlebotomy without volume replacement,maintaining decreased baseline central venous pressure and cell saver. According to the actual results,the patients were divided into two groups: transfusion-free group( n=21) and allogeneic transfusion group( n=28). There were 13 males and 8 females aged of (56.3±11.6) years in the transfusion-free group;and there were 16 males and 12 females aged (54.3±14.2)years in the allogeneic transfusion group. The transplant recipients who had not adopted transfusion management strategy from January to July 2019 were included as control group(27 males and 13 females,aged of (58.9±14.1)years). The clinical data of patients in perioperative period were collected to compare whether there were differences in the recovery of liver function and early complications among the three groups, one-way ANOVA test, rank-sum test, and χ 2 test were used for data analysis. Results:The amount of intraoperative blood loss in both the transfusion-free group and the transfusion group was less than that in the control group((454.2±271.3)ml vs.(673.6±333.4)ml vs.(890.3±346.7)ml; q=-6.342,-5.286,both P<0.05).The duration of stay in ICU of the transfusion-free group was less than that of the transfusion group and control group((36.4±9.1)hours vs.(44.3±14.9)hours vs.(58.2±21.1)hours; q=-4.432,-3.824,both P<0.05).The mean ALT level at 7 days after operation was significantly lower in the transfusion-free group than in the control group((56.8±32.1)U/L vs.(89.6±45.6)U/L; q=-3.358, P<0.05). Conclusions:The improvement of multi-disciplinary transfusion management technology aimed at transfusion-free liver transplantation can effectively reduce intraoperative hemorrhage and help to avoid surgical transfusion. Transfusion-free liver transplantation is beneficial to the early postoperative recovery,and its long-term clinical significance is worthy of further clinical research.

Objective To investigate the curative effects of Retzius sparing robotic assisted laparoscopic radical prostatectomy(RARP) through anterior path.Methods From July 2015 to July 2017,75 patients undergoing Retzius sparing RARP(Rs-RARP group) and 75 patients undergoing conventional anterior approach RARP(CA-RARP group) were retrospectively reviewed.Preoperative data of patients was collected as follows:age of (68.6 ± 5.3) years,median prostate volume of 38.9 (20.6-60.1) m1,tPSA of (15.7 ± 3.3) ng/ml,BMI of (25.2 ± 3.6) kg/m2,biopsy Gleason score of 3 + 3 in 24 cases,3 + 4 in 28 cases,4 + 3 in 23 cases,cTMN T1c in 11 cases,T2a-T2b in 59 cases,T2c in 5 cases,in Rs-RARP group;age of (69.6 ± 5.6) years,median prostate volume of 38.3 (18.4-59.8)ml,tPSA of (17.6 ± 4.4) ng/ml,BMI of (27.5 ± 2.7) kg/m2,biopsy Gleason score of 3 + 3 in 29 cases,3 + 4 in 26 cases,4 + 3 in 20 cases,cTMN T1c in 17 cases,T2a-T2b in 51 cases,T2c in 7 cases,in CA-RARP group.The clinical data of the two groups,including operation time (OT),intraoperative blood loss,perioperative blood transfusion rate,24h/1m/3m/6m/12m continence situation and erectile function recovery,and postoperative oncological results were analyzed statistically.Results All cases were successfully performed robotically without conversion or major intraoperative or postoperative complications.For operative time,Rs-RARP group was (125.3 ± 15.6) mins and CA-RARP group was (108.4 ± 21.7) mins,and the difference was not statistically significant (P ＞ 0.05).For estimated blood loss (EBL),Rs-RARP group was (106.1 ± 10.3) ml,with perioperative blood transfusion in 2 cases (2.67％),and CA-RARP group was (82.2 ± 18.4)ml,with perioperative blood transfusion in 1 cases(1.33％).The Rs-RARP group had more EBL than the CA-RARP group(P ＜0.05).No difference was found in perioperative blood transfusion rate(P ＞ 0.05).The postoperative oral intake time was (1.5 ± 0.6) d,postoperative hospital stay was (8.0 ± 1.2) d,total hospitalization expense was (58.4 ± 13.2) thousand Yuan,and there were 5 cases (6.67％) with postoperative complications in Rs-RARP group,and was (2.0 ±0.6) d,(9.0 ± 1.8) d,(60.2 ± 16.4)thousand Yuan and 3 cases (4.00％) in corresponding items in CA-RARP group.No significant difference was found in the above mentioned parameters (all P ＞ 0.05).Postoperative pathology confirmed pT1c of 18 cases,T2a-T2b of 52 cases,and pT2c of 5 cases in Rs-RARP group and pT1c of 12 cases,T2a-T2b of 56 cases,pT2c of 7 cases in CA-RARP group (P ＞ 0.05).There was no significant difference between RsRARP and CA-RARP groups in the surgical positive margin (5 cases vs.4 cases,P ＞ 0.05).No tumor recurrence appeared for all cases (tPSA ＜0.2 ng/ml) during 12 months follow-up.The continence rate for Rs-RARP group and CA-RARP group were 84.0％ (63/75) vs.28.0％ (21/75) (24h postoperatively),90.7％ (68/75) vs.46.7％ (35/75) (1 month postoperatively),93.3 ％ (70/75) vs.57.3％ (43/75)(3 months postoperatively),96.0％ (72/75) vs.89.3％ (67/75) (6 months postoperatively) and 100％ (75/75) vs.96.3％ (72/75) (1 year postoperatively).Rs-RARP group showed superiority in continence recovery at 24 h and 1,3 months postoperatively (all P ＜ 0.05),but no statistical differences at 6,12 months postoperatively(all P ＞ 0.05).On erectile function,Rs-RARP group was significantly better than the conventional group at 1,3,6,12 months postoperatively in ≤75-year-old patients(all P ＜ 0.05).But in ＞ 75-year-old patients,two groups had no difference during the follow-up (all P ＞ 0.05).Conclusions Retzius sparing RARP through anterior path can treat early and intermediate stage prostate cancer effectively,and continence and erectile function recovered shortly.

Objective To explore the clinical efficacy of raltitrexed combined with oxaliplatin in the treatment of patients with advanced colorectal cancer (CRC) and its influence on tumor necrosis factor-α (TNF-α) and interleukin-2 (IL-2).Methods A total of 69 patients with advanced CRC were selected and randomly divided into treatment group (n =35) and control group (n =34).Treatment group was treated with raltitrexed combined with oxaliplatin,while control group was treated with capecitabine combined with oxaliplatin.Short-and long-term clinical efficacy as well as the changes of levels of TNF-α and IL-2 before and 3 weeks after treatment were compared,and the occurrence rates of toxic and adverse reactions were recorded during treatment.Results Treatment group was slightly higher than control group in clinical efficacy and disease control rate (P ＞0.05),and there was also no significant difference between two groups in time to progression (TFP)and median overall survival time (OS) (P ＞ 0.05).After treatment for 3 weeks,levels of TNF-α and IL-2 increased in both groups (P ＜ 0.01),which increased more significantly in treatment group than control group (P ＜ 0.01).Treatment group was significantly lower in the rates of diarrhea,nausea and vomiting,and neutropenia,bur was prominently higher in the increase of transaminase than control group (P ＜ 0.05).Conclusion Rahitrexed combined with oxaliplatin has similar clinical efficacy to capecitabine combined with oxaliplatin in the treatment of advanced CRC,but the former is mild in toxic and adverse reactions.

Objective To explore the clinical efficacy of raltitrexed combined with oxaliplatin in the treatment of patients with advanced colorectal cancer (CRC) and its influence on tumor necrosis factor-α (TNF-α) and interleukin-2 (IL-2).Methods A total of 69 patients with advanced CRC were selected and randomly divided into treatment group (n =35) and control group (n =34).Treatment group was treated with raltitrexed combined with oxaliplatin,while control group was treated with capecitabine combined with oxaliplatin.Short-and long-term clinical efficacy as well as the changes of levels of TNF-α and IL-2 before and 3 weeks after treatment were compared,and the occurrence rates of toxic and adverse reactions were recorded during treatment.Results Treatment group was slightly higher than control group in clinical efficacy and disease control rate (P ＞0.05),and there was also no significant difference between two groups in time to progression (TFP)and median overall survival time (OS) (P ＞ 0.05).After treatment for 3 weeks,levels of TNF-α and IL-2 increased in both groups (P ＜ 0.01),which increased more significantly in treatment group than control group (P ＜ 0.01).Treatment group was significantly lower in the rates of diarrhea,nausea and vomiting,and neutropenia,bur was prominently higher in the increase of transaminase than control group (P ＜ 0.05).Conclusion Rahitrexed combined with oxaliplatin has similar clinical efficacy to capecitabine combined with oxaliplatin in the treatment of advanced CRC,but the former is mild in toxic and adverse reactions.

Objective To analyze the related factors that influence the stone free rate ( SFR) in flexible ureteroscopic lithotripsy ( FURL ) and develop a stone free index ( SFI ) model to estimate and predict the outcome of FURL.Methods A total of 393 patients receiving FURL were included in this study from May 2013 to August 2014.All patients′and calculous characteristics were recorded.It was evaluated the correlation of one-stage SFR with body mass index, the degree of hydronephrosis, the sterile urine, the renal insufficiency, the stone location, the stone number, the cumulative stone diameter ( CSD) , the stone density, the average of CT values, the minimum angle of pelvis ureter long axis with lamp long axis, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.Multivariate regression analysis was used to analyze the relationship between preoperative characteristics and the SFR.Results The one-stage postoperative SFR in our study was 92.4% ( 363/393).We found that the staghorn stone, bacteriuria, CSD, average of CT values, the average length of stone located calyx-neck, the minimum ratio of stone located calyx-neck′width with calyx′width were significantly correlated with the postoperative SFR ( P <0.05 ) .We used logistic regression analysis to determine statistical significant variables and to create predictable mathematical model.The SFI system was consist of four stone characteristics, including the staghorn stone, the cumulative stone diameter, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.The SFI had a high ROC curve (AUC=0.867) for predicting the one-stage postoperative stone free outcome.SFI score >7.5 meant a relatively high SFR ( SFR>85%) of FURL.Conclusions A SFI model using preclinical data was developed to predict the postoperative outcome of FURL, as well as the one-stage SFR.This model needs further prospective studies in the future.

Objective To explore the CCR7 expression status in bladder urothelial carcinoma (BUC) and the relationship between CCR7 expression and lymph node metastasis,and analyze the impact of CCR7 expression on prognosis.Methods The expression levels of CCR7 in 57 BUC tissues and 10 normal bladder tissues were estimated by immunohistochemistry technique,and the correlation between CCR7 with lymph node metastasis,tumor stage,grade,number,size,relapse or not,and patients' age/sex of BUC was analyzed.The influence factors of lymph node metastasis were tested,and so were the influence factors of prognosis.Results The positive rate of CCR7 expression among 57 patients was 82.5％ (47/57) (high expression rate was 45.6％),which was higher than that in normal bladder tissue (20.0％,all were low expression,P ＜ 0.05).The high expression rate of CCR7 in lymph node metastasis group was 68.2％ (15/22),higher than that in none lymph node metastasis group (31.4％,11/35,P ＜ 0.01).The expression level of CCR7 had no significant correlation with tumor stage,grade or other parameters.CCR7 expression,tumor stage and tumor grade were correlated with lymph node status (P ＜ 0.05),but only the first was an independent one.High CCR7 expression had a significant link with low relapse free survival (P ＜ 0.05).Conclusion The expression of CCR7 was highly expressed in BUC,which may be a positive independent influence factor of lymph node metastasis,and a predictor of poor prognosis.