Objective To investigate the diagnostic value of multimodality-enhanced CT-based radiomics nomogram for muscle-inva-sive bladder urothelial carcinoma.Methods A retrospective analysis was performed on the preoperative data of 644 patients with pathologically confirmed bladder urothelial carcinoma from three medical centers.Region of interest(ROI)were drawn on preopera-tive contrast-enhanced CT images,and radiomics features were extracted.Patients from medical center 1 were randomly divided into training set and internal validation set in a 7∶3 ratio,while patients from medical centers 2 and 3 were combined as an external val-idation set.The diagnostic performance of the models was evaluated using receiver operating characteristic(ROC)curve.Results In the external validation set,the area under the curve(AUC)for diagnosing muscle-invasive bladder urothelial carcinoma using the multi-phase fusion radiomics model was 0.861[95％ confidence interval(CI)0.811-0.911].The nomogram constructed by combi-ning the multi-phase fusion radiomics model with clinical factors achieved an AUC of 0.901(95％ CI 0.862-0.939).Conclusion The nomogram combining multimodality-enhanced CT-based radiomics with clinical factors can effectively diagnose muscle-invasive bladder urothelial carcinoma.

Objective:To investigate the prognosis of postoperative adjuvant therapy for hepatocellular carcinoma after conversion therapy of combined targeted therapy and immunotherapy followed by sequential hepatectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 103 patients with initially unresectable hepatocellular carcinoma (HCC) who were admitted to 11 medical centers in China, including Mengchao Hepatobiliary Hospital of Fujian Medical University et al, from November 2019 to May 2023 were collected. There were 83 males and 20 females, aged (54±12)years. All 103 patients underwent conversion therapy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) successfully followed by sequential hepatectomy, of which 72 patients undergoing postoperative adjuvant therapy were divided into the adjuvant therapy group, and 31 patients undergoing postoperative follow-up monitoring were divided into the follow-up monitoring group. Observation indicators: (1) follow-up and postoperative condi-tions; (2) analysis of factors influencing recurrence-free survival time of patients; (3) stratified ana-lysis. Comparison of count data between group was conducted using the chi-square test or Fisher exact probability. The R software was used to draw survival curves, and the Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the Cox proportional hazard model. Results:(1) Follow-up and postoperative conditions. All 103 patients were followed up for 21.0(range, 1.9?47.2)months, with the median recurrence-free survival time of 28.7 months and the 1-, 2-, 3-year recurrence-free survival rates of 68.6%, 55.6%, 41.2%. The median overall survival time of 103 patients was unreached, and the 1-, 2-, 3-year overall survival rates were 90.9%, 82.1%, 69.6%, respectively. The median recurrence-free survival time was 33.1 months in patients of the adjuvant therapy group, with the 1-, 2-year recurrence-free survival rates as 77.2%, 61.5%. The median recurrence-free survival time was 11.1 months in patients of the follow-up monitoring group, with the 1-, 2-year recurrence-free survival rates as 46.6%, 40.8%. There was a significant difference in recurrence-free survival between the two groups of patients ( χ2=5.492, P<0.05). (2) Analysis of factors influencing recurrence-free survival time of patients. Results of multivariate analy-sis showed that pathologic complete response and postoperative adjuvant therapy were independent factors influencing recurrence-free survival time of HCC patients undergoing conversion therapy of combined targeted therapy and immunotherapy followed by sequential hepatectomy ( hazard ratio=0.297, 0.492, 95% confidence interval as 0.137?0.647, 0.268?0.903, P<0.05). (3) Stratified analysis. Of the 71 patients with non-pathologic complete response, the median recurrence-free survival time of 48 patients in the adjuvant therapy group was 24.0 months, with the 1-, 2-year recurrence-free survival rates as 67.4%, 48.8%. The median recurrence-free survival time of 23 patients with non-pathological complete response in the follow-up monitoring group was 7.4 months, with the 1-, 2-year recurrence-free survival rates as 35.0%, 26.3%. There was a significant difference in recurrence-free survival between the 48 patients with non-pathologic complete response in the adjuvant therapy group and the 23 patients with non-pathologic complete response in the follow-up monitoring group ( χ2=5.241, P<0.05). Conclusion:For HCC patients with conversion therapy of TKIs and ICIs followed by sequential hepatectomy, postoperative adjuvant therapy, compared to postoperative follow-up monitoring, can prolong the recurrence-free survival time of patients, of whom cases with non-pathologic complete response can benefit from adjuvant therapy.

Objective To investigate the diagnostic value of multimodality-enhanced CT-based radiomics nomogram for muscle-inva-sive bladder urothelial carcinoma.Methods A retrospective analysis was performed on the preoperative data of 644 patients with pathologically confirmed bladder urothelial carcinoma from three medical centers.Region of interest(ROI)were drawn on preopera-tive contrast-enhanced CT images,and radiomics features were extracted.Patients from medical center 1 were randomly divided into training set and internal validation set in a 7∶3 ratio,while patients from medical centers 2 and 3 were combined as an external val-idation set.The diagnostic performance of the models was evaluated using receiver operating characteristic(ROC)curve.Results In the external validation set,the area under the curve(AUC)for diagnosing muscle-invasive bladder urothelial carcinoma using the multi-phase fusion radiomics model was 0.861[95％ confidence interval(CI)0.811-0.911].The nomogram constructed by combi-ning the multi-phase fusion radiomics model with clinical factors achieved an AUC of 0.901(95％ CI 0.862-0.939).Conclusion The nomogram combining multimodality-enhanced CT-based radiomics with clinical factors can effectively diagnose muscle-invasive bladder urothelial carcinoma.

Objective:To investigate the prognosis of postoperative adjuvant therapy for hepatocellular carcinoma after conversion therapy of combined targeted therapy and immunotherapy followed by sequential hepatectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 103 patients with initially unresectable hepatocellular carcinoma (HCC) who were admitted to 11 medical centers in China, including Mengchao Hepatobiliary Hospital of Fujian Medical University et al, from November 2019 to May 2023 were collected. There were 83 males and 20 females, aged (54±12)years. All 103 patients underwent conversion therapy of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) successfully followed by sequential hepatectomy, of which 72 patients undergoing postoperative adjuvant therapy were divided into the adjuvant therapy group, and 31 patients undergoing postoperative follow-up monitoring were divided into the follow-up monitoring group. Observation indicators: (1) follow-up and postoperative condi-tions; (2) analysis of factors influencing recurrence-free survival time of patients; (3) stratified ana-lysis. Comparison of count data between group was conducted using the chi-square test or Fisher exact probability. The R software was used to draw survival curves, and the Log-rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the Cox proportional hazard model. Results:(1) Follow-up and postoperative conditions. All 103 patients were followed up for 21.0(range, 1.9?47.2)months, with the median recurrence-free survival time of 28.7 months and the 1-, 2-, 3-year recurrence-free survival rates of 68.6%, 55.6%, 41.2%. The median overall survival time of 103 patients was unreached, and the 1-, 2-, 3-year overall survival rates were 90.9%, 82.1%, 69.6%, respectively. The median recurrence-free survival time was 33.1 months in patients of the adjuvant therapy group, with the 1-, 2-year recurrence-free survival rates as 77.2%, 61.5%. The median recurrence-free survival time was 11.1 months in patients of the follow-up monitoring group, with the 1-, 2-year recurrence-free survival rates as 46.6%, 40.8%. There was a significant difference in recurrence-free survival between the two groups of patients ( χ2=5.492, P<0.05). (2) Analysis of factors influencing recurrence-free survival time of patients. Results of multivariate analy-sis showed that pathologic complete response and postoperative adjuvant therapy were independent factors influencing recurrence-free survival time of HCC patients undergoing conversion therapy of combined targeted therapy and immunotherapy followed by sequential hepatectomy ( hazard ratio=0.297, 0.492, 95% confidence interval as 0.137?0.647, 0.268?0.903, P<0.05). (3) Stratified analysis. Of the 71 patients with non-pathologic complete response, the median recurrence-free survival time of 48 patients in the adjuvant therapy group was 24.0 months, with the 1-, 2-year recurrence-free survival rates as 67.4%, 48.8%. The median recurrence-free survival time of 23 patients with non-pathological complete response in the follow-up monitoring group was 7.4 months, with the 1-, 2-year recurrence-free survival rates as 35.0%, 26.3%. There was a significant difference in recurrence-free survival between the 48 patients with non-pathologic complete response in the adjuvant therapy group and the 23 patients with non-pathologic complete response in the follow-up monitoring group ( χ2=5.241, P<0.05). Conclusion:For HCC patients with conversion therapy of TKIs and ICIs followed by sequential hepatectomy, postoperative adjuvant therapy, compared to postoperative follow-up monitoring, can prolong the recurrence-free survival time of patients, of whom cases with non-pathologic complete response can benefit from adjuvant therapy.

Endothelial-mesenchymal transition (EndMT) disrupts vascular endothelial integrity and induces atherosclerosis. Active integrin β1 plays a pivotal role in promoting EndMT by facilitating TGFβ/Smad signaling in endothelial cells. Here, we report a novel anthraquinone compound, Kanglexin (KLX), which prevented EndMT and atherosclerosis by activating MAP4K4 and suppressing integrin β1/TGFβ signaling. First, KLX effectively counteracted the EndMT phenotype and mitigated the dysregulation of endothelial and mesenchymal markers induced by TGFβ1. Second, KLX suppressed TGFβ/Smad signaling by inactivating integrin β1 and inhibiting the polymerization of TGFβR1/2. The underlying mechanism involved the activation of FGFR1 by KLX, resulting in the phosphorylation of MAP4K4 and Moesin, which led to integrin β1 inactivation by displacing Talin from its β-tail. Oral administration of KLX effectively stimulated endothelial FGFR1 and inhibited integrin β1, thereby preventing vascular EndMT and attenuating plaque formation and progression in the aorta of atherosclerotic Apoe^-/- mice. Notably, KLX (20 mg/kg) exhibited superior efficacy compared with atorvastatin, a clinically approved lipid-regulating drug. In conclusion, KLX exhibited potential in ameliorating EndMT and retarding the formation and progression of atherosclerosis through direct activation of FGFR1. Therefore, KLX is a promising candidate for the treatment of atherosclerosis to mitigate vascular endothelial injury.
Animals ; Atherosclerosis/prevention & control* ; Mice ; Receptor, Fibroblast Growth Factor, Type 1/metabolism* ; Signal Transduction/drug effects* ; Anthraquinones/pharmacology* ; Humans ; Integrin beta1/metabolism* ; Epithelial-Mesenchymal Transition/drug effects* ; Male ; Transforming Growth Factor beta/metabolism* ; Disease Models, Animal ; Mice, Inbred C57BL ; Human Umbilical Vein Endothelial Cells/drug effects*

Objective:To investigate the adverse reactions and postoperative inflammatory reactions of Bill-Roth Ⅱ (BⅡ) gastroenterostomy with jejunal anastomosis and jejunal nutrient tube placement using linear cutting and closing device in gastric cancer surgery.Methods:A retrospective case-control study was conducted on 93 patients undergoing gastric cancer surgery in The Affiliated Hospital of North China University of Science and Technology from February 2017 to April 2020. According to 2016 (American Joint Committee on Cancer/Universal Integrated Circuit Card) AJCC/UICC, (Tumor, Node, stage; Tumor lymph node metastasis; Distant metastasis) TNM, there were 11 cases in stage ⅠA, 14 cases in stage ⅠB, 13 cases in stage ⅡA, 15 cases in stage ⅡB, 11 cases in stage ⅢA, 13 cases in stage ⅢB, and 16 cases in stage ⅢC. There were 51 cases of gastric antrum carcinoma, 26 cases of gastric body carcinoma and 16 cases of gastric pylorus carcinoma. There were 27 cases of papillary adenocarcinoma, 26 cases of tubular adenocarcinoma, 22 cases of mucinous adenocarcinoma, 9 cases of signet-ring cell carcinoma, 7 cases of adenosquamous carcinoma, and 2 cases of squamous carcinoma. The patients were divided into experimental group (48 cases) and control group (45 cases) according to whether or not the linear cutting and closing device was added and jejunal anastomosis was performed and jejunal nutrition tube was placed. The gender composition, age, lesion site, pathological type, pathological stage, postoperative hospital stay and postoperative complications were compared between the two groups, and the white blood cell count WBC, C-reactive protein CRP on the 7th day after surgery, erythrocyte Sedimentation rate (ESR), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) inflammation indicators were compared between the two groups.Results:There was no significant difference in gender composition, age, lesion location, pathological type and pathological stage between the two groups (all P>0.05). The incidence of abdominal pain, abdominal distension, nausea, vomiting and pleural effusion in 93 patients were 18.3%(17/93), 21.5%(20/93), 23.7%(22/93), 17.2%(16/93) and 18.3%(17/93), respectively. The complication rates of the above indexes in the two groups were 10.4% (5/48) Compared with 26.7% (12/45), 12.5% (6/48) and 31.1% (14/45), 15.6%(7/48) and 33.3% (15/45), 8.3%(4/48) and 26.7% (12/45), 8.3% (4/48) and 28.9% (13/45) (χ 2 values were 4.11, 4.77, 4.52, 4.27 and 5.27, respectively; P values were 0.043, 0.029, 0.033, 0.039 and 0.022, respectively). There was no significant difference in lower extremity venous thrombosis, anastomotic bleeding, accumulated pneumonia and incision dehiscence between the two groups ( P>0.05). WBC on the 7th day after operation in the experimental group and the control group (7.02±1.83)×10 9/L and (8.39±2.27)×10 9/L ( t=3.22, P=0.002), TNF-α (2.44±0.70) μg/L and (3.56±1.14) μg/L ( t=5.71, P<0.001), IL-6 (235.31±41.72) μg/L and (365.91±73.16) μg/L ( t=10.66, P<0.001) there was significant difference between the two groups. There was no significant difference in CRP and ESR between the two groups on the 7th day after operation ( P>0.05). The postoperative hospital stay between the experimental group and the control group was (13.88±2.81) d and (22.78±2.51) d, the difference was statistically significant ( t=16.07, P<0.001). Conclusion:The application of side-to-side jejunostomy combined with jejunal nutrition tube for enteral nutrition in gastric cancer surgery can reduce the occurrence of adverse reactions such as postoperative abdominal pain, abdominal distension, accumulated pneumonia, nausea, vomiting and pleural effusion, reduce the postoperative hospital stay and reduce the postoperative inflammatory reaction to a certain extent.

Objective:To investigate the effect of 300 m saturation diving at sea on tremor intensity of divers’ finger.Methods:The finger tremor intensities of four divers were measured before entering pressurization chamber, during increasing pressurization, and at the stable stage of 300 m saturation pressurization.Results:The mean values of the tremor intensities of the divers’ fingers during the period from entering the chamber and starting pressurization to the stable stage of 300 m pressurization were higher than that before pressurization; specifically, the increases of tremor intensity of the divers’ fingers were the most significant at 250 m, 270 m, and 290 m pressurization ( P<0.05). However, there was no statistically significant difference in the mean value of the finger tremor intensities between that before pressurization and those at 195 m, 220 m, 250 m, 300 m pressurization, and during the 24 h-stay at the 300 m saturation pressurization ( P>0.05). Conclusion:The monitoring of finger tremor intensity in saturation diving at each pressurization stage can objectively and quantificationally evaluate the onset and development of high-pressure neurological syndrome (HPNS), which, combined with the traditional evaluation method, can provide a basis for improving the saturation diving pressurization rate and ensuring the safety of divers.

Objective:To investigate the effect of 300 m saturation diving at sea on tremor intensity of divers’ finger.Methods:The finger tremor intensities of four divers were measured before entering pressurization chamber, during increasing pressurization, and at the stable stage of 300 m saturation pressurization.Results:The mean values of the tremor intensities of the divers’ fingers during the period from entering the chamber and starting pressurization to the stable stage of 300 m pressurization were higher than that before pressurization; specifically, the increases of tremor intensity of the divers’ fingers were the most significant at 250 m, 270 m, and 290 m pressurization ( P<0.05). However, there was no statistically significant difference in the mean value of the finger tremor intensities between that before pressurization and those at 195 m, 220 m, 250 m, 300 m pressurization, and during the 24 h-stay at the 300 m saturation pressurization ( P>0.05). Conclusion:The monitoring of finger tremor intensity in saturation diving at each pressurization stage can objectively and quantificationally evaluate the onset and development of high-pressure neurological syndrome (HPNS), which, combined with the traditional evaluation method, can provide a basis for improving the saturation diving pressurization rate and ensuring the safety of divers.

Objective To compare the effect of enteral nutrition by jejunum colostomy nutrition infusion pump of patients after Whipple surgery as well as reduce adverse reactions in patients.Methods Sixty-five cases with the implementation of Whipple and jejunum of colostomy were selected as our subjects,who were hospitalized in the Affiliated hospital of Hebei United University from Feb.2009 to Nov.2013.All patients were divided into observation group (33 cases) and control group (32 cases) according to the methods of nutrient input.Patients in observation group were given nutrition infusion pump pumping (15 to 50 ml/h) ;and patients in control group were adopted disposable infusion connection infusion with the speed of 30 drops/min with the thermostat heating temperature and the water pipe.The blood glucose,serum albumin,blood electrolyte concentration of postoperative,and the adverse reactions during input nutrient solution including vomiting,abdominal distention,diarrhea and other adverse circumstance were recorded.Results At 1st,3rd,5th day,there was no statistically significant difference in terms of the levels of glucose,blood albumin,blood C1,Na +,K + between two groups(blood glucose:F inner grouP =3.01,P ＞ 0.05 ; F between group =2.90,P ＞ 0.05 ; F cross group =2.87,P ＞ 0.05 ; serum albumin:F inner group =2.94,P ＞ 0.05 ; F between group =2.89,P ＞ 0.05 ; F cross group =2.76,P ＞ 0.05 ; blood Cl:F inner group =1.78,P ＞ 0.05 ; F between group =1.96,P ＞ 0.05 ; F cross group =1.88,P ＞ 0.05 ; blood Na +:F inner group =1.06,P ＞ 0.05 ; F between group =1.35,P ＞ 0.05 ; F cross group =1.27,P ＞ 0.05 ; blood K +:F inner group =3.12,P ＞ 0.05 ; F between group =3.04,P ＞ 0.05 ; F cross group =2.93,P ＞ 0.05).There were significant differences regarding of the rate of vomiting,abdominal distention,diarrhea and other adverse conditions compared with the infusion enteral nutrition has good clinical effect,postoperative blood (x2 =4.029,4.381,4.905 respectively; P ＜ 0.05).Conclusion The methods of colostomy enteral nutrition with infusion pump after Whipple surgery is proved to be with the better clinical effect in reducing postoperative vomiting,abdominal distention,diarrhea and other adverse conditions compared with the infusion enteral nutrition,and there are no significant difference in the terms of the levels of glucose,blood albumin,blood Cl,Na +,K +.

Objective To investigate the clinical significance of setting nasojejunal nutrition tube in Whipple operation,which can promote patient recovery and prevent complications.Methods Fourty-one patients were undergone Whipple operation and they were randomly divided into eternal nutrition (EN) and parenteral nutrition group (PN).Patients in EN group were set nasojejunal nutrition tube during Whipple operation in order to supply eternal nutrition at earlier period,while in PN group were supplied parenteral nutrition in earlier period.The operative procedure time,the complication in post-operation,the cost of hospitalization and the periods of hospitalization of two groups were recorded.The scores of nutritional status were measured.Results The operative time in EN group and PN group were (200.71 ±51.33)min and (160.48 ± 47.62) min,and no significant difference was found between two groups (t =-1.524,P ＞ 0.05).The hospitalization expenses in EN group was (38835.65 ± 537.69)yuan,lower than that in PN group ((47833.18 ±659.24) yuan,t =2.073,P ＜ 0.05).The hospital periods of EN group and PN group were 10 (3) d and 18(3) d,and the difference was significant (Z =-5.374,P ＜0.001).There were 2 cases who occurred complications after operation in EN group,including 1 cases with incision infection,and 1 cases of pancreatic fistula.Nine cases occurred complications in PN group,including 3 cases with incision infection,2 cases with pancreatic fistula,2 cases with pulmonary infection,2 cases with gastric paralysis,and all were cured by conservative treatment.There was statistically significant difference in the incidence of postoperative complications (P =0.027).All cases with complication were recovery after corresponding treatment.At 7th day after operation,hemoglobin in EN group and PN group were (113.09 ± 12.35) g/L and (107.04 ± 11.81) g/L,and the difference was significant (t =2.035,P ＜ 0.05).The levels of retinol binding protein,serumalbumin,serum prealbumin,serum transferrin in EN group were (42.62 ± 5.64) mg/L,(40.24 ± 6.79) g/L,(321.43±31.28) mg/L,(32.86±4.67) mg/L,(32.86 ±4.67) mg/L,significant different from those in PN group ((15.50 ± 4.26) mg/L,(31.52 ± 5.92) g/L; (197.86 ± 37.71) mg/L,(23.59 ± 4.32) mg/L; t=2.398,2.606,2.119,2.569; P ＜0.01 or P ＜ 0.05).Conclusion Nutritional status and prognosis are improved obviously by setting nasojejunal nutrition tube in Whipple operation.And the cost of hospitalization,the periods of hospitalization are decrease.