Objective To analyze the influencing factors for postoperative anastomotic leak (AL) in carcinoma of the esophagus and gastroesophageal junction and construct a nomogram predictive model. Methods The patients who underwent radical esophagectomy at Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2018 to June 2020 were included in this study. Relevant variables were screened using univariate and multivariate logistic regression analyses. A nomogram was then developed to predict the risk factors associated with postoperative AL. The predictive performance of the nomogram was validated using the receiver operating characteristic (ROC) curve. Results A total of 468 patients with carcinoma of the esophagus and gastroesophageal junction were included in the study, comprising 354 males and 114 females, with a mean age of (62.8±7.2) years. The tumors were predominantly located in the middle or lower esophagus, and 51 (10.90%) patients experienced postoperative AL. Univariate logistic regression analysis indicated that age, body mass index (BMI), tumor location, preoperative albumin levels, diabetes mellitus, anastomosis technique, anastomosis site, and C-reactive protein (CRP) levels were potentially associated with AL (P<0.05). Multivariate logistic regression analysis identified age, BMI, tumor location, diabetes mellitus, anastomosis technique, and CRP levels as independent risk factors for AL (P<0.05). A nomogram was developed based on the findings from the multivariate logistic regression analysis. The area under the receiver operating characteristic (ROC) curve was 0.803, indicating a strong concordance between the actual observations and the predicted outcomes. Furthermore, decision curve analysis demonstrated that the newly established nomogram holds significant value for clinical decision-making. Conclusion The predictive model for postoperative AL in patients with carcinoma of the esophagus and gastroesophageal junction demonstrates strong predictive validity and is essential for guiding clinical monitoring, early detection, and preventive strategies.

In recent years, robot-assisted esophagectomy has become increasingly widespread, but the esophagogastric anastomosis step remains relatively complex and cumbersome. Currently, commonly used gastrointestinal reconstruction anastomosis techniques include end-to-end anastomosis, end-to-side anastomosis, and side-to-side anastomosis. Depending on the anastomosis method, they can be further divided into manual anastomosis and mechanical anastomosis, with common instruments including circular staplers and linear staplers. In esophageal cancer surgery, the choice of esophagogastric anastomosis technique is typically based on the tumor’s location and size as well as the surgeon’s preference. Each anastomosis technique has its advantages and disadvantages. With continuous improvements in anastomosis techniques and updates in stapling instruments, the incidence of complications after esophagogastric anastomosis has been effectively reduced. However, safely and efficiently completing gastrointestinal reconstruction during surgery remains a significant challenge. Scholars have made extensive explorations in this field, actively proposing and achieving various reconstruction methods, leading to significant progress. This article reviews the research progress of robot-assisted esophagogastric anastomosis techniques from both the anastomosis techniques and methods perspectives.

OBJECTIVE: This study aims to analyze the influence factors of lower urinary tract symptoms (LUTS) in patients receiving radical prostatectomy for prostate cancer, and to explore effective nursing strategy in order to provide a theoretical basis for improving the postoperative quality of life of patients. METHODS: A retrospective study was conducted on 103 elderly male patients who underwent radical prostatectomy for prostate cancer in the Department of Urology at General Hospital of Eastern Theater Command from August 2022 to August 2024. The patients were categorized into two groups based on whether LUTS occurred. Demographic and clinical characteristics, perioperative parameters, follow-up data, and participation in pelvic floor muscle training were analyzed to identify risk factors associated with postoperative LUTS. RESULTS: The incidence of postoperative LUTS in the patients with LUTS before the operation was significantly higher than that in the patients without LUTS before the operation (68.42% vs 32.61%, P=0.001). Additionally, the use of larger catheters (22F) was closely associated with an increased incidence of postoperative LUTS(P<0.01). Pelvic floor exercises demonstrated a significant protective effect, with patients who engaged in pelvic floor exercises exhibiting a lower incidence of postoperative LUTS (38.60% vs 60.87%, P=0.040). Regression analysis further revealed that pelvic floor exercises was the protective factor for postoperative LUTS (OR=0.215, 95%CI: 0.091－0.508, P<0.01). CONCLUSION Preoperative LUTS and catheter size are significant risk factors for the occurrence of postoperative LUTS following radical prostatectomy. Pelvic floor muscle exercise after surgery has a protective effect. Postoperative personalized nursing interventions are necessary for different patients to achieve optimal recovery outcomes.
Humans ; Male ; Prostatectomy/adverse effects* ; Retrospective Studies ; Lower Urinary Tract Symptoms/nursing* ; Aged ; Risk Factors ; Quality of Life ; Pelvic Floor ; Prostatic Neoplasms/surgery* ; Postoperative Complications/prevention & control* ; Exercise Therapy ; Middle Aged

OBJECTIVE: To explore the potential effects and mechanisms of Liang-Ge-San (LGS) for the treatment of acute respiratory distress syndrome (ARDS) through network pharmacology analysis and to verify LGS activity through biological experiments. METHODS: The key ingredients of LGS and related targets were obtained from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform. ARDS-related targets were selected from GeneCards and DisGeNET databases. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were performed using the Metascape Database. Molecular docking analysis was used to confirm the binding affinity of the core compounds with key therapeutic targets. Finally, the effects of LGS on key signaling pathways and biological processes were determined by in vitro and in vivo experiments. RESULTS: A total of LGS-related targets and 496 ARDS-related targets were obtained from the databases. Network pharmacological analysis suggested that LGS could treat ARDS based on the following information: LGS ingredients luteolin, wogonin, and baicalein may be potential candidate agents. Mitogen-activated protein kinase 14 (MAPK14), recombinant V-Rel reticuloendotheliosis viral oncogene homolog A (RELA), and tumor necrosis factor alpha (TNF-α) may be potential therapeutic targets. Reactive oxygen species metabolic process and the apoptotic signaling pathway were the main biological processes. The p38MAPK/NF-κ B signaling pathway might be the key signaling pathway activated by LGS against ARDS. Moreover, molecular docking demonstrated that luteolin, wogonin, and baicalein had a good binding affinity with MAPK14, RELA, and TNF α. In vitro experiments, LGS inhibited the expression and entry of p38 and p65 into the nucleation in human bronchial epithelial cells (HBE) cells induced by LPS, inhibited the inflammatory response and oxidative stress response, and inhibited HBE cell apoptosis (P<0.05 or P<0.01). In vivo experiments, LGS improved lung injury caused by ligation and puncture, reduced inflammatory responses, and inhibited the activation of p38MAPK and p65 (P<0.05 or P<0.01). CONCLUSION LGS could reduce reactive oxygen species and inflammatory cytokine production by inhibiting p38MAPK/NF-κ B signaling pathway, thus reducing apoptosis and attenuating ARDS.
Drugs, Chinese Herbal/pharmacology* ; Respiratory Distress Syndrome/enzymology* ; p38 Mitogen-Activated Protein Kinases/metabolism* ; NF-kappa B/metabolism* ; Animals ; Signal Transduction/drug effects* ; Molecular Docking Simulation ; Humans ; Male ; Network Pharmacology ; Apoptosis/drug effects* ; Mice

OBJECTIVE: To identify the underlying mechanism by which quercetin (Que) alleviates sepsis-related acute respiratory distress syndrome (ARDS). METHODS: In vivo, C57BL/6 mice were assigned to sham, cecal ligation and puncture (CLP), and CLP+Que (50 mg/kg) groups (n=15 per group) by using a random number table. The sepsisrelated ARDS mouse model was established using the CLP method. In vitro, the murine alveolar macrophages (MH-S) cells were classified into control, lipopolysaccharide (LPS), LPS+Que (10 μmol/L), and LPS+Que+acetylcysteine (NAC, 5 mmol/L) groups. The effect of Que on oxidative stress, inflammation, and apoptosis in mice lungs and MH-S cells was determined, and the mechanism with reactive oxygen species (ROS)/p38 mitogen-activated protein kinase (MAPK) pathway was also explored both in vivo and in vitro. RESULTS: Que alleviated lung injury in mice, as reflected by a reversal of pulmonary histopathologic changes as well as a reduction in lung wet/dry weight ratio and neutrophil infiltration (P<0.05 or P<0.01). Additionally, Que improved the survival rate and relieved gas exchange impairment in mice (P<0.01). Que treatment also remarkedly reduced malondialdehyde formation, superoxide dismutase and catalase depletion, and cell apoptosis both in vivo and in vitro (P<0.05 or P<0.01). Moreover, Que treatment diminished the release of inflammatory factors interleukin (IL)-1β, tumor necrosis factor-α, and IL-6 both in vivo and in vitro (P<0.05 or P<0.01). Mechanistic investigation clarifified that Que administration led to a decline in the phosphorylation of p38 MAPK in addition to the suppression of ROS expression (P<0.01). Furthermore, in LPS-induced MH-S cells, ROS inhibitor NAC further inhibited ROS/p38 MAPK pathway, as well as oxidative stress, inflammation, and cell apoptosis on the basis of Que treatment (P<0.05 or P<0.01). CONCLUSION Que was found to exert anti-oxidative, anti-inflammatory, and anti-apoptotic effects by suppressing the ROS/p38 MAPK pathway, thereby conferring protection for mice against sepsis-related ARDS.
Animals ; Sepsis/drug therapy* ; Quercetin/therapeutic use* ; Respiratory Distress Syndrome/enzymology* ; p38 Mitogen-Activated Protein Kinases/metabolism* ; Mice, Inbred C57BL ; Reactive Oxygen Species/metabolism* ; Apoptosis/drug effects* ; Male ; Oxidative Stress/drug effects* ; MAP Kinase Signaling System/drug effects* ; Lung/drug effects* ; Mice ; Lipopolysaccharides ; Macrophages, Alveolar/pathology* ; Inflammation/pathology* ; Protective Agents/therapeutic use*

Background The threshold limit values (TLVs) established and regularly updated by the American Conference of Governmental Industrial Hygienists (ACGIH) are widely adopted and referenced globally, serving as a crucial reference for China's occupational exposure limits (OELs). It is necessary to track it regularly and compare it with China's OELs. Objective To compare the OELs stipulated in Occupational exposure limits for hazardous agents in the workplace—Part 1: Chemical hazardous agents (GBZ 2.1—2019) and the ACGIH TLVs (2024) and to provide references for subsequent formulation and revision of OELs in China. Methods The OELs specified in GBZ 2.1—2019 and the TLVs issued by ACGIH were used to establish a database using Microsoft Excel 2019 software. Cross verification was conducted through matching Chemical Abstracts Service Registry Numbers (CAS Rn) and both Chinese and English names to ensure accuracy. Then, comparisons and analyses were carried out based on the type of limit values, which were matched as follows: permissible concentration-time weighted average (PC-TWA) with threshold limit value-time weighted average (TLV-TWA), permissible concentration-short term exposure limit (PC-STEL) with threshold limit value-short term exposure limit (TLV-STEL), and maximum allowable concentration (MAC) with threshold limit value-ceiling (TLV-C). Comparisons included types, quantities, and sizes of limits. Results The GBZ 2.1—2019 OELs and the ACGIH TLVs (2024) were generally consistent in terms of types and definitions, but there were differences in the number and size of the limits. In terms of the number of limits, GBZ 2.1—2019 specified 365 OELs for 358 chemical hazardous agents, while ACGIH TLVs (2024) included 316 corresponding limits. Among these, 148 (46.9%) limits were consistent, 38 (12.0%) were basically consistent, and 130 (41.1%) were inconsistent. In terms of the size of the limits, out of the 130 inconsistent limits, 51 OELs were lower than the corresponding TLVs, 67 OELs were higher than the corresponding TLVs, and 12 were under different limit types. For some chemical hazardous agents, their OELs were significantly lower or higher than their TLVs. Conclusion Some of the OELs for chemical hazardous agents specified in GBZ 2.1—2019 are significantly lower or higher than the TLVs. For these chemical hazardous factors, it is recommended to prioritize their inclusion in research projects and to complete the revisions as soon as possible based on the latest scientific evidence.

AIM:To investigate the effect and mechanism of velvet antler polypeptide(VAP)on premature ovarian failure induced by cisplatin(DDP)in rats.METHODS:Female rats with normal estrous cycle were randomly di-vided into the control,model,and VAP groups,with 10 rats in each group.Premature ovarian failure was induced in the model and VAP groups by intraperitoneal injection of DDP(4 mg·kg-1·d-1)for 20 consecutive days,and the VAP group was treated with VAP(400 mg·kg-1·d-1)for 20 consecutive days.Hematoxylin and eosin(HE)staining was used to ob-serve the morphological manifestations of the ovary,and the number of developing follicles at all levels was counted.En-zyme-linked immunosorbent assay(ELISA)was performed to detect serum estradiol(E2),follicle-stimulating hormone(FSH),and anti-Mullerian hormone(AMH)levels.The levels of glutathione(GSH)and malondialdehyde(MDA)in ovarian tissues were detected by biochemical methods.The level of reactive oxygen species(ROS)in ovarian tissue was detected by the probe labeling method.Prussian blue staining was performed to observe the iron accumulation in ovarian tissue,as well as the ferrous ion(Fe2+)level was detected by Fe2+content analysis kit.Immunohistochemistry and West-ern blot analysis were performed to detect the expressions of solute carrier family 7 member 11(SCL7A11),glutathione peroxidase 4(GPX4),and acyl-CoA synthetase long-chain family member 4(ACSL4)in the ovarian tissue.The fertility of rats was monitored in each group.RESULTS:Compared with control group,the model group showed ovarian atrophy,iron accumulation(P<0.01),reduced development of follicles at all levels and total follicles(P<0.05),increased atretic follicles(P<0.01),reduced litter size(P<0.01),decreased serum E2 and AMH levels(P<0.01),increased FSH levels(P<0.01),decreased GSH level and SCL7A11 and GPX4 protein expression levels in the ovarian tissue(P<0.01),and increased levels of Fe2+,MDA,and ROS and expression levels of ACSL4(P<0.01).Compared with model group,the VAP group had improvement in these aforementioned changes caused by DDP(P<0.01).CONCLUSION:Treatment with VAP can improve ovarian function,maintain normal follicle development,and improve fertility in cisplatin-induced premature ovarian failure rats,and the mechanism may be related to the inhibition of lipid peroxidation and ferroptosis.

Objective To study the serum expression of interleukin-36α(IL-36α),C1q/tumor necrosis factor-related protein 6(CTRP6)levels in patients with polycystic ovary syndrome(PCOS)and their diagnostic value.Methods A total of 98 PCOS patients diagnosed and treated in the Fifth Affiliated Hospital of Xinjiang Medical University from April 2019 to April 2022 were taken as the PCOS group,and 70 healthy women were taken as the control group.Enzyme-linked immunosorbent assay was applied to detect serum IL-36 α and CTRP6 level expression.The correlation between the expression of serum IL-36 α,CTRP6 levels and clinical indicators was analyzed by Pearson correlation analysis.Multivariate logistic regression analysis was used to analyze factors affecting the occurrence of PCOS.Receiver operating characteristic curve was used to evaluate the diagnostic efficacy of serum IL-36α,CTRP6 and combination in PCOS.Results Serum CTRP6(18.25±3.67μg/L),FPG(5.71±0.49nmol/L),FINS(18.96±2.68mIU/L),HOMA-IR(4.72±0.46),LH(6.17±1.44IU/L),T(1.32±0.42nmol/L),ovarian number(17.86±5.20)and ovarian volume(9.29±2.14cm3)in the PCOS group were higher,while serum IL-36 α(0.67±0.13ng/L)and FSH((4.27±1.33IU/L)were lower compared with those in the control group(5.14±1.28μg/L,4.76±0.54mmol/L,8.63±1.65mIU/L,1.83±0.33,4.92±1.39IU/L,0.86±0.28nmol/L,6.76±1.94 个,5.26±1.31cm3,2.11±0.38ng/L,5.42±1.67IU/L),with significant differences(t/x2=4.962～44.934,all P<0.05).Serum IL-36α(0.87±0.15ng/L,0.70±0.12ng/L,0.51±0.11ng/L,0.42±0.10ng/L)levels in patients with type 1,type 2,type 3,and type 4 PCOS were decreased sequentially,while CTRP6(14.07±3.35 μg/L,17.66±3.97 μg/L,21.16±3.67 μg/L,24.08±3.53 μg/L)were increased sequentially,with significant differences(F=61.281,33.854,all P<0.05).There was a negative correlation between serum IL-36 α and ovarian number,ovarian volume,FINS and HOMA-IR(r=-0.661,-0.621,-0.554,-0.671,all P<0.05).Serum CTRP6 was positively correlated with ovarian number,ovarian volume,FINS and HOMA-IR(r=0.625,0.631,0.537,0.738,all P<0.05).CTRP6(OR=1.327,95%CI:1.104～1.596)was an independent risk factor affecting the occurrence of PCOS,while IL-36 α(OR=0.707,95%CI:0.547～0.914)was a protective factor.The area under the curve(95%CI)of combination of IL-36 α and CTRP6 for the diagnosis of PCOS was 0.933(0.872～0.969),which was greater than that of IL-36 α,CTRP6 alone[0.870(0.821～0.926),0.898(0.854～0.940)],with significant differences(Z=4.258,4.119,all P<0.05).Conclusion The decrease of serum IL-36α and the increase of CTRP6 in PCOS patients are related to the severity of PCOS,and the combined detection of the two may have high diagnostic value for PCOS.

OBJECTIVE: To study the impacts of varicocele (VC) and varicocelectomy (VCT) on the proteomics of rat testis tissue, and to analyze the differential proteins and signaling pathways, and observe the microstructural changes of the testis tissue. METHODS: We selected 60 male SD rats and divided them into a sham operation (SO), a VC model control, and a VCT group. We harvested the testis tissues from the rats at 4 weeks after modeling for determination of the differential protein expressions by mass spectrometry, analysis of the changes in the protein signaling pathways by KEGG pathway repolarization, and observation of the microstructural changes in the spermatogenic cells under the transmission electron microscope (TEM). RESULTS: A total of 15 clinically significant proteins were effectively identified, among which RPS24, KIFAP3, HPX, RPL38, TOP2A, PRPF19, TRPM3, RPL32, CNBP and AHSG were upregulated, while RPS9, TKFC, SH3BGRL3, ACAA2 and FABP3 downregulated. The differential pathways found included the Type-I 4-aminobutyrate degradation pathway, eIF2 signaling pathway, and Type-III glutamate degradation pathway, which were all related to the pathogenesis of testicular growth arrest. Compared with the rats in the VCT group, those of the VC group rats showed ultrastructural changes in the testis tissue under the TEM, such as mitochondrial vacuolar degeneration, dense nucleoli, invagination of cell nuclear membranes, and irregularity, which were detrimental to the survival of testicular cells. CONCLUSION VCT affects the development and growth of the testis by altering the expressions of relevant proteins and influencing the changes of the gene pathways in the testicular cells, which may be one of the causes of VC inducing testis injury and testicular spermatogenic dysfunction. The changes in these molecular pathways can provide some theoretical evidence for an insight VC as well as potential therapeutic targets for its treatment.
Male ; Animals ; Varicocele/pathology* ; Rats ; Testis/ultrastructure* ; Rats, Sprague-Dawley ; Proteomics ; Signal Transduction ; Proteome

OBJECTIVE: To evaluate the clinical efficacy and safety of Wuziyuye Decoction in the treatment of type-II diabetes mellitus (DM) with qi-yin deficiency complicated by asthenospermia. METHODS: We selected 100 cases of type-II DM with qi-yin deficiency complicated by asthenospermia treated in the First Hospital Affiliated to Ningbo University from January 2023 to March 2024, and randomly assigned them to receive Wuziyuye Decoction (the trial group, n = 50) and oral L-carnitine solution (the control group, n = 50) in addition to Western medicine to reduce fasting blood glucose to normal in both groups. After 12 weeks of medication, we followed up the patients for 24 weeks, obtained their semen parameters, traditional Chinese medicine (TCM) syndrome scores and levels of reproductive hormones, and the clinical pregnancy outcomes of their partners, followed by comparison of the data collected between the two groups before and after treatment. RESULTS: After 12 weeks of treatment, the trial group showed significant improvement over the baseline in the percentage of progressive motility (PR%) (［35.5±6.1］% vs ［18.0±4.2］%, P<0.05), sperm concentration (［54.0±33.4］ vs ［40.0±36.1］ × 10⁶/ml, P<0.05), and TCM syndrome score (4.5±2.3 vs 18.5±5.2, P<0.05), but no statistically significant difference in the semen volume (［2.85±0.36］ vs ［2.84±0.59］ ml, P>0.05), while the controls exhibited markedly improved percentage of PR% (［29.5±6.2］% vs ［18.5±4.5］%, P<0.05) and sperm concentration (［45.0±34.1］ vs ［42.0±38.3］ × 10⁶/ml, P<0.05), but no statistically significant difference in the semen volume (［3.04±0.89］ vs ［2.90±0.78］ ml, P>0.05) and TCM syndrome score (17.2±4.5 vs 17.8±4.8, P>0.05). The patients treated with Wuziyuye Decoction achieved even more significant improvement than the controls in the percentage of PR%, sperm concentration and TCM syndrome score (P<0.05), but there were no statistically significant differences in the reproductive hormone levels and clinical pregnancy outcomes between the two groups of patients after treatment (P>0.05). And no severe adverse reactions were observed in either group. CONCLUSION Wuziyuye Decoction is safe and effective for the treatment of type-II DM with qi-yin deficiency complicated by asthenospermia by improving the sperm motility and concentration of the patient.
Humans ; Drugs, Chinese Herbal/therapeutic use* ; Male ; Asthenozoospermia/complications* ; Diabetes Mellitus, Type 2/drug therapy* ; Yin Deficiency/complications* ; Adult ; Medicine, Chinese Traditional ; Sperm Motility ; Qi ; Female ; Pregnancy